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Lule SA, Kushitor SB, Grijalva-Eternod CS, Adjaye-Gbewonyo K, Sanuade OA, Kushitor MK, Okoibhole L, Awuah R, Baatiema L, Kretchy IA, Arhinful D, de-Graft Aikins A, Koram K, Fottrell E. The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana. Glob Health Action 2024; 17:2297513. [PMID: 38323339 PMCID: PMC10851827 DOI: 10.1080/16549716.2023.2297513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/16/2023] [Indexed: 02/08/2024] Open
Abstract
Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.
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Affiliation(s)
| | - Sandra Boatemaa Kushitor
- Department of Community Health, Ensign Global College, Kpong, Ghana
- Department of Food Science and Centre for Sustainability Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Carlos S. Grijalva-Eternod
- Institute for Global Health, University College London, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Olutobi Adekunle Sanuade
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Mawuli Komla Kushitor
- Department of Health Policy, Fred Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Lydia Okoibhole
- Institute for Global Health, University College London, London, UK
| | - Raphael Awuah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
- Center for Tropical Medicine and Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Irene Akwo Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Accra, Ghana
| | - Daniel Arhinful
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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Mahmud I, Guesdon B, Kerac M, Grijalva-Eternod CS. Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis. Maternal & Child Nutrition 2024:e13635. [PMID: 38433606 DOI: 10.1111/mcn.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Small and nutritionally at-risk infants aged under 6 months (<6 months) are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6 months admitted to inpatient therapeutic care. A secondary analysis of 2002-2008 data included 5034 infants aged <6 months from 12 countries. We estimated the prevalence, concurrence, and severity of wasted, stunted, and underweight, as stand-alone indicators, and using the Composite Index of Anthropometric Failure (CIAF), which combines these indicators into six subgroups of single and multiple anthropometric deficits and into one combined indicator called CIAF. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality. Among 3692 infants aged <6 months with complete data, 3539 (95.8%) were underweight, 3058 (82.8%) were wasted, 2875 (77.8%) were stunted and 3575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were presented with significantly lower anthropometric indices, that is, they were more severely wasted, stunted and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.2-2.7, p = 0.009, and OR = 3.3, 95% CI: 0.8-13.6, p = 0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR = 1.40, 95% CI: 1.02-1.92, p = 0.03). Mortality was only observed in infants <6 months presenting multiple anthropometric deficits, although their odds of mortality were not significant, for example, OR = 2.4, 95% CI: 0.5-10.0, p = 0.21 for stunted, wasted and underweight infants <6 months. In conclusion, multiple anthropometric deficits (CIAF) is common among infants <6 months and may be reported in nutrition care programmes and surveys. Both weight-for-length/height z-score and weight-for-age z-score were found to be useful indicators for programme admission and in-programme prognosis. Future work needs to explore which better accounts for admission bias. Boys appear to be most at-risk of dying while receiving malnutrition therapeutic care. Programmes should ensure that all infants receive timely, evidence-based, effective care.
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Affiliation(s)
- Imteaz Mahmud
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Public Health, North South University, Dhaka, Bangladesh
- The Power of Nutrition, London, UK
| | | | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Kerac M, McGrath M, Berkley JA, Grijalva-Eternod CS, Lelijveld N, Mwangome M, Rogers E. Letter to the Editor of the Journal of Nutritional Science. J Nutr Sci 2023; 12:e26. [PMID: 36843969 PMCID: PMC9947747 DOI: 10.1017/jns.2022.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Marko Kerac
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Marie McGrath
- Emergency Nutrition Network, 69 High Street, Marlborough House, Kidlington, Oxfordshire OX5 2DN, UK
| | - James A. Berkley
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, P.O Box 230, Kilifi, Kenya
| | - Carlos S. Grijalva-Eternod
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- UCL Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Natasha Lelijveld
- Emergency Nutrition Network, 69 High Street, Marlborough House, Kidlington, Oxfordshire OX5 2DN, UK
| | - Martha Mwangome
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, P.O Box 230, Kilifi, Kenya
| | - Eleanor Rogers
- Emergency Nutrition Network, 69 High Street, Marlborough House, Kidlington, Oxfordshire OX5 2DN, UK
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van Immerzeel TD, Diagne M, Deme/Ly I, Murungi AE, Diouf S, Kerac M, Grijalva-Eternod CS, Day LT. Implementing a Care Pathway for small and nutritionally at-risk infants under six months of age: A multi-country stakeholder consultation. Matern Child Nutr 2023; 19:e13455. [PMID: 36373777 PMCID: PMC9749585 DOI: 10.1111/mcn.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/07/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
Abstract
Nutritional vulnerability under the age of 6 months is prevalent in low- and middle-income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders' views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed-methods study: an online survey plus in-depth interviews with country-level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at-risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community-specific needs and health care seeking barriers, health workers' lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients' preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale-up.
