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Chimhashu TL, Verhoef H, Symington EA, Zandberg L, Baumgartner J, Malan L, Smuts CM, Feskens EJM, Melse-Boonstra A. Comparison of test performance of two commonly used multiplex assays to measure micronutrient and inflammatory markers in serum: results from a survey among pregnant women in South Africa. Br J Nutr 2024; 131:248-255. [PMID: 37560803 PMCID: PMC10751947 DOI: 10.1017/s0007114523001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023]
Abstract
The combined sandwich-ELISA (s-ELISA; VitMin Lab, Germany) and the Quansys Q-Plex™ Human Micronutrient Array (7-Plex) are multiplex serum assays that are used to assess population micronutrient status in low-income countries. We aimed to compare the agreement of five analytes, α-1-acid glycoprotein (AGP), C-reactive protein (CRP), ferritin, retinol-binding protein 4 (RBP4) and soluble transferrin receptor (sTfR) as measured by the 7-Plex and the s-ELISA. Serum samples were collected between March 2016 and December 2017. Pregnant women (n 249) were recruited at primary healthcare clinics in Johannesburg, and serum samples were collected between March 2016 and December 2017. Agreement between continuous measurements was assessed by Bland-Altman plots and concordance measures. Agreement in classifications of deficiency or inflammation was assessed by Cohen's kappa. Strong correlations (r > 0·80) were observed between the 7-Plex and s-ELISA for CRP and ferritin. Except for CRP, the 7-Plex assay gave consistently higher measurements than the s-ELISA. With the exception of CRP (Lin's ρ = 0·92), there was poor agreement between the two assays, with Lin's ρ < 0·90. Discrepancies of test results difference between methods increased as the serum concentrations rose. Cohen's kappa for all the five analytes was < 0·81 and ranged from slight agreement (vitamin A deficiency) to substantial (inflammation and Fe deficiency) agreement. The 7-Plex 1.0 is a research and or surveillance tool with potential for use in low-resource laboratories but cannot be used interchangeably with the s-ELISA. Further optimising and validation is required to establish its interchangeability with other validated methods.
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Affiliation(s)
- Tsitsi Letwin Chimhashu
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Elizabeth A. Symington
- Department of Life and Consumer Sciences, University of South Africa, Johannesburg, South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
- Department of Nutritional Sciences, King’s College, London, UK
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | | | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Babah OA, Akinajo OR, Beňová L, Hanson C, Abioye AI, Adaramoye VO, Adeyemo TA, Balogun MR, Banke-Thomas A, Galadanci HS, Sam-Agudu NA, Afolabi BB, Larsson EC. Prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in Nigeria: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:39. [PMID: 38182997 PMCID: PMC10768359 DOI: 10.1186/s12884-023-06169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 12/03/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Anaemia during pregnancy causes adverse outcomes to the woman and the foetus, including anaemic heart failure, prematurity, and intrauterine growth restriction. Iron deficiency anaemia (IDA) is the leading cause of anaemia and oral iron supplementation during pregnancy is widely recommended. However, little focus is directed to dietary intake. This study estimates the contribution of IDA among pregnant women and examines its risk factors (including dietary) in those with moderate or severe IDA in Lagos and Kano states, Nigeria. METHODS In this cross-sectional study, 11,582 women were screened for anaemia at 20-32 weeks gestation. The 872 who had moderate or severe anaemia (haemoglobin concentration < 10 g/dL) were included in this study. Iron deficiency was defined as serum ferritin level < 30 ng/mL. We described the sociodemographic and obstetric characteristics of the sample and their self-report of consumption of common food items. We conducted bivariate and multivariable logistic regression analysis to identify risk factors associated with IDA. RESULTS Iron deficiency was observed among 41% (95%CI: 38 - 45) of women with moderate or severe anaemia and the prevalence increased with gestational age. The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 - 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 - 0.73) among daily consumers, compared to those who do not eat it. Daily consumption of edible kaolin clay was associated with increased odds of having IDA compared to non-consumption, aOR 9.13 (95%CI: 3.27 - 25.48). Consumption of soybeans three to four times a week was associated with higher odds of IDA compared to non-consumption, aOR: 1.78 (95%CI: 1.12 - 2.82). CONCLUSION About 4 in 10 women with moderate or severe anaemia during pregnancy had IDA. Our study provides evidence for the protective effect of green leafy vegetables against IDA while self-reported consumption of edible kaolin clay and soybeans appeared to increase the odds of having IDA during pregnancy. Health education on diet during pregnancy needs to be strengthened since this could potentially increase awareness and change behaviours that could reduce IDA among pregnant women with moderate or severe anaemia in Nigeria and other countries.
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Affiliation(s)
- Ochuwa Adiketu Babah
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Opeyemi Rebecca Akinajo
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ajibola Ibraheem Abioye
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Victoria Olawunmi Adaramoye
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Titilope A Adeyemo
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Mobolanle Rasheedat Balogun
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Global Maternal and Newborn Health Hub, Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Hadiza S Galadanci
- African Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
- Department of Obstetrics and Gynaecology, College of Health Sciences Bayero University Kano/ Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Bosede Bukola Afolabi
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
- Centre for Clinical Trials and Implementation Science (CCTRIS), College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Mamme NY, Roba HS, Fite MB, Asefa G, Abrahim J, Yuya M, Wilfong T, Gurmu DB, Waka FC, Tessema M, Habtu W, Woldeyohannes M, Raru TB, Kure MA, Alemayehu D, Motuma A, Roba KT. Serum folate deficiency and associated factors among pregnant women in Haramaya District, Eastern Ethiopia: a community-based study. BMJ Open 2023; 13:e068076. [PMID: 37156586 PMCID: PMC10174039 DOI: 10.1136/bmjopen-2022-068076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES We aimed to estimate the prevalence of folate deficiency and contributing factors among pregnant women. DESIGN A community-based, cross-sectional study. SETTING Haramaya District, Eastern Ethiopia. PARTICIPANTS Four hundred and forty-six pregnant women participated in the study. PRIMARY OUTCOME MEASURE The prevalence of folate deficiency and risk factors. RESULTS Overall, the prevalence of folate deficiency was 49.3% (95% CI 44.6% to 54.1%). Pregnant women with iron deficiency anaemia were 2.94 times more likely to develop folate deficiency (adjusted OR (AOR)=2.9, 95% CI 1.9 to 4.7). Respondents with good knowledge of folate-rich foods (AOR=0.3, 95% CI 0.1 to 0.7) and those who took iron and folic acid supplementation (AOR=0.6, 95% CI 0.4 to 0.9) during their pregnancy were less likely to develop folate deficiency. CONCLUSIONS In this study, a considerable proportion of pregnant women had folate deficiency during their pregnancy. Therefore, it is critical that nutritional treatment, education and counselling be strengthened to facilitate iron and folic acid supplementation during pregnancy.
