The objective of this study was therefore to manage the nutritional status of school aged children affected by malaria in Bamenda. This was conducted using a population of 397 for children whose parents consented. The data collected was analysed using SPSS version 23 and findings revealed that majority (52.4%) were females, 26.4% aged between 8-9years, 40.8% had occupations not specified, 64% were Christians, 70.8% were of the grass field, 65.2% earned less than 50.000frs per month and 49.9% had attained secondary education. And the BMI (Body Mass Index) classification, majority (19.1%) and (11.5%) for girls and boys respectively, were classified as moderately malnourished. Then, clinical data revealed that majority (81.1%) had pallor nails, 58.9% had scaly skin, 50.6% had week extremities, 40.8% had pale eyes, 40.1% had pale and dry eyes, 51.4% had temperature >37.5 while a few (24.7%) had brittle hair and mouth sore (29.7%). Majority (70.5%) consumed cereals, 12.6% ate legumes, 5.5% ate meat/fish/eggs, 4.5% ate milk/dairy, 3.8% ate vegetables and 3% ate fruits. Majority (60.7%) did not sleep under mosquito net, 58.4% accepted there is stagnant water and bushes around their house, 65.7% had monthly incomes <50.000frs, 59.2% did not eat green leafy vegetables, bananas, apples, meat, beans, chicken, 75.8% did not eat okro, meat, poultry, guavas, mushroom, pumkin seeds, pork, beans, yoghurt. 

For nutritional interventions, 87.9% accepted nutrition education, 92.4% accepted advice be given to pupils to consume food containing vitamin A, iron, zinc and 90.2% accepted gardening be encouraged. The study concluded shown that nutritional interventions made has improve the nutritional status of school aged children affected by malaria in Bamenda.

Globally, 212 million new cases of malaria were reported in 2015 and in this same year, 429,000 lives were lost mainly young children from Africa. The disease results to the death of a child every 2 minutes. The WHO estimates that 90% of malaria cases and 92% of death associated with malaria were reported in Africa. In Sub-Saharan Africa, it is estimated that 114 million people are infected with the disease. The highest proportion being children aged 2-10years. Malaria is associated with malnutrition in children which eventually leads to about 50

Study design

A cross-sectional study design looks at a population at a single point in time, using a cross section of a group and variables are recorded for each participant. They are relevant when assessing the prevalence of disease, attitudes and knowledge among patients or health personnel. This allow researchers to compare many different variables at the time, it’s cheap and quick but requires a larger sample size as well as allow bias to affect results when there is a non-response during data collection. A cross sectional study design was therefore used to assess and manage the nutritional status of school aged children affected by malaria in Bamenda.

Study Area

The study was carried out in two selected hospitals; Regional Hospital Bamenda and District Hospital Nkwen formally known as CMA Nkwen. The Regional Hospital Bamenda is a Referral hospital found in Mankon, precisely in Bamenda II, in Mezam Division of the North West Region of Cameroon. It is subdivided into departments which include: Hemodialysis, opthamology, intensive care unit, emergency unit, pharmacy, internal medicine, maternity (post and antenatal units), treatment centre, theatre, social services, radiology, surgery, nephrology, outpatient department, paediatric unit which is the area of study.

The District Hospital Nkwen is located in mile2 directly opposite Amour Mezam travelling agency in Bamenda, North West Region of Cameroon. It’s headed by a Medical Doctor and has Assistant General Supervisor. It is subdivided into wards (female, male, paediatric), maternity, ANC, infant welfare clinic and family planning, theatre, laboratory and casualty.

Study population and Study Procedure

The populations of this study included all children aged 2-10 years attending nursery and primary schools in Bamenda. Children aged 2-10 years who lived and attended schools in nursery and primary schools in Bamenda whose teachers and parents gave consent were included in the study while children who were seriously ill and those whose parents did not give consent were excluded.

Nutritional status was evaluated using anthropometric, dietary, and clinical assessment of school aged children affected by malaria.

