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Erchick DJ, Lama TP, Subedi S, Verhulst A, Guillot M, Khatry SK, LeClerq SC, Tielsch JM, Mullany LC, Katz J. Comparison of pregnancy and neonatal outcomes in a retrospective full pregnancy history survey versus population-based prospective records: a validation study in rural Sarlahi District, Nepal. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:139. [PMID: 38066542 PMCID: PMC10709973 DOI: 10.1186/s41043-023-00472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Countries without complete civil registration and vital statistics systems rely on retrospective full pregnancy history surveys (FPH) to estimate incidence of pregnancy and mortality outcomes, including stillbirth and neonatal death. Yet surveys are subject to biases that impact demographic estimates, and few studies have quantified these effects. We compare data from an FPH vs. prospective records from a population-based cohort to estimate validity for maternal recall of live births, stillbirths, and neonatal deaths in a rural population in Sarlahi District, Nepal. METHODS We used prospective data, collected through frequent visits of women from early pregnancy through the neonatal period, from a population-based randomized trial spanning 2010-2017. We randomly selected 76 trial participants from three pregnancy outcome groups: live birth (n = 26), stillbirth (n = 25), or neonatal death (n = 25). Data collectors administered the Nepal 2016 Demographic and Health Surveys (DHS)-VII pregnancy history survey between October 22, 2021, and November 18, 2021. We compared total pregnancy outcomes and numbers of pregnancy and neonatal outcomes between the two data sources. We matched pregnancy outcomes dates in the two sources within ± 30 days and calculated measures of validity for adverse outcomes. RESULTS Among 76 participants, we recorded 122 pregnancy outcomes in the prospective data and 104 outcomes in the FPH within ± 30 days of each woman's total observation period in the trial. Among 226 outcomes, we observed 65 live births that survived to 28 days, 25 stillbirths, and 32 live births followed by neonatal death in the prospective data and participants reported 63 live births that survived to 28 days, 15 stillbirths, and 26 live births followed by neonatal death in the pregnancy history survey. Sixty-two FPH outcomes were matched by date within ± 30 days to an outcome in prospective data. Stillbirth, neonatal death, higher parity, and delivery at a health facility were associated with likelihood of a non-matched pregnancy outcome. CONCLUSIONS Stillbirth and neonatal deaths were underestimated overall by the FPH, potentially underestimating the burden of mortality in this population. There is a need to develop tools to reduce or adjust for biases and errors in retrospective surveys to improve reporting of pregnancy and mortality outcomes.
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Affiliation(s)
- Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Tsering P Lama
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Seema Subedi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Michel Guillot
- University of Pennsylvania, Philadelphia, PA, USA
- French Institute for Demographic Studies (INED), Aubervilliers, France
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Luke C Mullany
- Applied Physics Laboratory, Johns Hopkins University, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Diamond-Smith NG, Epstein A, Zlatnik MG, Treleaven E. The association between timing in pregnancy of drought and excess rainfall, infant sex, and birthweight: Evidence from Nepal. Environ Epidemiol 2023; 7:e263. [PMID: 37840861 PMCID: PMC10569756 DOI: 10.1097/ee9.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/26/2022] [Accepted: 06/26/2023] [Indexed: 10/17/2023] Open
Abstract
Background Past research on the impact of climatic events, such as drought, on birth outcomes has primarily been focused in Africa, with less research in South Asia, including Nepal. Existing evidence has generally found that drought impacts birthweight and infant sex, with differences by trimester. Additionally, less research has looked at the impact of excess rain on birth outcomes or focused on the impact of rainfall extremes in the preconception period. Using data from a large demographic surveillance system in Nepal, combined with a novel measure of drought/excess rainfall, we explore the impact of these on birthweight by time in pregnancy. Methods Using survey data from the 2016 to 2019 Chitwan Valley Study in rural Nepal combined with data from Climate Hazards InfraRed Precipitation with Station, we explored the association between excess rainfall and drought and birthweight, looking at exposure in the preconception period, and by trimester of pregnancy. We also explore the impact of excess rainfall and drought on infant sex and delivery with a skilled birth attendant. We used multilevel regressions and explored for effect modification by maternal age. Results Drought in the first trimester is associated with lower birthweight (β = -82.9 g; 95% confidence interval [CI] = 164.7, -1.2) and drought in the preconception period with a high likelihood of having a male (odds ratio [OR] = 1.41; 95% CI = 1.01, 2.01). Excess rainfall in the first trimester is associated with high birthweight (β = 111.6 g; 95% CI = 20.5, 202.7) and higher odds of having a male (OR = 1.48; 95% CI = 1.02, 2.16), and in the third trimester with higher odds of low birth weight (OR = 2.50; 95% CI = 1.40, 4.45). Conclusions Increasing rainfall extremes will likely impact birth outcomes and could have implications for sex ratios at birth.
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Affiliation(s)
- Nadia G. Diamond-Smith
- Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California
| | - Adrienne Epstein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Marya G. Zlatnik
- Division of Maternal Fetal Medicine, Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California
| | - Emily Treleaven
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Clark RB, Chalise M, Visick MK, Ghosh V, Dhungana R. Scale-Up of a Newborn Resuscitation Capacity-Building and Skill Retention Program Associated With Improved Neonatal Outcomes in Gandaki Province, Nepal. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00046. [PMID: 36853629 PMCID: PMC9972378 DOI: 10.9745/ghsp-d-22-00046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Intrapartum events leading to asphyxia at birth are a leading cause of neonatal morbidity and mortality in Nepal. In response, the Nepal Ministry of Health and Population adopted the Helping Babies Breathe (HBB) training curriculum in 2015 as a tool to improve neonatal resuscitation and outcomes. Although the effectiveness of HBB training has been well documented, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN) designed an evidence-based intervention for scaling up newborn resuscitation training and skill retention. We report on its implementation and the changes in newborn outcomes during the program period. METHODS The program empowered facility-based trainers in newborn resuscitation and skill retention at 12 facilities in Gandaki Province. Seven of 14 level I hospitals and 5 of 6 level II hospitals were selected. A single external mentor coached the facility-based trainers, provided general support, and monitored progress. Program evaluation tracked changes in newborn metrics over 21 Nepali months (March 2018-November 2019). All deliveries occurring in the health facilities during the program period were included in the evaluation. We assessed program effectiveness by analyzing time trends of neonatal mortality, morbidity, and stillbirths. RESULTS We gathered data on neonatal health outcomes of 33,417 deliveries, including 23,820 vaginal deliveries and 9,597 cesarean deliveries. During the program, 43 facility-based trainers taught resuscitation skills to 425 medical personnel and supported skill retention. Neonatal deaths within 24 hours of birth (incidence rate ratio [IRR]=0.993, P=.044) and newborn morbidities (IRR=0.996, P<.001) showed a significantly declining trend. CONCLUSION Our findings suggest that the SSN program had a substantial influence on critical neonatal outcomes. Future neonatal resuscitation capacity-building and skill retention efforts may benefit from incorporating elements of the program.