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Affiliation(s)
- Newas Yusuf Mamme
- School of Public Health, Haramaya University College of Health and Medical sciences, Harar, Ethiopia
| | - Hirbo Shore Roba
- School of Public Health, Haramaya University College of Health and Medical sciences, Harar, Ethiopia
| | - Meseret Belete Fite
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Gemechu Asefa
- School of Public Health, Haramaya University College of Health and Medical sciences, Harar, Ethiopia
| | - Jemal Abrahim
- School of Public Health, Haramaya University College of Health and Medical sciences, Harar, Ethiopia
| | - Mohammed Yuya
- School of Public Health, Haramaya University College of Health and Medical sciences, Harar, Ethiopia
| | - Tara Wilfong
- School of Public Health, Haramaya University College of Health and Medical sciences, Harar, Ethiopia
| | - Demiraw Bikila Gurmu
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Feyissa Challa Waka
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Masresha Tessema
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Wossene Habtu
- Department of National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Meseret Woldeyohannes
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Temam Beshir Raru
- School of Public Health, Haramaya University College of Health and Medical sciences, Harar, Ethiopia
| | - Mohammed Abdurke Kure
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Dawit Alemayehu
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Aboma Motuma
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
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Sandalinas F, Filteau S, Joy EJM, Segovia de la Revilla L, MacDougall A, Hopkins H. Measuring the impact of malaria infection on indicators of iron and vitamin A status: a systematic literature review and meta-analysis. Br J Nutr 2023; 129:87-103. [PMID: 35260210 PMCID: PMC9816655 DOI: 10.1017/s0007114522000757] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 01/21/2023]
Abstract
Inflammation and infections such as malaria affect estimates of micronutrient status. Medline, Embase, Web of Science, Scopus and the Cochrane library were searched to identify studies reporting mean concentrations of ferritin, hepcidin, retinol or retinol binding protein in individuals with asymptomatic or clinical malaria and healthy controls. Study quality was assessed using the US National Institute of Health tool. Random effects meta-analyses were used to generate summary mean differences. In total, forty-four studies were included. Mean ferritin concentrations were elevated by: 28·2 µg/l (95 % CI 15·6, 40·9) in children with asymptomatic malaria; 28·5 µg/l (95 % CI 8·1, 48·8) in adults with asymptomatic malaria; and 366 µg/l (95 % CI 162, 570) in children with clinical malaria compared with individuals without malaria infection. Mean hepcidin concentrations were elevated by 1·52 nmol/l (95 % CI 0·92, 2·11) in children with asymptomatic malaria. Mean retinol concentrations were reduced by: 0·11 µmol/l (95 % CI -0·22, -0·01) in children with asymptomatic malaria; 0·43 µmol/l (95 % CI -0·71, -0·16) in children with clinical malaria and 0·73 µmol/l (95 % CI -1·11, -0·36) in adults with clinical malaria. Most of these results were stable in sensitivity analyses. In children with clinical malaria and pregnant women, difference in ferritin concentrations were greater in areas with higher transmission intensity. We conclude that biomarkers of iron and vitamin A status should be statistically adjusted for malaria and the severity of infection. Several studies analysing asymptomatic infections reported elevated ferritin concentrations without noticeable elevation of inflammation markers, indicating a need to adjust for malaria status in addition to inflammation adjustments.
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Affiliation(s)
- Fanny Sandalinas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Edward J. M. Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Amy MacDougall
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi Hopkins
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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John SE, Azizi K, Hancy A, Twin'omujuni A, Katana D, Shine J, Lyatuu V, Sanga A, Mwiru RS, Abdallah F, Mchau G, Lukindo T, Kamala A, Codjia P, Leyna GH, Masumo RM. The prevalence and risk factors associated with Iron, vitamin B12 and folate deficiencies in pregnant women: A cross-sectional study in Mbeya, Tanzania. PLOS Glob Public Health 2023; 3:e0001828. [PMID: 37083656 PMCID: PMC10121015 DOI: 10.1371/journal.pgph.0001828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023]
Abstract
Maternal nutrition is an important forecaster of infant's and mother's health status in most developing countries. This study aimed at assessing the prevalence and associated risk factors of iron, vitamin B12, and folate deficiencies among pregnant women in Mbeya Tanzania. A cross-sectional study using a cluster randomized sampling was conducted among 420 pregnant women. A structured questionnaire was used to collect socio-demographic and dietary assessment. Body iron store was assessed using serum ferritin measured by immunoturbidimetric assays using a Roche Cobas 400+ biochemistry analyzer. Serum folate was measured by folate microbiological assay, while serum vitamin B12 was measured by immunochemiluminescence assay using a Roche Cobas e411 immunoassay analyzer. Multivariate analysis was performed using Poisson regression. The prevalence of iron, folate, and vitamin B12 deficiencies among pregnant women in Mbeya was 37.8%, 24.0%, and 9.7% respectively. Higher odds of iron deficiency were seen in pregnant women aged 20-24 years older [Adjusted OR = 1.20 (95%CI 1.03, 1.35)], not employed [Adjusted OR = 3.0(95%CI 1.03-1.77)] and, not received iron/folic acid supplementation [Adjusted OR = 1.11 (95%CI 1.003-1.23)]. Pregnant women with highest and middle socio-economic statuses had lower odds of vitamin B12 deficiency [Adjusted OR = 0.83 (95%CI 0.76-0.92)] and [Adjusted OR = 0.89 (95%CI 0.81-0.98)] respectively. Pregnant women who were not employed, not received iron and folic acid supplement during pregnancy and, not consumed edible vegetable cooking oil had significant higher odds of serum folate deficiency [Adjusted OR = 3.0 (95%CI 1.58-5.68)], [Adjusted OR = 1.53 (95%CI 1.21-1.93)] and, [Adjusted OR = 2.77 (1.03-7.44)] respectively. This study confirms that iron, folate and vitamin B12 deficiencies are still a major challenge among pregnant women in Tanzania. We recommend for public health interventions for the provision of vitamin B12 along with iron and folic acid supplementations, especially in pregnant women belong to low socio-economic status and limited knowledge of healthy diet.
