Cognition, behavior and social competence of preterm low birth weight children at school age

Prenatal exposure to multiple air pollutants and risks of preterm birth and low birth weight in twins: A comparison between natural conception and medically assisted reproduction

Exposure to air pollution has been linked to higher risks of adverse pregnancy outcomes. However, evidence from twin pregnancies is limited, and differences between natural conception (NC) and medically assisted reproduction (MAR) remain unexplored. This study enrolled 935 twin pairs in Wuxi, China, from 2017 to 2022. A high spatiotemporal resolution prediction model was used to assess prenatal exposure to air pollutants, including PM2.5, PM10, SO2, NO2, CO, and O3. Associations of prenatal air pollution exposure with preterm birth (PTB), low birth weight (LBW), and low birth weight preterm birth (LBWPT) were analyzed using generalized linear models. The prevalence of PTB, LBW, and LBWPT among the twin pairs was 68.0 %, 72.4 %, and 57.5 %, respectively. Prenatal exposures to PM2.5, PM10, SO2, and CO were significantly associated with increased risks of PTB, LBW, and LBWPT. Subgroup analyses revealed increased risks in the MAR group (SO2) for PTB and LBWPT, the NC group (CO) for LBW, and twins born in winter/spring (PM2.5, PM10, SO2) for PTB and LBWPT. Our findings underscore the importance of tailoring preventive measures to MAR-conceived twins, NC twins, and those born in winter/spring to better protect against the adverse effects of prenatal air pollution exposure.

Association between maternal khat use and other determinants and low birth weight in Halaba Zone, South Ethiopia: an unmatched case-control study

Introduction

Early newborn mortality, morbidity, and long-term health outcomes are significantly predicted by birth weight. Many babies are born underweight in Ethiopia, but few case-control studies have previously examined the risk variables associated with khat consumption and low birth weight (LBW). Therefore, the aim of this study was to identify maternal khat use and maternal sociodemographic and obstetric risk factors associated with LBW in the Halaba Kulito General Hospital, southern Ethiopia.

Methods

A hospital-based case-control study design was used on 334 neonates (111 cases and 223 controls) at Halaba General Hospital in Halaba Zone, southern Ethiopia, from 01 October 2023 to 27 February 2024. A consecutive sampling method was used to select both the cases and controls. Bi-variable and multivariable logistic regression models were fitted using Stata 14.0 to estimate the effect of maternal khat use and other factors on low birth weight. A p-value of <0.05 was considered a significant difference in low birth weight between the cases and controls.

Results

We found that the mean age of the cases and controls at birth was 25.4 ± 4.57 years and 24.2 ± 3.96 weeks, respectively. Illiteracy [adjusted OR (AOR) = 3.7, 95%CI 1.34, 10.45], rural residence (AOR = 4.1, 95%CI 1.51, 11.35), gestational age <37weeks (AOR = 16.5, 95%CI 7.05, 38.55), maternal mid-upper arm circumference (MUAC) <23 cm (AOR = 4.7, 95%CI 1.89, 11.65), weight gain <12 kg (AOR = 4.8, 95%CI 1.22, 18.59), monthly khat use (AOR = 9.5, 95%CI 2.13, 41.98), weekly khat use (AOR = 11.1, 95%CI 3.69, 33.40), and daily khat use (AOR = 14.1, 95%CI 4.74, 42.03) were the determinant factors for delivering a newborn with low birth weight.

Conclusion

The evidence from this study suggests that illiteracy, rural residence, gestational age <37weeks, maternal MUAC <23 cm, weight gain <12 kg, monthly khat use, weekly khat use, and daily khat use were independent predictors of low birth weight. Suggested strategies involve the early identification and management of identified modifiable variables. We recommend that stakeholders in khat control commit to providing health education and awareness, incorporating khat use among women in the khat control policy, and designing interventions for the cessation of khat use among women.

Interventions and their efficacy in supporting language development among preterm children aged 0-3 years - A systematic review

BACKGROUND

Preterm children have a higher risk for linguistic delays than full-term infants but are rarely provided with language intervention at an early age. Knowledge on early language interventions targeted to preterm children is scarce, and efficacy of the interventions is rarely reported.

AIM

This systematic review aims to identify interventions for preterm children aged 0-3 years with at least one language outcome. Efficacy of the interventions and quality of the study reports were evaluated.

STUDY DESIGN

The article search was carried out in six databases: EBSCOhost, Scopus, ERIC, LLBA, Ovid, and Web of Science. Effect sizes (Hedges' g) were calculated for language outcomes. Quality of the study reports was assessed using the levels of evidence system by the American Speech-Language-Hearing Association.

RESULTS

The 28 studies identified were divided into three groups: interventions at Neonatal Intensive Care Unit, interventions during the first year, and interventions during the second and/or third years. Most of the interventions focused on supporting child-care and general development. Of the interventions, 61 % were efficacious in supporting language development of preterm children. The most promising results regarding efficacy were interventions conducted during the second and/or third years (80 %). Quality of the reports varied from high/good (89 %) to low (11 %).

CONCLUSION

The 28 existing studies provide limited evidence of the efficacy of very early interventions promoting language development of preterm children. However, especially the results for interventions conducted during the second and/or third years show promise. More studies, particularly language-focused interventions with longer follow-ups, are needed.

Social Inequalities in Child Development: Analysis of Low-Birth-Weight Trends in Brazil, 2010-2020

INTRODUCTION

Low birth weight (LBW) is a global issue prevalent in low-income countries. Economic assessments of interventions to reduce this burden are crucial to guide health policies. However, there is a relative scarcity of research that illustrates the magnitude of LBW by country and region to support the design of public policies.

OBJECTIVE

This study aimed to analyze the temporal trend of fetal growth in newborns in Brazil between 2010 and 2020.

METHODS

A time series study was conducted using data from the Live Births Information System (SINASC), which is managed by the Department of Information and Informatics of the Unified Health System (DATASUS) of the Brazilian Ministry of Health. The Prais-Winsten linear model was applied to analyze the annual proportions of LBW. The annual percentage changes (APC) and their respective 95% confidence intervals (95%CI) were calculated. Prevalence rate averages of LBW were calculated and displayed on thematic maps to visualize the evolution dynamics in each Federation Unit (FU).

RESULTS

A total of 31,887,329 women from all Federative Units of Brazil were included in the study from 2010 to 2020. The Southeast region had the largest proportion of participants, with records from 2015 accounting for 9.5% of the total. Among the women in the study, 49.6% were between the ages of 20 and 29, and the majority (75.5%) had between 8 and 12 years of schooling. The newborns of these women were predominantly male (58.8%) and non-white (59.5%). The study found that there was a trend towards stabilization of increasing proportions of LBW in the North, Northeast, and Centre-West regions between 2010 and 2020. In Brazil and other regions, these tendencies remained stable.