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Affiliation(s)
- Robert B. Clark
- Brigham Young University, Provo, UT, USA.,Correspondence to Robert B. Clark ()
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Chu T, Wang D, Yu T, Zhai J. Effects of seasonal variations and meteorological factors on IVF pregnancy outcomes: a cohort study from Henan Province, China. Reprod Biol Endocrinol 2022; 20:113. [PMID: 35933344 PMCID: PMC9356437 DOI: 10.1186/s12958-022-00986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/24/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate whether seasonal variations and meteorological factors influence pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer (IVF-ET) treatment. DESIGN Retrospective cohort study. SETTING University-affiliated reproductive medical center. SUBJECTS Women aged < 35 years undergoing IVF from June 1, 2015, to June 1, 2019. INTERVENTIONS Cycles were divided into four groups according to the date of the beginning of ovulation induction: spring (659 cycles), summer (578 cycles), autumn (519 cycles), and winter (534 cycles). RESULTS The high-quality embryo rate was higher in autumn and winter than in cycles in which ovulation induction occurred in spring and summer (58.70% vs. 58.78% vs. 62.67% vs. 63.42%; P < 0.001). The results of linear regression analysis showed that the high-quality embryo rate was significantly correlated with the daily average temperature of ovulation induction (P = 0.037). The clinical pregnancy rates of cycles starting ovulation induction in spring, summer, and autumn were significantly higher than those starting in winter (70.71% vs. 73.18% vs. 70.13% vs. 65.17%; P = 0.031), while the biochemical pregnancy rate, early abortion rate, and live birth rate were not significantly different (P > 0.050). Multivariate logistic regression analysis showed significant seasonal variation in clinical pregnancy (OR = 1.643, 95% CI = 1.203-2.243; P = 0.002), and that a higher daily average temperature at the time of ovulation induction increased the clinical pregnancy rate (OR = 1.012, 95% CI = 1.001-1.022; P = 0.031). CONCLUSIONS In women younger than 35 years who undergo IVF treatment, the season and ambient temperature on the date of the beginning of ovulation induction may have an impact on embryo development and clinical pregnancy.
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Affiliation(s)
- Ting Chu
- grid.412633.10000 0004 1799 0733Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- grid.412633.10000 0004 1799 0733Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Di Wang
- grid.412633.10000 0004 1799 0733Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- grid.412633.10000 0004 1799 0733Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Yu
- grid.412633.10000 0004 1799 0733Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- grid.412633.10000 0004 1799 0733Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhai
- grid.412633.10000 0004 1799 0733Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- grid.412633.10000 0004 1799 0733Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Fledderjohann J, Channon M. Gender, nutritional disparities, and child survival in Nepal. BMC Nutr 2022; 8:50. [PMID: 35606833 PMCID: PMC9125883 DOI: 10.1186/s40795-022-00543-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This paper examines seemingly contradictory evidence from extant research that son preference is high, but male disadvantage in mortality is increasing in Nepal. To do so, we documented the timing, geographic patterning, and extent of gendered patterns in mortality and feeding practices for children under-five. METHODS We applied pooled multilevel regression models and survival analysis to five rounds of data from Nepal's nationally representative Demographic and Health Surveys (1996-2016). We controlled for potential sociodemographic confounders, including child, maternal, household, and regional correlates, and disaggregated findings by birth order and sibling gender. RESULTS We found evidence of regional variation in mortality, with girls in wealthy urban areas faring the worst in terms of mortality rates. Girls' comparative mortality advantage compared to boys in the neonatal period masks their mortality disadvantage in later periods. Mortality has fallen at a faster rate for boys than girls in most cases, leading to widening of gender inequalities. We also found evidence of female disadvantage in breastfeeding duration, which was linked to higher mortality risks, but no gender disparities in the consumption of other food items. Sibling gender and birth order also mattered for breastfeeding duration: Young girls with older sisters but with no brothers were most disadvantaged. CONCLUSION While we did not find evidence of postnatal discrimination in access to solid and semi-solid foods, girls in Nepal face a disadvantage in breastfeeding duration. Girls with older sisters but no older brothers facing the greatest disadvantage, with risks being particularly concentrated for girls aged 1-4 years. This disadvantage is linked to an increased risk of mortality. To address this, community-based health programs could be expanded to continue targeted healthcare for children beyond 12 months of age, with particular focus on nutrition monitoring and health service provision for girls.
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Affiliation(s)
| | - Melanie Channon
- Department of Social & Policy Sciences, University of Bath, Bath, UK
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Miller FA, Marphatia AA, Wells JC, Cortina-Borja M, Manandhar DS, Saville NM. Associations between early marriage and preterm delivery: Evidence from lowland Nepal. Am J Hum Biol 2021; 34:e23709. [PMID: 34862821 DOI: 10.1002/ajhb.23709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Preterm delivery (<37 weeks gestation) is the largest cause of child mortality worldwide. Marriage and pregnancy during adolescence have been associated with an increased risk of preterm delivery. We investigate independent associations of age at marriage and age at first pregnancy with preterm delivery in a cohort of women from rural lowland Nepal. METHODS We analyzed data from 17 974 women in the Low Birth Weight South Asia Trial. Logistic regression models tested associations of age at marriage and age at first pregnancy with preterm delivery, for primigravida (n = 6 243) and multigravida (n = 11 731) women. Models were adjusted for maternal education, maternal caste, and household asset score. RESULTS Ninety percent of participants had married at <18 years and 58% had their first pregnancy at <18 years. 20% of participants delivered preterm. Primigravida participants married at ≤14 years had higher odds of preterm delivery than those married ≥18 years, when adjusting for study design (adjusted odds ratio (aOR) 1.45, 95% CI: 1.15-1.83), confounders (aOR 1.28: 1.01-1.62) and confounders + age at pregnancy (aOR 1.29: 1.00-1.68). Associations were insignificant for multigravida women. No significant associations were observed between age at first pregnancy and preterm delivery. DISCUSSION In this population, early marriage, rather than pregnancy, is a risk factor for preterm delivery. We hypothesize that psychological stress, a driver of preterm delivery which is increased among those marrying young, rather than physiological immaturity, drives this association. Further research into the psychological consequences of child marriage in Nepal is needed.