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Affiliation(s)
- Sauli E John
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Kaunara Azizi
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Adam Hancy
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | | | - Doris Katana
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Julieth Shine
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Vumilia Lyatuu
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Abraham Sanga
- The United Nations Children's Fund (UNICEF) Tanzania, Dar es Salaam, Tanzania
| | - Ramadhani S Mwiru
- The United Nations Children's Fund (UNICEF) Tanzania, Dar es Salaam, Tanzania
| | - Fatma Abdallah
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Geofrey Mchau
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Tedson Lukindo
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Analice Kamala
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
| | - Patrick Codjia
- The United Nations Children's Fund (UNICEF) Tanzania, Dar es Salaam, Tanzania
| | - Germana H Leyna
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ray M Masumo
- Tanzania Food and Nutrition Centre (TFNC), Dar es Salaam, Tanzania
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Alemu G, Diddana TZ, Bosha T, Alemu T, Alemayehu FR, Hailemariam H, Daba AK, Getachew M. Zinc deficiency among pregnant women around Lake Awasa, Hawassa City, Ethiopia: a cross-sectional analysis. J Nutr Sci 2022; 11:e102. [PMID: 36452399 DOI: 10.1017/jns.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Zinc deficiency (ZD) during pregnancy has far-reaching consequences on the mother, fetus and subsequent child survival. Therefore, the present study aimed to assess the prevalence and associated factors of ZD among pregnant women around Lake Awasa, Hawassa City, Ethiopia. To this end, a facility-based cross-sectional study was conducted on 333 randomly sampled pregnant women from 08 April to 08 May 2021. The socio-economic, dietary intake, water, sanitation and hygiene, obstetric, and maternal health data were collected through face-to-face interviews. Moreover, on-spot blood and stool samples were taken. Descriptive statistics and binary and multivariable logistic regression analysis were conducted. The prevalence of ZD was 58⋅6 % (95 % CI 53⋅31, 63⋅89). The poorest (AOR = 3⋅28; 95 % CI 1⋅26, 8⋅50) and poor (AOR = 2⋅93; 95 % CI 1⋅14, 7⋅54) wealth quintiles, four of more family size (AOR = 1⋅84, 95 % CI 1⋅10, 3⋅35), poor dietary diversity (AOR = 4⋅11; 95 % CI 2⋅11, 7⋅62), not eating snacks (AOR = 3⋅40; 95 % CI 1⋅42, 8⋅15), not consuming fish (AOR = 3⋅53; 95 % CI 1⋅65, 7⋅56) and chicken (AOR = 2⋅53; 95 % CI 1⋅31, 4⋅88) at least once a month, and intestinal parasitic infection (AOR = 2⋅78; 95 % CI 1⋅52, 5⋅08) predicted zinc deficiency. In conclusion, ZD is a public health problem among pregnant women around Lake Awasa. The present study demonstrated that poor socio-economic status, large family size, poor nutritional practices and intestinal parasitic infection determine the zinc status in the present study area. The findings suggest the need for further analysis to deepen the understanding about ZD and consideration of livelihood in interventions to prevent and control ZD among pregnant women in Hawassa City, Ethiopia.
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Key Words
- AOR, adjusted odds ratio
- CI, confidence interval
- COR, crude odds ratio
- Ethiopia
- Hawassa City
- IBM, International Business Machine
- IZiNCG, International Zinc Nutrition Consultative Group
- Lake Awasa
- N, total number participants
- Pregnant Women
- UNICEF, United Nations International Children's Emergency Fund
- WASH, Water, sanitation and hygiene
- WHO, World Health Organization
- ZD, zinc deficiency
- Zinc Deficiency
- sd, standard deviation
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7
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Bi D, Lin J, Luo X, Lin L, Tang X, Luo X, Lu Y, Huang X. Biochemical characteristics of patients with imported malaria. Front Cell Infect Microbiol 2022; 12:1008430. [DOI: 10.3389/fcimb.2022.1008430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectivesThis study aimed to investigate the clinical and biochemical profiles of patients with imported malaria infection between 1 January 2011 and 30 April 2022 and admitted to the Fourth People’s Hospital of Nanning.MethodsThis cohort study enrolled 170 patients with conformed imported malaria infection. The clinical and biochemical profiles of these participants were analyzed with malaria parasite clearance, and signs and symptoms related to malaria disappearance were defined as the primary outcome. A multivariable logistic regression model was used to evaluate the odds ratios (ORs) with 95% confidence intervals (CIs) for cerebral malaria. The Cox model was used to estimate the hazard ratios (HRs) with 95% CIs for parasite clearance.ResultsAdenosine deaminase and parasitemia were found to be independent risk factors for severe malaria in patients with imported malaria (OR = 1.0088, 95% CI: 1.0010–1.0167, p = 0.0272 and OR = 2.0700, 95% CI: 1.2584–3.4050, p = 0.0042, respectively). A 0.5–standard deviation (SD) increase of variation for urea (HR = 0.6714, 95% CI: 0.4911–0.9180), a 0.5-SD increase of variation for creatinine (HR = 0.4566, 95% CI: 0.2762–0.7548), a 0.25-SD increase of variation for albumin (HR = 0.4947, 95% CI: 0.3197–0.7653), a 0.25-SD increase of variation for hydroxybutyrate dehydrogenase (HR = 0.6129, 95% CI: 0.3995–0.9402), and a 1.0-SD increase of variation for ferritin (HR = 0.5887, 95% CI: 0.3799–0.9125) were associated with a higher risk for increased parasite clearance duration than a low-level change.ConclusionsAspartate aminotransferase, urea, creatinine, albumin, hydroxybutyrate dehydrogenase, and ferritin are useful biochemical indicators in routine clinical practice to evaluate prognosis for imported malaria.
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Brindle E, Lillis L, Barney R, Bansil P, Hess SY, Wessells KR, Ouédraogo CT, Arredondo F, Barker MK, Craft NE, Fischer C, Graham JL, Havel PJ, Karakochuk CD, Zhang M, Mussai EX, Mapango C, Randolph JM, Wander K, Pfeiffer CM, Murphy E, Boyle DS. A multicenter analytical performance evaluation of a multiplexed immunoarray for the simultaneous measurement of biomarkers of micronutrient deficiency, inflammation and malarial antigenemia. PLoS One 2021; 16:e0259509. [PMID: 34735520 PMCID: PMC8568126 DOI: 10.1371/journal.pone.0259509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
A lack of comparative data across laboratories is often a barrier to the uptake and adoption of new technologies. Furthermore, data generated by different immunoassay methods may be incomparable due to a lack of harmonization. In this multicenter study, we describe validation experiments conducted in a single lab and cross-lab comparisons of assay results to assess the performance characteristics of the Q-plex™ 7-plex Human Micronutrient Array (7-plex), an immunoassay that simultaneously quantifies seven biomarkers associated with micronutrient (MN) deficiencies, inflammation and malarial antigenemia using plasma or serum; alpha-1-acid glycoprotein, C-reactive protein, ferritin, histidine-rich protein 2, retinol binding protein 4, soluble transferrin receptor, and thyroglobulin. Validations included repeated testing (n = 20 separately prepared experiments on 10 assay plates) in a single lab to assess precision and linearity. Seven independent laboratories tested 76 identical heparin plasma samples collected from a cohort of pregnant women in Niger using the same 7-plex assay to assess differences in results across laboratories. In the analytical validation experiments, intra- and inter-assay coefficients of variation were acceptable at <6% and <15% respectively and assay linearity was 96% to 99% with the exception of ferritin, which had marginal performance in some tests. Cross-laboratory comparisons showed generally good agreement between laboratories in all analyte results for the panel of 76 plasma specimens, with Lin's concordance correlation coefficient values averaging ≥0.8 for all analytes. Excluding plates that would fail routine quality control (QC) standards, the inter-assay variation was acceptable for all analytes except sTfR, which had an average inter-assay coefficient of variation of ≥20%. This initial cross-laboratory study demonstrates that the 7-plex test protocol can be implemented by users with some experience in immunoassay methods, but familiarity with the multiplexed protocol was not essential.
