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Issah I, Duah MS, Arko-Mensah J, Bawua SA, Agyekum TP, Fobil JN. Exposure to metal mixtures and adverse pregnancy and birth outcomes: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 908:168380. [PMID: 37963536 DOI: 10.1016/j.scitotenv.2023.168380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Prenatal exposure to metal mixtures is associated with adverse pregnancy and birth outcomes like low birth weight, preterm birth, and small for gestational age. However, prior studies have used individual metal analysis, lacking real-life exposure scenarios. OBJECTIVES This systematic review aims to evaluate the strength and consistency of the association between metal mixtures and pregnancy and birth outcomes, identify research gaps, and inform future studies and policies in this area. METHODS The review adhered to the updated Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) checklist, along with the guidelines for conducting systematic reviews and meta-analyses of observational studies of etiology (COSMOS-E). Our data collection involved searching the PubMed, MEDLINE, and SCOPUS databases. We utilized inclusion criteria to identify relevant studies. These chosen studies underwent thorough screening and data extraction procedures. Methodological quality evaluations were conducted using the NOS framework for cohort and case-control studies, and the AXIS tool for cross-sectional studies. RESULTS The review included 34 epidemiological studies, half of which focused on birth weight, and the others investigated neonate size, preterm birth, small for gestational age, miscarriage, and placental characteristics. The findings revealed significant associations between metal mixtures (including mercury (Hg), nickel (Ni), arsenic (As), cadmium (Cd), manganese (Mn), cobalt (Co), lead (Pb), zinc (Zn), barium (Ba), cesium (Cs), copper (Cu), selenium (Se), and chromium (Cr)) and adverse pregnancy and birth outcomes, demonstrating diverse effects and potential interactions. CONCLUSION In conclusion, this review consistently establishes connections between metal exposure during pregnancy and adverse consequences for birth weight, gestational age, and other vital birth-related metrics. This review further demonstrates the need to apply mixture methods with caution but also shows that they can be superior to traditional approaches. Further research is warranted to deeper understand the underlying mechanisms and to develop effective strategies for mitigating the potential risks associated with metal mixture exposure during pregnancy.
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Affiliation(s)
- Ibrahim Issah
- West Africa Center for Global Environmental & Occupational Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana.
| | - Mabel S Duah
- West Africa Center for Global Environmental & Occupational Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Biological, Environmental and Occupational Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; West African Center for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
| | - John Arko-Mensah
- West Africa Center for Global Environmental & Occupational Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Biological, Environmental and Occupational Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Serwaa A Bawua
- West Africa Center for Global Environmental & Occupational Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Biological, Environmental and Occupational Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Thomas P Agyekum
- Department of Occupational and Environmental Health and Safety, School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana
| | - Julius N Fobil
- West Africa Center for Global Environmental & Occupational Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Biological, Environmental and Occupational Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Chai Y, Nandi A, Heymann J. Is the impact of paid maternity leave policy on the prevalence of childhood diarrhoea mediated by breastfeeding duration? A causal mediation analysis using quasi-experimental evidence from 38 low-income and middle-income countries. BMJ Open 2024; 14:e071520. [PMID: 38216191 PMCID: PMC10806753 DOI: 10.1136/bmjopen-2022-071520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 09/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Quasi-experimental evidence suggests that extending the duration of legislated paid maternity leave is associated with lower prevalence of childhood diarrhoea in low-income and middle-income countries (LMICs). This could be due to a variety of mechanisms. This study examines whether this effect is mediated by changes in breastfeeding duration. DESIGN AND SETTING Difference-in-difference approach and causal mediation analysis were used to perform secondary statistical analysis of cross-sectional data from Demographic and Health Surveys (DHSs) in 38 LMICs. PARTICIPANTS We merged longitudinal data on national maternity leave policies with information on childhood diarrhoea related to 639 153 live births between 1996 and 2014 in 38 LMICs that participated in the DHS at least twice between 1995 and 2015. PRIMARY OUTCOME MEASURE Our outcome was whether the child had bloody stools in the 2 weeks prior to the interview. This measure was used as an indicator of severe diarrhoea because the frequency of loose stools in breastfed infants can be difficult to distinguish from pathological diarrhoea based on survey data. RESULTS A 1-month increase in the legislated duration of paid maternity leave was associated with a 34% (risk ratio 0.66, 95% CI 0.47 to 0.91) reduction in the prevalence of bloody diarrhoea. Breast feeding for at least 6 months and 12 months mediated 10.6% and 7.4% of this effect, respectively. CONCLUSION Extending the duration of paid maternity leave appears to lower diarrhoea prevalence in children under 5 years of age in LMICs. This effect is slightly mediated by changes in breastfeeding duration.
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Affiliation(s)
- Yan Chai
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Epidemiology, University of California, Los Angeles, California, USA
- Department of Health Policy and Management, University of California, Los Angeles, California, USA
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Killel E, Mchau G, Mbilikila H, Azizi K, Ngasa N, Hancy A, Lukindo T, Mwiru R, Noor R, Sanga A, Codjia P, Leyna GH, Masumo RM. Dietary intake and associated risk factors among pregnant women in Mbeya, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002529. [PMID: 38180949 PMCID: PMC10769095 DOI: 10.1371/journal.pgph.0002529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/17/2023] [Indexed: 01/07/2024]
Abstract
Poor dietary intake among pregnant women has serious detrimental consequences for pregnancy and offspring both in developed and developing countries. This study aimed to assess dietary intake and associated risk factors among pregnant women. A cross-sectional study was conducted in Mbeya, Tanzania with a sample size of 420 pregnant women attending antenatal clinics to assess the factors associated with dietary intake. Dietary intake was assessed using a piloted questionnaire of the Prime Diet Quality Score. A tested standard questionnaire was also used to collect factors that are associated with dietary intake among pregnant women. The strengths of the associations between the dependent and independent variables were tested using the Pearson chi-square tests and the multivariate log-binomial regression method was performed to calculate the adjusted risk ratios (ARR) and 95% confidence interval (CI). The study revealed that out of 420 pregnant women who participated in this study only 12.6% and 29.3% consumed at least four servings of fruits and vegetables per week respectively. Poor dietary intakes were less likely among cohabiting pregnant women [Adjusted RR 0.22 (95% CI 0.09-0.50)] and; those who reported taking Fansidar tablets during the pregnancy [Adjusted RR 0.55 (95% CI 0.31-0.96)]. Further, we found that poor dietary intakes were more likely among pregnant women who were classified as overweight and obesity by the MUAC above 33cm [Adjusted RR 3.49 (95% CI 1.10-11.06)]. The study results affirm that cohabitation and obesity affect dietary intakes among pregnant women differently compared to married women in rural settings of Tanzania. Further research is needed to investigate the social aspects that link dietary intake outcomes for developing a tailored gestational intervention to improve maternal and birth outcomes in sub-Saharan African countries.
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Affiliation(s)
- Erick Killel
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Geofrey Mchau
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Hamida Mbilikila
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Kaunara Azizi
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Nyamizi Ngasa
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Adam Hancy
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Tedson Lukindo
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Ramadhan Mwiru
- The United Nations Children’s Fund (UNICEF), Dar es Salaam, Tanzania
| | - Ramadhan Noor
- The United Nations Children’s Fund (UNICEF), Dar es Salaam, Tanzania
| | - Abraham Sanga
- The United Nations Children’s Fund (UNICEF), Dar es Salaam, Tanzania
| | - Patrick Codjia
- The United Nations Children’s Fund (UNICEF), Dar es Salaam, Tanzania
| | - Germana H. Leyna
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ray M. Masumo
- Department of Community Health and Nutrition, Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
- Department of Statistics, University of Dar es Salaam (UDSM), Dar es Salaam, Tanzania
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Kaur G, Porter CBM, Ashenberg O, Lee J, Riesenfeld SJ, Hofree M, Aggelakopoulou M, Subramanian A, Kuttikkatte SB, Attfield KE, Desel CAE, Davies JL, Evans HG, Avraham-Davidi I, Nguyen LT, Dionne DA, Neumann AE, Jensen LT, Barber TR, Soilleux E, Carrington M, McVean G, Rozenblatt-Rosen O, Regev A, Fugger L. Mouse fetal growth restriction through parental and fetal immune gene variation and intercellular communications cascade. Nat Commun 2022; 13:4398. [PMID: 35906236 PMCID: PMC9338297 DOI: 10.1038/s41467-022-32171-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Fetal growth restriction (FGR) affects 5-10% of pregnancies, and can have serious consequences for both mother and child. Prevention and treatment are limited because FGR pathogenesis is poorly understood. Genetic studies implicate KIR and HLA genes in FGR, however, linkage disequilibrium, genetic influence from both parents, and challenges with investigating human pregnancies make the risk alleles and their functional effects difficult to map. Here, we demonstrate that the interaction between the maternal KIR2DL1, expressed on uterine natural killer (NK) cells, and the paternally inherited HLA-C*0501, expressed on fetal trophoblast cells, leads to FGR in a humanized mouse model. We show that the KIR2DL1 and C*0501 interaction leads to pathogenic uterine arterial remodeling and modulation of uterine NK cell function. This initial effect cascades to altered transcriptional expression and intercellular communication at the maternal-fetal interface. These findings provide mechanistic insight into specific FGR risk alleles, and provide avenues of prevention and treatment.
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Affiliation(s)
- Gurman Kaur
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Caroline B M Porter
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Orr Ashenberg
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jack Lee
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Samantha J Riesenfeld
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Matan Hofree
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Maria Aggelakopoulou
- Oxford Centre for Neuroinflammation, Nuffield Department of Clinical Neurosciences, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | - Subita Balaram Kuttikkatte
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kathrine E Attfield
- Oxford Centre for Neuroinflammation, Nuffield Department of Clinical Neurosciences, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Christiane A E Desel
- Oxford Centre for Neuroinflammation, Nuffield Department of Clinical Neurosciences, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
- University Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Jessica L Davies
- Oxford Centre for Neuroinflammation, Nuffield Department of Clinical Neurosciences, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Hayley G Evans
- Oxford Centre for Neuroinflammation, Nuffield Department of Clinical Neurosciences, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Inbal Avraham-Davidi
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lan T Nguyen
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Danielle A Dionne
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Lise Torp Jensen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas R Barber
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Elizabeth Soilleux
- Department of Pathology, Tennis Court Rd, University of Cambridge, Cambridge, England
| | - Mary Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research in the Laboratory of Integrative Cancer Immunology, National Cancer Institute, Bethesda, MD, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Gil McVean
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Orit Rozenblatt-Rosen
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Genentech, 1 DNA Way, South San Francisco, CA, USA
| | - Aviv Regev
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Massachusetts Institute of Technology, Department of Biology, Cambridge, MA, USA.
- Howard Hughes Medical Institute, Chevy Chase, MD, USA.