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Affiliation(s)
- Faith A Miller
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Akanksha A Marphatia
- Department of Geography, University of Cambridge, Cambridge, UK.,Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Jonathan C Wells
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | | | - Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
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Dube K, Lavender T, Blaikie K, Sutton CJ, Heazell AEP, Smyth RMD. Identification of factors associated with stillbirth in Zimbabwe - a cross sectional study. BMC Pregnancy Childbirth 2021; 21:662. [PMID: 34587922 PMCID: PMC8482658 DOI: 10.1186/s12884-021-04102-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION 98% of the 2.6 million stillbirths per annum occur in low and middle income countries. However, understanding of risk factors for stillbirth in these settings is incomplete, hampering efforts to develop effective strategies to prevent deaths. METHODS A cross-sectional study of eligible women on the postnatal ward at Mpilo Hospital, Zimbabwe was undertaken between 01/08/2018 and 31/03/2019 (n = 1779). Data were collected from birth records for maternal characteristics, obstetric and past medical history, antenatal care and pregnancy outcome. A directed acyclic graph was constructed with multivariable logistic regression performed to fit the corresponding model specification to data comprising singleton pregnancies, excluding neonatal deaths (n = 1734), using multiple imputation for missing data. Where possible, findings were validated against all women with births recorded in the hospital birth register (n = 1847). RESULTS Risk factors for stillbirth included: previous stillbirth (29/1691 (2%) of livebirths and 39/43 (91%) of stillbirths, adjusted Odds Ratio (aOR) 2628.9, 95% CI 342.8 to 20,163.0), antenatal care (aOR 44.49 no antenatal care vs. > 4 antenatal care visits, 95% CI 6.80 to 291.19), maternal medical complications (aOR 7.33, 95% CI 1.99 to 26.92) and season of birth (Cold season vs. Mild aOR 14.29, 95% CI 3.09 to 66.08; Hot season vs. Mild aOR 3.39, 95% CI 0.86 to 13.27). Women who had recurrent stillbirth had a lower educational and health status (18.2% had no education vs. 10.0%) and were less likely to receive antenatal care (20.5% had no antenatal care vs. 6.6%) than women without recurrent stillbirth. CONCLUSION The increased risk in women who have a history of stillbirth is a novel finding in Low and Middle Income Countries (LMICs) and is in agreement with findings from High Income Countries (HICs), although the estimated effect size is much greater (OR in HICs ~ 5). Developing antenatal care for this group of women offers an important opportunity for stillbirth prevention.
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Affiliation(s)
- Kushupika Dube
- Mpilo School of Midwifery, PO Box 2096, Vera Road, Bulawayo, Zimbabwe.
| | - Tina Lavender
- Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kieran Blaikie
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christopher J Sutton
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biological, Medical and Human Sciences, University of Manchester, Manchester, UK.,National University of Science & Technology, P. O. Box AC 939, Ascot, Bulawayo, Zimbabwe
| | - Rebecca M D Smyth
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
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Saville NM, Cortina-Borja M, De Stavola BL, Pomeroy E, Marphatia A, Reid A, Manandhar DS, Wells JCK. Comprehensive analysis of the association of seasonal variability with maternal and neonatal nutrition in lowland Nepal. Public Health Nutr 2021; 25:1-16. [PMID: 34420531 PMCID: PMC9991647 DOI: 10.1017/s1368980021003633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To provide a comprehensive seasonal analysis of pregnant mothers' eating behaviour and maternal/newborn nutritional status in an undernourished population from lowland rural Nepal, where weather patterns, agricultural labour, food availability and disease prevalence vary seasonally. DESIGN Secondary analysis of cluster-randomised Low Birth Weight South Asia Trial data, applying cosinor analysis to predict seasonal patterns. OUTCOMES Maternal mid-upper arm circumference (MUAC), BMI, dietary diversity, meals per day, eating down and food aversion in pregnancy (≥31 weeks' gestation) and neonatal z-scores of length-for-age (LAZ), weight-for-age (WAZ) and head circumference-for-age (HCAZ) and weight-for-length (WLZ). SETTING Rural areas of Dhanusha and Mahottari districts in plains of Nepal. PARTICIPANTS 2831 mothers aged 13-50 and 3330 neonates. RESULTS We found seasonal patterns in newborn anthropometry and pregnant mothers' anthropometry, meal frequency, dietary diversity, food aversion and eating down. Seasonality in intake varied by food group. Offspring anthropometry broadly tracked mothers'. Annual amplitudes in mothers' MUAC and BMI were 0·27 kg/m2 and 0·22 cm, with peaks post-harvest and nadirs in October when food insecurity peaked. Annual LAZ, WAZ and WLZ amplitudes were 0·125, 0·159 and 0·411 z-scores, respectively. Neonates were the shortest but least thin (higher WLZ) in winter (December/January). In the hot season, WLZ was the lowest (May/June) while LAZ was the highest (March and August). HCAZ did not vary significantly. Food aversion and eating down peaked pre-monsoon (April/May). CONCLUSIONS Our analyses revealed complex seasonal patterns in maternal nutrition and neonatal size. Seasonality should be accounted for when designing and evaluating public heath nutrition interventions.
