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Nanga DC, Carboo JA, Chatenga H, Nienaber A, Conradie C, Lombard M, Dolman‐Macleod RC. Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition. MATERNAL & CHILD NUTRITION 2024; 20:e13636. [PMID: 38456385 PMCID: PMC11168367 DOI: 10.1111/mcn.13636] [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: 09/01/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under-5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under-5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron-supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000-180,000 IU, 3.1-7.7 mg per kg per day, and 3-5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.
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Affiliation(s)
- Doris Cement Nanga
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
- Department of Human Nutrition and Health, Faculty of Food and Human ScienceLilongwe University of Agriculture and Natural ResourcesLilongweMalawi
| | - Janet A. Carboo
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Humphrey Chatenga
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
- Department of Human Nutrition and Health, Faculty of Food and Human ScienceLilongwe University of Agriculture and Natural ResourcesLilongweMalawi
| | - Arista Nienaber
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Cornelia Conradie
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Martani Lombard
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Robin Claire Dolman‐Macleod
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
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Orish VN, Lokpo SY, Kwadzokpui PK, Safianu R, Marinkovic A, Prakash S, Okorie C, Izurieta R, Pandit R, Sanyaolu A. Association between asymptomatic Plasmodium falciparum malaria infection, anaemia and mean corpuscular volume of school children in the Volta Region of Ghana. Eur J Microbiol Immunol (Bp) 2024; 14:195-201. [PMID: 38407577 PMCID: PMC11097786 DOI: 10.1556/1886.2024.00007] [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: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Background Although, several studies have reported abnormal Mean Corpuscular Volume (MCV) values and anaemia associated with malaria infections with a focus on Plasmodium falciparum among patients with complicated and uncomplicated malaria, none has looked at the association with asymptomatic malaria. This study aimed to assess this association. Methods We conducted a cross-sectional study using 3 mL of blood samples from 549 children aged 5-17 years attending 5 schools selected in the Volta Region. Semi-structured questionnaires were administered to the children to obtain demographic data. Blood samples were collected to estimate the children's full blood count (FBC) and malaria status. Data obtained were analysed using STATA 15 software. P-values of less than 0.05 were considered statistically significant. Results Most of the children in this study (49.9%) had normal MCV (81.3-91.3 fL) with an overall malaria prevalence of 55.6 % (95% CI: 51.3-59.8) and anaemia prevalence of 48.6% (95% CI 44.4-52.9). Most anaemic children had normal MCV (81.3-91.3 fL) (49.8, 95% CI 43.7-56.0). The predicted probability of malaria was highly likely among children with normal MCV (81.3-91.3 fL) but with high variability and uncertainty among those with low MCV (<81.3 fL) and high MCV (>91.3 fL). Conclusion This study shows a reduced predicted probability of malaria among children with low and high MCV, playing a protective function against malaria. Further studies are required to elucidate the interaction.
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Affiliation(s)
- Verner N. Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvester Y. Lokpo
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | | | - Rufai Safianu
- Department of Basic Medical Sciences, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | | | | | - Chuku Okorie
- Union County College (Plainfield Campus), Plainfield, NJ, USA
| | - Ricardo Izurieta
- Global Communicable Diseases, College of Public Health, University of South Florida, Tampa, FL, USA
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Osei Bonsu E, Addo IY, Boadi C, Boadu EF, Okeke SR. Determinants of iron-rich food deficiency among children under 5 years in sub-Saharan Africa: a comprehensive analysis of Demographic and Health Surveys. BMJ Open 2024; 14:e079856. [PMID: 38458798 DOI: 10.1136/bmjopen-2023-079856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Iron deficiency is a major public health problem that affects the physical and cognitive development of children under 5 years of age (under-5 children) in sub-Saharan Africa (SSA). However, the factors associated with the limited consumption of iron-rich foods in the region are poorly understood. OBJECTIVE This study examined the prevalence and determinants of iron-rich food deficiency among under-5 children in 26 SSA countries. DESIGN This nationally representative quantitative study employed pooled data from Demographic and Health Surveys conducted between 2010 and 2019. METHODS Representative samples comprising 296 850 under-5 children from the various countries were used. Bivariate and multivariate logistic regression models were used to determine the associations between the lack of iron-rich food uptake and various sociodemographic factors. RESULT The overall prevalence of iron-rich food deficiency among the children in the entire sample was 56.75%. The prevalence of iron-rich food deficiency varied widely across the 26 countries, ranging from 42.76% in Congo Democratic Republic to 77.50% in Guinea. Maternal education, particularly primary education (OR 0.62, 95% CI 0.57 to 0.68) and higher education (OR 0.58, 95% CI 0.52 to 0.64), demonstrated a reduced likelihood of iron-rich food deficiency in the sample. Likewise, paternal education, with both primary education (OR 0.69, 95% CI 0.63 to 0.75) and higher education (OR 0.66, 95% CI 0.60 to 0.73) showed decreased odds of iron-rich food deficiency. Postnatal visits contributed significantly to reducing the odds of iron-rich food deficiency (OR 0.90, 95% CI 0.83 to 0.95), along with antenatal visits, which also had a positive impact (OR 0.84, 95% CI 0.74 to 0.95). Finally, residents in rural areas showed slightly higher odds of iron-rich food deficiency (OR 1.12, 95% CI 1.10 to 1.28). CONCLUSION Based on the findings, interventions targeting iron-food deficiency in the SSA region should take into strong consideration the key determinants highlighted in this study.
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Affiliation(s)
- Emmanuel Osei Bonsu
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Caleb Boadi
- Department of Operations and Management Information Systems, University of Ghana, Legon, Ghana
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Kajoba D, Egesa WI, Muyombya S, Ortiz YA, Nduwimana M, Ndeezi G. Prevalence and Factors Associated with Iron Deficiency Anaemia among Children Aged 6-23 Months in Southwestern Uganda. Int J Pediatr 2024; 2024:6663774. [PMID: 38469566 PMCID: PMC10927344 DOI: 10.1155/2024/6663774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024] Open
Abstract
Iron deficiency anaemia is still a global public health concern with the highest burden among children 6 to 23 months due to their rapid growth spurt exceeding breastmilk supply. Therefore, nutritional supply is a key source of iron to attain the required nutrients for better growth and development. This was a cross-sectional descriptive study done at Ishaka Adventist Hospital (IAH) and Kampala International University Teaching Hospital (KIUTH) from April to July 2022. Participants were consecutively enrolled in the study. Structured questionnaires, 24-hour dietary recall, and clinical assessment were used to obtain data. Data analysis was done using the statistical package for social scientists (SPSS) V22.0. Bivariable and multivariable analyses were done using logistic regression for associations with significance set at P value < 0.05. A total of 364 participants were enrolled, with the majority being males (198, 54.4%) and born at term (333, 91.5%). The modal age was 12-17 months [163(44.8%)] with a mean age of 14.1 months (SD 5.32). The overall prevalence of IDA was 151/364 (41.5%). The factors associated with IDA included male sex (aOR 1.61), current episode of diarrhoea (aOR 1.71), poor meal frequency (aOR 1.78), no vegetable consumption (aOR 2.47), and consuming fruits once (aOR 1.97) in 7 days preceding the study. The study finds a high prevalence of IDA among infants 6-23 months with at least four in 10 being affected. Screening for IDA should be recommended in male children with current diarrhoea, poor intake of fruits and vegetables, and poor meal frequency. The Mentzer index is an equally good alternative screening test for IDA.
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Affiliation(s)
- Dickson Kajoba
- Department of Paediatrics, Kampala International University, Kampala, Uganda
| | - Walufu Ivan Egesa
- Department of Paediatrics, Nile International Hospital, Jinja, Uganda
| | | | - Yamile Arias Ortiz
- Hispalense Institute of Paediatrics, Seville, Spain
- Quirónsalud Campo de Gibraltar Hospital, Cadiz, Spain
| | - Martin Nduwimana
- Department of Paediatrics, Kampala International University, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics, Kampala International University, Kampala, Uganda
- Department of Paediatrics, Makerere University, Kampala, Uganda
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Wolstenholme AJ, Andersen EC, Choudhary S, Ebner F, Hartmann S, Holden-Dye L, Kashyap SS, Krücken J, Martin RJ, Midha A, Nejsum P, Neveu C, Robertson AP, von Samson-Himmelstjerna G, Walker R, Wang J, Whitehead BJ, Williams PDE. Getting around the roundworms: Identifying knowledge gaps and research priorities for the ascarids. ADVANCES IN PARASITOLOGY 2024; 123:51-123. [PMID: 38448148 PMCID: PMC11143470 DOI: 10.1016/bs.apar.2023.12.002] [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] [Indexed: 03/08/2024]
Abstract
The ascarids are a large group of parasitic nematodes that infect a wide range of animal species. In humans, they cause neglected diseases of poverty; many animal parasites also cause zoonotic infections in people. Control measures include hygiene and anthelmintic treatments, but they are not always appropriate or effective and this creates a continuing need to search for better ways to reduce the human, welfare and economic costs of these infections. To this end, Le Studium Institute of Advanced Studies organized a two-day conference to identify major gaps in our understanding of ascarid parasites with a view to setting research priorities that would allow for improved control. The participants identified several key areas for future focus, comprising of advances in genomic analysis and the use of model organisms, especially Caenorhabditis elegans, a more thorough appreciation of the complexity of host-parasite (and parasite-parasite) communications, a search for novel anthelmintic drugs and the development of effective vaccines. The participants agreed to try and maintain informal links in the future that could form the basis for collaborative projects, and to co-operate to organize future meetings and workshops to promote ascarid research.
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Affiliation(s)
- Adrian J Wolstenholme
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Université de Tours, ISP, Nouzilly, France.
| | - Erik C Andersen
- Department of Biology, Johns Hopkins University, Baltimore, MD, United States
| | - Shivani Choudhary
- Department of Biomedical Sciences, Iowa State University, Ames, IA, United States
| | - Friederike Ebner
- Department of Molecular Life Sciences, School of Life Sciences, Technische Universität München, Freising, Germany
| | - Susanne Hartmann
- Institute for Immunology, Freie Universität Berlin, Berlin, Germany
| | - Lindy Holden-Dye
- School of Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Sudhanva S Kashyap
- Department of Biomedical Sciences, Iowa State University, Ames, IA, United States
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Richard J Martin
- Department of Biomedical Sciences, Iowa State University, Ames, IA, United States
| | - Ankur Midha
- Institute for Immunology, Freie Universität Berlin, Berlin, Germany
| | - Peter Nejsum
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cedric Neveu
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Université de Tours, ISP, Nouzilly, France
| | - Alan P Robertson
- Department of Biomedical Sciences, Iowa State University, Ames, IA, United States
| | | | - Robert Walker
- School of Biological Sciences, University of Southampton, Southampton, United Kingdom
| | - Jianbin Wang
- Department of Biochemistry & Cellular and Molecular Biology, University of Tennessee, Knoxville, TN, United States
| | | | - Paul D E Williams
- Department of Biomedical Sciences, Iowa State University, Ames, IA, United States
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Cliffer IR, Millogo O, Barry Y, Kouanda I, Compaore G, Wang D, Sie A, Fawzi W. School-based supplementation with iron-folic acid or multiple micronutrient tablets to address anemia among adolescents in Burkina Faso: a cluster-randomized trial. Am J Clin Nutr 2023; 118:977-988. [PMID: 37716443 DOI: 10.1016/j.ajcnut.2023.09.004] [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] [Received: 06/29/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Iron-deficiency anemia is a leading cause of morbidity among adolescents (aged 10-19 y), especially in low- and middle-income settings. Few policies and programs have targeted adolescent health. OBJECTIVES This study aimed to evaluate the effectiveness of school-based supplementation with iron-folic acid (IFA) or multiple micronutrient supplements (MMSs) in addressing anemia among adolescents in Burkina Faso. METHODS In this cluster-randomized trial, 3123 secondary school students aged 10 to 18 y in Burkina Faso were either supplemented with weekly IFA, daily MMSs, or received standard nutrition education as controls. Supplementation occurred between April 2021 and April 2022 over 2 supplementation periods (10 wk, then 16 wk) separated by a gap of 20 wk without supplementation. Hemoglobin was evaluated 4 times: at baseline prior to each supplementation period and at the end of each period. Anemia was categorized by the World Health Organization hemoglobin level cutoffs as none, mild, moderate, or severe. Associations between treatment arm and anemia or continuous hemoglobin (g/dL) were assessed using multilevel mixed effects generalized linear models with schools as a random effect, controlling for baseline hemoglobin or anemia status. RESULTS Baseline anemia prevalence was similar across study arms, with 32.7% in IFA, 31.2% in MMS, and 29.5% in the control arm. Over the full study period, adolescents provided IFA had hemoglobin levels higher than those in the control arm (adjusted β: 0.32; 95% CI: 0.02, 0.62). No significant associations were observed for MMS or for anemia outcomes; however, the direction and magnitude of nonsignificant associations indicate potential protective effects of IFA and MMSs on anemia. CONCLUSIONS The results do not provide strong evidence that weekly IFA or daily MMS alone is effective, but supplementation may play a role in addressing adolescent anemia if combined with cointerventions. Additional research is required to determine the best strategy to address anemia. This trial was registered at clinicaltrials.gov as NCT04657640.