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Affiliation(s)
- Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | | | | | - Pooja Bansil
- PATH, Seattle, Washington, United States of America
| | - Sonja Y. Hess
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - K. Ryan Wessells
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Césaire T. Ouédraogo
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
- Helen Keller International, Niamey, Niger
| | - Francisco Arredondo
- Duke University Medical Ctr. Durham, Durham, North Carolina, United States of America
| | - Mikaela K. Barker
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neal E. Craft
- Craft Nutrition Consulting, Elm City, North Carolina, United States of America
| | - Christina Fischer
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James L. Graham
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Peter J. Havel
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Crystal D. Karakochuk
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mindy Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ei-Xia Mussai
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carine Mapango
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jody M. Randolph
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Katherine Wander
- Binghamton University (SUNY), Binghamton, New York, United States of America
| | - Christine M. Pfeiffer
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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9
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Duclau A, Abad F, Adenis A, Sabbah N, Leneuve M, Nacher M. Prevalence and risk factors for micronutrient deficiencies during pregnancy in Cayenne, French Guiana. Food Nutr Res 2021; 65:5268. [PMID: 33776616 PMCID: PMC7955516 DOI: 10.29219/fnr.v65.5268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/11/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Involved in physical and brain development, immunity and metabolism, micronutrients have profound health effects. The nutritional status of pregnant women is a major determinant of foetal health. French Guiana has a rapid population growth. Social inequalities, cultural practices and gastrointestinal nematode infections in French Guiana could affect the prevalence of these deficiencies. The main objective of the present study was to estimate the prevalence of micronutrient deficiency among pregnant women in French Guiana. The secondary objective was to identify socio-demographic, dietary, obstetrical and neonatal risk factors associated with deficiencies. METHODS Pregnant women over 22 weeks of pregnancy hospitalized for delivery at the Obstetrical Emergency Department of the Hospital Center in Cayenne from May 2018 to March 2019 were included. A socio-demographic and food questionnaire was administered. Medical data were collected from the medical records. Blood and urine samples were taken. The descriptive analysis used Student and chi-squared tests. RESULTS A total of 341 women were included. The majority were born in Haiti (39%) and French Guiana (34%). At least one micronutrient deficiency was observed in 81% of women. Precarious women had a significantly greater risk of micronutrient deficiency during pregnancy compared to those with both normal and complementary health insurance. CONCLUSIONS Micronutrient deficiencies in pregnant women in French Guiana are a public health problem, a fact that was previously overlooked in the context of rising obesity. With over half the women overweight or obese, and 81% with at least 1 micronutrient deficiency, balanced nutrition should be a major focus.
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Affiliation(s)
- Amandine Duclau
- Centre d’Investigation Clinique, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Fanny Abad
- Centre d’Investigation Clinique, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d’Investigation Clinique, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Nadia Sabbah
- Service d’endocrinologie et diabétologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Malika Leneuve
- Pôle Femme Enfant, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- Centre d’Investigation Clinique, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
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10
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Ouédraogo CT, Vosti SA, Wessells KR, Arnold CD, Faye MT, Hess SY. Out-of-pocket costs and time spent attending antenatal care services: a case study of pregnant women in selected rural communities in Zinder, Niger. BMC Health Serv Res 2021; 21:47. [PMID: 33419448 PMCID: PMC7796614 DOI: 10.1186/s12913-020-06027-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Despite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services. We aimed to: 1) assess the OPC for pregnant woman attending ANC, 2) estimate the time spent to attend ANC and the opportunity cost of that time, and 3) assess how OPC and time spent to attend ANC affected ANC attendance. Methods Data were obtained from a quasi-experimental descriptive study carried out in the region of Zinder, Niger, which compared pre- and post-intervention cohorts of pregnant women (n = 1736 women who reported attending ANC during their current pregnancy). An ANC attendance score was developed to describe the timing of ANC attendance in regard to the WHO recommendation of attending 4 ANC sessions. OPC and time spent were evaluated separately for associations with ANC attendance using Spearman correlations. Results The mean (±SD) age of pregnant women was 25.0 ± 6.4 yr, 19.0% were ≤ 19 yr and 99.7% were in their second or third trimester of gestation at the time of the interview. Among those who were > 13 weeks and > 27 weeks of gestation, 4.0 and 74.4% had attended ANC during their first and second trimesters, respectively. The median (1st quartile (Q1), 3rd quartile (Q3)) ANC score was 0 (− 1, 0), reflecting that the majority of women failed to follow the WHO recommendation. More than half of the women (72.5%) experienced OPC related to ANC. The majority of women (> 80%) reported spending ~ 3 h for an ANC visit, including travel and waiting time. Time spent to attend ANC was not associated with ANC attendance score. Women who experienced OPC, and those who received iron folic acid (IFA) or long-lasting insecticide-treated bednets during an ANC visit, were more likely to have a higher ANC attendance score compared to those who did not. Conclusion OPC and time spent were not identified as barriers to ANC visits, and IFA and long-lasting insecticide-treated bednets distribution could be used to motivate pregnant women to attend ANC. Trial registration The NiMaNu project was registered at www.clinicaltrials.gov as NCT01832688. Registered 16 April 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06027-2.
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Affiliation(s)
- Césaire T Ouédraogo
- Department of Nutrition, Institute for Global Nutrition, University of California, One Shields Ave, Davis, CA, 95616, USA.
