474 results on '"Humphrey, Jean"'
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2. Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials.
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Dewey, Kathryn G, Arnold, Charles D, Wessells, K Ryan, Prado, Elizabeth L, Abbeddou, Souheila, Adu-Afarwuah, Seth, Ali, Hasmot, Arnold, Benjamin F, Ashorn, Per, Ashorn, Ulla, Ashraf, Sania, Becquey, Elodie, Brown, Kenneth H, Christian, Parul, Colford, John M, Dulience, Sherlie Jl, Fernald, Lia Ch, Galasso, Emanuela, Hallamaa, Lotta, Hess, Sonja Y, Humphrey, Jean H, Huybregts, Lieven, Iannotti, Lora L, Jannat, Kaniz, Lartey, Anna, Le Port, Agnes, Leroy, Jef L, Luby, Stephen P, Maleta, Kenneth, Matias, Susana L, Mbuya, Mduduzi Nn, Mridha, Malay K, Nkhoma, Minyanga, Null, Clair, Paul, Rina R, Okronipa, Harriet, Ouédraogo, Jean-Bosco, Pickering, Amy J, Prendergast, Andrew J, Ruel, Marie, Shaikh, Saijuddin, Weber, Ann M, Wolff, Patricia, Zongrone, Amanda, and Stewart, Christine P
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Humans ,Growth Disorders ,Cachexia ,Lipids ,Dietary Supplements ,Child ,Child ,Preschool ,Infant ,Randomized Controlled Trials as Topic ,Nutrients ,child undernutrition ,complementary feeding ,home fortification ,severe malnutrition ,stunting ,wasting ,Prevention ,Clinical Research ,Nutrition ,Clinical Trials and Supportive Activities ,Pediatric ,Zero Hunger ,Engineering ,Medical and Health Sciences ,Nutrition & Dietetics - Abstract
BackgroundMeta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.ObjectivesWe aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < -3) and severe stunting (length-for-age z score < -3).MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.ResultsSQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 95% CI: 0.55, 0.86; n = 34,373] and 17% in severe stunting (PR: 0.83; 95% CI: 0.78, 0.90; n = 36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded (PR: 0.74; 95% CI: 0.57, 0.96; n = 26,327 for severe wasting and PR: 0.88; 95% CI: 0.81, 0.95; n = 28,742 for severe stunting). Study-level characteristics generally did not significantly modify the effects of SQ-LNSs, but results suggested greater effects of SQ-LNSs in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.ConclusionsIncluding SQ-LNSs in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. This meta-analysis was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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- 2022
3. Quality of vital event data for infant mortality estimation in prospective, population-based studies: an analysis of secondary data from Asia, Africa, and Latin America
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Erchick, Daniel J., Subedi, Seema, Verhulst, Andrea, Guillot, Michel, Adair, Linda S., Barros, Aluísio J. D., Chasekwa, Bernard, Christian, Parul, da Silva, Bruna Gonçalves C., Silveira, Mariângela F., Hallal, Pedro C., Humphrey, Jean H., Huybregts, Lieven, Kariuki, Simon, Khatry, Subarna K., Lachat, Carl, Matijasevich, Alicia, McElroy, Peter D., Menezes, Ana Maria B., Mullany, Luke C., Perez, Tita Lorna L., Phillips-Howard, Penelope A., Roberfroid, Dominique, Santos, Iná S., ter Kuile, Feiko O., Ravilla, Thulasiraj D., Tielsch, James M., Wu, Lee S. F., and Katz, Joanne
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- 2023
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4. The gut microbiome and early-life growth in a population with high prevalence of stunting
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Robertson, Ruairi C., Edens, Thaddeus J., Carr, Lynnea, Mutasa, Kuda, Gough, Ethan K., Evans, Ceri, Geum, Hyun Min, Baharmand, Iman, Gill, Sandeep K., Ntozini, Robert, Smith, Laura E., Chasekwa, Bernard, Majo, Florence D., Tavengwa, Naume V., Mutasa, Batsirai, Francis, Freddy, Tome, Joice, Stoltzfus, Rebecca J., Humphrey, Jean H., Prendergast, Andrew J., and Manges, Amee R.
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- 2023
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5. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials.
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Dewey, Kathryn G, Wessells, K Ryan, Arnold, Charles D, Prado, Elizabeth L, Abbeddou, Souheila, Adu-Afarwuah, Seth, Ali, Hasmot, Arnold, Benjamin F, Ashorn, Per, Ashorn, Ulla, Ashraf, Sania, Becquey, Elodie, Bendabenda, Jaden, Brown, Kenneth H, Christian, Parul, Colford, John M, Dulience, Sherlie JL, Fernald, Lia CH, Galasso, Emanuela, Hallamaa, Lotta, Hess, Sonja Y, Humphrey, Jean H, Huybregts, Lieven, Iannotti, Lora L, Jannat, Kaniz, Lartey, Anna, Le Port, Agnes, Leroy, Jef L, Luby, Stephen P, Maleta, Kenneth, Matias, Susana L, Mbuya, Mduduzi NN, Mridha, Malay K, Nkhoma, Minyanga, Null, Clair, Paul, Rina R, Okronipa, Harriet, Ouédraogo, Jean-Bosco, Pickering, Amy J, Prendergast, Andrew J, Ruel, Marie, Shaikh, Saijuddin, Weber, Ann M, Wolff, Patricia, Zongrone, Amanda, and Stewart, Christine P
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Humans ,Child Nutrition Disorders ,Lipids ,Child Development ,Nutritional Status ,Dietary Supplements ,Child ,Preschool ,Infant ,Africa South of the Sahara ,Haiti ,Bangladesh ,Female ,Male ,Randomized Controlled Trials as Topic ,Infant Nutritional Physiological Phenomena ,Effect Modifier ,Epidemiologic ,child undernutrition ,complementary feeding ,home fortification ,nutrient supplements ,stunting ,wasting ,Clinical Trials and Supportive Activities ,Clinical Research ,Nutrition ,Pediatric ,Prevention ,Zero Hunger ,Good Health and Well Being ,Engineering ,Medical and Health Sciences ,Nutrition & Dietetics - Abstract
BackgroundMeta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design.ObjectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.ResultsSQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (
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- 2021
6. The Lancet Commission on water, sanitation and hygiene, and health
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Commissioners of the Lancet Commission on Water, Sanitation and Hygiene, Amebelu, Argaw, Ban, Radu, Bhagwan, Jay, brown, Joe, Chilengi, Roma, Chandler, Clare, Colford, John Matthew, Cumming, Oliver, Curtis, Valerie, Evans, Barbara Elvy, Freeman, Matthew Charles, Guiteras, Raymond, Howard, Guy, Humphrey, Jean, Kang, Gagandeep, Kulabako, Robinah, Lanata, Claudio Franco, Montgomery, Maggie Ann, Pickering, Amy Janel, Null, Clair, and Wolf, Jennyfer
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COVID-19 ,Developing Countries ,Global Health ,Human Rights ,Humans ,Hygiene ,Public Health ,Sanitation ,Sustainable Development ,Water Supply ,Commissioners of the Lancet Commission on Water ,Sanitation and Hygiene ,and Health ,Medical and Health Sciences ,General & Internal Medicine - Published
- 2021
7. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials
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Dewey, Kathryn, Wessells, Ryan, Arnold, Charles, Prado, Elizabeth, Abbeddou, Souheila, Adu-Afarwuah, Seth, Ali, Hasmot, Arnold, Benjamin, Ashorn, Per, Ashorn, Ulla, Ashraf, Sania, Becquey, Elodie, Bendabenda, Jaden, Brown, Kenneth, Christian, Parul, Colford, John, Dulience, Sherlie, Fernald, Lia CH, Galasso, Emanuela, Hallamaa, Lotta, Hess, Sonja, Humphrey, Jean, Huybregts, Lieven, Iannotti, Lora, Jannat, Kaniz, Lartey, Anna, Port, Agnes Le, Leroy, Jef, Luby, Stephen, Maleta, Kenneth, Matias, Susana, Mbuya, Mduduzi NN, Mridha, Malay, Nkhoma, Minyanga, Null, Clair, Paul, Rina, Okronipa, Harriet, Ouédraogo, Jean-Bosco, Pickering, Amy, Prendergast, Andrew, Ruel, Marie, Shaikh, Saijuddin, Weber, Ann, Wolff, Patricia, Zongrone, Amanda, and Stewart, Christine
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Clinical Research ,Clinical Trials and Supportive Activities ,Nutrition ,Pediatric ,Zero Hunger ,Good Health and Well Being - Abstract