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Affiliation(s)
- Ilana R Cliffer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States.
| | - Ourohiré Millogo
- Nouna Health Research Center (CRSN), Nouna, Burkina Faso; Institut de Recherche en Sciences de la Santé (IRSS), Centre National de Recherche Scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso
| | - Yllassa Barry
- Nouna Health Research Center (CRSN), Nouna, Burkina Faso
| | | | | | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Ali Sie
- Nouna Health Research Center (CRSN), Nouna, Burkina Faso
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
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McCann S, Mason L, Milosavljevic B, Mbye E, Touray E, Colley A, Johnson W, Lloyd-Fox S, Elwell CE, Moore SE. Iron status in early infancy is associated with trajectories of cognitive development up to pre-school age in rural Gambia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002531. [PMID: 37910494 PMCID: PMC10619872 DOI: 10.1371/journal.pgph.0002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Iron deficiency is among the leading risk factors for poor cognitive development. However, interventions targeting iron deficiency have had mixed results on cognitive outcomes. This may be due to previous interventions focusing on the correction of iron deficiency anaemia in late infancy and early childhood, at which point long lasting neural impacts may already be established. We hypothesise that the relationship between iron status and cognitive development will be observable in the first months of life and will not be recovered by 5 years of age. METHODS Using data from the Brain Imaging for Global Health (BRIGHT) Study in Gambia (n = 179), we conducted mixed effects modelling to assess the relationship between iron status at 5 months of age and trajectories of cognitive development from 5 months- 5 years using (i) a standardised measure of cognitive development (Mullen Scales of Early Learning) and (ii) an eye-tracking assessment of attention processing (visual disengagement time). RESULTS All infants were iron sufficient at 1 month of age. At 5 and 12 months of age 30% and 55% of infants were iron deficient respectively. In fully adjusted analyses, infants in the lowest tercile of soluble transferrin receptor (sTfR) (best iron status) achieved MSEL Cognitive Scores on average 1.9 points higher than infants in the highest sTfR tercile (p = 0.009, effect size = 0.48). There was no evidence that this group difference was recovered by 5 years of age. Infants in the lowest sTfR tercile had visual disengagement time 57ms faster than the highest tercile (p = 0.001, effect size = 0.59). However, this difference diminished by early childhood (p = 0.024). CONCLUSION Infants are at risk of iron deficiency in early infancy. A relationship between iron status and cognitive development is apparent from 5 months of age and remains observable at 5 years of age. One mechanism by which iron availability in early infancy impacts brain development may be through effects on early attentional processing, which is rapidly developing and has substantial nutritional requirements during this period. To support neurocognitive development, prevention of iron deficiency in pre- and early postnatal life may be more effective than correcting iron deficiency once already established.
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Affiliation(s)
- Samantha McCann
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Luke Mason
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | | | - Ebrima Mbye
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ebou Touray
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Alhassan Colley
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - William Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Sarah Lloyd-Fox
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Clare E. Elwell
- Department of Medical Physics, University College London, London, United Kingdom
| | - Sophie E. Moore
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Mwangi MN, Mzembe G, Ngwira CC, Vokhiwa M, Kapulula MD, Larson LM, Braat S, Harding R, McLean ARD, Hamadani JD, Biggs BA, Ataíde R, Phiri KS, Pasricha SR. Protocol for a randomised, multicentre, four-arm, double-blinded, placebo-controlled trial to assess the benefits and safety of iron supplementation with malaria chemoprevention to children in Malawi: IRMA trial. BMJ Open 2023; 13:e069011. [PMID: 37832986 PMCID: PMC10583080 DOI: 10.1136/bmjopen-2022-069011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Approximately 40% of children aged 6-59 months worldwide are anaemic. Iron-containing multiple micronutrient powders (MNPs) and iron supplements (syrup/drops) are used to combat anaemia in children in different parts of the world. However, evidence for functional benefits of iron supplementation in children is scarce, and potential risks remain poorly defined, particularly concerning diarrhoea and malaria. This trial aims to determine if: (1) the efficacy of iron supplements or MNPs (containing iron) given with malaria chemoprevention is superior to malaria chemoprevention alone, or (2) if the efficacy of malaria chemoprevention alone is superior to placebo on child cognitive development. METHODS AND ANALYSIS IRMA is a four-arm, parallel-group, double-blinded, placebo-controlled, triple-dummy, randomised trial in Southern Malawi. The study recruits 2168 infants aged 6 months, with an intervention period of 6 months and a post-intervention period of a further 6 months. Children are randomised into four arms: (1) No intervention (placebo); (2) malaria chemoprevention only; (3) MNPs and malaria chemoprevention; and (4) iron syrup and malaria chemoprevention. The primary outcome, cognitive development (Cognitive Composite Score (CogCS)), is measured at the end of the 6 months intervention. Secondary outcomes include CogCS at a further 6 months post-intervention, motor, language and behavioural development, physical growth and prevalence of anaemia and iron deficiency. Safety outcomes include incidence of malaria and other infections, and prevalence of malaria parasitaemia during and post-intervention period. ETHICS AND DISSEMINATION The trial is approved by the National Health Sciences Research Committee (#19/01/2213) (Malawi) and the Human Research Ethics Committee (WEHI: 19/012) (Australia). Written informed consent in the local language is obtained from each participant before conducting any study-related procedure. Results will be shared with the local community and internationally with academic and policy stakeholders. TRIAL REGISTRATION NUMBER ACTRN12620000386932.
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Affiliation(s)
- Martin N Mwangi
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- The Micronutrient Forum, Healthy Mothers Healthy Babies Consortium, Washington DC, Washington, USA
| | - Glory Mzembe
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Maclean Vokhiwa
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Leila M Larson
- Department of Health Promotion, Education, and Behaviour, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Sabine Braat
- Department of Infectious Diseases at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne School of Population and Global Health, Carlton, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Rebecca Harding
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Alistair R D McLean
- Centre for Epidemiology and Biostatistics, University of Melbourne School of Population and Global Health, Carlton, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Jena D Hamadani
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Beverley-Ann Biggs
- Department of Infectious Diseases at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Diagnostic Haematology, The Royal Melbourne Hospital; and Clinical Haematology, Melbourne, Victoria, Australia
| | - Ricardo Ataíde
- Department of Infectious Diseases at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Kamija S Phiri
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Diagnostic Haematology, The Royal Melbourne Hospital; and Clinical Haematology, Melbourne, Victoria, Australia
- Department of Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Karthikappallil R, Atkinson SH. Universal iron supplementation: the best strategy to tackle childhood anaemia in malaria-endemic countries? Wellcome Open Res 2023; 8:345. [PMID: 37786779 PMCID: PMC10541535 DOI: 10.12688/wellcomeopenres.19750.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 10/04/2023] Open
Abstract
Iron deficiency presents a major public health concern in many malaria-endemic regions, and both conditions affect young children most severely. Daily iron supplementation is the standard public health intervention recommended to alleviate rates of iron deficiency in children, but there is controversy over whether universal supplementation could increase the incidence and severity of malaria infection. Current evidence suggests that iron supplementation of deficient individuals is safe and effective in high-transmission settings when accompanied by malaria prevention strategies. However, low-resource settings often struggle to effectively control the spread of malaria, and it remains unclear whether supplementation of iron replete individuals could increase their risk of malaria and other infections. This review explores the evidence for and against universal iron supplementation programmes, and alternative strategies that could be used to alleviate iron deficiency in malaria-endemic areas, while minimising potential harm.
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Affiliation(s)
- Roshan Karthikappallil
- Department of Paediatrics, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
| | - Sarah H. Atkinson
- Department of Paediatrics, University of Oxford, Oxford, England, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Mutumba R, Pesu H, Mbabazi J, Greibe E, Olsen MF, Briend A, Mølgaard C, Ritz C, Nabukeera-Barungi N, Mupere E, Filteau S, Friis H, Grenov B. Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda. Nutrients 2023; 15:3429. [PMID: 37571364 PMCID: PMC10421162 DOI: 10.3390/nu15153429] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Micronutrient deficiencies and stunting are prevalent. We assessed correlates of iron, cobalamin, folate, and vitamin A biomarkers in a cross-sectional study of stunted children aged 12-59 months in eastern Uganda. The biomarkers measured were serum ferritin (S-FE), soluble transferrin receptor (S-TfR), retinol binding protein (S-RBP), plasma cobalamin (P-Cob), methylmalonic acid (P-MMA), and folate (P-Fol). Using linear regression, we assessed socio-demography, stunting severity, malaria rapid test, and inflammation as correlates of micronutrient biomarkers. Of the 750 children, the mean (SD) age was 32.0 (11.7) months, and 45% were girls. Iron stores were depleted (inflammation-corrected S-FE < 12 µg/L) in 43%, and 62% had tissue iron deficiency (S-TfR > 8.3 mg/L). P-Cob was low (<148 pmol/L) and marginal (148-221 pmol/L) in 3% and 20%, and 16% had high P-MMA (>0.75 µmol/L). Inflammation-corrected S-RBP was low (<0.7 µmol/L) in 21% and P-Fol (<14 nmol/L) in 1%. Age 24-59 months was associated with higher S-FE and P-Fol and lower S-TfR. Breastfeeding beyond infancy was associated with lower iron status and cobalamin status, and malaria was associated with lower cobalamin status and tissue iron deficiency (higher S-TfR) despite iron sequestration in stores (higher S-FE). In conclusion, stunted children have iron, cobalamin, and vitamin A deficiencies. Interventions addressing stunting should target co-existing micronutrient deficiencies.
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Affiliation(s)
- Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark;
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - André Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, 33520 Tampere, Finland;
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark;
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (N.N.-B.); (E.M.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (H.P.); (J.M.); (M.F.O.); (C.M.); (H.F.); (B.G.)
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Dandadzi M, Musundire R, Muriithi A, Ngadze RT. Effects of drying on the nutritional, sensory and microbiological quality of edible stinkbug (Encosternumdelgorguei). Heliyon 2023; 9:e18642. [PMID: 37576258 PMCID: PMC10413077 DOI: 10.1016/j.heliyon.2023.e18642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/10/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023] Open
Abstract
Entomophagy has recently gained attention as a potential solution to the problems of food and nutritional security. One example is the consumption of edible stinkbug. Different drying techniques may affect the nutritional, microbiological and sensory properties of the edible stinkbugs. Thus, the study assessed the effects of toasting, microwave, oven and sun drying on the nutritional composition, microbiological quality and sensory attributes of processed edible stinkbugs. Drying significantly (p < 0.05) increased the crude protein and fat content of the edible stink bugs with the highest values being recorded for the toasted samples (66.65 & 37.17% respectively). Highest Ca, K, Zn, Mg, Fe and P values were recorded after microwave drying. Reduction of 2.94 and 2.99 log cycles of the total viable count (TVC) was observed in oven and microwave dried edible stinkbugs. Toasting and microwave drying eliminated the yeasts and moulds, Enterobacteriaceae and lactic acid bacteria (LAB) in edible stinkbugs. The appearance, aroma, taste, texture and overall acceptability scores were in the same order for toasted > oven dried > microwave dried > sun dried edible stinkbugs. Toasting, oven and microwave drying can be used for processing of edible stinkbugs.