CONCLUSION

To improve living conditions and reduce social inequalities and health inequities, public policies and actions are necessary. Strengthening the Unified Health System (SUS), income transfer programs, quota policies for vulnerable groups, and gender equality measures such as improving access to education for women and the labor sector are among the suggested approaches.

Antenatal Magnesium Sulfate Benefits Female Preterm Infants but Results in Poor Male Outcomes

Magnesium sulfate (MagSul) is used clinically to prevent eclamptic seizures during pregnancy and as a tocolytic for preterm labor. More recently, it has been implicated as offering neural protection in utero for at-risk infants. However, evidence is mixed. Some studies found that MagSul reduced the incidence of cerebral palsy (CP) but did not improve other measures of neurologic function. Others did not find any improvement in outcomes. Inconsistencies in the literature may reflect the fact that sex effects are largely ignored, despite evidence that MagSul shows sex effects in animal models of neonatal brain injury. The current study used retrospective infant data to assess differences in developmental outcomes as a function of sex and MagSul treatment. We found that on 18-month neurodevelopmental cognitive and language measures, preterm males treated with MagSul (n = 209) had significantly worse scores than their untreated counterparts (n = 135; p < 0.05). Female preterm infants treated with MagSul (n = 220), on the other hand, showed a cognitive benefit relative to untreated females (n = 123; p < 0.05). No significant effects of MagSul were seen among females on language (p > 0.05). These results have tremendous implications for risk-benefit considerations in the ongoing use of MagSul and may explain why benefits have been hard to identify in clinical trials when sex is not considered.

Maternal dietary deficiencies in folic acid or choline worsen stroke outcomes in adult male and female mouse offspring

Maternal one-carbon metabolism plays an important role in early life programming. There is a well-established connection between the fetal environment and the health status of the offspring. However, there is a knowledge gap on how maternal nutrition impacts stroke outcomes in offspring. The aim of our study was to investigate the role of maternal dietary deficiencies in folic acid or choline on stroke outcomes in 3-month-old offspring. Adult female mice were fed a folic acid-deficient diet, choline-deficient diet, or control diet 4 weeks before pregnancy. They were continued on diets during pregnancy and lactation. Male and female offspring were weaned onto a control diet and at 2 months of age were subjected to ischemic stroke within the sensorimotor cortex via photothrombotic damage. Mothers maintained on either a folic acid-deficient diet or choline-deficient diet had reduced levels of S-adenosylmethionine in the liver and S-adenosylhomocysteine in the plasma. After ischemic stroke, motor function was impaired in 3-month-old offspring from mothers receiving either a folic acid-deficient diet or choline-deficient diet compared to the animals receiving a control diet. In brain tissue, there was no difference in ischemic damage volume. When protein levels were assessed in ischemic brain tissue, there were lower levels of active caspase-3 and hypoxia-inducible factor 1α in males compared to females and betaine levels were reduced in offspring from the mothers receiving a choline-deficient diet. Our results demonstrate that a deficient maternal diet at critical time points in neurodevelopment results in worse stroke outcomes. This study emphasizes the importance of maternal diet and the impact it can have on offspring health.

Intelligence Quotient (IQ) in school-aged preterm infants: A systematic review

Preterm birth (before 37 weeks of gestational age) is associated with certain risks to child development. The aim of this systematic review was to summarize available and updated empirical evidence on prematurity as a risk factor for cognitive development in school age. Thus, we attempted to identify similarities and differences with the full-term population and to point out possible risk or protective factors among the biological, psychosocial and family variables. The conceptualization and methodology of this review followed the PRISMA recommendations. The search was carried out in Web of Science, Scopus, PsycInfo, and Dialnet databases, in May 2022. The search was limited to journal articles, published between 2012 and 2022, in English and Spanish. Research articles selected were those focused on the intelligence quotient (IQ) of preterm children aged 6-12 years. The review included studies with cross-sectional or longitudinal cohorts, compared to a control group of children born at term or to standardized scales. The quality of evidence of the selected studies was verified with the Mixed Methods Appraisal Tool (MMAT). The initial search identified 1,040 articles. Forty articles met the inclusion criteria and were finally included in this review. These studies involved 5,396 preterm children from 37 different cohorts. Despite the diversity found among the results, in general, total IQ scores were within the normative mean for premature children; however, compared to their full-term peers, these scores were lower. The most studied variables in relation to IQ are perinatal (e.g., gestational age and birth weight) and family (e.g., socioeconomic level and education level of the mother). Recent studies corroborate that premature birth affects cognitive development in school age, and identify associated perinatal and family variables.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=337371; identifier: CRD42022337371.

School and language performance in children born with low birth weight

OBJECTIVES

To identify the impact of birth weight on the development of metalinguistic skills and performance in reading, writing, and arithmetic in students aged 6 to 10 years, enrolled from the 1st to the 4th grade of Elementary School in public schools of the metropolitan region of São Paulo.

METHODS

The concurrent cohort included 315 students. Birth weight was the exposure variable, and the outcomes were performance in receptive and expressive language, oral metalinguistic skills, and performance in writing, arithmetic, and reading. The tools employed were the Test of Language Competence (TLC) and the School Performance Test (SPT). Students were grouped into quartiles by birth weight for data analysis (P1: < 2170 g, P2: from 2171 g to 2450 g, P3: from 2451 g to 3150 g, and P4: > 3150 g).

RESULTS

The authors observed a tendency for the lower performance of the two groups with lower birth weights in listening comprehension and oral expression. The lower-weight group tended to perform poorly compared to the other groups vis-à-vis reading. In the global result of the SPT, worse performance was observed in the students in the first quartile compared to the others (p = 0.019). The multivariate analysis revealed no association between birth weight and results in the tests applied after adjusting for maternal schooling.

CONCLUSIONS

Birth weight can interfere with oral and written language development. However, the determination of these processes occurs in the face of complex interaction that includes sociodemographic factors, especially family support and maternal schooling.

Impact of pregnancy-related anxiety on preschoolers' emotional and behavioral development: Gender specificity, critical time windows and cumulative effect

BACKGROUND

Studies on the gender-specific effect of PrA on children's emotional and behavioral development are limited. Lack of PrA data on the entire pregnancy had caused difficulties in identifying the key time window and cumulative effects.

