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Murray AF, Englund JA, Kuypers J, Tielsch JM, Katz J, Khatry SK, Leclerq SC, Chu HY. Infant Pneumococcal Carriage During Influenza, RSV, and hMPV Respiratory Illness Within a Maternal Influenza Immunization Trial. J Infect Dis 2019; 220:956-960. [PMID: 31056697 PMCID: PMC6688054 DOI: 10.1093/infdis/jiz212] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/25/2019] [Indexed: 01/26/2023] Open
Abstract
In this post-hoc analysis of midnasal pneumococcal carriage in a community-based, randomized prenatal influenza vaccination trial in Nepal with weekly infant respiratory illness surveillance, 457 of 605 (75.5%) infants with influenza, respiratory syncytial virus (RSV), or human metapneumovirus (hMPV) illness had pneumococcus detected. Pneumococcal carriage did not impact rates of lower respiratory tract disease for these 3 viruses. Influenza-positive infants born to mothers given influenza vaccine had lower pneumococcal carriage rates compared to influenza-positive infants born to mothers receiving placebo (58.1% versus 71.6%, P = 0.03). Maternal influenza immunization may impact infant acquisition of pneumococcus during influenza infection. Clinical Trials Registration. NCT01034254.
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Affiliation(s)
- Alastair F Murray
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Janet A Englund
- Seattle Children’s Hospital, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Seattle
| | - James M Tielsch
- Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Joanne Katz
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Steven C Leclerq
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
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Scott E, Kuypers J, Xue K, Stewart L, Shrestha L, Tielsch J, Steinhoff MC, Katz J, Khatry S, Leclerq SC, Bloom J, Englund J, Chu H. 613. Transmission of Influenza Virus in Mother and Infant Transmission Events in Nepal. Open Forum Infect Dis 2018. [PMCID: PMC6254034 DOI: 10.1093/ofid/ofy210.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emily Scott
- School of Medicine, University of Washington, Seattle, Washington
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Katherine Xue
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Laveta Stewart
- Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Laxman Shrestha
- Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Mark C Steinhoff
- Division of Infectious Diseases, Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joanne Katz
- Johns Hopkins University, Baltimore, Maryland
| | | | | | - Jesse Bloom
- Basic Sciences Division and Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janet Englund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Helen Chu
- Medicine, University of Washington, Seattle, Washington
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Murray A, Englund J, Kuypers J, Tielsch J, Katz J, Shrestha L, Khatry S, Leclerq SC, Steinhoff MC, Chu HY. 117. Effect of Nasopharyngeal Pneumococcal Carriage on RSV and hMPV Illness Severity in Infants in Nepal. Open Forum Infect Dis 2018. [PMCID: PMC6253043 DOI: 10.1093/ofid/ofy209.008] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Pneumococcal pneumonia after a preceding respiratory viral illness is associated with morbidity and mortality in infants. Our study sought to determine how pneumococcal carriage impacted illness severity due to respiratory syncytial virus (RSV) or human metapneumovirus (hMPV) in infants 0–6 months in a low resource setting in South Asia without pneumococcal vaccination. Previous studies in this population found an overall 79.4% prevalence of pneumococcal carriage in ages 1–36 months with higher rates of carriage among healthy controls when compared with those with respiratory illness. Methods Infants were enrolled at the time of birth in a maternal influenza immunization trial conducted in rural Nepal from 2011 to 2014. Weekly household-based active surveillance was performed from birth to 6 months to assess for infant respiratory illness, defined as fever, cough, difficulty breathing, wheeze, or otorrhea. Mid-nasal swabs were collected and tested by PCR for RSV, hMPV, and streptococcus pneumoniae with inclusion of first illness episode in the surveillance period. Disease severity was defined using the World Health Organization Integrated Management of Childhood Illness criteria. Results Altogether, 247 (73.5%) of 336 infants with RSV and 154 (83.7%) of 184 infants with hMPV had S. pneumoniae detected. Mean age at RSV illness with concurrent pneumococcal carriage was 97.0 days (91.3–102.6) versus 72.8 days (63.3–82.4) for infants without carriage (P < 0.001). Mean age at hMPV illness with concurrent pneumococcal carriage was 101.3 days (93.9–108.7) versus 77.2 days (56.5–98.0) for infants without carriage (P = 0.01). Frequency of reported lower respiratory tract infection did not differ with or without carriage (RSV: 64.4% vs. 65.2% respectively; P = 0.89, hMPV: 52.6% vs. 50.0% P = 0.79). S. pneumoniae PCR cycle threshold value did not differ by duration or severity of RSV or hMPV illness episode. Conclusion High rates of pneumococcal carriage were observed with RSV and hMPV illness episodes in a birth cohort of infants in rural Nepal. The majority of infants with RSV or hMPV illness had pneumococcus detected at the time of first observed illness. However, no increase in RSV or hMPV illness severity or duration was seen with pneumococcal carriage. ![]()
Disclosures H. Y. Chu, sanofi pasteur: Grant Investigator, Grant recipient. Novavax: Grant Investigator, Grant to co-investigator’s institution.