ABSTRACT Background Meta-analyses have demonstrated that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce stunting and wasting prevalence among infants and young children. Identification of subgroups who benefit most from SQ-LNS may facilitate program design. Objective Our objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child growth outcomes. Methods We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n=37,066). We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models, with random-effects models as sensitivity analyses. We used random effects meta-regression to examine study-level effect modifiers. Heterogeneity was assessed using I 2 and Tau 2 statistics. Sensitivity analyses were conducted to examine whether results differed depending on inclusion criteria for arms within trials and types of comparisons. Results SQ-LNS provision decreased stunting (length-for-age z-score < −2) by 12% (relative reduction), wasting (weight-for-length (WLZ) z-score < −2) by 14%, low mid-upper arm circumference (MUAC < 125 mm or MUACZ < −2) by 18%, acute malnutrition (WLZ < −2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z-score < −2) by 13%, and small head size (head-circumference z-score < −2) by 9%. Effects of SQ-LNS on growth outcomes generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact or average reported compliance with SQ-LNS. Effects of SQ-LNS on stunting, wasting, low MUAC and small head size were greater among girls than among boys; effects on stunting, underweight and low MUAC were greater among later-born (vs. first-born) children; and effects on wasting and acute malnutrition were greater among children in households with improved (vs. unimproved) sanitation. Results were similar across sensitivity analyses. Conclusions The positive impact of SQ-LNS on growth is apparent across a wide variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNS in the mix of interventions to prevent both stunting and wasting. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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- 2021
8. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting
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Ashorn, Per, Black, Robert E, Lawn, Joy E, Ashorn, Ulla, Klein, Nigel, Hofmeyr, G Justus, Temmerman, Marleen, Askari, Sufia, Ohuma, Eric O, Moller, Ann-Beth, Bradley, Ellen, Chakwera, Samuel, Hussain-Alkhateeb, Laith, Lewin, Alexandra, Okwaraji, Yemisrach B, Retno Mahanani, Wahyu, White Johansson, Emily, Lavin, Tina, Estevez Fernandez, Diana, Gatica Domínguez, Giovanna, de Costa, Ayesha, Cresswell, Jenny A, Krasevec, Julia, Blencowe, Hannah, Requejo, Jennifer, Moran, Allisyn C, Pingray, Veronica, Cormick, Gabriela, Gibbons, Luz, Belizan, José, Guevel, Carlos, Warrilow, Kara, Gordon, Adrienne, Flenady, Vicki, Sexton, Jessica, Lawford, Harriet, Paixao, Enny S., Rocha Falcão, Ila, Lima Barreto, Mauricio, Lisonkova, Sarka, Wen, Qi, Mardones, Francisco, Caulier-Cisterna, Raúl, Acuña, José, Velebil, Petr, Jirova, Jitka, Horváth-Puhó, Erzsébet, Sørensen, Henrik Toft, Sakkeus, Luule, Abuladze, Liili, Gissler, Mika, Moradi-Lakeh, Maziar, Heidarzadeh, Mohammad, Khalili, Narjes, A. Yunis, Khalid, Al Bizri, Ayah, Nakad, Pascale, Devi Karalasingam, Shamala, R Jeganathan, J Ravichandran, binti Baharum, Nurakman, Suárez-Idueta, Lorena, Barranco Flores, Arturo, Gonzalez Roldan, Jesus F, Lopez Alvarez, Sonia, van Dijk, Aimée E., Broeders, Lisa, Huicho, Luis, Quezada Pinedo, Hugo G, Cajachagua-Torres, Kim N, Carrillo-Larco, Rodrigo M, Tarazona Meza, Carla Estefania, Guzman-Vilca, Wilmer Cristobal, Olukade, Tawa O., Ali, Hamdy A., Alyafei, Fawziya, AlQubaisi, Mai, Alturk, Mohamad R, Kim, Ho Yeon, Cho, Geum Joon, Razaz, Neda, Söderling, Jonas, Smith, Lucy K, Kurinczuk, Jennifer J, Matthews, Ruth J, Manktelow, Bradley N, Draper, Elizabeth S, Fenton, Alan C, Lowry, Estelle, Rowland, Neil, Wood, Rachael, Monteath, Kirsten, Pereyra, Isabel, Pravia, Gabriella, Davis, Celina, Clarke, Samantha, Wu, Lee S.F., Yoshida, Sachiyo, Bahl, Rajiv, Grandi, Carlos, Labrique, Alain B, Rashid, Mabhubur, Ahmed, Salahuddin, Roy, Arunangshu D., Haque, Rezwanul, Shaikh, Saijuddin, Baqui, Abdullah H., Saha, Samir K., Khanam, Rasheda, Rahman, Sayedur, Shapiro, Roger, Zash, Rebecca, Silveira, Mariângela F., Buffarini, Romina, Kolsteren, Patrick, Lachat, Carl, Huybregts, Lieven, Roberfroid, Dominique, Zeng, Lingxia, Zhu, Zhonghai, He, Jianrong, Qui, Xiu, Gebreyesus, Seifu H., Tesfamariam, Kokeb, Bekele, Delayehu, Chan, Grace, Baye, Estifanos, Workneh, Firehiwot, Asante, Kwaku P., Boanmah-Kaali, Ellen, Adu-Afarwuah, Seth, Dewey, Kathryn G., Gyaase, Stephaney, Wylie, Blair J., Kirkwood, Betty R., Manu, Alexander, Thulasiraj, Ravilla D, Tielsch, James, Chowdhury, Ranadip, Taneja, Sunita, Babu, Giridhara R, Shriyan, Prafulla, Maleta, Kenneth, Mangani, Charles, Acevedo-Gallegos, Sandra, Rodriguez-Sibaja, Maria J., Khatry, Subarna K., LeClerq, Steven C., Mullany, Luke C., Jehan, Fyezah, Ilyas, Muhammad, Rogerson, Stephen J., Unger, Holger W., Ghosh, Rakesh, Musange, Sabine, Ramokolo, Vundli, Zembe-Mkabile, Wanga, Lazzerini, Marzia, Mohamed, Rishard, Wang, Dongqing, Fawzi, Wafaie W., Minja, Daniel T.R., Schmiegelow, Christentze, Masanja, Honorati, Smith, Emily, Lusingu, John P.A., Msemo, Omari A., Kabole, Fathma M., Slim, Salim N., Keentupthai, Paniya, Mongkolchati, Aroonsri, Kajubi, Richard, Kakuru, Abel, Waiswa, Peter, Walker, Dilys, Hamer, Davidson H., Semrau, Katherine E.A., Chaponda, Enesia B., Chico, R. Matthew, Banda, Bowen, Musokotwane, Kebby, Manasyan, Albert, Pry, Jake M., Chasekwa, Bernard, Humphrey, Jean, Shamim, Abu Ahmed, Christian, Parul, Ali, Hasmot, Klemm, Rolf D.W., Massie, Alan B., Mitra, Maithili, Mehra, Sucheta, Schulze, Kerry J., Shamim, Abu Amed, Sommer, Alfred, Ullah, Barkat, West, Keith P., Jr, Begum, Nazma, Chowdhury, Nabidul Haque, Islam, Shafiqul, Mitra, Dipak Kumar, Quaiyum, Abdul, Diseko, Modiegi, Makhema, Joseph, Cheng, Yue, Guo, Yixin, Yuan, Shanshan, Roro, Meselech, Shikur, Bilal, Goddard, Frederick, Haneuse, Sebastien, Hunegnaw, Bezawit, Berhane, Yemane, Worku, Alemayehu, Kaali, Seyram, Arnold, Charles D., Jack, Darby, Amenga-Etego, Seeba, Hurt, Lisa, Shannon, Caitlin, Soremekun, Seyi, Bhandari, Nita, Martines, Jose, Mazumder, Sarmila, Ana, Yamuna, R, Deepa, Hallamaa, Lotta, Pyykkö, Juha, Lumbreras-Marquez, Mario I., Mendoza-Carrera, Claudia E., Hussain, Atiya, Karim, Muhammad, Kausar, Farzana, Mehmood, Usma, Nadeem, Naila, Nisar, Muhammad Imran, Sajid, Muhammad, Mueller, Ivo, Ome-Kaius, Maria, Butrick, Elizabeth, Sayinzoga, Felix, Mariani, Ilaria, Urassa, Willy, Theander, Thor, Deloron, Phillippe, Nielsen, Birgitte Bruun, Muhihi, Alfa, Noor, Ramadhani Abdallah, Bygbjerg, Ib, Moeller, Sofie Lykke, Aftab, Fahad, Ali, Said M., Dhingra, Pratibha, Dhingra, Usha, Dutta, Arup, Sazawal, Sunil, Suleiman, Atifa, Mohammed, Mohammed, Deb, Saikat, Kamya, Moses R., Nakalembe, Miriam, Mulowooz, Jude, Santos, Nicole, Biemba, Godfrey, Herlihy, Julie M., Mbewe, Reuben K., Mweena, Fern, Yeboah-Antwi, Kojo, Bruce, Jane, Chandramohan, Daniel, Prendergast, Andrew, Idueta, Lorena Suárez, Hazel, Elizabeth, Erchick, Daniel J, Yargawa, Judith, Katz, Joanne, Lee, Anne C C, Diaz, Mike, Salasibew, Mihretab, Hayashi, Chika, and Borghi, Elaine
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- 2023
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9. Moving towards transformational WASH – Authors' reply
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Pickering, Amy J, Arnold, Benjamin F, Prendergast, Andrew J, Null, Clair, Winch, Peter J, Njenga, Sammy M, Rahman, Mahbubur, Ntozini, Robert, Benjamin-Chung, Jade, Stewart, Christine P, Colford, John M, Luby, Stephen, and Humphrey, Jean H
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Epidemiology ,Health Services and Systems ,Public Health ,Health Sciences ,Diarrhea ,Humans ,Microbiology ,Public Health and Health Services ,Health services and systems ,Public health - Published
- 2019
10. Spatiotemporal variation in risk of Shigella infection in childhood: a global risk mapping and prediction model using individual participant data
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Badr, Hamada S, Colston, Josh M, Nguyen, Nhat-Lan H, Chen, Yen Ting, Burnett, Eleanor, Ali, Syed Asad, Rayamajhi, Ajit, Satter, Syed M, Van Trang, Nguyen, Eibach, Daniel, Krumkamp, Ralf, May, Jürgen, Adegnika, Ayola Akim, Manouana, Gédéon Prince, Kremsner, Peter Gottfried, Chilengi, Roma, Hatyoka, Luiza, Debes, Amanda K, Ateudjieu, Jerome, Faruque, Abu S G, Hossain, M Jahangir, Kanungo, Suman, Kotloff, Karen L, Mandomando, Inácio, Nisar, M Imran, Omore, Richard, Sow, Samba O, Zaidi, Anita K M, Lambrecht, Nathalie, Adu, Bright, Page, Nicola, Platts-Mills, James A, Mavacala Freitas, Cesar, Pelkonen, Tuula, Ashorn, Per, Maleta, Kenneth, Ahmed, Tahmeed, Bessong, Pascal, Bhutta, Zulfiqar A, Mason, Carl, Mduma, Estomih, Olortegui, Maribel P, Peñataro Yori, Pablo, Lima, Aldo A M, Kang, Gagandeep, Humphrey, Jean, Ntozini, Robert, Prendergast, Andrew J, Okada, Kazuhisa, Wongboot, Warawan, Langeland, Nina, Moyo, Sabrina J, Gaensbauer, James, Melgar, Mario, Freeman, Matthew, Chard, Anna N, Thongpaseuth, Vonethalom, Houpt, Eric, Zaitchik, Benjamin F, and Kosek, Margaret N
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- 2023
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11. The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement.