METHODS

Based on Ma'anshan Birth Cohort in China, mothers at pregnancy and children followed up to 4 years of age were tested using the PrA questionnaire and the Achenbach Child Behavior Checklist (CBCL) 1.5-5. Finally, 1699 mother-child pairs were included in the study and regression models were developed for analysis.

RESULTS

Children of mothers with PrA are at significantly elevated risk for abnormal mood/behavior at preschool age. Girls seemed to be more sensitive to maternal PrA than boys, mainly manifested in internalizing problems; The third trimester of pregnancy might be a critical time window when maternal PrA affected children's internalizing problems; Longer the duration women had PrA during pregnancy, more possibilities their children would have to develop internalizing and externalizing problems.

LIMITATIONS

The PrA questionnaire may be different from PrA questionnaires in other countries such as due to different cultural contexts. Findings need to be interpreted with more caution. Factors such as maternal postpartum depression and care practices of nursing staff were not considered. No data were collected on disease as well as caregiver emotional status, which also impacts the reporting and identification of emotional/behavioral problems in children.

CONCLUSIONS

Gender-specific and cumulative effect of PrA on preschoolers' emotional/behavioral development is observed. The third trimester of pregnancy might be the critical time window.

Motor and cognitive outcomes of neonates with low birth weight in Brazil: a systematic review and meta-analysis

BACKGROUND

 Data on the outcomes of preterm newborns in South American countries are scarce. Given the great effect of low birth weight (LBW) and/or prematurity on children's neurodevelopment, it is extremely necessary to conduct studies on these phenomena in greater depth in more heterogeneous populations such as those ones from countries with limited resources.

METHODS

 We conducted a comprehensive literature search on databases including PubMed, the Cochrane Library, and Web of Science for articles published in Portuguese and English up to March 2021 involving children born and evaluated in Brazil. The analysis of the risk of bias was adapted from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and used to evaluate the methodology of the included studies.

RESULTS

 From the eligible trials, 25 articles were selected for qualitative synthesis, and 5 of those, for quantitative synthesis (meta-analysis). The meta-analyses showed that children born with LBW presented lower scores on motor development when compared with controls (standardized mean difference: -1.15; 95% confidence interval [95%CI]: -1.56--0.73]; I²: 80%) and also scored lower in terms of cognitive development (standardized mean difference: -0.71; 95% CI: -0.99--0.44; I²: 67%).

CONCLUSION

 The results of the present study reinforce that impaired motor and cognitive functions can be a significant long-term outcome of LBW. The lower the gestational age at delivery, the higher the risk of impairment in those domains. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database under number CRD42019112403.

Sex Differences in Microglia Activation in a Rodent Model of Preterm Hypoxic Ischemic Injury with Caffeine Treatment

Preterm infants are often treated with caffeine as a respiratory stimulant. However, follow-up data shows caffeine may also have neuroprotective potential. There are several theories as to how caffeine might protect the brain, but none have been proven. This study looked at caffeine effects on microglial activation in rodent brains post hypoxic ischemic (HI) injury. Rat pups underwent either sham or HI surgery on P6, followed by treatment with either caffeine or saline. Forty-eight hours post-injury, brains were collected and underwent paraffin embedding and sectioning followed by immunofluorescence staining. Ionized calcium binding adaptor molecule 1 (Iba-1) was used to label microglia, and 4',6-diamindino-2-phenylindole (DAPI) was used to label DNA. Cell size measurements of microglia were obtained to gauge microglia activation, and chromatin condensation (DAPI optical density) was used as an index of neuronal cell death. Results suggest that caffeine does offer protective effects, based on significantly increased levels of cell death in HI-saline animals not seen in caffeine-treated HI males and females. However, the mechanism of action may be different. Male HI animals showed marginally reduced microglial activation following caffeine treatment, whereas females did not. Results indicate that though caffeine may act protectively in both sexes by reducing cell death, the benefits may be mediated by different mechanisms.

Poultry Concentrated Animal-Feeding Operations on the Eastern Shore, Virginia, and Geospatial Associations with Adverse Birth Outcomes

Concentrated animal-feeding operations (CAFOs) emit pollution into surrounding areas, and previous research has found associations with poor health outcomes. The objective of this study was to investigate if home proximity to poultry CAFOs during pregnancy is associated with adverse birth outcomes, including preterm birth (PTB) and low birth weight (LBW). This study includes births occurring on the Eastern Shore, Virginia, from 2002 to 2015 (N = 5768). A buffer model considering CAFOs within 1 km, 2 km, and 5 km of the maternal residence and an inverse distance weighted (IDW) approach were used to estimate proximity to CAFOs. Associations between proximity to poultry CAFOs and adverse birth outcomes were determined by using regression models, adjusting for available covariates. We found a −52.8 g (−95.8, −9.8) change in birthweight and a −1.51 (−2.78, −0.25) change in gestational days for the highest tertile of inverse distance to CAFOs. Infants born with a maternal residence with at least one CAFO within a 5 km buffer weighed −47 g (−94.1, −1.7) less than infants with no CAFOs within a 5 km buffer of the maternal address. More specific measures of exposure pathways via air and water should be used in future studies to refine mediators of the association found in the present study.

The effect of maternal anaemia on low birth weight among newborns in Northwest Ethiopia

Low birth weight is an indicator of maternal-related multifactorial problems such as malnutrition, illness, and work overload. As a result, low birth weight is associated with maternal anaemia, and both of them were significant public health issues in developing nations. Low birth weight and anaemia are caused by insufficient nutrient intake, which is especially severe during pregnancy. So, this study aimed to assess the effect of maternal anaemia during the late trimester on low birth weight among newborns in Northwest Ethiopia. A systematic random sampling technique was used to select 211 participants for the primary data collection. Face-to-face interviews were used to collect data, while blood samples were collected using standard operating procedures. For further analysis, the data file was imported into Stata version 16 (MP) software. The binary logistic regression model was used to investigate significant factors related to low birth weight. Finally, the statistical significance of the variables was determined using a p value of ≤ 0.05. The prevalence of anaemia among pregnant women in the late trimester and newborns was 34 (16.11%, 95% CI: 11.42, 21.78) and 64 (30.33%, 95% CI: 24.20, 37.01), respectively. The mean ± standard deviation of the newborn babies' weight was 3.19 ± 0.49 kg. The proportion of low birth weight among newborns was 26 (12.32%, 95% CI: 8.20, 17.53%). The independent effect of anaemia on low birth weight was 4.19 times while all other factors were constant (COR = 4.19, 95% CI: 1.70, 10.30). Maternal educational status [unable to read and write (AOR = 10.94, 95% CI: 1.74, 68.58) and attained secondary education (AOR = 8.06, 95% CI: 1.53, 42.36)], and maternal anaemia (AOR = 3.51, 95% CI: 1.29, 9.55) were associated with low birth weight after adjusting with all other variables. In this study, the proportion of low birth weight was high. Here, maternal anaemia alone had a significant independent role in the development of low birth weight. Maternal education status and anaemic conditions were associated with low birth weight among newborns. Early detection and treatment of maternal anaemia during pregnancy is crucial with the usual nutritional-related care.

