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1. 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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2. 'I Can't Answer What You're Asking Me. Let Me Go, Please.': Cognitive Interviewing to Assess Social Support Measures in Ethiopia and Kenya

Author

Martin, Stephanie L., Birhanu, Zewdie, Omotayo, Moshood O., Kebede, Yohannes, Pelto, Gretel H., Stoltzfus, Rebecca J., and Dickin, Katherine L.

Abstract

Cognitive interviewing is a method to develop culturally appropriate survey questions and scale items. We conducted two rounds of cognitive interviews with 24 pregnant women in Ethiopia and Kenya to assess the appropriateness, acceptability, and comprehension of general and micronutrient supplement adherence-specific social support scales. We stopped the first round of cognitive interviews after receiving negative feedback from interviewers and participants about their distressing and uncomfortable experiences with cognitive probes and challenges related to cultural perspectives on social support. Through an iterative process, we made substantial changes to the cognitive interview guides and items from both social support scales. In the second round, the revised cognitive interviewing process substantially improved interviewer and participant experiences and increased comprehension and appropriateness of both social support scales. This study confirms the importance of cultural adaptation of the cognitive interviewing process as well as social support scales.

Published
2017
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3. 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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4. Differences and Commonalities in Physical, Chemical and Mineralogical Properties of Zanzibari Geophagic Soils

Author

Young, Sera L., Wilson, M. Jeffrey, Hillier, Stephen, Delbos, Evelyne, Ali, Said M., and Stoltzfus, Rebecca J.

Subjects
Life Sciences, Agriculture, Biological Microscopy, Entomology, Biochemistry, general, Ecology, Pica, Geophagy, Nutrition, Detoxification, Africa, Pregnancy, Mineralogy, Health
Abstract

The function of human geophagy has long been questioned. We sought to test hypotheses concerning its potential physiological effects through analysis of soils and patterns in geophagy behavior. Eleven samples of geophagic soils consumed by pregnant women on Pemba Island, Zanzibar, Tanzania, were characterized according to their color, texture, major element chemistry, trace element chemistry, bulk mineralogy, and clay mineralogy. An epidemiological study (N = 2367) and ethnographic interviews (N = 57) on Pemba yielded information about geophagic behaviors and socio-demographic and biological characteristics of those who consumed earth. The soils varied widely in color, ranging from light red to white through various shades of brown and yellow, and texture ranged from clay to sand. Major element chemistry of the soils also varied greatly; most were low in Fe and Ca. Trace elements, whether of biological or non-biological significance, were uniformly low when compared with normal ranges of mineral soils. The sole commonality among the samples is that all clay fractions were dominated by a kaolin mineral: kaolinite, halloysite, or a mixture of both. Geophagy behavior also varied greatly, with one major exception: a greater proportion of pregnant women (7.1%) and young children (4.5%) consumed earth than non-pregnant women (0.2%) or men (0%). The presence of kaolin mineral in all samples, its palliative and detoxifying properties, and the highest prevalence of geophagy among those most biologically vulnerable suggest that geophagy may be a protective behavior.

Published
2010

21. 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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29. 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., Humphrey, Jean H., for the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, Jones, Andrew D., Manges, Amee, Mangwadu, Goldberg, Maluccio, John A., Mbuya, Mduduzi N. N., Moulton, Lawrence H., Stoltzfus, Rebecca J., Tielsch, James M., Smith, Laura E., and Chasokela, Cynthia

Subjects
DELIVERY (Obstetrics), NEONATAL mortality, CLUSTER randomized controlled trials, WOMEN'S mortality, PREMATURE labor, HEALTH facilities, INFANT nutrition
Abstract

Background: Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions. Methods: This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. Results: Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference. Conclusions: Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe. Trial registration: The trial is registered with ClinicalTrials.gov, number NCT01824940. [ABSTRACT FROM AUTHOR]

Published
2022
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36. Maternal fecal microbiome predicts gestational age, birth weight and neonatal growth in rural Zimbabwe.