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Affiliation(s)
- Alastair Murray
- George Washington University School of Medicine, Washington, DC
| | - Janet Englund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, DC
| | - Jane Kuypers
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, DC
| | | | - Joanne Katz
- Johns Hopkins University, Baltimore, Maryland
| | - Laxman Shrestha
- Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | - Mark C Steinhoff
- Division of Infectious Diseases, Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Helen Y Chu
- Allergy and Infectious Diseases, University of Washington, Seattle, Washington, DC
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Newman K, Gustafson K, Englund J, Katz J, Magaret A, Khatry S, Shreshtha L, Leclerq SC, Tielsch J, Steinhoff MC, Chu H. 1096. Effect of Diarrheal Illness During Pregnancy on Adverse Birth Outcomes in Nepal. Open Forum Infect Dis 2018. [PMCID: PMC6255527 DOI: 10.1093/ofid/ofy210.931] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Adverse birth outcomes, including low birthweight (LBW), small-for-gestational-age (SGA) and preterm birth, contribute to 60–80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. We sought to identify whether diarrhea during pregnancy was associated with adverse birth outcomes. Methods We used data from a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011 to 2014. Illness episodes were defined as at least three watery bowel movements per day for one or more days with 7 diarrhea-free days between episodes. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. The c2 test, two-sample t-test, and log-binomial regression were performed to evaluate baseline characteristics and the association between diarrhea during pregnancy and adverse birth outcomes. Results Of 3,682 women in the study, 527 (14.3%) experienced one or more episodes of diarrhea during pregnancy. Diarrhea incidence was not seasonal. Women with diarrhea had a median of one episode of diarrhea (interquartile range (IQR) 1–2 episodes) and two cumulative days of diarrhea (IQR 1–3 days). Of women with diarrhea, 16.1% (85) sought medical care. Mean maternal age, parity, biomass cook stove use, home latrine, water source, caste, and smoking did not differ in pregnant women with and without diarrhea. In crude and adjusted analyses, women with diarrhea during pregnancy were significantly more likely to have SGA infants (42.6% vs. 36.8%; adjusted risk ratio=1.20, 95% CI 1.06–1.36, P = 0.005). LBW and preterm birth incidence did not significantly differ between women with diarrhea during pregnancy and those without. There was no significant association between seeking medical care for diarrhea and birth outcomes. ![]()
Conclusion Diarrheal illness during pregnancy was associated with a significantly higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Kira Newman
- Internal Medicine, University of Washington, Seattle, Washington
| | | | - Janet Englund
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joanne Katz
- Johns Hopkins University, Baltimore, Maryland
| | - Amalia Magaret
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | | | | | | | - Mark C Steinhoff
- Division of Infectious Diseases, Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Helen Chu
- Medicine, University of Washington, Seattle, Washington
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Murray AF, Englund JA, Tielsch JM, Katz J, Shrestha L, Khatry SK, Carlin K, Leclerq SC, Steinhoff MC, Chu HY. Measles and Rubella Seroprevalence in Mother-Infant Pairs in Rural Nepal and the United States: Pre- and Post-Elimination Populations. Am J Trop Med Hyg 2018; 99:1342-1345. [PMID: 30403166 PMCID: PMC6221218 DOI: 10.4269/ajtmh.17-0836] [Citation(s) in RCA: 4] [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: 10/26/2017] [Accepted: 05/22/2018] [Indexed: 12/30/2022] Open
Abstract
We sought to compare seroprevalence of protective measles and rubella-specific antibody in mother-infant pairs across two populations: a pre-disease elimination Nepal population with recently introduced rubella vaccine and post-disease elimination U.S. population. Qualitative measles and rubella immunoglobulin G was assessed in maternal serum and cord blood from 258 pairs in Nepal, 2012-2013 and 49 pairs in Seattle, WA, 2014-2015. High rates of protective antibody were observed in both populations. Two hundred and forty-four (95%) pregnant women in Nepal had protective measles antibody versus 44 (92%) in Seattle (P = 0.42). Ninety-six percent of infants in Nepal (N = 246) and Seattle (N = 43) had protective measles antibody (P = 0.75). Ninety-four percentage of pregnant women in Nepal (N = 242) and Seattle (N = 45) had protective rubella antibody (P = 0.23). Two hundred and thirty-eight (93%) infants in Nepal had protective rubella antibody versus 44 (98%) in Seattle (P = 0.12). Continued surveillance will be necessary to ensure protective immunity, inform progress toward disease elimination in Nepal and avoid reemergence in the United States.
