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352. Implication of New WHO Growth Standards on Identification of Risk Factors and Estimated Prevalence of Malnutrition in Rural Malawian Infants

Author

Prost, Marc-André, primary, Jahn, Andreas, additional, Floyd, Sian, additional, Mvula, Hazzie, additional, Mwaiyeghele, Eleneus, additional, Mwinuka, Venance, additional, Mhango, Thomas, additional, Crampin, Amelia C., additional, McGrath, Nuala, additional, Fine, Paul E. M., additional, and Glynn, Judith R., additional

Published
2008
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354. Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi

Author

Jahn, Andreas, primary, Floyd, Sian, additional, Crampin, Amelia C, additional, Mwaungulu, Frank, additional, Mvula, Hazzie, additional, Munthali, Fipson, additional, McGrath, Nuala, additional, Mwafilaso, Johnbosco, additional, Mwinuka, Venance, additional, Mangongo, Bernard, additional, Fine, Paul EM, additional, Zaba, Basia, additional, and Glynn, Judith R, additional

Published
2008
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355. Implication of new WHO growth standards on estimated prevalence and identification of early risk factors for malnutrition in rural Malawian infants

Author

Prost, Marc Andre, primary, Jahn, Andreas, additional, Floyd, Sian, additional, Mvula, Hazzie, additional, Mwaiyeghele, Eleneus, additional, Mwinuka, Venance, additional, Mhango, Thomas, additional, Crampin, Amelia C, additional, McGrath, Nuala, additional, Fine, Paul E. M., additional, and Glynn, Judith R., additional

Published
2008
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356. CD209 Genetic Polymorphism and Tuberculosis Disease

Author

Vannberg, Fredrik O., primary, Chapman, Stephen J., additional, Khor, Chiea C., additional, Tosh, Kerrie, additional, Floyd, Sian, additional, Jackson-Sillah, Dolly, additional, Crampin, Amelia, additional, Sichali, Lifted, additional, Bah, Boubacar, additional, Gustafson, Per, additional, Aaby, Peter, additional, McAdam, Keith P. W. J., additional, Bah-Sow, Oumou, additional, Lienhardt, Christian, additional, Sirugo, Giorgio, additional, Fine, Paul, additional, and Hill, Adrian V. S., additional

Published
2008
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359. The Importance of Recent Infection withMycobacterium tuberculosisin an Area with High HIV Prevalence: A Long‐Term Molecular Epidemiological Study in Northern Malawi

Author

Glynn, Judith R., primary, Crampin, Amelia C., additional, Yates, Malcolm D., additional, Traore, Hamidou, additional, Mwaungulu, Frank D., additional, Ngwira, Bagrey M., additional, Ndlovu, Richard, additional, Drobniewski, Francis, additional, and Fine, Paul E. M., additional

Published
2005
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360. HIV and Mortality of Mothers and Children

Author

Zaba, Basia, primary, Whitworth, Jimmy, additional, Marston, Milly, additional, Nakiyingi, Jessica, additional, Ruberantwari, Anthony, additional, Urassa, Mark, additional, Issingo, Raphaeli, additional, Mwaluko, Gabriel, additional, Floyd, Sian, additional, Nyondo, Andrew, additional, and Crampin, Amelia, additional

Published
2005
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361. Mycobacterium tuberculosisBeijing Genotype, Northern Malawi

Author

Glynn, Judith R., primary, Crampin, Amelia C., additional, Traore, Hamidou, additional, Yates, Malcolm D., additional, Mwaungulu, Frank D., additional, Ngwira, Bagrey M., additional, Chaguluka, Steven D., additional, Mwafulirwa, Donex T., additional, Floyd, Sian, additional, Murphy, Caroline, additional, Drobniewski, Francis A., additional, and Fine, Paul E.M., additional

Published
2005
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363. DNA Fingerprint Changes in Tuberculosis: Reinfection, Evolution, or Laboratory Error?

Author

Glynn, Judith R., primary, Yates, Malcolm D., additional, Crampin, Amelia C., additional, Ngwira, Bagrey M., additional, Mwaungulu, Frank D., additional, Black, Gillian F., additional, Chaguluka, Steven D., additional, Mwafulirwa, Donex T., additional, Floyd, Sian, additional, Murphy, Caroline, additional, Drobniewski, Francis A., additional, and Fine, Paul E. M., additional

Published
2004
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366. Gamma Interferon Responses Induced by a Panel of Recombinant and Purified Mycobacterial Antigens in Healthy, Non- Mycobacterium bovis BCG-Vaccinated Malawian Young Adults

Author

Black, Gillian F., primary, Weir, Rosemary E., additional, Chaguluka, Steven D., additional, Warndorff, David, additional, Crampin, Amelia C., additional, Mwaungulu, Lorren, additional, Sichali, Lifted, additional, Floyd, Sian, additional, Bliss, Lyn, additional, Jarman, Elizabeth, additional, Donovan, Linda, additional, Andersen, Peter, additional, Britton, Warwick, additional, Hewinson, Glyn, additional, Huygen, Kris, additional, Paulsen, Jens, additional, Singh, Mahavir, additional, Prestidge, Ross, additional, Fine, Paul E. M., additional, and Dockrell, Hazel M., additional

Published
2003
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369. Factors affecting immunogenicity of BCG in infants, a study in Malawi, the Gambia and the UK.

Author

Yun-Gyoung Hur, Gorak-Stolinska, Patricia, Lalor, Maeve K., Mvula, Hazzie, Floyd, Sian, Raynes, John, Ben-Smith, Anne, Fichett, Joseph R., Flanagan, Katie L., Burl, Sarah, Ota, Martin O., Crampin, Amelia C., Smith, Steven G., and Dockrell, Hazel M.

Subjects
BCG vaccines, VACCINATION of infants, MICRONUTRIENTS, C-reactive protein, CYTOKINES, BLOOD sampling, MYCOBACTERIUM tuberculosis
Abstract

Background BCG immunogenicity in infants differs between populations and these differences have been attributed to various factors. In this study, the influence of geographical location, season of birth, timing of vaccination, micronutrient status (zinc) and inflammatory status (C-reactive protein, CRP) were assessed. Methods Immunogenicity was assessed by cytokine signature in culture supernatants from diluted whole blood samples stimulated with M. tuberculosis PPD, using a multiplex bead assay. Results were correlated with the plasma zinc and CRP concentrations at the time of sampling, and with interview and household data. BCG vaccinated infants were recruited in Malawi, The Gambia and the UK. Results In Malawi, infants vaccinated within the first week after birth showed lower production of most cytokines measured than those vaccinated later. The number of cytokines showing significant differences between Malawian and Gambian infants decreased after adjusting for season of birth. In Malawi, a proportion of infants had zinc deficiency and elevated plasma CRP (>10 mg/L), but neither zinc deficiency nor high CRP was associated with production of any of the cytokines measured. Conclusions The cytokine/chemokine signatures observed in response to M. tuberculosis PPD in infants at 3 months post BCG vaccination were affected by geographical location, season of birth, and timing of vaccination but not associated with the concentration of plasma zinc or inflammatory status. These factors should be considered in future trials of new TB vaccines. [ABSTRACT FROM AUTHOR]

Published
2014
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370. InterVA-4 as a public health tool for measuring HIV/AIDS mortality: a validation study from five African countries.