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Affiliation(s)
- Melania Dandadzi
- School of Agricultural and Food Sciences, Jaramogi Oginga Odinga University of Science and Technology, P. O. Box 210-40601, Bondo, Kenya
- Department of Food Science and Technology, Chinhoyi University of Technology, P. O Box 7724, Chinhoyi, Zimbabwe
| | - Robert Musundire
- Research and Postgraduate Studies, Chinhoyi University of Technology, P. Bag 7724, Chinhoyi, Zimbabwe
| | - Alice Muriithi
- School of Agricultural and Food Sciences, Jaramogi Oginga Odinga University of Science and Technology, P. O. Box 210-40601, Bondo, Kenya
| | - Ruth T. Ngadze
- Department of Food Science and Technology, Chinhoyi University of Technology, P. O Box 7724, Chinhoyi, Zimbabwe
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12
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Zirimenya L, Zalwango F, Owino EA, Karanja HK, Natukunda A, Nkurunungi G, Bukirwa V, Kiwanuka A, Chibita M, Mogire R, Chi P, Webb E, Kaleebu P, Elliott AM. NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard): Concept and Launch event report. NIHR OPEN RESEARCH 2023; 3:35. [PMID: 39144544 PMCID: PMC11323737 DOI: 10.3310/nihropenres.13417.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/16/2024]
Abstract
Background Vaccination is an important public health intervention, but not everyone benefits equally. Biological, social and structural factors render some communities vulnerable and unable to secure optimal health benefits from vaccination programmes. This drives health inequity and undermines wider vaccine impact by allowing the persistence of non-immune communities as foci for recurrent disease outbreaks. The NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard) aims to understand how biological, social, and structural factors interact to impair vaccine impact in vulnerable African communities. Methods The VAnguard project will be implemented through three thematic work packages (1-3) and four cross-cutting work packages (4-7). Work package 1 will investigate the biological drivers and mechanisms of population differences in vaccine responses. Work package 2 will support the understanding of how structural, social and biological determinants of vaccine response interrelate to determine vaccine impact. Work package 3 will synthesise data and lead analyses to develop, model and test community-based integrated strategies to optimise vaccine access, uptake and effectiveness. Work package 4 will plan and implement field investigations (community survey and qualitative studies (with support of work package 2) to explore structural, social & biological determinants impairing vaccine impact. Work package 5 will collaborate with work packages 1-4, to engage communities in designing interventions that aim to directly optimise vaccine impact through a process of co-learning and co-creation between them and the researchers. Work package 6 will build capacity for, and a culture of, consultative, collaborative multidisciplinary vaccine research in East Africa. Work package 7 will support the overall project management and governance. Following the project inception on the 1 st of September 2022, project launch was held in November 2022. Conclusion Results from this project will contribute to the development of integrated strategies that will optimise vaccine benefits and drive health equity.
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Affiliation(s)
- Ludoviko Zirimenya
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | | | - Esther A. Owino
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Henry K. Karanja
- Uganda Virus Research Institute, Entebbe, 49, Uganda
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Agnes Natukunda
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | - Gyaviira Nkurunungi
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | | | - Achilles Kiwanuka
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | - Monica Chibita
- Journalism, Media & Communication, Uganda Christian University, Mukono, 4, Uganda
| | - Reagan Mogire
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Primus Chi
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Emily Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - Pontiano Kaleebu
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
- Uganda Virus Research Institute, Entebbe, 49, Uganda
| | - Alison M Elliott
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | - NIHR VAnguard group
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
- Uganda Virus Research Institute, Entebbe, 49, Uganda
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
- Journalism, Media & Communication, Uganda Christian University, Mukono, 4, Uganda
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13
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Goosen C, Proost S, Baumgartner J, Mallick K, Tito RY, Barnabas SL, Cotton MF, Zimmermann MB, Raes J, Blaauw R. Associations of HIV and iron status with gut microbiota composition, gut inflammation and gut integrity in South African school-age children: a two-way factorial case-control study. J Hum Nutr Diet 2023; 36:819-832. [PMID: 36992541 PMCID: PMC10946596 DOI: 10.1111/jhn.13171] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/19/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) and iron deficiency (ID) affect many African children. Both HIV and iron status interact with gut microbiota composition and related biomarkers. The study's aim was to determine the associations of HIV and iron status with gut microbiota composition, gut inflammation and gut integrity in South African school-age children. METHODS In this two-way factorial case-control study, 8- to 13-year-old children were enrolled into four groups based on their HIV and iron status: (1) With HIV (HIV+) and ID (n = 43), (2) HIV+ and iron-sufficient nonanaemic (n = 41), (3) without HIV (HIV-) and ID (n = 44) and (4) HIV- and iron-sufficient nonanaemic (n = 38). HIV+ children were virally suppressed (<50 HIV RNA copies/ml) on antiretroviral therapy (ART). Microbial composition of faecal samples (16S rRNA sequencing) and markers of gut inflammation (faecal calprotectin) and gut integrity (plasma intestinal fatty acid-binding protein [I-FABP]) were assessed. RESULTS Faecal calprotectin was higher in ID versus iron-sufficient nonanaemic children (p = 0.007). I-FABP did not significantly differ by HIV or iron status. ART-treated HIV (redundancy analysis [RDA] R2 = 0.009, p = 0.029) and age (RDA R2 = 0.013 p = 0.004) explained the variance in the gut microbiota across the four groups. Probabilistic models showed that the relative abundance of the butyrate-producing genera Anaerostipes and Anaerotruncus was lower in ID versus iron-sufficient children. Fusicatenibacter was lower in HIV+ and in ID children versus their respective counterparts. The prevalence of the inflammation-associated genus Megamonas was 42% higher in children with both HIV and ID versus HIV- and iron-sufficient nonanaemic counterparts. CONCLUSIONS In our sample of 8- to 13-year-old virally suppressed HIV+ and HIV- children with or without ID, ID was associated with increased gut inflammation and changes in the relative abundance of specific microbiota. Moreover, in HIV+ children, ID had a cumulative effect that further shifted the gut microbiota to an unfavourable composition.
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Affiliation(s)
- Charlene Goosen
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Sebastian Proost
- Laboratory of Molecular Bacteriology, Department of Microbiology and ImmunologyRega Institute, KU LeuvenLeuvenBelgium
- Center for Microbiology, VIBLeuvenBelgium
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Department of Nutritional SciencesKing's College LondonLondonUK
| | - Kashish Mallick
- Laboratory of Human Nutrition, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
| | - Raul Y. Tito
- Laboratory of Molecular Bacteriology, Department of Microbiology and ImmunologyRega Institute, KU LeuvenLeuvenBelgium
- Center for Microbiology, VIBLeuvenBelgium
| | - Shaun L. Barnabas
- Department of Paediatrics and Child Health, Family Centre for Research with UbuntuStellenbosch UniversityCape TownSouth Africa
| | - Mark F. Cotton
- Department of Paediatrics and Child Health, Family Centre for Research with UbuntuStellenbosch UniversityCape TownSouth Africa
| | - Michael B. Zimmermann
- Laboratory of Human Nutrition, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
| | - Jeroen Raes
- Laboratory of Molecular Bacteriology, Department of Microbiology and ImmunologyRega Institute, KU LeuvenLeuvenBelgium
- Center for Microbiology, VIBLeuvenBelgium
| | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
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Abuga KM, Nairz M, MacLennan CA, Atkinson SH. Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections. Wellcome Open Res 2023; 8:48. [PMID: 37600584 PMCID: PMC10439361 DOI: 10.12688/wellcomeopenres.18829.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 08/22/2023] Open
Abstract
Severe anaemia and invasive bacterial infections remain important causes of hospitalization and death among young African children. The emergence and spread of antimicrobial resistance demand better understanding of bacteraemia risk factors to inform prevention strategies. Epidemiological studies have reported an association between severe anaemia and bacteraemia. In this review, we explore evidence that severe anaemia is associated with increased risk of invasive bacterial infections in young children. We describe mechanisms of iron dysregulation in severe anaemia that might contribute to increased risk and pathogenesis of invasive bacteria, recent advances in knowledge of how iron deficiency and severe anaemia impair immune responses to bacterial infections and vaccines, and the gaps in our understanding of mechanisms underlying severe anaemia, iron deficiency, and the risk of invasive bacterial infections.
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Affiliation(s)
- Kelvin M. Abuga
- Kenya Medical Research Institute (KEMRI) Centre for Geographical Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Open University, KEMRI-Wellcome Trust Research Programme – Accredited Research Centre, Kilifi, 80108, Kenya
| | - Manfred Nairz
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Calman A. MacLennan
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Centre for Geographical Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, UK
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15
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Tanga CM, Mokaya HO, Kasiera W, Subramanian S. Potential of Insect Life Stages as Functional Ingredients for Improved Nutrition and Health. INSECTS 2023; 14:136. [PMID: 36835705 PMCID: PMC9959540 DOI: 10.3390/insects14020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to provide information on the nutrients of the edible larval stage of Gonimbrasia cocaulti (GC) for the first time, while exploring the potential nutrient content of the pupal life stages of the domestic silkworm (Bombyx mori; BM) and the Eri silkworm (Samia Cynthia ricini; SC). The three insects were analyzed for fatty acids, minerals, proximate composition and vitamins. Among the fatty acids, linoleic, a polyunsaturated fatty acid, was approximately threefold higher in GC than in the silkworms. The Ca, Fe and K contents were highest in GC. However, the Zn and Na contents were highest in BM, while Mg content was predominant in SC. The crude protein content of the various developmental life stages of the edible caterpillars and pupae ranged between 50 and 62%. Further, the fiber content of GC was substantially higher compared to the pupal stages of the two silkworm species. The vitamin (B6, B9, B12 and α-tocopherol) levels of the two insect life stages were considerably high. These insects are comparably rich in nutrients with potential suitability to be utilized in food fortification and thus ease pressure on the over-reliance on animal and plant-based sources, which are becoming unsustainable.
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Sandalinas F, Filteau S, Joy EJM, Segovia de la Revilla L, MacDougall A, Hopkins H. Measuring the impact of malaria infection on indicators of iron and vitamin A status: a systematic literature review and meta-analysis. Br J Nutr 2023; 129:87-103. [PMID: 35260210 PMCID: PMC9816655 DOI: 10.1017/s0007114522000757] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 01/21/2023]
Abstract
Inflammation and infections such as malaria affect estimates of micronutrient status. Medline, Embase, Web of Science, Scopus and the Cochrane library were searched to identify studies reporting mean concentrations of ferritin, hepcidin, retinol or retinol binding protein in individuals with asymptomatic or clinical malaria and healthy controls. Study quality was assessed using the US National Institute of Health tool. Random effects meta-analyses were used to generate summary mean differences. In total, forty-four studies were included. Mean ferritin concentrations were elevated by: 28·2 µg/l (95 % CI 15·6, 40·9) in children with asymptomatic malaria; 28·5 µg/l (95 % CI 8·1, 48·8) in adults with asymptomatic malaria; and 366 µg/l (95 % CI 162, 570) in children with clinical malaria compared with individuals without malaria infection. Mean hepcidin concentrations were elevated by 1·52 nmol/l (95 % CI 0·92, 2·11) in children with asymptomatic malaria. Mean retinol concentrations were reduced by: 0·11 µmol/l (95 % CI -0·22, -0·01) in children with asymptomatic malaria; 0·43 µmol/l (95 % CI -0·71, -0·16) in children with clinical malaria and 0·73 µmol/l (95 % CI -1·11, -0·36) in adults with clinical malaria. Most of these results were stable in sensitivity analyses. In children with clinical malaria and pregnant women, difference in ferritin concentrations were greater in areas with higher transmission intensity. We conclude that biomarkers of iron and vitamin A status should be statistically adjusted for malaria and the severity of infection. Several studies analysing asymptomatic infections reported elevated ferritin concentrations without noticeable elevation of inflammation markers, indicating a need to adjust for malaria status in addition to inflammation adjustments.
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Affiliation(s)
- Fanny Sandalinas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Edward J. M. Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Amy MacDougall
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi Hopkins
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Singh A, Baalasubramanian S, Kalaivani M, Kapoor R, Bhagwat K, Ghosh-Jerath S. Standardisation and application of a novel multiplex assay for estimating micronutrient status and inflammatory markers in women of Sauria Paharia and Santhal tribes of Jharkhand. Br J Nutr 2022; 128:2464-2479. [PMID: 35115060 PMCID: PMC7613878 DOI: 10.1017/s0007114522000320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study aimed to document the method standardisation and assessment of micronutrient and inflammatory markers in women from indigenous tribal communities of Jharkhand using a low-volume, high-throughput assay. This cross-sectional study was done among women of the reproductive age group from Sauria Paharia and Santhal tribal households (HH) in selected villages. Capillary blood samples were collected from the women during a HH survey to estimate ferritin, soluble transferrin receptor, retinol binding protein 4 and inflammatory biomarkers, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) using a multiplex assay. Vitamin D and Hb were estimated using an LC-MS technique and cyanmethaemoglobin method, respectively. A multiplex Luminex-based method was developed and standardised. The assay was used to estimate biomarkers in samples from 413 women (178 and 235 from Sauria Paharia and Santhal tribes, respectively). Over 51 % of women had raised CRP or AGP levels. Fe status was significantly better in Sauria Paharia compared with the Santhal women. Anaemia prevalence was 72 % among Santhal women. The proportion of women with Fe deficiency increased after adjusting for inflammation. The overall prevalence of vitamin A deficiency and insufficiency was 25 and 34 %, respectively, with similar prevalence in both tribes. All Santhal women had sufficient vitamin D levels, while 25 and 20 % of Sauria Paharia women had insufficient and deficient vitamin D levels, respectively. Our low-volume, high-throughput multiplex assays may provide a feasible approach for assessing nutritional biomarkers in nutritionally vulnerable hard-to-reach communities.
