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2. Growth, physical, and cognitive function in children who are born HIV-free: School-age follow-up of a cluster-randomised trial in rural Zimbabwe

Author

Piper, Joe D, Mazhanga, Clever, Mwapaura, Marian, Mapako, Gloria, Mapurisa, Idah, Mashedze, Tsitsi, Munyama, Eunice, Kuona, Maria, Mashiri, Thombizodwa, Sibanda, Kundai, Matemavi, Dzidzai, Tichagwa, Monica, Nyoni, Soneni, Saidi, Asinje, Mangwende, Manasa, Chidhanguro, Dzivaidzo, Mpofu, Eddington, Tome, Joice, Mbewe, Gabriel, Mutasa, Batsirai, Chasekwa, Bernard, Njovo, Handrea, Nyachowe, Chandiwana, Muchekeza, Mary, Mutasa, Kuda, Sauramba, Virginia, Evans, Ceri, Gladstone, Melissa J, Wells, Jonathan C, Allen, Elizabeth, Smuk, Melanie, Humphrey, Jean H, Langhaug, Lisa F, Tavengwa, Naume V, Ntozini, Robert, and Prendergast, Andrew J

Subjects
HIV (Viruses) -- Research, Cognition -- Physiological aspects, Children -- Physiological aspects -- Growth, Pediatric research, Company growth, Biological sciences
Abstract

Background Globally, over 16 million children were exposed to HIV during pregnancy but remain HIV-free at birth and throughout childhood by 2022. Children born HIV-free (CBHF) have higher morbidity and mortality and poorer neurodevelopment in early life compared to children who are HIV-unexposed (CHU), but long-term outcomes remain uncertain. We characterised school-age growth, cognitive and physical function in CBHF and CHU previously enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods and findings The SHINE trial enrolled pregnant women between 2012 and 2015 across 2 rural Zimbabwean districts. Co-primary outcomes were height-for-age Z-score and haemoglobin at age 18 months (clinicaltrials.gov NCT01824940). Children were re-enrolled if they were aged 7 years, resident in Shurugwi district, and had known pregnancy HIV-exposure status. From 5,280 pregnant women originally enrolled, 376 CBHF and 2016 CHU reached the trial endpoint at 18 months in Shurugwi; of these, 264 CBHF and 990 CHU were evaluated at age 7 years using the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox. Cognitive function was evaluated using the Kaufman Assessment Battery for Children (KABC-II), with additional tools measuring executive function, literacy, numeracy, fine motor skills, and socioemotional function. Physical function was assessed using standing broad jump and handgrip for strength, and the shuttle-run test for cardiovascular fitness. Growth was assessed by anthropometry. Body composition was assessed by bioimpedance analysis and skinfold thicknesses. A caregiver questionnaire measured demographics, socioeconomic status, nurturing, child discipline, food, and water insecurity. We prespecified the primary comparisons and used generalised estimating equations with an exchangeable working correlation structure to account for clustering. Adjusted models used covariates from the trial (study arm, study nurse, exact child age, sex, calendar month measured, and ambient temperature). They also included covariates derived from directed acyclic graphs, with separate models adjusted for contemporary variables (socioeconomic status, household food insecurity, religion, social support, gender norms, caregiver depression, age, caregiver education, adversity score, and number of children's books) and early-life variables (length-for-age-Z-score) at 18 months, birthweight, maternal baseline depression, household diet, maternal schooling and haemoglobin, socioeconomic status, facility birth, and gender norms. We applied a Bonferroni correction for the 27 comparisons (0.05/27) with threshold of p < 0.00185 as significant. We found strong evidence that cognitive function was lower in CBHF compared to CHU across multiple domains. The KABC-II mental processing index was 45.2 (standard deviation (SD) 10.5) in CBHF and 48.3 (11.3) in CHU (mean difference 3.3 points [95% confidence interval (95% CI) 2.0, 4.5]; p < 0.001). The school achievement test score was 39.0 (SD 26.0) in CBHF and 45.7 (27.8) in CHU (mean difference 7.3 points [95% CI 3.6, 10.9]; p < 0.001); differences remained significant in adjusted analyses. Executive function was reduced but not significantly in adjusted analyses. We found no consistent evidence of differences in growth or physical function outcomes. The main limitation of our study was the restriction to one of two previous study districts, with possible survivor and selection bias. Conclusions In this study, we found that CBHF had reductions in cognitive function compared to CHU at 7 years of age across multiple domains. Further research is needed to define the biological and psychosocial mechanisms underlying these differences to inform future interventions that help CBHF thrive across the life-course. Trial registration ClinicalTrials.gov The SHINE follow-up study was registered with the Pan-African Clinical Trials Registry (PACTR202201828512110). The original SHINE trial was registered at NCT https://clinicaltrials.gov/study/NCT01824940., Author(s): Joe D Piper 1,2,3,*, Clever Mazhanga 1, Marian Mwapaura 1, Gloria Mapako 1, Idah Mapurisa 1, Tsitsi Mashedze 1, Eunice Munyama 1, Maria Kuona 1, Thombizodwa Mashiri 1, Kundai [...]