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Affiliation(s)
- Alastair F. Murray
- George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - James M. Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laxman Shrestha
- Department of Pediatrics and Child Health, Nepal Institute of Medicine, Kathmandu
| | - Subarna K. Khatry
- Nepal Nutrition Intervention Project—Sarlahi (NNIPS), Kathmandu, Nepal
| | - Kristen Carlin
- Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington
| | - Steven C. Leclerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark C. Steinhoff
- Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
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Scott A, Englund J, Chu H, Tielsch J, Tielsch J, Khatry S, Leclerq SC, Shrestha L, Kuypers J, Steinhoff MC, Katz J. Meterology-driven Prediction of RSV/RHV Incidence in Rural Nepal. Open Forum Infect Dis 2017. [PMCID: PMC5631296 DOI: 10.1093/ofid/ofx163.873] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Incidence of respiratory syncytial virus (RSV) and rhinovirus (RHV) varies throughout the year. We aim to quantify the relationship between weather variables (temperature, humidity, precipitation, and aerosol concentration) and disease incidence in order to quantify how outbreaks of RSV and RHV are related to seasonal or sub-seasonal meteorology, and if these relationships can predict viral outbreaks of RSV and RHV. Methods Health data were collected in a community-based, prospective randomized trial of maternal influenza immunization of pregnant women and their infants conducted in rural Nepal from 2011–2014. Adult illness episodes were defined as fever plus cough, sore throat, runny nose, and/or myalgia, with infant illness defined similarly but without fever requirement. Cases were identified through longitudinal household-based weekly surveillance. Temperature, humidity, precipitation, and fine particulate matter (PM 2.5) data come from reanalysis data products NCEP, Era-Interim, and Merra-2, which are produced by assimilating historical in-situ and satellite-based observations into a weather model. Results RSV exhibits a relationship with temperature after removing the seasonal cycle (r = -0.16, N = 208, P = 0.02), and RHV exhibits a strong relationship to daily temperature (r =-0.14, N =208, P = 0.05). When lagging meteorology by up to 15 weeks, correlations with disease count and weather improve (RSV: r_max = 0.45, P < 0.05; RHV: r_max = 0.15, P = 0.05). We use an SIR model forced by lagged meteorological variables to predict RSV and RHV, suggesting that disease burden can be predicted at lead times of weeks to months. Conclusion Meteorological variables are associated with RSV and RHV incidence in rural Nepal and can be used to drive predictive models with a lead time of several months. Disclosures J. Englund, Gilead: Consultant and Investigator, Research support Chimerix: Investigator, Research support Alios: Investigator, Research support Novavax: Investigator, Research support MedImmune: Investigator, Research support GlaxoSmithKline: Investigator, Research support
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Affiliation(s)
- Anna Scott
- Johns Hopkins University, Baltimore, Maryland
| | - Janet Englund
- University of Washington/Seattle Children’s Hospital, Seattle, Washington
| | - Helen Chu
- Medicine, University of Washington, Seattle, Washington
| | - James Tielsch
- Global Health, George Washington University, Washington, DC
| | - James Tielsch
- Global Health, George Washington University, Washington, DC
| | | | | | - Laxman Shrestha
- Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Jane Kuypers
- Laboratory Medicine, University of Washington, Seattle, Washington
| | - Mark C Steinhoff
- Division of Infectious Diseases, Global Health Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joanne Katz
- Johns Hopkins University, Baltimore, Maryland
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Philpott E, Englund J, Tielsch J, Katz J, Khatry S, Leclerq SC, Shrestha L, Kuypers J, Steinhoff MC, Chu H. Effect of Febrile Rhinovirus Illness During Pregnancy on Adverse Birth Outcomes in Nepal. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Erin Philpott
- Internal Medicine, University of Washington, Seattle, Washington
| | - Janet Englund
- Infectious Disease/Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
| | - James Tielsch
- Global Health, George Washington University, Washington, District of Columbia
| | - Joanne Katz
- Johns Hopkins University, Baltimore, Maryland
| | | | | | - Laxman Shrestha
- Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Jane Kuypers
- Laboratory Medicine, University of Washington, Seattle, Washington
| | - Mark C. Steinhoff
- Division of Infectious Diseases, Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Helen Chu
- Medicine, University of Washington, Seattle, Washington
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Chu H, Katz J, Tielsch J, Steinhoff MC, Englund J, Kuypers J, Leclerq SC, Khatry S, Magaret A. Respiratory Syncytial Virus Infection in Infants is Associated With Low Mortality in Rural Nepal. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Steinhoff M, Tielsch J, Katz J, Englund J, Kuypers J, Khatry S, Leclerq SC, Shrestha L. Evaluation of Year-Round Maternal Influenza Immunization in Tropical SE Asia: A Placebo-Controlled Randomized Trial. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lenahan JL, Englund J, Tielsch J, Katz J, Khatry S, Leclerq SC, Kuypers J, Steinhoff MC, Chu HY. Human Metapneumovirus Infection in Pregnant and Postpartum Women. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Campbell RK, Talegawkar SA, Christian P, Leclerq SC, Khatry SK, Wu LSF, Stewart CP, West KP. Evaluation of a Novel Single-administration Food Frequency Questionnaire for Assessing Seasonally Varied Dietary Patterns among Women in Rural Nepal. Ecol Food Nutr 2015; 54:314-27. [PMID: 25679094 DOI: 10.1080/03670244.2014.990635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Novel dietary assessment methods are needed to study chronic disease risk in agrarian cultures where food availability is highly seasonal. In 16,320 rural Nepalese women, we tested a novel food frequency questionnaire, administered once, to assess past 7-day intake and usual frequency of intake throughout the year for year-round foods and when in season for seasonal foods. Spearman rank correlations between usual and past 7-day intakes were 0.12-0.85 and weighted kappa statistics, representing chance-corrected agreement, were 0.10-0.80, with better agreement for frequently consumed foods. The questionnaire performed well, but may require refinement for settings of extremely low dietary diversity.