- Genentech, 1 DNA Way, South San Francisco, CA, USA.
| | - Lars Fugger
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
- Oxford Centre for Neuroinflammation, Nuffield Department of Clinical Neurosciences, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Karimi T, Eini-Zinab H, Rezazadeh A, Moslemi Z. Maternal dietary diversity and nutritional adequacy in relation with anthropometric measurements of newborns at birth: a cohort study in Tehran city. BMC Pediatr 2022; 22:129. [PMID: 35279127 PMCID: PMC8917625 DOI: 10.1186/s12887-021-03102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/28/2021] [Indexed: 11/30/2022] Open
Abstract
Background Maternal dietary intake during pregnancy plays an important role in fetal development and birth outcomes. The aim of the present study was to determine maternal dietary diversity and Nutritional adequacy in relation with anthropometric measurements of newborn at birth as a cohort study in Tehran city. Methods This prospective cohort study, was conducted by participation of 585 pregnant women referred to public health centers and hospitals covered by Shahid Beheshti, Tehran and Iran Universities in Tehran City. Using face-to-face interviews, general characteristics were obtained by questionnaire. Pre-pregnancy dietary intake was measured by a 168-item semi-quantitative food frequency questionnaire at the first visit, and dietary intake during pregnancy was measured by 2 non-consecutive 24-h food recall (one holiday and one regular day) at 31–34 weeks. Maternal height and weight were measured using standard tools and protocol at the first visit, and maternal weight at the end of pregnancy and data related to neonatal anthropometric indices were collected from mothers and neonates health records in the Sib electrical system. By applying SPSS software (version 23) the association was analyzed by linear regression with adjusting for confounding factors. P-value< 0.05 was considered as significant. Results Mean ± standard deviation of body mass index (BMI) of pre-pregnancy, pregnancy weight gain, BMI for age z-score (BAZ) at birth of infants were 24.52 ± 4.12, 12.16 ± 6.85 kg and − 0.61 ± 1.48, respectively. Mean ± SD of the Dietary Diversity Score (DDS) and Mean Adequacy Ratio (MAR) before and during pregnancy were 5.31 ± 1.11, vs.5.23 ± 1.42 and 289.85 ± 113.12 vs. 371.07 ± 197.28, respectively. After adjusting for confounding factors DDS in the third trimester of pregnancy was inversely correlated with WAZ (B = -0.16, 95% CI = - 0.23_0.30) and BAZ (B = − 0.24, 95% CI = - 0.06_0. 42) at birth, MAR of pre-pregnancy (B = − 0.001, 95% CI = - 0.002_0.00) and in the third trimester of pregnancy (B = − 0.18, 95% CI = - 0.35_0.004) were negatively associated with WAZ at birth. Conclusion The findings showed that maternal nutritional status (dietary diversity and nutritional adequacy) before and during pregnancy were correlated with neonatal anthropometric indices at birth.
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L SI, H B, Eo O, M CB. Maternal Risk Factors for Small-for-Gestational-Age Newborns in Mexico: Analysis of a Nationwide Representative Cohort. Front Public Health 2022; 9:707078. [PMID: 35004559 PMCID: PMC8732993 DOI: 10.3389/fpubh.2021.707078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Small for gestational age (SGA) is a key contributor to premature deaths and long-term complications in life. Improved characterization of maternal risk factors associated with this adverse outcome is needed to inform the development of interventions, track progress, and reduce the disease burden. This study aimed to identify socioeconomic, demographic, and clinical factors associated with SGA in Mexico. Methods: We analyzed administrative data from 1,841,477 singletons collected by the National Information Subsystem of Livebirths during 2017. Small-for-gestational-age was defined as being <10th centiles according to the INTERGROWTH-21st standards. The comparison group was defined as being in ≥10th centiles. We fitted logistic regression models to determine odds ratios for the maternal factors associated with SGA. Results: Among the 1,841,477 singletons, 51% were male, 6.7% were SGA, 6.1% were term-SGA, and 0.5% were preterm-SGA. Maternal education presented a protective gradient of being SGA among mothers who achieved 1 to 6 years of education (adjusted odds ratio (aOR)0.95; 95% CI:0.91,0.99), 7 to 9 years (aOR 0.86; 95% CI:0.83,0.89), 10 to 12 years (aOR 0.75; 95% CI: 0.72, 0.79) and > 12 years (aOR 0.63; 95% CI:0.6,0.66) compared with those without education. SGA was particularly likely to occur among primiparous (aOR 1.42; 95% CI: 1.39, 1.43), mothers living in very high deprivation localities (aOR 1.39; 95% CI: 1.36, 1.43), young (aOR 1.04; 95% CI: 1.02, 1.06), advanced age (aOR 1.14; 95% CI 1.09, 1.19), and mothers living in areas above 2,000 m (aOR 1.69; 95% CI: 1.65, 1.73). Antenatal care was associated with a reduced risk of SGA by 30% (aOR 0.7; 95% CI:0.67,0.73), 23% (OR 0.77; 95% CI:0.74,0.8), and 21% (OR 0.79; 95% CI:0.75,0.83), compared with those mothers who never received antenatal care, when women visited the clinic at the first, second and third trimester, respectively. Conclusion: Almost 7% of live births were found to be SGA. Parity, maternal age, education, place of residence, and social deprivation were significantly associated with this outcome. Antenatal care was protective. These findings imply that interventions focusing on early and adequate contact with health care facilities, reproductive health counseling, and maternal education should reduce SGA in Mexico.
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Affiliation(s)
- Suárez-Idueta L
- Population, Policy, and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Bedford H
- Population, Policy, and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ohuma Eo
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cortina-Borja M
- Population, Policy, and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Ariff S, Maznani I, Bhura M, Memon Z, Arshad T, Samejo TA, Zaidi S, Umer M, Ahmed I, Habib MA, Soofi SB, Bhutta ZA. Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study. JMIR Form Res 2022; 6:e30663. [PMID: 34994692 PMCID: PMC8783273 DOI: 10.2196/30663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant’s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. Objective We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. Methods We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. Results Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. Conclusions KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice.
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Affiliation(s)
- Shabina Ariff
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Ikram Maznani
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Maria Bhura
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zahid Memon
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Tayyaba Arshad
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Tariq Ahmed Samejo
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Shujaat Zaidi
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Atif Habib
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
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Nutritional support and prophylaxis of azithromycin for pregnant women to improve birth outcomes in peri-urban slums of Karachi, Pakistan-a protocol of multi-arm assessor-blinded randomized controlled trial (Mumta PW trial). Trials 2022; 23:2. [PMID: 34980232 PMCID: PMC8721479 DOI: 10.1186/s13063-021-05960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal undernutrition is critical in the etiology of poor perinatal outcomes and accounts for 20% of small-for-gestational-age (SGA) births. High levels of food insecurity, antenatal undernourishment, and childhood undernutrition necessitate the supplementation of fortified balanced energy protein (BEP) during pregnancy in low-income settings especially with scarce literature available in this subject. Hence, this paper extensively covers the protocol of such a trial conducted in an urban slum of Karachi, Pakistan. METHODS The trial is community-based, open-labelled, four-arm, and randomized controlled that will include parallel group assignments with a 1:1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. All pregnant women (PW), if identified between > 8 and < 19 weeks of gestation based on ultrasound, will be offered routine antenatal care (ANC) counseling and voluntary participation in the trial after written informed consent. A total number of 1836 PW will be enrolled with informed consent and randomly allocated to one of the four arms receiving: (1) ANC counseling only (control group), (2) ANC counseling plus BEP supplement (intervention arm 1), (3) ANC counseling plus BEP supplement plus 2 doses azithromycin (intervention arm 2), or (4) ANC counseling plus BEP supplement plus daily single dose of nicotinamide and choline (intervention arm 3). TRIAL REGISTRATION ClinicalTrials.gov NCT04012177 . Registered on July 9, 2019.
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Vesel L, Spigel L, Behera JN, Bellad RM, Das L, Dhaded S, Goudar SS, Guruprasad G, Misra S, Panda S, Shamanur LG, Vernekar SS, Hoffman IF, Mvalo T, Phiri M, Saidi F, Kisenge R, Manji K, Salim N, Somji S, Sudfeld CR, Adair L, Caruso BA, Duggan C, Israel-Ballard K, Lee AC, Martin SL, Mansen KL, North K, Young M, Benotti E, Marx Delaney M, Fishman E, Fleming K, Henrich N, Miller K, Subramanian L, Tuller DE, Semrau KE. Mixed-methods, descriptive and observational cohort study examining feeding and growth patterns among low birthweight infants in India, Malawi and Tanzania: the LIFE study protocol. BMJ Open 2021; 11:e048216. [PMID: 34857554 PMCID: PMC8640640 DOI: 10.1136/bmjopen-2020-048216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Ending preventable deaths of newborns and children under 5 will not be possible without evidence-based strategies addressing the health and care of low birthweight (LBW, <2.5 kg) infants. The majority of LBW infants are born in low- and middle-income countries (LMICs) and account for more than 60%-80% of newborn deaths. Feeding promotion tailored to meet the nutritional needs of LBW infants in LMICs may serve a crucial role in curbing newborn mortality rates and promoting growth. The Low Birthweight Infant Feeding Exploration (LIFE) study aims to establish foundational knowledge regarding optimal feeding options for LBW infants in low-resource settings throughout infancy. METHODS AND ANALYSIS LIFE is a formative, multisite, observational cohort study involving 12 study facilities in India, Malawi and Tanzania, and using a convergent parallel, mixed-methods design. We assess feeding patterns, growth indicators, morbidity, mortality, child development and health system inputs that facilitate or hinder care and survival of LBW infants. ETHICS AND DISSEMINATION This study was approved by 11 ethics committees in India, Malawi, Tanzania and the USA. The results will be disseminated through peer-reviewed publications and presentations targeting the global and local research, clinical, programme implementation and policy communities. TRIAL REGISTRATION NUMBERS NCT04002908 and CTRI/2019/02/017475.
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Affiliation(s)
- Linda Vesel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lauren Spigel
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Roopa M Bellad
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Leena Das
- Department of Paediatrics, SCB Medical College and Hospital, Cuttack, Orissa, India
| | - Sangappa Dhaded
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Shivaprasad S Goudar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Gowdar Guruprasad
- Department of Neonatology, JJM Medical College, Davangere, Karnataka, India
| | - Sujata Misra
- Department of Paediatrics, SCB Medical College and Hospital, Cuttack, Orissa, India
| | - Sanghamitra Panda
- Department of Obstetrics and Gynaecology, City Hospital, Cuttack, Orissa, India
| | - Latha G Shamanur
- Department of Paediatrics, SS Institute of Medical Sciences and Research Center, Davangere, Karnataka, India
| | - Sunil S Vernekar
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
| | - Irving F Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Tisungane Mvalo
- Department of Pediatrics, University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Melda Phiri
- Department of Pediatrics, University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Friday Saidi
- Department of Pediatrics, University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nahya Salim
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Linda Adair
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bethany A Caruso
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Christopher Duggan
- Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephanie L Martin
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kimberly L Mansen
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, Washington, USA
| | - Krysten North
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Melissa Young
- Hubert Department of Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Emily Benotti
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan Marx Delaney
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eliza Fishman
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katelyn Fleming
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natalie Henrich
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kate Miller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laura Subramanian
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Danielle E Tuller
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katherine Ea Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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10
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Rossouw L, Burger RP, Burger R. Testing an Incentive-Based and Community Health Worker Package Intervention to Improve Maternal Health and Nutrition Outcomes: A Pilot Randomized Controlled Trial. Matern Child Health J 2021; 25:1913-1922. [PMID: 34618311 DOI: 10.1007/s10995-021-03229-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In order to address South Africa's maternal and infant mortality and morbidity rates, patient and community-level preventable factors need to be identified and addressed. However, there are few rigorously implemented and tested studies in low- and middle-income countries that evaluate the impact of community-level interventions on maternal and infant health outcomes. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on maternal depressive symptoms, maternal nutrition and intention to exclusively breastfeed. METHOD The intervention was tested using a pilot randomised controlled trial consisting of 72 (39 treatment and 33 control) adult women, implemented in a low-income, peri-urban area in Cape Town, South Africa. Data was collected using a baseline questionnaire conducted shortly after recruitment, and an end line questionnaire conducted a week after giving birth. RESULTS The intervention resulted in a 0.928-point drop in the maternal depressive symptom scale (which ranges from 1 to 8). We find no evidence that the intervention has either a sizeable or precisely estimated impact on maternal nutrition, measured using middle-upper arm circumference. While the intervention has almost no effect on the infant feeding intention of women who own refrigerators, it has a very large positive effect of 3.349-points (on a scale ranging from 1 to 8) for women without refrigerators. CONCLUSION A package intervention consisting of psycho-social support, additional tailored health information, and an incentive to utilise public antenatal care services has the potential to increase exclusive breastfeeding intention and reduce maternal depressive symptoms among the economically vulnerable.