Published
2024
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3. School-age growth and development following infant feeding and/or water, sanitation, and hygiene interventions in rural Zimbabwe: long-term follow-up of a cluster-randomised trial

Author

Piper, Joe D., Mazhanga, Clever, Mwapaura, Marian, Mapako, Gloria, Mapurisa, Idah, Mashedze, Tsitsi, Munyama, Eunice, Kuona, Maria, Mashiri, Thombizodwa, Sibanda, Kundai, Matemavi, Dzidzai, Tichagwa, Monica, Nyoni, Soneni, Saidi, Asinje, Mangwende, Manasa, Mbewe, Gabriel, Chidhanguro, Dzivaidzo, Mpofu, Eddington, Tome, Joice, Mutasa, Batsirai, Chasekwa, Bernard, Njovo, Handrea, Nyachowe, Chandiwana, Muchekeza, Mary, Sauramba, Virginia, Gladstone, Melissa J., Wells, Jonathan C., Allen, Elizabeth, Moulton, Lawrence H., Smuk, Melanie, Humphrey, Jean H., Langhaug, Lisa F., Tavengwa, Naume V., Ntozini, Robert, and Prendergast, Andrew J.

Published
2024
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4. 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.

Author

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

Subjects
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.

Published
2022

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.

Author

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

Subjects
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) (

Published
2021

6. 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

Author

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

Published
2023
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7. The gut microbiome and early-life growth in a population with high prevalence of stunting

Author

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.

Published
2023
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8. Moving towards transformational WASH – Authors' reply

Author

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

Subjects
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

9. The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement.

Author

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

Subjects
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.

Published
2019

10. The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea.

Author

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

Subjects
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.

Published
2019

14. Associations between biomarkers of environmental enteric dysfunction and oral rotavirus vaccine immunogenicity in rural Zimbabwean infants

Author

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

Published
2021
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15. Maternal fecal microbiome predicts gestational age, birth weight and neonatal growth in rural Zimbabwe.

Author

Gough, Ethan K., Edens, Thaddeus J., Geum, Hyun Min, Baharmand, Iman, Gill, Sandeep K., Robertson, Ruairi C., Mutasa, Kuda, Ntozini, Robert, Smith, Laura E, Chasekwa, Bernard, Majo, Florence D., Tavengwa, Naume V., Mutasa, Batsirai, Francis, Freddy, Carr, Lynnea, Tome, Joice, Stoltzfus, Rebecca J., Moulton, Lawrence H., Prendergast, Andrew J., Humphrey, Jean H., Manges, Amee R., and Team, SHINE Trial

Published
2021
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20. 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

Author

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.

Subjects
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 [...]