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Affiliation(s)
- Rebecca K Campbell
- a Department of International Health , Johns Hopkins University , Baltimore , Maryland , USA
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Khan RJ, Stewart CP, Christian P, Schulze KJ, Wu L, Leclerq SC, Khatry SK, West KP. A cross-sectional study of the prevalence and risk factors for hypertension in rural Nepali women. BMC Public Health 2013; 13:55. [PMID: 23336578 PMCID: PMC3566953 DOI: 10.1186/1471-2458-13-55] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 12/22/2012] [Indexed: 02/05/2023] Open
Abstract
Background The prevalence of hypertension is increasing in much of the South Asian region, including Nepal. This paper reports the prevalence and risk factors of hypertension and pre-hypertension among adult women in a rural community of Nepal. Methods Cross-sectional data on socioeconomic status (SES), lifestyle factors and blood pressure (BP) were collected from a cohort of 15,934 women in rural Nepal in 2006–08. Among a subsample (n = 1679), anthropometry and biomarkers of cardiovascular risk were measured. Results The mean age of women was 34.2 years (range 16.4-71.2 years). More than three percent (3.3%) had hypertension and 14.4% had pre-hypertension. In an adjusted analysis, lower SES, especially lower household farm assets and storage of food for long term consumption, was associated with increased odds of hypertension (OR = 1.14 for mid-level SES and OR = 1.40 for low SES; p for trend < 0.01). Smoking, alcohol use and not working outside the home were also associated with higher risk. In a subsample, both systolic BP (SBP) and diastolic BP (DBP) were positively associated with high triglycerides (SBP β = 4.1 mm Hg; DBP β =3.6 mm Hg), high HbA1c (SBP β = 14.0; DBP β = 9.2), raised fasting glucose (SBP β = 10.0; DBP β = 6.9), high BMI (SBP β = 6.7; DBP β = 5.1) and high waist circumference (SBP β = 6.2; DBP β = 5.3) after adjusting for potential confounders (p for all <0.01). Conclusions Although the prevalence of hypertension was low in this cohort, it was more prevalent among the poorer women and was strongly associated with other cardiovascular risks. These associations at a relatively young age may confer greater risk for cardiovascular disease among women in later life, indicating the need for interventions to reduce the progression from pre-hypertension to hypertension.
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Affiliation(s)
- Rumana J Khan
- Program in Human Nutrition, Department of International Health Bloomberg, School of Public Health Johns Hopkins University, Baltimore, 21205 MD, USA
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Schmitz J, West KP, Khatry SK, Wu L, Leclerq SC, Karna SL, Katz J, Sommer A, Pillion J. Vitamin A supplementation in preschool children and risk of hearing loss as adolescents and young adults in rural Nepal: randomised trial cohort follow-up study. BMJ 2012; 344:d7962. [PMID: 22234907 PMCID: PMC3254201 DOI: 10.1136/bmj.d7962] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood. DESIGN Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation. SETTING South central, rural Nepal. PARTICIPANTS 2378 adolescents and young adults aged 14 to 23, representing 51% of those who finished the original trial and 71% of those living in the study area in 2006. INTERVENTIONS Every four months for 16 months preschool children were visited at home, given an oral 200,000 IU dose of vitamin A (half dose at age 1-11 months, quarter dose at <1 month) or placebo and the parents were queried about any childhood illnesses in the previous week, including purulent discharge from the ears. MAIN OUTCOME MEASURES Prevalence of mild or worse hearing loss (≥ 30 dB) in the most affected ear and tympanometric measures of middle ear function (peak height, ear canal volume, and gradient). RESULTS During the original trial, the prevalence of middle ear infection during the preschool years did not differ between the supplement groups. By adolescence and early adulthood, a non-significant 17% reduction in hearing loss occurred among those who had periodically received vitamin A compared with placebo as preschool aged children (odds ratio 0.83, 95% confidence interval 0.62 to 1.12). Among participants with any ear discharge in early childhood, vitamin A supplementation was associated with a reduced risk of hearing loss, by 42% (0.58, 0.37 to 0.92) compared with controls, after adjusting the confidence interval for the design effect of the original trial. Abnormal tympanometric peak height of the middle ear system was less likely among participants supplemented with vitamin A in childhood. CONCLUSION In undernourished settings, periodic, high dose vitamin A supplementation may reduce the risk of hearing loss associated with purulent ear infections in early childhood.
