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Amoadu M, Abraham SA, Adams AK, Akoto-Buabeng W, Obeng P, Hagan JE. Risk Factors of Malnutrition among In-School Children and Adolescents in Developing Countries: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:476. [PMID: 38671693 PMCID: PMC11049343 DOI: 10.3390/children11040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Malnutrition among in-school children is a complex issue influenced by socio-economic, environmental, and health-related factors, posing significant challenges to their well-being and educational trajectories in developing countries. This review synthesized evidence on the multifaceted aspects of child malnutrition within the educational setting in developing countries. This review followed the six steps outlined by Arksey and O'Malley's framework. Four main databases (PubMed, CENTRAL, JSTOR, and Scopus) were searched. Additional searches were conducted in WHO Library, ProQuest, HINARI, Google Scholar, and Google. Reference lists of eligible papers were checked. This review found that low family income, varying family sizes, parental employment status, and educational levels significantly impact malnutrition among in-school children and adolescents. Environmental elements, including rural/urban residence, household sanitation, and living conditions, also influence malnutrition. In addition, nutrition knowledge, dietary habits, nutrient deficiencies, physical activity, and prevalent health conditions compound the risk of malnutrition. This study underscores the extensive health impact of malnutrition on general health, specific nutrient deficiencies, fetal/maternal health concerns, and overall morbidity. Also, malnutrition affects school performance and attendance, impacting cognitive abilities, and academic achievements. Addressing these challenges requires comprehensive policy actions aligned with Sustainable Development Goals, emphasizing poverty alleviation, health literacy, and gender equity.
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Affiliation(s)
- Mustapha Amoadu
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - Susanna Aba Abraham
- Department of Public Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast PMB TF0494, Ghana;
| | - Abdul Karim Adams
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - William Akoto-Buabeng
- Department of Education and Psychology, University of Cape Coast, Cape Coast PMB TF0494, Ghana;
| | - Paul Obeng
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana; (M.A.); (A.K.A.); (P.O.)
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
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Giguère-Johnson M, Ward S, Ndéné Ndiaye A, Galibois I, Blaney S. Dietary intake and food behaviours of Senegalese adolescent girls. BMC Nutr 2021; 7:41. [PMID: 34289906 PMCID: PMC8296647 DOI: 10.1186/s40795-021-00436-0] [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: 01/12/2021] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malnutrition is a public health concern in low- and middle-income countries. In Senegal, 35% of adolescent girls are undernourished and 56% are anemic. METHODS This study assessed the dietary intake of 14-18-year-old adolescent girls in Dakar, Senegal. Specifically, the study 1) assessed their intake in energy, fibre, macro- and micronutrients, 2) described the types and the quality of the foods they consume, and 3) assessed some of their eating behaviours. Dietary intake was measured using three non-consecutive 24-h recalls from 136 adolescent girls attending two colleges. Energy and nutrient intakes were measured and compared to recommendations. Foods were classified by food group and by whether they were healthy or unhealthy. Adolescents' daily intake (g) of fruits and vegetables, as well as the proportion of girls who ate breakfast and who consumed three meals a day were calculated. RESULTS Sodium intake was high, while fibre intake was low. On average, 40% of the adolescents' total energy intake came from fats. Mean intakes of zinc and calcium were higher on the weekend than on weekdays, while the opposite was observed for sodium. Eighty-three percent of adolescents had an inadequate intake of iron and 99% were at risk of calcium deficiency. Approximately 60% of the foods consumed were classified as healthy, however, the majority came from grains. CONCLUSIONS Adolescent nutrition deserves attention given the poor quality of their dietary intake which may put them at risk of malnutrition and chronic diseases. These findings may be used to help improve programs targeting Senegalese adolescent girls' nutrition.
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Affiliation(s)
- Madélie Giguère-Johnson
- École des Sciences des Aliments, de Nutrition et d'études Familiales, Université de Moncton, 18 Antonine-Maillet Ave, Moncton, New Brunswick, E1A 3E9, Canada.