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Cumming, Oliver, Arnold, Benjamin F, Ban, Radu, Clasen, Thomas, Esteves Mills, Joanna, Freeman, Matthew C, Gordon, Bruce, Guiteras, Raymond, Howard, Guy, Hunter, Paul R, Johnston, Richard B, Pickering, Amy J, Prendergast, Andrew J, Prüss-Ustün, Annette, Rosenboom, Jan Willem, Spears, Dean, Sundberg, Shelly, Wolf, Jennyfer, Null, Clair, Luby, Stephen P, Humphrey, Jean H, and Colford, John M
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Humans ,Growth Disorders ,Diarrhea ,Water ,Hygiene ,Sanitation ,Public Health ,Poverty ,Child ,Rural Population ,Randomized Controlled Trials as Topic ,Child Health ,Stunting ,Undernutrition ,Nutrition ,Prevention ,Pediatric ,General & Internal Medicine ,Medical and Health Sciences - Abstract
BackgroundThree large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners.Main bodyHere we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health.ConclusionThese results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle that - in any context - a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.
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- 2019
12. The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea.
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Pickering, Amy J, Null, Clair, Winch, Peter J, Mangwadu, Goldberg, Arnold, Benjamin F, Prendergast, Andrew J, Njenga, Sammy M, Rahman, Mahbubur, Ntozini, Robert, Benjamin-Chung, Jade, Stewart, Christine P, Huda, Tarique MN, Moulton, Lawrence H, Colford, John M, Luby, Stephen P, and Humphrey, Jean H
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Humans ,Growth Disorders ,Diarrhea ,Hygiene ,Sanitation ,Child ,Preschool ,Infant ,Rural Population ,Health Promotion ,Kenya ,Zimbabwe ,Bangladesh ,Randomized Controlled Trials as Topic ,Water Quality ,Hand Disinfection ,Clinical Trials and Supportive Activities ,Prevention ,Pediatric ,Clinical Research ,Nutrition ,Clean Water and Sanitation ,Microbiology ,Public Health and Health Services - Abstract
Child stunting is a global problem and is only modestly responsive to dietary interventions. Numerous observational studies have shown that water quality, sanitation, and handwashing (WASH) in a household are strongly associated with linear growth of children living in the same household. We have completed three randomised efficacy trials testing improved household-level WASH with and without improved infant and young child feeding (IYCF) on stunting and diarrhoea in Bangladesh, Kenya, and Zimbabwe. In all trials, improved IYCF had a statistically significant benefit, but WASH had no effect on linear growth. In observational analyses of data from the control groups of the three trials, baseline sanitation was a strong risk factor for stunting in the study populations, suggesting this frequently reported association might be confounded by unmeasured factors of household wellbeing. WASH interventions reduced diarrhoea in Bangladesh, but not in Kenya or Zimbabwe. Intervention promoters visited participants six times per month in Bangladesh compared with monthly in Kenya and Zimbabwe; a review of the literature shows that virtually all published studies that have reported an effect on diarrhoea through home-based water treatment and handwashing promotion achieved high adherence by visiting participants at daily to fortnightly intervals. Despite achieving substantial behavioural change and significant reduction in infection prevalence for some enteric pathogens, detection of enteropathogens among children in the WASH groups of the trials was typically at ten times higher prevalence compared with high-income countries. Considering these results, we recommend that future research in the WASH sector focus on developing and evaluating interventions that are radically more effective in reducing faecal contamination in the domestic environment than the interventions implemented in these trials.
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- 2019
13. The WASH Benefits and SHINE Trials. Interpretation of Findings on Linear Growth and Diarrhoea and Implications for Policy: Perspective of the Investigative Teams (P10-136-19).
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Humphrey, Jean, Pickering, Amy, Null, Clair, Winch, Peter, Mangwadu, Goldberg, Arnold, Ben, Prendergast, Andrew, Njenga, Sammy, Rahman, Mahbubar, Ntozini, Robert, Benjamin-Chung, Jade, Stewart, Christine, Huda, Tarique, Moulton, Lawrence, Colford, John, and Luby, Stephen
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Objectives:We recently completed 3 efficacy trials (Bangladesh, Kenya, Zimbabwe) testing the independent and combined effects of improved complementary feeding (CF) and intensive household water quality, sanitation, and hygiene (WASH) on child diarrhea and length-for-age-Z-score (LAZ) at 18 to 24 mo. Intervention uptake was high. In all three trials: CF increased LAZ but WASH had no effect on LAZ. WASH reduced diarrhea in Bangladesh but not in Kenya or Zimbabwe. We present a synthesis of trial findings and their implications. Methods:Reviews of the literature and reanalyses of trial data were conducted. Results:WASH and stunting: Copious observational studies have demonstrated a strong association between household-level WASH and child LAZ. We conducted an observational anlaysis (nested birth cohort) from our control arms. In adjusted analyses of all three trials, having an improved latrine when the pregnant woman was enrolled was associated with ∼0.2LAZ increase in her child at 18-24 mo. The frequently reported association between household WASH indicators and child growth may be confounded and drawing causal inferance misguided.WASH and diarrhea: Promoters visited intervention households 6 times per month in Bangladesh and monthly in Kenya and Zimbabwe. We conducted a systematic literature review: virtually all evidence that household water chlorination and handwashing reduce diarrhea comes from studies with daily to fortnightly intervention contact. In studies with follow-up after the trial ending, behaviors steeply declined and the effect on child diarrhea disappeared. Household water chlorination and handwashing promotion implemented through sporadic message delivery may not reduce child diarrhea.Enteropathogen transmission: Despite achieving substantial contrast between WASH and non-WASH households, children in the WASH arms still experienced high enteropathogen transmission, illustrating the recalcitrance of pervasive fecal contamination in rural low-income communities to even intense intervention. Conclusions:Household WASH interventions are unlikely to reduce child stunting and may not reduce child diarrhea. We call for substantial investment in research to identify and in programming to deliver much more efficacious interventions. Funding Sources:Bill & Melinda Gates Foundation, USAID, DFID/UKAID, Wellcome Trust.
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- 2019
14. Associations between maternal obesity and infectious morbidity in Zimbabwean infants
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Althaus, Thomas, Chasekwa, Bernard, Robertson, Ruairi C., Ntozini, Robert, Greenland, Katie, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2022
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15. Implementation and maintenance of infant dietary diversity in Zimbabwe: contribution of food and water insecurity
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Koyratty, Nadia, Mbuya, Mduduzi N. N., Jones, Andrew D., Schuster, Roseanne C., Kordas, Katarzyna, Li, Chin-Shang, Tavengwa, Naume V., Majo, Florence D., Chasekwa, Bernard, Ntozini, Robert, Humphrey, Jean H., and Smith, Laura E.