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Affiliation(s)
- Jane Schmitz
- Institute for Global Health and Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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Christian P, Murray-Kolb LE, Khatry SK, Katz J, Schaefer BA, Cole PM, Leclerq SC, Tielsch JM. Prenatal micronutrient supplementation and intellectual and motor function in early school-aged children in Nepal. JAMA 2010; 304:2716-23. [PMID: 21177506 DOI: 10.1001/jama.2010.1861] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Iron and zinc are important for the development of both intellectual and motor skills. Few studies have examined whether iron and zinc supplementation during gestation, a critical period of central nervous system development, affects children's later functioning. OBJECTIVE To examine intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy. DESIGN, SETTING, AND PARTICIPANTS Cohort follow-up of 676 children aged 7 to 9 years in June 2007-April 2009 who had been born to women in 4 of 5 groups of a community-based, double-blind, randomized controlled trial of prenatal micronutrient supplementation between 1999 and 2001 in rural Nepal. Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial. INTERVENTIONS Women whose children were followed up had been randomly assigned to receive daily iron/folic acid, iron/folic acid/zinc, or multiple micronutrients containing these plus 11 other micronutrients, all with vitamin A, vs a control group of vitamin A alone from early pregnancy through 3 months postpartum. These children did not receive additional micronutrient supplementation other than biannual vitamin A supplementation. MAIN OUTCOME MEASURES Children's intellectual functioning, assessed using the Universal Nonverbal Intelligence Test (UNIT); tests of executive function, including go/no-go, the Stroop test, and backward digit span; and motor function, assessed using the Movement Assessment Battery for Children (MABC) and finger-tapping test. RESULTS The difference across outcomes was significant (Bonferroni-adjusted P < .001) for iron/folic acid vs control but not for other supplement groups. The mean UNIT T score in the iron/folic acid group was 51.7 (SD, 8.5) and in the control group was 48.2 (SD, 10.2), with an adjusted mean difference of 2.38 (95% confidence interval [CI], 0.06-4.70; P = .04). Differences were not significant between the control group and either the iron/folic acid/zinc (0.73; 95% CI, -0.95 to 2.42) or multiple micronutrient (1.00; 95% CI, -0.55 to 2.56) groups. In tests of executive function, scores were better in the iron/folic acid group relative to the control group for the Stroop test (adjusted mean difference in proportion who failed, -0.14; 95% CI, -0.23 to -0.04) and backward digit span (adjusted mean difference, 0.36; 95% CI, 0.01-0.71) but not for the go/no-go test. The MABC score was lower (better) in the iron/folic acid group compared with the control group but not after adjustment for confounders (mean difference, -1.47; 95% CI, -3.06 to 0.12; P = .07). Finger-tapping test scores were higher (mean difference, 2.05; 95% CI, 0.87-3.24; P = .001) in the iron/folic acid group. CONCLUSION Aspects of intellectual functioning including working memory, inhibitory control, and fine motor functioning among offspring were positively associated with prenatal iron/folic acid supplementation in an area where iron deficiency is prevalent. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00115271.
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Affiliation(s)
- Parul Christian
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room W2041, Baltimore, MD 21205, USA.
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Mullany LC, Katz J, Khatry SK, Leclerq SC, Darmstadt GL, Tielsch JM. Incidence and seasonality of hypothermia among newborns in southern Nepal. Arch Pediatr Adolesc Med 2010; 164:71-7. [PMID: 20048245 PMCID: PMC4546825 DOI: 10.1001/archpediatrics.2009.239] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To quantify incidence, age distribution, and seasonality of neonatal hypothermia among a large population cohort. DESIGN Longitudinal cohort study. SETTING Sarlahi, Nepal. PARTICIPANTS A total of 23 240 newborns born between September 2, 2002, and February 1, 2006. Main Exposures Community-based workers recorded axillary temperature on days 1 through 4, 6, 8, 10, 12, 14, 21, and 28 (213 636 total measurements). MAIN OUTCOME MEASURES Regression smoothing was used to describe axillary temperature patterns during the newborn period. Hypothermia incidence in the first day, week, and month were estimated using standard cutoffs. Ambient temperatures allowed comparison of mild hypothermia (36.0 degrees C to <36.5 degrees C) and moderate or severe hypothermia (<36.0 degrees C) incidence over mean ambient temperature quintiles. RESULTS Measurements lower than 36.5 degrees C were observed in 21 459 babies (92.3%); half (48.6%) had moderate or severe hypothermia, and risk peaked in the first 24 to 72 hours of life. Risk of moderate or severe hypothermia increased by 41.3% (95% confidence interval, 40.0%-42.7%) for every 5 degrees C decrease in average ambient temperature. Relative to the highest quintile, risk was 4.03 (95% confidence interval, 3.77-4.30) times higher among babies exposed to the lowest quintile of average ambient temperature. In the hot season, one-fifth of the babies (18.2%) were observed below the moderate hypothermia cutoff. CONCLUSIONS Mild or moderate hypothermia was nearly universal, with substantially higher risk in the cold season. However, incidence in the hot season was also high; thus, year-round thermal care promotion is required. Research on community, household, and caretaker practices associated with hypothermia can guide behavioral interventions to reduce risk.