| | - Stéphanie Ward
- École des Sciences des Aliments, de Nutrition et d'études Familiales, Université de Moncton, 18 Antonine-Maillet Ave, Moncton, New Brunswick, E1A 3E9, Canada
| | | | | | - Sonia Blaney
- École des Sciences des Aliments, de Nutrition et d'études Familiales, Université de Moncton, 18 Antonine-Maillet Ave, Moncton, New Brunswick, E1A 3E9, Canada
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Hoang NTD, Orellana L, Gibson RS, Le TD, Worsley A, Sinclair AJ, Hoang NTT, Szymlek-Gay EA. Multiple micronutrient supplementation improves micronutrient status in primary school children in Hai Phong City, Vietnam: a randomised controlled trial. Sci Rep 2021; 11:3728. [PMID: 33580103 PMCID: PMC7881239 DOI: 10.1038/s41598-021-83129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/28/2021] [Indexed: 01/21/2023] Open
Abstract
We aimed to determine the efficacy of multiple micronutrient supplementation on the biomarkers of iron, zinc, and vitamin A status across anthropometric status categories in Vietnamese school children. In this 22-week randomised controlled trial, 347 undernourished, normal weight, or overweight/obese children aged 6-9 years were allocated to receive every school day a multiple micronutrient supplement (10 mg iron, 10 mg zinc, 400 µg vitamin A) or a placebo. Haematological indices; circulating ferritin, zinc, and retinol (corrected for inflammation); and C-reactive protein were measured at baseline and 22 weeks. At week 22, linear mixed models showed that mean corpuscular volume increased by 0.3 fL, serum ferritin by 9.1 µg/L, plasma zinc by 0.9 µmol/L, and plasma retinol by 15%, and the prevalence of zinc deficiency decreased by 17.3% points in the intervention group compared to placebo. No intervention effects were found for other haematological indices, or the prevalence of anaemia. Multiple micronutrient supplementation for 22 weeks improved the biomarkers of zinc and vitamin A status and some biomarkers of iron status, and reduced the prevalence of zinc deficiency in Vietnamese school children.Trial registration: This trial was registered on 06/09/2016 at www.anzctr.org.au as ACTRN12616001245482.
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Affiliation(s)
- Ngan T D Hoang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Tuyen D Le
- National Institute of Nutrition, Hanoi, Vietnam
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | | | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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Comandini O, Cabras S, Ssensamba JT, Bukenya JN, Cipriano A, Carmignani G, Carmignani G, Marini E. Nutritional status of Ugandan school-children: The effect of age imprecision. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 170:88-97. [PMID: 31281985 DOI: 10.1002/ajpa.23895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To analyze the nutritional status of Ugandan school-children in a cross-sectional and longitudinal perspective, considering the effect of age imprecision. MATERIALS AND METHODS Anthropometric measurements of 831 school-children (381 males and 450 females) were analyzed. A subsample of 246 children was measured in July 2014 and 2015. Stunting (based on height-for-age Z-scores), underweight (weight-for-age), and thinness (body mass index-for-age) prevalence were calculated. Three different ages were used: declared (from schools registers), attributed (based on multiple information sources), and bootstrap (from 10,000 replicates). Significant differences among malnutrition prevalence calculated with different ages and in different groups were assessed by means of bootstrap analysis. Longitudinal analysis was conducted using a paired t test. RESULTS The mean prevalence of malnutrition calculated with declared, attributed, or bootstrap ages were very similar: stunting (11.9-12.7); underweight (5.4-5.9); thinness (3.3-3.7); and obesity (0.7). Undernutrition was more prevalent among older children, while obesity was mostly associated with young age. Obesity was equally distributed among sexes, while undernutrition was more prevalent among females of up to 10 years of age and males above 10 years. The longitudinal analysis indicated a reduction in underweight and thinness, and an increase in stunting, especially among older children. DISCUSSION Age imprecision did not significantly affect malnutrition estimates. Despite the decline in the prevalence of thinness and underweight observed over a 1-year period, undernutrition persists, with an observed rise in stunting. On the other hand, obesity is starting to appear. Public health efforts are required to eliminate stunting and address the emerging burden of obesity.
