Nutrition and Malaria

IDevice Icon Preknowledge
Please read the table to gain knowledge on some of the key terms used in this section.

Other key terms also included in this section:
(Gibney et al.,2009; UNICEF, 2004)

 

Nutritional status of a person suffering from malaria is thought to be one of the biggest factors of host resistance and recovery. Unfortunately, malaria is more present in countries and regions where undernourishment and poverty levels are high. Access to levels of treatment may also be low, prolonging the illness and increasing levels of malnourishment in the sufferer. There are a number of nutritional issues that are involved with malaria such as:

 

  • Malaria and pregnancy
  • Malaria and iron deficiency anaemia
  • Protein energy malnutrition
  • Malaria in children under 5 years old

As undernutrition has been linked to increased risk of morbidity (especially in children) it is crucial to address these issues in order to combat malnourishment and the risk of death in malaria sufferers.

(Caulfield et al., 2004).

Malaria and iron deficiency anaemia

 

Iron deficiency anaemia is wide-spread in sub-Saharan Africa and has a large impact socially and economically on malaria endemic areas. Please see the pre-knowledge box above for a full explanation of iron deficiency anaemia.

In malaria pathogenesis, iron is essential for the vectors growth and development in their life cycle.
Severe malarial anaemia is the biggest cause of child hospitalization in sub-Saharan Africa and is the cause of between 17% and 54% of malaria related mortality in children under 5 years old.

It is thought that the mechanisms that contribute to malarial anaemia are:

 

  • Increased destruction of red blood cells, lowering the level of iron in the body.

  • Decreased production of red blood cells

  • Development of badly functioning red blood cells

  • Destruction of uninfected red blood cells

These changes in RBC functioning affects the level of iron within the body and the body begins to show signs of iron deficiency anaemia. By improving the iron status of the sufferer along with treatment of the parasitic disease it is felt that the level of anaemia will decrease and recovery from both the disease and deficiency will be more successful. Previous recommendations to combat severe malaria and anaemia have been blood transfusions, but there have been questions over the safety of this method due to HIV/AIDs being highly present in areas where malaria is endemic. Therefore other methods for treating IDA need to be recommended.

When anaemia is acute, levels of iron can be increased in the diet to help prevent against this deficiency. As shown in the table above, good sources of iron are meat, fish, green leafy vegetables, legumes and fortified grains. Increasing levels of these foods where possible can help to raise iron levels in the body.
There are two sources of iron. They are:

 

1. Heme iron- These are animal products like meat and fish. Iron is more easily absorbed into the body from these foods.

2. Non- heme iron- These are non-animal products like vegetables. Absorption of non-heme iron can be increased by consuming vitamin C at the same time, as it makes non-heme more readily absorbed in the body.

 

So if an individual is suffering from anaemia but does not eat meat, recommendations should include sources of non-heme foods rich in iron and combined with vitamin C rich foods such as citrus fruits.

(Obonyo et al., 2007, Chang & Stevenson 2004)

Pregnancy and malaria.

One of the detrimental effects of malaria in pregnancy is the risk of becoming anaemic. In Africa, 5-10% of pregnant women will be suffering from severe anaemia, with 26% of these cases being attributable to malaria. Anaemia in pregnant women is a more crucial public health problem within Tanzania with 65% of women that attend antenatal clinics in Dar es Salaam suffering from anaemia.

The most at risk groups of pregnant women are those who are pregnant for the first time and women of young maternal age. Another stage of pregnancy that is at high risk of being infected with malaria is the first and second trimester of pregnancy.

During pregnancy there are a number of changes that happen that put the mother at risk of infection. This risk is made worse by the ability of infected erythrocytes generated by the malaria infection to target the placenta.
Anaemia occurs during the erythrocytic stage of malaria. During this stage red blood cells are digested by the parasite and as a result of this, remove iron from the blood. If this continues it develops into maternal anaemia.
Maternal malaria can have health impacts on the child as it grows. There is the risk that infants whose mothers have suffered from malaria may also suffer from increased risk of malaria infection.
Effects may also be seen in the infant in their mental growth and development. Increased risk to metabolic diseases may also occur.