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Affiliation(s)
- Laura Rossouw
- School of Economics and Finance, University of the Witwatersrand, 1 Jan Smuts Ave, Johannesburg, South Africa.
| | - Rulof Petrus Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Ronelle Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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11
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Madzorera I, Isanaka S, Wang M, Msamanga GI, Urassa W, Hertzmark E, Duggan C, Fawzi WW. Maternal dietary diversity and dietary quality scores in relation to adverse birth outcomes in Tanzanian women. Am J Clin Nutr 2020; 112:695-706. [PMID: 32651998 PMCID: PMC7458779 DOI: 10.1093/ajcn/nqaa172] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/11/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Preterm birth (PTB), small for gestational age (SGA), and low birth weight (LBW) are risk factors for morbidity and mortality among infants. High-quality maternal diets during pregnancy may protect against these adverse birth outcomes. OBJECTIVES The aim of this study was to prospectively examine the association of maternal dietary diversity and quality during pregnancy with birth outcomes among women in Dar es Salaam, Tanzania. METHODS We analyzed data from 7553 HIV-negative pregnant women enrolled in a multivitamin trial at 12-27 weeks of gestation. Dietary intake was assessed using 24-h dietary recalls. Dietary diversity scores (DDS; range: 0-10) were computed as the number of food groups consumed by women, using FAO's Minimum Dietary Diversity for Women index. The Prime Diet Quality Score (PDQS; range: 0-42) assessed maternal diet quality based on consumption of 21 healthy and unhealthy food groups. Log binomial regression methods were used to assess associations of DDS and PDQS with PTB, SGA, LBW, and fetal loss. RESULTS In the previous 24 h, 99.9% of all women had consumed cereal and staples, 57.9% meats, 4.7% eggs, and 0.5% nuts and seeds. Median DDS was 3.0 (IQR: 2.5-3.5). For the PDQS, all women consumed ≥4 servings/wk of green leafy vegetables and refined grains. Higher DDS was associated with lower risk of SGA (RR highest compared with lowest quintile: 0.74; 95% CI: 0.62, 0.89). Higher PDQS was associated with lower risk of PTB (RR highest compared with lowest quintile: 0.55; 95% CI: 0.46, 0.66), LBW (RR: 0.53; 95% CI: 0.40, 0.70), and fetal loss (RR: 0.53; 95% CI, 0.34, 0.82). CONCLUSIONS PDQS was inversely associated with PTB, LBW, and fetal loss, and DDS was inversely associated with SGA. These findings suggest that in addition to dietary diversity, diet quality should be considered as important in understanding dietary risk factors for poor birth outcomes.This trial was registered at clinicaltrials.gov as NCT00197548.
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Affiliation(s)
- Isabel Madzorera
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sheila Isanaka
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Departments of Epidemiology and Biostatistics, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gernard I Msamanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Willy Urassa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christopher Duggan
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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12
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Brown JV, Lin L, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 2020; 6:CD000343. [PMID: 35658821 PMCID: PMC7268980 DOI: 10.1002/14651858.cd000343.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Human breast milk-fed preterm infants can accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human milk could increase nutrient accretion and growth rates and improve neurodevelopmental outcomes. Concern exists, however, that multi-nutrient fortifiers are associated with adverse events such as feed intolerance and necrotising enterocolitis. OBJECTIVES To determine whether multi-nutrient fortified human milk, compared with unfortified human milk, affects important outcomes (including growth rate and neurodevelopment) of preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), MEDLINE via PubMed (1966 to 26 September 2019), Embase (1980 to 26 September 2019), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 September 2019). We searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins, or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed the certainty of the body of evidence at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods. MAIN RESULTS We identified 18 trials in which a total of 1456 preterm infants participated. These trials were generally small and methodologically weak. Meta-analyses provided low- to moderate-certainty evidence showing that multi-nutrient fortification of human milk increases in-hospital rate of weight gain (MD 1.76 g/kg/d, 95% confidence interval (CI) 1.30 to 2.22), body length (MD 0.11 cm/week, 95% CI 0.08 to 0.15), or head circumference (MD 0.06 cm/week, 95% CI 0.03 to 0.08) among preterm infants. Few data on growth and developmental outcomes assessed beyond infancy are available, and these do not show effects of multi-nutrient fortification. The data do not suggest other benefits or harms and provide low-certainty evidence suggesting effects of multi-nutrient fortification on the risk of necrotising enterocolitis in preterm infants (typical RR 1.37, 95% CI 0.72 to 2.63; 13 studies, 1110 infants). AUTHORS' CONCLUSIONS Feeding preterm infants with multi-nutrient fortified human breast milk compared with unfortified human breast milk is associated with modest increases in in-hospital growth rates. Evidence is insufficient to show whether multi-nutrient fortification has any effect on long-term growth or neurodevelopment.
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Affiliation(s)
- Jennifer Ve Brown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust and University of Newcastle, Newcastle upon Tyne, UK
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
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González-Fernández D, Pons EDC, Rueda D, Sinisterra OT, Murillo E, Scott ME, Koski KG. Identification of High-Risk Pregnancies in a Remote Setting Using Ambulatory Blood Pressure: The MINDI Cohort. Front Public Health 2020; 8:86. [PMID: 32292772 PMCID: PMC7121149 DOI: 10.3389/fpubh.2020.00086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Ambulatory blood pressure is a potential tool for early detection of complications during pregnancy, but its utility in impoverished settings has not been assessed. This cross-sectional study aimed to determine whether maternal infections, nutrient deficiencies and inflammation (MINDI) were associated with four measures of maternal blood pressure (BP) and to determine their association with symphysis-fundal-height (SFH). Methods: Environmental and dietary factors, intake of iron and a multiple-nutrient supplement (MNS), markers of inflammation, protein, anemia, folate, vitamins B12, A and D status, and urogenital, skin, oral and intestinal nematode infections were measured in indigenous pregnant Panamanian women. Stepwise multiple linear and logistic regression models explored determinants of systolic and diastolic blood pressure (SBP, DBP), hypotension (SBP < 100 and DBP < 60), mean arterial pressure (MAP), elevated MAP (eMAP), and pulse pressure (PP). Associations of BP with intestinal nematodes and with SFH Z scores (≥16 wk) were also explored. Results: Despite absence of high SBP or DBP, 11.2% of women had eMAP. Furthermore, 24.1% had hypotension. Linear regression showed that hookworm infection was associated with higher SBP (P = 0.049), DBP (P = 0.046), and MAP (P = 0.016), whereas Ascaris was associated with lower DBP (P = 0.018) and MAP (P = 0.028). Trichomonas was also associated with lower SBP (P < 0.0001) and MAP (P = 0.009). The presence of Trichuris (OR: 6.7, 95% CI 1.0-44.5) and folic acid deficiency (OR: 6.9, 95% CI 1.4-33.8) were associated with increased odds of eMAP. The odds of low BP was higher in the presence of Ascaris (OR: 3.63 ± 2.28, P = 0.040), but odds were lowered by MNS (OR: 0.35 ± 0.11, P = 0.001), more intake of animal-source foods/wk (OR: 0.7, 95% CI 0.5-0.9) and by higher concentrations of IL-17 (OR: 0.87 ± 0.05, P = 0.016). Conclusion: MINDI were bi-directionally associated with blood pressure indicators. In this MINDI cohort, infections, nutrients and cytokines both raised, and lowered BP indices. The presence of eMAP identified pregnant women at risk of hypertension whereas low PP was associated with lower SFH. Therefore, MAP and PP may help in detecting women at risk of adverse pregnancy outcomes in settings with limited access to technology.
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Affiliation(s)
- Doris González-Fernández
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University (Macdonald Campus), Ste-Anne-de-Bellevue, QC, Canada
| | | | - Delfina Rueda
- "Comarca Ngäbe-Buglé" Health Region, Ministry of Health, San Félix, Panama
| | | | - Enrique Murillo
- Department of Biochemistry, University of Panama, Panama City, Panama
| | - Marilyn E Scott
- Faculty of Agricultural and Environmental Sciences, Institute of Parasitology, McGill University, Ste-Anne-de-Bellevue, QC, Canada
| | - Kristine G Koski
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University (Macdonald Campus), Ste-Anne-de-Bellevue, QC, Canada
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Chai Y, Nandi A, Heymann J. Association of increased duration of legislated paid maternity leave with childhood diarrhoea prevalence in low-income and middle-income countries: difference-in-differences analysis. J Epidemiol Community Health 2020; 74:437-444. [PMID: 32111639 PMCID: PMC7307660 DOI: 10.1136/jech-2019-212127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/07/2020] [Accepted: 02/05/2020] [Indexed: 11/12/2022]
Abstract
Background Diarrhoea is the second-leading infectious cause of death in children younger than age 5 years. The global burden of severe diarrhoeal disease is concentrated in Africa and Southeast Asia, where a significant percentage of the population resides in low-resource settings. We aimed to quantitatively examine whether extending the duration of legislated paid maternity leave affected the prevalence of childhood diarrhoea in low-income and middle-income countries (LMICs). Methods We merged longitudinal data measuring national maternity leave policies with information on the prevalence of bloody diarrhoea related to 884 517 live births occurring between 1996 and 2014 in 40 LMICs that participated at least twice in the Demographic and Health Surveys between 2000 and 2015. We used a difference-in-differences approach to compare changes in the percentage of children with bloody diarrhoea across eight countries that lengthened their paid maternity leave policy between 1995 and 2013 to the 32 countries that did not. Results The prevalence of bloody diarrhoea in the past 2 weeks was 168 (SD=40) per 10 000 children under 5 years in countries that changed their policies and 136 (SD=15) in countries that did not. A 1-month increase in the legislated duration of paid maternity leave was associated with 61 fewer cases of bloody diarrhoea (95% CI −98.86 to −22.86) per 10 000 children under 5 years of age, representing a 36% relative reduction. Conclusion Extending the duration of paid maternity leave policy appears to reduce the prevalence of bloody diarrhoea in children under 5 years of age in LMICs.