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, CA, USA
| | - K Ryan Wessells
- Department of Nutrition, Institute for Global Nutrition, University of California, One Shields Ave, Davis, CA, 95616, USA
| | - Charles D Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, One Shields Ave, Davis, CA, 95616, USA
| | | | - Sonja Y Hess
- Department of Nutrition, Institute for Global Nutrition, University of California, One Shields Ave, Davis, CA, 95616, USA
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11
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Hiruy AF, Teshome AA, Desta YT, Zuo X, He S, Assefa EG, Ying C. Dietary condition and feeding practices of children aged 6-23 months in Ethiopia: analysis of 2005-2016 demographic and health survey. Eur J Clin Nutr 2021; 75:1047-1059. [PMID: 33402739 DOI: 10.1038/s41430-020-00828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/28/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Childhood malnutrition is well estimated as the major underlying risk factor for morbidity and mortality in children under 5 years. Feeding practices greatly influence the dietary condition of children aged 6-23 months in developing countries. Therefore, this study was performed to determine the association between infant young children feeding (IYCF) practices and the dietary conditions of children aged 6-23 months in Ethiopia. METHOD A cross-sectional study was conducted based on data on 5638 children aged 6-23 months from three Ethiopia Demographic and Health Surveys (EDHS) (2005, 2011, 2016). Multivariable logistic regression was performed to estimate the odd ratios (ORs) and 95% confidence intervals (CIs) of stunting and anaemia with IYCF practices. RESULT The prevalence of stunting among children aged 6-23 months in Ethiopia decreased greatly from 49% in 2005 to 32% in 2016. Among the IYCF practices, consumption of iron-rich foods, minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were significant predictors of stunting. In addition, the prevalence of anaemia declined significantly from 26% in 2005 to 16% in 2011, but increased to 29% in 2016. Among the IYCF practices, breastfeeding and minimum meal frequency (MMF) had lower odds of childhood anaemia. CONCLUSIONS The present study showed that anaemia and stunting among children aged 6-23 months in Ethiopia is critical public health problems that need urgent attention.
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Affiliation(s)
- Aschalew Fikru Hiruy
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Anissa Abebe Teshome
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yemane Tadesse Desta
- Department of Immunology, School of basic medical science, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shuiqing He
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Eskedar Getachew Assefa
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China. .,Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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12
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Nsereko E, Uwase A, Muvunyi CM, Rulisa S, Ntirushwa D, Moreland P, Corwin EJ, Santos N, Lin J, Chen JL, Nzayirambaho M, Wojcicki JM. Association between micronutrients and maternal leukocyte telomere length in early pregnancy in Rwanda. BMC Pregnancy Childbirth 2020; 20:692. [PMID: 33187486 PMCID: PMC7664098 DOI: 10.1186/s12884-020-03330-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exposure to environmental stressors can lead to shorter leukocyte telomere length and increase the risk of chronic diseases. Preservation of leukocyte telomere length by reducing oxidative stress exposure and reinforcing immunity may be a mechanism by which nutritional factors delay or prevent chronic disease development. METHODS Healthy pregnant women (aged 18-45 years) at 9-15 weeks of gestation living in Gasabo District, Kigali, Rwanda, were recruited from 10 health centers for a prospective, longitudinal study from September to October 2017 to determine possible associations between nutrition health, infectious disease and leukocyte telomere length. Anthropometric and laboratory measurements were performed using standard procedures; sociodemographic parameters and health histories were assessed via surveys, and leukocyte telomere length was assessed using quantitative PCR expressed as the ratio of a telomeric product to a single-copy gene product (T/S). RESULTS Mean gestational age of participants (n = 297) at enrollment was 13.04 ± 3.50 weeks, age was 28.16 ± 6.10 years and leukocyte telomere length was 1.16 ± 0.22 (T/S). Younger age; no schooling vs. primary schooling; and lower levels of ferritin, soluble transferrin receptors and retinol-binding protein were independent predictors of longer telomere length in multivariable models. CONCLUSIONS Leukocyte telomere length is an indicator of biological aging in pregnant Rwandan women. Maternal micronutrient status, specifically lower ferritin, soluble transferrin receptor levels, and retinol-binding protein levels were associated with longer maternal telomere length in contrast with some studies from North America and Europe. There were no associations between inflammation and infectious disease status and maternal leukocyte telomere length. Further studies are needed to enhance our understanding of the interplay between maternal nutritional status and infectious disease in relation to leukocyte telomere length in developing countries.
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Affiliation(s)
- Etienne Nsereko
- College of Medicine and Health Sciences School of Health Sciences, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda.
| | - Aline Uwase
- College of Medicine and Health Sciences School of Health Sciences, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - Claude Mambo Muvunyi
- College of Medicine and Health Sciences School of Medicine and Pharmacy, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - Stephen Rulisa
- College of Medicine and Health Sciences School of Medicine and Pharmacy, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - David Ntirushwa
- College of Medicine and Health Sciences School of Medicine and Pharmacy, University of Rwanda, P.O. Box: 3538, Kigali, Rwanda
| | - Patricia Moreland
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | | | - Nicole Santos
- University of California San Francisco, Institute for Global Health Sciences, San Francisco, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, USA
| | - Jyu-Lin Chen
- Departmentof Family Health Care Nursing, University of California San Francisco, San Francisco, USA
| | - Manasse Nzayirambaho
- University of Rwanda College of Medicine and Health Sciences School of Public Health, P.O. Box: 3538, Kigali, Rwanda
| | - Janet M Wojcicki
- Department of Pediatrics, University of California San Francisco, San Francisco, USA.
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, San Francisco, CA, 941558, USA.
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13
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Namaste SML, Ou J, Williams AM, Young MF, Yu EX, Suchdev PS. Adjusting iron and vitamin A status in settings of inflammation: a sensitivity analysis of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach. Am J Clin Nutr 2020; 112:458S-467S. [PMID: 32743650 PMCID: PMC7396268 DOI: 10.1093/ajcn/nqaa141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Accurate assessment of iron and vitamin A status is needed to inform public health decisions, but most population-level iron and vitamin A biomarkers are independently influenced by inflammation. OBJECTIVES We aimed to assess the reproducibility of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) regression approach to adjust iron [ferritin, soluble transferrin receptor (sTfR)] and vitamin A [retinol-binding protein (RBP), retinol] biomarkers for inflammation (α-1-acid glycoprotein and C-reactive protein). METHODS We conducted a sensitivity analysis comparing unadjusted and adjusted estimates of iron and vitamin A deficiency using the internal-survey regression approach from BRINDA phase 1 (16 surveys in children, 10 surveys in women) and 13 additional surveys for children and women (BRINDA phase 2). RESULTS The relations between inflammation and iron or vitamin A biomarkers were statistically significant except for vitamin A biomarkers in women. Heterogeneity of the regression coefficients across surveys was high. Among children, internal-survey adjustments increased the estimated prevalence of depleted iron stores (ferritin <12 µg/L) by a median of 11 percentage points (pp) (24 pp and 9 pp in BRINDA phase 1 and phase 2, respectively), whereas estimates of iron-deficient erythropoiesis (sTfR >8.3 mg/L) decreased by a median of 15 pp (15 pp and 20 pp in BRINDA phase 1 and phase 2, respectively). Vitamin A deficiency (RBP <0.7 µmol/L or retinol <0.7 µmol/L) decreased by a median of 14 pp (18 pp and 8 pp in BRINDA phase 1 and phase 2, respectively) in children. Adjustment for inflammation in women resulted in smaller differences in estimated iron deficiency than in children. CONCLUSIONS Our findings are consistent with previous BRINDA conclusions that not accounting for inflammation may result in an underestimation of iron deficiency and overestimation of vitamin A deficiency. Research is needed to understand the etiology of the heterogeneity in the regression coefficients before a meta-analyzed regression correction can be considered.