Author

Byass, Peter, Herbst, Kobus, Calvert, Clara, Todd, Jim, Zaba, Basia, Crampin, Amelia, Miiro-Nakiyingi, Jessica, Lutalo, Tom, Michael, Denna, Takaruza, Albert, Gregson, Simon, and Robertson, Laura

Subjects
MORTALITY of AIDS patients, AIDS, MALNUTRITION, AGE distribution, AUTOPSY, CONFIDENCE intervals, INTERVIEWING, RESEARCH methodology, MENINGITIS, PUBLIC health, RESPIRATORY infections, SEX distribution, TUBERCULOSIS
Abstract

Background: Reliable population-based data on HIV infection and AIDS mortality in sub-Saharan Africa are scanty, even though that is the region where most of the world's AIDS deaths occur. There is therefore a great need for reliable and valid public health tools for assessing AIDS mortality. Objective: The aim of this article is to validate the InterVA-4 verbal autopsy (VA) interpretative model within African populations where HIV sero-status is recorded on a prospective basis, and examine the distribution of cause-specific mortality among HIV-positive and HIV-negative people. Design: Data from six sites of the Alpha Network, including HIV sero-status and VA interviews, were pooled. VA data according to the 2012 WHO format were extracted, and processed using the InterVA-4 model into likely causes of death. The model was blinded to the sero-status data. Cases with known pre-mortem HIV infection status were used to determine the specificity with which InterVA-4 could attribute HIV/AIDS as a cause of death. Cause-specific mortality fractions by HIV infection status were calculated, and a person-time model was built to analyse adjusted cause-specific mortality rate ratios. Results: The InterVA-4 model identified HIV/AIDS-related deaths with a specificity of 90.1% (95% CI 88.7-91.4%). Overall sensitivity could not be calculated, because HIV-positive people die from a range of causes. In a person-time model including 1,739 deaths in 1,161,688 HIV-negative person-years observed and 2,890 deaths in 75,110 HIV-positive person-years observed, the mortality ratio HIV-positive:negative was 29.0 (95% CI 27.1-31.0), after adjustment for age, sex, and study site. Cause-specific HIV-positive:negative mortality ratios for acute respiratory infections, HIV/AIDS-related deaths, meningitis, tuberculosis, and malnutrition were higher than the all-cause ratio; all causes had HIV-positive:negative mortality ratios significantly higher than unity. Conclusions: These results were generally consistent with relatively small post-mortem and hospital-based diagnosis studies in the literature. The high specificity in cause of death attribution achieved in relation to HIV status, and large differences between specific causes by HIV status, show that InterVA-4 is an effective and valid tool for assessing HIV-related mortality. [ABSTRACT FROM AUTHOR]

Published
2014
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371. How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa.

Author

Marston, Milly, Slaymaker, Emma, Zaba, Basia, Todd, Jim, Crampin, Amelia, Michael, Denna, Calvert, Clara, Nakiyingi-Miiro, Jessica, Lutalo, Tom, and Herbst, Kobus

Subjects
ANTIRETROVIRAL agents, CONFIDENCE intervals, HIV infections, PUBLIC health surveillance, REGRESSION analysis, DEVELOPED countries
Abstract

Background: Substantial falls in the mortality of people living with HIV (PLWH) have been observed since the introduction of antiretroviral therapy (ART) in sub-Saharan Africa. However, access and uptake of ART have been variable in many countries.We report the excess deaths observed in PLWH before and after the introduction of ART. We use data from five longitudinal studies in Malawi, South Africa, Tanzania, and Uganda, members of the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Methods: Individual data from five demographic surveillance sites that conduct HIV testing were used to estimate mortality attributable to HIV, calculated as the difference between the mortality rates in PLWH and HIV-negative people. Excess deaths in PLWH were standardized for age and sex differences and summarized over periods before and after ART became generally available. An exponential regression model was used to explore differences in the impact of ART over the different sites. Results: 127,585 adults across the five sites contributed a total of 487,242 person years. Before the introduction of ART, HIV-attributable mortality ranged from 45 to 88 deaths per 1,000 person years. Following ART availability, this reduced to 14-46 deaths per 1,000 person years. Exponential regression modeling showed a reduction of more than 50% (HR-0.43, 95% CI: 0.32-0.58), compared to the period before ART was available, in mortality at ages 15-54 across all five sites. Discussion: Excess mortality in adults living with HIV has reduced by over 50% in five communities in sub-Saharan Africa since the advent of ART. However, mortality rates in adults living with HIV are still 10 times higher than in HIV-negative people, indicating that substantial improvements can be made to reduce mortality further. This analysis shows differences in the impact across the sites, and contrasts with developed countries where mortality among PLWH on ART can be similar to that of the general population. Further research is urgently needed to establish why the different impacts on mortality were observed and how the care and treatment programmes in these countries can be more effective in reducing mortality further. [ABSTRACT FROM AUTHOR]

Published
2014
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372. The Importance of Recent Infection with Mycobacterium tuberculosis in an Area with High HIV Prevalence: A Long-Term Molecular Epidemiological Study in Northern Malawi.

Author

Glynn, Judith R., Crampin, Amelia C., Yates, Malcolm D., Traore, Hamidou, Mwaungulu, Frank D., Ngwira, Bagrey M., Ndlovu, Richard, Drobniewski, Francis, and Fine, Paul E. M.

Subjects
*MYCOBACTERIUM tuberculosis, *TUBERCULOSIS, *HIV, *PATIENTS, *MOLECULAR epidemiology
Abstract

Background. The proportion of cases of tuberculosis due to recent infection can be estimated in long-term population-based studies using molecular techniques. Here, we present what is, to our knowledge, the first such study in an area with high human immunodeficiency virus (HIV) prevalence. Methods. All patients with tuberculosis in Karonga District, Malawi, were interviewed. Isolates were genotyped using restriction-fragment-length polymorphism (RFLP) patterns. Strains were considered to be ‘clustered’ if at least 1 other patient had an isolate with an identical pattern. Results. RFLP results were available from 83% of culture-positive patients from late 1995 to early 2003. When strains with <5 bands were excluded, 72% (682/948) were clustered. Maximum clustering was reached using a 4-year window, with an estimated two-thirds of cases due to recent transmission. The proportion clustered decreased with age and varied by area of residence. In older adults, clustering was less common in men and more common in patients who were HIV positive (adjusted odds ratio, 5.1 [95% confidence interval, 2.1–12.6]). Conclusions. The proportion clustered found in the present study was among the highest in the world, suggesting high rates of recent transmission. The association with HIV infection in older adults may suggest that HIV has a greater impact on disease caused by recent transmission than on that caused by reactivation. [ABSTRACT FROM AUTHOR]

Published
2005
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374. BCG-induced increase in interferon-gamma response to mycobacterial antigens and efficacy of BCG vaccination in Malawi and the UK: two randomised controlled studies.

Author

Black, Gillian F, Weir, Rosemary E, Floyd, Sian, Bliss, Lyn, Warndorff, David K, Crampin, Amelia C, Ngwira, Bagrey, Sichali, Lifted, Nazareth, Bernadette, Blackwell, Jenefer M, Branson, Keith, Chaguluka, Steven D, Donovan, Linda, Jarman, Elizabeth, King, Elizabeth, Fine, Paul E M, and Dockrell, Hazel M

Abstract

Background The efficacy of BCG vaccines against pulmonary tuberculosis varies between populations, showing no protection in Malawi but 50–80% protection in the UK. To investigate the mechanism underlying these differences, randomised controlled studies were set up to measure vaccine-induced immune responsiveness to mycobacterial antigens in both populations.Methods 483 adolescents and young adults in Malawi and 180 adolescents in the UK were tested for interferon-gamma (IFN-γ) response to M tuberculosis purified protein derivative (PPD) in a whole blood assay, and for delayed type hypersensitivity (DTH) skin test response to tuberculin PPD, before and 1year after receiving BCG (Glaxo 1077) vaccination or placebo or no vaccine.Findings The percentages of the randomised individuals who showed IFN-γ and DTH responses were higher in Malawi than in the UK pre-vaccination—ie, 61% (331/546) versus 22% (47/213) for IFN-γ and 46% (236/517) versus 13% (27/211) for DTH. IFN-γ responses increased more in the UK than in Malawi, with 83% (101/122) and 78% (251/321) respectively of the vaccinated groups responding, with similar distributions in the two populations 1 year post-vaccination. The DTH response increased following vaccination in both locations, but to a greater extent in the UK than Malawi. The IFN-γ and DTH responses were strongly associated, except among vaccinees in Malawi.Interpretation The magnitude of the BCG-attributable increase in IFN-γ responsiveness to M tuberculosis PPD, from before to 1 year post-vaccination, correlates better with the known levels of protection induced by immunisation with BCG than does the absolute value of the IFN-γ or DTH response after vaccination. It is likely that differential sensitisation due to exposure to environmental mycobacteria is the most important determinant of the observed differences in protection by BCG between populations. [Copyright &y& Elsevier]

Published
2002
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375. Patterns and Implications of Naturally Acquired Immune Responses to Environmental and Tuberculous Mycobacterial Antigens in Northern Malawi .

