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Prakoso R, Simanjorang CNS, Kurniawati Y, Mendel B, Rahmat B, Zahara R, Rudiktyo E, Sakti DDA, Sukmawan R. Ductal stenting vs. surgical shunting in late presenting duct-dependent pulmonary circulation: a single-center experience. Front Cardiovasc Med 2024; 11:1382879. [PMID: 38707893 PMCID: PMC11066280 DOI: 10.3389/fcvm.2024.1382879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction PDA stenting is an option to mBTT shunt for younger patients; nevertheless, few reports of this palliative approach have been made for the late presenter population, especially for patients who are older than 30 days but under 5 years. This study aimed to evaluate the clinical result and intra-hospital costs of ductal stenting in late-presenting patients in comparison to surgical shunting. Methods A single-center, retrospective cohort study was conducted from August 2016 to August 2022. This study included patients with pulmonary duct dependent CHD who were hospitalized for palliative therapy. The extracted data were baseline characteristics, clinical findings, supportive examination findings, complications, outcomes, and length of stay of the patients. Monitoring was carried out during treatment up to 30 days after the procedure. Results A total of 143 patients were included in the analysis; 43 patients underwent PDA stent and 100 patients underwent mBTT shunt with median age of PDA stent group 110 (31-1,498) days and mBTT shunt group 174.5 (30-1,651) days. Primary outcome composite was not significant in both groups including 30 days mortality [6 (14%) vs. 14 (14%), p = 1.000], reintervention [1 (2.3%) vs. 7 (7%), p = 0.436], and 30 days rehospitalization [0 (0%) vs. 2 (2%), p = 0.319]. Secondary outcome analysis showed shorter ICU length of stay in the PDA stent group [2 (0-16) days vs. 4 (1-63) days, p = 0.002]. Conclusions PDA stent has an outcome that is non inferior from the mBTT shunt procedure in the composite outcome including 30 days mortality, reintervention, and 30 days rehospitalization but significantly lower in ICU length of stay.
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Affiliation(s)
- Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | | | - Yovi Kurniawati
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, Indonesia
| | - Budi Rahmat
- Division of Pediatric and Congenital Heart Surgery, Department of Surgery, National Cardiovascular Centre of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Rita Zahara
- Division of Intensive and Cardiovascular Care, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Estu Rudiktyo
- Division of Non-Invasive Diagnostic and Cardiovacular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Damba Dwisepto Aulia Sakti
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Renan Sukmawan
- Division of Non-Invasive Diagnostic and Cardiovacular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Rocha AS, Ribeiro-Silva RDC, Silva JFM, Pinto EJ, Silva NJ, Paixao ES, Fiaccone RL, Kac G, Rodrigues LC, Anderson C, Barreto ML. Postnatal growth in small vulnerable newborns: a longitudinal study of 2 million Brazilians using routine register-based linked data. Am J Clin Nutr 2024; 119:444-455. [PMID: 38128734 PMCID: PMC10884605 DOI: 10.1016/j.ajcnut.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/21/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Preterm, low-birth weight (LBW) and small-for-gestational age (SGA) newborns have a higher frequency of adverse health outcomes, including linear and ponderal growth impairment. OBJECTIVE To describe the growth trajectories and to estimate catch-up growth during the first 5 y of life of small newborns according to 3 vulnerability phenotypes (preterm, LBW, SGA). METHODS Longitudinal study using linked data from the 100 Million Brazilian Cohort baseline, the Brazilian National Live Birth System (SINASC), and the Food and Nutrition Surveillance System (SISVAN) from 2011 to 2017. We estimated the length/height-for-age (L/HAZ) and weight-for-age z-score (WAZ) trajectories from children of 6-59 mo using the linear mixed model for each vulnerable newborn phenotype. Growth velocity for both L/HAZ and WAZ was calculated considering the change (Δ) in the mean z-score between 2 time points. Catch-up growth was defined as a change in z-score > 0.67 at any time during follow-up. RESULTS We analyzed 2,021,998 live born children and 8,726,599 observations. The prevalence of at least one of the vulnerable phenotypes was 16.7% and 0.6% were simultaneously preterm, LBW, and SGA. For those born at term, all phenotypes had a period of growth recovery from 12 mo. For preterm infants, the onset of L/HAZ growth recovery started later at 24 mo and the growth trajectories appear to be lower than those born at term, a condition aggravated among children with the 3 phenotypes. Preterm and female infants seem to experience slower growth recovery than those born at term and males. The catch-up growth occurs at 24-59 mo for males preterm: preterm + AGA + NBW (Δ = 0.80), preterm + AGA + LBW (Δ = 0.88), and preterm + SGA + LBW (Δ = 1.08); and among females: term + SGA + NBW (Δ = 0.69), term + AGA + LBW (Δ = 0.72), term + SGA + LBW (Δ = 0.77), preterm + AGA + LBW (Δ = 0.68), and preterm + SGA + LBW (Δ = 0.83). CONCLUSIONS Children born preterm seem to reach L/HAZ and WAZ growth trajectories lower than those attained by children born at term, a condition aggravated among the most vulnerable.
