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Nel S, Feucht UD, Botha T, Wenhold FAM. Infant growth by INTERGROWTH-21st and Fenton Growth Charts: Predicting 1-year anthropometry in South African preterm infants. MATERNAL & CHILD NUTRITION 2024:e13663. [PMID: 38783411 DOI: 10.1111/mcn.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/09/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
Post-natal growth influences short- and long-term preterm infant outcomes. Different growth charts, such as the Fenton Growth Chart (FGC) and INTERGROWTH-21st Preterm Post-natal Growth Standards (IG-PPGS), describe different growth curves and targets. This study compares FGC- and IG-PPGS-derived weight-for-postmenstrual age z-score (WZ) up to 50 weeks postmenstrual age (PMA50) for predicting 1-year anthropometry in 321 South African preterm infants. The change in WZ from birth to PMA50 (ΔWZ, calculated using FGC and IG-PPGS) was correlated to age-corrected 1-year anthropometric z-scores for weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ) and BMI-for-age (BMIZ), and categorically compared with rates of underweight (WAZ < -2), stunting (LAZ < -2), wasting (WLZ < -2) and overweight (BMIZ > + 2). Multivariable analyses explored the effects of other early-life exposures on malnutrition risk. At PMA50, mean WZ was significantly higher on IG-PPGS (-0.56 ± 1.52) than FGC (-0.90 ± 1.52; p < 0.001), but ΔWZ was similar (IG-PPGS -0.26 ± 1.23, FGC -0.11 ± 1.14; p = 0.153). Statistically significant ΔWZ differences emerged among small-for-gestational age infants (FGC -0.38 ± 1.22 vs. IG-PPGS -0.01 ± 1.30; p < 0.001) and appropriate-for-gestational age infants (FGC + 0.02 ± 1.08, IG-PPGS -0.39 ± 1.18; p < 0.001). Correlation coefficients of ΔWZ with WAZ, LAZ, WLZ and BMIZ were low (r < 0.45), though higher for FGC than IG-PPGS. Compared with IG-PPGS, ΔWZ < -1 on FGC predicted larger percentages of underweight (42% vs. 36%) and wasting (43% vs. 39%) and equal percentages of stunting (33%), while ΔWZ > + 1 predicted larger percentages overweight (57% vs. 38%). Both charts performed similarly in multivariable analysis. Differences between FGC and IG-PPGS are less apparent when considering ΔWZ, highlighting the importance of assessing growth as change over time, irrespective of growth chart.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Atteridgeville, South Africa
| | - Ute Dagmar Feucht
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Atteridgeville, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa
| | - Tanita Botha
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Atteridgeville, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Friedeburg Anna Maria Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Atteridgeville, South Africa
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Patriota ÉSO, Abrantes LCS, Figueiredo ACMG, Pizato N, Buccini G, Gonçalves VSS. Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies. MATERNAL & CHILD NUTRITION 2024; 20:e13609. [PMID: 38196291 PMCID: PMC10981479 DOI: 10.1111/mcn.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/17/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition-related chronic diseases in adulthood. Our study aimed to systematically review and conduct a meta-analysis of cohort studies investigating the association between HFI and stunting in children aged 0-59 months. Peer-reviewed and grey literature were systematically searched in electronic databases with no language or date restrictions. Two reviewers independently assessed the studies for pre-established eligibility criteria. Data were extracted using a standard protocol. Random-effects meta-analysis models were used, and I2 > 40% indicated high heterogeneity across studies. We used the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of the evidence. Nine cohort studies comprising 46,300 children were included. Approximately 80% (n = 7) of the studies found a positive association between HFI and stunting. Pooled odds ratio was 1.00 (95% confidence interval [CI]: 0.87-1.14; I2: 76.14%). The pooled hazard ratio between moderate and severe HFI and stunting was 1.02 (95% CI: 0.84-1.22; I2: 85.96%). Due to high heterogeneity, the quality of evidence was very low. Individual studies showed an association between HFI and stunting in children aged 0-59 months; however, this association was not sustained in the pooled analysis, possibly because of high heterogeneity across studies.