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Affiliation(s)
- Archna Singh
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ridhima Kapoor
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Haryana, India
| | - Ketaki Bhagwat
- Indoor Biotechnologies Private India Limited, Bangalore, India
| | - Suparna Ghosh-Jerath
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Haryana, India
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18
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Abstract
PURPOSE OF REVIEW This review examines recent research on the prevalence and importance of iron deficiency in blood donors, and on efforts to mitigate it. RECENT FINDINGS Premenopausal females, teenagers, and high-frequency donors are at the highest risk for donation-induced iron deficiency, in both high-resource and low-resource settings. The physiology relating iron stores to hemoglobin levels and low hemoglobin deferral is well elucidated in blood donor populations, yet the clinical effects attributable to iron loss in the absence of anemia are challenging to identify. Expanded adoption of ferritin testing is improving donor management but may cause decreases in the blood supply from temporary donor loss. The potential for personalized donor management is emerging with development of computational models that predict individual interdonation intervals that aim to optimize blood collected from each donor while minimizing low hemoglobin deferrals. SUMMARY Measures to reduce iron deficiency are available that can be deployed on a standardized or, increasingly, personalized basis. Blood centers, regulators, and donors should continue to evaluate different tactics for addressing this problem, to obtain a balanced approach that is optimal for maintaining adequate collections while safeguarding donor health.
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Affiliation(s)
| | - Alan E. Mast
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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19
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Davis JN, Williams A, Arnold CD, Rohner F, Wirth JP, Addo Y, Flores-Ayala RC, Oaks BM, Young MF, Suchdev PS, Engle-Stone R. The Relationship Between Ferritin and BMI is Mediated by Inflammation Among Women in Higher-Income Countries, But Not in Most Lower-Income Countries Nor Among Young Children: A Multi-Country Analysis. Curr Dev Nutr 2022; 6:nzac139. [PMID: 36475018 PMCID: PMC9718651 DOI: 10.1093/cdn/nzac139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 10/03/2023] Open
Abstract
Background In the presence of inflammation, the serum or plasma ferritin concentration ("ferritin" hereafter) transiently increases, confounding its interpretation as an iron status marker. The extent to which adiposity-related inflammation may influence ferritin interpretation is uncertain. Objectives We describe relationships between weight status, inflammation, and ferritin among nonpregnant women of reproductive age (WRA; 15-49 years) and preschool-age children (PSC; 6-59 months) with normal weight to overweight or obesity (OWOB) in differing geographic settings. Methods Cross-sectional data were separately analyzed from 18 surveys (WRA) and 25 surveys (PSC) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, excluding observations with underweight, wasting, pregnancy, or malaria. Relationships were assessed between BMI (in WRA) or BMI-for-age z-score (BAZ; in PSC), inflammatory biomarkers of C-reactive protein (CRP) and/or α-1-acid glycoprotein (AGP), ferritin by linear regression, and potential mediation by CRP and/or AGP in relationships between BMI or BAZ and ferritin with structural equation modeling. Regression and mediation models accounted for complex survey designs. Results were grouped by World Bank income classifications. Results In 5 of 6 surveys among WRA from upper-middle and high-income countries, ferritin was significantly positively associated with BMI, and this relationship was partially (or fully, in the United States) mediated by CRP and/or AGP. Mediation was present in 4 of 12 surveys for WRA in low- and lower-middle income countries. Among PSC, ferritin was positively associated with CRP and/or AGP in all surveys, but there were no significant CRP- or AGP-mediated relationships between ferritin and BAZ, except a negative relationship in the Philippines. Conclusions Where having OWOB is common among WRA, measurements of inflammatory biomarkers and their uses in interpreting ferritin may improve iron status assessments. While these relationships were inconsistent among PSC, inflammation was common and should be measured to interpret iron status. Included Kenyan trial data are registered at clinicaltrials.gov as NCT01088958.
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Affiliation(s)
- Jennie N Davis
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | - Anne Williams
- University of Otago, Department of Human Nutrition, Dunedin, New Zealand
| | - Charles D Arnold
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
| | | | | | - Yaw Addo
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rafael C Flores-Ayala
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Melissa F Young
- Global Health Department, Emory University, Atlanta, GA, USA
| | - Parminder S Suchdev
- Department of Pediatrics and Global Health, Emory University, Atlanta, GA, USA
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reina Engle-Stone
- University of California, Davis Department of Nutrition, Institute for Global Nutrition, Davis, CA, USA
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20
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Dwomoh D, Sewor C, Mohammed SA, Annim S, Stranges S, Kandala NB, Amegah AK. Secular trends in low birth weight and child undernutrition in West Africa: evidence from complex nationwide surveys, 1985-2019. Public Health Nutr 2022; 25:2358-2370. [PMID: 35039103 PMCID: PMC9991671 DOI: 10.1017/s1368980022000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We present prevalence estimates and secular trends of stunting, wasting, underweight, and anaemia among children under 5 years of age and low birth weight (LBW) over the period 1985-2019 in West Africa (WA). DESIGN Analysis of Demographic and Health Survey (DHS) and World Bank data. DerSimonian-Laird random effect model with the Knapp-Hartung adjustment to the standard error was used to derive overall prevalence estimates. We used fixed effect ordinary least square regression models with cluster robust standard error to conduct time trends analyses. SETTING West Africa. PARTICIPANTS Children aged 0 to 59 months. RESULTS Three distinct periods (1986-1990, 1993-1996 and 1997-2000) of sharp increases in prevalence of all outcomes was observed. After the year 2000, prevalence of all outcomes except LBW started to decline with some fluctuations. LBW prevalence showed a steady increase after 2000. We observed a decline in prevalence of stunting (β = -0·20 %; 95 % CI -0·43 %, 0·03 %), log-wasting (β = -0·02 %; 95 % CI -0·02 %, -0·01 %), log-underweight (β = -0·02 %; 95 % CI -0·03 %, -0·01 %) anaemia (β = -0·44; 95 % CI -0·55 %, -0·34 %), and an increase in LBW (β = 0·06 %; 95 % CI -0·10 %, 0·22 %) in WA over the period. Pooled prevalence of stunting, wasting, underweight, anaemia and LBW in WA for the period 1985-2019 was 26·1 %, 16·4 %, 22·7 %, 76·2 % and 11·3 %, respectively. CONCLUSIONS Child undernutrition prevalence varied greatly between countries and the year cohorts. We observed marginal reductions in prevalence of all outcomes except anaemia where the reductions were quite striking and LBW where an increase was noted. There is the need for more rigorous and sustained targeted interventions in WA.
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Affiliation(s)
- Duah Dwomoh
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana
- Department of Biostatistics, School of Public Health, University of Ghana, Legon – Accra, Ghana
| | - Christian Sewor
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana
| | - Seidu Awal Mohammed
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Annim
- Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
- Ghana Statistical Service, Accra, Ghana
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics and Africa Institute, Western University, London, ON, Canada
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ngianga-Bakwin Kandala
- University of Warwick, Division of Health Sciences, Warwick Medical School, Coventry, UK
- University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
| | - A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Private Mail Bag, Cape Coast, Ghana
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21
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Mank I, Sorgho R, Zerbo F, Kagoné M, Coulibaly B, Oguso J, Mbata M, Khagayi S, Muok EMO, Sié A, Danquah I. ALIMUS-We are feeding! Study protocol of a multi-center, cluster-randomized controlled trial on the effects of a home garden and nutrition counseling intervention to reduce child undernutrition in rural Burkina Faso and Kenya. Trials 2022; 23:449. [PMID: 35650583 PMCID: PMC9157031 DOI: 10.1186/s13063-022-06423-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/24/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Climate change heavily affects child nutritional status in sub-Saharan Africa. Agricultural and dietary diversification are promising tools to balance agricultural yield losses and nutrient deficits in crops. However, rigorous impact evaluation of such adaptation strategies is lacking. This project will determine the potential of an integrated home gardening and nutrition counseling program as one possible climate change adaptation strategy to improve child health in rural Burkina Faso and Kenya. METHODS Based on careful co-design with stakeholders and beneficiaries, we conduct a multi-center, cluster-randomized controlled trial with 2 × 600 households in North-Western Burkina Faso and in South-Eastern Kenya. We recruit households with children at the age of complementary feed introduction (6-24 months) and with access to water sources. The intervention comprises the bio-diversification of horticultural home gardens and nutritional health counseling, using the 7 Essential Nutrition Action messages by the World Health Organization. After 12-months of follow-up, we will determine the intervention effect on the primary health outcome height-for-age z-score, using multi-level mixed models in an intention-to-treat approach. Secondary outcomes comprise other anthropometric indices, iron and zinc status, dietary behavior, malaria indicators, and household socioeconomic status. DISCUSSION This project will establish the potential of a home gardening and nutrition counseling program to counteract climate change-related quantitative and qualitative agricultural losses, thereby improving the nutritional status among young children in rural sub-Saharan Africa. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00019076 . Registered on 27 July 2021.
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Affiliation(s)
- Isabel Mank
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.,German Institute for Development Evaluation (DEval), Bonn, Germany
| | - Raissa Sorgho
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Fanta Zerbo
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | | | | | - John Oguso
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research (CGHR), Kisumu, Kenya
| | - Michael Mbata
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research (CGHR), Kisumu, Kenya
| | - Sammy Khagayi
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research (CGHR), Kisumu, Kenya
| | - Erick M O Muok
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research (CGHR), Kisumu, Kenya
| | - Ali Sié
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital Heidelberg, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
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22
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Chouraqui JP. Dietary Approaches to Iron Deficiency Prevention in Childhood-A Critical Public Health Issue. Nutrients 2022; 14:1604. [PMID: 35458166 PMCID: PMC9026685 DOI: 10.3390/nu14081604] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Iron is an essential nutrient, and individual iron status is determined by the regulation of iron absorption, which is driven by iron requirements. Iron deficiency (ID) disproportionately affects infants, children, and adolescents, particularly those who live in areas with unfavorable socioeconomic conditions. The main reason for this is that diet provides insufficient bioavailable iron to meet their needs. The consequences of ID include poor immune function and response to vaccination, and moderate ID anemia is associated with depressed neurodevelopment and impaired cognitive and academic performances. The persistently high prevalence of ID worldwide leads to the need for effective measures of ID prevention. The main strategies include the dietary diversification of foods with more bioavailable iron and/or the use of iron-fortified staple foods such as formula or cereals. However, this strategy may be limited due to its cost, especially in low-income countries where biofortification is a promising approach. Another option is iron supplementation. In terms of health policy, the choice between mass and targeted ID prevention depends on local conditions. In any case, this remains a critical public health issue in many countries that must be taken into consideration, especially in children under 5 years of age.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Nutrition and Gastroenterology Unit, Woman, Mother and Child Department, University Hospital of Lausanne, 1011 Lausanne, Switzerland
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23
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Nampijja M, Mutua AM, Elliott AM, Muriuki JM, Abubakar A, Webb EL, Atkinson SH. Low Hemoglobin Levels Are Associated with Reduced Psychomotor and Language Abilities in Young Ugandan Children. Nutrients 2022; 14:nu14071452. [PMID: 35406065 PMCID: PMC9002834 DOI: 10.3390/nu14071452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Children living in Sub-Saharan Africa are vulnerable to developmental delay, particularly in the critical first five years due to various adverse exposures including disease and nutritional deficiencies. Anemia and iron deficiency (ID) are highly prevalent in pregnant mothers and young children and are implicated in abnormal brain development. However, available evidence on the association between anemia, ID and neurodevelopment in sub-Saharan Africa is limited. Using data from the Entebbe Mother and Baby Study prospective birth cohort, we examined the effect of maternal and child hemoglobin (Hb) levels and child iron status on developmental scores in 933 and 530 pre-school Ugandan children respectively. Associations between Hb levels, iron status and developmental scores were assessed using regression analyses adjusting for potential confounders. Lower maternal and child Hb levels were associated with reduced psychomotor scores at 15 months, while only lower Hb levels in infancy were associated with reduced language scores. We found no evidence that anemia or ID was associated with cognitive or motor scores at five years. This study emphasizes the importance of managing anemia in pregnancy and infancy and highlights the need for further studies on the effects of anemia and ID in children living in Sub-Saharan Africa.