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Affiliation(s)
- Aline S Rocha
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - Rita de Cássia Ribeiro-Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil; Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Juliana F M Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Elizabete J Pinto
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
| | - Natanael J Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; ISGlobal, Hospital Clínic. Universitat de Barcelona, Barcelona, Spain
| | - Enny S Paixao
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Rosemeire L Fiaccone
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura C Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Craig Anderson
- School of Mathematics and Statistics, University of Glasgow, Scotland, United Kingdom
| | - Mauricio L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
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3
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Gupta PM, Sivalogan K, Oliech R, Alexander E, Klein J, Addo OY, Gethi D, Akelo V, Blau DM, Suchdev PS. Impact of anthropometry training and feasibility of 3D imaging on anthropometry data quality among children under five years in a postmortem setting. PLoS One 2023; 18:e0292046. [PMID: 37768936 PMCID: PMC10538800 DOI: 10.1371/journal.pone.0292046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The Child Health and Mortality Prevention Surveillance Network (CHAMPS) identifies causes of under-5 mortality in high mortality countries. OBJECTIVE To address challenges in postmortem nutritional assessment, we evaluated the impact of anthropometry training and the feasibility of 3D imaging on data quality within the CHAMPS Kenya site. DESIGN Staff were trained using World Health Organization (WHO)-recommended manual anthropometry equipment and novel 3D imaging methods to collect postmortem measurements. Following training, 76 deceased children were measured in duplicate and were compared to measurements of 75 pre-training deceased children. Outcomes included measures of data quality (standard deviations of anthropometric indices and digit preference scores (DPS)), precision (absolute and relative technical errors of measurement, TEMs or rTEMs), and accuracy (Bland-Altman plots). WHO growth standards were used to produce anthropometric indices. Post-training surveys and in-depth interviews collected qualitative feedback on measurer experience with performing manual anthropometry and ease of using 3D imaging software. RESULTS Manual anthropometry data quality improved after training, as indicated by DPS. Standard deviations of anthropometric indices exceeded limits for high data quality when using the WHO growth standards. Reliability of measurements post-training was high as indicated by rTEMs below 1.5%. 3D imaging was highly correlated with manual measurements; however, on average 3D scans overestimated length and head circumference by 1.61 cm and 2.27 cm, respectively. Site staff preferred manual anthropometry to 3D imaging, as the imaging technology required adequate lighting and additional considerations when performing the measurements. CONCLUSIONS Manual anthropometry was feasible and reliable postmortem in the presence of rigor mortis. 3D imaging may be an accurate alternative to manual anthropometry, but technology adjustments are needed to ensure accuracy and usability.
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Affiliation(s)
- Priya M Gupta
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Kasthuri Sivalogan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | | | - Eugene Alexander
- Body Surface Translations, Inc., Athens, Georgia, United States of America
| | - Jamie Klein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - O Yaw Addo
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dickson Gethi
- US Centers for Disease Control and Prevention-Kenya, Kisumu and Nairobi, Kenya
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu and Nairobi, Kenya
| | - Dianna M Blau
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Parminder S Suchdev
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Jannat K, Agho KE, Parvez SM, Rahman M, Thomson R, Amin MB, Merom D. The Effects of Yogurt Supplementation and Nutritional Education on Malnourished Infants: A Pilot RCT in Dhaka's Slums. Nutrients 2023; 15:2986. [PMID: 37447313 DOI: 10.3390/nu15132986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Our objective was to quantify the effects of yogurt supplementation and nutrition education over three months on the linear growth of infants at risk of stunting. We conducted a three-arm pilot randomized controlled trial: (1) nutrition education for mothers; (2) nutrition education plus a daily yogurt supplement (50 g) for the index child; and (3) usual care (control). Dyads of children aged 4-6 months and at risk of stunting [length-for-age z-score (LAZ) ≤ -1 SD and >-2 SD] and their mothers with ≤10 years of education were eligible for the study. Participants were recruited from five slum areas in Dhaka, Bangladesh. Intention-to-treat (N = 162) and complete-case analyses (N = 127) showed no between-group statistically significant differences in LAZ or weight-for-age (WAZ). However, the yogurt group showed greater change in linear growth compared to the control (LAZ: mean difference 0.20, 95% CI: -0.06, 0.47, p-value 0.13), which was also slightly greater than the education-only group. Children in the yogurt plus group were five times (95% CI: 0.80, 31.80, p-value 0.09) more likely to meet the minimum dietary diversity (MDD) score compared to the control. A 3-month follow-up of this pilot study did not demonstrate that yogurt was beneficial to linear growth. However, there were encouraging trends that merit replication of the intervention with larger samples and longer follow-ups.
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Affiliation(s)
- Kaniz Jannat
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Kingsley Emwinyore Agho
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Sarker Masud Parvez
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Mahbubur Rahman
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Russell Thomson
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Mohammed Badrul Amin
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Dafna Merom
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Bragg MG, Prado EL, Caswell BL, Arnold CD, George M, Oakes LM, Beckner AG, DeBolt MC, Bennett BJ, Maleta KM, Stewart CP. The association between plasma choline, growth and neurodevelopment among Malawian children aged 6-15 months enroled in an egg intervention trial. MATERNAL & CHILD NUTRITION 2023; 19:e13471. [PMID: 36567549 PMCID: PMC10019050 DOI: 10.1111/mcn.13471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
Choline is an essential micronutrient that may influence growth and development; however, few studies have examined postnatal choline status and children's growth and development in low- and middle-income countries. The aim of this observational analysis was to examine associations of plasma choline with growth and development among Malawian children aged 6-15 months enrolled in an egg intervention trial. Plasma choline and related metabolites (betaine, dimethylglycine and trimethylamine N-oxide) were measured at baseline and 6-month follow-up, along with anthropometric (length, weight, head circumference) and developmental assessments (the Malawi Developmental Assessment Tool [MDAT], the Infant Orienting with Attention task [IOWA], a visual paired comparison [VPC] task and an elicited imitation [EI] task). In cross-sectional covariate-adjusted models, each 1 SD higher plasma choline was associated with lower length-for-age z-score (-0.09 SD [95% confidence interval, CI -0.17 to -0.01]), slower IOWA response time (8.84 ms [1.66-16.03]) and faster processing speed on the VPC task (-203.5 ms [-366.2 to -40.7]). In predictive models, baseline plasma choline was negatively associated with MDAT fine motor z-score at 6-month follow-up (-0.13 SD [-0.22 to -0.04]). There were no other significant associations of plasma choline with child measures. Similarly, associations of choline metabolites with growth and development were null except higher trimethylamine N-oxide was associated with slower information processing on the VPC task and higher memory scores on the EI task. In this cohort of children with low dietary choline intake, we conclude that there were no strong or consistent associations between plasma choline and growth and development.