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- 2022
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16. 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
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Noble, Christie, Mooney, Ciaran, Makasi, Rachel, Ntozini, Robert, Majo, Florence D., Church, James A., Tavengwa, Naume V., Prendergast, Andrew J., and Humphrey, Jean H.
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- 2022
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17. Associations between biomarkers of environmental enteric dysfunction and oral rotavirus vaccine immunogenicity in rural Zimbabwean infants
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Church, James A, Rukobo, Sandra, Govha, Margaret, Gough, Ethan K, Chasekwa, Bernard, Lee, Benjamin, Carmolli, Marya P, Panic, Gordana, Giallourou, Natasa, Ntozini, Robert, Mutasa, Kuda, McNeal, Monica M, Majo, Florence D., Tavengwa, Naume V., Swann, Jonathan R., Moulton, Lawrence H, Kirkpatrick, Beth D, Humphrey, Jean H, and Prendergast, Andrew J
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- 2021
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18. Formulation and acceptability of local nutrient‐dense foods for young children: A formative study for the Child Health, Agriculture and Integrated Nutrition (CHAIN) Trial in rural Zimbabwe.
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Chagwena, Dexter T., Fernando, Shamiso, Tavengwa, Naume V., Sithole, Shadreck, Nyachowe, Chandiwana, Njovo, Handrea, Datta, Kavita, Brown, Tim, Humphrey, Jean H., Prendergast, Andrew J., and Smith, Laura E.
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CHILDREN'S health ,HEALTH literacy ,INFANTS ,HUMAN services programs ,SECONDARY analysis ,FOCUS groups ,EGGS ,CULTURE ,POWDERS ,CONTENT analysis ,CONSUMER attitudes ,NUTRITIONAL requirements ,EMOTIONS ,DESCRIPTIVE statistics ,ELEMENTAL diet ,THEMATIC analysis ,RURAL conditions ,INDUSTRIAL research ,RESEARCH methodology ,RELIGION ,ARTIFICIAL feeding ,COUNSELING ,HEALTH of indigenous peoples ,FAMILY support ,AGRICULTURE ,DIETARY supplements ,CUSTOMER satisfaction - Abstract
Stunting affects almost one‐quarter of children globally, leading to reduced human capacity and increased long‐term risk of chronic disease. Despite intensive infant and young child feeding (IYCF) interventions, many children do not meet their requirements for essential nutrients. This study aimed to assess the feasibility of implementing an IYCF intervention utilizing nutrient‐dense powders from egg, biofortified sugar beans and Moringa oleifera leaf in rural Zimbabwe. A mixed‐methods formative study was conducted comprising the following: (i) a recipe formulation trial, (ii) trials of improved practices to assess acceptability of the intervention, and (iii) a participatory message formulation process to develop counselling modules for the IYCF‐plus intervention. Twenty‐seven mother–baby pairs were recruited between November 2019 and April 2020. Key domains affecting IYCF practices that emerged were time, emotional and physical space, cultural and religious beliefs, indigenous knowledge systems and gender dynamics. Household observations and sensory evaluation indicated high acceptability of the new ingredients. Recipe formulation and participatory message formulation by participants instilled community ownership and served to demystify existing misconceptions about the new food products. Families noted the potential for intervention sustainability because the foods could be grown locally. Supplementing complementary foods with nutrient‐dense local food ingredients as powders has the potential to sustainably address nutrient‐gaps in the diets of young children living in rural lower‐ and middle‐income countries. Comprehensive IYCF counselling utilizing a gender‐lens approach, family support and indigenous knowledge systems or resources are key elements to support positive behaviour change in complementary feeding interventions. Key messages: Incorporating locally available solid foods into complementary feeding is a major challenge for caregivers in rural communities. There are several barriers that hinder mothers from feeding nutrient‐dense solid foods such as animal source foods, fruits and vegetables, resulting in nondiversified complementary diets.Formulation of nutrient‐dense, high‐quality protein complementary meals using powdered locally available food supplements is feasible, well tolerated and allows young children to be fed nutrient‐dense complementary meals in rural LMICs.Utilizing traditionally recognized functional foods such as Moringa olifeira encourages the involvement of elderly women/grandmothers in infant and young child feeding, enabling support for mothers.Integrated complementary feeding interventions incorporating behaviour change communication, provision/promotion of specific nutrient‐dense complementary foods (SQ‐LNS and local foods as powdered supplements), family support and agricultural production has potential for success in rural settings. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Early child development in children who are HIV-exposed uninfected compared to children who are HIV-unexposed: observational sub-study of a cluster-randomized trial in rural Zimbabwe
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Ntozini, Robert, Chandna, Jaya, Evans, Ceri, Chasekwa, Bernard, Majo, Florence D., Kandawasvika, Gwendoline, Tavengwa, Naume V., Mutasa, Batsirai, Mutasa, Kuda, Moulton, Lawrence H., Humphrey, Jean H., Gladstone, Melissa J., and Prendergast, Andrew J.
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Clinical trials -- Research -- Comparative analysis ,Infants -- Comparative analysis -- Research ,HIV -- Research ,Sanitation -- Research -- Comparative analysis ,Pregnant women -- Research -- Comparative analysis ,Health - Abstract
Introduction: Exposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV-exposed uninfected (CHEU) and children who were HIV-unexposed (CHU) recruited to the SHINE trial in rural Zimbabwe. Methods: SHINE was a community-based cluster-randomized trial of improved infant feeding and/or improved water, sanitation and hygiene. Pregnant women were enrolled between 2012 and 2015. We assessed ECD in a sub-study at 24 months of age, between 2016 and 2017, using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social development); MacArthur-Bates Communicative Development Inventory (CDI) (assessing vocabulary and grammar); A-not-B test (assessing object permanence); and a self-control task. Mothers and infants were tested longitudinally for HIV. We used generalized estimating equations to compare ECD scores between CHEU and CHU, accounting for the cluster-randomized design. Primary results were adjusted for trial-related factors that could affect measurement reliability of ECD: study nurse, age of child, calendar month of birth, sex and randomized arm. Results: A total of 205 CHEU and 1175 CHU were evaluated. Mean total MDAT score was 90.6 (SD 8.7) in CHEU compared to 92.4 (9.1) in CHU (adjusted mean difference -1.3, 95% CI: -2.3, -0.3), driven mostly by differences in gross motor (-0.5, 95% CI: -0.9, -0.2) and language scores (-0.6, 95% CI: -1.1, -0.1). There was evidence that fine motor scores were lower in CHEU (adjusted mean difference -0.4, 95% CI: -0.8, 0.0) but no evidence of a difference in social scores (0.1, 95% CI: -0.2, 0.4). Mean MacArthur-Bates CDI vocabulary score was 57.9 (SD 19.2) in CHEU compared to 61.3 (18.8) in CHU (adjusted mean difference -2.9 words, 95% CI: -5.7, -0.1). Object permanence and self-control scores were similar between groups. Conclusions: CHEU in rural Zimbabwe had total child development and vocabulary scores that were approximately 0.15 standard deviations lower than CHU at two years of age. More detailed and specific studies are now needed to unravel the reasons for developmental delay in CHEU and the likelihood that these delays persist in the longer term. Keywords: child development; language; motor; self-control; HIV-exposed uninfected; Zimbabwe, 1 | INTRODUCTION The increasing coverage of prevention of mother-to-child transmission (PMTCT) interventions in sub-Saharan Africa has dramatically reduced the number of children with HIV infection. However, this success has [...]