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Affiliation(s)
- Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Bianca L De Stavola
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Emma Pomeroy
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | | | - Alice Reid
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Jonathan CK Wells
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
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Mueller W, Tantrakarnapa K, Johnston HJ, Loh M, Steinle S, Vardoulakis S, Cherrie JW. Exposure to ambient particulate matter and biomass burning during pregnancy: associations with birth weight in Thailand. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:672-682. [PMID: 33603098 PMCID: PMC8263346 DOI: 10.1038/s41370-021-00295-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/12/2020] [Accepted: 01/18/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND There is a growing evidence that exposure to ambient particulate air pollution during pregnancy is associated with adverse birth outcomes, including reduced birth weight (BW). The objective of this study was to quantify associations between BW and exposure to particulate matter (PM) and biomass burning during pregnancy in Thailand. METHODS We collected hourly ambient air pollutant data from ground-based monitors (PM with diameter of <10 µm [PM10], Ozone [O3], and nitrogen dioxide [NO2]), biomass burning from satellite remote sensing data, and individual birth weight data during 2015-2018. We performed a semi-ecological analysis to evaluate the association between mean trimester exposure to air pollutants and biomass burning with BW and low-birth weight (LBW) (<2500 g), adjusting for gestation age, sex, previous pregnancies, mother's age, heat index, season, year, gaseous pollutant concentrations, and province. We examined potential effect modification of PM10 and biomass burning exposures by sex. RESULTS There were 83,931 eligible births with a mean pregnancy PM10 exposure of 39.7 µg/m3 (standard deviation [SD] = 7.7). The entire pregnancy exposure was associated with reduced BW both for PM10 (-6.81 g per 10 µg/m3 increase in PM10 [95% CI = -12.52 to -1.10]) and biomass burning (-6.34 g per 1 SD increase in fires/km2 [95% CI = -11.35 to -1.34]) only after adjustment for NO2. In contrast with these findings, a reduced odds ratio (OR) of LBW was associated with PM10 exposure only in trimesters one and two, with no relationship across the entire pregnancy period. Associations with biomass burning were limited to increased ORs of LBW with exposure in trimester three, but only for male births. CONCLUSION Based on our results, we encourage further investigation of air pollution, biomass burning and BW in Thailand and other low-income and middle-income countries.
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Affiliation(s)
| | - Kraichat Tantrakarnapa
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Helinor Jane Johnston
- School of Engineering and Physical Sciences, Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot Watt University, Edinburgh, UK
| | - Miranda Loh
- Institute of Occupational Medicine, Edinburgh, UK
| | | | - Sotiris Vardoulakis
- Institute of Occupational Medicine, Edinburgh, UK
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - John W Cherrie
- Institute of Occupational Medicine, Edinburgh, UK.
- School of Engineering and Physical Sciences, Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot Watt University, Edinburgh, UK.
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Nicol MP, MacGinty R, Workman L, Stadler JAM, Myer L, Allen V, Ah Tow Edries L, Zar HJ. A Longitudinal Study of the Epidemiology of Seasonal Coronaviruses in an African Birth Cohort. J Pediatric Infect Dis Soc 2021; 10:607-614. [PMID: 33528016 PMCID: PMC7928775 DOI: 10.1093/jpids/piaa168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Since non-epidemic, seasonal human coronaviruses (sHCoV) commonly infect children, an improved understanding of the epidemiology of these infections may offer insights into the context of severe acute respiratory syndrome (SARS)-CoV-2. We investigated the epidemiology of sHCoV infection during the first year of life, including risk factors and association with lower respiratory tract infection (LRTI). METHODS We conducted a nested case-control study of infants enrolled in a birth cohort near Cape Town, South Africa, from 2012 to 2015. LRTI surveillance was implemented, and nasopharyngeal swabs were collected fortnightly over infancy. Quantitative PCR detected respiratory pathogens, including coronaviruses-229E, -NL63, -OC43, and -HKU1. Swabs were tested from infants at the time of LRTI and from the 90 days prior as well as from age-matched control infants from the cohort over the equivalent period. RESULTS In total, 885 infants were included, among whom 464 LRTI events occurred. Of the 4751 samples tested for sHCoV, 9% tested positive, with HCoV-NL63 the most common. Seasonal HCoV detection was associated with LRTI; this association was strongest for coronavirus-OC43, which was also found in all sHCoV-associated hospitalizations. Birth in winter was associated with sHCoV-LRTI, but there were no clear seasonal differences in detection. Co-detection of Streptococcus pneumoniae was weakly associated with sHCoV-LRTI (odds ratio: 1.8; 95% confidence interval: 0.9-3.6); detection of other respiratory viruses or bacteria was not associated with sHCoV status. CONCLUSIONS Seasonal HCoV infections were common and associated with LRTI, particularly sHCoV-OC43, which is most closely related to the SARS group of coronaviruses. Interactions of coronaviruses with bacteria in the pathogenesis of LRTI require further study.