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Affiliation(s)
- Megan G. Bragg
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
- AJ Drexel Autism InstituteDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | | | - Bess L. Caswell
- USDA Western Human Nutrition Research CenterDavisCaliforniaUSA
| | - Charles D. Arnold
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Matthews George
- School of Public Health and Family MedicineKamuzu University of Health SciencesBlantyreMalawi
| | - Lisa M. Oakes
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | - Aaron G. Beckner
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | - Michaela C. DeBolt
- Center for Mind and BrainUniversity of California DavisDavisCaliforniaUSA
| | | | - Kenneth M. Maleta
- School of Public Health and Family MedicineKamuzu University of Health SciencesBlantyreMalawi
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van Buuren S, Eekhout I. Child development with the D-score: turning milestones into measurement. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13222.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The chapter equips the reader with a basic understanding of robust psychometric methods that are needed to turn developmental milestones into measurements, introducing the fundamental issues in defining a unit for child development and demonstrates the relevant quantitative methodology. It reviews quantitative approaches to measuring child development;introduces the Rasch model in a non-technical way;shows how to estimate model parameters from real data;puts forth a set of principles for model evaluation and assessment of scale quality;analyses the relation between early D-scores and later intelligence;and compares the D-scores from three studies that all use the same instrument.
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Raysmith BP, Timpka T, Jacobsson J, Drew MK, Dahlström Ö. Design of the performance outcome scoring template (POS-T) with example application on CO 2 emissions reduction amongst 36 OECD member countries. Sci Rep 2022; 12:4404. [PMID: 35292671 PMCID: PMC8924175 DOI: 10.1038/s41598-022-08368-w] [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: 09/12/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
In applied program settings, such as in natural environment control and education, performance evaluation is usually conducted by evaluators considering both self-comparison and comparison with peers. We have developed the performance outcome scoring template (POS-T) for assessments with high face-validity in these settings. POS-T puts achievements of individuals or groups in context, i.e. the resulting performance outcome score (POS) reflects a meaningful measure of performance magnitude with regards to internal and external comparisons. Development of a POS is performed in four steps supported by a statistical framework. Software is supplied for creation of scoring applications in different performance evaluation settings. We demonstrate the POS-T by evaluation of CO2 emissions reduction amongst 36 OECD member countries.
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Affiliation(s)
- Benjamin P Raysmith
- Athletics Research Centre, Linköping University, Linköping, Sweden. .,Western Australian Institute of Sport, Perth, Australia. .,Athletics Australia, Melbourne, Australia.
| | - Toomas Timpka
- Athletics Research Centre, Linköping University, Linköping, Sweden
| | - Jenny Jacobsson
- Athletics Research Centre, Linköping University, Linköping, Sweden.,Swedish Athletics Association, Stockholm, Sweden
| | - Michael K Drew
- Athlete Availability Program, Australian Institute of Sport, Bruce, ACT, Australia.,Australian Collaboration for Research into Injury in Sport and Its Prevention (ACRISP), Perth, Australia.,University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, ACT, Australia
| | - Örjan Dahlström
- Athletics Research Centre, Linköping University, Linköping, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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8
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Paganelli CR, Kassebaum N, Strong K, Suchdev PS, Voskuijl W, Bassat Q, Blau DM, Denno DM. Guidance for Systematic Integration of Undernutrition in Attributing Cause of Death in Children. Clin Infect Dis 2021; 73:S374-S381. [PMID: 34910171 PMCID: PMC8672773 DOI: 10.1093/cid/ciab851] [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] [Indexed: 11/16/2022] Open
Abstract
Minimally invasive tissue sampling (MITS) is increasingly being used to better understand causes of death in low-resource settings. Undernutrition (eg, wasting, stunting) is prevalent among children globally and yet not consistently coded or uniformly included on death certificates in MITS studies when present. Consistent and accurate attribution of undernutrition is fundamental to understanding its contribution to child deaths. In May 2020, members of the MITS Alliance Cause of Death Technical Working Group convened a panel of experts in public health, child health, nutrition, infectious diseases, and MITS to develop guidance for systematic integration of undernutrition, as assessed by anthropometry, in cause of death coding, including as part of the causal chain or as a contributing condition, in children <5 years of age. The guidance presented here will support MITS and other researchers, public health practitioners, and clinicians with a systematic approach to assigning and interpreting undernutrition in death certification.
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Affiliation(s)
| | - Nicholas Kassebaum
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Parminder S Suchdev
- Department of Pediatrics and Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Wieger Voskuijl
- University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Centre for Global Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, the Netherlands.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Dianna M Blau
- Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Donna M Denno
- Department of Global Health, University of Washington, Seattle, Washington, USA.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
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9
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Das SK, Burma AD, Amudhan S, Mishra V, Mahapatra P, Ashok A, Philip M. Do children in India grow well into adolescents? Longitudinal analysis of growth transitions from Young Lives panel survey in India. Public Health 2021; 202:18-25. [PMID: 34875532 DOI: 10.1016/j.puhe.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Studies that examined the growth during late childhood and early adolescence beyond 8 years of age are very limited. Further, most studies have used dichotomized classification of stunting, thereby limiting the understanding of moderate stunting in childhood growth trajectory. We aimed to examine the course of stunting from childhood to adolescence by undertaking robust analyses of the Young Lives Survey (YLS) longitudinal data from India using multilevel categorization of stunting. STUDY DESIGN Retrospective cohort analysis was undertaken from YLS in India among 1827 children from the younger cohort born in 2001-02 with complete follow-up data in all five rounds of YLS collected in 2002, 2006, 2009, 2013, and 2016. METHODS A three-state multistate Markov model (not stunted, moderate, severe) was performed to estimate annual transition probabilities, mean sojourn-time, and transition-specific risk factors. RESULTS Between Round-one and Round-five, cross-sectional prevalence of severe stunting decreased from 10.4% (95% confidence interval [CI]: 7.8%, 13.7%) to 5.3% (95% CI: 3.8%, 7.3%), while moderate stunting increased from 19.9% (95% CI: 16.3%,23.9%) to 21.7% (95% CI: 18.4%, 24.9%). Mean Sojourn time estimation indicated a relatively concise state for moderate stunting. The stunting trajectory had shown gender differential where more faltering to severe stunting and lower recovery to the normal state was observed among girls between 8 and 12 years and among boys between 12 and 15 years. Compared with boys, girls had 40% excess likelihood (Hazard Ratio: 1.40; 95% CI 1.00 to 1.95) for moderate-to-severe stunting transition and also had 19% excess likelihood (Hazard Ratio: 1.19; 95% CI 1.01 to 1.40) of favorable transition (moderate-to-non-stunted). CONCLUSIONS The transition trajectory highlights preadolescence, especially among girls, as an additional window of opportunity to ensure better nutrition in adolescent life. With a fifth of adolescents living in India, study findings call for coordinated, multisectoral, age-appropriate, and gender-responsive approach to take India closer to meeting SDG-2.
