Despite notable efforts in vector control with insecticide-treated bed nets and indoor residual spraying, malaria remains a major public health problem, especially in tropical areas where the infection is endemic. Although the proportion of deaths due to malaria has significantly decreased over the past 15 years, as of 2018, there were still approximately 405,000 deaths, mostly children, many of whom died after a short and undiagnosed illness. Proper nutrition strengthens the immune system and is therefore an integral part of malaria control and prevention. This article addresses the relationship between nutrition and malaria prevention, with a focus on how nourishing children builds a stronger immune system and leads to better health outcomes.
Understanding the Impact of Malaria on Children
Children under the age of five are the most susceptible to the disease and can, if infected, develop severe malaria, with potential complications including high fever, severe anemia, and death. Malaria is a devastating disease for children – taking its toll through stunted growth, developmental delays, and slowed cognitive abilities. In children, the effect of the disease is already permanent. It also has long-term consequences on schooling and life prospects.
With nutrition as the foundation for effective and sustainable prevention of malaria, the synergies and window of opportunity should be employed to substantially reduce malaria and ultimately eliminate the disease. The importance of adequate nutrition for the general target population is undoubtable. Adequate nutrition, as a means of strengthening the individual’s innate defense mechanisms against infections and acceleration of recovery from illness, can support a comprehensive approach to prevention. Nutrition is also important as the basis for the proper functioning of the human immune system.
The Role of Nutrition in Immune Function
Nutrition underpins immune function. Much of what the immune system does depends on nutrients. The production of antimalarial antibodies is one example. Indeed, many of the nutrients important for the immune system include:
- Protein: Tissues involved in the immune response must be built and repaired to respond effectively to invaders. Too little protein – especially from plant sources such as grains and legumes – leaves immune cells starved for nutrients, compromising the immune system’s defenses. Antibodies and other tasks critical to immune function rely on proteins, so adequate dietary protein aids tissue building and repair related to immunity.
- Vitamins and Minerals: The vitamins and minerals such as A, C, and E, and also Zinc and Iron, are particularly important for bullet-proofing the immune system. For instance:
- Vitamin A: Maintains the integrity of mucosal barriers and control of immune responses.
- Vitamin C: Increases white blood cell production and stabilizes immune system components.
- Vitamin D: Modulates the immune system and helps reduce inflammation.
- Iron: Essential for the production of hemoglobin and the effective functioning of immune cells.
- Good Fats: Omega-3 fatty acids (found primarily in fish, green vegetables, and some plant oils) dampen down immune responses.
Malnutrition and Its Impact on Malaria Risk
Poor nutrition compromises the immune response, leaving people more vulnerable to infection and malaria. Severely malnourished children are more likely to suffer the worst effects of malaria since they already have limited capacity for an effective immune response. Malaria can worsen malnutrition, too. A fever, lack of appetite, vomiting, and diarrhea leave sufferers listless and unable to eat, which means their bodies are rapidly depleted of any nutritional reserves.
Common forms of malnutrition that impact malaria risk include:
- Protein-Energy Malnutrition: and protein intake results in weakened immunological defenses and greater susceptibility to infections.
- Micronutrient Deficiencies: Low levels of vitamin A, zinc, or iron, which are all essential for growing children, can both suppress immune function and lead to more serious illness from malaria.
- Anemia: Malaria can cause or worsen anemia by destroying red blood cells. Deficiencies in nutrients such as iron and folate can worsen anemia, and reduce coping capacity.
Strategies for Improving Nutrition to Prevent Malaria
Considering nutrition as part of a broader nutrition-based malaria-prevention strategy entails a combination of dietary improvements, supplementation, and public health measures. Here are some ways in which dietary improvements and strengthened immunity against malaria can interact:
- Increase nutritious food consumption: Encouraging a diet with various foods such as fresh or frozen fruits, vegetables, lean meats or poultry dry beans, peas, whole grains, and fat-free or low-fat milk can enhance diets and support proper immune function. Purdue Extension, a community-based program offered through colleges and universities across US states, can help consumers understand how to increase their consumption of nutritious foods.
- Micronutrient Supplementation: Where micronutrient deficiencies appear to be a problem, targeted supplementation can help fill nutrient deficits. Vitamin A and iron supplements for children improve immune function and reduce the risks of severe malaria.
- Screening and treatment programs for anemia, particularly in regions where malaria is common, could help to reduce the effect of malaria on hemoglobin levels. The diet should include sources of iron (lean meats, legumes, and fortified cereals).
- Nutrition and Malaria Programs Working Together across the continuum of malaria care will increase the impact of malaria control programs. For example, integrating nutrition provision with malaria treatment and prevention will ensure that children get the care they need.
- Community Education and Empowerment: Teaching families about the role of nutrition in preventing malaria and other illnesses helps to empower them in their food choices. Community workshops, schools, and health campaigns can effectively spread knowledge and healthy eating habits.
- To enhance access to nutritious foods, food security, and agricultural development programs can ensure that individuals have access to essential nutrients, especially when diverse food options are not readily available. School feeding programs and community gardens with access to healthy nutrients can help address nature’s diversity scarcity.
Case Studies and Success Stories
There are already many successful programs demonstrating the ability to prevent malaria and enhance child health through nutrition; and how the reverse is also true if these activities are integrated.
- The Vitamin A Supplementation Program in Africa significantly reduces the incidence of severe malaria and improves overall child health. By providing vitamin A supplements to children in malaria-endemic areas, the program lowers both morbidity and mortality rates.
- The Integrated Management of Childhood Illness (IMCI) Program: The World Health Organization (WHO) and UNICEF run the Integrated Management of Childhood Illness (IMCI) Program, which combines malaria treatment and prevention, nutrition support, and other child health interventions in one community-based management approach. In several countries, the integrative approach has helped save children’s lives.
- Food and Nutrition Security Program in Mozambique: The Food and Nutrition Security Program in Mozambique reduces malnutrition in rural areas, helps improve food security through agricultural practices and other community-based health approaches, and increases dietary diversity. A controlled trial of the program found that the children in the program, compared with controls, were eating a much better diet, had higher levels of vitamins A and B6, had lost less weight during the malaria season, and were in better health overall.
Challenges and Future Directions
While integrating nutrition and malaria prevention is crucial, several challenges must be addressed:
- Resource Constraints: Lack of resources is a major constraining factor in the scale-up of comprehensive nutrition programs. There is a need to increase funding and support for nutrition programs.
- Cultural and Social Factors: Cultural beliefs and practices may shape food habits and nutrition-related behaviors, and ultimately affect the uptake of nutrition programs and interventions. It is important to engage communities in program design and implementation as appropriate.
- Monitoring and Evaluation: Measuring the efficacy of nutritional interventions for the prevention and control of malaria requires rigorous monitoring and evaluation, which requires enhanced research and data collection to refine goals and improve measurement approaches.
Through nutrition, children can be empowered to have stronger and more resilient immune systems. This has implications for their overall risk for malaria. By focusing on diets that emphasize essential micronutrients or supplementing those diets, integrated programs can build a strong malaria prevention strategy. Addressing malaria in all its forms is a multifaceted endeavor and one that nutrition can further support. As we work toward eliminating malaria, we have an opportunity to invest in children and their futures – not just by improving interventions, but with more holistic programs. If children are nourished today, the benefits will carry over into tomorrow.