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Affiliation(s)
- Tabitha D van Immerzeel
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Indou Deme/Ly
- University Cheick Anta Diop, Dakar, Senegal.,Centre Hospitalier National D'Enfants Albert Royer, Dakar, Senegal
| | | | | | - Marko Kerac
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Carlos S Grijalva-Eternod
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise T Day
- Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
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Kretchy IA, Okoibhole LO, Sanuade OA, Jennings H, Strachan DL, Blandford A, Agyei F, Asante P, Todowede O, Kushitor M, Adjaye-Gbewonyo K, Arhinful D, Baatiema L, Dankyi E, Grijalva-Eternod CS, Fottrell EF, de-Graft Aikins A. Scoping review of community health participatory research projects in Ghana. Glob Health Action 2022; 15:2122304. [DOI: 10.1080/16549716.2022.2122304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | | | - Olutobi Adekunle Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Hannah Jennings
- Department of Health Sciences, University of York and Hull York Medical School, York, UK
| | - Daniel Ll Strachan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Ann Blandford
- Department of Computer Science, UCLIC, University College London, London, UK
| | - Francis Agyei
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Paapa Asante
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Olamide Todowede
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Mawuli Kushitor
- Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Kafui Adjaye-Gbewonyo
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Daniel Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Leonard Baatiema
- Department of Health Policy, School of Public Health, Planning and ManagementUniversity of Ghana, Legon, Ghana
| | - Ernestina Dankyi
- Centre for Social Policy Studies, University of Ghana, Legon, Ghana
| | - Carlos S. Grijalva-Eternod
- Institute for Global Health, University College London, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Dunning H, Zadutsa B, Kainja E, Colbourn T, McCollum ED, Makwenda C, Wells J, Grijalva-Eternod CS, King C. Bioelectrical impedance vector analysis as an indicator of malnutrition in children under five years with and without pneumonia in Mchinji District, Malawi: An exploratory mixed-methods analysis. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13655.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Bioelectrical impedance vector analysis (BIVA) is a non-invasive assessment of body composition and cellular health, which may improve the assessment of nutritional status in sick children. We explored the reliability, clinical utility, and acceptability of BIVA, as an indicator of nutritional status for children under five years with and without pneumonia, in Malawi. Methods: We conducted a parallel convergent mixed-methods exploratory study in Mchinji District Hospital, Malawi, in 2017. We planned to recruit a convenience sample of children aged 0-59 months with clinical pneumonia, and without an acute illness. Children had duplicate anthropometric and BIVA measurements taken. BIVA measurements of phase angle (PA) were taken of the whole body, and trunk and arm segments. Reliability was assessed by comparing the variability in the two measures, and clinical utility by estimating the association between anthropometry and PA using linear regression. Focus group discussions with healthcare workers who had not previously used BIVA instrumentation were conducted to explore acceptability. Results: A total of 52 children (24 with pneumonia and 28 healthy) were analysed. The reliability of sequential PA measurements was lower than anthropometric measurements, but trunk and arm segments performed better. The largest associations with PA were a negative relationship with weight-for-age z-score (WAZ) and PA in children with pneumonia in the trunk segment, and a positive association with WAZ in the full body measurement in healthy children. Healthcare workers in focus group discussions expressed trust in BIVA technology and that it would enable more accurate diagnosis of malnutrition; however, they raised concerns about the sustainability and necessary resources to implement BIVA. Conclusions: While healthcare workers were positive towards BIVA as a novel technology, implementation challenges should be expected. The differential direction of association between anthropometry and PA for children with pneumonia warrants further investigation.
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Jibat N, Rana R, Negesse A, Abera M, Abdissa A, Girma T, Haile A, Barthorp H, McGrath M, Grijalva-Eternod CS, Kerac M, Berhane M. Carers’ and health workers’ perspectives on malnutrition in infants aged under six months in rural Ethiopia: A qualitative study. PLoS One 2022; 17:e0271733. [PMID: 35862411 PMCID: PMC9302717 DOI: 10.1371/journal.pone.0271733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
Supporting small and nutritionally at-risk (potentially malnourished) infants under six months is a global health priority, albeit with a weak evidence-base. To inform policy and research in this area, we aimed to assess the perceptions and understanding of infant malnutrition and its management among carers, communities, and healthcare workers in rural Ethiopia.