Author

Sichali, Lifted, Mwaungulu, Lorren, Kanyongoloka, Huxley, Ngwira, Bagrey, Warndorff, David K., Black, Gillian F., Crampin, Amelia C., Dockrell, Hazel M., Floyd, Sian, Weir, Rosemary E., Bliss, Lyn, and Fine, Paul E. M.

Subjects
MYCOBACTERIAL diseases, TUBERCULOSIS, INTERFERONS
Abstract

Presents a study which assessed the interferon-gamma responsiveness to purified protein derivative and tuberculin antigens from mycobacteria species among adults in Malawi, where vaccination provides no protection against pulmonary tuberculosis. Information on mycobacteria vaccines; Materials and methods used; Results and discussion.

Published
2001

376. Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA)

Author

Reniers, Georges, Slaymaker, Emma, Nakiyingi-Miiro, Jessica, Nyamukapa, Constance, Crampin, Amelia Catharine, Herbst, Kobus, Urassa, Mark, Otieno, Fred, Gregson, Simon, Sewe, Maquins, Michael, Denna, Lutalo, Tom, Hosegood, Victoria, Kasamba, Ivan, Price, Alison, Nabukalu, Dorean, Mclean, Estelle, and Zaba, Basia

Abstract

Supplemental Digital Content is available in the text

Published
2014
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378. Can biosampling really be "non-invasive"? An examination of the socially invasive nature of physically non-invasive biosampling in urban and rural Malawi.

Author

Ndambo, Myness Kasanda, Bunn, Christopher, Pickersgill, Martyn, Stewart, Robert C., Crampin, Amelia C., Nyasulu, Maisha, Kanyenda, Beatson, Mnthali, Wisdom, Umar, Eric, Reynolds, Rebecca M., and Manda-Taylor, Lucinda

Subjects
*SAMPLING (Process), *PUBLIC health research, *MEDICAL personnel, *RESEARCH personnel, *FOCUS groups
Abstract

Glucocorticoids are understood to represent useful biomarkers of stress and can be measured in saliva, hair, and breastmilk. The collection of such biosamples is increasingly included in biobank and cohort studies. While collection is considered "non-invasive" by biomedical researchers (compared to sampling blood), community perspectives may differ. This cross-sectional, qualitative study utilising eight focus groups aimed to determine the feasibility and acceptability of collecting ostensibly "non-invasive" biological samples in Malawi. Breastfeeding women, couples, field workers, and healthcare providers were purposively sampled. Data about prior understandings of, barriers to, and feasibility of "non-invasive" biosampling were analysed. Participants described biomaterials intended for "non-invasive" collection as sometimes highly sensitive, with sampling procedures raising community concerns. Sampling methods framed as physically "non-invasive" within biomedicine can consequently be considered socially "invasive" by prospective sample donors. Biomedical and community framings of "invasiveness' can therefore diverge, and the former must respond to and be informed by the perspectives of the latter. Further, considerations of collection procedures are shaped by therapeutic misconceptions about the immediate health-related utility of biomedical and public health research. When researchers engage with communities about biosampling, they must ensure they are not furthering therapeutic misconceptions and actively seek to dispel these. [ABSTRACT FROM AUTHOR]

Published
2024
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379. Identification of Immunological Biomarkers Which May Differentiate Latent Tuberculosis from Exposure to Environmental Nontuberculous Mycobacteria in Children

Author

Hur, Yun-Gyoung, Crampin, Amelia C., Chisambo, Christina, Kanyika, James, Houben, Rein, Ndhlovu, Richard, Mzembe, Themba, Lalor, Maeve K., Saul, Jacky, Branson, Keith, Stanley, Carolynne, Ngwira, Bagrey, French, Neil, Ottenhoff, Tom H., Dockrell, Hazel M., and Gorak-Stolinska, Patricia

Abstract

ABSTRACTA positive gamma interferon (IFN-?) response to Mycobacterium tuberculosisearly secretory antigenic target-6 (ESAT-6)/culture filtrate protein-10 (CFP-10) has been taken to indicate latent tuberculosis (TB) infection, but it may also be due to exposure to environmental nontuberculous mycobacteria in which ESAT-6 homologues are present. We assessed the immune responses to M. tuberculosisESAT-6 and cross-reactive responses to ESAT-6 homologues of Mycobacterium aviumand Mycobacterium kansasii. Archived culture supernatant samples from children at 3 years post-BCG vaccination were tested for cytokine/chemokine responses to M. tuberculosisantigens. Furthermore, the IFN-? responses to M. tuberculosisantigens were followed up for 40 children at 8 years post-BCG vaccination, and 15 TB patients were recruited as a control group for the M. tuberculosisESAT-6 response in Malawi. IFN-? enzyme-linked immunosorbent assays (ELISAs) on supernatants from diluted whole-blood assays, IFN-? enzyme-linked immunosorbent spot (ELISpot) assays, QuantiFERON TB Gold-In Tube tests, and multiplex bead assays were performed. More than 45% of the responders to M. tuberculosisESAT-6 showed IFN-? responses to M. aviumand M. kansasiiESAT-6. In response to M. tuberculosisESAT-6/CFP-10, interleukin 5 (IL-5), IL-9, IL-13, and IL-17 differentiated the stronger IFN-? responders to M. tuberculosisESAT-6 from those who preferentially responded to M. kansasiiand M. aviumESAT-6. A cytokine/chemokine signature of IL-5, IL-9, IL-13, and IL-17 was identified as a putative immunological biosignature to differentiate latent TB infection from exposure to M. aviumand M. kansasiiin Malawian children, indicating that this signature might be particularly informative in areas where both TB and exposure to environmental nontuberculous mycobacteria are endemic.

Published
2013
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381. Molecular Detection of Mixed Infections of Mycobacterium tuberculosisStrains in Sputum Samples from Patients in Karonga District, Malawi

Author

Mallard, Kim, McNerney, Ruth, Crampin, Amelia C., Houben, Rein, Ndlovu, Richard, Munthali, Lumbani, Warren, Robin M., French, Neil, and Glynn, Judith R.

Abstract

ABSTRACTThe occurrence of mixed infections of Mycobacterium tuberculosisis no longer disputed. However, their frequency, and the impact they may have on our understanding of tuberculosis (TB) pathogenesis and epidemiology, remains undetermined. Most previous studies of frequency applied genotyping techniques to cultured M. tuberculosisisolates and found mixed infections to be rare. PCR-based techniques may be more sensitive for detecting multiple M. tuberculosisstrains and can be applied to sputum. To date, one study in South Africa has used a PCR approach and suggested that mixed infection could be common. We investigated mixed infections in northern Malawi using two lineage-specific PCR assays targeting the Latin American-Mediterranean (LAM) and Beijing lineages. Compared with spoligotyping, the specificity and sensitivity of both assays was 100%. From 160 culture-positive sputa, mixed LAM and non-LAM strains were detected in 4 sputa belonging to 2 (2.8%) patients. Both patients were HIV positive, with no history of TB. Cultured isolates from both patients showed only LAM by PCR and spoligotyping. In a set of 377 cultured isolates, 4 were mixed LAM and non-LAM. Only one showed evidence of more than one M. tuberculosisstrain using IS6110-based restriction fragment length polymorphism (IS6110-RFLP) and spoligotyping analyses. Corresponding sputa for the 4 isolates were unavailable. Mixed Beijing and non-Beijing strains were not detected in this study. Mixed infections appear to be rare in our setting and are unlikely to affect findings based on DNA fingerprinting data. Molecular methods, which avoid the selective nature of culture and target distinct strains, are well suited to detection of mixed infections.