Author

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

Published
2021
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37. Biomarkers of environmental enteric dysfunction are not consistently associated with linear growth velocity in rural Zimbabwean infants

Author

Mutasa, Kuda, primary, Ntozini, Robert, additional, Mbuya, Mduduzi NN, additional, Rukobo, Sandra, additional, Govha, Margaret, additional, Majo, Florence D, additional, Tavengwa, Naume, additional, Smith, Laura E, additional, Caulfield, Laura, additional, Swann, Jonathan R, additional, Stoltzfus, Rebecca J, additional, Moulton, Lawrence H, additional, Humphrey, Jean H, additional, Gough, Ethan K, additional, and Prendergast, Andrew J, additional

Published
2021
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39. Heat treatment of expressed breast milk is a feasible option for feeding hiv-exposed, uninfected children after 6 months of age in rural Zimbabwe

Author

Mbuya, Mduduzi N.N., Humphrey, Jean H., Majo, Florence, Chasekwa, Bernard, Jenkins, Alison, Israel-Ballard, Kiersten, Muti, Monica, Paul, Keriann H., Madzima, Rufaro C., Moulton, Lawrence H., and Stoltzfus, Rebecca J.

Subjects
HIV infection -- Research, Children -- Food and nutrition, Children -- Health aspects, Breast feeding -- Methods, Breast feeding -- Research, Disease transmission -- Research, Disease transmission -- Prevention, Food/cooking/nutrition
Abstract

In the context of a prevention of mother to child transmission of HIV program promoting exclusive breast-feeding (EBF) to 6 mo and offering HIV-PCR testing at ~6 mo, we ascertained the feasibility of expressing and heat-treating (EHT) all breast milk fed to HIV-exposed, uninfected infants following 6 mo of EBF. Twenty mother-baby pairs were enrolled from a hospital in rural Zimbabwe. Research nurses provided lactation, EHT, and complementary feeding counseling through 21 home visits conducted over an 8-wk period and collected quantitative and qualitative data on the mothers' EHT experiences, children's diets, and anthropometric measurements. Mothers kept daily logs of EHT volumes and direct breast-feeding episodes. Mothers successfully initiated and sustained EHT for 4.5 mo (range, 1-11 mo), feeding 426 [+ or -] 227 mL/d (mean [+ or -] SD). By wk 2 of follow-up, children were receiving EHT and Nutributter-enriched complementary foods that satisfied 100% of their energy requirements. During the 8-wk follow-up period, no growth faltering was experienced [changes in weight-for-age, weight-for-length, and length-for-age Z scores = +0.03 [+ or -] 0.50; +0.77 [+ or -] 1.59; and +0.02 [+ or -] 0.85 (mean [+ or -] SD), respectively]. Stigma was not a major deterrent, likely due to a social marketing campaign for EBF that promoted EHT as a practice to sustain breast-feeding for all women. This study provides evidence that resource-poor rural women can initiate and sustain EHT given family and health systems support. EHT provides a strategy for improving the diets of HIV-exposed but uninfected children after direct breast-feeding has ceased. doi: 10.3945/jn.110.122457.

Published
2010

40. Daily supplementation with iron plus folic acid, zinc, and their combination is not associated with younger age at first walking unassisted in malnourished preschool children from a deficient population in rural Nepal

Author

Katz, Joanne, Khatry, Subarna K., LeClerq, Steven C., Mullany, Luke C., Yanik, Elizabeth L., Stoltzfus, Rebecca J., Siegel, Emily H., and Tielsch, James M.

Subjects
Malnutrition in children -- Control, Child development -- Management, Folic acid -- Dosage and administration, Iron in the body -- Dosage and administration, Zinc in the body -- Dosage and administration, Company business management, Food/cooking/nutrition
Abstract

A community-based, cluster-randomized, placebo-controlled trial of daily zinc and/or iron+folic acid supplementation was conducted in rural southern Nepal to examine motor milestone attainment among 3264 children 1-36 mo of age between 2001 and 2006. Treatment groups included placebo, zinc (10 mg), iron+folic acid (12.5 mg iron + 50 [micro]g folic acid), and zinc +iron+folic acid (10 mg zinc + 12.5 mg iron + 50[micro]g folic acid). Infants received half of these doses. The iron arms were stopped November 2003 by recommendation of the Data Safety and Monitoring Board; zinc and placebo continued until January 2006. A total of 2457 children had not walked at the time of entry into the trial and 1775 were followed through 36 mo. Mean age at first walking unassisted did not differ among groups and was 444 [+ or -] 81 d (mean [+ or -] SD) in the placebo group, 444 [+ or -] 81 d in the zinc group, 464 [+ or -] 85 d in the iron+folic acid group, and 446 [+ or -] 87 d in the iron+folic acid+zinc group. Results were similar after adjustment for age at enrollment, asset ownership, maternal literacy, and prior child deaths in the household and in children who consumed at least 60 tablets. Compared with placebo, iron+folic acid was associated with an adjusted mean delay of 28.0 d (95% Ch 11.3, 44.7) in time to walking among infants and the delay was more pronounced with mid-upper arm circumference (MUAC) < 9.5 cm [60.6 d, (95% CI: 28.5, 92.6)). Risks and benefits of universal iron+folic acid supplementation of infants beyond improved hematologic status deserve further consideration. doi: 10.3945/jn.109.119925

