Objectives: To determine the levels and possible role of pro-inflammatory cytokines TNFα, IL-1 and IL-6 in children with clinical protein energy malnutrition (kwashiorkor, marasmic kwashiorkor or marasmus) alone and in combination with malaria in Western Kenya. Settings: Webuye District Hospital, Western province and Moi Teaching and Referral Hospital in Rift Valley province in Western part of Kenya. Subjects and Methods: This hospital based study was done from 2003 to 2005 on inpatient children in the paediatric ward and children at the outpatient clinic. Children aged between 6 to 60 months, admitted to paediatric wards of Webuye sub-District Hospital or Moi teaching and referral hospital Eldoret suffering from either protein-energy malnutrition or malaria or both conditions during the study period were included. Protein energy malnourished was diagnosed both clinically and through anthropometric measurements. Malaria was diagnosed through blood smears using field stain diagnostic method. Controls were children in outpatient clinic on routine medical check-up and ascertained to be without protein energy malnutrition or malaria. A blood drop was taken for malaria blood smears without fasting. Plasma samples from children suffering from protein energy malnutrition alone and malaria alone as well as combination of the two conditions were also taken. Equal number of controls were taken. Enzyme linked immunosorbent assay kit was used to assay for the concentrations of the cytokines (TNFα, IL1and IL6) using test kits from Roche diagnostics, Germany. Results: A total of 59 children were included in the study. The mean concentrations of cytokine (TNFα) were 41.3 pg/ml in kwashiorkor, 45.2 pg/ml in marasmic/kwashiorkor and 41.9 pg/ml in marasmus patients. The values for IL1 were 67.2 pg/ml in kwashiorkor, 0 pg/ml in marasmic/kwashiorkor and 25.1pg/ml in marasmus patients. The values for IL6 were 65 pg/ml in kwashiorkor, 40.5 pg/ml in marasmic/kwashiorkor and 10 pg/ml in marasmus patients showing, significantly low (p<0.005) values when compared to IL1. Those with kwashiorkor and malaria were 48.8% (p<0.005), marasmic kwashiokor with malaria (81.8%), marasmus with malaria (88.2%) and Controls (83.3%). Conclusions: The cytokines were more elevated in kwashiorkor than marasmic kwashiorkor, marasmus or malaria alone. Policy Message: TNFα and IL6 could be used as indicators of protein energy malnutrition in malaria infected population.
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