Malaria and other risk factors for malnutrition, and the impact of intermittent preventive therapy for malaria on nutritional status of school-age children in Tanzania. A cross-sectional survey and a randomized controlled open-label trial

Background WHO and the Lancet reported that malaria and malnutrition form a double health burden in low and middle-income countries. Despite the massive implementation of several malaria interventions, there is limited information on the impact of intermittent preventive therapy (IPTsc) for malaria on the nutritional status of school-age children. Objective To determine malnutrition risk factors and evaluate the impact of IPTsc for malaria on the nutritional status of school-age children in North-East Tanzania. Methods We analyzed secondary data from a cross-sectional baseline survey and a randomized controlled open-label trial. Study participants were randomized to three treatment groups and thereafter followed for 20 months. Data were analyzed using logistic regression and a linear mixed model. Findings At baseline, the prevalence of malaria was 27%. 23% of ≤10 years children were underweight, 21% were stunted, and 28% were either thin or severely thin. The odds of stunting were 78% higher (AOR=1.78, 95%CI=[1.36, 2.33], P < 0.001) among children who had malaria compared to those who did not. Children from low socioeconomic status (SES) had higher odds of being underweight (AOR=1.50, 95%CI=[1.13,2.01], P=0.006) compared to their high SES counterparts. During the intervention, change in mean weight, height, and BMI over time as estimated from age-treatment interaction was not significantly different in the DP and ASAQ treatment groups compared to the control group. A unit change in age increased weight, height, and BMI by 2.2 units (p-value < 0.001), 3.3 units (p-value < 0.001), and 0.5 units (p-value < 0.001). The height and weight in female children were higher compared to that of male children by 1 unit (p-value < 0.001) and 0.8 unit (p-value < 0.001), respectively. Conclusion The burden of malaria and malnutrition in this study’s setting is remarkable. Instead of focusing only on malaria, public health agencies should reinforce nutritional programs by collaborating with local communities to ensure food availability in schools and provide sustainable nutritional education to the local community members. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT03640403 ### Clinical Protocols ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study acquired regulatory approval from the Medical Research Coordination Committee (MRCC) of the National Institute of Medical Research (NIMR), Tanzania. The approval number was NIMR/HQ/R.8a/Vol.IX/2818 and NIMR/HQ/R.8c/Vol.I/668 (for amendment) also NIMR/HQ/R.8c/Vol.I/1276 for ethical clearance extension I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The de-identified data will be available upon request. The approval for accessibility will be granted by the National Institute for Medical Research, Tanzania. This will involve signing data transfer agreement.