Methods
We conducted in-depth and key-informant interviews, from May-August 2020 in Jimma Zone and Deder District, Ethiopia. We used purposive sampling to recruit the participants. Interviews were transcribed into Amharic or Afaan Oromo and then translated into English. Atlas ti-7 was used to support data analysis. Findings were narrated based on the different themes arising from the interviews.
Results
Carers/community members and healthcare workers reported on five different themes: 1) Perceptions about health and well-being: an ‘ideal infant’ slept well, fed well, was active and looked ‘fat’; 2)Perceptions of feeding: overall knowledge of key recommendations like exclusive breastfeeding was good but practices were suboptimal, notably a cultural practice to give water to young infants; 3)Awareness about malnutrition: a key limitation was knowledge of exactly how to identify small and nutritionally at-risk infants; 4) Reasons for malnutrition: levels of understanding varied and included feeding problems and caregiver’s work pressures resulting in the premature introduction of complementary feeds; 5) Perceptions about identification & treatment: carers prefer treatment close to home but were concerned about the quality of community-based services.
Conclusion
To succeed, research projects that investigate programes that manage small and nutritionally at-risk infants under six months should understand and be responsive to the culture and context in which they operate. They should build on community strengths and tackle misunderstandings and barriers. Interventions beyond just focusing on knowledge and attitude of the carers and health workers are necessary to tackle the challenges around infants under 6 months of age at risk of malnutrition. Moreover, stakeholders beyond the health sector should also be involved in order to support the infants under 6 months and their mothers as some of the key reasons behind the at-risk infants are just beyond the capacity of the health sector or health system. Our list of themes could be used to inform infant nutrition work not just in Ethiopia but also in many others.
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Affiliation(s)
- Nega Jibat
- Department of Sociology, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Ritu Rana
- GOAL Global, Dublin, Ireland
- Indian Institute of Public Health, Gandhinagar, India
| | - Ayenew Negesse
- Department of Human Nutrition, Debre Markos University, Debre Markos, Ethiopia
| | - Mubarek Abera
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Department of Laboratory and Microbiology, Jimma University, Jimma, Ethiopia
- Armaeur Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- Harvard Chan School of Public Health, Addis Ababa, Ethiopia
| | | | | | | | - Carlos S. Grijalva-Eternod
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UCL Institute for Global Health, London, United Kingdom
| | - Marko Kerac
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melkamu Berhane
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
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Seal AJ, Jelle M, Grijalva-Eternod CS, Mohamed H, Ali R, Fottrell E. Use of verbal autopsy for establishing causes of child mortality in camps for internally displaced people in Mogadishu, Somalia: a population-based, prospective, cohort study. Lancet Glob Health 2021; 9:e1286-e1295. [PMID: 34416214 DOI: 10.1016/s2214-109x(21)00254-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People in humanitarian emergencies are likely to experience excess mortality but information on the causes of death is often unreliable or non-existent. This study aimed to provide evidence on the causes of death among children younger than 5 years in camps for internally displaced people in southern Somalia, during periods of protracted displacement and emergency influx amid the 2017 drought and health emergency. METHODS We did a prospective, cohort study in 25 camps in the Afgooye corridor, on the outskirts of Mogadishu, Somalia. All internally displaced children aged 6-59 months were included and followed up with monthly household visits by community health workers. Nutrition, health, and vaccination status were ascertained and verbal autopsy interviews were done with the caregivers of deceased children. We calculated death rates in these children and used verbal autopsy to establish the cause-specific mortality fraction (CSMF). Bayesian InterVA software was used to assign likely causes to each death. FINDINGS Between March, 2016, and March, 2018, 3898 children were followed up. 153 deaths were recorded during 34 746 person-months of observation. The death rate among children younger than 5 years exceeded emergency thresholds (>2 deaths per 10 000 children per day), reaching a peak of seven deaths per 10 000 children per day during the emergency influx. Verbal autopsy data were gathered for 80% of deaths, and the CSMF for the three leading causes of death were diarrhoeal diseases (25·9%), measles (17·8%), and severe malnutrition (8·8%). Coverage of measles vaccination during the first 3 months of the emergency was 42% and the CSMF for measles doubled during the influx. During protracted displacement, symptoms that could be attributable to HIV/AIDS related deaths accounted for 1·6% of the CSMF. INTERPRETATION It is feasible to establish a health and nutrition surveillance system that ascertains causes of death, using verbal autopsy, in this humanitarian context. These data can inform policy, response planning, and priority setting. The high mortality rate from infectious diseases and malnutrition among children younger than 5 years suggests the need for strengthening a range of public health interventions, including vaccination and provision of water, sanitation, and hygiene. FUNDING UK Department of International Development.