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Affiliation(s)
| | - Jiangda Ou
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anne M Williams
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA,McKing Consulting Corporation, Atlanta, GA, USA
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Emma X Yu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA,CDC, Atlanta, GA, USA
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14
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Heck S, Campos H, Barker I, Okello JJ, Baral A, Boy E, Brown L, Birol E. Resilient agri-food systems for nutrition amidst COVID-19: evidence and lessons from food-based approaches to overcome micronutrient deficiency and rebuild livelihoods after crises. Food Secur 2020; 12:823-830. [PMID: 32839664 PMCID: PMC7381414 DOI: 10.1007/s12571-020-01067-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/30/2020] [Indexed: 12/01/2022]
Abstract
COVID-19 has had an instant effect on food systems in developing countries. Restrictions to the movement of people and goods have impaired access to markets, services and food. Unlike other concurrent crises, rather than threatening the material hardware of food systems, COVID-19 has so far affected the 'software' of food systems, highlighting again that connectivity is at the heart of these systems. Drops in demand, the loss of markets and employment and growing concerns about international cooperation are indications of possible deeper disruptions to come. Amidst this uncertainty, strategies to safeguard food and nutrition security of the world's poor need to prioritize diversification of production and markets. Nutritious, biofortified crops such as potato, sweetpotato, but also wheat, maize and beans among others, can play a more significant role to provide key micronutrients (vitamin A, iron, zinc) at large scale. Strong local market chains, robust smallholder production systems and increasing commercial utilization make these crops powerful vehicles for securing nutrition when markets and mobility look uncertain. We posit that the evolving impacts of COVID-19 provide an opportunity to focus agricultural innovations, including the development and delivery of biofortified crops, on new and more specifically defined 'jobs to be done' throughout the food system. This will help bridge some of the current disruptions in supply and demand and will help prepare food systems for future crises.
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Affiliation(s)
- Simon Heck
- International Potato Center, Nairobi, Kenya
| | | | - Ian Barker
- International Potato Center, Basel, Switzerland
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15
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Ouédraogo CT, Wessells KR, Young RR, Faye MT, Hess SY. Prevalence and determinants of gestational weight gain among pregnant women in Niger. Matern Child Nutr 2020; 16:e12887. [PMID: 31568674 PMCID: PMC7038899 DOI: 10.1111/mcn.12887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/12/2019] [Accepted: 08/20/2019] [Indexed: 01/18/2023]
Abstract
Low gestational weight gain (GWG) and low mid-upper arm circumference (MUAC) are associated with adverse pregnancy outcomes. We aimed to assess the prevalence and determinants of low GWG and low MUAC among pregnant women in rural Zinder, Niger. A community-based survey was conducted among 1,384 pregnant women in the catchment areas of 18 integrated health centers in the region of Zinder, Niger. Weight and MUAC were measured during an in-home visit and again 1 month later, when haemoglobin concentration and micronutrient status were also assessed. The prevalence of low GWG was defined based on the 2009 United States Institute of Medicine (U.S. IOM) guidelines (<0.35 kg/week) and less than the third centile of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standards. Factors associated with GWG and MUAC were identified using logistic regression models adjusting for season, village, and gestational age. The median (interquartile range) age was 25.0 (20.7, 30.0) years, and 16.4% were ≤19 years. The prevalence of low GWG were 62.9% and 27.5% according to 2009 IOM and less than the third INTERGROWTH-21st centile, respectively; 24.9% had low MUAC. Higher α-1-acid glycoprotein (OR = 1.7, 95% CI [1.1, 2.8]) and C-reactive protein (OR = 1.2, 95% CI [1.02, 1.50]) increased the odds of low GWG. Adolescents (OR = 2.7, 95% CI [1.8, 4.0]), housewives (OR = 1.97, 95% CI [1.36, 2.86]), and those who reported recent food assistance (OR = 1.80, 95% CI [1.04, 3.11]) had higher odds of low MUAC. Prevalence of low GWG and low MUAC was high among pregnant women. Determinants of GWG and MUAC included socio-economic, demographic, and biological factors, although only markers of inflammation were consistent predictors across different definitions of low GWG.
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Affiliation(s)
- Césaire T. Ouédraogo
- Program in International and Community Nutrition, Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - K. Ryan Wessells
- Program in International and Community Nutrition, Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Rebecca R. Young
- Program in International and Community Nutrition, Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | | | - Sonja Y. Hess
- Program in International and Community Nutrition, Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
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16
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Ouedraogo CT, Wessells KR, Young RR, Bamba IF, Faye MT, Banda N, Hess SY. The mixed effects of a package of multilevel interventions on the health and care of pregnant women in Zinder, Niger. BMJ Glob Health 2019; 4:e001200. [PMID: 31908852 PMCID: PMC6936581 DOI: 10.1136/bmjgh-2018-001200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background Anaemia is prevalent among pregnant women in rural Niger and antenatal care (ANC) attendance is suboptimal. We designed a programmatic intervention including community-based behaviour change communication, provision of essential drugs (including iron folic acid (IFA) supplements) and quality improvement activities at selected integrated health centres (IHCs). Objective To assess the impact of the programmatic intervention on: (1) utilisation of ANC, (2) adherence to daily IFA supplementation and (3) prevalence of adequate gestational weight gain (GWG) and anaemia among pregnant women in Zinder, Niger. Methods Using a quasi-experimental study design comparing a cohort of women at baseline to another cohort of women at endline, 18 IHCs and surrounding villages were randomly assigned to time of enrolment over 1 year. A baseline survey was implemented among randomly selected pregnant women in 68 village clusters. Subsequently, the intervention was rolled out and an endline survey was implemented 6 months later in the same villages. Results Mean age in the baseline (n=1385) and endline (n=922) surveys was 25.8±6.4 years. The percentage of pregnant women who reported attending any number of ANC and an adequate number of ANC for their gestational age, respectively, was not significantly different between the endline and the baseline surveys. Pregnant women in the endline survey were more likely to have received IFA (60.0% vs 45.8%, OR: 2.7 (1.2, 6.1)); and the proportion of pregnant women who reportedly consumed IFA daily in the previous 7 days was significantly higher in the endline than in the baseline survey (46.4% vs 32.8%, OR: 2.8 (1.2, 6.5)). There was no impact on the prevalence of adequate GWG or anaemia. Conclusions The programmatic intervention resulted in a modest increase in the number of pregnant women who reported receiving and consuming IFA supplements as recommended, but did not affect ANC attendance and nutritional status.