Published
2010
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382. Emergence of a Three Codon Deletion in gag p17 in HIV Type 1 Subtype C Long-Term Survivors, and General Population Spread

Author

McCormack, Grace P., Glynn, Judith R., Clewley, Jonathan P., Crampin, Amelia C., Travers, Simon A.A., Redmond, Niamh, Keane, Thomas M., Sibande, Felix, Mulawa, Dominic, and Fine, Paul E.M.

Abstract

In a population-based study in northern Malawi we investigated HIV-1 subtype C gag and env gene sequences associated with long-term survival. DNA samples were available from 31 individuals surviving between population surveys carried out in the 1980s and 1990s. Most survivors with paired sequences dating from the 1980s and the 1990s had a three codon deletion in the gag p17 region of the sequence retrieved from the sample collected in the 1990s that was not present in the sequence from the same individual dating from the 1980s. This deletion was also not present in any other 1980s sequences from Malawi, but was common in samples collected in Malawi in the 1990s. The deletion is equivalent to the loss of three amino acids in the D helix region of the gag protein, and may be associated with longer survival and onward transmission.

Published
2006
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383. Gamma Interferon Responses Induced by a Panel of Recombinant and Purified Mycobacterial Antigens in Healthy, Non-Mycobacterium bovisBCG-Vaccinated Malawian Young Adults

Author

Black, Gillian F., Weir, Rosemary E., Chaguluka, Steven D., Warndorff, David, Crampin, Amelia C., Mwaungulu, Lorren, Sichali, Lifted, Floyd, Sian, Bliss, Lyn, Jarman, Elizabeth, Donovan, Linda, Andersen, Peter, Britton, Warwick, Hewinson, Glyn, Huygen, Kris, Paulsen, Jens, Singh, Mahavir, Prestidge, Ross, Fine, Paul E. M., and Dockrell, Hazel M.

Abstract

ABSTRACTWe have previously shown that young adults living in a rural area of northern Malawi showed greater gamma interferon (IFN-?) responses to purified protein derivatives (PPD) prepared from environmental mycobacteria than to PPD from Mycobacterium tuberculosis. In order to define the mycobacterial species to which individuals living in a rural African population have been exposed and sensitized, we tested T-cell recognition of recombinant and purified antigens from M. tuberculosis(38 kDa, MPT64, and ESAT-6), M. bovis(MPB70), M. bovisBCG (Ag85), and M. leprae(65 kDa, 35 kDa, and 18 kDa) in >600 non-M. bovisBCG-vaccinated young adults in the Karonga District of northern Malawi. IFN-? was measured by enzyme-linked immunosorbent assay (ELISA) in day 6 supernatants of diluted whole-blood cultures. The recombinant M. leprae35-kDa and 18-kDa and purified native M. bovisBCG Ag85 antigens induced the highest percentages of responders, though both leprosy and bovine tuberculosis are now rare in this population. The M. tuberculosisantigens ESAT-6 and MPT64 and the M. bovisantigen MPB70 induced the lowest percentages of responders. One of the subjects subsequently developed extrapulmonary tuberculosis; this individual had a 15-mm-diameter reaction to the Mantoux test and responded to M. tuberculosisPPD, Ag85, MPT64, and ESAT-6 but not to any of the leprosy antigens. We conclude that in this rural African population, exposure to M. tuberculosisor M. bovisis much less frequent than exposure to environmental mycobacteria such as M. avium, which have antigens homologous to the M. leprae35-kDa and 18-kDa antigens. M. tuberculosisESAT-6 showed the strongest association with the size of the Mantoux skin test induration, suggesting that among the three M. tuberculosisantigens tested it provided the best indication of exposure to, or infection with, M. tuberculosis.

Published
2003
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384. Abstract 9163: Demographic Differences in Hypertension and Its Treatment in Malawi

Author

Shakil, Saate S, Price, Alison J, Roth, Gregory A, Crampin, Amelia, Nkoka, Owen, and Kanjala, Chifundo

Abstract

Background:Hypertension (HTN), a strong risk factor for cardiovascular disease (CVD), is highly prevalent in Sub-Saharan Africa. Health system interventions targeting demographic determinants of diagnosis and treatment may reduce downstream CVD burden. We investigated age, sex, and location-specific differences in HTN diagnosis and treatment in Malawi.Methods:We examined population-based household survey data (2013 - 2017) from the Malawi Epidemiology and Intervention Research Unit of 30,575 adults >18 years with self-reported HTN diagnosis/treatment status and resting blood pressure measurements using standardized protocols. We used logistic regression to explore associations between demographic variables (age, sex, rural/urban location) and two outcomes: (1) measured HTN (defined as SBP >130 mmHg, regardless of diagnosis/treatment status), and (2) treatment for previously diagnosed HTN.Results:The overall prevalence of diagnosed and undiagnosed HTN was 9% and 19.6%, respectively; 45.4% of those previously diagnosed were on antihypertensive treatment. The probability of measured HTN regardless of treatment for those aged >65 years was 80.8% (95% CI 79.1 - 82.5) and 66.5% (64.0 - 68.9) for urban women and men, respectively, and 65.6% (63.5 - 67.7) and 52.2% (49.7 - 54.7) for rural women and men, respectively. Among those with previously diagnosed HTN, probability of treatment was higher in older age groups, but did not differ between locations.Conclusions:We observed a high prevalence of undiagnosed HTN among rural- and urban-dwelling Malawians; over half of those reporting a diagnosis were untreated. Probability of measured HTN varied by sex and location, but probability of treatment did not. Population-level interventions that account for these patterns are needed in both rural and urban settings to increase effective HTN treatment coverage.

Published
2021
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385. Prevalence and risk factors for chronic kidney disease of unknown cause in Malawi: a cross-sectional analysis in a rural and urban population.

Author

Hamilton, Sophie A., Nakanga, Wisdom P., Prynn, Josephine E., Crampin, Amelia C., Fecht, Daniela, Vineis, Paolo, Caplin, Ben, Pearce, Neil, and Nyirenda, Moffat J.

Subjects
CHRONIC kidney failure, CITY dwellers, RURAL population, CROSS-sectional method, GLOMERULAR filtration rate
Abstract

Background: An epidemic of chronic kidney disease of unknown cause (CKDu) is occurring in rural communities in tropical regions of low-and middle-income countries in South America and India. Little information is available from Southern African countries which have similar climatic and occupational characteristics to CKDu-endemic countries. We investigated whether CKDu is prevalent in Malawi and identified its potential risk factors in this setting.Methods: We conducted a cross-sectional study from January-August 2018 collecting bio samples and anthropometric data in two Malawian populations. The sample comprised adults > 18 years (n = 821) without diabetes, hypertension, and proteinuria. Estimates of glomerular filtration rate (eGFR) were calculated using the CKD-EPI equation. Linear and logistic regression models were applied with potential risk factors, to estimate risk of reduced eGFR.Results: The mean eGFR was 117.1 ± 16.0 ml/min per 1.73m2 and the mean participant age was 33.5 ± 12.7 years. The prevalence of eGFR< 60 was 0.2% (95% confidence interval (95% CI) 0.1, 0.9); the prevalence of eGFR< 90 was 5% (95% CI =3.2, 6.3). We observed a higher prevalence in the rural population (5% (3.6, 7.8)), versus urban (3% (1.4, 6.7)). Age and BMI were associated with reduced eGFR< 90 [Odds ratio (OR) (95%CI) =3.59 (2.58, 5.21) per ten-year increment]; [OR (95%CI) =2.01 (1.27, 3.43) per 5 kg/m2 increment] respectively. No increased risk of eGFR < 90 was observed for rural participants [OR (95%CI) =1.75 (0.50, 6.30)].Conclusions: Reduced kidney function consistent with the definition of CKDu is not common in the areas of Malawi sampled, compared to that observed in other tropical or sub-tropical countries in Central America and South Asia. Reduced eGFR< 90 was related to age, BMI, and was more common in rural areas. These findings are important as they contradict some current hypothesis that CKDu is endemic across tropical and sub-tropical countries. This study has enabled standardized comparisons of impaired kidney function between and within tropical/subtropical regions of the world and will help form the basis for further etiological research, surveillance strategies, and the implementation and evaluation of interventions. [ABSTRACT FROM AUTHOR]

Published
2020
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386. Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data.