Long-term cognitive outcomes of prematurely born infants: A longitudinal follow-up of Denver II, Bayley III and WISC-IV Tests

BACKGROUND

Prematurity constitutes a risk factor for developmental delay in infancy and childhood. This study aims to: (i) determine long-term cognitive outcomes in prematurely delivered children and compare them with term-delivered children using the WISC-IV and Stroop tests; (ii) examine the relation between Denver II, Bayley III and WISC-IV, Stroop tests.

METHODS

The study group consisted of children born prematurely who had been tested with Denver II and Bayley III in their first 2 years, and had been evaluated with WISC-IV and Stroop tests under follow up, 6-10 years later.

RESULTS

The study group (n = 60, 25 F, 35 M) was 8.0 ± 2.4 (6-10.7) years old when given WISC-IV and Stroop tests. Gestational age in the study group was 34-37 weeks in 25%, 30-33 weeks in 48.3%, and <29 weeks in 26.7%. On WISC-IV, the verbal comprehension index, perceptual reasoning index, working memory index, and full-scale IQ scores were lower in the study group than the control group (P < 0.05). The study group took longer to complete the Stroop test (P < 0.05). Lower socioeconomic status (P = 0.005) and parental education level (P = 0.000) were associated with lower verbal comprehension index scores. Denver II and Bayley III test results were related to WISC-IV results (P < 0.05) but not to the Stroop test results (P > 0.05).

CONCLUSIONS

Our results showed prematurity negatively influences the results of WISC-IV and Stroop tests at school age. Denver II and Bayley III tests applied at age 2 years likely predict WISC-IV results.

Social cognition in individuals born preterm

Faces hold a substantial value for effective social interactions and sharing. Covering faces with masks, due to COVID-19 regulations, may lead to difficulties in using social signals, in particular, in individuals with neurodevelopmental conditions. Daily-life social participation of individuals who were born preterm is of immense importance for their quality of life. Here we examined face tuning in individuals (aged 12.79 ± 1.89 years) who were born preterm and exhibited signs of periventricular leukomalacia (PVL), a dominant form of brain injury in preterm birth survivors. For assessing the face sensitivity in this population, we implemented a recently developed experimental tool, a set of Face-n-Food images bordering on the style of Giuseppe Arcimboldo. The key benefit of these images is that single components do not trigger face processing. Although a coarse face schema is thought to be hardwired in the brain, former preterms exhibit substantial shortages in the face tuning not only compared with typically developing controls but also with individuals with autistic spectrum disorders. The lack of correlations between the face sensitivity and other cognitive abilities indicates that these deficits are domain-specific. This underscores impact of preterm birth sequelae for social functioning at large. Comparison of the findings with data in individuals with other neurodevelopmental and neuropsychiatric conditions provides novel insights into the origins of deficient face processing.

Maternal dietary diversity during pregnancy and risk of low birth weight in newborns: a systematic review

OBJECTIVE

Maternal nutrition during pregnancy is a key factor influencing birth outcome. Dietary diversity is a proxy for multiple macro- and/or micronutrient sufficiency of an individual's diet. This systematic review aimed to summarise the findings on the association between maternal dietary diversity during pregnancy and the risk of low birth weight (LBW) in newborns.

DESIGN

This is a systematic review study.

SETTING

Google and the PubMed, Scopus and Google Scholar databases were searched to extract original studies on humans published until June 2020, without date restrictions. There was no limitation regarding geographic region or economic condition of countries. Duplicated and irrelevant studies were screened out and data were obtained through critical analysis.

PARTICIPANTS

Articles that examined the association between maternal dietary diversity during pregnancy and the risk of LBW in infants were included.

RESULTS

Of the ninety-eight studies retrieved, fifteen articles were included in the final review. All included articles represent low- and middle-income countries. Eighty percentage of the studies (n 12) indicated that low maternal dietary diversity during pregnancy is associated with an increased risk of LBW infants. Three studies that included a small number of LBW infants and did not take into account factors which may bias study results failed to show this association.

CONCLUSION

The results suggest that low maternal dietary diversity during pregnancy may be associated with the risk of LBW, more specifically in developing countries. Dietary diversity might be a valuable predictor of maternal nutrition during pregnancy and the chance of giving birth to a LBW infant.

Development of visuospatial memory in preterm infants: A new paradigm to assess short-term and working memory

Preterm infants have a higher risk of showing visuospatial memory impairment, the function that allows to encode and remember visual and spatial information. It has been studied in late childhood in preterm children. Studies on visuospatial memory throughout the first 2 years of life are still scarce. Behavior, temperament, and overall cognition could be altered in preterm children affecting memory performance. Therefore, the main aim of this study was to evaluate short-term and visuospatial working memory performance in a preterm sample followed longitudinally at 12, 15, 18, and 22 months (N = 15), and compare their performance with that of full-term children (N = 65). The secondary aim was to analyze the course of mnesic development in preterm infants and relate their memory performance to other cognitive abilities and behavioral tendencies. Assessment included previously published tasks and an experimental paradigm. Results showed that preterm children scored lower than full-term children on visuospatial short-term and working memory at 12 and 22 months of age, although these results varied depending on the memory test used. Preterm children's memory results showed that these skills improve in this population between the first and second year of life. Finally, memory performance was directly associated with the level of cognitive development and the presence of proactive behaviors, while being inversely correlated with the presence of disruptive behaviors and a difficult temperamental style. These preliminary findings suggest that it is possible to detect visuospatial memory difficulties in the preterm population before the age of two.

Disadvantaged neighborhoods, birth weight, and problem behavior in five- and six-year-old pre-school children: Evidence from a cohort born in Amsterdam

RATIONALE

Low birth weight has been found to increase the problem behavior of children. Yet, little attention has been given to adequately account for the impact of the child's neighborhood on this relation. The residential neighborhood is a choice, based on factors that are usually not observed that may also influence birth weight and problem behavior.

OBJECTIVE

Using a model that accounts for such endogeneity of both neighborhood choice and birth weight, we have analyzed behavioral problems in 4210 pre-school children between the ages of 5 and 6, birth weight, and neighborhood status, simultaneously.

