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Noble C, Mooney C, Makasi R, Ntozini R, Majo FD, Church JA, Tavengwa NV, Prendergast AJ, Humphrey JH, Manges A, Mangwadu G, Maluccio JA, Mbuya MNN, Moulton LH, Stoltzfus RJ, Tielsch JM, Smith LE, Chasokela C, Chigumira A, Heylar W, Hwena P, Kembo G, Mutasa B, Mutasa K, Rambanepasi P, Sauramba V, Van Der Keilen F, Zambezi C, Chidhanguro D, Chigodora D, Chipanga JF, Gerema G, Magara T, Mandava M, Mavhudzi T, Mazhanga C, Muzaradope G, Mwapaura MT, Phiri S, Tengende A, Banda C, Chasekwa B, Chidamba L, Chidawanyika T, Chikwindi E, Chingaona LK, Chiorera CK, Dandadzi A, Govha M, Gumbo H, Gwanzura KT, Kasaru S, Matsika AM, Maunze D, Mazarura E, Mpofu E, Mushonga J, Mushore TE, Muzira T, Nembaware N, Nkiwane S, Nyamwino P, Rukobo SD, Runodamoto T, Seremwe S, Simango P, Tome J, Tsenesa B, Amadu U, Bangira B, Chiveza D, Hove P, Jombe HA, Kujenga D, Madhuyu L, Mandina-Makoni P, Maramba N, Maregere B, Marumani E, Masakadze E, Mazula P, Munyanyi C, Musanhu G, Mushanawani RC, Mutsando S, Nazare F, Nyarambi M, Nzuda W, Sigauke T, Solomon M, Tavengwa T, Biri F, Chafanza M, Chaitezvi C, Chauke T, Chidzomba C, Dadirai T, Fundira C, Gambiza AC, Godzongere T, Kuona M, Mafuratidze T, Mapurisa I, Mashedze T, Moyo N, Musariri C, Mushambadope M, Mutsonziwa TR, Muzondo A, Mwareka R, Nyamupfukudza J, Saidi B, Sakuhwehwe T, Sikalima G, Tembe J, Chekera TE, Chihombe O, Chikombingo M, Chirinda T, Chivizhe A, Hove R, Kufa R, Machikopa TF, Mandaza W, Mandongwe L, Manhiyo F, Manyaga E, Mapuranga P, Matimba FS, Matonhodze P, Mhuri S, Mike J, Ncube B, Nderecha WTS, Noah M, Nyamadzawo C, Penda J, Saidi A, Shonhayi S, Simon C, Tichagwa M, Chamakono R, Chauke A, Gatsi AF, Hwena B, Jawi H, Kaisa B, Kamutanho S, Kaswa T, Kayeruza P, Lunga J, Magogo N, Manyeruke D, Mazani P, Mhuriyengwe F, Mlambo F, Moyo S, Mpofu T, Mugava M, Mukungwa Y, Muroyiwa F, Mushonga E, Nyekete S, Rinashe T, Sibanda K, Chemhuru M, Chikunya J, Chikwavaire VF, Chikwiriro C, Chimusoro A, Chinyama J, Gwinji G, Hoko-Sibanda N, Kandawasvika R, Madzimure T, Maponga B, Mapuranga A, Marembo J, Matsunge L, Maunga S, Muchekeza M, Muti M, Nyamana M, Azhuda E, Bhoroma U, Biriyadi A, Chafota E, Chakwizira A, Chamhamiwa A, Champion T, Chazuza S, Chikwira B, Chingozho C, Chitabwa A, Dhurumba A, Furidzirai A, Gandanga A, Gukuta C, Macheche B, Marihwi B, Masike B, Mutangandura E, Mutodza B, Mutsindikwa A, Mwale A, Ndhlovu R, Nduna N, Nyamandi C, Ruvata E, Sithole B, Urayai R, Vengesa B, Zorounye M, Bamule M, Bande M, Chahuruva K, Chidumba L, Chigove Z, Chiguri K, Chikuni S, Chikwanda R, Chimbi T, Chingozho M, Chinhamo O, Chinokuramba R, Chinyoka C, Chipenzi X, Chipute R, Chiribhani G, Chitsinga M, Chiwanga C, Chiza A, Chombe F, Denhere M, Dhamba E, Dhamba M, Dube J, Dzimbanhete F, Dzingai G, Fusira S, Gonese M, Gota J, Gumure K, Gwaidza P, Gwangwava M, Gwara W, Gwauya M, Gwiba M, Hamauswa J, Hlasera S, Hlukani E, Hotera J, Jakwa L, Jangara G, Janyure M, Jari C, Juru D, Kapuma T, Konzai P, Mabhodha M, Maburutse S, Macheka C, Machigaya T, Machingauta F, Machokoto E, Madhumba E, Madziise L, Madziva C, Madzivire M, Mafukise M, Maganga M, Maganga S, Mageja E, Mahanya M, Mahaso E, Mahleka S, Makanhiwa P, Makarudze M, Makeche C, Makopa N, Makumbe R, Mandire M, Mandiyanike E, Mangena E, Mangiro F, Mangwadu A, Mangwengwe T, Manhidza J, Manhovo F, Manono I, Mapako S, Mapfumo E, Mapfumo T, Mapuka J, Masama D, Masenge G, Mashasha M, Mashivire V, Matunhu