Determination of Malaria Status

Rapid diagnostic tests were done to determine the children’s malaria status. This was done using the P. falciparum Antigen rapid kit according to the manufacturer’s instructions. The thumb was cleaned with swabs provided and pricked with the lancet to obtain capillary blood. The blood sample was collected using the loop and blotted into a small hole on the rapid test kit labeled the sample part A. Two drops of buffer were added to the buffer part B. The test result was read after 15minutes [5].

Measurement of Body Temperature

The children’s body temperature was measured with Omron digital thermometer. The thermometer was placed in the armpits of the children; the body temperature appeared on the screen after 5-10 seconds and was documented for every child. Fever was characterised as an axillary temperature >37.5C [5].

Inclusion and exclusion criteria

Inclusion criteria: - children aged 2-10 years, their caretakers/teachers/ parents who gave consent, lived and schooled in Bamenda

Exclusion criteria: -Children aged 2-10 years, their caretakers/parents/teachers who were seriously ill, did not give consent, and were not available in Bamenda during the time of the survey were not included in the study.

Sampling Techniques

Systemic sampling and Random sampling technique was used to select children aged 

2-10 years who lived and schooled in Bamenda.

Study Variable

Dependent variable: - Malnutrition was indicated by stunting, wasting, underweight and obesity.

Independent variable: -

• Child characteristics; age, gender, tribe, religion.
• Maternal characteristics; education level, occupation, income.
• Environmental health condition; water supply, sanitation and housing condition.

Sample Size

The sample size was determined by using the Taro Yamane Formula:

n = N/ (1+Ne2); where n = corrected sample size; N = population size; e = margin of error (MoE)

The number of children aged 2-10years who lived and schooled in Bamenda= 50,000

Margin of error= 5%; n=50,000/(1+50,000(0.052)=50,000/126= 396.8 which is approximately 397.

Therefore, per Taro Yamane formula a sample size of 397 was used.

Pre-Testing

The questionnaire was pretested among few selected children and their caretakers/ teachers/parents for accuracy and clarity of questionnaire after which any wrongly asked questions or unnecessary material was eliminated and the questionnaire adjusted to complete the study.

Validity and Reliability of Instrument

The researcher submitted her questionnaire to her supervisor for examination and correction. The questionnaire was pre-tested prior to data collection for validity among few selected children and their parents in Bamenda.

The questionnaires were checked on a daily basis to identify corrections, and to verify if it was completed or well understood by respondents.

Data collection Techniques

Data was collected using a structured questionnaire which was developed and designed to suit all children aged 2-10years who lived and schooled in Bamenda. The structured questionnaire was self- administered to respondents by the researcher. The questionnaire was divided into parts to cover all the specific objectives of the study. It constituted both closed and open-ended questions.

Data analysis

The collected data was reviewed and entered into Excel sheets for analysis for computing for means, and standard deviation (SD). Statistical analysis was accomplished using Statistical Package for Social Science (SPSS), version 20 for unpaired t-test. Data was used to calculate Z-scores of anthropometric measurements, height for age, and weight for height and weight for age as compared with the National Center of Health Statistics (NCHS/WHO) reference values. Z scores (standard deviation scores): The Z-score represents how far the data are distributed (higher or lower) around the reference median. 

Following the classification of WHO database on child growth: Stunted child is defined as one whose height for age (HAZ) is less than -2 SD of the reference median, reflecting a long-term growth faltering. Wasted child is defined as one with weight for height (WHZ) less than -2 SD below the reference median, which reflects acute or recent growth disturbances. Underweight child is defined as one with weight for age (WAZ) less than -2 SD of the reference median, reflecting a combination of disturbances in linear growth and body proportion. 

Ethical Consideration

Authorization was obtained from the following hierarchies:

• College of Technology (The University of Bamenda).
• Regional Delegation of Public Health.
• Study site.
• Informed consent from participants.

Consent was documented and validated by signing. Issues surrounding confidentiality, privacy and the purpose of the study were explained. 

The results from Nutritional interventions revealed that 349/397 (87.9%) of the respondents accepted that children affected by malaria can be supplemented with Vitamin A while only 48/397 (12.1%) of the respondents disagreed.

Also, 340/397 (85.6%) of the respondents accepted that supplementation with Zinc will help children affected by malaria while 57/397 (14.4%) of the respondents disagreed.