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Affiliation(s)
- Ornella Comandini
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Cabras
- Department of Mathematics and Informatics, University of Cagliari, Cagliari, Italy.,Department of Statistics, Universidad Carlos III de Madrid, Getafe, Spain
| | - Jude T Ssensamba
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Justine N Bukenya
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Alessandro Cipriano
- Bhalobasa Association, Perignano, Pisa, Italy.,Emergency Department, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Giovanni Carmignani
- Bhalobasa Association, Perignano, Pisa, Italy.,Department of General Medicine, Hospital of Livorno, Livorno, Italy
| | - Gabriele Carmignani
- Bhalobasa Association, Perignano, Pisa, Italy.,Emergency Department, Azienda USL Toscana Nord Ovest, Lucca, Italy
| | - Elisabetta Marini
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
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Hosseinzadeh-Attar MJ, Belay GD, Ardalan A, Assen M, Khoei EM, Ostadtaghizadeh A. Assessment of malnutrition and anthropometric measurement among 0-59 months aged children in Amibara and Awash Fentale districts, afar national regional state of Ethiopia. Hum Antibodies 2019; 27:43-52. [PMID: 30958342 DOI: 10.3233/hab-190371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Famines and food shortages are one of the most common long time histories of Ethiopia. Hence, malnutrition has been persisted at alarming raters in the country. Moreover, it is a major cause of morbidity and mortality in Afar National Regional State of Ethiopia. Specifically, in Amibara and Awash Fentale districts. The anthropometric data were presented on height, weight, MUAC, weight/height/Age and Body Mass Index (BMI) of under-five children. METHODS A cross-sectional descriptive survey was conducted from March 01, 2017 to June 15, 2018. The data was collected by using anthropometric measurement. A multi stage random sampling procedure was applied in order to recruit the required sample size. The data collections were conducted at two selected districts in Afar region by trained interviewers and health care providers. The data were analyzed by using SPSS Version 23. Bivariate analysis between dependent and independent variables was employed. Multivariate analysis was also done to control for possible confounding variable by selecting variable which show statistically significant association (P< 0.05). RESULTS Out of 410 under five children's anthropometric finding, the majorities (62.7%) of those registered under five children were male and (33.3%) were female. The majority (46.8%) of under five children were less than or equal to 50 cm by their height. Most (54.1%) of under five children were less than or equal to 12.5 cm by their MUAC. It indicated that they were diagnosed with severe malnutrition based on anthropometric measurements. Meanwhile, majority (64%) of under five children were less than 60% their weight/age. Regression analysis result indicated that all of the variables were not significant predictors of BMI for under five children (P> 0.05). Based on ANOVA result, there was significant difference between sex and other predictors (P= 0.031). This finding implies that improvement in food aid and poverty alleviation programs are very important. Based on the finding, it is important to provide high quality and quantity of food. Moreover, less access to assets and health services commonly contributed for malnutrition. Highlighting under five children's malnutrition will help to develop and design future policies and programs in Ethiopia.
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Affiliation(s)
| | - Gosaye Degu Belay
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Disaster and Emergency Health, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ardalan
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammed Assen
- Department of Geography and Environmental Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Effat Merghati Khoei
- The National Center for Addiction Studies (INCAS); Tehran University of Medical Sciences (TUMS); Family and Sexual Health Division, Brian and Spinal Injury Research Center (BASIR), Neuroscience Institution, TUMS, Tehran, Iran
| | - Abbas Ostadtaghizadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Traoré S, Fokou G, Ndour A, Yougbare B, Koné P, Alonso S, Roesel K, Bakou S, Dao D, Grace D, Bonfoh B. Assessing knowledge, beliefs and practices related to the consumption of sheep and goat meat in Senegal. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2018. [DOI: 10.1016/j.gfs.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cames C, Pascal L, Ba A, Mbodj H, Ouattara B, Diallo NF, Msellati P, Mbaye N, Sy Signate H, Blanche S, Diack A. Low prevalence of lipodystrophy in HIV-infected Senegalese children on long-term antiretroviral treatment: the ANRS 12279 MAGGSEN Pediatric Cohort Study. BMC Infect Dis 2018; 18:374. [PMID: 30081838 PMCID: PMC6090843 DOI: 10.1186/s12879-018-3282-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 07/30/2018] [Indexed: 12/02/2022] Open
Abstract
Background The long-term benefits of antiretroviral treatment (ART) are associated with metabolic complications, especially lipodystrophy, which has been well described among HIV-infected adults and children on ART in developed settings. Specifically, stavudine, and to a lesser extent zidovudine and protease inhibitors (PI), have been consistently implicated in the development of lipodystrophy. In 2006, following advice from the WHO, Senegal began phasing out stavudine from first-line ART. The objectives of this cross-sectional analysis are to assess and identify risk factors affecting the prevalence of lipodystrophy in Senegalese children and adolescents on long-term ART participating in a cohort study. Methods Lipodystrophy was clinically assessed in two- to 18-year-old children on ART for at least six months and with no concurrent severe acute malnutrition. Risk factors for lipodystrophy were identified using stepwise multivariable logistic regression. Explanatory variables included clinical and personal data, immunovirologic status, and therapeutic history. Results Overall, 254 children were assessed for lipodystrophy. The median age was 10.9 years (IQR: 8.1–14.2) and the median duration on ART was 54 months (32–84). Only 18% had been previously treated with stavudine, with a median treatment duration of 8 months (5–25). Ongoing treatment included 76% of children receiving zidovudine (median duration of 48 months (26–74)) and 27% receiving PI (lopinavir/ritonavir; median duration of 49 months (23–59)). Mild signs of lipodystrophy were observed in 33 children (13%): 28 with lipoatrophy, 4 with lipohypertrophy and one with combined type. Boys were more likely to present with lipoatrophy than girls (aOR: 4.3, 95% CI: 1.6–11.7). Children previously treated with stavudine for ≥1 year had a greater risk for lipoatrophy than those never exposed (3.8, 1.0–14.0), although the association was weak. There was no association between lipodystrophy and age or current or cumulative treatment with lopinavir/ritonavir or zidovudine. Conclusions We report low prevalence of mild lipodystrophy in children and adolescents on long-term ART receiving a stavudine-sparing regimen. These findings are reassuring for clinicians in low-income settings where zidovudine is massively prescribed and lopinavir/ritonavir is the only widely available PI. Trial registration ClinicalTrials.gov identifier: NCT01771562 (registration date: 01/18/2013).