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Affiliation(s)
- Margaret Nampijja
- Maternal and Child Wellbeing (MCW) Unit, African Population and Health Research Center, Nairobi 00100, Kenya;
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
| | - Alison M. Elliott
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Institute for Human Development, Aga Khan University, Nairobi 30270-00100, Kenya
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
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24
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Mogire RM, Muriuki JM, Morovat A, Mentzer AJ, Webb EL, Kimita W, Ndungu FM, Macharia AW, Cutland CL, Sirima SB, Diarra A, Tiono AB, Lule SA, Madhi SA, Prentice AM, Bejon P, Pettifor JM, Elliott AM, Adeyemo A, Williams TN, Atkinson SH. Vitamin D Deficiency and Its Association with Iron Deficiency in African Children. Nutrients 2022; 14:nu14071372. [PMID: 35405984 PMCID: PMC9002534 DOI: 10.3390/nu14071372] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Vitamin D regulates the master iron hormone hepcidin, and iron in turn alters vitamin D metabolism. Although vitamin D and iron deficiency are highly prevalent globally, little is known about their interactions in Africa. To evaluate associations between vitamin D and iron status we measured markers of iron status, inflammation, malaria parasitemia, and 25-hydroxyvitamin D (25(OH)D) concentrations in 4509 children aged 0.3 months to 8 years living in Kenya, Uganda, Burkina Faso, The Gambia, and South Africa. Prevalence of iron deficiency was 35.1%, and prevalence of vitamin D deficiency was 0.6% and 7.8% as defined by 25(OH)D concentrations of <30 nmol/L and <50 nmol/L, respectively. Children with 25(OH)D concentrations of <50 nmol/L had a 98% increased risk of iron deficiency (OR 1.98 [95% CI 1.52, 2.58]) compared to those with 25(OH)D concentrations >75 nmol/L. 25(OH)D concentrations variably influenced individual markers of iron status. Inflammation interacted with 25(OH)D concentrations to predict ferritin levels. The link between vitamin D and iron status should be considered in strategies to manage these nutrient deficiencies in African children.
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Affiliation(s)
- Reagan M. Mogire
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- KEMRI-Wellcome Trust Research Programme-Accredited Research Centre, Open University, P.O. Box 230, Kilifi 80108, Kenya
- Correspondence: (R.M.M.); (S.H.A.); Tel.: +254-709-983274 (R.M.M.); +254-709-983000 (S.H.A.)
| | - John Muthii Muriuki
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Alireza Morovat
- Department of Clinical Biochemistry, Oxford University Hospitals, Oxford OX3 9DU, UK;
| | - Alexander J. Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK;
- Li Ka Shing Centre for Health Information and Discovery, Big Data Institute, University of Oxford, Oxford OX3 7LF, UK
| | - Emily L. Webb
- Medical Research Council (MRC) International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (E.L.W.); (S.A.L.)
| | - Wandia Kimita
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Francis M. Ndungu
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Alex W. Macharia
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
| | - Clare L. Cutland
- African Leadership in Vaccinology Expertise (Alive), Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa;
| | - Sodiomon B. Sirima
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Amidou Diarra
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Alfred B. Tiono
- Groupe de Recherche Action en Sante (GRAS), Ouagadougou 06 BP 10248, Burkina Faso; (S.B.S.); (A.D.); (A.B.T.)
| | - Swaib A. Lule
- Medical Research Council (MRC) International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (E.L.W.); (S.A.L.)
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa;
| | - Andrew M. Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia;
| | - Philip Bejon
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - John M. Pettifor
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, R68 Old Potchefstroom Road, Bertsham, Johannesburg 2050, South Africa;
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Adebowale Adeyemo
- Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20891-5635, USA;
| | - Thomas N. Williams
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College, London SW7 2NA, UK
| | - Sarah H. Atkinson
- Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), P.O. Box 230, Kilifi 80108, Kenya; (J.M.M.); (W.K.); (F.M.N.); (A.W.M.); (P.B.); (T.N.W.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (R.M.M.); (S.H.A.); Tel.: +254-709-983274 (R.M.M.); +254-709-983000 (S.H.A.)
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25
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Effect of individual, household and regional socioeconomic factors and PM 2.5 on anaemia: A cross-sectional study of sub-Saharan African countries. Spat Spatiotemporal Epidemiol 2022; 40:100472. [PMID: 35120685 DOI: 10.1016/j.sste.2021.100472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/28/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
There is limited knowledge on the effect of contextual and environmental factors on the risk of anaemia, as well as the spatial distribution of anaemia in the Sub-Saharan Africa region. In this study, we used multi-country data from the Demographic & Health survey (DHS) with 270,011 observations and PM2.5 data from NASA, applied to the spatial risk pattern of anaemia in the SSA region. The prevalence of anaemia amongst women (41%) was almost twice that of men (22%). A Bayesian hierarchical model showed that individual household, neighbourhood and regional socioeconomic factors were significantly associated with the likelihood of being anaemic. 1 μg/m3 increase in cumulative lifetime PM2.5 exposure accounted for 1% (β = 0.011, CI = 0.008 - 0.015) increase in the likelihood of being anaemic. The results suggest the need for a multidimensional approach to tackle anaemia in the Sub-Saharan African region and identify high-risk areas for target intervention policies or programs.
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Uyoga MA, Mzembe G, Stoffel NU, Moretti D, Zeder C, Phiri K, Sabatier M, Hays NP, Zimmermann MB, Mwangi MN. Iron Bioavailability from Infant Cereals Containing Whole Grains and Pulses: A Stable Isotope Study in Malawian Children. J Nutr 2021; 152:826-834. [PMID: 34958374 PMCID: PMC8891185 DOI: 10.1093/jn/nxab406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/29/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Compared with infant cereals based on refined grains, an infant cereal containing whole grains (WGs) and pulses with adequate amounts of ascorbic acid to protect against absorption inhibitors could be a healthier source of well-absorbed iron. However, iron absorption from such cereals is uncertain. OBJECTIVE We measured iron bioavailability from ferrous fumarate (Fefum) added to commercial infant cereals containing 1) refined wheat flour (reference meal), 2) WG wheat and lentil flour (WG-wheat-lentil), 3) WG wheat and chickpea flour (WG-wheat-chickpeas), and 4) WG oat flour (WG-oat) and from ferrous bisglycinate (FeBG) added to the same oat-based cereal (WG-oat-FeBG). METHODS In a prospective, single-blinded randomized crossover study, 6- to 14-mo-old Malawian children (n = 30) consumed 25-g servings of all 5 test meals containing 2.25 mg stable isotope-labeled iron and 13.5 mg ascorbic acid. Fractional iron absorption (FIA) was assessed by erythrocyte incorporation of isotopes after 14 d. Comparisons were made using linear mixed models. RESULTS Seventy percent of the children were anemic and 67% were iron deficient. Geometric mean FIA percentages (-SD, +SD) from the cereals were as follows: 1) refined wheat, 12.1 (4.8, 30.6); 2) WG-wheat-lentil, 15.8 (6.6, 37.6); 3) WG-wheat-chickpeas, 12.8 (5.5, 29.8); and 4) WG-oat, 9.2 (3.9, 21.5) and 7.4 (2.9, 18.9) from WG-oat-FeBG. Meal predicted FIA (P ≤ 0.001), whereas in pairwise comparisons, only WG-oat-FeBG was significantly different compared with the refined wheat meal (P = 0.02). In addition, FIAs from WG-wheat-lentil and WG-wheat-chickpeas were significantly higher than from WG-oat (P = 0.002 and P = 0.04, respectively) and WG-oat-FeBG (P < 0.001 and P = 0.004, respectively). CONCLUSION In Malawian children, when given with ascorbic acid at a molar ratio of 2:1, iron bioavailability from Fefum-fortified infant cereals containing WG wheat and pulses is ≈13-15%, whereas that from FeBG- and Fefum-fortified infant cereals based on WG oats is ≈7-9%.
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Affiliation(s)
| | - Glory Mzembe
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland,Swiss Distance University of Applied Sciences, Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Kamija Phiri
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Magalie Sabatier
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Vers-Chez-Les-Blanc, Lausanne, Switzerland
| | - Nicholas P Hays
- Nestlé Product Technology Center—Nutrition, Société des Produits Nestlé S.A., Vevey, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Martin N Mwangi
- Training and Research Unit of Excellence (TRUE), Blantyre, Malawi,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Mutua AM, Mwangi K, Abubakar A, Atkinson SH. Effects of iron intake on neurobehavioural outcomes in African children: a systematic review and meta-analysis of randomised controlled trials. Wellcome Open Res 2021; 6:181. [PMID: 35106382 PMCID: PMC8777511 DOI: 10.12688/wellcomeopenres.16931.2] [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] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Iron deficiency and developmental delay are common in African children. While experimental studies indicate an important role of iron in brain development, effects of iron on child development remain unclear. We aimed to evaluate the effects of iron supplementation or fortification on neurobehavioural outcomes in African children and further summarise these effects in children living in non-African countries for comparison. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus and Cochrane Library for studies published up to 22 nd October 2021. We included randomised controlled trials (RCTs) evaluating effects of iron supplementation or fortification on neurobehavioural outcomes in children. Due to heterogeneity in study methods, we analysed all studies qualitatively and in secondary analyses only seven RCTs with 11 arms were meta-analysed. Results: We identified 2231 studies and included 35 studies (n=9988) in the systematic review. Only five studies (n=1294) included African children while 30 (n=8694) included children living in non-African countries. Of the five African studies, two (n=647) reported beneficial effects of iron supplementation on neurobehavioural outcomes in anaemic children, while three (n=647) found no beneficial effects. Of 30 studies in children living in non-African countries, 10 (n=3105) reported beneficial effects of iron supplementation or fortification on neurobehavioural outcomes, seven (n=786) reported beneficial effects only in children who had iron deficiency, iron deficiency anaemia or anaemia while 13 (n=4803) reported no beneficial effects. Conclusions: There are few studies in African children despite the high burden of iron deficiency and developmental delay in this population. Evidence on the effects of iron supplementation on neurobehavioural outcomes remains unclear and there is need for further well-powered studies evaluating these effects in African populations. PROSPERO registration: CRD42018091278 (20/03/2018).
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Affiliation(s)
- Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Kelvinson Mwangi
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, 30270-00100, Kenya
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 195-80108, Kenya
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, UK
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28
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Mwangi MN, Mzembe G, Moya E, Verhoef H. Iron deficiency anaemia in sub-Saharan Africa: a review of current evidence and primary care recommendations for high-risk groups. Lancet Haematol 2021; 8:e732-e743. [PMID: 34481549 DOI: 10.1016/s2352-3026(21)00193-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022]
Abstract
The epidemiology of iron deficiency anaemia in sub-Saharan Africa differs from that in other parts of the world. The low-quality diets prevalent in this region are a poor source of iron, the population is frequently exposed to infection, and demographic characteristics result in a greater prevalence of people at high risk of iron deficiency anaemia than in other parts of the world. We herein review the causes, disease burden, and consequences of iron deficiency anaemia in the general population in this region, and current policies and interventions for its control. The current debate is dominated by concerns about the safety of iron interventions, namely regarding its effects on malaria and other infectious diseases. However, universal antenatal iron supplementation and delayed cord clamping are safe interventions and stand out for their potential to improve maternal and infant health. Effective infection control is a precondition to safe and efficacious iron interventions in children. Greater emphasis should be given to approaches aiming to reduce iron loss due to helminth infections and menstruation, alongside interventions to increase iron intake. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Martin N Mwangi
- Training and Research Unit of Excellence, Blantyre, Malawi; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Glory Mzembe
- Training and Research Unit of Excellence, Blantyre, Malawi; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ernest Moya
- Training and Research Unit of Excellence, Blantyre, Malawi; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands; MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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29
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Abuga KM, Muriuki JM, Uyoga SM, Mwai K, Makale J, Mogire RM, Macharia AW, Mohammed S, Muthumbi E, Mwarumba S, Mturi N, Bejon P, Scott JAG, Nairz M, Williams TN, Atkinson SH. Hepcidin regulation in Kenyan children with severe malaria and non-typhoidal Salmonella bacteremia. Haematologica 2021; 107:1589-1598. [PMID: 34498446 PMCID: PMC9244826 DOI: 10.3324/haematol.2021.279316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Indexed: 11/09/2022] Open
Abstract
Malaria and invasive non-typhoidal Salmonella (NTS) are life-threatening infections that often co-exist in African children. The iron-regulatory hormone hepcidin is highly upregulated during malaria and controls the availability of iron, a critical nutrient for bacterial growth. We investigated the relationship between Plasmodium falciparum malaria and NTS bacteremia in all pediatric admissions aged <5 years between August 1998 and October 2019 (n=75,034). We then assayed hepcidin and measures of iron status in five groups: (1) children with concomitant severe malarial anemia (SMA) and NTS (SMA+NTS, n=16); and in matched children with (2) SMA (n=33); (3) NTS (n=33); (4) cerebral malaria (CM, n=34); and (5) community-based children. SMA and severe anemia without malaria were associated with a 2-fold or more increased risk of NTS bacteremia, while other malaria phenotypes were not associated with increased NTS risk. Children with SMA had lower hepcidin/ferritin ratios (0.10; interquartile range [IQR]: 0.03-0.19) than those with CM (0.24; IQR: 0.14-0.69; P=0.006) or asymptomatic malaria (0.19; IQR: 0.09-0.46; P=0.01) indicating suppressed hepcidin levels. Children with SMA+NTS had lower hepcidin levels (9.3 ng/mL; IQR: 4.7-49.8) and hepcidin/ferritin ratios (0.03; IQR: 0.01-0.22) than those with NTS alone (105.8 ng/mL; IQR: 17.3-233.3; P=0.02 and 0.31; IQR: 0.06-0.66; P=0.007, respectively). Since hepcidin degrades ferroportin on the Salmonella-containing vacuole, we hypothesize that reduced hepcidin in children with SMA might contribute to NTS growth by modulating iron availability for bacterial growth. Further studies are needed to understand how the hepcidin-ferroportin axis might mediate susceptibility to NTS in severely anemic children.
