Malaria and Malnutrition: Kwashiorkor Associated with Low Levels of Parasitaemia.

BACKGROUND: The relationship between protein energy malnutrition (PEM) and malaria is controversial. While most studies demonstrate that PEM is associated with greater malaria morbidity, some indicate that PEM may in fact have a protective effect. PEM is differentiated into three subgroups: kwashiorkor (marked protein deficiency), marasmus (calorie deficiency), and kwashiorkor/marasmus. None of the studies concerning PEM and malaria seem to distinguish between these subgroups, and significant differences in susceptibility to malaria between these subgroups may have been overlooked. Plasmodium parasites and malaria infected erythrocytes are sensitive to oxidative stress. Since kwashiorkor patients seem to display an excess of prooxidants and as serum albumin is an important antioxidant, we hypothesized that patients with different forms of PEM might have different levels of malaria parasitaemia. METHODS: 72 PEM children older than 6 months admitted to Kwale Family Life Training Programme (Kenya) were included in the study. RESULTS: Mean parasitaemia was significantly lower in the kwashiorkor group than in the marasmus group (p < 0,001). There was no correlation between serum albumin and parasitaemia. CONCLUSION: Our study suggests a protective effect of kwashiorkor against malaria, warranting further studies.

What works and why? Evaluation of a community nutrition programme in Kenya.

OBJECTIVE: To investigate the nutritional impact of a community-based programme that focused on social cohesion and action. DESIGN: The change in nutritional status of children aged 12­60 months was examined over a period of 3 years in Makueni District in Eastern Province of Kenya in six communities in which an intervention programme of Participatory Learning and Action was introduced and in ten communities in which only basic preparations were made but no intervention was started. SETTING: The intervention was part of the Government of Kenya Community Based Nutrition Programme and was supported by the Government of Denmark. SUBJECTS: Children aged 12­60 months. RESULTS: Among communities without intervention there were similar levels of underweight (mean Z-score: −1·63 v. −1·50 (NS); % with Z-score<­2: 36·6% v. 34·5% (NS)) and stunting (mean Z-score: −2·0 v. −1·99 (NS); % with Z-score<­2: 44·3% and 47·4% (NS)) at baseline and after 3 years. By contrast, among communities who had received interventions, there were significant improvements after 3 years in the levels of underweight (mean Z-score: −1·66 v. −1·37 (P<0·02); % with Z-score <­2: 42·9% v. 31·4% (P<0·035)) and stunting (mean Z-score: −2·05 v. −1·59 (P<0·05); % with Z-score<­2: 52·7% v. 39·7% (P<0·02)). CONCLUSIONS: The results indicate considerable potential for using Participatory Learning and Action as a community-based approach to effectively address child undernutrition. It is suggested that these interventions are developed, implemented and evaluated more widely as a mean of tackling childhood undernutrition and improving child survival and development.

Social capital and healthy urbanization in a globalized world.

This paper critically reviews the extent in which social capital can be a resource to promote health equity in urban contexts. It analyzes the concept of social capital and reviews evidence to link social capital to health outcomes and health equity, drawing on evidence from epidemiological studies and descriptive case studies from both developed and developing countries. The findings show that in certain environments social capital can be a key factor influencing health outcomes of technical interventions. Social capital can generate both the conditions necessary for mutual support and care and the mechanisms required for communities and groups to exert effective pressure to influence policy. The link between social capital and health is shown to operate through different pathways at different societal levels, but initiatives to strengthen social capital for health need to be part of a broader, holistic, social development process that also addresses upstream structural determinants of health. A clearer understanding is also needed of the complexity and dynamics of the social processes involved and their contribution to health equity and better health. The paper concludes with recommendations for policy and programming and identifies ten key elements needed to build social capital.