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Affiliation(s)
- Cecile Cames
- Institut de Recherche pour le Développement (IRD), UMI233 IRD, INSERM U1175, Université de Montpellier, 911, avenue Agropolis, BP 64501, 34394, Montpellier cedex 5, France.
| | - Lea Pascal
- Institut de Recherche pour le Développement (IRD), UMI233 IRD, INSERM U1175, Université de Montpellier, 911, avenue Agropolis, BP 64501, 34394, Montpellier cedex 5, France
| | - Aissatou Ba
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | - Hélène Mbodj
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | - Baly Ouattara
- Synergie Pour l'Enfance, Centre Hospitalier Roi Baudouin, Guediawaye, Sénégal
| | | | - Philippe Msellati
- Institut de Recherche pour le Développement (IRD), UMI233 IRD, INSERM U1175, Université de Montpellier, 911, avenue Agropolis, BP 64501, 34394, Montpellier cedex 5, France
| | - Ngagne Mbaye
- Synergie Pour l'Enfance, Centre Hospitalier Roi Baudouin, Guediawaye, Sénégal
| | - Haby Sy Signate
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
| | | | - Aminata Diack
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal
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Comandini O, Carmignani G, Cipriano A, Carmignani G, Tiba D, Marini E. Cross-sectional and longitudinal analysis of nutritional status of school-children from Bumbire Island (United Republic of Tanzania). Am J Hum Biol 2018; 30:e23098. [PMID: 29350450 DOI: 10.1002/ajhb.23098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/22/2017] [Accepted: 12/29/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyze the nutritional status of schoolchildren from Bumbire Island (Tanzania) from cross-sectional and longitudinal perspectives. METHODS During 2014 and 2015, we collected anthropometric measurements in a sample of 437 schoolchildren (226 males, 211 females; 5-16 years). A sub-sample of 126 children were measured in both surveys. Socio-demographic data have been taken and dietary habits investigated. The accuracy of age data was checked. Malnutrition prevalence was calculated according to the WHO references and the z-score criteria. RESULTS The prevalence of undernutrition was high (stunting: 30.7%; underweight: 12.9%; thinness: 4.5%), while overweight was rare (2.4%). The prevalence of stunting was higher in males and in older children. The one-year longitudinal analysis indicated that stunting prevalence increased. CONCLUSIONS Undernutrition is affecting Bumbire Island children, likely due to micronutrient deficiencies. The effects of linear growth deficit continue to accumulate throughout childhood and adolescent years.
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Affiliation(s)
- Ornella Comandini
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Cagliari 09042, Italy
| | - Gabriele Carmignani
- Emergency Department, Azienda USL Toscana Nord Ovest, Lucca, Italy.,Bhalobasa Association, Perignano, Pisa, Italy
| | - Alessandro Cipriano
- Bhalobasa Association, Perignano, Pisa, Italy.,Emergency Department, Azienda Ospedaliero - Universitaria Pisana (AOUP), Pisa, Italy
| | - Giovanni Carmignani
- Bhalobasa Association, Perignano, Pisa, Italy.,Department of General Medicine, Hospital of Livorno, Livorno, Italy
| | - Deodatus Tiba
- Dioceses of Bukoba, Muleba District, Kagera Region, United Republic of Tanzania
| | - Elisabetta Marini
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Cagliari 09042, Italy
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Subclinical inflammation affects iron and vitamin A but not zinc status assessment in Senegalese children and Cambodian children and women. Public Health Nutr 2018; 21:1266-1277. [PMID: 29343315 DOI: 10.1017/s1368980017003809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the impact of the acute-phase response (APR) during inflammation on Fe, Zn and vitamin A biomarkers to allow accurate evaluation of micronutrient status in populations. DESIGN Ferritin (FER), soluble transferrin receptor (TfR), retinol-binding protein (RBP), Zn, α1-acid glycoprotein and C-reactive protein concentrations were measured. Correction factors (CF) for each biomarker were calculated as the ratio for groups at different stages of inflammation v. the reference group without inflammation.Setting/SubjectsSenegalese (n 594) and Cambodian schoolchildren (n 2471); Cambodian women of reproductive age (n 2117). RESULTS TfR was higher during the incubation phase (CF=1·17) and lower during early and late convalescence (CF=0·87 and 0·78). FER was higher during all phases (CF=0·83, 0·48 and 0·65, respectively). RBP was higher during incubation (CF=0·88) and lower during early convalescence (CF=1·21). No effect of inflammation on Zn status was found. CONCLUSIONS Inflammation led to overestimation of Fe status and underestimation of vitamin A status. The response of the biomarker for vitamin A status to inflammation depended on the vitamin A status of the populations. Surprisingly, the assessment of Zn status was hardly affected by inflammation. Different phases of the APR had opposite effects on the assessment of Fe status using TfR. More research is needed to define the correct methods to adjust for inflammation in nutritional studies.