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Affiliation(s)
- Yan Chai
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Health Policy and Management, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
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Nisha MK, Raynes-Greenow C, Rahman A, Alam A. Perceptions and practices related to birthweight in rural Bangladesh: Implications for neonatal health programs in low- and middle-income settings. PLoS One 2019; 14:e0221691. [PMID: 31887122 PMCID: PMC6936797 DOI: 10.1371/journal.pone.0221691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/06/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Globally, low birthweight (LBW) infants (<2.5 kilograms) contribute up to 80% of neonatal mortality. In Bangladesh, approximately 62% of all births occur at home and therefore, weighing newborns immediately after birth is not feasible. Thus, estimates of birthweight in Bangladesh are mostly obtained based on maternal perception of the newborn's birth size. Little is known about how birthweight is perceived in rural communities, and whether families associate birthweight with newborn's health status. Our objective was to explore families' perceptions of newborn's birthweight, and preventive and care practices for a LBW newborn in rural Bangladesh. METHODS We conducted a qualitative study in two rural settings of Bangladesh, including 32 in-depth interviews (11 with pregnant women, 12 with recently delivered women, 4 with husbands whose wives were pregnant or had a recent birth, 5 with mothers-in-law whose daughters-in-law were pregnant or had a recent birth), 2 focus group discussions with husbands and 4 key-informant interviews with community health workers. We used thematic analysis to analyse the data. RESULTS Most participants did not consider birthweight a priority for assessing a newborn's health status, although there was a desire for a healthy newborn. Recognition of different categories of birthweight was subjective and often included several physical descriptors including birth size of the newborn. LBW was not considered as a criterion of a newborn's illness unless the newborn appeared unwell. Maternal poor nutrition, inadequate diet in pregnancy, anaemia, illness during pregnancy, short stature, twin births and influence of supernatural spirit were identified as the major causes of LBW. Women's preventive practices for LBW or small newborns were predominantly constrained by a lack of awareness of birthweight and fear of caesarean section. As an effort to avoid caesarean section during birth, several women tended to perform potentially harmful practices in order to give birth to a small size newborn; such as avoiding nutritious food and eating less in pregnancy. Common practices to treat a LBW or small newborn who appeared ill included breastfeeding, feeding animal milk, feeding sugary water, feeding formula, oil massage, keeping the small newborn warm and seeking care from formal and informal care providers including a spiritual leader. Maternal lack of decision-making power, financial constraint, home birth and superstition were the major challenges to caring for a LBW newborn. CONCLUSION Birthweight was not well-understood in the rural community, which highlighted substantial challenges to the prevention and care practices of LBW newborns. Community-level health education is needed to promote awareness related to the recognition of birthweight in rural settings.
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Affiliation(s)
- Monjura Khatun Nisha
- Sydney School of Public Health, The University of Sydney, NSW, Sydney, Australia
| | | | - Aminur Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, NSW, Sydney, Australia
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16
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Chand S, Ahmed F, Shah MH, Leghari AL, Usman P, Advani R, Salat MS, Ariff S. Frequency of Early Morbidities in Low Birth Weight Neonates at The Aga Khan University Hospital, Karachi. Cureus 2019; 11:e6061. [PMID: 31827991 PMCID: PMC6890161 DOI: 10.7759/cureus.6061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Globally, approximately 14.6% children are born with low birth weight (LBW) annually. In Pakistan, this figure however reaches approximately 16%. Low birth weight infants are vulnerable to develop early morbidities like hypothermia, hypoglycemia, respiratory distress syndrome and hypocalcemia. There is a scarcity of statistics which creates a gap in development of strategies for improving quality of care in developing countries. The aim of our study was to determine the frequency of early morbidities such as respiratory distress syndrome (RDS), hypoglycemia, hypothermia and hypocalcemia in low birth weight neonates. Methodology A prospective descriptive study was conducted via non-probability sampling technique from 1st April 2016 to 30th September 2016 at The Aga Khan University Hospital, Karachi. All low birth weight infants, i.e., those with birth weight < 2500 grams were included in this study and observed for early morbidities, including hypothermia, hypoglycemia, hypocalcemia and respiratory distress syndrome. Descriptive analysis was done using SPSS version 22 (IBM Corp., Armonk, NY), mean and standard deviation were determined for quantitative variables, whereas frequency and percentages were calculated for qualitative variables. Results A total of 2082 neonates were born during the study period, of which 271 (13%) were born with low birth weight. One hundred and eighty-five (68.1%) of these LBW neonates were preterm babies while 86 (31.9%) were born at term. Among LBW neonates 137 (51.0%) were males and 134 (49.0%) females. In the study population, hypoglycemia was seen in 17.3%, hypocalcemia in 13.6%, respiratory distress syndrome in 11%, and hypothermia in 2.5%. Conclusion Our study highlighted major early morbidities of LBW neonates, and their association with birth weight, gestational age and gender. Significant association of birth weight was found with hypothermia and hypocalcemia, whereas hypocalcemia and RDS were significantly associated with gestational age. However, none of the early morbidities had significant association with gender. Keeping in perspective the early morbidities in this population we propose that priority be given to providing adequate attention to low birth weight neonates.
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Affiliation(s)
- Saroop Chand
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | - Fayaz Ahmed
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | | | | | - Parveen Usman
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | | | | | - Shabina Ariff
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
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Abstract
BACKGROUND When human milk is not available for feeding preterm infants, protein hydrolysate, rather than standard cow's milk formulas (with intact proteins), is often used because it is perceived as being tolerated better and less likely to lead to complications. However, protein hydrolysate formulas are more expensive than standard formulas, and concern exists that their use in practice is not supported by high-quality evidence. OBJECTIVES To assess the effects of feeding preterm infants hydrolysed formula (vs standard cow's milk formula) on risk of feed intolerance, necrotising enterocolitis, and other morbidity and mortality. SEARCH METHODS We used the standard Cochrane Neonatal search strategy including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1), in the Cochrane Library; Ovid MEDLINE (1966 to 28 January 2019); Ovid Embase (1980 to 28 January 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (28 January 2019), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants protein hydrolysate versus standard (non-hydrolysed) cow's milk formula. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and extracted data independently. We analysed treatment effects as described in the individual trials and reported risk ratios and risk differences for dichotomous data, and mean differences for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored potential causes of heterogeneity in sensitivity analyses. We assessed quality of evidence at the outcome level using the GRADE approach. MAIN RESULTS We identified 11 trials for inclusion in the review. All trials were small (total participants 665) and had various methodological limitations including uncertainty about methods to ensure allocation concealment and blinding. Most participants were clinically stable preterm infants of less than about 34 weeks' gestational age or with birth weight less than about 1750 g. Fewer participants were extremely preterm, extremely low birth weight, or growth restricted. Most trials found no effects on feed intolerance, assessed variously as mean pre-feed gastric residual volume, incidence of abdominal distension or other gastrointestinal signs of concern, or time taken to achieve full enteral feeds (meta-analysis was limited because studies used different measures). Meta-analysis showed no effect on the risk of necrotising enterocolitis (typical risk ratio 1.10, 95% CI 0.36 to 3.34; risk difference 0.00, 95% CI -0.03 to 0.04; 5 trials, 385 infants) (low-certainty evidence; downgraded for imprecision and design weaknesses). AUTHORS' CONCLUSIONS The identified trials provide only low-certainty evidence about the effects of feeding preterm infants protein hydrolysate versus standard formula. Existing data do not support conclusions that feeding protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis. Additional large, pragmatic trials are needed to provide more reliable and precise estimates of effectiveness and cost-effectiveness.
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Affiliation(s)
- Derek Hang Cheong Ng
- Hull York Medical School & Centre for Reviews and Dissemination, University of York, York, UK
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18
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Walsh V, Brown JVE, Askie LM, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants. Cochrane Database Syst Rev 2019; 7:CD004204. [PMID: 31314903 PMCID: PMC6636703 DOI: 10.1002/14651858.cd004204.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with nutrient-enriched rather than standard formula might increase nutrient accretion and growth rates and might improve neurodevelopmental outcomes. OBJECTIVES To compare the effects of feeding with nutrient-enriched formula versus standard formula on growth and development of preterm infants. SEARCH METHODS We used the Cochrane Neonatal standard search strategy. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11), MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (until November 2018), as well as conference proceedings, previous reviews, and clinical trials databases. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with nutrient-enriched formula (protein and energy plus minerals, vitamins, or other nutrients) versus standard formula. DATA COLLECTION AND ANALYSIS We extracted data using the Cochrane Neonatal standard methods. Two review authors separately evaluated trial quality and extracted and synthesised data using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed certainty of evidence at the outcome level using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS We identified seven trials in which a total of 590 preterm infants participated. Most participants were clinically stable preterm infants of birth weight less than 1850 g. Few participants were extremely preterm, extremely low birth weight, or growth restricted at birth. Trials were conducted more than 30 years ago, were formula industry funded, and were small with methodological weaknesses (including lack of masking) that might bias effect estimates. Meta-analyses of in-hospital growth parameters were limited by statistical heterogeneity. There is no evidence of an effect on time to regain birth weight (MD -1.48 days, 95% confidence interval (CI) -4.73 to 1.77) and low-certainty evidence suggests that feeding with nutrient-enriched formula increases in-hospital rates of weight gain (MD 2.43 g/kg/d, 95% CI 1.60 to 3.26) and head circumference growth (MD 1.04 mm/week, 95% CI 0.18 to 1.89). Meta-analysis did not show an effect on the average rate of length gain (MD 0.22 mm/week, 95% CI -0.70 to 1.13). Fewer data are available for growth and developmental outcomes assessed beyond infancy, and these do not show consistent effects of nutrient-enriched formula feeding. Data from two trials did not show an effect on Bayley Mental Development Index scores at 18 months post term (MD 2.87, 95% CI -1.38 to 7.12; moderate-certainty evidence). Infants who received nutrient-enriched formula had higher Bayley Psychomotor Development Index scores at 18 months post term (MD 6.56. 95% CI 2.87 to 10.26; low-certainty evidence), but no evidence suggested an effect on cerebral palsy (typical RR 0.79, 95% CI 0.30 to 2.07; 2 studies, 377 infants). Available data did not indicate any other benefits or harms and provided low-certainty evidence about the effect of nutrient-enriched formula feeding on the risk of necrotising enterocolitis in preterm infants (typical RR 0.72, 95% CI 0.41 to 1.25; 3 studies, 489 infants). AUTHORS' CONCLUSIONS Available trial data show that feeding preterm infants nutrient-enriched (compared with standard) formulas has only modest effects on growth rates during their initial hospital admission. No evidence suggests effects on long-term growth or development. The GRADE assessment indicates that the certainty of this evidence is low, and that these findings should be interpreted and applied with caution. Further randomised trials would be needed to resolve this uncertainty.
