Exclusive Breastfeeding and Clinical Malaria Risk in 6-Month-Old Infants: A Cross-Sectional Study from Kinshasa, Democratic Republic of the Congo

Brazeau, Nicholas F.; Tabala, Martine; Kiketa, Landry; Kayembe, D. L.; Chalachala, Jean Lambert; Kawende, Bienvenu; Lapika, Bruno; Meshnick, Steven R.; Yotebieng, Marcel

doi:10.4269/ajtmh.16-0011

Cited by 16 publications

(20 citation statements)

References 11 publications

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“…Other than poor housing structures and wealth status in rural areas compared to urban areas which were adjusted for in this study, other factors still make rural residents more at risk of malaria than their urban counterparts such as outdoor activities for example farming, fishing, animal rearing which have been shown in literature to increase vector-human contact [34]. Under five children are generally more at risk of malaria than the general population [35], however, infants (age group 0–11 months) were less at risk of malaria positivity in this study compared to older under five children aged 12–59 months, this was similar to what was found in Uganda [28] and the Democratic Republic of Congo [36]. It is documented that babies acquire passive antibodies from their mothers in utero and during breastfeeding against malaria which gives some protection in early infancy; however, these wane off around 6 months of age [37].…”

Section: Discussionsupporting

confidence: 87%

Investigating the upsurge of malaria prevalence in Zambia between 2010 and 2015: a decomposition of determinants

Mukumbuta

Halmai

Morse

et al. 2019

Malar J

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Background Malaria is among the top causes of mortality and morbidity in Zambia. Efforts to control, prevent, and eliminate it have been intensified in the past two decades which has contributed to reductions in malaria prevalence and under-five mortality. However, there was a 21% upsurge in malaria prevalence between 2010 and 2015. Zambia is one of the only 13 countries to record an increase in malaria among 91 countries monitored by the World Health Organization in 2015. This study investigated the upsurge by decomposition of drivers of malaria. Methods The study used secondary data from three waves of nationally representative cross-sectional surveys on key malaria indicators conducted in 2010, 2012 and 2015. Using multivariable logistic regression, determinants of malaria prevalence were identified and then marginal effects of each determinant were derived. The marginal effects were then combined with changes in coverage rates of determinants between 2010 and 2015 to obtain the magnitude of how much each variable contributed to the change in the malaria prevalence. Results The odds ratio of malaria for those who slept under an insecticide-treated net (ITN) was 0.90 (95% CI 0.77–0.97), indoor residual spraying (IRS) was 0.66 (95% CI 0.49–0.89), urban residence was 0.23 (95% CI 0.15–0.37), standard house was 0.40 (95% CI 0.35–0.71) and age group 12–59 Months against those below 12 months was 4.04 (95% CI 2.80–5.81). Decomposition of prevalence changes by determinants showed that IRS reduced malaria prevalence by − 0.3% and ITNs by − 0.2% however, these reductions were overridden by increases in prevalence due to increases in the proportion of more at-risk children aged 12–59 months by + 2.3% and rural residents by + 2.2%. Conclusion The increases in interventions, such as ITNs and IRS, were shown to have contributed to malaria reduction in 2015; however, changes in demographics such as increases in the proportion of more at risk groups among under-five children and rural residents may have overridden the impact of these interventions and resulted in an overall increase. The upsurge in malaria in 2015 compared to 2010 may not have been due to weaknesses in programme interventions but due to increases in more at-risk children and rural residents compared to 2010. The apparent increase in rural residents in the sample population may not have been a true reflection of the population structure but due to oversampling in rural areas which was not fully adjusted for. The increase in malaria prevalence may therefore have been overestimated.

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Section: Discussionsupporting

confidence: 87%

Investigating the upsurge of malaria prevalence in Zambia between 2010 and 2015: a decomposition of determinants

Mukumbuta

Halmai

Morse

et al. 2019

Malar J

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“…Subsequent reports demonstrated that Hbf does not inhibit P. falciparum growth in infant red blood cells 18 , 19 . The dietary elements of neonatal period can also be contributing to the protection of infants from malaria 20 . Maternal milk is shown to contain lactoferrin and IgA antibodies directed against parasite antigens, both of which can control parasite growth, at least in vitro 21 .…”

Section: Introductionmentioning

confidence: 99%

Neonatal mice resist Plasmodium yoelii infection until exposed to para-aminobenzoic acid containing diet after weaning