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- 2020
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20. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial
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Humphrey, Jean H, Jones, Andrew D, Manges, Amee, Mangwadu, Goldberg, Maluccio, John A, Mbuya, Mduduzi N N, Moulton, Lawrence H, Ntozini, Robert, Prendergast, Andrew J, Stoltzfus, Rebecca J, Tielsch, James M, Chasokela, Cynthia, Chigumira, Ancikaria, Heylar, William, Hwena, Preston, Kembo, George, Majo, Florence D, Mutasa, Batsirai, Mutasa, Kuda, Rambanepasi, Philippa, Sauramba, Virginia, Tavengwa, Naume V, Van Der Keilen, Franne, Zambezi, Chipo, Chidhanguro, Dzivaidzo, Chigodora, Dorcas, Chipanga, Joseph F, Gerema, Grace, Magara, Tawanda, Mandava, Mandava, Mavhudzi, Tafadzwa, Mazhanga, Clever, Muzaradope, Grace, Mwapaura, Marian T, Phiri, Simon, Tengende, Alice, Banda, Cynthia, Chasekwa, Bernard, Chidamba, Leah, Chidawanyika, Theodore, Chikwindi, Elisha, Chingaona, Lovemore K, Chiorera, Courage K, Dandadzi, Adlight, Govha, Margaret, Gumbo, Hlanai, Gwanzura, Karen T, Kasaru, Sarudzai, Makasi, Rachel, Matsika, Alois M, Maunze, Diana, Mazarura, Exevia, Mpofu, Eddington, Mushonga, Johnson, Mushore, Tafadzwa E, Muzira, Tracey, Nembaware, Netsai, Nkiwane, Sibongile, Nyamwino, Penias, Rukobo, Sandra D, Runodamoto, Thompson, Seremwe, Shepherd, Simango, Pururudzai, Tome, Joice, Tsenesa, Blessing, Amadu, Umali, Bangira, Beauty, Chiveza, Daniel, Hove, Priscilla, Jombe, Horaiti A, Kujenga, Didymus, Madhuyu, Lenin, Makoni, Prince M, Maramba, Naume, Maregere, Betty, Marumani, Ellen, Masakadze, Elisha, Mazula, Phathisiwe, Munyanyi, Caroline, Musanhu, Grace, Mushanawani, Raymond C, Mutsando, Sibongile, Nazare, Felicia, Nyarambi, Moses, Nzuda, Wellington, Sigauke, Trylife, Solomon, Monica, Tavengwa, Tendai, Biri, Farisai, Chafanza, Misheck, Chaitezvi, Cloud, Chauke, Tsundukani, Chidzomba, Collen, Dadirai, Tawanda, Fundira, Clemence, Gambiza, Athanasios C, Godzongere, Tatenda, Kuona, Maria, Mafuratidze, Tariro, Mapurisa, Idah, Mashedze, Tsitsi, Moyo, Nokuthula, Musariri, Charles, Mushambadope, Matambudzo, Mutsonziwa, Tawanda R, Muzondo, Augustine, Mwareka, Rudo, Nyamupfukudza, Juleika, Saidi, Baven, Sakuhwehwe, Tambudzai, Sikalima, Gerald, Tembe, Jenneth, Chekera, Tapiwanashe E, Chihombe, Owen, Chikombingo, Muchaneta, Chirinda, Tichaona, Chivizhe, Admire, Hove, Ratidzai, Kufa, Rudo, Machikopa, Tatenda F, Mandaza, Wilbert, Mandongwe, Liberty, Manhiyo, Farirai, Manyaga, Emmanuel, Mapuranga, Peter, Matimba, Farai S, Matonhodze, Patience, Mhuri, Sarah, Mike, Joice, Ncube, Bekezela, Nderecha, Walter T S, Noah, Munyaradzi, Nyamadzawo, Charles, Penda, Jonathan, Saidi, Asinje, Shonhayi, Sarudzai, Simon, Clemence, Tichagwa, Monica, Chamakono, Rachael, Chauke, Annie, Gatsi, Andrew F, Hwena, Blessing, Jawi, Hillary, Kaisa, Benjamin, Kamutanho, Sithembile, Kaswa, Tapiwa, Kayeruza, Paradhi, Lunga, Juliet, Magogo, Nomatter, Manyeruke, Daniel, Mazani, Patricia, Mhuriyengwe, Fungai, Mlambo, Farisai, Moyo, Stephen, Mpofu, Tawanda, Mugava, Mishelle, Mukungwa, Yvonne, Muroyiwa, Fungai, Mushonga, Eddington, Nyekete, Selestino, Rinashe, Tendai, Sibanda, Kundai, Chemhuru, Milton, Chikunya, Jeffrey, Chikwavaire, Vimbai F, Chikwiriro, Charity, Chimusoro, Anderson, Chinyama, Jotam, Gwinji, Gerald, Hoko-Sibanda, Nokuthula, Kandawasvika, Rutendo, Madzimure, Tendai, Maponga, Brian, Mapuranga, Antonella, Marembo, Joana, Matsunge, Luckmore, Maunga, Simbarashe, Muchekeza, Mary, Muti, Monica, Nyamana, Marvin, Azhuda, Efa, Bhoroma, Urayai, Biriyadi, Ailleen, Chafota, Elizabeth, Chakwizira, Angelline, Chamhamiwa, Agness, Champion, Tavengwa, Chazuza, Stella, Chikwira, Beauty, Chingozho, Chengeto, Chitabwa, Abigail, Dhurumba, Annamary, Furidzirai, Albert, Gandanga, Andrew, Gukuta, Chipo, Macheche, Beauty, Marihwi, Bongani, Masike, Barbara, Mutangandura, Eunice, Mutodza, Beatrice, Mutsindikwa, Angeline, Mwale, Alice, Ndhlovu, Rebecca, Nduna, Norah, Nyamandi, Cathrine, Ruvata, Elias, Sithole, Babra, Urayai, Rofina, Vengesa, Bigboy, Zorounye, Micheal, Bamule, Memory, Bande, Michael, Chahuruva, Kumbirai, Chidumba, Lilian, Chigove, Zvisinei, Chiguri, Kefas, Chikuni, Susan, Chikwanda, Ruvarashe, Chimbi, Tarisai, Chingozho, Micheal, Chinhamo, Olinia, Chinokuramba, Regina, Chinyoka, Chiratidzo, Chipenzi, Xaviour, Chipute, Raviro, Chiribhani, Godfrey, Chitsinga, Mary, Chiwanga, Charles, Chiza, Anamaria, Chombe, Faith, Denhere, Memory, Dhamba, Ephania, Dhamba, Miriam, Dube, Joyas, Dzimbanhete, Florence, Dzingai, Godfrey, Fusira, Sikhutele, Gonese, Major, Gota, Johnson, Gumure, Kresencia, Gwaidza, Phinias, Gwangwava, Margret, Gwara, Winnet, Gwauya, Melania, Gwiba, Maidei, Hamauswa, Joyce, Hlasera, Sarah, Hlukani, Eustina, Hotera, Joseph, Jakwa, Lovemore, Jangara, Gilbert, Janyure, Micheal, Jari, Christopher, Juru, Duvai, Kapuma, Tabeth, Konzai, Paschalina, Mabhodha, Moly, Maburutse, Susan, Macheka, Chipo, Machigaya, Tawanda, Machingauta, Florence, Machokoto, Eucaria, Madhumba, Evelyn, Madziise, Learnard, Madziva, Clipps, Madzivire, Mavis, Mafukise, Mistake, Maganga, Marceline, Maganga, Senzeni, Mageja, Emmanuel, Mahanya, Miriam, Mahaso, Evelyn, Mahleka, Sanelisiwe, Makanhiwa, Pauline, Makarudze, Mavis, Makeche, Constant, Makopa, Nickson, Makumbe, Ranganai, Mandire, Mascline, Mandiyanike, Eunice, Mangena, Eunice, Mangiro, Farai, Mangwadu, Alice, Mangwengwe, Tambudzai, Manhidza, Juliet, Manhovo, Farai, Manono, Irene, Mapako, Shylet, Mapfumo, Evangelista, Mapfumo, Timothy, Mapuka, Jane, Masama, Douglas, Masenge, Getrude, Mashasha, Margreth, Mashivire, Veronica, Matunhu, Moses, Mavhoro, Pazvichaenda, Mawuka, Godfrey, Mazango, Ireen, Mazhata, Netsai, Mazuva, David, Mazuva, Mary, Mbinda, Filomina, Mborera, John, Mfiri, Upenyu, Mhandu, Florence, Mhike, Chrispen, Mhike, Tambudzai, Mhuka, Artwell, Midzi, Judith, Moyo, Siqondeni, Mpundu, Michael, Msekiwa, Nicholas, Msindo, Dominic, Mtisi, Choice, Muchemwa, Gladys, Mujere, Nyadziso, Mukaro, Ellison, Muketiwa, Kilvera, Mungoi, Silvia, Munzava, Esline, Muoki, Rosewita, Mupura, Harugumi, Murerwa, Evelyn, Murisi, Clarieta, Muroyiwa, Letwin, Muruvi, Musara, Musemwa, Nelson, Mushure, Christina, Mutero, Judith, Mutero, Philipa, Mutumbu, Patrick, Mutya, Cleopatra, Muzanango, Lucia, Muzembi, Martin, Muzungunye, Dorcus, Mwazha, Valeliah, Ncube, Thembeni, Ndava, Takunda, Ndlovu, Nomvuyo, Nehowa, Pauline, Ngara, Dorothy, Nguruve, Leonard, Nhigo, Petronella, Nkiwane, Samukeliso, Nyanyai, Luckson, Nzombe, Judith, Office, Evelyn, Paul, Beatrice, Pavari, Shambadzirai, Ranganai, Sylvia, Ratisai, Stella, Rugara, Martha, Rusere, Peter, Sakala, Joyce, Sango, Prosper, Shava, Sibancengani, Shekede, Margaret, Shizha, Cornellious, Sibanda, Tedla, Tapambwa, Neria, Tembo, John, Tinago, Netsai, Tinago, Violet, Toindepi, Theresa, Tovigepi, John, Tuhwe, Modesta, Tumbo, Kundai, Zaranyika, Tinashe, Zaru, Tongai, Zimidzi, Kamurayi, Zindo, Matilda, Zindonda, Maria, Zinhumwe, Nyaradzai, Zishiri, Loveness, Ziyambi, Emerly, Zvinowanda, James, Bepete, Ekenia, Chiwira, Christine, Chuma, Naume, Fari, Abiegirl, Gavi, Samson, Gunha, Violet, Hakunandava, Fadzai, Huku, Constance, Hungwe, Given, Maduke, Grace, Manyewe, Elliot, Mapfumo, Tecla, Marufu, Innocent, Mashiri, Chenesai, Mazenge, Shellie, Mbinda, Euphrasia, Mhuri, Abigail, Muguti, Charity, Munemo, Lucy, Musindo, Loveness, Ngada, Laina, Nyembe, Dambudzo, Taruvinga, Rachel, Tobaiwa, Emma, Banda, Selina, Chaipa, Jesca, Chakaza, Patricia, Chandigere, Macdonald, Changunduma, Annie, Chibi, Chenesai, Chidyagwai, Otilia, Chidza, Elika, Chigatse, Nora, Chikoto, Lennard, Chingware, Vongai, Chinhamo, Jaison, Chinhoro, Marko, Chiripamberi, Answer, Chitavati, Esther, Chitiga, Rita, Chivanga, Nancy, Chivese, Tracy, Chizema, Flora, Dera, Sinikiwe, Dhliwayo, Annacolleta, Dhononga, Pauline, Dimingo, Ennia, Dziyani, Memory, Fambi, Tecla, Gambagamba, Lylian, Gandiyari, Sikangela, Gomo, Charity, Gore, Sarah, Gundani, Jullin, Gundani, Rosemary, Gwarima, Lazarus, Gwaringa, Cathrine, Gwenya, Samuel, Hamilton, Rebecca, Hlabano, Agnes, Hofisi, Ennie, Hofisi, Florence, Hungwe, Stanley, Hwacha, Sharai, Hwara, Aquiiline, Jogwe, Ruth, Kanikani, Atanus, Kuchicha, Lydia, Kutsira, Mitshel, Kuziyamisa, Kumbulani, Kuziyamisa, Mercy, Kwangware, Benjamin, Lozani, Portia, Mabuto, Joseph, Mabuto, Vimbai, Mabvurwa, Loveness, Machacha, Rebecca, Machaya, Cresenzia, Madembo, Roswitha, Madya, Susan, Madzingira, Sheneterai, Mafa, Lloyd, Mafuta, Fungai, Mafuta, Jane, Mahara, Alfred, Mahonye, Sarudzai, Maisva, Admire, Makara, Admire, Makover, Margreth, Mambongo, Ennie, Mambure, Murenga, Mandizvidza, Edith, Mangena, Gladys, Manjengwa, Elliot, Manomano, Julius, Mapfumo, Maria, Mapfurire, Alice, Maphosa, Letwin, Mapundo, Jester, Mare, Dorcas, Marecha, Farai, Marecha, Selina, Mashiri, Christine, Masiya, Medina, Masuku, Thembinkosi, Masvimbo, Priviledge, Matambo, Saliwe, Matarise, Getrude, Matinanga, Loveness, Matizanadzo, John, Maunganidze, Margret, Mawere, Belinda, Mawire, Chipiwa, Mazvanya, Yulliana, Mbasera, Maudy, Mbono, Magret, Mhakayakora, Cynthia, Mhlanga, Nompumelelo, Mhosva, Bester, Moyo, Nomuhle, Moyo, Over, Moyo, Robert, Mpakami, Charity, Mpedzisi, Rudo, Mpofu, Elizabeth, Mpofu, Estery, Mtetwa, Mavis, Muchakachi, Juliet, Mudadada, Tsitsi, Mudzingwa, Kudakwashe, Mugwira, Mejury, Mukarati, Tarsisio, Munana, Anna, Munazo, Juliet, Munyeki, Otilia, Mupfeka, Patience, Murangandi, Gashirai, Muranganwa, Maria, Murenjekwa, Josphine, Muringo, Nothando, Mushaninga, Tichafara, Mutaja, Florence, Mutanha, Dorah, Mutemeri, Peregia, Mutero, Beauty, Muteya, Edina, Muvembi, Sophia, Muzenda, Tandiwe, Mwenjota, Agnes, Ncube, Sithembisiwe, Ndabambi, Tendai, Ndava, Nomsa, Ndlovu, Elija, Nene, Eveln, Ngazimbi, Enniah, Ngwalati, Atalia, Nyama, Tafirenyika, Nzembe, Agnes, Pabwaungana, Eunica, Phiri, Sekai, Pukuta, Ruwiza, Rambanapasi, Melody, Rera, Tambudzai, Samanga, Violet, Shirichena, Sinanzeni, Shoko, Chipiwa, Shonhe, More, Shuro, Cathrine, Sibanda, Juliah, Sibangani, Edna, Sibangani, Nikisi, Sibindi, Norman, Sitotombe, Mercy, Siwawa, Pearson, Tagwirei, Magret, Taruvinga, Pretty, Tavagwisa, Antony, Tete, Esther, Tete, Yeukai, Thandiwe, Elliot, Tibugari, Amonilla, Timothy, Stella, Tongogara, Rumbidzai, Tshuma, Lancy, Tsikira, Mirirayi, Tumba, Constance, Watinaye, Rumbidzayi, Zhiradzango, Ethel, Zimunya, Esther, Zinengwa, Leanmary, Ziupfu, Magret, Ziyambe, Job, Church, James A, Desai, Amy, Fundira, Dadirai, Gough, Ethan, Kambarami, Rukundo A, Matare, Cynthia R, Malaba, Thokozile R, Mupfudze, Tatenda, Ngure, Francis, Smith, Laura E, Curtis, Val, Dickin, Katherine L, Habicht, Jean-Pierre, Masimirembwa, Collen, Morgan, Peter, Pelto, Gretel H, Sheffner-Rogers, Corinne, Thelingwani, Roslyn, Turner, Paul, Zungu, Lindiwe, Makadzange, Tariro, Mujuru, Hilda A, Nyachowe, Chandiwana, Chakadai, Rugare, Chanyau, Gabriel, Makamure, Mary G, Chiwariro, Humphrey, Mtetwa, Tambudzai, Maguwu, Lisbern, Nyadundu, Simon, Moyo, Tshebukani, Chayima, Beauty, Mvindi, Lucy, Rwenhamo, Pauline, Muzvarwandoga, Shamiso, Chimukangara, Rumbidzai, Njovo, Handrea, Makoni, Talent, Majo, Florence, Chasokela, Cynthia M, and Manges, Amee R
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- 2019
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21. Contribution of Maternal Antiretroviral Therapy and Breastfeeding to 24-Month Survival in Human Immunodeficiency Virus-Exposed Uninfected Children : An Individual Pooled Analysis of African and Asian Studies
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Arikawa, Shino, Rollins, Nigel, Jourdain, Gonzague, Humphrey, Jean, Kourtis, Athena P., Hoffman, Irving, Essex, Max, Farley, Tim, Coovadia, Hoosen M., Gray, Glenda, Kuhn, Louise, Shapiro, Roger, Leroy, Valériane, Bollinger, Robert C., Onyango-Makumbi, Carolyne, Lockman, Shahin, Marquez, Carina, Doherty, Tanya, Dabis, François, Mandelbrot, Laurent, Le Coeur, Sophie, Rolland, Matthieu, Joly, Pierre, Newell, Marie-Louise, and Becquet, Renaud
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- 2018
22. Intestinal Damage and Inflammatory Biomarkers in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Zimbabwean Infants
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Prendergast, Andrew J, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, and Humphrey, Jean H.
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- 2017
23. Cytomegalovirus Acquisition and Inflammation in Human Immunodeficiency Virus–Exposed Uninfected Zimbabwean Infants
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Evans, Ceri, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2017
24. Inflammation, cytomegalovirus and the growth hormone axis in HIV-exposed uninfected Zimbabwean infants
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Evans, Ceri, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2020
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25. Enteropathogens and Rotavirus Vaccine Immunogenicity in a Cluster Randomized Trial of Improved Water, Sanitation and Hygiene in Rural Zimbabwe
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Church, James A., Rogawski McQuade, Elizabeth T., Mutasa, Kuda, Taniuchi, Mami, Rukobo, Sandra, Govha, Margaret, Lee, Benjamin, Carmolli, Marya P., Chasekwa, Bernard, Ntozini, Robert, McNeal, Monica M., Moulton, Lawrence H., Kirkpatrick, Beth D., Liu, Jie, Houpt, Eric R., Humphrey, Jean H., Platts-Mills, James A., and Prendergast, Andrew J.