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Affiliation(s)
- Luke C Mullany
- International Center for Advancing Neonatal Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Ste E8646, Baltimore, MD 21205,USA.
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Stewart CP, Christian P, Schulze KJ, Leclerq SC, West KP, Khatry SK. Antenatal micronutrient supplementation reduces metabolic syndrome in 6- to 8-year-old children in rural Nepal. J Nutr 2009; 139:1575-81. [PMID: 19549749 DOI: 10.3945/jn.109.106666] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Previously, we showed that antenatal micronutrient supplementation increases birth weight in a malnourished rural South Asian setting, but the long-term effects are unknown. Between 1999 and 2001, pregnant women were sector-randomized to receive from early pregnancy through 3 mo postpartum daily micronutrient supplements containing either vitamin A alone as the control or with folic acid; folic acid+iron; folic acid+iron+zinc; or a multiple micronutrient supplement that included the above nutrients plus 11 others. From 2006 to 2008, 3524 children (93% of surviving children) were revisited between the ages of 6 and 8 y. Blood pressure, BMI, waist circumference, glycated hemoglobin, cholesterol, triglycerides, glucose, insulin, and the urinary microalbumin:creatinine ratio were assessed among children. Insulin resistance was estimated using the homeostasis model assessment (HOMA) and metabolic syndrome was defined using a modified National Cholesterol Education Program definition. None of the micronutrient supplement combinations affected blood pressure, cholesterol, triglycerides, glucose, insulin, or HOMA. There was a reduced risk of microalbuminuria (> or =3.40 mg/mmol creatinine) in the folic acid [odds ratio (OR), 0.56; 95%CI, 0.33-0.93; P = 0.02) and folic acid+iron+zinc (OR, 0.53; CI, 0.32-0.89; P = 0.02) groups and a reduced risk of metabolic syndrome in the folic acid group (OR, 0.63; CI, 0.41-0.97; P = 0.03). Maternal supplementation with folic acid or folic acid+iron+zinc reduced the risk of kidney dysfunction and, to some extent, metabolic syndrome among children at 6-8 y of age. Supplementation with multiple micronutrients had no such affect. Future follow-up studies are needed to examine long-term supplementation effects on risk of chronic diseases in adults.
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Affiliation(s)
- Christine P Stewart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Coles CL, Sherchand JB, Khatry SK, Katz J, Leclerq SC, Mullany LC, Tielsch JM. Nasopharyngeal carriage of S. pneumoniae among young children in rural Nepal. Trop Med Int Health 2009; 14:1025-33. [PMID: 19563428 DOI: 10.1111/j.1365-3156.2009.02331.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide epidemiologic data on Streptococcus pneumoniae (Spn) carriage in Nepal. METHODS Prospective, population-based study among children in Sarlahi, Nepal to estimate carriage prevalence, identify risk factors, and determine antibiotic susceptibility patterns and serotype distribution. Between December 2003 and July 2004, NP specimens were collected from 604 children aged 1-36 months with acute lower respiratory infection (ALRI) and 604 healthy, age- and season-matched controls. RESULTS Of the 1100 specimens analysed, carriage prevalence was approximately 80% in both groups. In the multivariate analyses, significant risk factors for Spn carriage in controls were Muslim religion [adjusted odds ratio (AOR): 2.93] and no latrine in the household (AOR: 2.41). Those treated for a recent illness had lower carriage rates (AOR: 0.37). Results were similar for ALRI cases with the addition of age >or=12 months (AOR: 1.68), and symptomatic infection (AOR: 3.78) as risk factors. The antibiotics and proportions of isolates resistant to them were as follows: penicillin 4.5%, cotrimoxazole 89.2%, chloramphenicol 1.4%, erythromycin 1.5% and tetracycline 22.7%. The most prevalent serogroups/types were 6, 19, 23, 15, 9 and 10. CONCLUSIONS Young children in rural Nepal experience high rates of Spn carriage. Most isolates were resistant to cotrimoxazole. Current conjugate Spn vaccines may substantially reduce the risk of a severe pneumonia and other Spn infections.