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Affiliation(s)
- Verena Walsh
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
| | | | - Lisa M Askie
- University of SydneyNHMRC Clinical Trials CentreLocked Bag 77CamperdownNSWAustralia2050
| | - Nicholas D Embleton
- Newcastle Hospitals NHS Foundation Trust and University of NewcastleNewcastle Neonatal ServiceRichardson RoadNewcastle upon TyneUKNE1 4LP
| | - William McGuire
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
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19
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Harding KL, Aguayo VM, Webb P. Birthweight and feeding practices are associated with child growth outcomes in South Asia. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 4:e12650. [PMID: 30499248 PMCID: PMC6972829 DOI: 10.1111/mcn.12650] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 05/08/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022]
Abstract
Although there has been a focus on preventing stunting over the past decade, wasting has received less policy and programmatic attention. Recent national surveys from six South Asian countries were pooled to generate a dataset of 62,509 children aged 0 to 59 months to explore associations between low birthweight (LBW) and suboptimal infant and young child feeding (IYCF) practices with child wasting, severe wasting, and the co-occurrence of wasting and stunting. Logistic regression models accounted for the surveys' clustered designs and adjusted for a potential confounding factors. Children with reported LBW had significantly higher odds of being wasted (adjusted odds ratio [95% CI]: 1.60 [1.45, 1.76]) or severely wasted (1.57 [1.34, 1.83]), compared with non-LBW children. Similarly, children aged 0 to 23 months who were not breastfed within the first hour post-partum, those who were provided prelacteal feeds, and those aged 0 to 5 months who were not exclusively breastfed, were more likely to be wasted (P < 0.05 for all three feeding practices). In India, not achieving minimum diet diversity and minimum adequate diet were significantly associated with the co-occurrence of stunting and wasting. In other words, many key domains of concern to development agents who seek to address stunting are also of direct concern to those focused on wasting. The co-occurrence of wasting and stunting requires more integrated interventions. That is, programmes aimed at preventing LBW and poor IYCF to avert stunting should be linked more effectively with actions aimed at the management of wasting.
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Affiliation(s)
- Kassandra L Harding
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Víctor M Aguayo
- United Nations Children's Fund (UNICEF) Programme Division, New York, New York
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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20
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Tancred T, Mandu R, Hanson C, Okuga M, Manzi F, Peterson S, Schellenberg J, Waiswa P, Marchant T. How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda. Health Policy Plan 2018; 33:e1-e13. [PMID: 29304250 DOI: 10.1093/heapol/czu070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 01/01/2023] Open
Abstract
Background Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff. Aim To describe experiences implementing EQUIP's QI approach at the community level. Methods A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also. Results Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce. Conclusions Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices.
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Affiliation(s)
- Tara Tancred
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Rogers Mandu
- Makerere University School of Public Health, Kampala, Uganda
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Monica Okuga
- Makerere University School of Public Health, Kampala, Uganda
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Stefan Peterson
- Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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21
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Bautista LE, Herrera VM. An assessment of public health surveillance of Zika virus infection and potentially associated outcomes in Latin America. BMC Public Health 2018; 18:656. [PMID: 29793453 PMCID: PMC5968501 DOI: 10.1186/s12889-018-5566-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated whether outbreaks of Zika virus (ZIKV) infection, newborn microcephaly, and Guillain-Barré syndrome (GBS) in Latin America may be detected through current surveillance systems, and how cases detected through surveillance may increase health care burden. METHODS We estimated the sensitivity and specificity of surveillance case definitions using published data. We assumed a 10% ZIKV infection risk during a non-outbreak period and hypothetical increases in risk during an outbreak period. We used sensitivity and specificity estimates to correct for non-differential misclassification, and calculated a misclassification-corrected relative risk comparing both periods. To identify the smallest hypothetical increase in risk resulting in a detectable outbreak we compared the misclassification-corrected relative risk to the relative risk corresponding to the upper limit of the endemic channel (mean + 2 SD). We also estimated the proportion of false positive cases detected during the outbreak. We followed the same approach for microcephaly and GBS, but assumed the risk of ZIKV infection doubled during the outbreak, and ZIKV infection increased the risk of both diseases. RESULTS ZIKV infection outbreaks were not detectable through non-serological surveillance. Outbreaks were detectable through serologic surveillance if infection risk increased by at least 10%, but more than 50% of all cases were false positive. Outbreaks of severe microcephaly were detected if ZIKV infection increased prevalence of this condition by at least 24.0 times. When ZIKV infection did not increase the prevalence of severe microcephaly, 34.7 to 82.5% of all cases were false positive, depending on diagnostic accuracy. GBS outbreaks were detected if ZIKV infection increased the GBS risk by at least seven times. For optimal GBS diagnosis accuracy, the proportion of false positive cases ranged from 29 to 54% and from 45 to 56% depending on the incidence of GBS mimics. CONCLUSIONS Current surveillance systems have a low probability of detecting outbreaks of ZIKV infection, severe microcephaly, and GBS, and could result in significant increases in health care burden, due to the detection of large numbers of false positive cases. In view of these limitations, Latin American countries should consider alternative options for surveillance.
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Affiliation(s)
- Leonelo E Bautista
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin at Madison, 610 Walnut Street, WARF 703, Madison, WI, 53726-2397, USA.
| | - Víctor M Herrera
- Center for Biomedical Research, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Carducci B, Bhutta ZA. Care of the growth-restricted newborn. Best Pract Res Clin Obstet Gynaecol 2018; 49:103-116. [PMID: 29571821 DOI: 10.1016/j.bpobgyn.2018.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/15/2018] [Indexed: 12/23/2022]
Abstract
With the first 1,000 days of life proving to be a critical window of opportunity for physical and cognitive growth and development, an optimal intrauterine environment is vital. If fetus needs are compromised prenatally, there is an increased risk of intrauterine growth restriction (IUGR), and infants being born premature, low birth weight (LBW), or small-for-gestational age (SGA). Specialized care of these high-risk infants is necessary in terms of preconception interventions, resuscitation, thermoregulation, nutritional support and kangaroo mother care. Significant evidence supports exclusive breastfeeding as the standard of care for feeding SGA, preterm, LBW and very low birth weight infants. Expressed milk or donor milk may also require fortification, to meet higher nutrient needs of these newborns. Future research should address the gap in the literature on specific care of term and preterm IUGR and or SGA infants, and strengthening evidence for human milk bank models and emollient care.
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Affiliation(s)
- Bianca Carducci
- Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
| | - Zulfiqar A Bhutta
- Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
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23
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Goodarzi-Khoigani M, Baghiani Moghadam MH, Nadjarzadeh A, Mardanian F, Fallahzadeh H, Mazloomy-Mahmoodabad S. Impact of Nutrition Education in Improving Dietary Pattern During Pregnancy Based on Pender's Health Promotion Model: A Randomized Clinical Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:18-25. [PMID: 29344041 PMCID: PMC5769180 DOI: 10.4103/ijnmr.ijnmr_198_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Different types of nutrients in adequate amounts are required to meet the increased demands of the mother and the developing fetus. Therefore, we examined the impact of nutrition education on the number of food servings per day. Materials and Methods: Pregnant mothers were recruited to a prospective, randomized clinical trial from May to September, 2016. At 6–10 weeks of gestation, the participants were randomly divided into the intervention (n = 96) or the control group (n = 96), and were followed-up until the end of pregnancy. Each woman in the experimental group met the study nutritionist at the time of enrollment and an individualized nutrition plan was developed. In addition, the nutrition education based on Pender's Health Promotion Model (HPM) was designed, including three 45–60 min training sessions in 6–10, 18, and 26 weeks of pregnancy. The participants' usual food intake using a three-day dietary record was assessed at 6–10 weeks and 34–36 weeks of gestation. Results: The mean scores of the perceived benefits, self-efficacy, activity-related affect, interpersonal influences (husband support), and commitment to action increased while the competing demand scores decreased in the interventional group compared with the control group. The mean standard deviation (SD) of food portions from grain [10.40 (1.96) versus 12.70 (1.93) in the control group], vegetable [3.88 (1.33) versus 2.96 (0.91)], fruit [4.02 (0.05) versus 3.95 (0.91)], dairy [2.33 (0.68) versus 2.11 (0.45)], and meat [3.17 (0.68) versus 2.96 (0.67)] were improved in the experimental group. Conclusions: Pender's HPM for nutrition education is effective based on the compliance of pregnant women to the dietary guideline and the food guide pyramid.
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Affiliation(s)
- Masoomeh Goodarzi-Khoigani
- Social Determinants of Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Azadeh Nadjarzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farahnaz Mardanian
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Fallahzadeh
- Department of Statistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - SeyedSaeed Mazloomy-Mahmoodabad
- Department of Health Education and Promotion, Social Determinants of Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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24
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Adewuyi EO, Zhao Y, Khanal V, Auta A, Bulndi LB. Rural-urban differences on the rates and factors associated with early initiation of breastfeeding in Nigeria: further analysis of the Nigeria demographic and health survey, 2013. Int Breastfeed J 2017; 12:51. [PMID: 29299048 PMCID: PMC5747139 DOI: 10.1186/s13006-017-0141-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background This study investigates and compares the rates and factors associated with early initiation of breastfeeding (EIBF) within one hour of birth in rural and urban Nigeria. Methods Data from the 2013 Nigeria Demographic and Health Survey (NDHS) were analyzed. The rates of EIBF were reported using frequency tabulation. Associated factors were examined using Chi-Square test and further assessed on multivariable logistic regression analysis. Results The rates of EIBF were 30.8% (95% confidence interval [CI] 29.0, 32.6) and 41.9% (95% CI 39.6, 44.3) in rural and urban residences, respectively (p < 0.001). The North-Central region had the highest EIBF rates both in rural (43.5%) and urban (63.5%) residences. Greater odds of EIBF in rural residence were significantly associated with higher birth order (Adjusted Odds Ratio [AOR] 1.29, 95% CI 1.10, 1.60), large birth size (AOR 1.33, 95% CI 1.10, 1.60), and health facility delivery (AOR 1.46, 95% CI 1.23, 1.72). Rural mothers in the rich wealth index, not working and whose husbands obtained at least a secondary school education had significantly higher odds of early initiation of breastfeeding. Regardless of residence, greater odds of EIBF were significantly associated with non-cesarean delivery (Rural AOR 3.50, 95% CI 1.84, 6.62; Urban AOR 2.48, 95% CI 1.60, 3.80) and living in North-Central (Rural AOR 1.84, 95% CI 1.34, 2.52; Urban AOR 4.40, 95% CI 3.15, 6.15) region. Also, higher odds of EIBF were significantly associated with living in North-East (Rural AOR 1.48, 95% CI 1.05, 2.08; Urban AOR 3.50, 95% CI 2.55, 4.83), South-South (Rural AOR 1.51, 95% CI 1.11, 2.10; Urban AOR 2.84, 95% CI 2.03, 3.97) and North-West (Urban residence only AOR 2.08, 95% CI 1.54, 2.80) regions. Conclusions Rural-urban differences in the rates and factors associated with EIBF exist in Nigeria with rural residence having significantly lower rates. Intervention efforts which address the risk factors identified in this study may contribute to improved EIBF rates. Efforts need to prioritize rural mothers generally, (particularly, those in rural North-West region) as well as mothers in urban South-West region of Nigeria.