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Affiliation(s)
- S K Das
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - A D Burma
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - S Amudhan
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
| | - V Mishra
- Consultant-Rapid Response Team, WHO, India
| | - P Mahapatra
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - A Ashok
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - M Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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10
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Yang KP, Wong CP, Khanna SK, Bray TM. A Locally-Produced Plant-Based Supplement Swathi Savi (SAVI) Enrichment Improves Body Growth, Bone Development, and Immune Functions in Protein Malnourished Mice: Implications for Strategies to Combat Child Malnutrition. Ecol Food Nutr 2021; 61:182-200. [PMID: 34591710 DOI: 10.1080/03670244.2021.1977636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Child malnutrition is a critical global challenge. India alone is home to nearly 46 million stunted children, a third of the world's total. Supplementing locally-produced foods has been acknowledged as a sustainable strategy for combating child malnutrition. We used an established protein malnutrition (PM) model in young mice to evaluate the safety and efficacy of the SAVI-enriched diet as a food supplement to combat child malnutrition in India. Results indicate that feeding the SAVI-enriched diet improves body weight, lean muscle mass, bone, and immune health in PM young mice. Based on the results of our study in mice, we suggest future human trials to examine the supplement's potential benefits for humans.
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Affiliation(s)
- Kristen Pinchun Yang
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Carmen P Wong
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Sunil K Khanna
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.,Center for Global Health, Oregon State University, Corvallis, Oregon, USA
| | - Tammy M Bray
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.,Center for Global Health, Oregon State University, Corvallis, Oregon, USA
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11
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Chilyabanyama ON, Chilengi R, Laban NM, Chirwa M, Simunyandi M, Hatyoka LM, Ngaruye I, Iqbal NT, Bosomprah S. Comparing growth velocity of HIV exposed and non-exposed infants: An observational study of infants enrolled in a randomized control trial in Zambia. PLoS One 2021; 16:e0256443. [PMID: 34424916 PMCID: PMC8382174 DOI: 10.1371/journal.pone.0256443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Impaired growth among infants remains one of the leading nutrition problems globally. In this study, we aimed to compare the growth trajectory rate and evaluate growth trajectory characteristics among children, who are HIV exposed uninfected (HEU) and HIV unexposed uninfected (HUU), under two years in Zambia. METHOD Our study used data from the ROVAS II study (PACTR201804003096919), an open-label randomized control trial of two verses three doses of live, attenuated, oral RotarixTM administered 6 &10 weeks or at 6 &10 weeks plus an additional dose at 9 months of age, conducted at George clinic in Lusaka, Zambia. Anthropometric measurements (height and weight) were collected on all scheduled and unscheduled visits. We defined linear growth velocity as the rate of change in height and estimated linear growth velocity as the first derivative of the mixed effect model with fractional polynomial transformations and, thereafter, used the second derivative test to determine the peak height and age at peak heigh. RESULTS We included 212 infants in this study with median age 6 (IQR: 6-6) weeks of age. Of these 97 (45.3%) were female, 35 (16.4%) were stunted, and 59 (27.6%) were exposed to HIV at baseline. Growth velocity was consistently below the 3rd percentile of the WHO linear growth standard for HEU and HUU children. The peak height and age at peak height among HEU children were 74.7 cm (95% CI = 73.9-75.5) and 15.5 months (95% CI = 14.7-16.3) respectively and those for HUU were 73 cm (95% CI = 72.1-74.0) and 15.6 months (95% CI = 14.5-16.6) respectively. CONCLUSION We found no difference in growth trajectories between infants who are HEU and HUU. However, the data suggests that poor linear growth is universal and profound in this cohort and may have already occurred in utero.