Author

Rawson, Helen, Crampin, Amelia, and Noah, Norman

Subjects
*CHICKENPOX, *MORTALITY, *DISEASES, *EPIDEMIOLOGY
Abstract

Objective: To evaluate the epidemiology and impact of mortality from chickenpox in England and Wales. Design: Review of death certificates from the Office for National Statistics on which codes for "chickenpox" or "varicella" were mentioned. Further information ascertained from certifying physician. Participants: Those certified as having died from chickenpox in England and Wales, 1995-7. Main outcome measures: Diagnosis and age and sex distributions of deaths from chickenpox. Results: On average, 25 people a year die from chickenpox. Overall case fatality was 9.22 per 100 000 consultations for chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths were twice as common in men as in women. More of those who died were born outside United Kingdom than expected (12% v 4%). Conclusions: Chickenpox is not a mild disease. Deaths in adults are increasing, both in number and proportion. [ABSTRACT FROM AUTHOR]

Published
2001
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387. An integrated whole genome analysis of Mycobacterium tuberculosis reveals insights into relationship between its genome, transcriptome and methylome.

Author

Gomez-Gonzalez, Paula J., Andreu, Nuria, Phelan, Jody E., de Sessions, Paola Florez, Glynn, Judith R., Crampin, Amelia C., Campino, Susana, Butcher, Philip D., Hibberd, Martin L., and Clark, Taane G.

Abstract

Human tuberculosis disease (TB), caused by Mycobacterium tuberculosis (Mtb), is a complex disease, with a spectrum of outcomes. Genomic, transcriptomic and methylation studies have revealed differences between Mtb lineages, likely to impact on transmission, virulence and drug resistance. However, so far no studies have integrated sequence-based genomic, transcriptomic and methylation characterisation across a common set of samples, which is critical to understand how DNA sequence and methylation affect RNA expression and, ultimately, Mtb pathogenesis. Here we perform such an integrated analysis across 22 M. tuberculosis clinical isolates, representing ancient (lineage 1) and modern (lineages 2 and 4) strains. The results confirm the presence of lineage-specific differential gene expression, linked to specific SNP-based expression quantitative trait loci: with 10 eQTLs involving SNPs in promoter regions or transcriptional start sites; and 12 involving potential functional impairment of transcriptional regulators. Methylation status was also found to have a role in transcription, with evidence of differential expression in 50 genes across lineage 4 samples. Lack of methylation was associated with three novel variants in mamA, likely to cause loss of function of this enzyme. Overall, our work shows the relationship of DNA sequence and methylation to RNA expression, and differences between ancient and modern lineages. Further studies are needed to verify the functional consequences of the identified mechanisms of gene expression regulation. [ABSTRACT FROM AUTHOR]

Published
2019
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389. Probabilistic Cause-of-death Assignment using Verbal Autopsies

Author

McCormick, Tyler H., Zehang Richard Li, Calvert, Clara, Crampin, Amelia C., Kahn, Kathleen, and Clark, Samuel J.

Subjects
3. Good health
Abstract

In regions without complete-coverage civil registration and vital statistics systems there is uncertainty about even the most basic demographic indicators. In such regions the majority of deaths occur outside hospitals and are not recorded. Worldwide, fewer than one-third of deaths are assigned a cause, with the least information available from the most impoverished nations. In populations like this, verbal autopsy (VA) is a commonly used tool to assess cause of death and estimate cause-specific mortality rates and the distribution of deaths by cause. VA uses an interview with caregivers of the decedent to elicit data describing the signs and symptoms leading up to the death. This paper develops a new statistical tool known as InSilicoVA to classify cause of death using information acquired through VA. InSilicoVA shares uncertainty between cause of death assignments for specific individuals and the distribution of deaths by cause across the population. Using side-by-side comparisons with both observed and simulated data, we demonstrate that InSilicoVA has distinct advantages compared to currently available methods.

390. Additional file 2: of Identifying mixed Mycobacterium tuberculosis infections from whole genome sequence data

Author

Sobkowiak, Benjamin, Glynn, Judith, Houben, Rein, Mallard, Kim, Phelan, Jody, JosÊ Guerra-Assunção, Banda, Louis, Themba Mzembe, Viveiros, Miguel, McNerney, Ruth, Parkhill, Julian, Crampin, Amelia, and Taane Clark

Subjects
parasitic diseases, 3. Good health
Abstract

Analysis and interpretation of Regions of Difference (RD) analysis in clinically-derived Malawi strains. (DOCX 127 kb)

391. Evaluation of Host Serum Protein Biomarkers of Tuberculosis in sub-Saharan Africa

Author

Morris, Thomas C., Hoggart, Clive J., Chegou, Novel N., Kidd, Martin, Oni, Tolu, Goliath, Rene, Wilkinson, Katalin A., Dockrell, Hazel M., Sichali, Lifted, Banda, Louis, Crampin, Amelia C., French, Neil, Walzl, Gerhard, Levin, Michael, Wilkinson, Robert J., and Hamilton, Melissa S.

Subjects
tuberculosis, diagnosis, FOS: Clinical medicine, Immunology, Africa, biomarker, HIV, protein, serum, 3. Good health
Abstract

Accurate and affordable point-of-care diagnostics for tuberculosis (TB) are needed. Host serum protein signatures have been derived for use in primary care settings, however validation of these in secondary care settings is lacking. We evaluated serum protein biomarkers discovered in primary care cohorts from Africa reapplied to patients from secondary care. In this nested case-control study, concentrations of 22 proteins were quantified in sera from 292 patients from Malawi and South Africa who presented predominantly to secondary care. Recruitment was based upon intention of local clinicians to test for TB. The case definition for TB was culture positivity for Mycobacterium tuberculosis; and for other diseases (OD) a confirmed alternative diagnosis. Equal numbers of TB and OD patients were selected. Within each group, there were equal numbers with and without HIV and from each site. Patients were split into training and test sets for biosignature discovery. A nine-protein signature to distinguish TB from OD was discovered comprising fibrinogen, alpha-2-macroglobulin, CRP, MMP-9, transthyretin, complement factor H, IFN-gamma, IP-10, and TNF-alpha. This signature had an area under the receiver operating characteristic curve in the training set of 90% (95% CI 86–95%), and, after adjusting the cut-off for increased sensitivity, a sensitivity and specificity in the test set of 92% (95% CI 80–98%) and 71% (95% CI 56–84%), respectively. The best single biomarker was complement factor H [area under the receiver operating characteristic curve 70% (95% CI 64–76%)]. Biosignatures consisting of host serum proteins may function as point-of-care screening tests for TB in African hospitals. Complement factor H is identified as a new biomarker for such signatures.

392. Probabilistic Cause-of-Death Assignment Using Verbal Autopsies

Author

McCormick, Tyler H., Zehang Richard Li, Calvert, Clara, Crampin, Amelia C., Kahn, Kathleen, and Clark, Samuel J.

Subjects
3. Good health
Abstract

In regions without complete-coverage civil registration and vital statistics systems there is uncertainty about even the most basic demographic indicators. In such regions, the majority of deaths occur outside hospitals and are not recorded. Worldwide, fewer than one-third of deaths are assigned a cause, with the least information available from the most impoverished nations. In populations like this, verbal autopsy (VA) is a commonly used tool to assess cause of death and estimate cause-specific mortality rates and the distribution of deaths by cause. VA uses an interview with caregivers of the decedent to elicit data describing the signs and symptoms leading up to the death. This article develops a new statistical tool known as InSilicoVA to classify cause of death using information acquired through VA. InSilicoVA shares uncertainty between cause of death assignments for specific individuals and the distribution of deaths by cause across the population. Using side-by-side comparisons with both observed and simulated data, we demonstrate that InSilicoVA has distinct advantages compared to currently available methods. Supplementary materials for this article are available online.