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Affiliation(s)
- Kelvin M. Abuga
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya,Kelvin M. Abuga
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Sophie M. Uyoga
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Kennedy Mwai
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Epidemiology and Biostatistics Division, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Johnstone Makale
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Reagan M. Mogire
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Open University, KEMRI-Wellcome Trust Research Program – Accredited Research Center, Kilifi, Kenya
| | - Alex W. Macharia
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Open University, KEMRI-Wellcome Trust Research Program – Accredited Research Center, Kilifi, Kenya
| | - Shebe Mohammed
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Esther Muthumbi
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Salim Mwarumba
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Neema Mturi
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - J. Anthony G. Scott
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Manfred Nairz
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas N. Williams
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK,Department of Infectious Diseases and Institute of Global Health Innovation, Imperial College, London, UK
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Center for Geographic Medicine Research, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya,Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK,Department of Pediatrics, University of Oxford, Oxford, UK,Sarah H. Atkinson
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30
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Speich C, Brittenham GM, Cercamondi CI, Zeder C, Nkosi-Gondwe T, Phiri KS, Moretti D, Zimmermann MB. Isotopic measurement of iron requirements in sub-Saharan African children. Am J Clin Nutr 2021; 114:986-996. [PMID: 34113969 DOI: 10.1093/ajcn/nqab161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prevention of iron deficiency in African children is a public health priority. Current WHO/FAO estimations of iron requirements are derived from factorial estimates based on healthy, iron-sufficient "model" children using data derived mainly from adults. OBJECTIVES In this study, we aimed to quantify iron absorption, loss, and balance in apparently healthy 5- to 7-y-old children living in rural Africa. METHODS We directly measured long-term iron absorption and iron loss in a 2-y observational study in Malawian children (n = 48) using a novel stable iron isotope method. RESULTS Of the 36 children with height-for-age and weight-for-age z scores ≥-2, 13 (36%) were iron deficient (soluble transferrin receptor >8.3 mg/L) and 23 were iron sufficient. Iron-deficient children weighed more than iron-sufficient children [mean difference (95% CI): +2.1 (1.4, 2.7) kg; P = 0.01]. Mean iron losses did not differ significantly between iron-deficient and iron-sufficient children and were comparable to WHO/FAO median estimates of 19 µg/(d × kg). In iron-sufficient children, median (95% CI) dietary iron absorption was 32 (28, 34) µg/(d × kg), comparable to WHO/FAO-estimated median requirements of 32 µg/(d × kg). In iron-deficient children, absorption of 28 (25, 30) µg/(d × kg) was not increased to correct their iron deficit, likely because of a lack of bioavailable dietary iron. Twelve children (25%) were undernourished (underweight, stunted, or both). CONCLUSIONS Our results suggest that WHO/FAO iron requirements are adequate for healthy iron-sufficient children in this rural area of Malawi, but iron-deficient children require additional bioavailable iron to correct their iron deficit.
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Affiliation(s)
- Cornelia Speich
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Gary M Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Colin I Cercamondi
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
| | - Thandile Nkosi-Gondwe
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kamija S Phiri
- Training and Research Unit of Excellence, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland.,Nutrition Group, Health Department, Swiss Distance University of Applied Sciences, Regensdorf, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zurich, Switzerland
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31
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Mutua AM, Mwangi K, Abubakar A, Atkinson SH. Effects of iron intake on neurobehavioural outcomes in African children: a systematic review and meta-analysis of randomised controlled trials. Wellcome Open Res 2021; 6:181. [PMID: 35106382 PMCID: PMC8777511 DOI: 10.12688/wellcomeopenres.16931.1] [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] [Accepted: 05/26/2021] [Indexed: 04/06/2024] Open
Abstract
Background: Iron deficiency and developmental delay are common in African children. While experimental studies indicate an important role of iron in brain development, effects of iron on child development remain unclear. We aimed to evaluate the effects of iron supplementation or fortification on neurobehavioural outcomes in African children and further summarise these effects in children living in non-African countries for comparison. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus and Cochrane Library for studies published up to 9 th March 2021. We included randomised controlled trials (RCTs) evaluating effects of iron supplementation or fortification on neurobehavioural outcomes in children. Due to heterogeneity in study methods, we analysed the studies qualitatively and only seven RCTs with 11 arms were meta-analysed. Results: We identified 2155 studies and included 34 studies (n=9808) in the systematic review. Only five studies (n=1294) included African children while 29 (n=8514) included children living in non-African countries. Of the five African studies, two (n=647) reported beneficial effects of iron supplementation on neurobehavioural outcomes in anaemic children while three (n=647) found no beneficial effects. Of 29 studies in children living in non-African countries, nine (n=2925) reported beneficial effects of iron supplementation or fortification on neurobehavioural outcomes, seven (n=786) reported beneficial effects only in children who had iron deficiency, iron deficiency anaemia or anaemia while 13 (n=4803) reported no beneficial effects. Meta-analysis of seven studies (n=775) in non-African countries showed no beneficial effects of iron supplementation on cognitive or motor development in children. Conclusions: There are few studies in African children despite the high burden of iron deficiency and developmental delay in this population. Evidence on the effects of iron supplementation on neurobehavioural outcomes remains unclear and there is need for further well-powered studies evaluating these effects in African populations. PROSPERO registration: CRD42018091278 (20/03/2018).
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Affiliation(s)
- Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Kelvinson Mwangi
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, 30270-00100, Kenya
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 195-80108, Kenya
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, UK
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32
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Affonfere M, Chadare FJ, Fassinou FTK, Talsma EF, Linnemann AR, Azokpota P. A complementary food supplement from local food ingredients to enhance iron intake among children aged 6-59 months in Benin. Food Sci Nutr 2021; 9:3824-3835. [PMID: 34262740 PMCID: PMC8269688 DOI: 10.1002/fsn3.2358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
Nutritious complementary feeding is often not affordable in Benin, and iron deficiency exists. This research aimed at formulating an affordable and sensory acceptable complementary food supplement using local food ingredients to increase iron intake among children aged 6-59 months in Benin. The complementary food supplement was formulated to ensure that 10 g would cover 25% of the estimated average requirements for iron for children aged 6 to 12 months. Adansonia digitata fruit pulp, Moringa oleifera leaf powder, and Cochlospermum tinctorium root powder were used to compose the complementary food supplement, which was mixed with maize and sorghum ogi porridges before being presented to the mothers and children for the acceptability test. The mineral contents of Adansonia digitata fruit pulp in mg/100 g dw were 9.9 ± 0.1 for iron and 0.9 ± 0.1 for zinc. The iron and zinc contents of Moringa oleifera leaf powder and Cochlospermum tinctorium root powder in mg/100 g dw were 34.1 ± 2.2 and 26.8 ± 2.7 and 9 ± 0.0 and 0.9 ± 0.0, respectively. The complementary food supplement contained, in mg/100 g dw, 17.4 ± 1.1 of iron and 1.2 ± 0.1 of zinc. The maize and sorghum ogi porridges enriched with the complementary food supplement at substitution rates of 15% and 16% (in dry weight), respectively, were acceptable to 85% of children for sorghum ogi porridge and 87% for maize ogi porridge. The present study demonstrated the potential of local food ingredients in the formulation of an iron-rich and acceptable complementary food supplement for children aged 6-59 months in Benin.
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Affiliation(s)
- Marius Affonfere
- Laboratoire de Sciences et Technologie des Aliments et Bioressources et de Nutrition HumaineEcole des Sciences et Techniques de Conservation et de Transformation des Produits Agricoles, Centre Universitaire de SakétéUniversité Nationale d’AgricultureSakétéRépublique du Bénin
- Laboratoire de Sciences des AlimentsFaculté des Sciences AgronomiquesUniversité d’Abomey‐CalaviJéricho, CotonouRépublique du Bénin
| | - Flora Josiane Chadare
- Laboratoire de Sciences et Technologie des Aliments et Bioressources et de Nutrition HumaineEcole des Sciences et Techniques de Conservation et de Transformation des Produits Agricoles, Centre Universitaire de SakétéUniversité Nationale d’AgricultureSakétéRépublique du Bénin
- Laboratoire de Sciences des AlimentsFaculté des Sciences AgronomiquesUniversité d’Abomey‐CalaviJéricho, CotonouRépublique du Bénin
| | - Finagnon Toyi Kévin Fassinou
- Laboratoire de Sciences et Technologie des Aliments et Bioressources et de Nutrition HumaineEcole des Sciences et Techniques de Conservation et de Transformation des Produits Agricoles, Centre Universitaire de SakétéUniversité Nationale d’AgricultureSakétéRépublique du Bénin
- Laboratoire de Sciences des AlimentsFaculté des Sciences AgronomiquesUniversité d’Abomey‐CalaviJéricho, CotonouRépublique du Bénin
| | - Elise F. Talsma
- Division of Human Nutrition and HealthWageningen University and ResearchWageningenThe Netherlands
| | - Anita R. Linnemann
- Food Quality and DesignWageningen University and ResearchWageningenThe Netherlands
| | - Paulin Azokpota
- Laboratoire de Sciences des AlimentsFaculté des Sciences AgronomiquesUniversité d’Abomey‐CalaviJéricho, CotonouRépublique du Bénin
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33
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Bundi CK, Nalwoga A, Lubyayi L, Muriuki JM, Mogire RM, Opi H, Mentzer AJ, Mugyenyi CK, Mwacharo J, Webb EL, Bejon P, Williams TN, Gikunju JK, Beeson JG, Elliott AM, Ndungu FM, Atkinson SH. Iron Deficiency Is Associated With Reduced Levels of Plasmodium falciparum-specific Antibodies in African Children. Clin Infect Dis 2021; 73:43-49. [PMID: 32507899 PMCID: PMC8246895 DOI: 10.1093/cid/ciaa728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) and malaria are common causes of ill-health and disability among children living in sub-Saharan Africa. Although iron is critical for the acquisition of humoral immunity, little is known about the effects of ID on antibody responses to Plasmodium falciparum malaria. METHODS The study included 1794 Kenyan and Ugandan children aged 0-7 years. We measured biomarkers of iron and inflammation, and antibodies to P. falciparum antigens including apical merozoite antigen 1 (anti-AMA-1) and merozoite surface antigen 1 (anti-MSP-1) in cross-sectional and longitudinal studies. RESULTS The overall prevalence of ID was 31%. ID was associated with lower anti-AMA-1 and anti-MSP-1 antibody levels in pooled analyses adjusted for age, sex, study site, inflammation, and P. falciparum parasitemia (adjusted mean difference on a log-transformed scale (β) -0.46; 95 confidence interval [CI], -.66, -.25 P < .0001; β -0.33; 95 CI, -.50, -.16 P < .0001, respectively). Additional covariates for malaria exposure index, previous malaria episodes, and time since last malaria episode were available for individual cohorts. Meta-analysis was used to allow for these adjustments giving β -0.34; -0.52, -0.16 for anti-AMA-1 antibodies and β -0.26; -0.41, -0.11 for anti-MSP-1 antibodies. Low transferrin saturation was similarly associated with reduced anti-AMA-1 antibody levels. Lower AMA-1 and MSP-1-specific antibody levels persisted over time in iron-deficient children. CONCLUSIONS Reduced levels of P. falciparum-specific antibodies in iron-deficient children might reflect impaired acquisition of immunity to malaria and/or reduced malaria exposure. Strategies to prevent and treat ID may influence antibody responses to malaria for children living in sub-Saharan Africa.