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Affiliation(s)
- Obvious Nchimunya Chilyabanyama
- African Centre of Excellence in Data Science (ACEDS), University of Rwanda, Kigali, Rwanda
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Roma Chilengi
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Masuzyo Chirwa
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Michelo Simunyandi
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Innocent Ngaruye
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
| | | | - Samuel Bosomprah
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
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12
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Sidhu ST, Morphew T, Galant SP. Normal growth variance by Z scores should be considered when interpreting the growth inhibitory effect of inhaled corticosteroids. Pediatr Pulmonol 2021; 56:1464-1470. [PMID: 33713585 DOI: 10.1002/ppul.25340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Randomized clinical trials suggest that long-term inhaled corticosteroid (ICS) treatment significantly inhibits growth velocity (GV) assessed by centimeters/year (cm/year) in primarily prepubescent, mild asthmatics. However, several observational studies measuring normal growth variance by Z score suggest the absence of the ICS inhibitory effect. OBJECTIVE To demonstrate the generalizability of ICS growth inhibition in cm/year by establishing whether this measure exceeds the expected normal changes in GV by Z score for similar age and sex. METHODS This was a retrospective, observational study comparing height and GV across a 2 year period in asthmatics aged 2-10 years, receiving ICS therapy (Group 3) with non-asthmatics, and non-ICS asthmatics (Groups 1 and 2), respectively. Generalized linear model procedure compared GV measures after adjustment for age, gender, and dependence of group differences on the age of the child. RESULTS Before initiation of ICS therapy at baseline, Group 3 patients (n = 22) were shorter than Groups 1 (n = 67) and 2 (n = 44) by mean height in cm, and height for age Z score in the adjusted model (p < .05). GV was also significantly reduced in Group 3 after initiation of ICS therapy versus Groups 1 and 2 by 1.0-1.5 cm/year, respectively, p < .05, but not significantly in comparison to expected normal GV variance determined by Z score, p ≥ .05. CONCLUSION Our findings suggest the need to consider normal growth variance by Z scores in addition to absolute changes (cm/year) when interpreting the inhibitory effect of ICS on GV. Larger sample size studies will be necessary to confirm our findings.
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Affiliation(s)
- Sonam Tanna Sidhu
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Tricia Morphew
- Morphew Consulting, LLC, Bothell, Washington, USA.,CHOC Breathmobile, Children's Hospital of Orange County, Orange, California, USA
| | - Stanley P Galant
- CHOC Breathmobile, Children's Hospital of Orange County, Orange, California, USA.,Department of Pediatrics, University of California Irvine, Irvine, California, USA
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13
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van Buuren S, Eekhout I. Child development with the D-score: turning milestones into measurement. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13222.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The chapter equips the reader with a basic understanding of robust psychometric methods that are needed to turn developmental milestones into measurements, introducing the fundamental issues in defining a unit for child development and demonstrates the relevant quantitative methodology. It reviews quantitative approaches to measuring child development;introduces the Rasch model in a non-technical way;shows how to estimate model parameters from real data;puts forth a set of principles for model evaluation and assessment of scale quality;analyses the relation between early D-scores and later intelligence;and compares the D-scores from three studies that all use the same instrument.
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14
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Simelane MS, Chemhaka GB, Zwane E. A multilevel analysis of individual, household and community level factors on stunting among children aged 6-59 months in Eswatini: A secondary analysis of the Eswatini 2010 and 2014 Multiple Indicator Cluster Surveys. PLoS One 2020; 15:e0241548. [PMID: 33125409 PMCID: PMC7598515 DOI: 10.1371/journal.pone.0241548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Child stunting is a significant public health problem in Eswatini. It is associated with a range of child health outcomes, including morbidity, physical and cognitive growth. Objective To determine the individual, household, and community-level factors associated with child stunting in Eswatini in 2010 and 2014. Methods Using the Eswatini Multiple Indicator Cluster Surveys conducted in 2010 and 2014, a secondary analysis was done of the children surveyed, aged 6–59 months. A total of 1,891 were surveyed in 2010, and 1,963 children in 2014. Univariate, bivariable analysis and multivariable multilevel logistic regression were used to establish the factors associated with stunting. Results The study found that stunting decreased significantly between 2010 and 2014, from 31.4% to 25.5% (p<0.001). In both 2010 and 2014, lower odds of stunting were observed among female children, in children born to women with tertiary education compared to those born to women with no formal education. Lower odds of stunting were observed among children from rich households compared to poorest households. In both 2010 and 2014, increased odds of stunting were observed among children aged 12–23, 24–35 and 36–47 months compared to children aged 6–11 months. At the household level, higher odds of stunting were observed among children from households with two and more children under five years of age compared to those with only one child and in 2010, among children from households with a pit latrine and no toilet facility compared to households with a flush toilet. At the community level, in 2010, higher odds of stunting were observed among children from the Shiselweni compared to those from the Lubombo region. Conclusion The findings highlight the individual, household, and community-level factors significantly associated with stunting and the changes between the two surveys.
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Affiliation(s)
- Maswati S. Simelane
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni, Eswatini
- * E-mail:
| | - Garikayi B. Chemhaka
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni, Eswatini
| | - Eugene Zwane
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni, Eswatini
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15
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Gupta PM, Wieck E, Conkle J, Betters KA, Cooley A, Yamasaki S, Laibhen-Parkes N, Suchdev PS. Improving assessment of child growth in a pediatric hospital setting. BMC Pediatr 2020; 20:419. [PMID: 32883257 PMCID: PMC7469098 DOI: 10.1186/s12887-020-02289-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate anthropometric measurements are essential for assessing nutritional status, monitoring child growth, and informing clinical care. We aimed to improve height measurements of hospitalized pediatrics patients through implementation of gold standard measurement techniques. METHODS A quality improvement project implemented computerized training modules on anthropometry and standardized wooden boards for height measurements in a tertiary children's hospital. Heights were collected pre- and post-intervention on general pediatric inpatients under 5 years of age. Accuracy of height measurements was determined by analyzing the variance and by comparing to World Health Organization's defined biologically plausible height-for-age z-scores. Qualitative interviews assessed staff attitudes. RESULTS Ninety-six hospital staff completed the anthropometry training. Data were available on 632 children pre- and 933 post-intervention. Training did not increase the proportion of patients measured for height (78.6% pre-intervention vs. 75.8% post-intervention, p = 0.19). Post-intervention, wooden height boards were used to measure height of 34.8% patients, while tape measures and wingspan accounted for 42.0% and 3.5% of measurements, respectively. There was no improvement in the quality of height measurements based on plausibility (approximately 3% height-for-age z-scores measurements flagged out of range pre- and post-intervention), digit preference (13.4% of digits pre- and 12.3% post-intervention requiring reclassification), or dispersion of measurements (height-for-age z-scores standard deviation 1.9 pre- and post-intervention). Staff reported that using the wooden board was too labor consuming and cumbersome. CONCLUSIONS Our findings suggest that efforts to improve anthropometric measurements of hospitalized children have multiple obstacles, and further investigation of less cumbersome methods of measurements may be warranted.