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Carvalho AC, Machado A, Embalo AR, Bordalo AA. Endemic goiter and iodine deficiency status among Guinea-Bissau school-age children. Eur J Clin Nutr 2017; 72:1576-1582. [PMID: 29284787 DOI: 10.1038/s41430-017-0055-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/29/2017] [Accepted: 11/20/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Iodine deficiency disorders are estimated to affect 25% of all school-age children around the world. Current policies concerning iodine deficiency disorders in many countries are not based on robust or recent national data. Our objective was to evaluate the current status of iodine nutrition in Guinea-Bissau (West Africa). SUBJECT/METHODS A cross-sectional survey including 299 school-age children, aged 6-14 years old, from four distinct regions of Guinea-Bissau across a coast-hinterland gradient (Bolama, Bissau, Cambaju-Bafatá, and Gabú) was performed. Several iodine deficiency disorders indicators were used: total goiter rate, median urinary iodine concentration (UIC) and regional iodine content in household salt and drinking water samples. Data on the total goiter rate were obtained by thyroid ultrasound. RESULTS Goiter was found in 73.5% (CI 95%, 68.5-78.2%) of the school-age children. We observed a median urinary iodine concentration of 110 mcg/l, with 7.3% of the studied population presenting urinary iodine concentration < 50 mcg/l. Only 12.5% of the household salt samples revealed iodine content ≥ 15 mg/kg. Median well water iodine concentration was 11.7 mcg/l. CONCLUSIONS Guinea-Bissau presents high rates of goiter in school-age children despite satisfactory median urinary iodine concentration population levels. Salt and drinking water iodine median content cannot explain these findings. Further studies following the progress in iodine deficiency status and the presence of potential goitrogens in diet of this vulnerable population are in needed.
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Affiliation(s)
- Andre Couto Carvalho
- Division of Endocrinology, Diabetes and Metabolism. Centro Hospitalar do Porto, Porto, Portugal. .,Life and Health Sciences Research Institute (ICVS), 3B's Associate Institute, University of Minho, Braga, Portugal.
| | - Ana Machado
- Laboratory of Hydrobiology and Ecology, Institute of Biomedical Sciences (ICBAS-UP) & CIIMAR, University of Porto, Porto, Portugal
| | | | - Adriano A Bordalo
- Laboratory of Hydrobiology and Ecology, Institute of Biomedical Sciences (ICBAS-UP) & CIIMAR, University of Porto, Porto, Portugal
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Effect of multi-micronutrient-fortified rice on cognitive performance depends on premix composition and cognitive function tested: results of an effectiveness study in Cambodian schoolchildren. Public Health Nutr 2017; 21:816-827. [DOI: 10.1017/s1368980017002774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveEven though current policy is strongly focused on the crucial first ‘1000 days’, it might be still possible to enhance cognitive function during the pre-adolescent and adolescent years by improving micronutrient status. In Cambodia, nutritional status is poor. Provision of rice fortified with micronutrients through a school meal programme (SMP) could be a cost-effective strategy to help improve health and school performance. The present study aimed to evaluate the effect of three different micronutrient-fortified rice formulations on cognitive function in Cambodian children.SettingSixteen Cambodian schools receiving SMP.DesignThe FORISCA-UltraRice®+NutriRice®study was a randomized, double-blind, placebo-controlled trial. Four groups of four schools were randomly allocated to receive normal rice, UltraRice®Original, UltraRice®New or NutriRice®. Within each school, 132 children were randomly selected. Data on cognitive performance (picture completion, block design and Raven’s coloured progressive matrices (RCPM)), anthropometry, parasite infestation and micronutrient status were collected before the intervention and after 6 months.SubjectsCognitive data were available for 1796 children aged 6–16 years.ResultsAll cognitive scores improved after 6 months (P<0·001). Block design score improvement was significantly higher in children consuming UltraRice®Original (P=0·03) compared with the other fortified rice groups and placebo. No difference among groups was found on RCPM or picture completion scores. Stunting, parasite infestation and inflammation negatively affected the impact of the intervention.ConclusionsCombined with other interventions, using SMP to distribute fortified rice to schoolchildren may be a cost-effective way to increase cognitive performance and thereby improve school performance and educational achievements.