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Affiliation(s)
- Andrew J Seal
- Institute for Global Health, University College London, London, UK.
| | - Mohamed Jelle
- Institute for Global Health, University College London, London, UK
| | | | | | - Raha Ali
- Concern Worldwide Somalia, Mogadishu, Somalia
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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Fottrell E, Ahmed N, Nahar B, Shaha SK, Kuddus A, Grijalva-Eternod CS, Nahar T, Fall C, Osmond C, Govoni V, Finer S, Yajnik C, Khan AKA, Costello A, Azad K, Hitman GA. Growth and body composition of children aged 2-4 years after exposure to community mobilisation women's groups in Bangladesh. J Epidemiol Community Health 2018; 72:888-895. [PMID: 29907704 DOI: 10.1136/jech-2017-210134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/24/2018] [Accepted: 05/16/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Women's groups interventions in Bangladesh reduced neonatal deaths by 38% and improved hygienic delivery, newborn care practices and breast feeding. We explore the longer-term impact of exposure to women's groups during pregnancy on child growth at 2-4 years. METHODS We performed a cross-sectional survey of child anthropometric measures (analysed as z-scores) among children born to women who had participated in the women's groups interventions while pregnant, compared with an age-matched and sex-matched sample of children born to control mothers. Results were stratified by maternal body mass index (BMI) and adjusted for possible confounding effects of maternal education, household asset ownership and, in a separate model, mother-child height difference, a proxy for improved survival of small babies in intervention groups. RESULTS Data were obtained from 2587 mother-child pairs (91% response). After adjustment for asset ownership, maternal education and potential survival effects, children whose mothers were exposed to the women's group intervention had higher head (0.16 (0.04 to 0.28)), mid-upper arm (0.11 (0.04 to 0.19)), abdominal (0.13 (0.00 to 0.26)) and chest (0.18 (0.08 to 0.29)) circumferences than their control counterparts. No significant differences in subcutaneous fat (subscapular and triceps skinfold thickness) were observed. When stratified by maternal BMI, intervention children had higher weight, BMI and circumferences, and these effects decreased with increasing maternal BMI category. CONCLUSIONS Women's groups appear to have had a lasting, positive impact on child anthropometric outcomes, with most significant results clustering in children of underweight mothers. Observed differences are likely to be of public health significance in terms of the nutritional and metabolic development of children.
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Affiliation(s)
- Edward Fottrell
- Institute For Global Health, University College London, London, UK
| | - Naveed Ahmed
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Badrun Nahar
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Sanjit Kumer Shaha
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Abdul Kuddus
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Tasmin Nahar
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Virginia Govoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - A K Azad Khan
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute For Global Health, University College London, London, UK
- WHO Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Graham A Hitman
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Jelle M, Grijalva-Eternod CS, Haghparast-Bidgoli H, King S, Cox CL, Skordis-Worrall J, Morrison J, Colbourn T, Fottrell E, Seal AJ. The REFANI-S study protocol: a non-randomised cluster controlled trial to assess the role of an unconditional cash transfer, a non-food item kit, and free piped water in reducing the risk of acute malnutrition among children aged 6-59 months living in camps for internally displaced persons in the Afgooye corridor, Somalia. BMC Public Health 2017; 17:632. [PMID: 28683834 PMCID: PMC5501117 DOI: 10.1186/s12889-017-4550-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/28/2017] [Indexed: 11/11/2022] Open
Abstract
Background The prevalence of acute malnutrition is often high in emergency-affected populations and is associated with elevated mortality risk and long-term health consequences. Increasingly, cash transfer programmes (CTP) are used instead of direct food aid as a nutritional intervention, but there is sparse evidence on their nutritional impact. We aim to understand whether CTP reduces acute malnutrition and its known risk factors. Methods/design A non-randomised, cluster-controlled trial will assess the impact of an unconditional cash transfer of US$84 per month for 5 months, a single non-food items kit, and free piped water on the risk of acute malnutrition in children, aged 6–59 months. The study will take place in camps for internally displaced persons (IDP) in peri-urban Mogadishu, Somalia. A cluster will consist of one IDP camp and 10 camps will be allocated to receive the intervention based on vulnerability targeting criteria. The control camps will then be selected from the same geographical area. Needs assessment data indicates small differences in vulnerability between camps. In each trial arm, 120 households will be randomly sampled and two detailed household surveys will be implemented at baseline and 3 months after the initiation of the cash transfer. The survey questionnaire will cover risk factors for malnutrition including household expenditure, assets, food security, diet diversity, coping strategies, morbidity, WASH, and access to health care. A community surveillance system will collect monthly mid-upper arm circumference measurements from all children aged 6–59 months in the study clusters to assess the incidence of acute malnutrition over the duration of the intervention. Process evaluation data will be compiled from routine quantitative programme data and primary qualitative data collected using key informant interviews and focus group discussions. The UK Department for International Development will provide funding for this study. The European Civil Protection and Humanitarian Aid Operations will fund the intervention. Concern Worldwide will implement the intervention as part of their humanitarian programming. Discussion This non-randomised cluster controlled trial will provide needed evidence on the role of unconditional CTP in reducing the risk of acute malnutrition among IDP in this context. Trial registration ISRCTN29521514. Registered 19 January 2016.