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Affiliation(s)
- Cesaire T Ouedraogo
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
- Helen Keller International, Niamey, Niger
| | - K Ryan Wessells
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Rebecca R Young
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | | | | | | | - Sonja Y Hess
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
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Kung'u JK, Pendame R, Ndiaye MB, Gerbaba M, Ochola S, Faye A, Basnet S, Frongillo EA, Wuehler S, De-Regil LM. Integrating nutrition into health systems at community level: Impact evaluation of the community-based maternal and neonatal health and nutrition projects in Ethiopia, Kenya, and Senegal. Matern Child Nutr 2019; 14 Suppl 1. [PMID: 29493902 DOI: 10.1111/mcn.12577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Abstract
Maternal undernutrition and mortality remain high in several African countries. Key nutrition and health interventions improve maternal and birth outcomes. Evidence is scarce on how to strengthen health systems to ensure pregnant women and newborns are reached with these interventions. We conducted three quasi-experimental nonrandomized Community Based Maternal and Neonatal Health and Nutrition projects in regions of Ethiopia, Senegal, and Kenya to demonstrate how proven nutrition interventions could be integrated into health programs to improve knowledge and practices during pregnancy, birth, and postpartum. We evaluated impact on knowledge and practices related to maternal and neonatal care using logistic regression and repeated-measures models with districts as a fixed variable and adjusted for covariates. Combined country analyses show significant positive effects of the intervention on women receiving first antenatal care visit (ANC) during first trimester (OR = 1.44; p < .001), those consuming any iron and folic acid supplement during their latest pregnancy (OR = 1.60; p = .005), those whose <6 months infants were exclusively breastfed (OR = 2.01; p=.003), those whose delivery was facility based (OR = 1.48; p=.031), and those whose postnatal care was facility based (OR = 2.15; p<.001). There was no significant differences between intervention and control groups regarding one or more and four or more ANC visits, women consuming iron and folic acid for ≥90 days, and early initiation of breastfeeding. We conclude that integrating proven nutrition interventions into health programs at community level improved components of access to and use of ANC, delivery services, and postnatal care by women in three African countries.
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Affiliation(s)
| | - Richard Pendame
- Africa Regional Office, Nutrition International, Nairobi, Kenya
| | | | - Mulusew Gerbaba
- Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Sophie Ochola
- Foods, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Adama Faye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
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Wessells KR, Young RR, Ferguson EL, Ouédraogo CT, Faye MT, Hess SY. Assessment of Dietary Intake and Nutrient Gaps, and Development of Food-Based Recommendations, among Pregnant and Lactating Women in Zinder, Niger: An Optifood Linear Programming Analysis. Nutrients 2019; 11:E72. [PMID: 30609695 PMCID: PMC6357040 DOI: 10.3390/nu11010072] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Pregnant and lactating women in rural Niger are at high risk for inadequate intakes of multiple micronutrients. Thus, 24 h dietary recalls were conducted and analyzed for dietary intakes in this population (n = 202). Using linear programming analyses, micronutrient gaps in women's diets were identified, food-based recommendations (FBR) to improve dietary micronutrient adequacy were developed, and various supplementation strategies were modelled. Energy intakes were below estimated requirements, and, for most micronutrients, >50% of women were at risk of inadequate intakes. Linear programming analyses indicated it would be difficult to select a diet that achieved recommended dietary allowances for all but three (vitamin B₆, iron and zinc) of 11 modeled micronutrients. Consumption of one additional meal per day, and adherence to the selected FBR (daily consumption of dark green leafy vegetables, fermented milk, millet, pulses, and vitamin A fortified oil), would result in a low percentage of women at risk of inadequate intakes for eight modeled micronutrients (vitamin A, riboflavin, thiamin, B6, folate, iron, zinc, and calcium). Because the promotion of realistic FBRs likely will not ensure that a low percentage of women are at risk of inadequate intakes for all modeled micronutrients, multiple micronutrient supplementation or provision of nutrient-dense foods should be prioritized.
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Affiliation(s)
- K Ryan Wessells
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
| | - Rebecca R Young
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
| | - Elaine L Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Césaire T Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
| | | | - Sonja Y Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
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Adam I, Ibrahim Y, Elhardello O. Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC Hematol 2018; 18:31. [PMID: 30455961 PMCID: PMC6225563 DOI: 10.1186/s12878-018-0124-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023]
Abstract
Background Anemia during pregnancy is a public health problem especially in developing countries and it is associated with maternal and perinatal adverse outcomes. There is no meta-analysis on anemia during pregnancy in Sudan. The current systemic review and meta-analysis was conducted to assess the prevalence, types and determinant of anemia during pregnancy in Sudan. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The databases (PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online) were searched using; anemia, pregnancy related anemia and Sudan. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Modified Newcastle – Ottawa quality assessment scale were used for critical appraisal of studies. The pooled Meta logistic regression was computed using OpenMeta Analyst software. Results Sixteen cross-sectional studies included a total of 15, 688 pregnant women were analyzed. The pooled prevalence of anemia among pregnant women in Sudan was 53.0% (95%, CI = 45.9–60.1). The meta-analysis showed no statistical significant between the age (mean difference = 0.143, 95 CI = − 0.033 − 0.319, P = 0.112), parity (mean difference = 0.021, 95% CI = − 0.035 − 0.077, P = 0.465) between the anemic and no anemic women. Malaria was investigated in six studies. Pregnant women who had malaria infection during pregnancy were 1.94 times more likely to develop anemia than women who had no malaria infection (OR = 1.94, 95% CI =1.33–2.82). Six (37.5%) studies investigated type of anemia. The pooled prevalence of iron deficiency anemia (IDA) among pregnant women in Sudan was 13.6% (95% CI = 8.9–18.2). Conclusion There is a high prevalence of anemia among pregnant in the different region of Sudan. While age and parity have no association with anemia, malaria infection was associated with anemia. Interventions to promote the strengthening of antenatal care, and access and adherence to nutrition, and malaria preventive measures are needed to reduce the high level of anemia among pregnant women in Sudan. Electronic supplementary material The online version of this article (10.1186/s12878-018-0124-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ishag Adam
- 1Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan
| | - Yassin Ibrahim
- 2Faculty of Medicine, University of Tabuk, P.O. Box 741, Tabuk, Saudi Arabia
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Mohammed SH, Taye H, Sissay TA, Larijani B, Esmaillzadeh A. Teff consumption and anemia in pregnant Ethiopian women: a case-control study. Eur J Nutr 2019; 58:2011-8. [PMID: 29936535 DOI: 10.1007/s00394-018-1759-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/20/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Teff, an iron-rich staple grain in Ethiopia, is consumed mainly in the form of teff injera (TI). Studies on the association of TI consumption with anemia are limited. We aimed to determine the association of frequencies of TI consumption with anemia, in Addis Ababa, Ethiopia. METHODS We conducted a hospital-based case-control study involving 592 pregnant women: 187 anemic cases, and 405 non-anemic controls. TI consumption was assessed by a food frequency questionnaire (FFQ). Multiple logistic regression, adjusted for dietary and non-dietary covariates, was performed to determine the relation of TI consumption to anemia status. RESULTS We found that a decrease in frequency of TI consumption was significantly associated with an increase in the likelihood of anemia (p-trend = 0.009). Compared with everyday TI consumption, the adjusted odds ratios (AORs) of anemia associated with the other frequencies of teff consumption were 1.50 [95% confidence interval (CI) 0.71, 3.23; p = 0.285] for every other day, 2.13 (95% CI 1.03, 4.41; p = 0.04) for 1-2 times a week, and 3.17 (95% CI 1.62, 6.22; p < 0.001) for once in 2 weeks. CONCLUSIONS Teff consumption was associated with reduced odds of anemia in pregnant women. Further studies are warranted, including determining the feasibility and effectiveness of TI use for anemia prevention. REGISTRATION The study was registered as https://clinicaltrials.gov/ct2/show/NCT03251664 .