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Affiliation(s)
- Mark P Nicol
- Division of Infection and Immunity, School of Biomedical Sciences, Faculty of Health Sciences, University of Western Australia, Perth, Australia
- Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Rae MacGinty
- Department of Paediatrics and Child Health and SA-MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | - Lesley Workman
- Department of Paediatrics and Child Health and SA-MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | - Jacob A M Stadler
- Department of Paediatrics and Child Health and SA-MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Veronica Allen
- Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Lemese Ah Tow Edries
- Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health and SA-MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
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11
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Katz J, Tielsch JM, Khatry SK, Shrestha L, Breysse P, Zeger SL, Kozuki N, Checkley W, LeClerq SC, Mullany LC. Impact of Improved Biomass and Liquid Petroleum Gas Stoves on Birth Outcomes in Rural Nepal: Results of 2 Randomized Trials. GLOBAL HEALTH, SCIENCE AND PRACTICE 2020; 8:372-382. [PMID: 32680912 DOI: 10.9745/ghsp-d-2000011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/26/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Few randomized trials have assessed the impact of reducing household air pollution from biomass stoves on adverse birth outcomes in low-income countries. METHODS Two sequential trials were conducted in rural low-lying Nepal. Trial 1 was a cluster-randomized step-wedge trial comparing traditional biomass stoves and improved biomass stoves vented with a chimney. Trial 2 was a parallel household-randomized trial comparing vented biomass stoves and liquid petroleum gas (LPG) stoves with a year's supply of gas. Kitchen particulate matter of 2.5 μm or less (PM2.5) and carbon monoxide (CO) were assessed before and after stove installation. Prevalent and incident pregnancies were enrolled at baseline and throughout the trials. Birth anthropometry was compared across differing exposure times in pregnancy. RESULTS In trial 1, the mean 20-hour kitchen PM2.5 concentration was reduced from 1380 µg/m3 to 936 µg/m3. Among infants born before the intervention, mean birth weight and gestational age were 2627 g (SD=443) and 38.8 weeks (SD=3.1), and 39% were low birth weight (LBW), 22% preterm, and 55% small for gestational age (SGA). Adverse birth outcomes were not significantly different with increasing exposure to improved stoves during pregnancy. In trial 2, the mean 20-hour PM2.5 concentration was 885 µg/m3 in households with vented biomass and 442 µg/m3 in those with LPG stoves. Mean birth weight was 2780 g (SD=427) and 2742 g (SD=431), among households with vented and LPG stoves, respectively. Respective percentages for LBW, SGA, and preterm were 23%, 13%, and 42% in the vented stove group and not statistically different from 31%, 17%, and 42% in the LPG group. CONCLUSIONS Improved biomass or LPG stoves did not reduce adverse birth outcomes. PM2.5 and CO following improved stove installation remained well above the World Health Organization indoor air standard of 25 µg/m3 or intermediate air quality guideline of 37.5 µg/m3. Trials that lower indoor air pollution further are needed.
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Affiliation(s)
- Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Laxman Shrestha
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Patrick Breysse
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott L Zeger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William Checkley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Katz J, Tielsch JM, Khatry SK, Shrestha L, Breysse P, Zeger SL, Kozuki N, Checkley W, LeClerq SC, Mullany LC. Impact of Improved Biomass and Liquid Petroleum Gas Stoves on Birth Outcomes in Rural Nepal: Results of 2 Randomized Trials. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:372-382. [PMID: 32680912 PMCID: PMC7541104 DOI: 10.9745/ghsp-d-20-00011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/26/2020] [Indexed: 01/10/2023]
Abstract
Improved biomass stoves may not reduce indoor air pollution as much as is needed to have an impact on adverse birth outcomes. Background: Few randomized trials have assessed the impact of reducing household air pollution from biomass stoves on adverse birth outcomes in low-income countries. Methods: Two sequential trials were conducted in rural low-lying Nepal. Trial 1 was a cluster-randomized step-wedge trial comparing traditional biomass stoves and improved biomass stoves vented with a chimney. Trial 2 was a parallel household-randomized trial comparing vented biomass stoves and liquid petroleum gas (LPG) stoves with a year’s supply of gas. Kitchen particulate matter of 2.5 μm or less (PM2.5) and carbon monoxide (CO) were assessed before and after stove installation. Prevalent and incident pregnancies were enrolled at baseline and throughout the trials. Birth anthropometry was compared across differing exposure times in pregnancy. Results: In trial 1, the mean 20-hour kitchen PM2.5 concentration was reduced from 1380 µg/m3 to 936 µg/m3. Among infants born before the intervention, mean birth weight and gestational age were 2627 g (SD=443) and 38.8 weeks (SD=3.1), and 39% were low birth weight (LBW), 22% preterm, and 55% small for gestational age (SGA). Adverse birth outcomes were not significantly different with increasing exposure to improved stoves during pregnancy. In trial 2, the mean 20-hour PM2.5 concentration was 885 µg/m3 in households with vented biomass and 442 µg/m3 in those with LPG stoves. Mean birth weight was 2780 g (SD=427) and 2742 g (SD=431), among households with vented and LPG stoves, respectively. Respective percentages for LBW, SGA, and preterm were 23%, 13%, and 42% in the vented stove group and not statistically different from 31%, 17%, and 42% in the LPG group. Conclusions: Improved biomass or LPG stoves did not reduce adverse birth outcomes. PM2.5 and CO following improved stove installation remained well above the World Health Organization indoor air standard of 25 µg/m3 or intermediate air quality guideline of 37.5 µg/m3. Trials that lower indoor air pollution further are needed.
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Affiliation(s)
- Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Laxman Shrestha
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Patrick Breysse
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott L Zeger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William Checkley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Seasonal variability does not impact in vitro fertilization success. Sci Rep 2019; 9:17185. [PMID: 31748683 PMCID: PMC6868277 DOI: 10.1038/s41598-019-53919-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 11/07/2019] [Indexed: 01/20/2023] Open
Abstract
It is unknown whether seasonal variation influences the outcome of in vitro fertilization (IVF). Previous studies related to seasonal variation of IVF were all small sample size, and the results were conflicting. We performed a retrospective cohort study evaluating the relationship between seasonal variability and live birth rate in the year of 2014–2017. Patients were grouped into four seasons (Winter (December-February), Spring (March-May), Summer (June-August), and Autumn (September-November)) according to the day of oocyte pick-up (OPU). Multivariate logistic regression analysis was performed to evaluate association between seasonal variation and live birth. Models were adjusted for covariates including temperature, sunshine hour, infertility type, infertility duration, infertility factor and BMI. In total 38,476 women were enrolled, of which 25,097 underwent fresh cycles, 13,379 were frozen embryo transfer. Live birth rates of fresh embryo transfer were 50.36%, 53.14%, 51.94% and 51.33% for spring, summer, autumn and winter, respectively. Clinical pregnancy rate between the calendar months varied between 55.1% and 63.4% in fresh embryo transfer (ET) and between 58.8% and 65.1% in frozen embryo transfer (FET) (P-values 0.073 and 0.220). In the unadjusted model and adjust model, seasonal variation was not associated with live birth. In conclusion, there was no significant difference of seasonal variations in the outcome of IVF with fresh embryo transfer and frozen embryo transfer.