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Affiliation(s)
- Mohamed Jelle
- UCL Institute for Global Health, WC1N 1EH, London, UK
| | | | | | - Sarah King
- Concern Worldwide Somalia, Nairobi Office, Nairobi, Kenya
| | - Cassy L Cox
- Concern Worldwide Somalia, Nairobi Office, Nairobi, Kenya
| | | | | | | | | | - Andrew J Seal
- UCL Institute for Global Health, WC1N 1EH, London, UK
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11
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Grijalva-Eternod CS, Kerac M, McGrath M, Wilkinson C, Hirsch JC, Delchevalerie P, Seal AJ. Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis. Matern Child Nutr 2016; 13. [PMID: 27453170 DOI: 10.1111/mcn.12345] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6-60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight-for-length z-score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care.
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Affiliation(s)
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Epidemiology & Public Health, Leonard Cheshire Leonard Cheshire Disability and Inclusive Development Centre, 1-19 Torrington Place, London, WC1E 6BT, UK
| | | | - Caroline Wilkinson
- Action Contre la Faim (at the time of data submission), 14/16 Boulevard Douaumont, CS 80060 75854, Paris Cedex 17, France.,United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - June C Hirsch
- Action Contre la Faim, 14/16 Boulevard Douaumont, CS 80060 75854, Paris Cedex 17, France
| | - Pascale Delchevalerie
- Medical Department, Médecins Sans Frontières, 46, Rue de l'Arbre Bénit, 1050, Bruxelles, France
| | - Andrew J Seal
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
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12
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Wells JCK, Devakumar D, Grijalva-Eternod CS, Manandhar DS, Costello A, Osrin D. Blood pressure and the capacity-load model in 8-year-old children from Nepal: Testing the contributions of kidney size and intergenerational effects. Am J Hum Biol 2016; 28:555-65. [PMID: 26848931 PMCID: PMC7611548 DOI: 10.1002/ajhb.22829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/08/2015] [Accepted: 12/21/2015] [Indexed: 12/13/2022] Open
Abstract
Objectives Growth patterns in early life are increasingly linked with subsequent cardio-metabolic risk, but the underlying mechanisms require elucidation. We have developed a theoretical model of blood pressure, treating it as a function of homeostatic metabolic capacity, and antagonistic metabolic load. We sought to differentiate prenatal and postnatal components of metabolic capacity, and to identify intergenerational contributions to offspring capacity and load. Methods We followed up at 8 years a cohort of children originally recruited into a randomized trial of maternal micronutrient supplementation in pregnancy. Maternal anthropometry was measured at recruitment. Offspring anthropometry was measured at birth, 2 years and 8 years. Offspring blood pressure, kidney size, and body composition were measured at 8 years. Regression analysis was used to investigate potential associations of maternal phenotype, birth phenotype, and current body composition with kidney size and blood pressure. Results Blood pressure was positively associated with body fat, but negatively associated with birth weight and relative leg length. Kidney size was positively associated with birth weight but not with relative leg length. Adjusting for adiposity, blood pressure was independently negatively associated with birth weight, relative leg length, and kidney length. Maternal height and BMI predicted offspring size at birth and at 8 years, but not blood pressure. Conclusions Our data provide support for the capacity-load model of blood pressure in Nepalese children. Fetal and postnatal growth and kidney dimensions all contribute to metabolic capacity. Maternal phenotype contributed to offspring capacity and load, but these associations did not propagate to blood pressure.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom
| | | | | | | | | | - David Osrin
- UCL Institute for Global Health, London, United Kingdom
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13
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Sibson VL, Grijalva-Eternod CS, Bourahla L, Haghparast-Bidgoli H, Morrison J, Puett C, Trenouth L, Seal A. The REFANI-N study protocol: a cluster-randomised controlled trial of the effectiveness and cost-effectiveness of early initiation and longer duration of emergency/seasonal unconditional cash transfers for the prevention of acute malnutrition among children, 6-59 months, in Tahoua, Niger. BMC Public Health 2015; 15:1289. [PMID: 26700866 PMCID: PMC4690269 DOI: 10.1186/s12889-015-2640-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background The global burden of acute malnutrition among children remains high, and prevalence rates are highest in humanitarian contexts such as Niger. Unconditional cash transfers are increasingly used to prevent acute malnutrition in emergencies but lack a strong evidence base. In Niger, non-governmental organisations give unconditional cash transfers to the poorest households from June to September; the ‘hunger gap’. However, rising admissions to feeding programmes from March/April suggest the intervention may be late. Methods/design This cluster-randomised controlled trial will compare two types of unconditional cash transfer for ‘very poor’ households in ‘vulnerable’ villages defined and identified by the implementing organisation. 