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Affiliation(s)
- Christian L Coles
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Christian P, Darmstadt GL, Wu L, Khatry SK, Leclerq SC, Katz J, West KP, Adhikari RK. The effect of maternal micronutrient supplementation on early neonatal morbidity in rural Nepal: a randomised, controlled, community trial. Arch Dis Child 2008; 93:660-4. [PMID: 18644934 DOI: 10.1136/adc.2006.114009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Micronutrient deficiencies during pregnancy may be linked to poor newborn health and poor host defences against infection. We assessed newborn morbidity to determine the effect of four combinations of antenatal micronutrient supplements. DESIGN Cluster-randomised, double-masked, controlled trial. SETTING Rural community in Nepal. INTERVENTIONS Women received daily supplements from early pregnancy through to 3 months postpartum of vitamin A alone (control) or vitamin A with folic acid, folic acid plus iron, folic acid plus iron plus zinc or a multiple micronutrient supplement containing these and 11 other nutrients. MAIN OUTCOME MEASURES Infants were visited in their home at birth (n = 3927) and for each of 9 days thereafter to elicit a 24-h history of nine infant morbidity symptoms, measure infant respiratory rate and axial temperature, and assess the infant for chest indrawing. At 6 weeks of age, infants were visited again in their homes to elicit a 30-day and 7-day history of 10 morbidity symptoms using parental recall. RESULTS Maternal micronutrient supplementation had no effect on 10-day morbidity or morbidity 30-day and 7-day morbidity assessed at 6 weeks of age all relative risks were close to 1. Symptoms of birth asphyxia increased by about 60% (p<0.05) in infants of women who received the multiple micronutrient supplement compared with the control. Symptoms of combinations of sepsis, preterm and birth asphyxia were associated with 8- to 14-fold increased odds of 6-month infant mortality. CONCLUSIONS None of the combinations of antenatal micronutrient supplements tested improved symptoms of neonatal morbidity in the first 10 days of life or at 6 weeks of age. Further research is needed to elucidate the association and mechanism of increased risk of birth asphyxia following maternal multiple micronutrient supplementation. TRIAL REGISTRATION NUMBERS NCT00115271.
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Affiliation(s)
- P Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA.
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Mullany LC, Darmstadt GL, Khatry SK, Leclerq SC, Tielsch JM. Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal. Eur J Clin Nutr 2006; 61:40-6. [PMID: 16885929 PMCID: PMC2329807 DOI: 10.1038/sj.ejcn.1602504] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Classification of infants into low birth weight (LBW, <2500 g) or very low birth weight (VLBW, <2000 g) categories is a crucial step in targeting interventions to high-risk infants. OBJECTIVE To compare the validity of chest circumference and foot length as surrogate anthropometric measures for the identification of LBW and VLBW infants. SUBJECTS AND SETTING Newborn infants (n=1640) born between March and June 2004 in 30 Village Development Committees of Sarlahi district, Nepal. DESIGN Chest circumference, foot length and weight (SECA 727, precise to 2 g) of newborns were measured within 72 h after birth. The sensitivity, specificity and predictive values for a range of cutoff points of the anthropometric measures were estimated using the digital scale measurements as the gold standard. RESULTS Among LBW infants (469/1640, 28.6%), chest circumference measures <30.3 cm were 91% sensitive and 83% specific. Similar levels of sensitivity for foot length were achieved only with considerable loss of specificity (<45%). Foot length measurements <6.9 cm were 88% sensitive and 86% specific for the identification of VLBW infants. CONCLUSION Chest circumference was superior to foot length in classification of infants into birth weight categories. For the identification of VLBW infants, foot length performed well, and may be preferable to chest circumference, as the former measure does not require removal of infant swaddling clothes. In the absence of more precise direct measures of birth weight, chest circumference is recommended over foot length for the identification of LBW infants.
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Affiliation(s)
- L C Mullany
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2103, USA.
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Siegel EH, Stoltzfus RJ, Khatry SK, Leclerq SC, Katz J, Tielsch JM. Epidemiology of anemia among 4- to 17-month-old children living in south central Nepal. Eur J Clin Nutr 2006; 60:228-35. [PMID: 16234835 PMCID: PMC1360164 DOI: 10.1038/sj.ejcn.1602306] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the distribution of hemoglobin and prevalence of anemia in Nepali children living in the Terai region by potential risk factors for deficiency. DESIGN This was a cross-sectional, community-based study of baseline characteristics of children enrolled in a randomized, placebo-controlled clinical trial between January and March 2002. Participants were weighed and measured and had their blood drawn. Their mothers contributed demographic, morbidity, and feeding data. SUBJECTS There were 569 4- to 17-month-old children. Statistical models were based on 490 children. RESULTS Anemia was prevalent: 58% of the children had a hemoglobin <105 g/l. Iron-deficiency anemia (anemia with erythrocyte protoporphyrin (EP) > or =90 micromol/mol heme) was present in 43% of the children. Severe anemia was rare: less than 2% of the children had a hemoglobin <70 g/l. The mean (s.d.) hemoglobin concentration was 101 (12.5) g/l. Stunting and wasting were prevalent: 30.8% were stunted (length-for-age Z-score <-2) and 18.1% were wasted (weight-for-length Z-score <-2). Bivariate analyses revealed that age, caste, socioeconomic status, dietary diversity, stunting, and underweight were associated with hemoglobin concentration and/or anemia. In multivariate models with and without EP, age and caste were found to be strong predictors of both hemoglobin concentration and anemia. CONCLUSIONS Anemia and iron deficiency increased strongly with age and low-caste status among the study children. The data reveal the importance of targeting interventions to children in the first year of life before they become anemic and iron deficient.