M, Mavhoro P, Mawuka G, Mazango I, Mazhata N, Mazuva D, Mazuva M, Mbinda F, Mborera J, Mfiri U, Mhandu F, Mhike C, Mhike T, Mhuka A, Midzi J, Moyo S, Mpundu M, Msindo NM, Msindo D, Mtisi C, Muchemwa G, Mujere N, Mukaro E, Muketiwa K, Mungoi S, Munzava E, Muoki R, Mupura H, Murerwa E, Murisi C, Muroyiwa L, Muruvi M, Musemwa N, Mushure C, Mutero J, Mutero P, Mutumbu P, Mutya C, Muzanango L, Muzembi M, Muzungunye D, Mwazha V, Ncube T, Ndava T, Ndlovu N, Nehowa P, Ngara D, Nguruve L, Nhigo P, Nkiwane S, Nyanyai L, Nzombe J, Office E, Paul B, Pavari S, Ranganai S, Ratisai S, Rugara M, Rusere P, Sakala J, Sango P, Shava S, Shekede M, Shizha C, Sibanda T, Tapambwa N, Tembo J, Tinago N, Tinago V, Toindepi T, Tovigepi J, Tuhwe M, Tumbo K, Zaranyika T, Zaru T, Zimidzi K, Zindo M, Zindonda M, Zinhumwe N, Zishiri L, Ziyambi E, Zvinowanda J, Bepete E, Chiwira C, Chuma N, Fari A, Gavi S, Gunha V, Hakunandava F, Huku C, Hungwe G, Maduke G, Manyewe E, Mapfumo T, Marufu I, Mashiri C, Mazenge S, Mbinda E, Mhuri A, Muguti C, Munemo L, Musindo L, Ngada L, Nyembe D, Taruvinga R, Tobaiwa E, Banda S, Chaipa J, Chakaza P, Chandigere M, Changunduma A, Chibi C, Chidyagwai O, Chidza E, Chigatse N, Chikoto L, Chingware V, Chinhamo J, Chinhoro M, Chiripamberi A, Chitavati E, Chitiga R, Chivanga N, Chivese T, Chizema F, Dera S, Dhliwayo A, Dhononga P, Dimingo E, Dziyani M, Fambi T, Gambagamba L, Gandiyari S, Gomo C, Gore S, Gundani J, Gundani R, Gwarima L, Gwaringa C, Gwenya S, Hamilton R, Hlabano A, Hofisi E, Hofisi F, Hungwe S, Hwacha S, Hwara A, Jogwe R, Kanikani A, Kuchicha L, Kutsira M, Kuziyamisa K, Kuziyamisa M, Kwangware B, Lozani P, Mabuto J, Mabuto V, Mabvurwa L, Machacha R, Machaya C, Madembo R, Madya S, Madzingira S, Mafa L, Mafuta F, Mafuta J, Mahara A, Mahonye S, Maisva A, Makara A, Makover M, Mambongo E, Mambure M, Mandizvidza E, Mangena G, Manjengwa E, Manomano J, Mapfumo M, Mapfurire A, Maphosa L, Mapundo J, Mare D, Marecha F, Marecha S, Mashiri C, Masiya M, Masuku T, Masvimbo P, Matambo S, Matarise G, Matinanga L, Matizanadzo J, Maunganidze M, Mawere B, Mawire C, Mazvanya Y, Mbasera M, Mbono M, Mhakayakora C, Mhlanga N, Mhosva B, Moyo N, Moyo O, Moyo R, Mpakami C, Mpedzisi R, Mpofu E, Mpofu E, Mtetwa M, Muchakachi J, Mudadada T, Mudzingwa K, Mugwira M, Mukarati T, Munana A, Munazo J, Munyeki O, Mupfeka P, Murangandi G, Muranganwa M, Murenjekwa J, Muringo N, Mushaninga T, Mutaja F, Mutanha D, Mutemeri P, Mutero B, Muteya E, Muvembi S, Muzenda T, Mwenjota A, Ncube S, Ndabambi T, Ndava N, Ndlovu E, Nene E, Ngazimbi E, Ngwalati A, Nyama T, Nzembe A, Pabwaungana E, Phiri S, Pukuta R, Rambanapasi M, Rera T, Samanga V, Shirichena S, Shoko C, Shonhe M, Shuro C, Sibanda J, Sibangani E, Sibangani N, Sibindi N, Sitotombe M, Siwawa P, Tagwirei M, Taruvinga P, Tavagwisa A, Tete E, Tete Y, Thandiwe E, Tibugari A, Timothy S, Tongogara R, Tshuma L, Tsikira M, Tumba C, Watinaye R, Zhiradzango E, Zimunya E, Zinengwa L, Ziupfu M, Ziyambe J. Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial. BMC Pregnancy Childbirth 2022; 22:981. [PMID: 36585673 PMCID: PMC9805263 DOI: 10.1186/s12884-022-05282-x] [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] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions. METHODS This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. RESULTS Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference. CONCLUSIONS Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov, number NCT01824940.