METHOD

The data used are from the Amsterdam Born Children and their Development (ABCD) cohort for whom a complete prospective record of birth outcomes, pregnancy, socio-demographic characteristics, and indicators of problem behavior are available. Neighborhood data obtained from Statistics Netherlands are merged with the ABCD data file.

RESULTS

Our results suggest that ignoring endogeneity attenuates the effect of disadvantaged neighborhoods on both birth weight and problem behavior in pre-school children. Living in a disadvantaged neighborhood decreases the birth weight and increases the probability of problem behavior. Accounting for the endogeneity of neighborhood choice increases the estimated impacts (marginal effects: from -10% to -44% for birth weight and from 3% to 11% for problem behavior). Lower birth weight increases the probability of problem behavior, but it is only significant after adjusting for endogeneity. The coefficients of other factors have the expected associations with problem behavior.

CONCLUSIONS

These significant effects of disadvantaged neighborhood on birth weight and problem behavior could inform policies and practices that improve neighborhood development for children born in Amsterdam.

Low birth weight and its associated risk factors: Health facility-based case-control study

Background

Low birth weight is a preventable public health problem. It is an important determinant of child survival and development, as well as long-term consequences like the onset of non-communicable disease in the life course. A large number of mortality and morbidity can be prevented by addressing the factors associated with low birth weight. The main objective of this study was to identify associated risk factors of low birth weight.

Methodology

A health facility-based unmatched case-control study was carried out from July 2018 to March 2019 among the mothers who delivered in health facilities of Dang district of Nepal from 17^th August to 16^th November 2018. The total sample size for the study was 369; 123 cases and 246 controls. Cases and controls were randomly selected independent of the exposure status in the ratio of 1:2. Information regarding exposure status was assessed through interviews and medical records. Mothers who delivered outside Dang districts were excluded from the study. Ethical clearance was obtained from the Institutional Review Committee (IRC) of the Institute of Medicine, Tribhuvan University and written consent was taken from each participant after explaining the objectives of the study.

Results

Multivariate logistic regression found that having the kitchen in the same living house (AOR 2.7, CI: 1.5–4.8), iron intake less than 180 tablets (AOR 3.2, CI: 1.7–5.7), maternal weight gain during second and third trimester less than 6.53 kg (AOR 2.6, CI: 1.5–4.7), co-morbidity during pregnancy (AOR 2.4, CI: 1.3–4.5), preterm birth (AOR 2.9, CI: 1.4–6.1) were the risk factors associated with low birth weight.

Conclusion

Having the kitchen in the same living house, iron intake less than 180 tablets during pregnancy, maternal weight gain less than 6.53 kg during the second and third trimester, co-morbidity during pregnancy and preterm birth were the risk factors associated with low birth weight.

Long-term cognitive, executive, and behavioral outcomes of moderate and late preterm at school age

BACKGROUND

There is increasing concern that moderate preterm (32-33 weeks' gestation) and late preterm (34-36 weeks' gestation) birth may be associated with minor neurodevelopmental problems affecting poor school performance.

PURPOSE

We explored the cognitive function, cognitive visual function, executive function, and behavioral problems at school age in moderate to late preterm infants.

METHODS

Children aged 7-10 years who were born at 32+0 to 36+6 weeks of gestation and admitted to the neonatal intensive care unit from August 2006 to July 2011 at the National Health Insurance Service Ilsan Hospital were included. We excluded children with severe neurologic impairments, congenital malformations, or chromosomal abnormalities. Neuropsychological assessments consisted of 5 neuropsychological tests and 3 questionnaires.

RESULTS

A total of 37 children (mean age, 9.1±1.2 years) participated. The mean gestational age at birth was 34.6±7.5 weeks, while the mean birth weight was 2,229.2±472.8 g. The mean full-scale intelligence quotient was 92.89±11.90; 24.3% scored between 70 and 85 (borderline intelligence functioning). An abnormal score was noted for at least one of the variables on the attention deficit hyperactivity disorder diagnostic system for 65% of the children. Scores below borderline function for executive quotient and memory quotient were 32.4% and 24.3%, respectively. Borderline or clinically relevant internalizing problems were noted in 13.5% on the Child Behavior Check List. There were no significant associations between perinatal factors or socioeconomic status and cognitive, visual perception, executive function, or behavior outcomes.

CONCLUSION

Moderate to late preterm infants are at risk of developing borderline intelligence functioning and attention problems at early school age. Cognitive and executive functions that are important for academic performance must be carefully monitored and continuously followed up in moderate to late preterm infants.

Impact of maternal HIV infection on pregnancy outcomes in southwestern China - a hospital registry based study

Globally, human immune deficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) continues to be a major public health issue. With improved survival, the number of people living with HIV/AIDS is increasing, with over 2 million among pregnant women. Investigating adverse pregnant outcomes of HIV-infected population and associated factors are of great importance to maternal and infant health. A cross-sectional data collected from hospital delivery records of 4397 mother-infant pairs in southwestern China were analysed. Adverse pregnant outcomes (including low birthweight/preterm delivery/low Apgar score) and maternal HIV status and other characteristics were measured. Two hundred thirteen (4.9%) mothers were HIV positive; maternal HIV infection, rural residence and pregnancy history were associated with all three indicators of adverse pregnancy outcomes. This research suggested that maternal population have high prevalence in HIV infection in this region. HIV-infected women had higher risks of experiencing adverse pregnancy outcomes. Rural residence predisposes adverse pregnancy outcomes. Findings of this study suggest social and medical support for maternal-infant care needed in this region, selectively towards rural areas and HIV-positive mothers.

A Follow-Up Study of Cognitive Development in Low Risk Preterm Children

The results of a longitudinal study on the cognitive development of one group of full-term and three groups of low risk preterm children with different gestational ages (GA) are presented. The 181 participants were divided into four GA groups of similar size. The aims were: 1) To check if there are differences in cognitive development (measured through the Batelle scale) among the GA groups. 2) To establish the predictive factors of cognitive development at 22 and 60 months of age, taking into account biomedical, environmental and individual factors. The results of the repeated measures ANOVA performed at 22 and 60 months of age indicated that the cognitive trajectories of the four GA groups were similar. Linear regression analyses showed that the effect of the different predictors changed in relation to the time of measurement of cognitive development. Biological factors and the quality of home environment had a moderate effect on the cognitive development at 22 months of age. Cognitive results obtained at 22 months of age, and, to a lesser extent, working memory had the greatest effect on cognitive development at 60 months. GA does not predict cognitive development. Preterm children do not show cognitive delay if they are healthy.

