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Background The effect of dietary macronutrient composition on the rate of gestational weight gain among women in sub-Saharan Africa is unclear.Objective To examine the effect of macronutrient intake on the rate of gestational weight gain among HIV-negative women in Tanzania.Methods The weights of 8,428 women were measured monthly from 12 weeks of gestation to term. Prenatal dietary intake was estimated as the cumulative average of multiple 24-hour dietary recalls. The association between energy intake and percentage of energy from carbohydrate, protein, and total fat and rate of weight gain (grams per month) was estimated from generalized estimating equation models. Macronutrient effects were adjusted for total energy using the nutrient density model and maternal age, maternal height, maternal mid-upper-arm circumference, parity, marital status, maternal occupation, maternal education, household wealth, season, and treatment regimen assignment. Body mass index (BMI) was considered as a confounder and a potential modifier of the effect of macronutrient intake on gestational weight gain.Results A 6 g/month increase in rate of weight gain was associated with every 100-kcal increment in daily total energy intake (95% CI, 1 to 12; p= .03). Analyses substituting 5% of energy from fat by protein showed that weight gain would decrease by 72 g/month (95% CI, 6 to 140; p= .03); substituting 5% of energy from carbohydrate by protein decreased gain by 70 g/month (95% CI, 15 to 124; p= .01). Baseline BMI did not modify these associations.Conclusions Further research on the effects of macronutrient composition on gestational weight gain is needed to inform the design of supplementation programs for women in developing countries.

Vitamin D may help prevent adverse pediatric outcomes, including infectious diseases and growth failure, based on its role in immune and metabolic functions. We examined the association of maternal vitamin D status and pediatric health outcomes in children born to human immunodeficiency virus (HIV)-infected women.

To determine the association between the timing of mother-to-child transmission of human immunodeficiency virus (HIV)-1 and neurodevelopment among children born to HIV-1 infected mothers in Tanzania.

Workers in small-scale wood industries (SSWI) have increased risks of developing asthma and other respiratory diseases. Wood dust and microbial agents have both been suggested to play a role, but few studies have measured endotoxin exposure in SSWI in Africa. We assessed inhalable dust levels in 281 samples from 115 workers and bacterial endotoxins levels in 157 samples from 136 workers from SSWI in Dar es Salaam, Tanzania. The overall geometric mean of personal exposure was 3.3 mg/m3; geometric standard deviation (GSD) 2.5; range 0.45–67.0 mg/m3) and 91 EU/m3(GSD 3.7; range 9–4914.8 EU/m3) for wood dust and endotoxins, respectively. Dust and endotoxin levels were weakly correlated (r=0.44, n=157, P<0.0001). Between- and within-worker variances and percentages explained by the differences among job titles and seasons were 0.31 (9%) and 0.35 (30%), respectively, for wood dust exposure, and 0.35 (0%) and 0.35 (38%) for endotoxin exposure. Higher dust and endotoxin exposure levels were observed in the dry compared to the wet season, after correcting for differences in exposure between jobs. Carving and manual cleaning were associated with the highest dust exposures. Sewing seat covers and manual cleaning were associated with the highest endotoxin exposures. Dust and endotoxin exposure levels in SSWI are high and appropriate control measures are necessary.Journal of Exposure Analysis and Environmental Epidemiology (2004) 14, 544–550. doi:10.1038/sj.jea.7500375 Published online 28 April 2004

The relationship between low birth weight and infant mortality among children born to human immunodeficiency virus (HIV)-infected mothers has not been thoroughly investigated.

ObjectiveTo examine the association between maternal HIV infection and pregnancy outcomes controlling for potential confounding factors among a cohort of HIV‐uninfected and HIV‐infected pregnant women in Dar es Salaam, Tanzania.

The mother’s micronutrient status is a key determinant of fetal growth and survival. While iron and folate supplements now are provided to pregnant women in many developing countries, the dietary intake of other micronutrients often is inadequate. Multivitamin supplements have significantly lowered rates of fetal death, preterm birth, and low birth weight in HIV-positive Tanzanian women. The present, similarly designed trial was done to learn whether supplements are equally effective in HIV-negative women. The double-blind trial enrolled 8468 women at 12–27 weeks’ gestational age, all of whom received supplemental iron and folic acid prenatally. Participants received either a multivitamin supplement or placebo daily up to 6 weeks after delivery. The supplement included 20 mg of vitamin B1, 20 mg of vitamin B2, 25 mg of vitamin B6, 100 mg of niacin, 50 g of vitamin B12, 500 mg of vitamin C, 30 mg of vitamin E, and 0.8 mg of folic acid. These doses were, on average, at least twice the recommended dietary allowance (RDA) and, in several instances, 6–10 times the RDA. Vitamin A and zinc were omitted.