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Affiliation(s)
- Caroline K Bundi
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medical Laboratory Science, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Angela Nalwoga
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Lawrence Lubyayi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Reagan M Mogire
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Alexander J Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Cleopatra K Mugyenyi
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Burnet Institute, Melbourne, Australia
| | - Jedida Mwacharo
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Medicine, Imperial College, London, United Kingdom
| | - Joseph K Gikunju
- Department of Medical Laboratory Science, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - James G Beeson
- Burnet Institute, Melbourne, Australia
- Department of Microbiology, and Central Clinical School, Monash University, Melbourne, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Francis M Ndungu
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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Catarino S, Brilhante M, Essoh AP, Charrua AB, Rangel J, Roxo G, Varela E, Moldão M, Ribeiro-Barros A, Bandeira S, Moura M, Talhinhas P, Romeiras MM. Exploring physicochemical and cytogenomic diversity of African cowpea and common bean. Sci Rep 2021; 11:12838. [PMID: 34145302 PMCID: PMC8213759 DOI: 10.1038/s41598-021-91929-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022] Open
Abstract
In sub-Saharan Africa, grain legumes (pulses) are essential food sources and play an important role in sustainable agriculture. Among the major pulse crops, the native cowpea (Vigna unguiculata) and introduced common bean (Phaseolus vulgaris) stand out. This paper has two main goals. First, we provide a comprehensive view of the available genetic resources of these genera in Africa, including data on germplasm collections and mapping biodiversity-rich areas. Second, we investigate patterns of physicochemical and cytogenomic variation across Africa to explore the geographical structuring of variation between native and introduced beans. Our results revealed that 73 Vigna and 5 Phaseolus species occur in tropical regions of Africa, with 8 countries accounting for more than 20 native species. Conversely, germplasm collections are poorly represented when compared to the worldwide collections. Regarding the nuclear DNA content, on average, V. unguiculata presents significantly higher values than P. vulgaris. Also, V. unguiculata is enriched in B, Mg, S, and Zn, while P. vulgaris has more Fe, Ca, and Cu. Overall, our study suggests that the physicochemical and cytogenomic diversity of native Vigna species is higher than previously thought, representing valuable food resources to reduce food insecurity and hunger, particularly of people living in African developing countries.
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Affiliation(s)
- Sílvia Catarino
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
- Forest Research Center (CEF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
| | - Miguel Brilhante
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016, Lisbon, Portugal
| | - Anyse Pereira Essoh
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
- Research Centre in Biodiversity and Genetic Resources (CIBIO), InBIO Associate Laboratory, Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
- Nova School of Business and Economics, Universidade Nova de Lisboa, Campus de Carcavelos, Rua da Holanda, n.1, Carcavelos, 2775-405, Cascais, Portugal
| | - Alberto B Charrua
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
- Nova School of Business and Economics, Universidade Nova de Lisboa, Campus de Carcavelos, Rua da Holanda, n.1, Carcavelos, 2775-405, Cascais, Portugal
- Department of Earth Sciences and Environment, Faculty of Science and Technology, Licungo University, P.O. Box 2025, 2100, Beira, Mozambique
| | - Josefa Rangel
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
- Centro de Botânica, Universidade Agostinho Neto, Luanda, Angola
| | - Guilherme Roxo
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
| | - Eromise Varela
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
| | - Margarida Moldão
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
| | - Ana Ribeiro-Barros
- Forest Research Center (CEF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
| | - Salomão Bandeira
- Department of Biological Sciences, Eduardo Mondlane University, PO Box 257, 1100, Maputo, Mozambique
| | - Mónica Moura
- Research Centre in Biodiversity and Genetic Resources (CIBIO), InBIO Associate Laboratory, Faculdade de Ciências e Tecnologia, Universidade dos Açores, Ponta Delgada, Portugal
| | - Pedro Talhinhas
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal
| | - Maria M Romeiras
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017, Lisbon, Portugal.
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016, Lisbon, Portugal.
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Akalu Y, Yeshaw Y, Tesema GA, Demissie GD, Molla MD, Muche A, Diress M, Tiruneh SA. Iron-rich food consumption and associated factors among children aged 6-23 months in sub-Saharan Africa: A multilevel analysis of Demographic and Health Surveys. PLoS One 2021; 16:e0253221. [PMID: 34138916 PMCID: PMC8211154 DOI: 10.1371/journal.pone.0253221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Anemia remains a major public health problem for children in sub-Saharan Africa (SSA). Iron-rich foods consumption has a determinant role on the anemia status. Hence, this study aimed to determine the prevalence of good consumption of iron-rich foods and its associated factors among children aged 6-23 months in SSA. MATERIALS AND METHODS The recent Demographic and Health Survey data sets of thirty-five SSA countries were used. Data were analyzed using STATA/MP version 16.0 and all statistical analyses were done after weighting the data. A generalized linear mixed model using Poisson regression with robust error variance was used to determine factors associated with good consumption of iron-rich food. Association of variables was declared at a p-value of ≤0.05 and adjusted prevalence ratio (aPR) ratio with its 95% confidence interval (CI) was calculated for each variable. RESULTS The total weighted samples of 77,001 children aged 6-23 months were included. The prevalence of consumption of iron rich foods was 42.1% (95% CI: 41.78-42.48). Children with age of 12-17 (adjusted prevalence ratio (aPR) = 1.96, 95% CI: 1.89-2.04) and 18-23 months (aPR = 2.05, 95% CI: 1.97-2.14), who took drugs for intestinal parasites (aPR = 1.30, 95% CI: 1.26-1.34), with postnatal check within 2 months (aPR = 1.09, 95% CI: 1.06-1.13), and children from women with ANC visit of 1-3 (aPR = 1.31, 95% CI: 1.24-1.37) and ≥4 (aPR = 1.41, 95% CI: 1.34-1.48) had higher prevalence of good consumption of iron rich foods. Moreover, the prevalence of consumptions of iron rich foods was higher among children from; family with rich (aPR = 1.36, 95%CI: 1.30-1.42) and middle (aPR = 1.14 95% CI: 1.09-1.19) wealth index, and mother with media exposure (aPR = 1.26, 95%CI: 1.22-1.31). CONCLUSION The prevalence of good consumption of iron-rich foods among children aged 6-23 months in SSA countries is low. Child factors, family factors, and community-level factors were significantly associated with consumption of iron rich foods. Strategies to increase the consumption of iron-rich foods during this critical stage of growth and development should be designed in SSA.
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Affiliation(s)
- Yonas Akalu
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getu Debalkie Demissie
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Muche
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistie Diress
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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36
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Selaledi L, Mabelebele M. The Influence of Drying Methods on the Chemical Composition and Body Color of Yellow Mealworm ( Tenebrio molitor L.). INSECTS 2021; 12:insects12040333. [PMID: 33917808 PMCID: PMC8068098 DOI: 10.3390/insects12040333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/31/2021] [Accepted: 04/03/2021] [Indexed: 11/16/2022]
Abstract
To preserve the quality of the yellow mealworm, different drying methods are being explored by farmers and processors. However, the energy costs associated with these methods are usually high for smallholder insect-rearing farmers. Thus, the core aim of this study was to investigate different drying procedures and their impact on the chemical composition of yellow mealworm larvae. Yellow mealworms (exposed to sun, oven and freeze drying) were later analyzed for their chemical composition and body color. Crude protein (CP) content of freeze and oven-dried mealworms were similar (p > 0.05), but higher (p < 0.05) than those of the sun-dried samples. The b (yellowness) color of the sun-dried samples scored the lowest value (p < 0.05) in comparison with both oven and freeze-dried samples. The majority of the essential amino acids were higher (p < 0.05) in the sun-dried mealworms than both oven and freeze-dried samples. Similarly, the fat content of sun-dried mealworms was higher (p < 0.05) than if they had been oven or freeze dried. However, SFA (saturated fatty acids), PUFA (polyunsaturated fatty acids) and n-6 fatty acids were similar (p > 0.05) for all drying methods. We, therefore, conclude that sun drying resulted in the same nutritional composition as freeze and oven drying despite the noted color changes. Freeze and oven-drying strategies can be used to formulate mealworm-based feed and food products without noticeable nutritional changes. For the benefit of small-scale insect-rearing farmers, an appropriate drying technology that is affordable and easy to use should be developed considering the needs and experiences of these farmers.
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Affiliation(s)
- Letlhogonolo Selaledi
- Department of Agriculture and Animal Health, College of Agriculture and Environmental Science, University of South Africa, Florida Campus, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa;
- Department of Zoology and Entomology, Mammal Research Institute, Faculty of Natural and Agricultural Sciences, University of Pretoria, Hatfield, Pretoria 0002, South Africa
| | - Monnye Mabelebele
- Department of Agriculture and Animal Health, College of Agriculture and Environmental Science, University of South Africa, Florida Campus, 28 Pioneer Ave, Florida Park, Roodepoort 1709, South Africa;
- Correspondence:
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Muriuki JM, Mentzer AJ, Mitchell R, Webb EL, Etyang AO, Kyobutungi C, Morovat A, Kimita W, Ndungu FM, Macharia AW, Ngetsa CJ, Makale J, Lule SA, Musani SK, Raffield LM, Cutland CL, Sirima SB, Diarra A, Tiono AB, Fried M, Gwamaka M, Adu-Afarwuah S, Wirth JP, Wegmüller R, Madhi SA, Snow RW, Hill AVS, Rockett KA, Sandhu MS, Kwiatkowski DP, Prentice AM, Byrd KA, Ndjebayi A, Stewart CP, Engle-Stone R, Green TJ, Karakochuk CD, Suchdev PS, Bejon P, Duffy PE, Davey Smith G, Elliott AM, Williams TN, Atkinson SH. Malaria is a cause of iron deficiency in African children. Nat Med 2021; 27:653-658. [PMID: 33619371 PMCID: PMC7610676 DOI: 10.1038/s41591-021-01238-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.
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Affiliation(s)
- John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Open University, KEMRI-Wellcome Trust Research Programme, Accredited Research Centre, Kilifi, Kenya.
| | - Alexander J Mentzer
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Ruth Mitchell
- Medical Research Council (MRC) Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony O Etyang
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Alireza Morovat
- Department of Clinical Biochemistry, Oxford University Hospitals, Oxford, UK
| | - Wandia Kimita
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francis M Ndungu
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alex W Macharia
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Caroline J Ngetsa
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Makale
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Swaib A Lule
- MRC/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Clare L Cutland
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sodiomon B Sirima
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Alfred B Tiono
- Groupe de Recherche Action en Sante (GRAS), 06 BP 10248, Ouagadougou, Burkina Faso
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Moses Gwamaka
- Mother Offspring Malaria Studies (MOMS) Project, Seattle Biomedical Research Institute, Seattle, WA, USA
- Muheza Designated District Hospital, Muheza, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | | | | | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert W Snow
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian V S Hill
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Centre for Clinical Vaccinology and Tropical Medicine and the Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Kirk A Rockett
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, UK
| | | | - Dominic P Kwiatkowski
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Wellcome Sanger Institute, Hinxton, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | | | | | | | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Tim J Green
- SAHMRi Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parminder S Suchdev
- Department of Pediatrics, Emory University and Emory Global Health Institute, Atlanta, GA, USA
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - George Davey Smith
- Medical Research Council (MRC) Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison M Elliott
- MRC/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas N Williams
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Institute of Global Health Innovation, Imperial College, London, UK
| | - Sarah H Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research, Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Department of Paediatrics, University of Oxford, Oxford, UK.
