Plasmodium falciparum Parasitaemia in Children from Different Breastfeeding Reg
Plasmodium falciparum Parasitaemia in Children from Different Breastfeeding Regimens Evaluated by the Deuterium Technique in Southern Benin Yolande Sissinto-Savi de Tové1,2*, Aurore Ogouyèmi-Hounto1,2, Gilles Cotrell2, Jules Maroufou Alao3, Amoussa Waliou Hounkpatin4, Tornyigah Bernard2, Georgia Damien2, Atika Mama2, Daniel Kintin1, Paul Bankolé1, Adicatou Adéothy1, Clemence Fassinou5, David Adomahou2, Lionel Adisso2, Khalid El Kari7, Clement Ahoussinou2, Kouassi Marcellin Amoussou Guenou5, Nama Gabriel Medoua6, Adrian Luty2, Tuikue Ndam Nicaise2, Achille Massougbodji1,2 and Dorothée Kindé Gazard1,2 1Unité d’Enseignement et de Recherche en Parasitologie-Mycologie/Faculté des Sciences de la Santé/Université d’Abomey Calavi 2Laboratoire de parasitologie du Centre de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance (CERPAGE)/Centre de Lutte Intégrée contre le Paludisme(CLIP)/Institut de Recherche et de Développement (IRD) 3Unité de Pédiatrie et de génétique médicale, Service de pédiatrie du Centre National Hospitalier et Universitaire de Cotonou. 01BP386 Cotonou, Bénin 4Faculté des Sciences Agronomiques 01BP 526 Université d’Abomey Calavi. Bénin 5Unité de médecine nucléaire/Faculté des Sciences de la Santé 01 BP188 Cotonou, Bénin/ Université d’Abomey Calavi 6Center for Food and Nutrition Research, IMPM, PO Box 6163 Yaoundé, Cameroon 7Unité Mixte de Recherche en Nutrition et Alimentation-URAC/ Unité de Biologie et Recherche Médicale, BP 1382 RP, Rabat 10001, Maroc *Corresponding author: Sissinto-Savi de Tove Yolande. Faculté des Sciences de la Santé, Université d’Abomey Calavi. 01 BP188 Cotonou Bénin Tel:+2299426926; E- mail: yolande.sissinto@yahoo.com Accepted date: March 19, 2018; Published date: March 28, 2018 Copyright: © 2018 Sissinto-Savi de Tove Yolande, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,distribution,and reproduction in any medium, provided the original author and source are credited. Abstract 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 breastmilk 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 Kpomassè 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. Keywords: Breastfeeding; Deuterium oxide technique; Plasmodium falciparum parasitaemia; Children; Breast milk; Benin Background Many studies on the health benefits of breastfeeding in developing countries have shown conflicting results. 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]. These studies often failed to account for dose-response effects [7]. The dose-to-mother deuterium dilution technique has made it possible to distinguish between water ingested by the baby via breastfeeding and water from sources other than human milk. This study allows an objective evaluation of whether a mother is exclusively breastfeeding her infant as well as the volume of human milk and water intake. We determined Plasmodium falciparum parasitaemia prevalence in breastfed children aged from 0 to 6 months according to breastfeeding regimens and a relation with ingested breastmilk dose evaluated with deuterium dilution technique in southern Benin. Materials and Methods Study sites A cross sectional study was performed between February to December 2014, primarily during the rainy season, in four hospitals, J o u r n a l o f T r o p i c a l D i s e a s e s & P u b l i c H e a l t h ISSN: 2329-891X Journal of Tropical Diseases de Tove et al., J Trop Dis 2018, 6:2 DOI: 10.4172/2329-891X.1000259 Research Article Open Access J Trop Dis, an open access journal ISSN: 2329-891X Volume 6 • Issue 2 • 1000259 namely the health centers of Ouidah, Pahou, Kindji and Tokpadomè, all located in the sanitary health zone of Ouidah Kpomassè Tori- Bossito (OKT) a mesoendemic area. Biological analyses were carried out in the Laboratory of Centre de Lutte Intégrée contre le Paludisme (CLIP) located in Cotonou. Subjects Sampling and inclusion criteria The sample size has been calculated by the Schwartz formula using the prevalence of Plasmodium falciparum infection (7.8%) obtained in the OKT health region in children under 12 months [7] and has yielded a total of 110 children. We used this sampling size calculation for children from 0 to 6 months in this study. During the first 2 weeks of the study, all lactating mothers attending the pediatric unit of follow-up and counselling, who agreed to sign the consent form, were included in the study. All Mother-Child Pairs (MCP) and who met the eligibility criteria were enrolled into the study. Inclusion criteria included: Resided for at least 6 months in the OKT area; HIV negative serologic status; Hemoglobin level greater than 7 g/dl; Agreed and signed the consent form. Training of field workers and data collection All lactating mothers who consented and met all the inclusion criteria were recruited into the study. Demographic, epidemiological and clinical data were collected by trained nurse, pediatrician, parasitologist and nutritionist. Each MCP responded to a questionnaire and benefited from a measurement of the anthropometric. Each child received a clinical examination with temperature and a biological check-up (qPCR and quantitative breast milk by oxyde de deuterium). Variables studied were demographic (age and sex), nutritional (weight, height, body mass index), epidemio-clinics (a fever with a temperature above 37.5°C), taking of at least one dose of Sulfadoxine- Pyrimethamine, and use of the long-lasting insecticidal nets or LLINSs. The SP use for malaria prevention during pregnancy as intermittent preventive treatment in pregnancy (IPTp), child HIV status, and child's birthweight were recorded in the child's health record and in the maternity register of the health centers. Taking the temperature and looking for an abnormality of the physical examination was carried out respectively by nurses and a pediatrician. Anthropometry Measurements were made by trained personnel using standard procedures [8,9]. Wearing minimal clothes, the mothers were weighed to the nearest 10 g with an electronic scale (Seca, Hamburg, Germany). Height was measured to the nearest millimeter with gauge of Shorr. The body mass index (BMI) was calculated as weight (kg) over height squared (m2). The children were weighed without clothes using a portable electronic infant scale accurate to 5 g. Length was measured using a standardized infantometer of Shorr. Assuming the recommended cut-offs for data exclusion, data were excluded if a child’s length-for-age z-score (LAZ) was below -6 or above +6, weight-for-age z-score (WAZ) was below -6 or above +5, or weight-for length z-score (WLZ) was below -5 or above +5, as these extreme values were most likely a result of errors in measurement or data entry [10]. All children admitted for pediatric consultation, and who met the inclusion criteria, were tested for P. falciparum in a blood specimen that was collected and sent to the CLIP Laboratory at Cotonou. Laboratory Examinations Capillary blood sampling Sample of blood in the heel of the child is extracted: one drops to perform hemoglobin test, and the remaining three drops of blood (50 μL × 3) on Whatman 3 MM filter paper. The dried blood impregnated filter papers were stored at -20°C (under conditions of good quality) in a sealed film with silica after complete air drying until DNA extraction and qPCR in real time was achieved. Haemoglobin measurement Finger-picked blood sample was used to measure hemoglobin using a portable spectrophotometer (Hemo-Control, EKF-Diagnostic, Germany) [11]. Individuals found with Plasmodium parasitaemia or hemoglobin level less than 7 g/dL were referred to the pediatrician for evaluation and treatment. The dose-to-the-mother deuterium-oxide technique The amount of breast milk consumed by the infant over uploads/Sante/ p26-pf-parasitaemia-in-children.pdf
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