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Miao H, Li B, Li W, Yao F, Chen Y, Chen R, Lin J, Wu Y, Guo P, Zhao Q. Adverse birth outcomes in Guangdong province, China, 2014-2017: a spatiotemporal analysis of 2.9 million births. BMJ Open 2019; 9:e030629. [PMID: 31727652 PMCID: PMC6886959 DOI: 10.1136/bmjopen-2019-030629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Adverse birth outcomes pose a great threat to the public health and bring a heavy burden of disease in China. A comprehensive examination of the temporal and spatial trends of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) epidemics can provide some elementary information for subsequent aetiological and epidemiological studies. This study aimed to characterise the spatiotemporal features of PTB, LBW and SGA based on a large cohort of live births in China. DESIGN Spatiotemporal descriptive analysis was performed in Guangdong province, China, from 2014 to 2017. SETTING Data involving 2 917 098 live births in Guangdong province, China from 2014 to 2017 was collected from Guangdong Birth Certificate System. Information was collected, including the date of birth, gestational age in week, birth weight, sex of the infant, age of the mother and registered residence of the mother. RESULTS The estimated rate of PTB, LBW and SGA was 4.16%, 4.14% and 12.86%, respectively. For temporal trends, the rates of PTB, LBW and SGA showed seasonal fluctuations, especially for LBW and SGA. In addition, there were regional differences in the rates of PTB, LBW and SGA between the Pearl River Delta and Non-Pearl River Delta regions. From 2014 to 2017, the high rates of PTB and LBW expanded from the Pearl River Delta region to the Non-Pearl River Delta regions. However, compared with the Pearl River Delta region, the rate of SGA was higher in the Non-Pearl River Delta regions on the whole. CONCLUSION The findings of this study contribute to the understanding of the aetiology and epidemiology of PTB, LBW and SGA in south China.
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Affiliation(s)
- Huazhang Miao
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Bing Li
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Wu Li
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Fei Yao
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Yuliang Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Ruyin Chen
- Department of Clinical Medicine, Shantou University Medical College, Shantou, China
| | - Jiumin Lin
- Department of Hepatology and Infectious Diseases, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yuntao Wu
- Guangdong Women and Children Hospital, Guangzhou, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Qingguo Zhao
- Epidemiological Research Office of Key Laboratory of Male Reproduction and Genetics (National Health Commission of PRC), Family Planning Special Hospital of Guangdong Province, Guangzhou, China
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15
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Fahey CA, Chevrier J, Crause M, Obida M, Bornman R, Eskenazi B. Seasonality of antenatal care attendance, maternal dietary intake, and fetal growth in the VHEMBE birth cohort, South Africa. PLoS One 2019; 14:e0222888. [PMID: 31553767 PMCID: PMC6760765 DOI: 10.1371/journal.pone.0222888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/09/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Seasonality of food availability, physical activity, and infections commonly occurs within rural communities in low and middle-income countries with distinct rainy seasons. To better understand the implications of these regularly occurring environmental stressors for maternal and child health, this study examined seasonal variation in nutrition and health care access of pregnant women and infants in rural South Africa. METHODS We analyzed data from the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE) birth cohort study of 752 mother-infant pairs recruited at delivery from August 2012 to December 2013 in the Vhembe District of Limpopo Province, the northernmost region of South Africa. We used truncated Fourier series regression to assess seasonality of antenatal care (ANC) attendance, dietary intake, and birth size. We additionally regressed ANC attendance on daily rainfall values. Models included adjustment for sociodemographic characteristics. RESULTS Maternal ANC attendance, dietary composition, and infant birth size exhibited significant seasonal variation in both unadjusted and adjusted analyses. Adequate frequency of ANC attendance during pregnancy (≥ 4 visits) was highest among women delivering during the gardening season and lowest during the lean (rainy) season. High rainfall during the third trimester was also negatively associated with adequate ANC attendance (adjusted OR = 0.59, 95% CI: 0.40, 0.86). Carbohydrate intake declined during the harvest season and increased during the vegetable gardening and lean seasons, while fat intake followed the opposite trend. Infant birth weight, length, and head circumference z-scores peaked following the gardening season and were lowest after the harvest season. Maternal protein intake and ANC ≤ 12 weeks did not significantly vary by season or rainfall. CONCLUSIONS Seasonal patterns were apparent in ANC utilization, dietary intake, and fetal growth in rural South Africa. Interventions to promote maternal and child health in similar settings should consider seasonal factors.
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Affiliation(s)
- Carolyn A. Fahey
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, California, United states of America
- * E-mail: (BE); (CAF)
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montréal, Québec, Canada
| | - Madelein Crause
- School of Health Systems and Public Health, University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Muvhulawa Obida
- School of Health Systems and Public Health, University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Riana Bornman
- School of Health Systems and Public Health, University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Pretoria, South Africa
| | - Brenda Eskenazi
- Center for Environmental Research and Children’s Health (CERCH), School of Public Health, University of California, Berkeley, California, United states of America
- * E-mail: (BE); (CAF)
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16
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van Deursen B, Lenglet A, Ariti C, Hussain B, Karsten J, Roggeveen H, Price D, Fernhout J, Abdi A, Carrion Martin AI. Risks and seasonal pattern for mortality among hospitalized infants in a conflict-affected area of Pakistan, 2013-2016. A retrospective chart review. F1000Res 2019; 8:954. [PMID: 31543955 PMCID: PMC6733381 DOI: 10.12688/f1000research.19547.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
Background: In recent years, Médecins Sans Frontières has observed high mortality rates among hospitalized infants in Pakistan. We describe the clinical characteristics of the infants admitted between 2013 and 2016 in order to acquire a better understanding on the risk factors for mortality. Methods: We analyzed routinely collected medical data from infants (<7 months) admitted in Chaman and Dera Murad Jamali (DMJ) hospitals. The association between clinical characteristics and mortality was estimated using Poisson regression. Results: Between 2013 and 2016, 5,214 children were admitted (male/female ratio: 1.60) and 1,178 (23%) died. Days since admission was associated with a higher risk of mortality and decreased with each extra day of admission after seven days. The first 48 hours of admission was strongly associated with a higher risk of mortality. A primary diagnosis of tetanus, necrotizing enterocolitis, prematurity, sepsis and hypoxic-ischemic encephalopathy were strongly associated with higher rates of mortality. We observed an annual peak in the mortality rate in September. Conclusions: The first days of admission are critical for infant survival. Furthermore, the found male/female ratio was exceedingly higher than the national ratio of Pakistan. The observed seasonality in mortality rate by week has not been previously reported. It is fully recommended to do further in-depth research on male/female ratio differences and the reasons behind the annual peaks in mortality rate by week.