To add, 130/397 (32.7%) of the respondents accepted that supplementation with Iron will help children affected by malaria frequency while 267/397 (67.3%) of the respondents refused.

Furthermore, the results showed that while 324/397(81.6%) of the respondents accepted that fortification of food with zinc will improve on the health status of children affected by malaria, only 73/397(18.4%) of the respondents refused.

The results also revealed that 311/397(78.3%) of the respondents accepted that fortification of food with Vitamin A will help children affected by malaria while 86/397(21.7%) of the respondents disagreed.

A total of 357/397 (89.9%) of the respondents accepted that Nutrition education to both children & their parents will help children affected by malaria while, 40/397 (10.1%) of the respondents refused.

More so, 367/397 (92.4%) of the respondents accepted that if pupils affected by malaria are advised to eat food containing Zinc/Iron/Vitamin A it will improve on their health status while 30/397 (7.6%) of the respondents disagreed.

Lastly, 358/397 (90.2%) of the respondents accepted that if parents & children are encouraged to do gardening, it will improve on the health status of children affected by malaria while, 39/397 (9.8%) of the respondents disagreed.

Table 1. Nutritional interventions

From the table below, the P value (>0.05) shows that there was no significant association between Nutritional interventions and malaria status of respondents.

Table 2: Correlation between Nutritional interventions and malaria status

The findings revealed that majority (87.9%) of the respondents accepted that supplementation with vitamin A can help school aged children affected by malaria. This is in line with a study which reported that the Vitamin A metabolite, 9 cis retinoic acid, decreased the malaria induced production of inflammatory cytokines especially the TNF alpha, increasing the clearance of P falciparum infected RBCs through up regulation of CD36 expression on human monocytes and macrophages [18].

Also, majority (85.6%) accepted that supplementation with zinc can help improve on the health status of children affected by malaria. These statistics support the work of [11], who reported that a 46-week period of supplemental zinc provided to school children in Papua New Guinea significantly reduced P falciparum attributable health center attendance by 38%.

More than half (67.3%) of the respondents refused that supplementation with iron will not be beneficial to children affected by malaria. This statistics tie with a study which reported that in a large randomized placebo trial (n=8000/group), routine supplementation with iron and folic acid in children aged 1-35months with high rates of malaria was associated with increased risk of illness and death [20]. According to [21], iron tablets will increase iron levels in the blood and this will promote the growth of the plasmodium parasite.

Furthermore, majority (81.6%) of the respondents accepted that zinc fortification can improve on the health status of school aged children affected by malaria. This finding ties with the results from a study which reported that Zinc fortification of centrally processed staple foods has the potential to increase zinc intake, and absorption although there are no data to demonstrate the efficacy and effectiveness in improving zinc status of young children [22].

Statistics revealed that 78.3% of the respondents accepted that fortification of food with vitamin A can help improve on the nutritional status of school aged children affected by malaria. Fortification with preformed Vitamin A has achieved better results than carotene rich diets [23].

Lastly, 89.9% of respondents accepted that Nutrition education be given to children affected by malaria, 92.4

The main objective of this study was to manage the nutritional status of school aged children affected by malaria in Bamenda. The factors that predisposed children to malaria were; - absence of carrots, fish, eggs, milk, - not sleep under a mosquito net, -presence of stagnant water or bushes around your house, -presence or no of parents monthly income, - Not eat foods like green leafy vegetables, bananas, apples, meat, beans, chicken, - Not often eat foods like okra, pear, red meat, milk, yoghurt, pork, pumpkin seeds, poultry, peanuts, mushrooms, guavas. Nutritional interventions that could help improve on the nutritional status of school aged children affected by malaria included; supplementation with vitamin A, Supplementation with zinc, fortification with vitamin A, fortification with zinc, Nutrition education, advice pupils to eat foods containing vitamin A, iron, zinc and to encourage home gardening.

Conflict of interest 

The authors have not declared any conflicts of interest. 

Acknowledgments 

We would like to thank Ejoh Richard for support in collaboration with local school and some advice for the final investigation.