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Affiliation(s)
- Érika S. O. Patriota
- Graduate Program in Public Health, Faculty of Health SciencesUniversity of BrasíliaBrasiliaDistrito FederalBrazil
| | - Lívia C. S. Abrantes
- Department of Nutrition and HealthGraduate Program in Nutrition Science, Federal University of Viçosa (UFV)ViçosaBrazil
| | - Ana C. M. G. Figueiredo
- Epidemiology Surveillance, Federal District Health State DepartmentBrasíliaFederal DistrictBrazil
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, Faculty of Health SciencesUniversity of BrasíliaBrasiliaDistrito FederalBrazil
| | - Gabriela Buccini
- Department of Social and Behavioral HealthUniversity of NevadaLas VegasUSA
| | - Vivian S. S. Gonçalves
- Graduate Program in Public Health, Faculty of Health SciencesUniversity of BrasíliaBrasiliaDistrito FederalBrazil
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Nel S, Wenhold F, Botha T, Feucht U. One-year anthropometric follow-up of South African preterm infants in kangaroo mother care: Which early-life factors predict malnutrition? Trop Med Int Health 2024; 29:292-302. [PMID: 38327260 DOI: 10.1111/tmi.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Preterm infants often have poor short- and long-term growth. Kangaroo mother care supports short-term growth, but longer-term outcomes are unclear. METHODS This study analysed longitudinally collected routine clinical data from a South African cohort of preterm infants (born <37 weeks gestation) attending the outpatient follow-up clinic of a tertiary-level hospital (Tshwane District, South Africa) for 1 year between 2012 and 2019. At 1 year, small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) infants were compared with regard to age-corrected anthropometric z-scores (weight-for-age [WAZ], length-for-age [LAZ], weight-for-length [WLZ] and BMI-for-age [BMIZ]) and rates of underweight (WAZ < -2), stunting (LAZ < -2), wasting (WLZ < -2) and overweight (BMIZ> + 2). Multiple regression analysis was used to investigate associations between maternal/infant characteristics and rates of underweight, stunting, wasting and overweight. RESULTS At 1 year, compared with AGA infants (n = 210), SGA infants (n = 111) had lower WAZ (-1.26 ± 1.32 vs. -0.22 ± 1.24, p < 0.001), LAZ (-1.50 ± 1.11 vs. -0.60 ± 1.06, p < 0.001), WLZ (-0.66 ± 1.31 vs. 0.11 ± 1.24, p < 0.001) and BMIZ (-0.55 ± 1.31 vs. 1.06 ± 1.23, p < 0.001), despite larger WAZ gains from birth (+0.70 ± 1.30 vs. +0.05 ± 1.30, p < 0.001). SGA infants had significantly more stunting (34.2% vs. 9.1%; p < 0.001), underweight (31.2% vs. 7.2%; p < 0.001) and wasting (12.6% vs. 4.3%, p = 0.012), with no difference in overweight (4.5% vs. 7.7%, p = 0.397). In multiple regression analysis, birth weight-for-GA z-score more consistently predicted 1-year malnutrition than SGA. CONCLUSION Preterm-born SGA infants remain more underweight, stunted and wasted than their preterm-born AGA peers at 1 year, despite greater WAZ gains. Interventions for appropriate catch-up growth especially for SGA preterm infants are needed.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
| | - Friede Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
| | - Tanita Botha
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Ute Feucht
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Gauteng Department of Health, Tshwane District Health Services, Pretoria, South Africa