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Risk Factors for Growth Retardation in HIV-infected Senegalese Children on Antiretroviral Treatment: The ANRS 12279 MAGGSEN Pediatric Cohort Study. Pediatr Infect Dis J 2017; 36:e87-e92. [PMID: 28187062 DOI: 10.1097/inf.0000000000001454] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To describe prevalence and risk factors for wasting and stunting among HIV-infected children with a median duration of 3 years of antiretroviral therapy (ART) at the time of their enrollment in the cohort study. METHODS Wasting and stunting at ART initiation and enrollment were defined as weight-for-height/body mass index-for-age Z scores < -2 and height-for-age Z scores < -2, respectively. Logistic regression was used to assess risk factors for wasting and stunting. Main predictive factors were age at enrollment, nutritional status and age (< or ≥5 years) at ART initiation and ART duration (< or ≥3 years on first-line, or ≥3 years including a switch to second-line ART). RESULTS Two hundred forty-four children 2-16 years of age were enrolled. Overall, wasting and stunting prevalence dropped off consistently in children 2-10 years of age, between ART initiation and enrollment, while it remained at high levels, 52% and 42%, respectively, in children 10-16 years of age. Risk factors for wasting at enrollment were ART duration of ≥3 years including a switch to second-line [adjusted odds ratio (aOR): 3.9, 95% confidence interval (CI): 1.7-8.9] and wasting at ART initiation (aOR: 2.7, 95% CI: 1.4-5.2). The risk factor for stunting at enrollment was stunting at ART initiation (aOR: 11.6, 95% CI: 5.4-25.0), independent of ART duration. CONCLUSIONS Malnutrition at the time of ART initiation was the main predictor of malnutrition at enrollment among HIV-infected children on ART. Longer duration on ART had no overall protective effect on wasting and stunting. Growth and virologic monitoring are of utmost importance in the comprehensive care of children with HIV infection.
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Saltzman E, Schlossman N, Brown CA, Balan I, Fuss P, Batra P, Braima de Sa A, Shea MK, Pruzensky WM, Bale C, Roberts SB. Nutrition Status of Primary School Students in Two Rural Regions of Guinea-Bissau. Food Nutr Bull 2016; 38:103-114. [PMID: 28027671 DOI: 10.1177/0379572116679071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nutrition status of primary schoolchildren in Africa has received relatively little attention in comparison to that of younger children. We surveyed primary school students in Guinea-Bissau, a nation that is among the poorest in the world. OBJECTIVE Anthropometry and prevalence of anemia and vitamin A deficiency were assessed in schoolchildren participating in International Partnership for Human Development's school feeding program in 2 regions of Guinea-Bissau. METHODS A cross-sectional survey of 32 schools in the regions of Cacheu and Oio was conducted in November 2011. Variables included age, gender, weight, height, hemoglobin, and retinol-binding protein concentrations. Z scores for height for age (HAZ), body mass index for age (BAZ), and weight for age were calculated using World Health Organization reference data. RESULTS Anthropometric assessment of 4784 students revealed stunting (HAZ < -2) in 15.5%, thinness (BAZ < -2) in 13.2%, and anemia in 42.0%. Stunting, thinness, and anemia were significantly more common in males, in students from Oio, and in older students. Vitamin A deficiency, detected in 21.5% of the population, was the only assessment that did not demonstrate significant differences between genders or regions. About 61.1% of all children had 1 or more indicators of undernutrition. CONCLUSION There are substantial rates of stunting, thinness, underweight, anemia, and vitamin A deficiency in primary schoolchildren in Guinea-Bissau, even among those participating in a school lunch program and particularly among males and older students. The results suggest the need for evaluating feeding programs and other methods to improve nutrition status in primary school students, especially in older students.