Parra

Yang

Weitner

et al. 2021

Sci Rep

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We developed a newborn (NB) mouse Plasmodium yoelii NL infection model to study malaria in early age. Surprisingly, the onset of parasitemia in P. yoelii challenged NB mice was delayed compared to adults and coincided with the weaning date when weanlings switched from maternal milk to normal chow diet. Also, compared to adult mice, parasitemia resolved much later (48 days vs 20 days post challenge) and the peak parasitemia was twice as high in weanlings. Concurrently, weanlings’ germinal center reaction was delayed and diminished compared to adult mice. Maternal milk is deficient in para-aminobenzoic acid (PABA), which is required for de novo folate synthesis by Plasmodium. Suggesting a possible role for the protection afforded by PABA-deficient maternal milk, mice fed with a PABA-deficient diet after the weaning continued to control parasitemia. Despite the reduced parasitemia, these mice developed robust T follicular helper (Tfh) responses and were protected from a second P. yoelii challenge. The NB malaria model provides mechanistic insight into the human infant malaria manifestations where a diet solely based on breast-feeding reduces the incidence of severe malaria in infants. NB mice experiments also support further studies to investigate dietary PABA restriction in the management of severe malaria in infants.

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“…The deuterium oxide "dose to the mother" allowed us to determine the amount of breastmilk and the amount of fluid consumed from sources other than breastmilk, which makes it possible to define in a very precise way the breastfeeding regimens. These quantitative results are not affected by recalls, found during mothers' declarations [5,6]. This technique classifies breastfeeding regimens into exclusive, predominant and partial types.…”

Section: Discussionmentioning

confidence: 92%

“…Studies from Uganda and Nigeria suggested that Exclusive Breastfeeding (EBF) had no significant effect on malaria infection risk [1,2]. Some studies from Malawi and Congo, found that maternel milk or EBF protected infants from developing malaria [3,4]. However, in all studies, the classification of EBF were based on questionnaires and is subject to recall bias because it may be affected by bias on mothers self-reported behavior [5,6].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Plasmodium falciparum Parasitaemia in Children from Different Breastfeeding Regimens Evaluated by the Deuterium Technique in Southern Benin

Tove¹,

Ogouyèmi-Hounto²,

Cotrell³

et al. 2018

J Trop Dis

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Studies on the health benefits of exclusive breastfeeding (EBF) and susceptibility to malaria have shown contradictory results. These studies often failed to account for dose response effects. The deuterium dilution technique was used to evaluate the breast milk intake, the amount of water from sources other than human milk and the exclusivity of breastfeeding. We determine Plasmodium falciparum parasitaemia prevalence in children aged less than six month according to their breastfeeding regimen and maternal milk dose ingested in southern Benin. We conducted a cross sectional study in the Ouidah Kpomasse Tori-Bossito (OKT) health zone in southern Benin from February to December 2014, an intense transmission season. 115 mothers paired with their children aged from 0 to 6 months were enrolled. The daily human milk was measured through saliva of each mother and child pair (MCP) over a period of 14 days by the technique of deuterium oxide "dose to the mother" using the Fourier Transformed Infrared Spectrometer (FTIR). Malaria parasitaemia in children was determined by quantitative Polymerase Chain Reaction (qPCR) in real time at day 14 and day 28. The average age was 2.3 months. The distribution of Plasmodium falciparum parasitaemia in children was 0.00%, 5.08% and 3.85% respectively in exclusive, predominant and partial breastfeeding regimens. The mean intake of breast milk was 641.71 mL per day; 256.75 mL of water per day was taken from sources other than breastmilk. Adjusted linear regression analysis revealed a significant association between quantity of breastmilk and parasitaemia prevalence; infected children (qPCR positive) had 164.11 mL of ingested breastmilk per day less than children without parasitaemia (p=0.00). Our findings highlighted the association between the low risk of Plasmodium falciparum parasitaemia and the ingested breastmilk dose. Study with larger numbers of patients would be necessary to confirm this relationship.

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Exclusive Breastfeeding and Clinical Malaria Risk in 6-Month-Old Infants: A Cross-Sectional Study from Kinshasa, Democratic Republic of the Congo

Cited by 16 publications

References 11 publications

Investigating the upsurge of malaria prevalence in Zambia between 2010 and 2015: a decomposition of determinants

Investigating the upsurge of malaria prevalence in Zambia between 2010 and 2015: a decomposition of determinants

Neonatal mice resist Plasmodium yoelii infection until exposed to para-aminobenzoic acid containing diet after weaning

Prevalence of Plasmodium falciparum Parasitaemia in Children from Different Breastfeeding Regimens Evaluated by the Deuterium Technique in Southern Benin

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