Published
2020
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22. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on stunting and anaemia among HIV-exposed children in rural Zimbabwe: a cluster-randomised controlled trial

Author

Prendergast, Andrew J, Chasekwa, Bernard, Evans, Ceri, Mutasa, Kuda, Mbuya, Mduduzi N N, Stoltzfus, Rebecca J, Smith, Laura E, Majo, Florence D, Tavengwa, Naume V, Mutasa, Batsirai, Mangwadu, Goldberg T, Chasokela, Cynthia M, Chigumira, Ancikaria, Moulton, Lawrence H, Ntozini, Robert, and Humphrey, Jean H

Published
2019
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23. 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

Author

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

Published
2019
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24. 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

Author

Chagwena, Dexter T., primary, Fernando, Shamiso, additional, Tavengwa, Naume V., additional, Sithole, Shadreck, additional, Nyachowe, Chandiwana, additional, Njovo, Handrea, additional, Datta, Kavita, additional, Brown, Tim, additional, Humphrey, Jean H., additional, Prendergast, Andrew J., additional, and Smith, Laura E., additional

Published
2023
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28. 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.

Author

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.

Subjects
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]

Published
2024
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31. Enteropathogens and Rotavirus Vaccine Immunogenicity in a Cluster Randomized Trial of Improved Water, Sanitation and Hygiene in Rural Zimbabwe

Author

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.

Published
2019
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32. Why small-quantity lipid-based nutrient supplements should be integrated into comprehensive strategies to prevent child undernutrition in nutritionally vulnerable populations: response to Gupta et al.’s commentary

Author

Dewey, Kathryn G.; Stewart, Christine P.; McDonald, Christine M.; Wessells, K. Ryan; Arnold, Charles D.; Prado, Elizabeth L.; Abbeddou, Souheila; Adu-Afarwuah, Seth; Arnold, Benjamin F.; Ashorn, Per; Ashorn, Ulla; Ashraf, Sania; Becquey, Elodie; Black, Robert E.; Brown, Kenneth H.; Christian, Parul; Colford, John M.; Fernald, Lia; Galasso, Emanuela; Hallamaa, Lotta; Hess, Sonja; Humphrey, Jean H.; Huybregts, Lieven; Iannotti, Lora L.; Jannat, Kaniz; Jimenez, Elizabeth Y.; Lartey, Anna; Le Port, Agnes; Leroy, Jef L.; Luby, Stephen P.; Maleta, Kenneth; Matchado, Andrew; Matias, Susana L.; Mbuya, Mduduzi; Mridha, Malay K.; Paul, Rina R.; Okronipa, Harriet; Ouedrago, Jean-Bosco; Pickering, Amy J.; Prendergast, Andrew J.; Ruel, Marie; Shaikh, Saijuddin; Weber, Ann M.; Wolff, Patricia, http://orcid.org/0000-0002-3068-2853 Huybregts, Lieven; http://orcid.org/0000-0002-9506-348X Ruel, Marie; http://orcid.org/0000-0002-8748-7637 Becquey, Elodie; http://orcid.org/0000-0001-9371-3832 Leroy, Jef, Dewey, Kathryn G.; Stewart, Christine P.; McDonald, Christine M.; Wessells, K. Ryan; Arnold, Charles D.; Prado, Elizabeth L.; Abbeddou, Souheila; Adu-Afarwuah, Seth; Arnold, Benjamin F.; Ashorn, Per; Ashorn, Ulla; Ashraf, Sania; Becquey, Elodie; Black, Robert E.; Brown, Kenneth H.; Christian, Parul; Colford, John M.; Fernald, Lia; Galasso, Emanuela; Hallamaa, Lotta; Hess, Sonja; Humphrey, Jean H.; Huybregts, Lieven; Iannotti, Lora L.; Jannat, Kaniz; Jimenez, Elizabeth Y.; Lartey, Anna; Le Port, Agnes; Leroy, Jef L.; Luby, Stephen P.; Maleta, Kenneth; Matchado, Andrew; Matias, Susana L.; Mbuya, Mduduzi; Mridha, Malay K.; Paul, Rina R.; Okronipa, Harriet; Ouedrago, Jean-Bosco; Pickering, Amy J.; Prendergast, Andrew J.; Ruel, Marie; Shaikh, Saijuddin; Weber, Ann M.; Wolff, Patricia, and http://orcid.org/0000-0002-3068-2853 Huybregts, Lieven; http://orcid.org/0000-0002-9506-348X Ruel, Marie; http://orcid.org/0000-0002-8748-7637 Becquey, Elodie; http://orcid.org/0000-0001-9371-3832 Leroy, Jef