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Affiliation(s)
- E H Siegel
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
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Christian P, West KP, Khatry SK, Leclerq SC, Pradhan EK, Katz J, Shrestha SR, Sommer A. Effects of maternal micronutrient supplementation on fetal loss and infant mortality: a cluster-randomized trial in Nepal. Am J Clin Nutr 2003; 78:1194-202. [PMID: 14668283 DOI: 10.1093/ajcn/78.6.1194] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We previously reported that maternal micronutrient supplementation in rural Nepal decreased low birth weight by approximately 15%. OBJECTIVE We examined the effect of daily maternal micronutrient supplementation on fetal loss and infant mortality. DESIGN The study was a double-blind, cluster-randomized, controlled trial among 4926 pregnant women and their 4130 infants in rural Nepal. In addition to vitamin A (1000 microg retinol equivalents), the intervention groups received either folic acid (FA; 400 microg), FA + iron (60 mg), FA + iron + zinc (30 mg), or multiple micronutrients (MNs; the foregoing plus 10 microg vitamin D, 10 mg vitamin E, 1.6 mg thiamine, 1.8 mg riboflavin, 2.2 mg vitamin B-6, 2.6 microg vitamin B-12, 100 mg vitamin C, 64 microg vitamin K, 20 mg niacin, 2 mg Cu, and 100 mg Mg). The control group received vitamin A only. RESULTS None of the supplements reduced fetal loss. Compared with control infants, infants whose mothers received FA alone or with iron or iron + zinc had a consistent pattern of 15-20% lower 3-mo mortality; this pattern was not observed with MNs. The effect on mortality was restricted to preterm infants, among whom the relative risks (RRs) were 0.36 (95% CI: 0.18, 0.75) for FA, 0.53 (0.30, 0.92) for FA + iron, 0.77 (0.45, 1.32) for FA + iron + zinc, and 0.70 (0.41, 1.17) for MNs. Among term infants, the RR for mortality was close to 1 for all supplements except MNs (RR: 1.74; 95% CI: 1.00, 3.04). CONCLUSIONS Maternal micronutrient supplementation failed to reduce overall fetal loss or early infant mortality. Among preterm infants, FA alone or with iron reduced mortality in the first 3 mo of life. MNs may increase mortality risk among term infants, but this effect needs further evaluation.
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Affiliation(s)
- Parul Christian
- Department of International Health, The Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Room 2041, Baltimore, MD 21205-2179, USA.
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Pradhan EK, West KP, Katz J, Christian P, Khatry SK, Leclerq SC, Dali SM, Shrestha SR. Risk of death following pregnancy in rural Nepal. Bull World Health Organ 2002; 80:887-91. [PMID: 12481211 PMCID: PMC2567681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVE To investigate the length of time following pregnancy during which the risk of mortality was elevated among women in rural Nepal. METHODS An analysis was performed of prospective data on women participating in the control group of a large, population-based trial. Weekly visits were made for three years to 14805 women aged 14-45 years. Pregnancy and vital status were assessed. A total of 7325 pregnancies were followed. Mortality during and following pregnancy, expressed on a person-time basis, was compared to referent mortality unrelated to pregnancy (52 weeks after pregnancy) in the same cohort. FINDINGS The relative risk (RR) of death during pregnancy but before the onset of labour was 0.93 (95% confidence interval (CI): 0.38-2.32). During the perinatal period, defined as lasting from the onset of labour until seven days after outcome, the RR of death was 37.02 (95% CI: 15.03-90.92). The RR for 2 to 6 weeks, 7 to 12 weeks, and 13 to 52 weeks after pregnancy were 4.82, 2.59 and 1.01 with 95% CI of 1.77-13.07, 0.81-8.26 and 0.40-2.53, respectively. The RR of death was 2.21 (95% CI. 1.03-4.71) during the conventional maternal mortality period (pregnancy until 6 weeks after outcome). It was 2.26 (95% CI: 1.05-4.90) when the period was extended to 12 weeks after pregnancy outcome. CONCLUSION The risk of mortality associated with pregnancy should be assessed over the first 12 weeks following outcome instead of over the first 6 weeks.
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Affiliation(s)
- Elizabeth Kimbrough Pradhan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205-2103, USA.
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Katz J, Khatry SK, West KP, Humphrey JH, Leclerq SC, Kimbrough E, Pohkrel PR, Sommer A. Night blindness is prevalent during pregnancy and lactation in rural Nepal. J Nutr 1995; 125:2122-7. [PMID: 7643246 DOI: 10.1093/jn/125.8.2122] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.7] [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] [Indexed: 01/26/2023] Open
Abstract
The prevalence of night blindness during pregnancy and lactation was assessed in a sample of 426 women living in the rural terai of Nepal. These women were also examined for ocular signs of vitamin A deficiency. Among 241 lactating women, 16.2% reported experiencing night blindness at some time during the pregnancy that produced the infant they were now breast-feeding. Among 185 pregnant women, 8.1% reported being night-blind at the time of the interview. The odds of night blindness in the current pregnancy were six times greater for women who reported night blindness in their previous pregnancy. Night-blind women were more likely to come from households with lower socioeconomic status. Teenage women and those over the age of 30 were at highest risk, particularly those of higher parity within these age groups. Vitamin A deficiency, for which night blindness is a marker, seems to be a problem in this population of pregnant and lactating women, with potential health consequences for women and their infants.
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Affiliation(s)
- J Katz
- Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205-2103, USA
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