Published
2010

49. Adjusting for the acute phase response is essential to interpret iron status indicators among young zanzibari children prone to chronic malaria and helminth infections

Author

Kung'u, Jacqueline K., Wright, Victoria J., Haji, Hamad J., Ramsan, Mahdi, Goodman, David, Tielsch, James M., Bickle, Quentin D., Raynes, John G., and Stoltzfus, Rebecca J.

Subjects
C-reactive protein -- Research, Acute phase reaction -- Research, Malaria -- Prevention, Food/cooking/nutrition
Abstract

The extent to which the acute phase response (APR) influences iron status indicators in chronic infections is not well documented. We investigated this relationship using reported recent fever and 2 acute phase proteins (APP), C-reactive protein (CRP), and [alpha]-l-acid glycoprotein (AGP). In a sample of 690 children matched on age and helminth infection status at baseline, we measured plasma for AGP, CRP, ferritin, transferrin receptor (TfR), and erythropoietin (EPO) and whole blood for hemoglobin (Hb) concentration, zinc protoporphyrin (ZPP), and malaria parasite density, and we obtained maternal reports of recent fever. We then examined the influence of the APR on each iron status indicator using regression analysis with Hb as the outcome variable. Ferritin was inversely related to Hb in the APR-unadjusted model. Adjusting for the APR using reported recent fever alone was not sufficient to reverse the inverse Hb-ferritin relationship. However, using CRP and/or AGP resulted in the expected positive relationship. The best fit model included reported recent fever, AGP and CRP ([R.sup.2] = 0.241 ; P < 0.001). The best fit Hb-ZPP, Hb-TfR, and Hb-EPO models included reported recent fever and AGP but not CRP ([R.sup.2] = 0.253, 0.310, and 0.292, respectively; P < 0.001). ZPP, TfR, and EPO were minimally influenced by the APR, whereas ferritin was immensely affected. Reported recent fever alone cannot be used asa marker for the APR. Either AGP or CRP is useful for adjusting if only 1 APP can be measured. However, AGP best predicted the APR in this population. J. Nutr. 139: 2124-2131, 2009. doi: 10.3945/jn.108.104026

Published
2009

50. Development of nutritionally at-risk young children is predicted by malaria, anemia, and Stunting in Pemba, Zanzibar

Author

Olney, Deanna K., Kariger, Patricia K., Stoltzfus, Rebecca J., Khalfan, Sabra S., Ali, Nadra S., Tielsch, James M., Sazawal, Sunil, Black, Robert, Allen, Lindsay H., and Pollitt, Ernesto

Subjects
Zanzibar -- Health aspects, Growth -- Research, Malaria -- Development and progression, Health risk assessment, Food/cooking/nutrition
Abstract

Nutritionally at-risk children suffer delays in physical growth and motor and language development. Infectious diseases such as malaria pose an additional risk. We examined the cross-sectional relationships among malaria infection, hemoglobin (Hb) concentration, length-for-age Z-scores (LAZ), motor activity, behavior, and motor and language development in 841 Zanzibari children 5-19 mo old. We used structural equation modeling to test the fit of the data to a theoretical model and to examine the relationships among the variables in 3 age groups (5-9, 10-14, and 15-19 mo). The model fit the data for all age groups. In the youngest and oldest groups, children with higher malaria parasite densities had significantly lower Hb and LAZ. Higher LAZ significantly predicted higher total motor activity, and motor and language development scores in all age groups. In the oldest group, children who had higher Hb had higher motor development and activity scores. Malaria was directly and indirectly related to motor activity in the 10- to 14-mo-old group [standardized total effects, -0.14; direct, -0.10 (P= 0.015); and indirect, -0.038]. The significant fit of the models to the data and the statistical significance of many of the specific pathways highlight the complexities of the relationships between health and nutrition and child development outcomes in this population. In addition, the results suggest that multiple interventions are likely necessary to improve child development outcomes in this population of nutritionally at-risk children and that the potential effectiveness of interventions may differ according to age (i.e. prevention and treatment of anemia, stunting, and malaria).

Published
2009

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