3,500 children (6–59 months) and 2,500 women (15–49 years) will be recruited exhaustively from households targeted for cash and from a random sample of non-recipient households in 40 villages in Tahoua district. Clusters of villages with a common cash distribution point will be assigned to either a control group which will receive the standard intervention (n = 10), or a modified intervention group (n = 10). The standard intervention is 32,500 FCFA/month for 4 months, June to September, given cash-in-hand to female representatives of ‘very poor’ households. The modified intervention is 21,500 FCFA/month for 5 months, April, May, July, August, September, and 22,500 FCFA in June, providing the same total amount. In both arms the recipient women attend an education session, women and children are screened and referred for acute malnutrition treatment, and the households receive nutrition supplements for children 6–23 months and pregnant and lactating women. The trial will evaluate whether the modified unconditional cash transfer leads to a reduction in acute malnutrition among children 6–59 months old compared to the standard intervention. The sample size provides power to detect a 5 percentage point difference in prevalence of acute malnutrition between trial arms. Quantitative and qualitative process evaluation data will be prospectively collected and programme costs will be collected and cost-effectiveness ratios calculated. Discussion This randomised study design with a concurrent process evaluation will provide evidence on the effectiveness and cost-effectiveness of earlier initiation of seasonal unconditional cash transfer for the prevention of acute malnutrition, which will be generalisable to similar humanitarian situations. Trial registration ISRCTN25360839, registered March 19, 2015.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrew Seal
- UCL Institute for Global Health, London, WC1N 1EH, UK.
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14
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Grijalva-Eternod CS, Wells JCK, Girma T, Kæstel P, Admassu B, Friis H, Andersen GS. Midupper arm circumference and weight-for-length z scores have different associations with body composition: evidence from a cohort of Ethiopian infants. Am J Clin Nutr 2015; 102:593-9. [PMID: 26224296 DOI: 10.3945/ajcn.114.106419] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/07/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A midupper arm circumference (MUAC) <115 mm and weight-for-height z score (WHZ) or weight-for-length z score (WLZ) less than -3, all of which are recommended to identify severe wasting in children, often identify different children. The reasons behind this poor agreement are not well understood. OBJECTIVE We investigated the association between these 2 anthropometric indexes and body composition to help understand why they identify different children as wasted. DESIGN We analyzed weight, length, MUAC, fat-mass (FM), and fat-free mass (FFM) data from 2470 measurements from 595 healthy Ethiopian infants obtained at birth and at 1.5, 2.5, 3.5, 4.5, and 6 mo of age. We derived WLZs by using 2006 WHO growth standards. We derived length-adjusted FM and FFM values as unexplained residuals after regressing each FM and FFM against length. We used a correlation analysis to assess associations between length, FFM, and FM (adjusted and nonadjusted for length) and the MUAC and WLZ and a multivariable regression analysis to assess the independent variability of length and length-adjusted FM and FFM with either the MUAC or the WLZ as the outcome. RESULTS At all ages, length showed consistently strong positive correlations with the MUAC but not with the WLZ. Adjustment for length reduced observed correlation coefficients of FM and FFM with the MUAC but increased those for the WLZ. At all ages, both length-adjusted FM and FFM showed an independent association with the WLZ and MUAC with higher regression coefficients for the WLZ. Conversely, length showed greater regression coefficients for the MUAC. At all ages, the MUAC was shown to be more influenced than was the WLZ by the FM variability relative to the FFM variability. CONCLUSIONS The MUAC and WLZ have different associations with body composition, and length influences these associations differently. Our results suggest that the WLZ is a good marker of tissue masses independent of length. The MUAC acts more as a composite index of poor growth indexing jointly tissue masses and length. This trial was registered at www.controlled-trials.com as ISRCTN46718296.