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Affiliation(s)
- Emmanuel Olorunleke Adewuyi
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Federal Ministry of Defense, 2 Division Hospital, Adekunle Fajuyi Cantonment, Ibadan, Oyo State, Nigeria
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Bentley Campus, Perth, Australia
| | | | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
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25
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Abstract
BACKGROUND When human milk is not available for feeding preterm infants, protein hydrolysate rather than standard cow's milk formulas (with intact proteins) are often used because they are perceived as being tolerated better and less likely to lead to complications. However, protein hydrolysate formulas are more expensive than standard formulas, and concern exists that their use in practice is not supported by high-quality evidence. OBJECTIVES To assess the effect of feeding preterm infants with hydrolysed formula (versus standard cow's milk formulas) on the risk of feed intolerance, necrotising enterocolitis, and other morbidity and mortality in preterm infants. SEARCH METHODS We used the standard Cochrane Neonatal search strategy including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), Ovid MEDLINE, Ovid Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (to April 2017), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with protein hydrolysate versus standard (non-hydrolysed) cow's milk formula. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and extracted data independently. We analysed treatment effects as described in the individual trials and reported risk ratios and risk differences for dichotomous data, and mean differences for continuous data, with respective 95% confidence intervals (CI). We used a fixed-effect model in meta-analyses and explored potential causes of heterogeneity in sensitivity analyses. We assessed quality of evidence at the outcome level using the GRADE approach. MAIN RESULTS We identified 11 trials for inclusion in the review. All trials were small (total participants 665) and had various methodological limitations including uncertainty about methods to ensure allocation concealment and blinding. Most participants were clinically stable preterm infants of gestational age less than about 34 weeks or birth weight less than about 1750 g. Fewer participants were extremely preterm, extremely low birth weight, or growth-restricted. Most trials found no effects on feed intolerance assessed variously as mean prefeed gastric residual volume, incidence of abdominal distention or other concerning gastrointestinal signs, or time taken to achieve full enteral feeds (meta-analysis was limited because studies used different measures). Meta-analysis found no effect on the risk of necrotising enterocolitis (typical risk ratio 1.10, 95% CI 0.36 to 3.34; risk difference 0.00, 95% CI -0.03 to 0.04; 5 trials, 385 infants) (low quality evidence; downgraded for imprecision and design weaknesses). AUTHORS' CONCLUSIONS The identified trials provide only low quality evidence about the effects of feeding preterm infants with protein hydrolysate versus standard formula. The existing data did not support conclusions that feeding with protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis. Further large, pragmatic trials are needed to provide more reliable and precise estimates of effectiveness and cost-effectiveness.
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Affiliation(s)
- Derek Hang Cheong Ng
- University of YorkHull York Medical School & Centre for Reviews and DisseminationYorkUK
| | - Joel Klassen
- University of YorkHull York Medical School & Centre for Reviews and DisseminationYorkUK
| | - Nicholas D Embleton
- Newcastle Hospitals NHS Foundation Trust and University of NewcastleNewcastle Neonatal ServiceRichardson RoadNewcastle upon TyneUKNE1 4LP
| | - William McGuire
- Centre for Reviews and Dissemination, The University of YorkYorkUK
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26
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Koenraads M, Phuka J, Maleta K, Theobald S, Gladstone M. Understanding the challenges to caring for low birthweight babies in rural southern Malawi: a qualitative study exploring caregiver and health worker perceptions and experiences. BMJ Glob Health 2017; 2:e000301. [PMID: 29082008 PMCID: PMC5656136 DOI: 10.1136/bmjgh-2017-000301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low birthweight (LBW) babies account for >80% of neonatal mortality in sub-Saharan Africa and South Asia and those who survive the neonatal period are still at risk of detrimental outcomes. LBW is a major public health problem in Malawi and strongly contributes to the country's high neonatal mortality rate. We aimed to get a better understanding of the care of LBW babies in rural Malawi in order to inform action to improve their outcomes. METHODS Qualitative methods were used to identify challenges faced by caregivers and health workers within communities and at the rural facility level. We conducted 33 in-depth interviews (18 with caregivers; 15 with health workers) and 4 focus group discussions with caregivers. Interviews were recorded, transcribed and translated. Thematic analysis was used to index the data into themes and develop a robust analytical framework. RESULTS Caregivers referred to LBW babies as weak, with poor health, stunted growth, developmental problems and lack of intelligence. Poor nutrition of the mother and illnesses during pregnancy were perceived to be important causes of LBW. Discrimination and stigma were described as a major challenge faced by carers of LBW babies. Problems related to feeding and the high burden of care were seen as another major challenge. Health workers described a lack of resources in health facilities, lack of adherence to counselling provided to carers and difficulties with continuity of care and follow-up in the community. CONCLUSION This study highlights that care of LBW babies in rural Malawi is compromised both at community and rural facility level with poverty and existing community perceptions constituting the main challenges. To make progress in reducing neonatal mortality and promoting better outcomes, we must develop integrated community-based care packages, improve care at facility level and strengthen the links between them.
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Affiliation(s)
- Marianne Koenraads
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John Phuka
- Department of Community Health, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Adewuyi EO, Zhao Y. Determinants of neonatal mortality in rural and urban Nigeria: Evidence from a population-based national survey. Pediatr Int 2017; 59:190-200. [PMID: 27378178 DOI: 10.1111/ped.13086] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/13/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Significant reduction in the global burden of neonatal mortality was achieved through the millennium development goals. In Nigeria, however, only a marginal reduction was realized. This study assesses the rural-urban differences in neonatal mortality rate (NMR) and the associated risk factors in Nigeria. METHODS The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural-urban residence (n = 20 449 and 9935, respectively), was explored using univariate, bivariate, and multivariable analysis. Complex samples analysis was applied to adjust for the unequal selection probabilities due to the multi-stage cluster sampling method used in the 2013 NDHS. The adjusted relationship between the outcome and predictor variables was assessed on multi-level logistic regression analysis. RESULTS NMR for rural and urban populations was 36 and 28 deaths per 1000 live births, respectively. Risk factors in urban residence were lack of electricity access (adjusted OR [AOR], 1.555; 95%CI: 1.089-2.220), small birth size (as a proxy for low birthweight; AOR, 3.048; 95%CI: 2.047-4.537), and male gender (AOR, 1.666; 95%CI: 1.215-2.284). Risk factors in rural residence were small birth size (a proxy for low birthweight; AOR, 2.118; 95%CI: 1.600-2.804), and birth interval <2 years (AOR, 2.149; 95%CI: 1.760-2.624). Cesarean delivery was a risk factor both in rural (AOR, 5.038; 95%CI: 2.617-9.700) and urban Nigeria (AOR, 2.632; 95%CI: 1.543-4.489). CONCLUSIONS Determinants of neonatal mortality were different in rural and urban Nigeria, and rural neonates had greater risk of mortality than their urban counterparts.
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Affiliation(s)
- Emmanuel O Adewuyi
- 2 Div Hospital, Adekunle Fajuyi Cantonment, Ibadan, Nigeria.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Yun Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Dhobale M. Neurotrophic Factors and Maternal Nutrition During Pregnancy. VITAMINS AND HORMONES 2017; 104:343-366. [DOI: 10.1016/bs.vh.2016.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Callaghan‐Koru JA, Estifanos AS, Sheferaw ED, Graft‐Johnson J, Rosado C, Patton‐Molitors R, Worku B, Rawlins B, Baqui A. Practice of skin-to-skin contact, exclusive breastfeeding and other newborn care interventions in Ethiopia following promotion by facility and community health workers: results from a prospective outcome evaluation. Acta Paediatr 2016; 105:e568-e576. [PMID: 27644765 DOI: 10.1111/apa.13597] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/23/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
AIM To assess the effects of a facility and community newborn intervention package on coverage of early skin-to-skin contact (SSC) and exclusive breastfeeding - the therapeutic components of kangaroo mother care. METHODS A multilevel community and facility intervention in Ethiopia trained health workers in 10 health centres and the surrounding communities to promote early SSC and exclusive breastfeeding for all babies born at home or in the facility. Changes in SSC and exclusive breastfeeding were assessed by comparing baseline and endline household surveys. RESULTS Overall practice of SSC at any time following delivery increased significantly from 13.1 to 44.1% of mothers. Coverage of immediate SSC also increased significantly from 8.4 to 24.1%. Breastfeeding within the first hour increased from 51.4 to 67.9% and exclusive breastfeeding within the first three days increased from 86 to 95.8%. At endline, SSC was significantly higher among facility births than home births and community health workers had limited contact with mothers. CONCLUSION While targeted behaviours improved overall, the programme did not achieve adequate increases in SSC and exclusive breastfeeding among home deliveries to expect a reduction in mortality for low birthweight babies. Newborn care programs in Ethiopia should continue to encourage facility delivery while strengthening coverage of community programmes.
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Affiliation(s)
- Jennifer A. Callaghan‐Koru
- Department of Sociology, Anthropology, and Health Administration and Policy University of Maryland Baltimore County Baltimore MD USA
- International Center for Maternal and Newborn Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
- Maternal and Child Health Integrated Program Washington DC USA
| | - Abiy Seifu Estifanos
- Department of Reproductive Health and Health Service Management School of Public Health College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
| | | | | | - Carina Rosado
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Rachel Patton‐Molitors
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Bogale Worku
- Department of Pediatrics Addis Ababa University Addis Ababa Ethiopia
| | - Barbara Rawlins
- Maternal and Child Health Integrated Program Washington DC USA
| | - Abdullah Baqui
- International Center for Maternal and Newborn Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
- Maternal and Child Health Integrated Program Washington DC USA
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Duan C, Liu M, Xu H, Tang W, Liu J, Hou L, Li L. Decreased expression of GLUT4 in male CG-IUGR rats may play a vital role in their increased susceptibility to diabetes mellitus in adulthood. Acta Biochim Biophys Sin (Shanghai) 2016; 48:872-882. [PMID: 27614316 DOI: 10.1093/abbs/gmw088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/28/2016] [Indexed: 11/14/2022] Open
Abstract
Rats with intrauterine growth retardation and catch-up growth (CG-IUGR) after birth show increased susceptibility to diabetes mellitus in adulthood. The expression of glucose transporter type 4 (GLUT4) decreases in female IUGR offspring rats with seminutrient restriction during pregnancy. However, the male CG-IUGR rats also display an increased susceptibility to diabetes mellitus in adulthood. Whether there is another factor, besides GLUT4, in male CG-IUGR rat that mediates their susceptibility to diabetes mellitus? The male IUGR rats with catch-up growth were selected as the research objects. CG-IUGR rats had an increased fasting blood glucose level, and increased serum total cholesterol, triglyceride and free fatty acid levels. Glucose tolerance test and insulin tolerance test showed higher glucose levels and much higher insulin levels after a glucose load in CG-IUGR. The mRNA and protein expressions of IRS-2 in liver tissue, and IRS-1 and GLUT4 in skeletal muscle in CG-IUGR rats were down-regulated, but only the GLUT4 down-regulation displayed strong negative correlations with the decreased glucose tolerance capability by Pearson's analysis. The methylation patterns of CpG islands in the promoter regions of IRS-1, IRS-2 and GLUT4 in CG-IUGR rats varied, which was not significantly correlated with their expressions. The male CG-IUGR rats showed decreased glucose tolerant capability, suggesting increased susceptibility to diabetes mellitus in adulthood. The GLUT4 down-regulation may play a vital role in the development of decreased glucose tolerance in male CG-IUGR rats. The methylation modification of the promoter region of GLUT4 does not appear to be involved in its expression.