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Affiliation(s)
- Edward Saltzman
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Nina Schlossman
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,3 Global Food and Nutrition Inc., Washington, DC, USA
| | - Carrie A Brown
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Ionela Balan
- 4 International Partnership for Human Development, Leesburg, VA, USA
| | - Paul Fuss
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Payal Batra
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Mary Kyla Shea
- 2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Carlito Bale
- 4 International Partnership for Human Development, Leesburg, VA, USA
| | - Susan B Roberts
- 1 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,2 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Fiorentino M, Landais E, Bastard G, Carriquiry A, Wieringa FT, Berger J. Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar. Nutrients 2016; 8:E650. [PMID: 27775598 PMCID: PMC5084037 DOI: 10.3390/nu8100650] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/05/2016] [Accepted: 10/14/2016] [Indexed: 11/16/2022] Open
Abstract
Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal). The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children). Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5-17 years, 45% < 10 years, 53% girls) and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2). Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9). Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3). To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal.
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Affiliation(s)
- Marion Fiorentino
- UMR 204 Nutripass IRD-UM-SupAgro, Institut de Recherche pour le Développement, 911 Avenue d'Agropolis, Montpellier 34394, France.
| | - Edwige Landais
- UMR 204 Nutripass IRD-UM-SupAgro, Institut de Recherche pour le Développement, 911 Avenue d'Agropolis, Montpellier 34394, France.
| | | | - Alicia Carriquiry
- Department of Statistics, Iowa State University, Ames, IA 50011, USA.
| | - Frank T Wieringa
- UMR 204 Nutripass IRD-UM-SupAgro, Institut de Recherche pour le Développement, 911 Avenue d'Agropolis, Montpellier 34394, France.
| | - Jacques Berger
- UMR 204 Nutripass IRD-UM-SupAgro, Institut de Recherche pour le Développement, 911 Avenue d'Agropolis, Montpellier 34394, France.
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Juwara A, Huang N, Chien LY, Chen HJ. Stunting and weight statuses of adolescents differ between public and private schools in urban Gambia. Int J Public Health 2016; 61:717-726. [PMID: 27220546 DOI: 10.1007/s00038-016-0836-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 03/18/2016] [Accepted: 05/11/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This study assessed the disparity in nutritional status of adolescents between public and private schools in urban Gambia. METHODS This is a school-based cross-sectional study in six private and six public upper basic schools in urban Gambia. This study recruited 491 students from public and 469 students from private schools (13-15 years of age). RESULTS The prevalence of stunting (WHO height-for-age Z < -2SD) was 13.4 % for public school students and 4.5 % for private schools. After adjustment for children's sex, age, and family socioeconomic status, the differences in prevalence of stunting and underweight were significant between public and private schools. Private school students are more likely to be overweight/obese (WHO BMI-for-age Z > +1SD) (OR = 2.85, 95 % CI 1.55-5.22), but less likely to be thin (BMI-for-age Z < -2SD) (OR = 0.61 [0.39-0.96]), compared to public school students. Children from lower income families had lower odds for overweight/obese than normal weight, compared to those from higher income families (OR = 0.34 [0.15-0.76]). CONCLUSIONS Public and private schools in urban regions of the Gambia may face different nutritional challenges due to differences in school environment and resources.
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Affiliation(s)
- Alimatou Juwara
- International Health Program, National Yang-Ming University, Taipei, Taiwan
| | - Nicole Huang
- International Health Program, National Yang-Ming University, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Ying Chien
- International Health Program, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical and Community Health Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Jen Chen
- International Health Program, National Yang-Ming University, Taipei, Taiwan. .,Institute of Public Health, School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St., Medical Building II, R213, Beitou District, Taipei, 112, Taiwan, ROC.
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Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial. Nutrients 2016; 8:nu8010029. [PMID: 26751473 PMCID: PMC4728643 DOI: 10.3390/nu8010029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 01/01/2023] Open
Abstract
In Cambodia, micronutrient deficiencies remain a critical public health problem. Our objective was to evaluate the impact of multi-micronutrient fortified rice (MMFR) formulations, distributed through a World Food Program school-meals program (WFP-SMP), on the hemoglobin concentrations and iron and vitamin A (VA) status of Cambodian schoolchildren. The FORISCA-UltraRice+NutriRice study was a double-blind, cluster-randomized, placebo-controlled trial. Sixteen schools participating in WFP-SMP were randomly assigned to receive extrusion-fortified rice (UltraRice Original, UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. Four additional schools not participating in WFP-SMP were randomly selected as controls. A total of 2440 schoolchildren (6–16 years old) participated in the biochemical study. Hemoglobin, iron status, estimated using inflammation-adjusted ferritin and transferrin receptors concentrations, and VA status, assessed using inflammation-adjusted retinol-binding protein concentration, were measured at the baseline, as well as at three and six months. Baseline prevalence of anemia, depleted iron stores, tissue iron deficiency, marginal VA status and VA deficiency were 15.6%, 1.4%, 51.0%, 7.9%, and 0.7%, respectively. The strongest risk factors for anemia were hemoglobinopathy, VA deficiency, and depleted iron stores (all p < 0.01). After six months, children receiving NutriRice and URN had 4 and 5 times less risk of low VA status, respectively, in comparison to the placebo group. Hemoglobin significantly increased (+0.8 g/L) after three months for the URN group in comparison to the placebo group; however, this difference was no longer significant after six months, except for children without inflammation. MMFR containing VA effectively improved the VA status of schoolchildren. The impact on hemoglobin and iron status was limited, partly by sub-clinical inflammation. MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated.