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Mbunga BK, Mapatano MA, Strand TA, Gjengedal ELF, Akilimali PZ, Engebretsen IMS. Prevalence of Anemia, Iron-Deficiency Anemia, and Associated Factors among Children Aged 1-5 Years in the Rural, Malaria-Endemic Setting of Popokabaka, Democratic Republic of Congo: A Cross-Sectional Study. Nutrients 2021; 13:nu13031010. [PMID: 33801005 PMCID: PMC8003967 DOI: 10.3390/nu13031010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Iron deficiency (ID), the leading cause of anemia and the most common nutritional deficiency globally, is not well reported among children in malaria-endemic settings, and little is known about its contribution to anemia in these settings. We aimed to assess the prevalence of anemia, the role of ID using multiple parameters, and the factors associated with anemia in a malaria-endemic rural area. We conducted a community-based cross-sectional study of 432 children aged 1-5 years from the Popokabaka Health Zone, Democratic Republic of Congo. Sociodemographic characteristics, medical history, anthropometric parameters, and biochemical parameters were considered. Hemoglobin and malaria prevalence were assessed using rapid finger-prick capillary blood testing in the field. Venous blood samples were analyzed for serum ferritin, serum iron, total iron-binding capacity, and C-reactive protein (CRP) in a laboratory. Anemia was found in 294 out of 432 (68%) patients. Malaria was found in 375 out of 432 (87%), and ID in 1.8% according to diagnosis by adjusted ferritin only and in 12.9% according to transferrin saturation. ID indicators were not significantly correlated with low hemoglobin levels. Malaria, fever, and CRP > 5 mg/L were major factors associated with anemia in Popokabaka. Anemia control should focus on treating inflammatory conditions and infectious diseases among children in such settings.
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Affiliation(s)
- Branly Kilola Mbunga
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo; (M.A.M.); (P.Z.A.)
- Correspondence: ; Tel.: +243-81-513-9303
| | - Mala Ali Mapatano
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo; (M.A.M.); (P.Z.A.)
| | - Tor A. Strand
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5009 Bergen, Norway; (T.A.S.); (I.M.S.E.)
| | - Elin Lovise F. Gjengedal
- Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, 1432 Aas, Norway;
| | | | - Ingunn Marie S. Engebretsen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5009 Bergen, Norway; (T.A.S.); (I.M.S.E.)
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Njunge JM, Gonzales GB, Ngari MM, Thitiri J, Bandsma RH, Berkley JA. Systemic inflammation is negatively associated with early post discharge growth following acute illness among severely malnourished children - a pilot study. Wellcome Open Res 2021; 5:248. [PMID: 33969227 PMCID: PMC8080977 DOI: 10.12688/wellcomeopenres.16330.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Rapid growth should occur among children with severe malnutrition (SM) with medical and nutritional management. Systemic inflammation (SI) is associated with death among children with SM and is negatively associated with linear growth. However, the relationship between SI and weight gain during therapeutic feeding following acute illness is unknown. We hypothesised that growth post-hospital discharge is associated with SI among children with SM. Methods: We conducted secondary analysis of data from HIV-uninfected children with SM (n=98) who survived and were not readmitted to hospital during one year of follow-up. We examined the relationship between changes in absolute deficits in weight and mid-upper-arm circumference (MUAC) from enrolment at stabilisation to 60 days and one year later, and untargeted plasma proteome, targeted cytokines/chemokines, leptin, and soluble CD14 using multivariate regularized linear regression. Results: The mean change in absolute deficit in weight and MUAC was -0.50kg (standard deviation; SD±0.69) and -1.20cm (SD±0.89), respectively, from enrolment to 60 days later. During the same period, mean weight and MUAC gain was 3.3g/kg/day (SD±2.4) and 0.22mm/day (SD±0.2), respectively. Enrolment interleukins; IL17-alpha and IL-2, and serum amyloid P were negatively associated with weight and MUAC gain during 60 days. Lipopolysaccharide binding protein and complement component 2 were negatively associated with weight gain only. Leptin was positively associated with weight gain. Soluble CD14, beta-2 microglobulin, and macrophage inflammatory protein 1 beta were negatively associated with MUAC gain only. Glutathione peroxidase 3 was positively associated with weight and MUAC gain during one year. Conclusions: Early post-hospital discharge weight and MUAC gain were rapid and comparable to children with uncomplicated SM treated in the community. Higher concentrations of SI markers were associated with less weight and MUAC gain, suggesting inflammation negatively impacts recovery from wasting. This finding warrants further research on reducing inflammation on growth among children with SM.
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Affiliation(s)
- James M. Njunge
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gerard Bryan Gonzales
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Moses M. Ngari
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert H.J. Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James A. Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Brilhante M, Varela E, P. Essoh A, Fortes A, Duarte MC, Monteiro F, Ferreira V, Correia AM, Duarte MP, Romeiras MM. Tackling Food Insecurity in Cabo Verde Islands: The Nutritional, Agricultural and Environmental Values of the Legume Species. Foods 2021; 10:foods10020206. [PMID: 33498384 PMCID: PMC7909421 DOI: 10.3390/foods10020206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
Legume species are important food sources to reduce hunger and deal with malnutrition; they also play a crucial role in sustainable agriculture in the tropical dry islands of Cabo Verde. To improve the knowledge of the heritage of plant genetic resources in this Middle Income Country, this study had three main goals: (i) to provide a checklist of food legumes; (ii) to investigate which species are traded in local markets and, based on field surveys, to compare species for their chemical, phenolic, antioxidant, and nutritional composition; and (iii) to discuss the agronomic value and contribution to food security in this archipelago. Our results revealed that 15 species are used as food and 5 of them are locally traded (Cajanus
cajan, Lablab
purpureus, Phaseolus
lunatus, Phaseolus vulgaris, and Vigna
unguiculata). The role of these species as sources of important minerals, antioxidants, and nutritional components for food security is highlighted, and the native ones (Lablab
purpureus and Vigna
unguiculata) stand-out as particularly well-adapted to the climate of these islands, which are already experiencing the adverse effects of climate change. We conclude that the sustainable use of these genetic resources can contribute to the reduction of hunger and poverty, thus meeting some challenges of the Sustainable Development Goals.
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Affiliation(s)
- Miguel Brilhante
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017 Lisboa, Portugal; (M.B.); (E.V.); (A.P.E.); (F.M.)
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal;
| | - Eromise Varela
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017 Lisboa, Portugal; (M.B.); (E.V.); (A.P.E.); (F.M.)
| | - Anyse P. Essoh
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017 Lisboa, Portugal; (M.B.); (E.V.); (A.P.E.); (F.M.)
- Research Centre in Biodiversity and Genetic Resources (CIBIO), InBIO Associate Laboratory, Pole of Azores, Faculdade de Ciências e Tecnologia, Universidade dos Açores, 9500-321 Ponta Delgada, Portugal
- Nova School of Business and Economics, Campus de Carcavelos, 2775-405 Carcavelos, Portugal
| | - Arlindo Fortes
- Escola Superior de Ciências Agrárias e Ambientais, Universidade de Cabo Verde, Santiago, Praia CP 379, Cape Verde; (A.F.); (V.F.)
- Centro de Estudos sobre África para o Desenvolvimento (CEsA), Instituto Superior de Economia e Gestão, Universidade de Lisboa, 1200-781 Lisboa, Portugal
| | - Maria Cristina Duarte
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal;
| | - Filipa Monteiro
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017 Lisboa, Portugal; (M.B.); (E.V.); (A.P.E.); (F.M.)
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal;
| | - Vladimir Ferreira
- Escola Superior de Ciências Agrárias e Ambientais, Universidade de Cabo Verde, Santiago, Praia CP 379, Cape Verde; (A.F.); (V.F.)
| | - Augusto Manuel Correia
- Centre of Tropical Studies for Development (CENTROP), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, 1349-017 Lisboa, Portugal;
| | - Maria Paula Duarte
- MEtRICs/DCTB, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
- Correspondence: (M.P.D.); (M.M.R.)
| | - Maria M. Romeiras
- Linking Landscape, Environment, Agriculture and Food (LEAF), Instituto Superior de Agronomia (ISA), Universidade de Lisboa, Tapada da Ajuda, 1340-017 Lisboa, Portugal; (M.B.); (E.V.); (A.P.E.); (F.M.)
- Centre for Ecology, Evolution and Environmental Changes (cE3c), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal;
- Correspondence: (M.P.D.); (M.M.R.)
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Galani YJH, Orfila C, Gong YY. A review of micronutrient deficiencies and analysis of maize contribution to nutrient requirements of women and children in Eastern and Southern Africa. Crit Rev Food Sci Nutr 2020; 62:1568-1591. [PMID: 33176441 DOI: 10.1080/10408398.2020.1844636] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper reviews and analyses the importance of maize as staple food in Eastern and Southern Africa (E&SA) and contributes in understanding the nexus between maize nutritional composition and prevalence of micronutrient deficiencies (MNDs) in these regions. MNDs remain a major public health concern particularly for women and children, with calcium, iodine, iron, selenium, zinc, folate and vitamin A deficiencies being the most common. Estimates of their prevalence are among the highest in E&SA: iron-deficient anemia affected 26 to 31% of women of reproductive age, and deficiencies up to 53%, 36%, 66%, 75% and 62% for vitamin A, iodine, zinc, calcium and selenium, respectively, were measured in populations of these regions. Besides, these two regions show the highest worldwide maize per capita consumption (g/person/day) as main staple, with 157 in Eastern Africa and 267 in Southern Africa, including up to 444 in Lesotho. The analysis of food composition tables from these regions showed that 100 g of maize foods consumed by these populations could to some extent, contribute in satisfying dietary reference intakes (DRIs) of children and women in energy, proteins, carbohydrates, magnesium, zinc, vitamins B1 and B6. However, it provides very low supply of fats, calcium, sodium, selenium, vitamins C, A and E. The high occurrence of MNDs and considerable nutritional potential of maize consumed in E&SA can be explained by loss of nutrients due to processing practices, low food diversification and reduced nutrients bioavailability. Success cases of the main strategies to tackle the issue of MNDs in these regions by improving maize nutritional quality are discussed in this paper. Maize fortification was shown to improve nutrition and health outcomes of population. Increasing dietary diversity by complementing maize with other foods has improved nutrition through integration of micronutrient-rich foods in the diet. Mostly, biofortification has successfully contributed in reducing vitamin A and zinc deficiencies in rural communities more than nutrient supplementation, fortification and dietary diversity.
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Affiliation(s)
- Y J H Galani
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - C Orfila
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Y Y Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
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Njunge JM, Gonzales GB, Ngari MM, Thitiri J, Bandsma RH, Berkley JA. Systemic inflammation is negatively associated with early post discharge growth following acute illness among severely malnourished children - a pilot study. Wellcome Open Res 2020; 5:248. [PMID: 33969227 PMCID: PMC8080977 DOI: 10.12688/wellcomeopenres.16330.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/03/2023] Open
Abstract
Background: Rapid growth should occur among children with severe malnutrition (SM) when medically and nutritionally treated. Systemic inflammation (SI) is associated with death among children with SM and is negatively associated with linear growth. However, the relationship between SI and weight gain during therapeutic feeding following acute illness is unknown. We hypothesised that growth in the first 60 days post-hospital discharge is associated with SI among children with SM. Methods: We conducted secondary analysis of data from HIV-uninfected children with SM (n=98) who survived and were not readmitted to hospital during one year of follow up. We examined the relationship between changes in absolute deficits in weight and mid-upper-arm circumference (MUAC) from enrolment at stabilisation to 60 days later and untargeted plasma proteome, targeted cytokines/chemokines, leptin, and soluble CD14 (sCD14) using multivariate regularized linear regression. Results: The mean change in absolute deficit in weight and MUAC was -0.50kg (standard deviation; SD±0.69) and -1.20cm (SD±0.89), respectively, from enrolment to 60 days later. During the same period, mean weight and MUAC gain was 3.3g/kg/day (SD±2.4) and 0.22mm/day (SD±0.2), respectively. Enrolment inflammatory cytokines interleukin 17 alpha (IL17α), interleukin 2 (IL2), and serum amyloid P (SAP) were negatively associated with weight and MUAC gain. Lipopolysaccharide binding protein (LBP) and complement component 2 were negatively associated with weight gain only. Leptin was positively associated with weight gain. sCD14, beta-2 microglobulin (β2M), and macrophage inflammatory protein 1 beta (MIP1β) were negatively associated with MUAC gain only. Conclusions: Early post-hospital discharge weight and MUAC gain were rapid and comparable to children with uncomplicated SM treated with similar diet in the community. Higher concentrations of SI markers were associated with less weight and MUAC gain, suggesting inflammation negatively impacts recovery from wasting. This finding warrants further research on the role of inflammation on growth among children with SM.
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Affiliation(s)
- James M. Njunge
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gerard Bryan Gonzales
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Moses M. Ngari
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Robert H.J. Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James A. Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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