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Affiliation(s)
- Chang Duan
- Department of Pathophysiology, Zunyi Medical University, Zunyi 563003, China
| | - Min Liu
- Stomatological Hospital Affiliated to Zunyi Medical University, Zunyi 563003, China
| | - Haiyan Xu
- Department of Pathophysiology, Zunyi Medical University, Zunyi 563003, China
| | - Weiwei Tang
- Department of Pathophysiology, Zunyi Medical University, Zunyi 563003, China
| | - Jiayun Liu
- Department of Pathophysiology, Zunyi Medical University, Zunyi 563003, China
| | - Lamei Hou
- Department of Pathophysiology, Zunyi Medical University, Zunyi 563003, China
| | - Lijuan Li
- Department of Pathophysiology, Zunyi Medical University, Zunyi 563003, China
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Zerfu TA, Umeta M, Baye K. Dietary diversity during pregnancy is associated with reduced risk of maternal anemia, preterm delivery, and low birth weight in a prospective cohort study in rural Ethiopia. Am J Clin Nutr 2016; 103:1482-8. [PMID: 27169832 DOI: 10.3945/ajcn.115.116798] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 04/08/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anemia during pregnancy is a leading nutritional disorder with serious short- and long-term consequences for both the mother and the fetus. OBJECTIVE The objective was to investigate the association between dietary diversity during pregnancy and maternal anemia, low birth weight (LBW), preterm birth (PTB), and stillbirth in rural Ethiopia. DESIGN We conducted a prospective cohort study and enrolled 432 pregnant women in their first antenatal care visit (24-28 gestational weeks); 374 women completed the follow-up. By using the FAO Women's Dietary Diversity Scores (WDDSs), subjects were categorized into "inadequate" (WDDS <4) and "adequate" (WDDS ≥4) groups and were followed until delivery. Primary outcomes were maternal anemia, birth weight, term delivery, and stillbirth. RESULTS The attrition rate was 13.7% and was balanced across the 2 groups. The proportion of women consuming dairy, animal-source foods, fruits, and vegetables including vitamin A-rich ones was higher in the adequate than in the inadequate WDDS group (P < 0.05). The overall incidence of maternal anemia increased from 28.6% to 32.4% during the follow-up period. The overall proportion of LBW, PTB, and stillbirth were 9.1%, 13.6%, and 4.5%, respectively. After control for baseline differences, women in the inadequate group had a higher risk of anemia [adjusted RR (ARR: 2.29; 95% CI: 1.62, 3.24], LBW (ARR: 2.06; 95% CI: 1.03, 4.11), and PTB (ARR: 4.61; 95% CI: 2.31, 9.19) but not of stillbirth (ARR: 2.71; 95% CI: 0.88, 8.36) than women in the adequate group (P < 0.05). CONCLUSIONS A WDDS of ≥4 food groups during pregnancy was shown to be associated with lower risk of maternal anemia, LBW, and PTB. Population-based controlled trials of various options to improve dietary diversity are needed before conclusive recommendations can be made. This trial was registered at clinicaltrials.gov as NCT02620943.
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Affiliation(s)
- Taddese A Zerfu
- Center for Food Science and Nutrition, College of Natural Sciences and College of Medicine and Health Sciences and Referral Hospital, Dilla University, Gedeo, Ethiopia
| | - Melaku Umeta
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; and
| | - Kaleab Baye
- Center for Food Science and Nutrition, College of Natural Sciences and
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Brown JVE, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 2016:CD000343. [PMID: 27155888 DOI: 10.1002/14651858.cd000343.pub3] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Exclusively breast milk-fed preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human breast milk rather than unfortified breast milk may increase nutrient accretion and growth rates and may improve neurodevelopmental outcomes. OBJECTIVES To determine whether multi-nutrient fortified human breast milk improves important outcomes (including growth and development) over unfortified breast milk for preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until February 2016), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of the Cochrane Neonatal Review Group. We separately evaluated trial quality, data extracted by two review authors and data synthesised using risk ratios (RRs), risk differences and mean differences (MDs). We assessed the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We identified 14 trials in which a total of 1071 infants participated. The trials were generally small and weak methodologically. Meta-analyses provided low-quality evidence that multi-nutrient fortification of breast milk increases in-hospital rates of growth (MD 1.81 g/kg/d, 95% confidence interval (CI) 1.23 to 2.40); length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17); and head circumference (MD 0.08 cm/wk, 95% CI 0.04 to 0.12). Only very limited data are available for growth and developmental outcomes assessed beyond infancy, and these show no effects of fortification. The data did not indicate other potential benefits or harms and provided low-quality evidence that fortification does not increase the risk of necrotising enterocolitis in preterm infants (typical RR 1.57, 95% CI 0.76 to 3.23; 11 studies, 882 infants). AUTHORS' CONCLUSIONS Limited available data do not provide strong evidence that feeding preterm infants with multi-nutrient fortified breast milk compared with unfortified breast milk affects important outcomes, except that it leads to slightly increased in-hospital growth rates.
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Seffah JD, Swarray-Deen A. Fetal middle cerebral artery Doppler indices and clinical application at Korle Bu Teaching Hospital, Accra, Ghana. Int J Gynaecol Obstet 2016; 134:135-9. [DOI: 10.1016/j.ijgo.2015.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/24/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
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Meher AP, Wadhwani N, Randhir K, Mehendale S, Wagh G, Joshi SR. Placental DHA and mRNA levels of PPARγ and LXRα and their relationship to birth weight. J Clin Lipidol 2016; 10:767-774. [PMID: 27578106 DOI: 10.1016/j.jacl.2016.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/20/2016] [Accepted: 02/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND A very large number of fatty acids play wide range of physiological roles in cellular growth and function in placental as well as fetal growth. However, docosahexaenoic acid (DHA), in addition to its critical role in cellular membranes, is known to act as a ligand for several nuclear receptors and regulates the activity of transcription factor families like peroxisome proliferator-activated receptor, liver X receptor (LXR), retinoid X receptor (RXR), and sterol regulatory element binding protein (SREBP). These transcription factors and DHA are known to regulate the placental and fetal growth and development. OBJECTIVE The objective of the present study was to examine the fatty acids and transcription factors in the placenta of women delivering low birth weight (LBW) babies. METHODS The present study examines the fatty acid and mRNA levels of various transcription factors in the placentae of women delivering normal birth weight (NBW) (n = 38) and women delivering LBW (n = 36). Placental fatty acids were analyzed using gas chromatography. Placental mRNA levels of PPARα, PPARγ, SREBP-1c, LXRα, RXRα, and RXRγ were examined using quantitative real time PCR. RESULT Placental DHA levels and mRNA levels of placental PPARγ and LXRα were lower (P < .05 for all) in women delivering LBW babies. There was a positive association of placental PPARγ mRNA levels and placental DHA levels with baby weight (P < .05 for both). CONCLUSION Our data suggest that lower placental DHA and transcription factors may have a vital role in the etiology of LBW babies.
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Affiliation(s)
- Akshaya P Meher
- Department of Nutritional Medicine, Interactive Research School for Health Affairs, Bharati Vidyapeeth University, Pune, India
| | - Nisha Wadhwani
- Department of Nutritional Medicine, Interactive Research School for Health Affairs, Bharati Vidyapeeth University, Pune, India
| | - Karuna Randhir
- Department of Nutritional Medicine, Interactive Research School for Health Affairs, Bharati Vidyapeeth University, Pune, India
| | - Savita Mehendale
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth University, Pune, India
| | - Girija Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth University, Pune, India
| | - Sadhana R Joshi
- Department of Nutritional Medicine, Interactive Research School for Health Affairs, Bharati Vidyapeeth University, Pune, India.
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Grabosch E, Krawinkel M. Kinderernährung unter Armutsbedingungen. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Atuahene M, Mensah D, Adjuik M. A cross-sectional study of determinants of birth weight of neonates in the Greater Accra region of Ghana. Matern Health Neonatol Perinatol 2015; 1:23. [PMID: 27057340 PMCID: PMC4823686 DOI: 10.1186/s40748-015-0023-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/31/2015] [Indexed: 11/29/2022] Open
Abstract
Background Birth weight is a major determinant of infant morbidity and mortality. Fetal undernourishment means an increased risk of dying during a baby’s early months and years. Birth weight has emerged as the leading indicator of infant health and welfare and the central focus of infant health policy. The issues have not been comprehensively evaluated in part due to lack of or limited empirical data. To this end, this study is aimed to evaluate the effects of maternal determinants on the birth weights of neonates in two major hospitals. Results Low birth weight neonates were significantly (p < 0.001) associated with low gestation at birth (34.8 ± 3.8) while mothers of low birth weight neonates had significantly (p = 0.034) lower body mass index (27.3 ± 5.4) than their normal birth weight counterparts (29.0 ± 6.3). Gestation at birth (p < 0.001), diastolic blood pressure (p = 0.008) was the only significant determinant of birth weight. Conclusion An increase in gestation at birth by 1 week results in over twice more likelihood of a normal birth weight while a rise in diastolic blood pressure is less likely to give rise to a normal birth weight neonate.
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Affiliation(s)
| | - David Mensah
- National Malaria Control Programme, Accra, Ghana
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Harvey TJ, Murphy RM, Morrison JL, Posterino GS. Maternal Nutrient Restriction Alters Ca2+ Handling Properties and Contractile Function of Isolated Left Ventricle Bundles in Male But Not Female Juvenile Rats. PLoS One 2015; 10:e0138388. [PMID: 26406887 PMCID: PMC4583465 DOI: 10.1371/journal.pone.0138388] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/28/2015] [Indexed: 01/09/2023] Open
Abstract
Intrauterine growth restriction (IUGR), defined as a birth weight below the 10th centile, may be caused by maternal undernutrition, with evidence that IUGR offspring have an increased risk of cardiovascular disease (CVD) in adulthood. Calcium ions (Ca2+) are an integral messenger for several steps associated with excitation-contraction coupling (ECC); the cascade of events from the initiation of an action potential at the surface membrane, to contraction of the cardiomyocyte. Any changes in Ca2+ storage and release from the sarcoplasmic reticulum (SR), or sensitivity of the contractile apparatus to Ca2+ may underlie the mechanism linking IUGR to an increased risk of CVD. This study aimed to explore the effects of maternal nutrient restriction on cardiac function, including Ca2+ handling by the SR and force development by the contractile apparatus. Juvenile Long Evans hooded rats born to Control (C) and nutrient restricted (NR) dams were anaesthetized for collection of the heart at 10–12 weeks of age. Left ventricular bundles from male NR offspring displayed increased maximum Ca2+-activated force, and decreased protein content of troponin I (cTnI) compared to C males. Furthermore, male NR offspring showed a reduction in rate of rise of the caffeine-induced Ca2+ force response and a decrease in the protein content of ryanodine receptor (RYR2). These physiological and biochemical findings observed in males were not evident in female offspring. These findings illustrate a sex-specific effect of maternal NR on cardiac development, and also highlight a possible mechanism for the development of hypertension and hypertrophy in male NR offspring.