394. Additional file 1: Table S1. of Recombination in pe/ppe genes contributes to genetic variation in Mycobacterium tuberculosis lineages

Author

Phelan, Jody, Coll, Francesc, Bergval, Indra, Anthony, Richard, Warren, Rob, Sampson, Samantha, Pittius, Nicolaas Gey Van, Glynn, Judith, Crampin, Amelia, Alves, Adriana, Theolis Bessa, Campino, Susana, Keertan Dheda, Grandjean, Louis, Rumina Hasan, Hasan, Zahra, Miranda, Anabela, Moore, David, Panaiotov, Stefan, Joao Perdigao, Portugal, Isabel, Sheen, Patricia, Erivelton De Oliveira Sousa, Streicher, Elizabeth, Helden, Paul Van, Viveiros, Miguel, Hibberd, Martin, Arnab Pain, McNerney, Ruth, and Taane Clark

Subjects
3. Good health
Abstract

a) The samples used for the assembly (*Malawi [55, 56], Netherlands [57], Pakistan [58], Portugal [59]) and b) the 21 reference strains. Table S2. Lineage, sequence coverage and polymorphism. Ď nucleotide diversity; Lineage 1 Indo-Oceanic; Lineage 2 East-Asian (Beijing); Lineage 3 East-African-Indian; Lineage 4 Euro-American. Table S3. Completeness of pe/ppe gene assemblies. Table S4. List of 87 pe/ppe lineage specific-markers. S synonymous, NS non-synonymous, * genes bolded if there are sites under selection using the Bayes Empirical Bayes method; Lineage 1 Indo-Oceanic; Lineage 2 East-Asian (Beijing); Lineage 3 East-African-Indian; Lineage 4 Euro-American. Table S5. Genes with more than 10 sites under selective pressure (dN/dS (Ď ) >1). Table S6. Epitopes. * identified using netMHCpan, ** epitopes that had sites under positive selection according to the Bayes Empirical Bayes (BEB) method. (DOCX 70 kb)

395. Additional file 1 of A comparison of the associations between adiposity and lipids in Malawi and the United Kingdom

Author

Soares, Ana Luiza G., Banda, Louis, Alemayehu Amberbir, Shabbar Jaffar, Musicha, Crispin, Price, Alison J., Crampin, Amelia C., Moffat J. Nyirenda, and Lawlor, Deborah A.

Subjects
2. Zero hunger, endocrine system diseases, parasitic diseases, nutritional and metabolic diseases, 3. Good health
Abstract

Additional file 1: Supplementary methods, tables and figures. Table S1. Distribution of covariates in original and imputed data in adolescents in Malawi and the UK, by sex. Table S2. Distribution of covariates in original and imputed data in adults in Malawi and the UK, by sex. Table S3. Age-standardised means lipids, body mass index (BMI) and waist-hip ratio (WHR) in Malawian and UK adolescents and adults, by sex. Table S4. Age-adjusted association between quintiles of BMI and serum lipids in Malawian and UK adolescents and adults, by sex. Table S5. Age-adjusted association between quintiles of WHR and serum lipids in Malawian and UK adolescents and adults, by sex. Table S6. Adjusted association between BMI/WHR and serum lipids in Malawian and UK adolescents and adults. Table S7. Adjusted association between BMI/WHR and dyslipidaemia in Malawian and UK adolescents and adults. Figure S1. Age-standardised prevalence of overweight, obesity and central obesity in Malawian and UK adolescents and adults, by sex. Figure S2. Age-standardised prevalence of dyslipidaemia in Malawian and UK adolescents and adults, by sex. Figure S3. Adjusted association between quintiles of BMI/WHR in adolescents and adults from Malawi (a) and ALSPAC (b). Figure S4. Age-adjusted association between BMI/WHR and serum lipids in Malawi and the UK.

396. Additional file 1 of A comparison of the associations between adiposity and lipids in Malawi and the United Kingdom

Author

Soares, Ana Luiza G., Banda, Louis, Alemayehu Amberbir, Shabbar Jaffar, Musicha, Crispin, Price, Alison J., Crampin, Amelia C., Moffat J. Nyirenda, and Lawlor, Deborah A.

Subjects
2. Zero hunger, endocrine system diseases, parasitic diseases, nutritional and metabolic diseases, 3. Good health
Abstract

Additional file 1: Supplementary methods, tables and figures. Table S1. Distribution of covariates in original and imputed data in adolescents in Malawi and the UK, by sex. Table S2. Distribution of covariates in original and imputed data in adults in Malawi and the UK, by sex. Table S3. Age-standardised means lipids, body mass index (BMI) and waist-hip ratio (WHR) in Malawian and UK adolescents and adults, by sex. Table S4. Age-adjusted association between quintiles of BMI and serum lipids in Malawian and UK adolescents and adults, by sex. Table S5. Age-adjusted association between quintiles of WHR and serum lipids in Malawian and UK adolescents and adults, by sex. Table S6. Adjusted association between BMI/WHR and serum lipids in Malawian and UK adolescents and adults. Table S7. Adjusted association between BMI/WHR and dyslipidaemia in Malawian and UK adolescents and adults. Figure S1. Age-standardised prevalence of overweight, obesity and central obesity in Malawian and UK adolescents and adults, by sex. Figure S2. Age-standardised prevalence of dyslipidaemia in Malawian and UK adolescents and adults, by sex. Figure S3. Adjusted association between quintiles of BMI/WHR in adolescents and adults from Malawi (a) and ALSPAC (b). Figure S4. Age-adjusted association between BMI/WHR and serum lipids in Malawi and the UK.

397. Probabilistic Cause-of-Death Assignment Using Verbal Autopsies

Author

McCormick, Tyler H., Zehang Richard Li, Calvert, Clara, Crampin, Amelia C., Kahn, Kathleen, and Clark, Samuel J.

Subjects
3. Good health
Abstract

In regions without complete-coverage civil registration and vital statistics systems there is uncertainty about even the most basic demographic indicators. In such regions, the majority of deaths occur outside hospitals and are not recorded. Worldwide, fewer than one-third of deaths are assigned a cause, with the least information available from the most impoverished nations. In populations like this, verbal autopsy (VA) is a commonly used tool to assess cause of death and estimate cause-specific mortality rates and the distribution of deaths by cause. VA uses an interview with caregivers of the decedent to elicit data describing the signs and symptoms leading up to the death. This article develops a new statistical tool known as InSilicoVA to classify cause of death using information acquired through VA. InSilicoVA shares uncertainty between cause of death assignments for specific individuals and the distribution of deaths by cause across the population. Using side-by-side comparisons with both observed and simulated data, we demonstrate that InSilicoVA has distinct advantages compared to currently available methods. Supplementary materials for this article are available online.

398. Changes in Fertility at the Population Level in the Era of ART in Rural Malawi

Author

McLean, Estelle, Price, Alison, Chihana, Menard, Kayuni, Ndoliwe, Marston, Milly, Koole, Olivier, Zaba, Basia, Crampin, Amelia, and ALPHA Network

Abstract

INTRODUCTION: HIV reduces fertility through biological and social pathways, and antiretroviral treatment (ART) can ameliorate these effects. In northern Malawi, ART has been available since 2007 and lifelong ART is offered to all pregnant or breastfeeding HIV-positive women. METHODS: Using data from the Karonga Health and Demographic Surveillance Site in Malawi from 2005 to 2014, we used total and age-specific fertility rates and Cox regression to assess associations between HIV and ART use and fertility. We also assessed temporal trends in in utero and breastfeeding HIV and ART exposure among live births. RESULTS: From 2005 to 2014, there were 13,583 live births during approximately 78,000 person years of follow-up of women aged 15-49 years. The total fertility rate in HIV-negative women decreased from 6.1 [95% confidence interval (CI): 5.5 to 6.8] in 2005-2006 to 5.1 (4.8-5.5) in 2011-2014. In HIV-positive women, the total fertility rate was more stable, although lower, at 4.4 (3.2-6.1) in 2011-2014. In 2011-2014, compared with HIV-negative women, the adjusted (age, marital status, and education) hazard ratio was 0.7 (95% CI: 0.6 to 0.9) and 0.8 (95% CI: 0.6 to 1.0) for women on ART for at least 9 months and not (yet) on ART, respectively. The crude fertility rate increased with duration on ART up to 3 years before declining. The proportion of HIV-exposed infants decreased, but the proportion of ART-exposed infants increased from 2.4% in 2007-2010 to 3.5% in 2011-2014. CONCLUSIONS: Fertility rates in HIV-positive women are stable in the context of generally decreasing fertility. Despite a decrease in HIV-exposed infants, there has been an increase in ART-exposed infants.

399. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author

NCD Risk Factor Collaboration (NCD-RisC), Iurilli, Maria LC, Zhou, Bin, Bennett, James E, Carrillo-Larco, Rodrigo M, Sophiea, Marisa K, Rodriguez-Martinez, Andrea, Bixby, Honor, Solomon, Bethlehem D, Taddei, Cristina, Danaei, Goodarz, Di Cesare, Mariachiara, Stevens, Gretchen A, Riley, Leanne M, Savin, Stefan, Cowan, Melanie J, Bovet, Pascal, Damasceno, Albertino, Chirita-Emandi, Adela, Hayes, Alison J, Ikeda, Nayu, Jackson, Rod T, Khang, Young-Ho, Laxmaiah, Avula, Liu, Jing, Miranda, J Jaime, Saidi, Olfa, Sebert, Sylvain, Sorić, Maroje, Starc, Gregor, Gregg, Edward W, Abarca-Gómez, Leandra, Abdeen, Ziad A, Abdrakhmanova, Shynar, Ghaffar, Suhaila Abdul, Rahim, Hanan F Abdul, Abu-Rmeileh, Niveen M, Garba, Jamila Abubakar, Acosta-Cazares, Benjamin, Adams, Robert J, Aekplakorn, Wichai, Afsana, Kaosar, Afzal, Shoaib, Agdeppa, Imelda A, Aghazadeh-Attari, Javad, Aguilar-Salinas, Carlos A, Agyemang, Charles, Ahmad, Mohamad Hasnan, Ahmad, Noor Ani, Ahmadi, Ali, Ahmadi, Naser, Ahmed, Soheir H, Ahrens, Wolfgang, Aitmurzaeva, Gulmira, Ajlouni, Kamel, Al-Hazzaa, Hazzaa M, Al-Lahou, Badreya, Al-Raddadi, Rajaa, Alarouj, Monira, AlBuhairan, Fadia, AlDhukair, Shahla, Ali, Mohamed M, Alkandari, Abdullah, Alkerwi, Ala'a, Allin, Kristine, Alvarez-Pedrerol, Mar, Aly, Eman, Amarapurkar, Deepak N, Amiri, Parisa, Amougou, Norbert, Amouyel, Philippe, Bo Andersen, Lars, Anderssen, Sigmund A, Ängquist, Lars, Anjana, Ranjit Mohan, Ansari-Moghaddam, Alireza, Aounallah-Skhiri, Hajer, Araújo, Joana, Ariansen, Inger, Aris, Tahir, Arku, Raphael E, Arlappa, Nimmathota, Aryal, Krishna K, Aspelund, Thor, Assah, Felix K, Assunção, Maria Cecília F, Aung, May Soe, Auvinen, Juha, Avdicová, Mária, Avi, Shina, Azevedo, Ana, Azimi-Nezhad, Mohsen, Azizi, Fereidoun, Azmin, Mehrdad, Babu, Bontha V, Jørgensen, Maja Bæksgaard, Baharudin, Azli, Bahijri, Suhad, Baker, Jennifer L, Balakrishna, Nagalla, Bamoshmoosh, Mohamed, Banach, Maciej, Bandosz, Piotr, Banegas, José R, Baran, Joanna, Barbagallo, Carlo M, Barceló, Alberto, Barkat, Amina, Barros, Aluisio JD, Barros, Mauro Virgílio Gomes, Basit, Abdul, Bastos, Joao Luiz D, Bata, Iqbal, Batieha, Anwar M, Batista, Rosangela L, Battakova, Zhamilya, Batyrbek, Assembekov, Baur, Louise A, Beaglehole, Robert, Bel-Serrat, Silvia, Belavendra, Antonisamy, Romdhane, Habiba Ben, Benedics, Judith, Benet, Mikhail, Bergh, Ingunn Holden, Berkinbayev, Salim, Bernabe-Ortiz, Antonio, Bernotiene, Gailute, Bettiol, Heloísa, Bezerra, Jorge, Bhagyalaxmi, Aroor, Bharadwaj, Sumit, Bhargava, Santosh K, Bhutta, Zulfiqar A, Bi, Hongsheng, Bi, Yufang, Bia, Daniel, Lele, Elysée Claude Bika, Bikbov, Mukharram M, Bista, Bihungum, Bjelica, Dusko J, Bjerregaard, Peter, Bjertness, Espen, Bjertness, Marius B, Björkelund, Cecilia, Bloch, Katia V, Blokstra, Anneke, Bo, Simona, Bobak, Martin, Boddy, Lynne M, Boehm, Bernhard O, Boeing, Heiner, Boggia, Jose G, Bogova, Elena, Boissonnet, Carlos P, Bojesen, Stig E, Bonaccio, Marialaura, Bongard, Vanina, Bonilla-Vargas, Alice, Bopp, Matthias, Borghs, Herman, Braeckevelt, Lien, Braeckman, Lutgart, Bragt, Marjolijn CE, Brajkovich, Imperia, Branca, Francesco, Breckenkamp, Juergen, Breda, João, Brenner, Hermann, Brewster, Lizzy M, Brian, Garry R, Brinduse, Lacramioara, Brophy, Sinead, Bruno, Graziella, Bueno-De-Mesquita, H Bas, Bugge, Anna, Buoncristiano, Marta, Burazeri, Genc, Burns, Con, De León, Antonio Cabrera, Cacciottolo, Joseph, Cai, Hui, Cama, Tilema, Cameron, Christine, Camolas, José, Can, Günay, Cândido, Ana Paula C, Cañete, Felicia, Capanzana, Mario V, Capková, Nadežda, Capuano, Eduardo, Capuano, Vincenzo, Cardol, Marloes, Cardoso, Viviane C, Carlsson, Axel C, Carmuega, Esteban, Carvalho, Joana, Casajús, José A, Casanueva, Felipe F, Celikcan, Ertugrul, Censi, Laura, Cervantes-Loaiza, Marvin, Cesar, Juraci A, Chamukuttan, Snehalatha, Chan, Angelique W, Chan, Queenie, Chaturvedi, Himanshu K, Chaturvedi, Nish, Rahim, Norsyamlina Che Abdul, Li Chee, Miao, Chen, Chien-Jen, Chen, Fangfang, Chen, Huashuai, Chen, Shuohua, Chen, Zhengming, Cheng, Ching-Yu, Cheraghian, Bahman, Chetrit, Angela, Chikova-Iscener, Ekaterina, Chiolero, Arnaud, Chiou, Shu-Ti, Chirlaque, María-Dolores, Cho, Belong, Christensen, Kaare, Christofaro, Diego G, Chudek, Jerzy, Cifkova, Renata, Cilia, Michelle, Cinteza, Eliza, Claessens, Frank, Clarke, Janine, Clays, Els, Cohen, Emmanuel, Concin, Hans, Confortin, Susana C, Cooper, Cyrus, Coppinger, Tara C, Corpeleijn, Eva, Costanzo, Simona, Cottel, Dominique, Cowell, Chris, Craig, Cora L, Crampin, Amelia C, Crujeiras, Ana B, Csilla, Semánová, Cucu, Alexandra M, Cui, Liufu, Cureau, Felipe V, Czenczek-Lewandowska, Ewelina, D'Arrigo, Graziella, D'Orsi, Eleonora, Dacica, Liliana, Re Saavedra, María Ángeles Dal, Dallongeville, Jean, Damsgaard, Camilla T, Dankner, Rachel, Dantoft, Thomas M, Dasgupta, Parasmani, Dastgiri, Saeed, Dauchet, Luc, Davletov, Kairat, De Backer, Guy, De Bacquer, Dirk, De Gaetano, Giovanni, De Henauw, Stefaan, De Oliveira, Paula Duarte, De Ridder, David, De Ridder, Karin, De Rooij, Susanne R, De Smedt, Delphine, Deepa, Mohan, Deev, Alexander D, Jr DeGennaro, Vincent, Dehghan, Abbas, Delisle, Hélène, Delpeuch, Francis, Demarest, Stefaan, Dennison, Elaine, Dereń, Katarzyna, Deschamps, Valérie, Dhimal, Meghnath, Di Castelnuovo, Augusto F, Dias-Da-Costa, Juvenal Soares, Díaz-Sánchez, María Elena, Diaz, Alejandro, Dika, Zivka, Djalalinia, Shirin, Djordjic, Visnja, Do, Ha TP, Dobson, Annette J, Donati, Maria Benedetta, Donfrancesco, Chiara, Donoso, Silvana P, Döring, Angela, Dorobantu, Maria, Dorosty, Ahmad Reza, Doua, Kouamelan, Dragano, Nico, Drygas, Wojciech, Li Duan, Jia, Duante, Charmaine A, Duboz, Priscilla, Duda, Rosemary B, Duleva, Vesselka, Dulskiene, Virginija, Dumith, Samuel C, Dushpanova, Anar, Dzerve, Vilnis, Dziankowska-Zaborszczyk, Elzbieta, Eddie, Ricky, Eftekhar, Ebrahim, Egbagbe, Eruke E, Eggertsen, Robert, Eghtesad, Sareh, Eiben, Gabriele, Ekelund, Ulf, El-Khateeb, Mohammad, El Ati, Jalila, Eldemire-Shearer, Denise, Eliasen, Marie, Elliott, Paul, Engle-Stone, Reina, Enguerran, Macia, Erasmus, Rajiv T, Erbel, Raimund, Erem, Cihangir, Eriksen, Louise, Eriksson, Johan G, La Peña, Jorge Escobedo-De, Eslami, Saeid, Esmaeili, Ali, Evans, Alun, Faeh, David, Fakhretdinova, Albina A, Fall, Caroline H, Faramarzi, Elnaz, Farjam, Mojtaba, Sant'Angelo, Victoria Farrugia, Farzadfar, Farshad, Fattahi, Mohammad Reza, Fawwad, Asher, Felix-Redondo, Francisco J, Ferguson, Trevor S, Fernandes, Romulo A, Fernández-Bergés, Daniel, Ferrante, Daniel, Ferrao, Thomas, Ferrari, Marika, Ferrario, Marco M, Ferreccio, Catterina, Ferrer, Eldridge, Ferrieres, Jean, Figueiró, Thamara Hubler, Fijalkowska, Anna, Fink, Günther, Fischer, Krista, Foo, Leng Huat, Forsner, Maria, Fouad, Heba M, Francis, Damian K, Do Carmo Franco, Maria, Frikke-Schmidt, Ruth, Frontera, Guillermo, Fuchs, Flavio D, Fuchs, Sandra C, Fujiati, Isti I, Fujita, Yuki, Fumihiko, Matsuda, Furusawa, Takuro, Gaciong, Zbigniew, Gafencu, Mihai, Galbarczyk, Andrzej, Galenkamp, Henrike, Galeone, Daniela, Galfo, Myriam, Galvano, Fabio, Gao, Jingli, Garcia-De-La-Hera, Manoli, García-Solano, Marta, Gareta, Dickman, Garnett, Sarah P, Gaspoz, Jean-Michel, Gasull, Magda, Gaya, Adroaldo Cesar Araujo, Gaya, Anelise Reis, Gazzinelli, Andrea, Gehring, Ulrike, Geiger, Harald, Geleijnse, Johanna M, Ghanbari, Ali, Ghasemi, Erfan, Gheorghe-Fronea, Oana-Florentina, Giampaoli, Simona, Gianfagna, Francesco, Gill, Tiffany K, Giovannelli, Jonathan, Gironella, Glen, Giwercman, Aleksander, Gkiouras, Konstantinos, Godos, Justyna, Gogen, Sibel, Goldberg, Marcel, Goldsmith, Rebecca A, Goltzman, David, Gómez, Santiago F, Gomula, Aleksandra, Da Silva, Bruna Goncalves Cordeiro, Gonçalves, Helen, Gonzalez-Chica, David A, Gonzalez-Gross, Marcela, González-Leon, Margot, González-Rivas, Juan P, González-Villalpando, Clicerio, González-Villalpando, María-Elena, Gonzalez, Angel R, Gottrand, Frederic, Graça, Antonio Pedro, Graff-Iversen, Sidsel, Grafnetter, Dušan, Grajda, Aneta, 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Subjects
2. Zero hunger, obesity, BMI, Epidemiology and Global Health, underweight, None, 1. No poverty, 3. Good health, Research Article
Abstract