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Affiliation(s)
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom
| | | | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; and
| | - Bitiya Admassu
- Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark; and
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15
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Devakumar D, Grijalva-Eternod CS, Roberts S, Chaube SS, Saville NM, Manandhar DS, Costello A, Osrin D, Wells JCK. Body composition in Nepalese children using isotope dilution: the production of ethnic-specific calibration equations and an exploration of methodological issues. PeerJ 2015; 3:e785. [PMID: 25780755 PMCID: PMC4358641 DOI: 10.7717/peerj.785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/02/2015] [Indexed: 01/09/2023] Open
Abstract
Background. Body composition is important as a marker of both current and future health. Bioelectrical impedance (BIA) is a simple and accurate method for estimating body composition, but requires population-specific calibration equations. Objectives. (1) To generate population specific calibration equations to predict lean mass (LM) from BIA in Nepalese children aged 7–9 years. (2) To explore methodological changes that may extend the range and improve accuracy. Methods. BIA measurements were obtained from 102 Nepalese children (52 girls) using the Tanita BC-418. Isotope dilution with deuterium oxide was used to measure total body water and to estimate LM. Prediction equations for estimating LM from BIA data were developed using linear regression, and estimates were compared with those obtained from the Tanita system. We assessed the effects of flexing the arms of children to extend the range of coverage towards lower weights. We also estimated potential error if the number of children included in the study was reduced. Findings. Prediction equations were generated, incorporating height, impedance index, weight and sex as predictors (R2 93%). The Tanita system tended to under-estimate LM, with a mean error of 2.2%, but extending up to 25.8%. Flexing the arms to 90° increased the lower weight range, but produced a small error that was not significant when applied to children <16 kg (p 0.42). Reducing the number of children increased the error at the tails of the weight distribution. Conclusions. Population-specific isotope calibration of BIA for Nepalese children has high accuracy. Arm position is important and can be used to extend the range of low weight covered. Smaller samples reduce resource requirements, but leads to large errors at the tails of the weight distribution.
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Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London , London , UK
| | | | - Sebastian Roberts
- Institute for Global Health, University College London , London , UK
| | | | - Naomi M Saville
- Institute for Global Health, University College London , London , UK
| | | | - Anthony Costello
- Institute for Global Health, University College London , London , UK
| | - David Osrin
- Institute for Global Health, University College London , London , UK
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, Institute of Child Health, University College London , London , UK
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16
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Montagnese C, Nutile T, Marphatia AA, Grijalva-Eternod CS, Siervo M, Ciullo M, Wells JC. Body composition, leg length and blood pressure in a rural Italian population: a test of the capacity-load model. Nutr Metab Cardiovasc Dis 2014; 24:1204-1212. [PMID: 24984827 DOI: 10.1016/j.numecd.2014.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/30/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Whereas adult weight or body mass index (BMI) are directly associated with blood pressure (BP), birth weight is inversely associated with BP. The scenario for height is more complex, as both tall and short stature have been associated with higher BP. We used a theoretical model treating sitting height (SH) and tissue masses (fat mass, lean mass) as components of metabolic load, and leg length (LL) as a marker of homeostatic metabolic capacity. We predicted that decreased capacity and increased load would be independently associated with increased BP.. METHODS AND RESULTS Anthropometry, body composition (bio-electrical impedance analysis) and BP were measured in 601 adults (228 male) aged 20-91 years from three hill villages in southern Italy. Multiple regression analysis was used to investigate associations of body composition and anthropometry with BP. Adjusting for age, systolic BP (SBP) was associated with lean mass in males, and with adiposity in females, whereas diastolic BP (DBP) was associated with fat mass in both sexes. Associations of LL and SH with BP were in opposite directions. LL was inversely associated with SBP and DBP in males, with a similar trend evident in females. SH was directly associated with SBP and DBP in females, and with DBP in males. CONCLUSIONS Consistent with our theoretical model, metabolic load is associated with increased BP, though differently between the sexes, whereas metabolic capacity is independently associated with lower BP. Our findings suggest that early growth improves hemodynamic tolerance of high metabolic load in adulthood..