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Affiliation(s)
- Christie Noble
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK
| | - Ciaran Mooney
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beechill House, 42 Beechill Rd, Belfast, BT8 7RL UK
| | - Rachel Makasi
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D. Majo
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - James A. Church
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V. Tavengwa
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Jean H. Humphrey
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Mutasa K, Tome J, Rukobo S, Govha M, Mushayanembwa P, Matimba FS, Chiorera CK, Majo FD, Tavengwa NV, Mutasa B, Chasekwa B, Humphrey JH, Ntozini R, Prendergast AJ, Bourke CD. Stunting Status and Exposure to Infection and Inflammation in Early Life Shape Antibacterial Immune Cell Function Among Zimbabwean Children. Front Immunol 2022; 13:899296. [PMID: 35769481 PMCID: PMC9234645 DOI: 10.3389/fimmu.2022.899296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/18/2022] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Children who are stunted (length-for-age Z-score<-2) are at greater risk of infectious morbidity and mortality. Previous studies suggest that stunted children have elevated inflammatory biomarkers, but no studies have characterised their capacity to respond to new infections (i.e., their immune function). We hypothesised that antibacterial immune function would differ between stunted and non-stunted children and relate to their health and environment during early life. Methods We enrolled a cross-sectional cohort of 113 HIV-negative children nested within a longitudinal cluster-randomised controlled trial of household-level infant and young child feeding (IYCF) and water, sanitation and hygiene (WASH) interventions in rural Zimbabwe (SHINE; Clinical trials registration: NCT01824940). Venous blood was collected at 18 months of age and cultured for 24 h without antigen or with bacterial antigens: heat-killed Salmonella typhimurium (HKST) or Escherichia coli lipopolysaccharide (LPS). TNFα, IL-6, IL-8, IL-12p70, hepcidin, soluble (s)CD163, myeloperoxidase (MPO) and IFNβ were quantified in culture supernatants by ELISA to determine antigen-specific immune function. The effect of stunting status and early-life exposures (anthropometry, inflammation at 18 months, maternal health during pregnancy, household WASH) on immune function was tested in logit and censored log-normal (tobit) regression models. Results Children who were stunted (n = 44) had higher proportions (86.4% vs. 65.2%; 88.6% vs. 73.4%) and concentrations of LPS-specific IL-6 (geometric mean difference (95% CI): 3.46 pg/mL (1.09, 10.80), p = 0.035) and IL-8 (3.52 pg/mL (1.20, 10.38), p = 0.022) than non-stunted children (n = 69). Bacterial antigen-specific pro-inflammatory cytokine concentrations were associated with biomarkers of child enteropathy at 18 months and biomarkers of systemic inflammation and enteropathy in their mothers during pregnancy. Children exposed to the WASH intervention (n = 33) produced higher LPS- (GMD (95% CI): 10.48 pg/mL (1.84, 60.31), p = 0.008) and HKST-specific MPO (5.10 pg/mL (1.77, 14.88), p = 0.003) than children in the no WASH group (n = 80). There was no difference in antigen-specific immune function between the IYCF (n = 55) and no IYCF groups (n = 58). Conclusions Antibacterial immune function among 18-month-old children in a low-income setting was shaped by their stunting status and prior exposure to maternal inflammation and household WASH. Heterogeneity in immune function due to adverse exposures in early life could plausibly contribute to infection susceptibility.
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Affiliation(s)
- Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Joice Tome
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Sandra Rukobo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Margaret Govha
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Farai S. Matimba
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Florence D. Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V. Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Queen Mary University of London, London, United Kingdom
| | - Claire D. Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Queen Mary University of London, London, United Kingdom
- *Correspondence: Claire D. Bourke,
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