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Affiliation(s)
- Priya M Gupta
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
| | - Emily Wieck
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Joel Conkle
- Health and Nutrition Section, UNICEF, Windhoek, Namibia
| | | | - Anthony Cooley
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Parminder S Suchdev
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
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16
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M. C. Lobo L, M. Schincaglia R, G. Peixoto MDR, C. M. Hadler MC. Multiple Micronutrient Powder Reduces Vitamin E Deficiency in Brazilian Children: A Pragmatic, Controlled Clinical Trial. Nutrients 2019; 11:nu11112730. [PMID: 31717948 PMCID: PMC6893530 DOI: 10.3390/nu11112730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/22/2022] Open
Abstract
Multiple micronutrient powder supplementation is a health promotion strategy, but data on its effectiveness regarding vitamin E are rare. The objective was to evaluate the impact of home fortification with powdered micronutrients on α-tocopherol concentrations, growth, and inflammation in Brazilian children aged 6–15 months. This is a pragmatic, controlled clinical trial, in which the intervention group received micronutrient powder sachets for up to 3 months. Vitamin E deficiency was considered when α-tocopherol was less than 11.6 µmol/L. The Poisson regression model was used to estimate adjusted values for prevalence ratios (PR) for the outcome variable. A total of 224 children participated in the study. The intervention group had a higher median α-tocopherol level (17.2 versus 3.6 µmol/L; p < 0.001) and an 82.0% reduction in the prevalence of vitamin deficiency (PR = 0.18; 95% CI 0.11–0.30) when compared with the control group. Consumption of multiple micronutrients in powder increases serum α-tocopherol concentrations, promotes better linear growth, and reduces morbidity in children.
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Affiliation(s)
- Lina M. C. Lobo
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás 74605-020, Brazil; (L.M.C.L.); (R.M.S.)
| | - Raquel M. Schincaglia
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás 74605-020, Brazil; (L.M.C.L.); (R.M.S.)
- Graduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goiás, Goiânia, Goiás 74605-080, Brazil;
| | - Maria do Rosário G. Peixoto
- Graduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goiás, Goiânia, Goiás 74605-080, Brazil;
| | - Maria Claret C. M. Hadler
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás 74605-020, Brazil; (L.M.C.L.); (R.M.S.)
- Graduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goiás, Goiânia, Goiás 74605-080, Brazil;
- Correspondence: ; Tel.: +55-062-98261-1506
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17
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Iqbal NT, Syed S, Sadiq K, Khan MN, Iqbal J, Ma JZ, Umrani F, Ahmed S, Maier EA, Denson LA, Haberman Y, McNeal MM, Setchell KDR, Zhao X, Qureshi S, Shen L, Moskaluk CA, Liu TC, Yilmaz O, Brown DE, Barratt MJ, Kung VL, Gordon JI, Moore SR, Ali SA. Study of Environmental Enteropathy and Malnutrition (SEEM) in Pakistan: protocols for biopsy based biomarker discovery and validation. BMC Pediatr 2019; 19:247. [PMID: 31331393 PMCID: PMC6643315 DOI: 10.1186/s12887-019-1564-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/31/2019] [Indexed: 12/26/2022] Open
Abstract
Background Environmental Enteropathy (EE), characterized by alterations in intestinal structure, function, and immune activation, is believed to be an important contributor to childhood undernutrition and its associated morbidities, including stunting. Half of all global deaths in children < 5 years are attributable to under-nutrition, making the study of EE an area of critical priority. Methods Community based intervention study, divided into two sub-studies, 1) Longitudinal analyses and 2) Biopsy studies for identification of EE features via omics analyses. Birth cohorts in Matiari, Pakistan established: moderately or severely malnourished (weight for height Z score (WHZ) < − 2) children, and well-nourished (WHZ > 0) children. Blood, urine, and fecal samples, for evaluation of potential biomarkers, will be collected at various time points from all participants (longitudinal analyses). Participants will receive appropriate educational and nutritional interventions; non-responders will undergo further evaluation to determine eligibility for further workup, including upper gastrointestinal endoscopy. Histopathological changes in duodenal biopsies will be compared with duodenal biopsies obtained from USA controls who have celiac disease, Crohn’s disease, or who were found to have normal histopathology. RNA-Seq will be employed to characterize mucosal gene expression across groups. Duodenal biopsies, luminal aspirates from the duodenum, and fecal samples will be analyzed to define microbial community composition (omic analyses). The relationship between histopathology, mucosal gene expression, and community configuration will be assessed using a variety of bioinformatic tools to gain better understanding of disease pathogenesis and to identify mechanism-based biomarkers. Ethical review committees at all collaborating institutions have approved this study. All results will be made available to the scientific community. Discussion Operational and ethical constraints for safely obtaining intestinal biopsies from children in resource-poor settings have led to a paucity of human tissue-based investigations to understand and reverse EE in vulnerable populations. Furthermore, EE biomarkers have rarely been correlated with gold standard histopathological confirmation. The Study of Environmental Enteropathy and Malnutrition (SEEM) is designed to better understand the pathophysiology, predictors, biomarkers, and potential management strategies of EE to inform strategies to eradicate this debilitating pathology and accelerate progress towards the 2030 Sustainable Development Goals. Trial registration Retrospectively registered; clinicaltrials.gov ID NCT03588013. Electronic supplementary material The online version of this article (10.1186/s12887-019-1564-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Najeeha T Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Sana Syed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Kamran Sadiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Marium N Khan
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Junaid Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Jennie Z Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Fayaz Umrani
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sheraz Ahmed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Elizabeth A Maier
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yael Haberman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Monica M McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kenneth D R Setchell
- Clinical Mass Spectrometry, Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Xueheng Zhao
- Clinical Mass Spectrometry, Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shahida Qureshi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Lanlan Shen
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | | | - Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Omer Yilmaz