Abstract

PR, IFPRI3; OA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, We write in response to the commentary by Gupta et al. (2023) on small-quantity lipid-based nutrient supplements (SQ-LNS) for infants and young children 6 to 24 months of age, which was prompted by the recent brief guidance note from UNICEF (2023) explaining when, why and how SQ-LNS are being prioritized as part of their package of preventive actions to combat early childhood malnutrition. The UNICEF document was disseminated shortly after publication of a correspondence in Nature Food (Aguayo et al. 2023), authored by nutrition leaders from several organizations, that summarized the evidence on the benefits of SQ-LNS and called for this intervention to be scaled up and integrated into programs for populations in which child undernutrition is prevalent and dietary quality is very poor.

Published
2023

33. 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

Author

Sustainable Healthy Diets, 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.; Katz, Joanne, http://orcid.org/0000-0002-3068-2853 Huybregts, Lieven, Sustainable Healthy Diets, 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.; Katz, Joanne, and http://orcid.org/0000-0002-3068-2853 Huybregts, Lieven

Abstract

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Introduction Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases. Methods We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data. Results Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources. Conclusions Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.

Published
2023

39. Additional file 1 of 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

Author

Noble, Christie, Mooney, Ciaran, Makasi, Rachel, Ntozini, Robert, Majo, Florence D., Church, James A., Tavengwa, Naume V., Prendergast, Andrew J., and Humphrey, Jean H.

Abstract

Additional file 1: Supplementary Figure. Participant flow for analyses examining antenatal and delivery practices among non-institutional and to institutional deliveries.

Published
2023
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46. 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

Author

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.

Subjects
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 [...]

Published
2019
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47. 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

Author

Dewey, Kathryn G., primary, Arnold, Charles D., additional, Wessells, K. Ryan, additional, Prado, Elizabeth L., additional, Abbeddou, Souheila, additional, Adu-Afarwuah, Seth, additional, Ali, Hasmot, additional, Arnold, Benjamin F., additional, Ashorn, Per, additional, Ashorn, Ulla, additional, Ashraf, Sania, additional, Becquey, Elodie, additional, Brown, Kenneth H., additional, Christian, Parul, additional, Colford, John M., additional, Dulience, Sherlie J. L., additional, Fernald, Lia C.H., additional, Galasso, Emanuela, additional, Hallamaa, Lotta, additional, Hess, Sonja Y., additional, Humphrey, Jean H., additional, Huybregts, Lieven, additional, Iannotti, Lora L., additional, Jannat, Kaniz, additional, Lartey, Anna, additional, Port, Agnes Le, additional, Leroy, Jef L., additional, Luby, Stephen P., additional, Maleta, Kenneth, additional, Matias, Susana L., additional, Mbuya, Mduduzi NN, additional, Mridha, Malay K., additional, Nkhoma, Minyanga, additional, Null, Clair, additional, Paul, Rina R., additional, Okronipa, Harriet, additional, Ouédraogo, Jean-Bosco, additional, Pickering, Amy J., additional, Prendergast, Andrew J., additional, Ruel, Marie, additional, Shaikh, Saijuddin, additional, Weber, Ann M., additional, Wolff, Patricia, additional, Zongrone, Amanda, additional, and Stewart, Christine P., additional

Published
2022
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48. Stunting Status and Exposure to Infection and Inflammation in Early Life Shape Antibacterial Immune Cell Function Among Zimbabwean Children

Author

Mutasa, Kuda, primary, Tome, Joice, additional, Rukobo, Sandra, additional, Govha, Margaret, additional, Mushayanembwa, Patience, additional, Matimba, Farai S., additional, Chiorera, Courage K., additional, Majo, Florence D., additional, Tavengwa, Naume V., additional, Mutasa, Batsirai, additional, Chasekwa, Bernard, additional, Humphrey, Jean H., additional, Ntozini, Robert, additional, Prendergast, Andrew J., additional, and Bourke, Claire D., additional

Published
2022
Full Text
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