Oligodendrocytes Death Induced Sensorimotor and Cognitive Deficit in N-nitro-L-arginine methyl Rat Model of Pre-eclampsia

Pre-eclampsia (PE) is a pregnancy complicated syndrome that affects multiple organs including the brain that continue post- delivery in both mother and the offspring. We evaluated the expression of oligodendrocytes in the brain of PE rat model through development as well as the cognitive changes and other behavioural modifications that may occur later in the life of offspring of PE-like rat model. Pregnant rats divided into early-onset and late-onset groups were administered with N-nitro- L-arginine methyl (L-NAME) through drinking water at gestational days (GD) 8-17. Rats were allowed free access to water throughout the pregnancy. At GD 19, post-natal day (PND) 1 and 60, rats were sacrificed and brain excised for further analysis. The offspring were subjected to behavioural studies for cognitive and sensorimotor impairments before sacrificed at PND 60. Results showed significant down-regulation in the expression of OLIG2 in PE at GD 19 brain which persists till PND 60. Likewise, there was a significant increase in the latency to locate the platform in Morris water maze, time to traverse the balance beam and reduced hanging time on the wire test between the control and the PE treated. PE could lead to impaired neuronal signalling through demyelination which may contributes significantly to long-term sensorimotor and cognitive deficit.

Low weight, socioeconomics and behavioral issues: examining a population in the Northeast of Brazil

Background

Preterm and low weight children at birth are exposed to higher risks and rates of motor, cognitive, behavioral and emotional problems. Being born under low socioeconomic conditions adds even more complexity to these children. This report describes the emotional and behavioral issues of a group of children who were born in low income families and had low weigh at birth in the Northeast region of Brazil.

Method

A total of 100 children (47 with adequate and 53 with low weigh) were assessed with the Child Behavior Checklist for behavioral and emotional problems, as well as with the Autism Behavior Checklist for autism symptoms.

Results

Results show no difference between the two groups (low and adequate weight) in terms of behavior problems or autism characteristics, however, it shows elevated clinical prevalence's of behavioral and emotional problems and more vulnerability for autism symptoms when compared to the general population. Data also showed the more years children spent in pre-school, the less internalizing problems they manifested.

Conclusion

This study indicates that the impact of low socioeconomics environment is more prominent in the development of behavioral and emotional problems than low weight at birth, in addition it points to the benefits of pre-school years for the emotional and behavioral adjustment of children from low income and with low weight at birth.

Chinese handwriting performance in preterm children in grade 2

Background

First graders born prematurely perform poorly on handwriting speed and legibility. However, whether there are specific legibility factors in which preterm children demonstrate difficulty remains unknown. In addition, handwriting performance beyond the first grade and the influence of sex on handwriting performance in preterm children are still unclear. We aimed to investigate the influence of prematurity and sex on multiple dimensions of handwriting in grade two and to identify the contributors to performance.

Methods

Sixty-three preterm (34 boys and 29 girls) and 67 full-term (27 boys and 40 girls) peers in grade two were included. Class teachers were asked to complete the Chinese Handwriting Evaluation Form. A subgroup of 39 preterm children received assessments on intelligence, visual perception, tactile and kinesthetic sensation, and fine motor skills. Their inattention behavior was rated using a maternal self-report with a behavioral scale.

Results

Boys born prematurely exhibited poorer performance in the speed dimension than full-term boys (p = 0.008), whereas there was comparable performance in the two groups of girls (p = 0.221). In the dimensions related to legibility, preterm boys (32.4%) had a higher percentage of children with difficulty in the construction dimension than the other groups (preterm girls: 6.9%, full-term boys: 7.4%, full-term girls: 5.0%). However, no group difference was found in the dimensions of accuracy and directionality. Of the sensory-perceptual-motor factors, attention was the most significant predictor of accuracy in performance (p = 0.046) and speed dimensions (p = 0.001) in preterm children.

Conclusions

Boys appear to be vulnerable to the adverse impacts of preterm birth in terms of performance in the dimensions of speed and construction in grade two. Based on the significant contribution of attention to handwriting performance in preterm children, assessment and intervention in the area of attention is strongly suggested for preterm children with handwriting problems.

Comparative Investigation of Indicators of Growth and Behavioral Disorders in Children with Normal, Low, and Very Low Birth Weight at Pre-school Age in Isfahan during 2015

INTRODUCTION

Birth weight is one of the most important indicators of infant's health and could predict their health condition in future. This study was conducted to determine and compare indicators of growth [weight, height, and body mass index (BMI)] and behavioral disorders in children with normal, low, and very low birth weight at pre-school age.

MATERIALS AND METHODS

In this descriptive analytical study, 236 children (126 with normal weight, 100 with low birth weight, and 10 with very low birth weight) at pre-school age were investigated in three groups. Data collection tools were a two-part questionnaire including the Rutter Children Behavior Questionnaire for parents, and parents' and children's demographic characteristics questionnaire, scale, and stadiometer. Data were analyzed using descriptive statistics, variance analysis, Chi square, and Kruskal-Wallis tests.

RESULTS

The mean of weight, height, and BMI at pre-school age in three groups had a significant difference (P = 0.009) and it was lower in the group with very low birth weight than the other two groups; however, the difference between the group with normal birth weight and the group with low birth weight was not significant (P = 0.10). The mean score of behavioral disorder had no significant difference between groups (P = 0.49).

CONCLUSIONS

Results showed that children with very low birth weight grew less than the other two groups. Therefore, this group needs special attention and long-term follow-up for taking care of them to ensure better growth. It is recommended to conduct more extended studies to evaluate behavioral disorders in these children.

Indicators of problems evaluated by parents and children stratified by birth weight

Abstract Studies on the impact of birth weight on child development require the participation of children as informants. The objective of this study was to compare the indicators of behavioral problems and depression in a cohort of school-age children stratified by birth weight and to investigate possible associations between the indicators of behavioral problems, evaluated by the parents, and depression, evaluated by the children. A total of 665 children, aged 10-11 years, distributed into five birth-weight groups were evaluated. The parents responded to the Strengths and Difficulties Questionnaire, and the children responded to the Children's Depression Inventory. It was found that there were: (a) significantly more indicators of hyperactivity and depression in the children born with very low birth weight; (b) associations between the indicators of childhood depression and the indicators of overall behavioral problems in all weight groups evaluated, except for the very low birth weight group. There was good consistency between the ratings of problems by children and parents.

