After eight weeks of study, children treated with Misola, Spiruline plus traditional meals and Misola plus Spiruline appeared clinically improved; their weight increased and many of them showed an increase of Hb levels. This improvement was less significant in the control group, who received only traditional meals. The enrolment of this group might seem unethical among these severely malnourished children, but it was organized by choosing a control group randomly between children whose mothers did not accept the protocol study, so they were treated only with traditional meals. In this way, the influence of being unwilling to participate in a study on caloric and nutrient intake (supplement of Spiruline vs. traditional meals) becomes negligible.
The association between Misola plus Spiruline achieved greater gains in terms of weight than the Misola or Spiruline alone. This result is clearly due to higher energy intake (767 ± 5 kcal/day) and to greater protein assumption (33.3 ± 1.2 g/day), which synergically favour the nutrition rehabilitation.
The results of this study prompted us to continue the culture of Spiruline in the CMSC of Ouagadougou in order to utilize the biochemical composition and the beneficial action of this cyanobacterium, which may be considered an alimentary integrator for undernourished children. In the context of low intake of proteins, 10 g a day per inhabitant in Africa against 29 g in Latin America and 63 g in the industrialized countries, and the integration of traditional meals with Spiruline and Misola plus Spiruline (57 % of protein), improve the nutritional and micronutrient requirement for undernourished children .
This may be due to the iron content of Spiruline supplement , which corrects anaemia owing to deficient iron intake.
This mechanism may be due to the high amount in the lipid fraction of ω-6 derivative, namely γ-linolenic acid . The exclusive presence of ω-6 represents a metabolic gain, since desaturase enzyme could be deficient in undernourished children .
Growth recovery was slower than weight recovery and this may have been compounded by the diarrhoea, which was present at the beginning of treatment of these children . In fact, in our eight week study, the variations of weight were more significant owing to the liquid content dehydration associated with malnutrition. The percentage of increment in weight with the association of Misola plus Spiruline confirms the suitability for continuing this kind of combination in undernourished children. A previous study made by Branger et al.  in Burkina Faso did not show a significant improvement by adding Spiruline to traditional meals and Misola, but, as considered by the same authors, the results they obtained could be due to the quantity of Spiruline, which was half that used in our study (5 g vs. 10 g). Moreover, the present study is more conclusive than the one realized in Dakar by Alling et al. , where weight gain was less, probably also due in this case, to a reduced supplement in Spiruline.
The anthropometric characteristics varied little according to sex (Table 2), but were different according to the nutritional and serologic status. This observation is the same as the one by Kelly et al.  in undernourished HIV-infected children with persistent diarrhoea. The strong prevalence of kwashiorkor and/or marasma is characteristic of sub-Saharan Africa, where maize and millet are the staple diet. In fact, high intake of linoleic acid in a diet deficient in other polyunsaturated fatty acids and in riboflavin results in high tissue production of prostaglandin E2 in these countries, which in turn causes inhibition of the proliferation and cytokine production of Th1 cells, mediators of cellular immunity . Diet-associated inhibition of the Th1 subset is a major contributor to the high prevalence of these diseases in sub-Saharan areas.
The high percentage of undernourished children in Burkina Faso puts a considerable strain on medical and nutritional resources and organizations, and this study could suggest a preliminary solution with Spiruline plus Misola or Spiruline plus traditional meal to accelerate nutritional rehabilitation.