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Koch Institute for Integrative Cancer Research at MIT and Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Donald E Brown
- Data Science Institute, University of Virginia, Charlottesville, VA, USA
| | - Michael J Barratt
- Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - Vanderlene L Kung
- Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey I Gordon
- Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sean R Moore
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
| | - S Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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18
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Faye CM, Fonn S, Levin J. Factors associated with recovery from stunting among under-five children in two Nairobi informal settlements. PLoS One 2019; 14:e0215488. [PMID: 30998790 PMCID: PMC6472785 DOI: 10.1371/journal.pone.0215488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
Childhood stunting is a public health concern in many low-and-middle income countries, as it is associated with both short-term and long-term negative effects on child cognitive development, physical health, and schooling outcomes. There is paucity of studies on recovery from stunting among under five children in these countries. Most studies focused on the recovery much later in adolescence. We used longitudinal data from two Nairobi urban settlements to determine the incidence of recovery from stunting and understand the factors associated with post-stunting linear growth among under-five children. A total of 1,816 children were recruited between birth and 23 months and were followed-up until they reached five years. We first looked at the time to recover from stunting using event history analysis and Cox regression. Second, we used height-for-age z-score slope modelling to estimate the change in linear growth among children who were stunted. Finally, we fitted a linear regression model of the variation in HAZ on a second degree fractional polynomials in child’s age to identify the factors associated with post-stunting linear growth. The principal findings are: i) the incidence of recovery from stunting was 45% among stunted under-five children in the two settlements; ii) timely child immunization, age at stunting, mother’s parity and household socioeconomic status are important factors associated with time to recover from stunting within the first five years of life; and iii) child illness status and age at first stunting, mother’s parity and age have a strong influence on child post-stunting linear growth. Access to child health services and increased awareness among health professionals and child caregivers, would be critical in improving child growth outcomes in the study settings. Additionally, specific maternal and reproductive health interventions targeting young mothers in the slums may be needed to reduce adolescent and young mother’s vulnerability and improve their child health outcomes.
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Affiliation(s)
- Cheikh Mbacké Faye
- African Population and Health Research Center, Nairobi, Kenya
- University of the Witwatersrand, School of Public Health, Parktown, Johannesburg, South Africa
- * E-mail: ,
| | - Sharon Fonn
- University of the Witwatersrand, School of Public Health, Parktown, Johannesburg, South Africa
| | - Jonathan Levin
- University of the Witwatersrand, School of Public Health, Parktown, Johannesburg, South Africa
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Accuracy and reliability of a low-cost, handheld 3D imaging system for child anthropometry. PLoS One 2018; 13:e0205320. [PMID: 30356325 PMCID: PMC6200231 DOI: 10.1371/journal.pone.0205320] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022] Open
Abstract
The usefulness of anthropometry to define childhood malnutrition is undermined by poor measurement quality, which led to calls for new measurement approaches. We evaluated the ability of a 3D imaging system to correctly measure child stature (length or height), head circumference and arm circumference. In 2016–7 we recruited and measured children at 20 facilities in and around metro Atlanta, Georgia, USA; including at daycare, higher education, religious, and medical facilities. We selected recruitment sites to reflect a generally representative population of Atlanta and to oversample newborns and children under two years of age. Using convenience sampling, a total of 474 children 0–5 years of age who were apparently healthy and who were present at the time of data collection were included in the analysis. Two anthropometrists each took repeated manual measures and repeated 3D scans of each child. We evaluated the reliability and accuracy of 3D scan-derived measurements against manual measurements. The mean child age was 26 months, and 48% of children were female. Based on reported race and ethnicity, the sample was 42% Black, 28% White, 8% Asian, 21% multiple races, other or race not reported; and 16% Hispanic. Measurement reliability of repeated 3D scans was within 1 mm of manual measurement reliability for stature, head circumference and arm circumference. We found systematic bias when analyzing accuracy—on average 3D imaging overestimated stature and head circumference by 6 mm and 3 mm respectively, and underestimated arm circumference by 2 mm. The 3D imaging system used in this study is reliable, low-cost, portable, and can handle movement; making it ideal for use in routine nutritional assessment. However, additional research, particularly on accuracy, and further development of the scanning and processing software is needed before making policy and clinical practice recommendations on the routine use of 3D imaging for child anthropometry.
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20
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Leung M, Perumal N, Mesfin E, Krishna A, Yang S, Johnson W, Bassani DG, Roth DE. Metrics of early childhood growth in recent epidemiological research: A scoping review. PLoS One 2018; 13:e0194565. [PMID: 29558499 PMCID: PMC5860780 DOI: 10.1371/journal.pone.0194565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 03/06/2018] [Indexed: 11/18/2022] Open
Abstract
Metrics to quantify child growth vary across studies of the developmental origins of health and disease. We conducted a scoping review of child growth studies in which length/height, weight or body mass index (BMI) was measured at ≥ 2 time points. From a 10% random sample of eligible studies published between Jan 2010-Jun 2016, and all eligible studies from Oct 2015-June 2016, we classified growth metrics based on author-assigned labels (e.g., 'weight gain') and a 'content signature', a numeric code that summarized the metric's conceptual and statistical properties. Heterogeneity was assessed by the number of unique content signatures, and label-to-content concordance. In 122 studies, we found 40 unique metrics of childhood growth. The most common approach to quantifying growth in length, weight or BMI was the calculation of each child's change in z-score. Label-to-content discordance was common due to distinct content signatures carrying the same label, and because of instances in which the same content signature was assigned multiple different labels. In conclusion, the numerous distinct growth metrics and the lack of specificity in the application of metric labels challenge the integration of data and inferences from studies investigating the determinants or consequences of variations in childhood growth.
