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Effects on serum retinol of multi-micronutrient supplementation and multi-helminth chemotherapy: a randomised, controlled trial in Kenyan school children

European Journal of Clinical Nutrition volume 56, pages 666–673 (2002)Cite this article

Abstract

Objective: To assess the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol concentration, using schools as a health delivery system.

Study area and population: From 19 primary schools in Bondo District, western Kenya, 977 children between 9 and 18 y were included in the trial. The 644 (65.9%) children on whom baseline serum retinol was available were included in this study.

Design: A randomised, placebo-controlled, double-blind, two-by-two factorial trial on the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on serum retinol after 8 months.

Intervention: Single treatment with albendazole (600 mg) and praziquantel (40 mg/kg of body weight) and daily multi-micronutrient supplementation with tablet containing 1000 µg vitamin A.

Results: Micronutrient supplementation (0.08 µmol/l, 95% CI 0.01, 0.14; P=0.025), but not treatment (0.03 µmol/l, 95% CI −0.04, 0.10; P=0.38), increased serum retinol. However, treatment did increase serum retinol in S. mansoni-infected (0.09, 95% CI 0.02, 0.16; P=0.009), but not in uninfected children (−0.07, 95% CI −0.18, 0.03; P=0.18; interaction, P=0.01). Similarly, reduction in egg output of S. mansoni, but none of the geohelminth, was a predictor, corresponding to a 0.008 µmol/l (95% CI 0.00002, 0.02; P=0.049) increase in serum retinol per 100 epg reduction. Interestingly, interactions were found between age and sex (P=0.046), and malaria parasitaemia and sickle cell phenotype (P=0.04).

Conclusion: Multi-micronutrient supplementation and reduction in S. mansoni egg output increased serum retinol, irrespective of initial serum retinol.

Sponsorship: The Danish International Development Assistance.

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Acknowledgements

The study was financed by the Danish International Development Assistance. Technical and logistical support was provided by Ministry of Health, Kenya Medical Research Institute (KEMRI) and the participating schools. We gratefully acknowledge support from local education authorities and in particular Education Officer, Mrs C Otieno. We are grateful to Dr W Watkins, Director of Wellcome Trust Laboratories in Nairobi for facilitating training our technicians and in the set up for vitamin A assays. Also thanks to Director of the Centre for Microbiology Research of KEMRI for availing a HPLC for use in the assays. We are indebted to the children, their teachers and the local community for their participation and cooperation. We also gratefully acknowledge the commitment of our technical staff and field workers. Finally, we would like to thank the Kenyan and the Danish KEDAHR Director for facilitating the research activities. This work is published with permission from the Director of Medical Services, Kenya, and the Director of KEMRI.

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Author notes

  1. H Friis: Guarantor: H Friis.

  2. D Mwaniki, B Omondi, E Muniu, F Thiong'o, J Ouma, P Magnussen, PW Geissler, K Fleischer Michaelsen and H Friis: Contributors: DM, EM, FT, JO, PM, PWG, KFM and HF were responsible for concept and planning. DM, BO, JO, FT and PWG were responsible for laboratory and field work. DM, EM and HF were responsible for data processing. DM, PM, KFM and HF were responsible for writing the manuscript.

Authors and Affiliations

  1. Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya

    D Mwaniki, B Omondi & E Muniu

  2. Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya

    F Thiong'o & J Ouma

  3. Danish Bilharziasis Laboratory, Charlottenlund, Denmark

    P Magnussen, PW Geissler & H Friis

  4. Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark

    K Fleischer Michaelsen & H Friis

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Mwaniki, D., Omondi, B., Muniu, E. et al. Effects on serum retinol of multi-micronutrient supplementation and multi-helminth chemotherapy: a randomised, controlled trial in Kenyan school children. Eur J Clin Nutr 56, 666–673 (2002). https://doi.org/10.1038/sj.ejcn.1601376

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