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Larson EA, Zhao Z, Bader-Larsen KS, Magkos F. Egg consumption and growth in children: a meta-analysis of interventional trials. Front Nutr 2024; 10:1278753. [PMID: 38249601 PMCID: PMC10796599 DOI: 10.3389/fnut.2023.1278753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Stunting and wasting are prevalent in low- and middle-income countries, putting children at risk for disease and disability. Eggs are a nutrient-rich food that can potentially facilitate growth. Purpose The aim of this meta-analysis was to evaluate the potential beneficial effect of egg supplementation on growth in children. Methods Following the PRISMA guidelines, PubMed and Healthline (Ovid) were systematically searched for interventional studies on egg supplementation for growth in children aged 6 months to 18 years, with no restrictions on date. Studies were evaluated for quality using Cochrane's GRADE technique. Data were pooled and reported as means and 95% confidence intervals. Results Seven studies reporting on 9 unique interventions in 3,575 male and female participants were included in the meta-analysis. Participants in the intervention groups experienced significantly greater increases in height/length (by 0.47 [0.13, 0.80] cm, p < 0.01) and weight (by 0.07 [0.01, 0.13] kg, p = 0.03) when compared to those in the control groups. Conclusion Eggs are an affordable, nutritious option for improving growth in children, though more studies with longer interventions are warranted.Systematic review registration: PROSPERO (CRD42021289609: https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Elisabeth A. Larson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Zaixin Zhao
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Karlen S. Bader-Larsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Nel S, Feucht UD, Mulol H, Wenhold FA. Association of Prenatal Placental Function with Anthropometry and Body Composition through 2 years of Age in South African Infants: The UmbiBaby Study. J Nutr 2023; 153:958-969. [PMID: 36775243 DOI: 10.1016/j.tjnut.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Placental insufficiency negatively impacts fetal growth and body composition (BC), potentially affecting lifelong health. Placental insufficiency, detectable as an abnormal umbilical artery resistance index (UmA-RI) on Doppler ultrasonography, is highly prevalent in otherwise healthy South African pregnant women. Appropriate intervention reduces stillbirth and perinatal death, but research on long-term outcomes of surviving infants is lacking. OBJECTIVES To describe and compare anthropometry and BC during the first 2 y of life in a cohort of term-born infants with normal and abnormal prenatal UmA-RI. METHODS Term-born infants (n = 81; n = 55 normal, n = 26 abnormal UmA-RI on third trimester Doppler screening) were followed up at 8-time points until age 2 y. Anthropometric measurements were taken, and FFM and FM were assessed by deuterium dilution. Age- and sex-specific z-scores were calculated for anthropometric indices, FM, FFM, FM index (FMI), and FFM index (FFMI) using appropriate reference data. Anthropometry and BC of infants with normal and abnormal UmA-RI were compared using an independent t-test or Mann-Whitney test. RESULTS At most ages, group mean z-scores were <0 for length-for-age and FM and >0 for weight-for-length and FFM. Compared with infants with normal UmA-RI, infants with abnormal UmA-RI had significantly lower weight-for-age z-scores at birth (-0.77 ± 0.75 compared with -0.30 ± 1.10, P = 0.026), ages 10 wk to 9 mo (-0.4 ± 0.87 to -0.2 ± 1.12 compared with 0.3 ± 0.85 to 0.6 ± 1.09; P = 0.007-0.017) and 18 mo (-0.6 ± 0.82 compared with 0.1 ± 1.18; P = 0.037); length-for-age z-scores at ages ≤14 wk (-1.3 ± 1.25 to -0.9 ± 0.87 compared with -0.2 ± 1.04 to -0.1 ± 1.00; P = 0.004-0.021); and FFM-for-age z-scores at ages ≤9 mo (-0.1 ± 0.82 to 0.7 ± 0.71 compared with 0.7 ± 1.00 to 1.3 ± 0.85; P = 0.002-0.028). FFMI, percentage FFM, FM, percentage FM, and FMI showed no consistent significant differences. CONCLUSIONS Infants with abnormal UmA-RI had lower weight-for-age and length-for-age z-scores, particularly at younger ages, with proportionally lower FFM but no consistent differences in percentage FFM and FFMI. These findings merit further investigation in larger cohorts. J Nutr 2023;xx:xx-xx.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa; Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa.