Funder: Wellcome Trust; FundRef: http://dx.doi.org/10.13039/100004440, Funder: Medical Research Council; FundRef: http://dx.doi.org/10.13039/501100000265, From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

400. Impact of monovalent rotavirus vaccine on diarrhoea-associated post-neonatal infant mortality in rural communities in Malawi: a population-based birth cohort study

Author

Bar-Zeev, Naor, King, Carina, Phiri, Tambosi, Beard, James, Mvula, Hazzie, Crampin, Amelia C, Heinsbroek, Ellen, Lewycka, Sonia, Tate, Jacqueline E, Parashar, Umesh D, Costello, Anthony, Mwansambo, Charles, Heyderman, Robert S, French, Neil, Cunliffe, Nigel A, and VacSurv Consortium

Abstract

BACKGROUND: Rotavirus is a major contributor to child mortality. The effect of rotavirus vaccine on diarrhoea mortality has been estimated in middle-income but not low-income settings, where mortality is high and vaccine effectiveness in reducing admissions to hospital is lower. Empirical population-based mortality studies have not been done in any setting. Malawi introduced monovalent rotavirus vaccine (RV1) in October, 2012. We aimed to investigate the impact and effectiveness of the RV1 vaccine in reducing diarrhoea-associated mortality in infants aged 10-51 weeks. METHODS: In this population-based cohort study, we included infants born between Jan 1, 2012, and June 1, 2015, in Mchinji, Central Malawi and analysed data on those surviving 10 weeks. Individual vaccination status was extracted from caregiver-held records or report at home visits at 4 months and 1 year of age. Survival to 1 year was confirmed at home visit, or cause of death ascertained by verbal autopsy. We assessed impact (1 minus mortality rate ratio following vs before vaccine introduction) using Poisson regression. Among vaccine-eligible infants (born from Sept 17, 2012), we assessed effectiveness (1 minus hazard ratio) using Cox regression. FINDINGS: Between Jan 1, 2012, and June 1, 2015, we recruited 48 672 livebirths in Mchinji, among whom 38 518 were vaccine-eligible and 37 570 survived to age 10 weeks. Two-dose versus zero-dose effectiveness analysis included 28 141 infants, of whom 101 had diarrhoea-associated death before 1 year of age. Diarrhoea-associated mortality declined by 31% (95% CI 1-52; p=0·04) after RV1 introduction. Effectiveness against diarrhoea-mortality was 34% (95% CI -28 to 66; p=0·22). INTERPRETATION: RV1 was associated with substantial reduction in diarrhoea-associated deaths among infants in this rural sub-Saharan African setting. These data add considerable weight to evidence showing the impact of rotavirus vaccine programmes. FUNDING: Wellcome Trust and GlaxoSmithKline Biologicals.

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