Other problems that can also occur when a pregnant mother contracts malaria is complications during the pregnancy. Malaria may cause the abortion of the child, still birth or pre-term delivery. 70% of intrauterine growth retardation is caused by malaria in malaria endemic areas.

(Akanbi et al, 2010; Desai et al, 2007; Yartey, 2006; Kindanto et al., 2009).

Protein energy malnutrition and malaria

Protein energy malnutrition has been linked to malaria due to the high levels of malnourishment that are already seen in sufferers (specifically children). Please see the pre-knowledge box above to read a full explanation of protein energy malnutrition.
A study carried out in Kenya investigated the link between PEM and malaria in 340 children and found that malaria affects nutritional status and protein energy malnutrition in the earliest stages of life (the first 2 years). It is thought that the presence of malaria can increase the severity of already present malnourishment and PEM.
Recommendations must be to increase levels of nutrition in sufferers and gradually introduce good sources of protein to the diet. When treating severe levels of PEM, milk-based formulas supplemented with protein are recommended to steadily increase levels of nutrition. Once the sufferer is at a level where appropriate levels of food can be consumed, foods high in protein can be recommended. These include meat, fish, eggs, legumes and pulses.

(Nyakeriga et al., 2004; Briend et al., 1999)

Malaria and children under 5 years old.

As mentioned in “Malaria and pregnancy”, intrauterine growth retardation can be caused by maternal malaria and can create nutritional problems for the foetus. If this continues through to delivery it can cause low birth weight (LBW). Maternal malaria contributes for up to 30% of LBW cases. Please see the pre-knowledge box above for a full explanation of LBW.

If a baby is of low birth weight due to maternal anaemia and poor nutrition it can develop hyperglycaemia (low blood glucose levels) which can cause brain damage. LBW can greatly increase the chance of infant mortality and poor growth and development in childhood.
Anaemia is also another effect of malaria in children under 5 years and can cause detrimental effect on the child’s health. Severe anaemia can be treated with a blood transfusion, but as mentioned earlier the risk of contracting HIV/AIDs through this treatment is high. Increasing consumption of iron is recommended to help combat this deficiency.

(Yartey, 2006; Maitland & Marsh, 2004)

 

Micronutrient deficiencies.

There has been some research to suggest that vitamin A and zinc deficiencies can affect the pathogenesis of malaria.

Vitamin A is essential for the functioning of the immune system, which protects the body against disease. Please see the pre-knowledge box for full information on vitamin A deficiency. A study carried out on 454 pre- school age children investigated the relationship between vitamin A deficiency and malaria attacks. The conclusion of the study found that 40.8% of the participants had an abnormal status of vitamin A in the blood during time of infection. This may occur as the vector utilizes vitamin A for growth and development in its life cycle.

Zinc also helps the body maintain a good immune system. Zinc status is thought to be affected by malaria. Please see the pre-knowledge box for full information on zinc deficiency. A study conducted in Malawi analysed the zinc statuses of 152 pregnant women and what factors affect their zinc status. It was found that 31.3% of the women in the study were suffering from malaria and when zinc levels were measured, a significant effect was found. It is thought that this occurs because of the loss of haemoglobin during the parasites life-cycle.

To prevent against Vitamin A deficiency, it is recommended that those at risk consume foods rich in vitamin A. These include spinach, tomatoes, eggs and other dairy products. To prevent against zinc deficiency, foods such as meat, fish, eggs, cereals and dairy products should be consumed.

(Galan et al., 1990; Gibson & Huddle, 1998)


True-False Question
Please complete this short true or false quiz after reading this section to test your knowledge on nutrition and malaria


1. Pregnant women are most at risk of contracting malaria in the third trimester of pregnancy.

True False


2. Maternal malaria contributes to up to 30% of low birth weight cases.

True False


3. Malaria affects protein energy malnutrition the most in the first 2 years of life .

True False