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Affiliation(s)
- Thomas J. Harvey
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, Vic, Australia
- * E-mail:
| | - Robyn M. Murphy
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Vic, Australia
| | - Janna L. Morrison
- School of Pharmacy and Medical Science, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Giuseppe S. Posterino
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, Vic, Australia
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Garza C. Fetal, neonatal, infant, and child international growth standards: an unprecedented opportunity for an integrated approach to assess growth and development. Adv Nutr 2015; 6:383-90. [PMID: 26178022 PMCID: PMC4496737 DOI: 10.3945/an.114.008128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The recent publication of fetal growth and gestational age-specific growth standards by the International Fetal and Newborn Growth Consortium for the 21st Century Project and the previous publication by the WHO of infant and young child growth standards based on the WHO Multicentre Growth Reference Study enable evaluations of growth from ∼9 wk gestation to 5 y. The most important features of these projects are the prescriptive approach used for subject selection and the rigorous testing of the assertion that growth is very similar among geographically and ethnically diverse nonisolated populations when health, nutrition, and other care needs are met and the environment imposes minimal constraints on growth. Both studies documented that with adequate controls, the principal source of variability in growth during gestation and early childhood resides among individuals. Study sites contributed much less to observed variability. The agreement between anthropometric measurements common to both studies also is noteworthy. Jointly, these studies provide for the first time, to my knowledge, a conceptually consistent basis for worldwide and localized assessments and comparisons of growth performance in early life. This is an important contribution to improving the health care of children across key periods of growth and development, especially given the appropriate interest in pursuing "optimal" health in the "first 1000 d," i.e., the period covering fertilization/implantation, gestation, and postnatal life to 2 y of age.
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Affiliation(s)
- Cutberto Garza
- Boston College, Chestnut Hill, MA; Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC; and Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Sen G, Govender V. Sexual and reproductive health and rights in changing health systems. Glob Public Health 2014; 10:228-42. [PMID: 25536851 PMCID: PMC4318007 DOI: 10.1080/17441692.2014.986161] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 11/06/2014] [Indexed: 11/17/2022]
Abstract
Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).
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Affiliation(s)
- Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Veloshnee Govender
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Doherty T, Jackson D, Swanevelder S, Lombard C, Engebretsen IMS, Tylleskär T, Goga A, Ekström EC, Sanders D. Severe events in the first 6 months of life in a cohort of HIV-unexposed infants from South Africa: effects of low birthweight and breastfeeding status. Trop Med Int Health 2014; 19:1162-9. [PMID: 25053420 PMCID: PMC4285159 DOI: 10.1111/tmi.12355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa. METHODS South African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother-infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate. RESULTS Seventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.2-5.1) and low birthweight (HR 2.4; 95% CI 1.3-4.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1-0.7). CONCLUSIONS A strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants.
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Affiliation(s)
- Tanya Doherty
- Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; School of Public Health, University of the Western Cape, Cape Town, South Africa
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Padonou G, Le Port A, Cottrell G, Guerra J, Choudat I, Rachas A, Bouscaillou J, Massougbodji A, Garcia A, Martin-Prevel Y. Factors associated with growth patterns from birth to 18 months in a Beninese cohort of children. Acta Trop 2014; 135:1-9. [PMID: 24674879 DOI: 10.1016/j.actatropica.2014.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 02/26/2014] [Accepted: 03/12/2014] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze factors influencing the growth pattern of children from birth to 18 months. A longitudinal prospective study was conducted in three maternity wards in Southern Benin. Inclusion took place between June 2007 and July 2008; children were followed-up until 18 months of age. Height-for-age and weight-for-height Z-scores were computed using the newborn's anthropometric measurements taken at delivery, every month up to 6 months and then quarterly. Infant and young child feeding (IYCF) practices and malarial morbidity were recorded. Gestational age was estimated using the Ballard method; William's sex-specific reference curve of birth weight-for-gestational-age was used to determine intrauterine growth retardation (IUGR). Analyses were performed on 520 children using a linear mixed model. Low birth weight (coef=-0.43; p=0.002), IUGR (coef=-0.49; p<0.001), maternal short stature (coef=-0.25; p=0.001) and maternal low weight status (coef=-0.19; p=0.006) were significantly associated with growth impairment. Only LBW (coef=-0.28; p=0.05) and maternal low weight status (coef=-0.23; p=0.004) were associated with wasting. A good IYCF score was positively associated with weight gain (coef=0.14; p<0.001) whereas we found a paradoxical association with length (coef=-0.18; p<0.001). Malaria morbidity was not associated with growth. LBW, IUGR and maternal low weight status and height were important determinants of children's growth. These results reinforce and justify continuing public health initiatives to fight IUGR and LBW and break the intergenerational cycle of malnutrition.
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Affiliation(s)
- Géraud Padonou
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole doctorale 393, Université Pierre et Marie Curie Paris 6, France; Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin.
| | - Agnès Le Port
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole doctorale 393, Université Pierre et Marie Curie Paris 6, France
| | - Gilles Cottrell
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin
| | - José Guerra
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Isabelle Choudat
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Antoine Rachas
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Julie Bouscaillou
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Achille Massougbodji
- Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin; Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - André Garcia
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
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Akhmat G, Zaman K, Shukui T, Abdul Malik I, Begum S, Ahmed A. A contemporary landscape of air pollution and greenhouse gas emissions leads to inevitable phenomena of low birthweight. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2014; 21:9408-9414. [PMID: 24756678 DOI: 10.1007/s11356-014-2867-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
The objective of the study is to empirically examine the air pollution, greenhouse gas (GHG) emissions and low birth weight in Pakistan through the cointegration and error correction model over a 36-year time period, i.e., between 1975 and 2012. The study employed the Johansen cointegration technique to estimate the long-run relationship between the variables, while an error correction model was used to determine the short-run dynamics of the system. The study was limited to the following variables, including carbon dioxide emissions, methane emissions, nitrous oxide emissions, GHG emissions, and low birth weight in order to manage robust data analysis. The results reveal that air pollution and GHG emissions significantly affects the low birth weight in Pakistan. In the long run, carbon dioxide emissions act as a strong contributor for low birth weight, as the coefficient value indicates there is a more elastic relationship (i.e., -1.214, p<0.000) between them, whereas in the short run, this results has been evaporated. Subsequently, in the short run, GHG emissions have a one-to-one corresponding relationship with the low birth weight in Pakistan. Nitrous oxide emissions, both in the short and long run, have a significant and less elastic relationship (i.e., -0.517 with p<0.001 and -0.335 with p<0.090). Methane emissions have no significant relationship with the low birth weight in Pakistan.
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Affiliation(s)
- Ghulam Akhmat
- College of Public Administration, Huazhong University of Science and Technology (HUST), 1037, Luoyu Road, Wuhan, People's Republic of China,
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Britto RPDA, Florêncio TMT, Benedito Silva AA, Sesso R, Cavalcante JC, Sawaya AL. Influence of maternal height and weight on low birth weight: a cross-sectional study in poor communities of northeastern Brazil. PLoS One 2013; 8:e80159. [PMID: 24244636 PMCID: PMC3823865 DOI: 10.1371/journal.pone.0080159] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 10/09/2013] [Indexed: 11/30/2022] Open
Abstract
Background Low birth weight (LBW) is associated with an increased risk of mortality, adverse metabolic conditions, and long-term chronic morbidities. The relationship between LWB and short maternal stature coupled with nutritional status was investigated in poor communities. Methods/Principal Findings A cross-sectional population-based study involving 2226 mother-child pairs was conducted during the period 2009-2010 in shantytowns of Maceió, Alagoas, Brazil. Associations between LBW and maternal sociodemographics, stature and nutritional status were investigated. The outcome variable was birth weight (< 2500g and ≥ 2500g). The independent variables were the age, income, educational background, stature and nutritional status (eutrophic, underweight, overweight and obese) of the mother. The frequency of LBW was 10%. Short-statured mothers (1st quartile of stature ≤ 152cm) showed a tendency of increased risk of LBW children compared to mothers in the 4th quartile of stature (>160.4cm) (OR: 1.42, 95% CI: 0.96 - 1.09, p = 0.078). Children from short-statured mothers weighed an average of 125g less than those from taller mothers (3.18±0.56kg vs. 3.30±0.58kg, respectively p = 0.002). Multivariate analyses showed that short stature, age < 20y (OR: 3.05, 95% CI:1.44 - 6.47) or were underweight (OR: 2.26, 95% CI:0.92 - 5.95) increased the risk of LBW, while overweight (OR: 0.38, 95% CI:0.16 - 0.95) and obesity (OR: 0.39, 95% CI:0.11 - 1.31) had lower risk for LBW. In taller mothers, lower income and underweight were associated with LBW (OR: 1.88, 95% CI: 1.07 - 3.29 and 2.85, 95% CI:1.09 - 7.47, respectively), and obese mothers showed a trend of increased risk of LBW (OR: 1.66, 95% CI:0.84 - 3.25). Conclusions/Significance Overweight was found to have a protective effect in short-statured mothers, indicating that a surplus of energy may diminish the risk of LBW. Short-statured younger mothers, but not taller ones, showed higher risk of LBW. The mother being underweight, regardless of stature, was associated with LBW.
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Affiliation(s)
- Revilane Parente de Alencar Britto
- Programa de Pós-graduação em Ciências Endocrinológicas, Escola Paulista de Medicina, Universidade Federal de São Paulo, Vila Clementino, São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Ana Amelia Benedito Silva
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Ermelino Matarazzo, São Paulo, São Paulo, Brazil
| | - Ricardo Sesso
- Department of Medicine, Division of Nephrology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Vila Clementino, São Paulo, São Paulo, Brazil
| | - Jairo Calado Cavalcante
- Faculdade de Medicina, Universidade Federal de Alagoas, Campus A. C. Simões, Maceió, Alagoas, Brazil
| | - Ana Lydia Sawaya
- Programa de Pós-graduação em Ciências Endocrinológicas, Escola Paulista de Medicina, Universidade Federal de São Paulo, Vila Clementino, São Paulo, São Paulo, Brazil
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Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, Black RE. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 2013; 381:1417-1429. [PMID: 23582723 DOI: 10.1016/s0140-6736(13)60648-0] [Citation(s) in RCA: 315] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Global mortality in children younger than 5 years has fallen substantially in the past two decades from more than 12 million in 1990, to 6·9 million in 2011, but progress is inconsistent between countries. Pneumonia and diarrhoea are the two leading causes of death in this age group and have overlapping risk factors. Several interventions can effectively address these problems, but are not available to those in need. We systematically reviewed evidence showing the effectiveness of various potential preventive and therapeutic interventions against childhood diarrhoea and pneumonia, and relevant delivery strategies. We used the Lives Saved Tool model to assess the effect on mortality when these interventions are applied. We estimate that if implemented at present annual rates of increase in each of the 75 Countdown countries, these interventions and packages of care could save 54% of diarrhoea and 51% of pneumonia deaths by 2025 at a cost of US$3·8 billion. However, if coverage of these key evidence-based interventions were scaled up to at least 80%, and that for immunisations to at least 90%, 95% of diarrhoea and 67% of pneumonia deaths in children younger than 5 years could be eliminated by 2025 at a cost of $6·715 billion. New delivery platforms could promote equitable access and community platforms are important catalysts in this respect. Furthermore, several of these interventions could reduce morbidity and overall burden of disease, with possible benefits for developmental outcomes.
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Affiliation(s)
- Zulfiqar A Bhutta
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Jai K Das
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan
| | - Neff Walker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Arjumand Rizvi
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan
| | - Harry Campbell
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Robert E Black
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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