Impact of neonatal risk and temperament on behavioral problems in toddlers born preterm

Children born preterm are at risk for later developmental disorders. The present study examined the predictive effects of neonatal, sociodemographic, and temperament characteristics on behavioral outcomes at toddlerhood, in children born preterm. The sample included 100 toddlers born preterm and with very-low-birth-weight, and their mothers. Neonatal characteristics were evaluated using medical records. The mothers were interviewed using the Early Childhood Behavior Questionnaire for temperament assessment, and the Child Behavior Checklist for behavioral assessment. Multiple linear regression analyses were performed. Predictors of 39% of the variability of the total behavioral problems in toddlers born prematurely were: temperament with more Negative Affectivity and less Effortful Control, lower family socioeconomic status, and younger mothers at childbirth. Temperament with more Negative Affectivity and less Effortful Control and lower family socioeconomic status were predictors of 23% of the variability of internalizing behavioral problems. Additionally, 37% of the variability of externalizing behavioral problems was explained by temperament with more Negative Affectivity and less Effortful Control, and younger mothers at childbirth. The neonatal characteristics and stressful events in the neonatal intensive care unit did not predict behavioral problems at toddlerhood. However, temperament was a consistent predictor of behavioral problems in toddlers born preterm. Preventive follow-up programs could assess dispositional traits of temperament to provide early identification of preterm infants at high-risk for behavioral problems.

Childhood Poverty and Cognitive Development in Latin America in the 21st Century

For at least eight decades, researchers have analyzed the association between childhood poverty and cognitive development in different societies worldwide, but few of such studies have been carried out in Latin America. The aim of the present paper is to systematically review the empirical studies that have analyzed the associations between poverty and cognitive development in children under 18 years of age from Latin American and Caribbean countries between 2000 and 2015. This analysis takes into consideration the country where the work was conducted, the experimental and analytical design, sample size and composition, cognitive and poverty paradigms implemented, levels of analysis, and the inclusion of mediation analyses. Through these, we identify common patterns in the negative impact of poverty that have been repeatedly verified in the literature in other continents; we also call attention to a set of issues regarding sample, design, paradigms, impact, and mediation analyses that should be considered in future studies in the region.

Antecedents of the child behavior checklist-dysregulation profile in children born extremely preterm

OBJECTIVE

Extremely preterm newborns are at heightened risk for emotional and behavioral dysregulation later in childhood. Our goal was to systematically evaluate the antenatal and early postnatal antecedents that might mediate the association between extreme preterm birth and emotional and behavioral dysregulation at age 2 years (corrected age).

METHOD

In a multi-site prospective study, the parents of 826 infants born before 28 weeks gestation completed a Child Behavior Checklist (CBCL) when the child was 2 years corrected age. We compared the maternal, pregnancy, placenta, delivery, and newborn characteristics, as well as early postnatal characteristics and exposures of those who satisfied criteria for the CBCL-Dysregulation Profile (CBCL-DP) to those of their peers. We then used time-oriented logistic regression models, starting first with antenatal variables that distinguished children with the CBCL-DP profile from their peers, and then added the distinguishing postnatal variables.

RESULTS

Approximately 9% of the children had a CBCL-DP. In the time-oriented logistic regression model with antenatal variables only, low maternal education achievement, passive smoking, and recovery of Mycoplasma from the placenta were associated with increased risk, whereas histologic chorioamnionitis was associated with reduced risk. None of the postnatal variables added statistically significant discriminating information.

CONCLUSION

Very preterm newborns who later manifest the CBCL-DP at age 2 years differ in multiple ways from their preterm peers who do not develop the CBCL-DP, raising the possibility that potentially modifiable antenatal and early postnatal phenomena contribute to the risk of developing emotional and behavioral dysregulation.

Prevalence of behavior problems and associated factors in preschool children from the city of Salvador, state of Bahia, Brazil

Objective:

To identify the prevalence of internalizing and externalizing behavior problems among preschoolers from the city of Salvador, state of Bahia, Brazil, and their associations with maternal mental health and family characteristics.

Methods:

This was a cross-sectional study of 349 children aged 49 to 72 months, randomly selected from 20,000 households representing the range of socioeconomic and environmental conditions in Salvador. In 1999, we assessed sociodemographic variables and family environment characteristics. In 2001, we used the Child Behavior Checklist to measure and describe the frequencies of behavior problems. We conducted bivariate and multivariate analysis to estimate associations between family and maternal factors and prevalence of behavior problems.

Results:

The overall prevalence of behavior problems was 23.5%. The prevalence of internalizing problems was 9.7%, and that of externalizing problems, 25.2%. Behavior problems were associated with several maternal mental health variables, namely: presence of at least one psychiatric diagnosis (odds radio [OR] 3.01, 95%CI 1.75-5.18), anxiety disorder (OR 2.06, 95%CI 1.20-3.46), affective disorder (OR 2.10, 95%CI 1.21-3.65), and mental health disorders due to use of psychoactive substances (OR 2.31, 95%CI 1.18-4.55).

Conclusion:

The observed prevalence of child behavior problems fell within the range reported in previous studies. Maternal mental health is an important risk factor for behavior problems in preschool-aged children.

Using Geographic Information Science to Explore Associations between Air Pollution, Environmental Amenities, and Preterm Births

The study uses geographic information science (GIS) and statistics to find out if there are statistical differences between full term and preterm births to non-Hispanic white, non-Hispanic Black, and Hispanic mothers in their exposure to air pollution and access to environmental amenities (green space and vendors of healthy food) in the second largest city in New England, Worcester, Massachusetts. Proximity to a Toxic Release Inventory site has a statistically significant effect on preterm birth regardless of race. The air-pollution hazard score from the Risk Screening Environmental Indicators Model is also a statistically significant factor when preterm births are categorized into three groups based on the degree of prematurity. Proximity to green space and to a healthy food vendor did not have an effect on preterm births. The study also used cluster analysis and found statistically significant spatial clusters of high preterm birth volume for non-Hispanic white, non-Hispanic Black, and Hispanic mothers.

Time, number and attention in very low birth weight children

Premature birth has been associated with damage in many regions of the cerebral cortex, although there is a particularly strong susceptibility for damage within the parieto-occipital lobes (Volpe, 2009). As these areas have been shown to be critical for both visual attention and magnitudes perception (time, space, and number), it is important to investigate the impact of prematurity on both the magnitude and attentional systems, particularly for children without overt white matter injuries, where the lack of obvious injury may cause their difficulties to remain unnoticed. In this study, we investigated the ability to judge time intervals (visual, audio and audio-visual temporal bisection), discriminate between numerical quantities (numerosity comparison), map numbers onto space (numberline task) and to maintain visuo-spatial attention (multiple-object-tracking) in school-age preterm children (N29). The results show that various parietal functions may be more or less robust to prematurity-related difficulties, with strong impairments found on time estimation and attentional task, while numerical discrimination or mapping tasks remained relatively unimpaired. Thus while our study generally supports the hypothesis of a dorsal stream vulnerability in children born preterm relative to other cortical locations, it further suggests that particular cognitive processes, as highlighted by performance on different tasks, are far more susceptible than others.