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Affiliation(s)
- Babette van Deursen
- Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Annick Lenglet
- Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, The Netherlands.,Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Cono Ariti
- Cardiff University Medical School, Cardiff, UK
| | - Barkat Hussain
- Pediatric Division Head Quarter-Ministry of Health, Balochistan, Pakistan
| | - Jaap Karsten
- Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Harriet Roggeveen
- Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Debbie Price
- Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Jena Fernhout
- Médecins Sans Frontières - Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Ahmed Abdi
- Médecins Sans Frontières - Pakistan, Balochistan, Pakistan
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17
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Madan EM, Haas JD, Menon P, Gillespie S. Seasonal variation in the proximal determinants of undernutrition during the first 1000 days of life in rural South Asia: A comprehensive review. GLOBAL FOOD SECURITY 2018. [DOI: 10.1016/j.gfs.2018.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Eriksson L, Nga NT, Hoa DTP, Duc DM, Bergström A, Wallin L, Målqvist M, Ewald U, Huy TQ, Thuy NT, Do TT, Lien PTL, Persson LÅ, Selling KE. Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam. J Epidemiol Community Health 2018; 72:776-782. [PMID: 29764902 PMCID: PMC6109254 DOI: 10.1136/jech-2017-209252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/03/2018] [Accepted: 04/28/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial. METHODS In Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008-2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data. RESULTS There were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers. CONCLUSIONS A community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas. TRIAL REGISTRATION NUMBER ISRCTN44599712, Post-results.
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Affiliation(s)
- Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Nguyen T Nga
- Research Institute for Child Health, Hanoi, Vietnam
| | | | - Duong M Duc
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Anna Bergström
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Målqvist
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Uwe Ewald
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tran Q Huy
- Department of Medical Services Administration, Ministry of Health, Nursing office, Hanoi, Vietnam
| | - Nguyen T Thuy
- Vietnam-Sweden Uong Bi General Hospital, Uong Bi, Vietnam
| | - Tran Thanh Do
- National Institute of Nutrition (NIN), Ministry of Health, Hanoi, Vietnam
| | | | - Lars-Åke Persson
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- London School of Hygiene & Tropical Medicine, London, UK
| | - Katarina Ekholm Selling
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Lenahan JL, Englund JA, Katz J, Kuypers J, Wald A, Magaret A, Tielsch JM, Khatry SK, LeClerq SC, Shrestha L, Steinhoff MC, Chu HY. Human Metapneumovirus and Other Respiratory Viral Infections during Pregnancy and Birth, Nepal. Emerg Infect Dis 2018; 23. [PMID: 28726613 PMCID: PMC5547777 DOI: 10.3201/eid2308.161358] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human metapneumovirus (HMPV) is a respiratory virus that can cause severe lower respiratory tract disease and even death, primarily in young children. The incidence and characteristics of HMPV have not been well described in pregnant women. As part of a trial of maternal influenza immunization in rural southern Nepal, we conducted prospective, longitudinal, home-based active surveillance for febrile respiratory illness during pregnancy through 6 months postpartum. During 2011-2014, HMPV was detected in 55 of 3,693 women (16.4 cases/1,000 person-years). Twenty-five women were infected with HMPV during pregnancy, compared with 98 pregnant women who contracted rhinovirus and 7 who contracted respiratory syncytial virus. Women with HMPV during pregnancy had an increased risk of giving birth to infants who were small for gestational age. An intervention to reduce HMPV febrile respiratory illness in pregnant women may have the potential to decrease risk of adverse birth outcomes in developing countries.
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20
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Philpott EK, Englund JA, Katz J, Tielsch J, Khatry S, LeClerq SC, Shrestha L, Kuypers J, Magaret AS, Steinhoff MC, Chu HY. Febrile Rhinovirus Illness During Pregnancy Is Associated With Low Birth Weight in Nepal. Open Forum Infect Dis 2017; 4:ofx073. [PMID: 28584855 PMCID: PMC5450902 DOI: 10.1093/ofid/ofx073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022] Open
Abstract
Background Adverse birth outcomes, including low birth weight (LBW), defined as <2500 grams, small-for-gestational-age (SGA), and prematurity, contribute to 60%–80% of infant mortality worldwide and may be related to infections during pregnancy. The aim of this study was to assess whether febrile human rhinovirus (HRV) illness is associated with adverse birth outcomes. Methods Active household-based weekly surveillance was performed for respiratory illness episodes in pregnant women as part of a community-based, prospective, randomized trial of maternal influenza immunization in rural Nepal. Rhinovirus (HRV) febrile illness episodes were defined as fever plus cough, sore throat, runny nose, and/or myalgia with HRV detected on mid-nasal swab. Multivariate regression analysis evaluated the association between febrile HRV respiratory illness and adverse birth outcomes. Results Overall, 96 (3%) of 3693 pregnant women had HRV-positive febrile respiratory illnesses. Infants born to pregnant women with HRV febrile illness had a 1.6-fold increased risk of being LBW compared with those with non-HRV febrile illness (28 of 96 [38%] vs 109 of 458 [24%]; relative risk [RR], 1.6; 95% confidence interval [CI], 1.1–2.3). No difference in risk of LBW was observed between infants born to mothers with non-HRV febrile respiratory illness and those without respiratory illness during pregnancy (109 of 458 [24%] vs 552 of 2220 [25%], respectively; RR, 1.0; 95% CI, 0.8–1.2). Conclusions Febrile illness due to rhinovirus during pregnancy was associated with increased risk of LBW in a rural South Asian population. Interventions to reduce the burden of febrile respiratory illness due to rhinovirus during pregnancy may have a significant impact on LBW and subsequent infant mortality.