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- 2019
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26. Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial
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Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, Ntozini, Robert, Marks, Sara J., Mangwadu, Goldberg, Mbuya, Mduduzi N. N., Gerema, Grace, Mutasa, Batsirai, Julian, Timothy R., Schwab, Kellogg J., Humphrey, Jean H., and Zungu, Lindiwe I.
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- 2015
27. Assessment of Environmental Enteric Dysfunction in the SHINE Trial: Methods and Challenges
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Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, Prendergast, Andrew J., Humphrey, Jean H., Mutasa, Kuda, Majo, Florence D., Rukobo, Sandra, Govha, Margaret, Mbuya, Mduduzi N. N., Moulton, Lawrence H., and Stoltzfus, Rebecca J.
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- 2015
28. Theory-Driven Process Evaluation of the SHINE Trial Using a Program Impact Pathway Approach
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Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, Mbuya, Mduduzi N. N., Jones, Andrew D., Ntozini, Robert, Humphrey, Jean H., Moulton, Lawrence H., Stoltzfus, Rebecca J., and Maluccio, John A.
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- 2015
29. The SHINE Trial Infant Feeding Intervention: Pilot Study of Effects on Maternal Learning and Infant Diet Quality in Rural Zimbabwe
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Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, Desai, Amy, Smith, Laura E., Mbuya, Mduduzi N. N., Chigumira, Ancikaria, Fundira, Dadirai, Tavengwa, Naume V., Malaba, Thokozile R., Majo, Florence D., Humphrey, Jean H., and Stoltzfus, Rebecca J.
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- 2015
30. Design of an Intervention to Minimize Ingestion of Fecal Microbes by Young Children in Rural Zimbabwe
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Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, Mbuya, Mduduzi N. N., Tavengwa, Naume V., Stoltzfus, Rebecca J., Curtis, Valerie, Pelto, Gretel H., Ntozini, Robert, Kambarami, Rukundo A., Fundira, Dadirai, Malaba, Thokozile R., Maunze, Diana, Morgan, Peter, Mangwadu, Goldberg, and Humphrey, Jean H.
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- 2015
31. The impact of antibiotics on growth in children in low and middle income countries : systematic review and meta-analysis of randomised controlled trials
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Gough, Ethan K, Moodie, Erica E M, Prendergast, Andrew J, Johnson, Sarasa M A, Humphrey, Jean H, Stoltzfus, Rebecca J, Walker, A Sarah, Trehan, Indi, Gibb, Diana M, Goto, Rie, Tahan, Soraia, de Morais, Mauro Batista, and Manges, Amee R
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- 2014
32. Modelling stunting in LiST: the effect of applying smoothing to linear growth data
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Cousens, Simon, Perin, Jamie, Christian, Parul, Wu, Lee Shu-Fune, Soofi, Sajid, Bhutta, Zulfiqar, Lanata, Claudio, Guerrant, Richard L., Lima, Aldo A. M., Mølbak, Kåre, Valentiner-Branth, Palle, Checkley, William, Gilman, Robert H., Sack, R. Bradley, Black, Robert E., Humphrey, Jean, and Walker, Neff
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- 2017
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33. Child Growth According to Maternal and Child HIV Status in Zimbabwe
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Omoni, Adetayo O., Ntozini, Robert, Evans, Ceri, Prendergast, Andrew J., Moulton, Lawrence H., Christian, Parul S., and Humphrey, Jean H.
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- 2017
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34. Independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved complementary feeding on early neurodevelopment among children born to HIV-negative mothers in rural Zimbabwe: Substudy of a cluster-randomized trial
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Gladstone, Melissa J., Chandna, Jaya, Kandawasvika, Gwendoline, Ntozini, Robert, Majo, Florence D., Tavengwa, Naume V., Mbuya, Mduduzi N. N., Mangwadu, Goldberg T., Chigumira, Ancikaria, Chasokela, Cynthia M., Moulton, Lawrence H., Stoltzfus, Rebecca J., Humphrey, Jean H., and Prendergast, Andrew J.
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Pediatric research ,Child development -- Research ,Hygiene -- Health aspects ,Rural water supply -- Health aspects -- Zimbabwe ,Poor children -- Health aspects -- Food and nutrition ,Medical personnel ,Glycosylated hemoglobin ,HIV ,Child care ,Health ,Pregnant women ,Child nutrition ,Grammar ,Poverty ,Nutrition ,Handwashing ,Hemoglobins ,Workers ,Child health ,Children ,Biological sciences - Abstract
Background Globally, nearly 250 million children (43% of all children under 5 years of age) are at risk of compromised neurodevelopment due to poverty, stunting, and lack of stimulation. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved infant and young child feeding (IYCF) on early child development (ECD) among children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods and findings SHINE was a cluster-randomized community-based 2x2 factorial trial. A total of 5,280 pregnant women were enrolled from 211 clusters (defined as the catchment area of 1-4 village health workers [VHWs] employed by the Zimbabwean Ministry of Health and Child Care). Clusters were randomly allocated to standard of care, IYCF (20 g of small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counseling), WASH (ventilated improved pit latrine, handwashing stations, chlorine, liquid soap, and play yard), and WASH + IYCF. Primary outcomes were child length-for-age Z-score and hemoglobin concentration at 18 months of age. Children who completed the 18-month visit and turned 2 years (102-112 weeks) between March 1, 2016, and April 30, 2017, were eligible for the ECD substudy. We prespecified that primary inferences would be drawn from findings of children born to HIV-negative mothers; these results are presented in this paper. A total of 1,655 HIV-unexposed children (64% of those eligible) were recruited into the ECD substudy from 206 clusters and evaluated for ECD at 2 years of age using the Malawi Developmental Assessment Tool (MDAT) to assess gross motor, fine motor, language, and social skills; the MacArthur-Bates Communicative Development Inventories (CDI) to assess vocabulary and grammar; the A-not-B test to assess object permanence; and a self-control task. Outcomes were analyzed in the intention-to-treat population. For all ECD outcomes, there was not a statistical interaction between the IYCF and WASH interventions, so we estimated the effects of the interventions by comparing the 2 IYCF groups with the 2 non-IYCF groups and the 2 WASH groups with the 2 non-WASH groups. The mean (95% CI) total MDAT score was modestly higher in the IYCF groups compared to the non-IYCF groups in unadjusted analysis: 1.35 (0.24, 2.46; p = 0.017); this difference did not persist in adjusted analysis: 0.79 (-0.22, 1.68; p = 0.057). There was no evidence of impact of the IYCF intervention on the CDI, A-not-B, or self-control tests. Among children in the WASH groups compared to those in the non-WASH groups, mean scores were not different for the MDAT, A-not-B, or self-control tests; mean CDI score was not different in unadjusted analysis (0.99 [95% CI -1.18, 3.17]) but was higher in children in the WASH groups in adjusted analysis (1.81 [0.01, 3.61]). The main limitation of the study was the specific time window for substudy recruitment, meaning not all children from the main trial were enrolled. Conclusions We found little evidence that the IYCF and WASH interventions implemented in SHINE caused clinically important improvements in child development at 2 years of age. Interventions that directly target neurodevelopment (e.g., early stimulation) or that more comprehensively address the multifactorial nature of neurodevelopment may be required to support healthy development of vulnerable children. Trial registration ClinicalTrials.gov NCT01824940, Author(s): Melissa J. Gladstone 1,*, Jaya Chandna 1,2, Gwendoline Kandawasvika 3, Robert Ntozini 2, Florence D. Majo 2, Naume V. Tavengwa 2, Mduduzi N. N. Mbuya 2,4, Goldberg T. Mangwadu [...]
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- 2019
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35. Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study
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Humphrey, Jean H, Marinda, Edmore, Mutasa, Kuda, Moulton, Lawrence H, Iliff, Peter J, Ntozini, Robert, Chidawanyika, Henry, Nathoo, Kusum J, Tavengwa, Naume, Jenkins, Alison, Piwoz, Ellen G, Van de Perre, Philippe, and Ward, Brian J
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- 2011
36. Associations between Breast Milk Viral Load, Mastitis, Exclusive Breast-Feeding, and Postnatal Transmission of HIV
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Lunney, Kevin M., Iliff, Peter, Mutasa, Kuda, Ntozini, Robert, Magder, Laurence S., Moulton, Lawrence H., and Humphrey, Jean H.
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- 2010
37. Effects of a Single Large Dose of Vitamin A, Given during the Postpartum Period to HIV-Positive Women and Their Infants, on Child HIV Infection, HIV-Free Survival, and Mortality
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ZVITAMBO Study Group, Humphrey, Jean H., Iliff, Peter J., Marinda, Edmore T., Mutasa, Kuda, Moulton, Lawrence H., Chidawanyika, Henry, Ward, Brian J., Nathoo, Kusum J., Malaba, Lucie C., Zijenah, Lynn S., Zvandasara, Partson, Ntozini, Robert, Mzengeza, Faith, Mahomva, Agnes I., Ruff, Andrea J., Mbizvo, Michael T., and Zunguza, Clare D.