| | - Ute D Feucht
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa; Department of Paediatrics, University of Pretoria, Pretoria, South Africa; Gauteng Department of Health, Tshwane District Health Services, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa; Department of Paediatrics, University of Pretoria, Pretoria, South Africa; Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Friede Am Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa; Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa; South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Pretoria, South Africa
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Veiga GRS, da Silva GAP, Padilha BM, Lima MDC. Determining factors of child linear growth from the viewpoint of Bronfenbrenner's Bioecological Theory. J Pediatr (Rio J) 2022; 99:205-218. [PMID: 36572387 DOI: 10.1016/j.jped.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To analyze the factors associated with children's linear growth, according to the different subsystems of the 6Cs model and Bronfenbrenner's Bioecological Theory. DATA SOURCES Narrative review, carried out in the Scielo, Lilacs, Pubmed, and Science Direct databases, based on research using the terms Bioecological Theory, child growth, and risk factors, combined with the use of Boolean operators. SUMMARY OF FINDINGS According to the 6Cs model, proposed based on Bronfenbrenner's Bioecological Theory, the determining factors of children's linear growth are in six interrelated subsystems - cell, child, clan, community, country/state and culture. The empirical studies included in this review made it possible to analyze protection and risk factors within the subsystems. Among the protective factors: are adequate birth weight and satisfactory weight gain, breastfeeding for six months or more; proper hygienic habit of hand washing, proper elimination of feces, and access to clean water. As risk factors: low, birth weight and size, prematurity, multiple deliveries, short interval between deliveries, non-exclusive breastfeeding until the 3rd month, frequency and severity of infectious processes and anemia, little parental education, short maternal statur, inadequate maternal nutritional status, domestic violence, family poverty, food, and nutritional insecurity, living in rural areas or at high altitudes. CONCLUSION Children's linear growth is determined by interrelated factors that encompass aspects prior to the child's birth, as well as socioeconomic, political, family and community issues.
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Affiliation(s)
- Gabriela Rossiter Stux Veiga
- Universidade Federal de Pernambuco, Pós-graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil; Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil.
| | | | | | - Marilia de Carvalho Lima
- Universidade Federal de Pernambuco, Pós-graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil
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Ekholuenetale M, Okonji OC, Nzoputam CI, Barrow A. Inequalities in the prevalence of stunting, anemia and exclusive breastfeeding among African children. BMC Pediatr 2022; 22:333. [PMID: 35681131 PMCID: PMC9178835 DOI: 10.1186/s12887-022-03395-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Childhood stunting and anemia are on the increase in many resource-constrained settings, without a counter increase in proper feeding practices such as exclusive breastfeeding. The objective of this study was to explore the prevalence of stunting, anemia and exclusive breastfeeding across African countries. Methods Demographic and Health Survey (DHS) data from 39 African countries was analyzed. Data from under 5 children were analyzed. Forest plot was used to determine inequalities in the prevalence of the outcome variables. Results The prevalence of stunting was highest in Burundi (56%), Madagascar (50%) and Niger (44%). In addition, Burkina Faso (88%), Mali (82%), Cote d’Ivoire and Guinea (75% each) and Niger (73%) had the highest prevalence of anemia. Furthermore, Burundi (83%), Rwanda (81%) and Zambia (70%) had the highest exclusive breastfeeding. We found statistical significant difference in the prevalence of stunting, anemia and exclusive breastfeeding (p < 0.001). Higher prevalence of stunting and anemia were estimated among the male, rural residents, those having mothers with low education and from poor household wealth. Conclusion Concerted efforts are required to improve childhood health, survival and proper feeding practice. Reduced stunting and anemia could be achieved through sustained socioeconomic improvement that is shared in equity and equality among the population. Interventions aimed at increasing food availability can also aid in the reduction of hunger, particularly in impoverished communities.
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Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Chimezie Igwegbe Nzoputam
- Department of Public Health, Center of Excellence in Reproductive Health Innovation (CERHI), College of Medical Sciences, University of Benin, Benin City, Nigeria.,Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin, Nigeria
| | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia.
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