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Galetti V, Mitchikpè CES, Kujinga P, Tossou F, Hounhouigan DJ, Zimmermann MB, Moretti D. Rural Beninese Children Are at Risk of Zinc Deficiency According to Stunting Prevalence and Plasma Zinc Concentration but Not Dietary Zinc Intakes. J Nutr 2016; 146:114-23. [PMID: 26609168 DOI: 10.3945/jn.115.216606] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/26/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Three commonly recommended indicators for risk assessment of population zinc deficiency are stunting rates among children aged <5 y, prevalence of inadequate dietary zinc intake, and prevalence of low plasma zinc (PZn). Data on zinc status in Benin are mainly drawn from stunting rates and data on PZn and dietary zinc intake are lacking. OBJECTIVES The aims of this study were 1) to assess the risk of zinc deficiency in preschool and school-age children from rural communities in northern Benin by means of the 3 indicators for population assessment, 2) to evaluate their level of agreement, and 3) to identify predictors of PZn and height-for-age z scores (HAZ). METHODS We analyzed preintervention data collected during 2 efficacy trials and cross-sectionally assessed the risk of zinc deficiency in preschool (1-5 y, n = 326) and school-age children (5-10 y, n = 272) by 1) conducting a 3-d weighed food record survey, coupled with direct zinc and phytic acid analysis of consumed foodstuffs, and calculating usual dietary zinc intakes in a subsample of school-age children (n = 36); 2) analyzing PZn in all children (n = 598); and 3) measuring anthropometry indexes for assessment of stunting (HAZ <-2 SD) in all children (n = 594) and in <5-y-old children only (n = 273). We derived predictors of PZn and HAZ by using multivariate regression with mixed-effect models. RESULTS Prevalence of inadequate intakes of zinc ranged from 11% to 80% depending on whether the estimated average requirements (EARs) by the International Zinc Nutrition Consultative Group or the EARs derived from the WHO's recommended nutrient intakes were used. Prevalence of low PZn adjusted for acute-phase protein status was 45.7%, with higher rates among preschoolers than school-age children (P = 0.002). The stunting rate in <5-y-old children was 51.3%. PZn was predicted by age, methodologic factors, and socioeconomic status, whereas HAZ was predicted by age, sex, hemoglobin, and socioeconomic status. CONCLUSIONS The prevalence of <5-y stunting and the prevalence of low PZn indicate that the risk of zinc deficiency is elevated in this population. Risk estimates based on the prevalence of inadequacy of zinc intakes varied depending on the EARs used, and a consensus would facilitate nutrition survey evaluations. These trials were registered at clinicaltrials.gov as NCT01472211 and NCT01790321.
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Affiliation(s)
- Valeria Galetti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland;
| | - Comlan Evariste S Mitchikpè
- Laboratory of Human Nutrition, Faculty of Agricultural Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Prosper Kujinga
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; and
| | - Félicien Tossou
- Natitingou Health Zone, Ministry of Health, Natitingou, Benin
| | - D Joseph Hounhouigan
- Laboratory of Human Nutrition, Faculty of Agricultural Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Michael B Zimmermann
- 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
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Dicko F, Desmonde S, Koumakpai S, Dior-Mbodj H, Kouéta F, Baeta N, Koné N, Akakpo J, Signate Sy H, Ye D, Renner L, Lewden C, Leroy V. Reasons for hospitalization in HIV-infected children in West Africa. J Int AIDS Soc 2014; 17:18818. [PMID: 24763078 PMCID: PMC3999943 DOI: 10.7448/ias.17.1.18818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 02/17/2014] [Accepted: 03/12/2014] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration). METHODS We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions. RESULTS From April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1-8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7-23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%). CONCLUSIONS Overall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.
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Affiliation(s)
- Fatoumata Dicko
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Sophie Desmonde
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France;
| | - Sikiratou Koumakpai
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Fla Kouéta
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Niaboula Koné
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Jocelyn Akakpo
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Diarra Ye
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Charlotte Lewden
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
| | - Valériane Leroy
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
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