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Affiliation(s)
| | - Janet A Englund
- Pediatrics.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Washington
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - James Tielsch
- Department of Global Healthy, George Washington University, Washington DC
| | | | | | - Laxman Shrestha
- Department of Pediatrics, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal; and
| | | | | | - Mark C Steinhoff
- Department of Global Health, Cincinnati Children's Hospital Medical Center, Ohio
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21
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Osei E, Agbemefle I, Kye-Duodu G, Binka FN. Linear trends and seasonality of births and perinatal outcomes in Upper East Region, Ghana from 2010 to 2014. BMC Pregnancy Childbirth 2016; 16:48. [PMID: 26944402 PMCID: PMC4779262 DOI: 10.1186/s12884-016-0835-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal variations greatly influence birth patterns differently from country to country. In Ghana, there is paucity of information on birth seasonal patterns. This retrospective study described the trends and seasonality of births and perinatal outcomes in Upper East Region of Ghana. METHODS Births occurring in each month of the calendar years (2010-2014; inclusive) were extracted from the District Health Information Management System (DHIMS2) database of the Bolgatanga Municipal Health Directorate and exported into Microsoft Excel spread sheet and Epi Ifo for analysis. Analysis was carried out by calculating average number of births per month correcting for unequal month length using 30 days. A Chi-square test for trend was performed to check for statistical significance (p < 0.05) in trends and seasonality of birth and perinatal outcomes. RESULTS There were 24,171 health facility deliveries, of which 97.7% were singleton deliveries and 2.3% were multiple (two or three) deliveries. There was a consistent rise in the annual health facility deliveries controlled for the number of fertile women, from 4169 in 2010 to 5474 in 2014 (p < 0.0001). Monthly birth distribution displayed a periodic pattern with peaks in May, September and October and troughs during the months of January, February and July (p < 0.0001). Women were likely to give birth during the raining season than the dry season. Caesarean Section (CS) rate showed a steady rise over the years (124 per 1000 births in 2010 to 185 per 1000 births in 2014 (p < 0.0001) with overall rate of 14.6%. Stillbirth (SB) rate, however decreased slightly over the years from 29 per 1000 births to 23 per 1000 births (p = 0.197) with overall SB rate of 2.6%. Similarly, Low Birth Weight (LBW) declined from 77 per 1000 live births to 71 per 1000 live births from 2010 to 2014 (p < 0.0001). Seasonal (rainy and dry) distributions did not show a clear difference in birth frequencies. CONCLUSION Health facility delivery was persistently high in the Bolgatanga Municipality with birth peaking in May, September and October. Despite the rising rate of caesarean section, stillbirth rate did not significantly improved over the years. A prospective study may reveal the reasons for the increasing caesarean section rate. Additionally, understanding the factors that affect the decreasing trends of low birth weight in the municipality is crucial to public health policy makers in Ghana.
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Affiliation(s)
- Eric Osei
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
- School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana.
| | - Isaac Agbemefle
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
| | - Gideon Kye-Duodu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
| | - Fred Newton Binka
- Chancellery, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
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Sex differences in the early life correlates of natural antibody concentrations. J Dev Orig Health Dis 2015; 6:501-11. [PMID: 26279187 DOI: 10.1017/s2040174415001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Innate-like B1a lymphocytes arise from long-lived progenitors produced exclusively by fetal stem cells. Any insults coinciding with this early lymphopoietic wave could have a permanent impact on the B1a population and its unique protein products, the natural antibodies (NAb). We investigated early life nutritional influences on NAb concentrations of pre-adolescent children (n=290) in rural Nepal for whom we had extensive information on exposures from pregnancy and early infancy. Infant size and growth were strongly associated with NAb concentrations at 9-13 years of age among males (e.g., for neonatal weight: βBOYS=0.43; P<0.001), but not females (e.g., for neonatal weight: βGIRLS=-0.16; P=0.26). In females, season of birth was associated with NAb concentrations, with marked reductions among girls born during the pre-monsoon (March-May; βGIRLS=-0.39; P=0.01) and pre-harvest (September-November; βGIRLS=-0.35; P=0.03) seasons. Our findings suggest that nutritional or other environmental influences on immune development may vary by sex, with potential consequences for immune function during infancy and long-term risk of immune-mediated disease.
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23
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Tielsch JM, Katz J, Zeger SL, Khatry SK, Shrestha L, Breysse P, Checkley W, Mullany LC, LeClerq SC. Designs of two randomized, community-based trials to assess the impact of alternative cookstove installation on respiratory illness among young children and reproductive outcomes in rural Nepal. BMC Public Health 2014; 14:1271. [PMID: 25511324 PMCID: PMC4301623 DOI: 10.1186/1471-2458-14-1271] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/09/2014] [Indexed: 11/14/2022] Open
Abstract
Background Acute lower respiratory infections (ALRI) are a leading cause of death among children. Low birthweight is prevalent in South Asia and associated with increased risks of mortality, and morbidity, high levels of indoor household air pollution caused by open burning of biomass fuels are common and associated with high rates of ALRI and low birthweight. Alternative stove designs that burn biomass fuel more efficiently have been proposed as one method for reducing these high exposures and lowering rates of these disorders. We designed two randomized trials to test this hypothesis. Methods/design We conducted a pair of community-based, randomized trials of alternative cookstove installation in a rural district in southern Nepal. Phase one was a cluster randomized, modified step-wedge design using an alternative biomass stove with a chimney. A pre-installation period of morbidity assessment and household environmental assessment was conducted for six months in all households. This was followed by a one year step-wedge phase with 12 monthly steps for clusters of households to receive the alternative stove. The timing of alternative stove introduction was randomized. This step-wedge phase was followed in all households by another six month follow-up phase. Eligibility criteria for phase one included household informed consent, the presence of a married woman of reproductive age (15–30 yrs) or a child < 36 months. Children were followed until 36 months of age or the end of the trial. Pregnancies were identified and followed until completion or end of the trial. Phase two was an individually randomized trial of the same alternative biomass stove versus liquid propane gas stove in a subset of households that participated in phase one. Follow-up for phase two was 12 months following stove installation. Eligibility criteria included the same components as phase one except children were only enrolled for morbidity follow-up if they were less than 24 months. The primary outcomes included: incidence of ALRI in children and birthweight. Discussion We presented the design and methods of two randomized trials of alternative cookstoves on rates of ALRI and birthweight. Trial registration Clinicaltrials.gov (NCT00786877, Nov. 5, 2008).
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Affiliation(s)
- James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
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