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Brindle E, Lillis L, Barney R, Hess SY, Wessells KR, Ouédraogo CT, Stinca S, Kalnoky M, Peck R, Tyler A, Lyman C, Boyle DS. Simultaneous assessment of iodine, iron, vitamin A, malarial antigenemia, and inflammation status biomarkers via a multiplex immunoassay method on a population of pregnant women from Niger. PLoS One 2017; 12:e0185868. [PMID: 28982133 PMCID: PMC5628875 DOI: 10.1371/journal.pone.0185868] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
Deficiencies of vitamin A, iron, and iodine are major public health concerns in many low- and middle-income countries, but information on their status in populations is often lacking due to high costs and logistical challenges associated with assessing micronutrient status. Accurate, user-friendly, and low-cost analytical tools are needed to allow large-scale population surveys on micronutrient status. We present the expansion of a 7-plex protein microarray tool for the simultaneous measurement of up to seven biomarkers with relevance to the assessment of the key micronutrients iron, iodine, and vitamin A, and inflammation and malaria biomarkers: α-1-acid glycoprotein, C-reactive protein, ferritin, retinol binding protein 4, soluble transferrin receptor, thyroglobulin, and histidine-rich protein II. Assay performance was assessed using international reference standards and then verified by comparing the multiplexed and conventional immunoassay results on a training panel of plasma samples collected from US adults. These data were used to assign nominal concentrations to the calibrators of the assay to further improve performance which was then assessed by interrogating plasma samples from a cohort of pregnant women from Niger. The correlation between assays for each biomarker measured from this cohort was typically good, with the exception of thyroglobulin, and the sensitivity ranged from 74% to 93%, and specificity from 81% to 98%. The 7-Plex micronutrient assay has the potential for use as an affordable tool for population surveillance of vitamin A, iron, and iodine deficiencies as well as falciparum malarial parasitemia infectivity and inflammation. The assay is easy-to-use, requires minimal sample volume, and is scalable, rapid, and accurate—needing only a low-cost reader and basic equipment present in most reference laboratory settings and so may be employed by low and middle income countries for micronutrient surveillance to inform on status in key populations. Micronutrient deficiencies including iron, iodine, and vitamin A affect a significant portion of the world’s population. Efforts to assess the prevalence of these deficiencies in vulnerable populations are challenging, partly due to measurement tools that are inadequate for assessing multiple micronutrients in large-scale population surveys. We have developed a 7-plex immunoassay for the simultaneous measurement of seven biomarkers relevant to assessing iodine, iron, and vitamin A status, inflammation and Plasmodium falciparum parasitemia by measuring levels of thyroglobulin, ferritin, soluble transferrin receptor, retinol binding protein 4, α-1-acid glycoprotein, C-reactive protein, and histidine-rich protein II. This 7-plex immunoassay technique has potential as a rapid and effective tool for use in large-scale surveys and assessments of nutrition intervention programs in low- and middle-income countries.
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Affiliation(s)
- Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States of America
| | | | | | - Sonja Y. Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - K. Ryan Wessells
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - Césaire T. Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
- Helen Keller International, Niamey, Niger
| | - Sara Stinca
- Laboratory of Human Nutrition, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Roger Peck
- PATH, Seattle, WA, United States of America
| | - Abby Tyler
- Quansys Biosciences, Logan, Utah, United States of America
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Hess SY, Ouédraogo CT, Bamba IF, Wessells KR, Keith N, Faye T, Ndiaye B, Doudou M, Nielsen J. Using formative research to promote antenatal care attendance and iron folic acid supplementation in Zinder, Niger. Matern Child Nutr 2017; 14:e12525. [PMID: 28924978 DOI: 10.1111/mcn.12525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/12/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022]
Abstract
In Niger, use of antenatal care (ANC) and iron folic acid (IFA) supplements is suboptimal. The objectives of this paper are as follows: (a) to conduct formative research to understand barriers and beliefs among pregnant women related to ANC, IFA supplementation, and pregnancy outcomes; (b) assess the quality of currently provided ANC services; (c) use the findings to guide the development of programmatic interventions to improve coverage of ANC services and IFA supplementation of pregnant women. Structured in-home interviews (n = 72) and focus groups (n = 4) were conducted with pregnant women in 4 randomly selected villages in rural Zinder. ANC consultations (n = 33) were observed in 5 randomly selected health centres, and exit interviews were conducted with all pregnant women and seven health agents following these observations. During workshops with stakeholders, results of the formative research were interpreted, and programmatic interventions were developed. In home interviews, 72% of women reported having attended at least one ANC visit. They also reported husbands (71%), mothers (40%), and friends (33%) supporting ANC attendance. Among those having attended ANC, only 65% reported taking IFA the day prior to the interview. Three of five health centres visited had IFA in stock. Health staff did not provide IFA supplements during 18 of 33 observed ANC consultations of which only 7 cases could be explained by the lack of IFA supplements in stock. Findings were used to design a 3-pronged intervention: (a) behaviour change communication activities in communities; (b) quality improvement activities in health centres to strengthen ANC; and (c) provision of key supplies required for ANC.
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Affiliation(s)
- Sonja Y Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | - Césaire T Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA.,Helen Keller International, Niamey, Niger
| | | | - K Ryan Wessells
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | - Nancy Keith
- Independent Consultant, Iowa City, Iowa, USA
| | | | - Banda Ndiaye
- Nutrition International, Africa Regional Office, Dakar, Senegal
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