Low educational level but not low income impairs the achievement of cytogenetic remission in chronic myeloid leukemia patients treated with imatinib in Brazil

OBJECTIVES

In Brazil, imatinib mesylate is supplied as the first-line therapy for chronic myeloid leukemia in the chronic phase through the public universal healthcare program, Sistema Único de Saúde (SUS). We studied the socio-demographic factors that influenced therapy success in a population in the northeast region of Brazil.

METHODS

Patients with chronic myeloid leukemia from the state of Piauí were treated in only one reference center. Diagnosis was based on WHO 2008 criteria. Risk was assessed by Sokal, Hasford and EUTOS scores. Patients received 400 mg imatinib daily. We studied the influence of the following factors on the achievement of complete cytogenetic response within one year of treatment: age, clinical risk category, time interval between diagnosis and the start of imatinib treatment, geographic distance from the patient's home to the hospital, years of formal education and monthly income.

RESULTS

Among 103 patients studied, the median age was 42 years; 65% of the patients had 2-9 years of formal education, and the median monthly income was approximately 100 US$. Imatinib was started in the first year after diagnosis (early chronic phase) in 69 patients. After 12 months of treatment, 68 patients had a complete cytogenetic response. The Hasford score, delay to start imatinib and years of formal education influenced the attainment of a complete cytogenetic response, whereas income and the distance from the home to the healthcare facility did not.

CONCLUSION

Patients require additional healthcare information to better understand the importance of long-term oral anticancer treatment and to improve their compliance with the treatment.

Prenatal exposure to phthalate esters and behavioral syndromes in children at 8 years of age: Taiwan Maternal and Infant Cohort Study

BACKGROUND

Few studies have shown an association between prenatal phthalate exposure and adverse effects on neurodevelopment and behavior in young children.

OBJECTIVES

We aimed to assess the relationship between prenatal exposure to phthalate esters and behavior syndromes in children at 8 years of age.

METHODS

A total of 122 mother-child pairs from the general population in central Taiwan were studied from 2000 to 2009. Mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), and three di-(2-ethylhexyl) phthalate (DEHP) metabolites-mono-2-ethylhexyl, mono-2-ethyl-5-hydroxyhexyl, and mono-2-ethyl-5-oxohexyl phthalates (MEHP, MEHHP, and MEOHP)--were measured in maternal urine collected during the third trimester of pregnancy using liquid chromatography-electrospray ionization-tandem mass spectrometry. Behavioral syndromes of children at 8 years of age were evaluated using the Child Behavior Checklist (CBCL). Associations between log10-transformed creatinine-corrected phthalate concentrations and standardized scores of the CBCL were estimated using linear regression models or multinomial logistic regressions with adjustments for potential confounders.

RESULTS

Externalizing problem scores were significantly higher in association with a 1-unit increase in log10-transformed creatinine-corrected concentrations of maternal MBP (β = 4.29; 95% CI: 0.59, 7.99), MEOHP (β = 3.74; 95% CI: 1.33, 6.15), and MEHP (β = 4.28 ; 95% CI: 0.03, 8.26) after adjusting for the child's sex, intelligence, and family income. Meanwhile, MBP and MEOHP were significantly associated with Delinquent Behavior and Aggressive Behavior scores. The same pattern was found for borderline and/or clinical ranges.

CONCLUSIONS

Our findings suggest positive associations between maternal DEHP and dibutyl phthalate (DBP) exposure and externalizing domain behavior problems in 8-year-old children.

Reducing occurrence of Giardia duodenalis in children living in semiarid regions: impact of a large scale rainwater harvesting initiative

Background

In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program “One Million Cisterns” (P1MC). Nevertheless, few epidemiological studies have been conducted to assess health risks or protection effects associated with consumption of this water source. The aim of this study was to evaluate whether access to rainwater harvesting cisterns is associated with the decrease in the occurrence of Giardia duodenalis infections in children, compared to other children living in households supplied by other water sources.

Methodology/Principal Findings

A quasi-experimental study with two concurrent cohorts was developed in two rural municipalities of the semiarid region of Brazil. A sample of 664 children, aged between 4 months and 5 years old, was followed up, of which 332 had access to rainwater cisterns (cistern group) and 332 did not, having water supplied from alternative sources (comparison group). In a period of approximately one year (2010) intestinal parasites were investigated in feces three times. The prevalence of G. duodenalis in children from the cistern group ranged from 4.8 to 10.5%, while the prevalence in the comparison group ranged from 7.6 to 16.7%. Multivariate analysis (GEE) showed a higher risk of G. duodenalis infection in children who did not have access to rainwater cisterns, when compared to children who did (OR 1.72; 95% CI 1.14–2.59). The other variables associated with G. duodenalis infection were: number of rooms per house (OR 0.89; 95% CI 0.80–0.99); family income (OR0.48; 95% CI 0.26–0.88); birth order (OR 1.72; 95% CI 1.17–2.51); preterm children (OR 1.70; 95% CI 1.19–2.43); and improper hand hygiene prior to food preparation (OR 4.78; 95% CI 1.95–11.76).

Conclusions/Significance

Ownership of a rainwater cistern is associated with a lower prevalence of G. duodenalis infection in children after adjustment for environmental and family-related factors. Nevertheless, the study suggests the necessity to complement physical interventions with actions related to personal and domestic hygiene to enable further reductions in parasite infections affecting mainly the underprivileged populations.

Currently, rainwater harvesting cisterns built up through the “One Million Cisterns” Program, coordinated by the Brazilian Government, represents the most important public policy for water supply in the rural semiarid region of Brazil. Despite the extensive use of this water provision, few studies have been performed to assess the associated health impact. To assess such impact, this study investigated factors associated with the occurrence of Giardia duodenalis (protozoan closely related to the ingestion of contaminated water) in children aged between 4 months and five years old. Two distinct groups of children, one with access to rainwater cisterns (cistern group) and the other without cisterns, with water supplied from alternative sources, including rivers, springs or dams (comparison group) were followed up for approximately one year. It was observed that the risk occurrence of G. duodenalis prevalence was greater in children from the comparison group, when compared with those from the cistern group, indicating that the odds of infection by this parasite were 1.72 times greater for comparison group children. In conclusion, the study showed health benefits related to rainwater cisterns, but also identified that other complementary sanitation interventions are needed to minimize the risk of disease in populations with limited access to drinking water.