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Affiliation(s)
- Michael Leung
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Nandita Perumal
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Elnathan Mesfin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aditi Krishna
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Diego G. Bassani
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel E. Roth
- Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
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Conkle J, Ramakrishnan U, Flores-Ayala R, Suchdev PS, Martorell R. Improving the quality of child anthropometry: Manual anthropometry in the Body Imaging for Nutritional Assessment Study (BINA). PLoS One 2017; 12:e0189332. [PMID: 29240796 PMCID: PMC5730209 DOI: 10.1371/journal.pone.0189332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022] Open
Abstract
Anthropometric data collected in clinics and surveys are often inaccurate and unreliable due to measurement error. The Body Imaging for Nutritional Assessment Study (BINA) evaluated the ability of 3D imaging to correctly measure stature, head circumference (HC) and arm circumference (MUAC) for children under five years of age. This paper describes the protocol for and the quality of manual anthropometric measurements in BINA, a study conducted in 2016–17 in Atlanta, USA. Quality was evaluated by examining digit preference, biological plausibility of z-scores, z-score standard deviations, and reliability. We calculated z-scores and analyzed plausibility based on the 2006 WHO Child Growth Standards (CGS). For reliability, we calculated intra- and inter-observer Technical Error of Measurement (TEM) and Intraclass Correlation Coefficient (ICC). We found low digit preference; 99.6% of z-scores were biologically plausible, with z-score standard deviations ranging from 0.92 to 1.07. Total TEM was 0.40 for stature, 0.28 for HC, and 0.25 for MUAC in centimeters. ICC ranged from 0.99 to 1.00. The quality of manual measurements in BINA was high and similar to that of the anthropometric data used to develop the WHO CGS. We attributed high quality to vigorous training, motivated and competent field staff, reduction of non-measurement error through the use of technology, and reduction of measurement error through adequate monitoring and supervision. Our anthropometry measurement protocol, which builds on and improves upon the protocol used for the WHO CGS, can be used to improve anthropometric data quality. The discussion illustrates the need to standardize anthropometric data quality assessment, and we conclude that BINA can provide a valuable evaluation of 3D imaging for child anthropometry because there is comparison to gold-standard, manual measurements.
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Affiliation(s)
- Joel Conkle
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States of America
- * E-mail: ,
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Rafael Flores-Ayala
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States of America
- Division of Nutrition, Physical Activity and Obesity; National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Parminder S. Suchdev
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Division of Nutrition, Physical Activity and Obesity; National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Department of Pediatrics, School of Medicine, Emory University. Atlanta, GA, United States of America
| | - Reynaldo Martorell
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Aceituno AM, Stanhope KK, Rebolledo PA, Burke RM, Revollo R, Iñiguez V, Suchdev PS, Leon JS. Using a monitoring and evaluation framework to improve study efficiency and quality during a prospective cohort study in infants receiving rotavirus vaccination in El Alto, Bolivia: the Infant Nutrition, Inflammation, and Diarrheal Illness (NIDI) study. BMC Public Health 2017; 17:911. [PMID: 29183280 PMCID: PMC5706310 DOI: 10.1186/s12889-017-4904-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 11/12/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Implementing rigorous epidemiologic studies in low-resource settings involves challenges in participant recruitment and follow-up (e.g., mobile populations, distrust), biological sample collection (e.g., cold-chain, laboratory equipment scarcity) and data collection (e.g., literacy, staff training, and infrastructure). This article describes the use of a monitoring and evaluation (M&E) framework to improve study efficiency and quality during participant engagement, and biological sample and data collection in a longitudinal cohort study of Bolivian infants. METHODS The study occurred between 2013 and 2015 in El Alto, Bolivia, a high-altitude, urban, low-resource community. The study's M&E framework included indicators for participant engagement (e.g., recruitment, retention, safety), biological sample (e.g., stool and blood), and data (e.g., anthropometry, questionnaires) collection and quality. Monitoring indicators were measured regularly throughout the study and used for course correction, communication, and staff retraining. RESULTS Participant engagement indicators suggested that enrollment objectives were met (461 infants), but 15% loss-to-follow-up resulted in only 364 infants completing the study. Over the course of the study, there were four study-related adverse events (minor swelling and bruising related to a blood draw) and five severe adverse events (infant deaths) not related to study participation. Biological sample indicators demonstrated two blood samples collected from 95% (333 of 350 required) infants and stool collected for 61% of reported infant diarrhea episodes. Anthropometry data quality indicators were extremely high (median SDs for weight-for-length, length-for-age and weight-for-age z-scores 1.01, 0.98, and 1.03, respectively), likely due to extensive training, standardization, and monitoring efforts. CONCLUSIONS Conducting human subjects research studies in low-resource settings often presents unique logistical difficulties, and collecting high-quality data is often a challenge. Investing in comprehensive M&E is important to improve participant recruitment, retention and safety, and sample and data quality. The M&E framework from this study can be applied to other longitudinal studies.
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Affiliation(s)
- Anna M. Aceituno
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709 USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Kaitlyn K. Stanhope
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Paulina A. Rebolledo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Emory School of Medicine, Atlanta, GA USA
| | - Rachel M. Burke
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Rita Revollo
- Servicio Departamental de Salud, La Paz, Bolivia
| | - Volga Iñiguez
- Instituto de Biotecnología y Microbiología, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Parminder S. Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Emory School of Medicine, Atlanta, GA USA
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Juan S. Leon
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
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Denno DM, Tarr PI, Nataro JP. Environmental Enteric Dysfunction: A Case Definition for Intervention Trials. Am J Trop Med Hyg 2017; 97:1643-1646. [PMID: 29016294 PMCID: PMC5805039 DOI: 10.4269/ajtmh.17-0183] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Donna M Denno
- Department of Pediatrics, University of Washington, Seattle, Washington.,Department of Global Health, University of Washington, Seattle, Washington
| | - Phillip I Tarr
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - James P Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
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