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- 2006
38. Genetic Variants in Nonclassical Major Histocompatibility Complex Class I Human Leukocyte Antigen (HLA)-E and HLA-G Molecules Are Associated with Susceptibility to Heterosexual Acquisition of HIV-1
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Lajoie, Julie, Hargrove, John, Zijenah, Lynn S., Humphrey, Jean H., Ward, Brian J., and Roger, Michel
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- 2006
39. Head circumferences of children born to HIV-infected and HIV-uninfected mothers in Zimbabwe during the preantiretroviral therapy era
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Evans, Ceri, Chasekwa, Bernard, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2016
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40. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries
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Mbuya, Mduduzi N. N. and Humphrey, Jean H.
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- 2016
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41. Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial.
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Chasekwa, Bernard, Ntozini, Robert, Church, James A, Majo, Florence D, Tavengwa, Naume, Mutasa, Batsirai, Noble, Christie, Koyratty, Nadia, Maluccio, John A, Prendergast, Andrew J, Humphrey, Jean H, Smith, Laura E, and Team, for the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial
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NEONATAL death ,PREGNANT women ,PREMATURE infants ,NEONATAL mortality ,PERINATAL death ,SMALL for gestational age - Abstract
Background Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g). Methods The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and 27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth. Results The prevalence of adverse birth outcomes was: miscarriage: 5.0% [95% confidence interval (CI), 4.4, 5.7]; stillbirth: 2.3% (95% CI 1.9, 2.7); preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); and neonatal mortality: 31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births. Conclusions Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthened management of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles. [ABSTRACT FROM AUTHOR]
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- 2022
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42. Effect of early exclusive breastfeeding on morbidity among infants born to HIV-negative mothers in Zimbabwe
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Koyanagi, Ai, Humphrey, Jean H, Moulton, Lawrence H, Ntozini, Robert, Mutasa, Kuda, Iliff, Peter, and Black, Robert E
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- 2009
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43. Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children.
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Dunne, Thomas Frederick, Chandna, Jaya, Majo, Florence, Tavengwa, Naume, Mutasa, Batsirai, Chasekwa, Bernard, Ntozini, Robert, Prendergast, Andrew J., Humphrey, Jean H., and Gladstone, Melissa J.
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FISHER exact test ,RURAL children ,INFANT nutrition ,LOW-income housing ,TEST validity ,HOUSING stability ,FOOD security - Abstract
Introduction: Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. Methods: A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. Findings: Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. Interpretation: Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood. [ABSTRACT FROM AUTHOR]
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- 2022
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44. Heat treatment of expressed breast milk is a feasible option for feeding hiv-exposed, uninfected children after 6 months of age in rural Zimbabwe
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Mbuya, Mduduzi N.N., Humphrey, Jean H., Majo, Florence, Chasekwa, Bernard, Jenkins, Alison, Israel-Ballard, Kiersten, Muti, Monica, Paul, Keriann H., Madzima, Rufaro C., Moulton, Lawrence H., and Stoltzfus, Rebecca J.
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HIV infection -- Research ,Children -- Food and nutrition ,Children -- Health aspects ,Breast feeding -- Methods ,Breast feeding -- Research ,Disease transmission -- Research ,Disease transmission -- Prevention ,Food/cooking/nutrition - Abstract
In the context of a prevention of mother to child transmission of HIV program promoting exclusive breast-feeding (EBF) to 6 mo and offering HIV-PCR testing at ~6 mo, we ascertained the feasibility of expressing and heat-treating (EHT) all breast milk fed to HIV-exposed, uninfected infants following 6 mo of EBF. Twenty mother-baby pairs were enrolled from a hospital in rural Zimbabwe. Research nurses provided lactation, EHT, and complementary feeding counseling through 21 home visits conducted over an 8-wk period and collected quantitative and qualitative data on the mothers' EHT experiences, children's diets, and anthropometric measurements. Mothers kept daily logs of EHT volumes and direct breast-feeding episodes. Mothers successfully initiated and sustained EHT for 4.5 mo (range, 1-11 mo), feeding 426 [+ or -] 227 mL/d (mean [+ or -] SD). By wk 2 of follow-up, children were receiving EHT and Nutributter-enriched complementary foods that satisfied 100% of their energy requirements. During the 8-wk follow-up period, no growth faltering was experienced [changes in weight-for-age, weight-for-length, and length-for-age Z scores = +0.03 [+ or -] 0.50; +0.77 [+ or -] 1.59; and +0.02 [+ or -] 0.85 (mean [+ or -] SD), respectively]. Stigma was not a major deterrent, likely due to a social marketing campaign for EBF that promoted EHT as a practice to sustain breast-feeding for all women. This study provides evidence that resource-poor rural women can initiate and sustain EHT given family and health systems support. EHT provides a strategy for improving the diets of HIV-exposed but uninfected children after direct breast-feeding has ceased. doi: 10.3945/jn.110.122457.
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- 2010
45. Maternal Decision-Making Autonomy, Mental Health, Gender Norm Attitudes, and Social Support During Pregnancy Predict Child Care-Giving and Stunting in Rural Zimbabwe
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Matare, Cynthia, Tome, Joice, Makasi, Rachel, Dickin, Katherine, Pelto, Gretel, Constas, Mark, Chasekwa, Bernard, Mbuya, Mduduzi, Ntozini, Robert, Prendergast, Andrew, Humphrey, Jean, and Stoltzfus, Rebecca
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- 2020
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46. Traditional Oral Remedies and Perceived Breast Milk Insufficiency Are Major Barriers to Exclusive Breastfeeding in Rural Zimbabwe1-3
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Desai, Amy, Mbuya, Mduduzi N.N., Chigumira, Ancikaria, Chasekwa, Bernard, Humphrey, Jean H., Moulton, Lawrence H., Pelto, Gretel, Gerema, Grace, and Stoltzfus, Rebecca J.
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- 2014
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47. Hepcidin decreases over the first year of life in healthy African infants
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Mupfudze, Tatenda G., Stoltzfus, Rebecca J., Rukobo, Sandra, Moulton, Lawrence H., Humphrey, Jean H., and Prendergast, Andrew J.
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- 2014
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48. Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links
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Ngure, Francis M., Reid, Brianna M., Humphrey, Jean H., Mbuya, Mduduzi N., Pelto, Gretel, and Stoltzfus, Rebecca J.
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- 2014
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49. Stunting Status and Exposure to Infection and Inflammation in Early Life Shape Antibacterial Immune Cell Function Among Zimbabwean Children.
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Mutasa, Kuda, Tome, Joice, Rukobo, Sandra, Govha, Margaret, Mushayanembwa, Patience, Matimba, Farai S., Chiorera, Courage K., Majo, Florence D., Tavengwa, Naume V., Mutasa, Batsirai, Chasekwa, Bernard, Humphrey, Jean H., Ntozini, Robert, Prendergast, Andrew J., and Bourke, Claire D.
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STUNTED growth ,CELL physiology ,CLINICAL trial registries ,BACTERIAL antigens ,SALMONELLA typhimurium ,INFLAMMATION - 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. [ABSTRACT FROM AUTHOR]
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- 2022
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50. Interventions to improve calcium intake through foods in populations with low intake.
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Bourassa, Megan W., Abrams, Steven A., Belizán, José M., Boy, Erick, Cormick, Gabriela, Quijano, Carolina Diaz, Gibson, Sarah, Gomes, Filomena, Hofmeyr, G. Justus, Humphrey, Jean, Kraemer, Klaus, Lividini, Keith, Neufeld, Lynnette M., Palacios, Cristina, Shlisky, Julie, Thankachan, Prashanth, Villalpando, Salvador, and Weaver, Connie M.
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CALCIUM supplements ,CALCIUM content of food ,ENRICHED foods ,CALCIUM ,BONE health ,FOOD consumption ,FERTILIZERS - Abstract
Calcium intake remains inadequate in many low‐ and middle‐income countries, especially in Africa and South Asia, where average intakes can be below 400 mg/day. Given the vital role of calcium in bone health, metabolism, and cell signaling, countries with low calcium intake may want to consider food‐based approaches to improve calcium consumption and bioavailability within their population. This is especially true for those with low calcium intake who would benefit the most, including pregnant women (by reducing the risk of preeclampsia) and children (by reducing calcium‐deficiency rickets). Specifically, some animal‐source foods that are naturally high in bioavailable calcium and plant foods that can contribute to calcium intake could be promoted either through policies or educational materials. Some food processing techniques can improve the calcium content in food or increase calcium bioavailability. Staple‐food fortification with calcium can also be a cost‐effective method to increase intake with minimal behavior change required. Lastly, biofortification is currently being investigated to improve calcium content, either through genetic screening and breeding of high‐calcium varieties or through the application of calcium‐rich fertilizers. These mechanisms can be used alone or in combination based on the local context to improve calcium intake within a population. [ABSTRACT FROM AUTHOR]
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- 2022
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