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Affiliation(s)
- C Montagnese
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK; Institute of Genetics and Biophysics, "A. Buzzati-Traverso" CNR, Napoli, Italy
| | - T Nutile
- Institute of Genetics and Biophysics, "A. Buzzati-Traverso" CNR, Napoli, Italy
| | - A A Marphatia
- Department of Geography, University of Cambridge, UK
| | | | - M Siervo
- Human Nutrition Research Centre, Institute for Ageing and Health, Newcastle University, UK
| | - M Ciullo
- Institute of Genetics and Biophysics, "A. Buzzati-Traverso" CNR, Napoli, Italy.
| | - J C Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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Grijalva-Eternod CS, Lawlor DA, Wells JCK. Testing a capacity-load model for hypertension: disentangling early and late growth effects on childhood blood pressure in a prospective birth cohort. PLoS One 2013; 8:e56078. [PMID: 23405253 PMCID: PMC3566037 DOI: 10.1371/journal.pone.0056078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2005, it was estimated that hypertension affected 26.4% of the adult population worldwide. By 2025, it is predicted that it will affect about 60% of adults, a total of 1.56 billion. Both pre- and postnatal growth patterns have been associated with later blood pressure (BP), but in contrasting directions. These inconsistent associations of growth during different developmental periods merit elucidation. We tested a theoretical model treating birth weight as a marker of homeostatic metabolic capacity, and childhood height, lean mass and fat mass as independent indices of metabolic load. We predicted that decreased capacity and increased load would be independently associated with increased BP. METHODS AND FINDINGS Data from the ALSPAC cohort on growth from birth to 7 years, and body composition by dual-energy X-ray absorptiometry and BP at 9 years, were analysed (n = 6579). Data were expressed as standard deviation scores (SDS) or standardised regression residuals (SRR). BP was independently and positively associated with each of height, lean mass and fat mass. In a joint model systolic BP was positively associated with conditional weight velocity [males 0.40 (95%CI: 0.37-0.44) & females 0.44 (95%CI: 0.40-0.47) SDS/SRR], but not birth weight [0.00 (95%CI: -0.03-0.04) & 0.03 (95%CI: -0.01-0.07) SDS/SDS]. Adjusting for height, lean mass and fat mass, the association of systolic BP and conditional weight velocity attenuated [0.00(95%CI: -0.09-0.08) & -0.06(95%CI: -0.14-0.03) SDS/SRR], whereas that with birth weight became negative [-0.10 (95%CI: -0.14-0.06) & -0.09 (95%CI: -0.13-0.05) SDS/SDS]. Similar results were obtained for diastolic BP and pulse pressure. CONCLUSIONS Consistent with our theoretical model, high metabolic load relative to metabolic capacity is associated with increased BP. Our data demonstrate the contribution of different growth and body composition components to BP variance, and clarify the developmental aetiology of hypertension.
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Grijalva-Eternod CS, Wells JCK, Cortina-Borja M, Salse-Ubach N, Tondeur MC, Dolan C, Meziani C, Wilkinson C, Spiegel P, Seal AJ. The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of Western Sahara refugees. PLoS Med 2012; 9:e1001320. [PMID: 23055833 PMCID: PMC3462761 DOI: 10.1371/journal.pmed.1001320] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 08/21/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency. METHODS AND FINDINGS We implemented a stratified nutrition survey in October-November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6-59 mo) and 1,781 women (15-49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively. The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden-affected (24.7%). CONCLUSIONS The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention and management with interventions to tackle under-nutrition. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Carlos S. Grijalva-Eternod
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
- Emergency Nutrition Network, Oxford, United Kingdom
| | - Jonathan C. K. Wells
- Medical Research Council Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom
| | - Mario Cortina-Borja
- Medical Research Council Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom
| | | | | | - Carmen Dolan
- Emergency Nutrition Network, Oxford, United Kingdom
| | - Chafik Meziani
- Tindouf Sub-Office, United Nations High Commissioner for Refugees, Tindouf, Algeria
| | - Caroline Wilkinson
- Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Paul Spiegel
- Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Andrew J. Seal
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
- Emergency Nutrition Network, Oxford, United Kingdom
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Monse B, Duijster D, Sheiham A, Grijalva-Eternod CS, van Palenstein Helderman W, Hobdell MH. The effects of extraction of pulpally involved primary teeth on weight, height and BMI in underweight Filipino children. A cluster randomized clinical trial. BMC Public Health 2012; 12:725. [PMID: 22938147 PMCID: PMC3490802 DOI: 10.1186/1471-2458-12-725] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/20/2012] [Indexed: 11/22/2022] Open
Abstract
Background Severe dental caries and the treatment thereof are reported to affect growth and well-being of young children. The objective of this study was to assess the effects of extraction of severely decayed pulpally involved primary teeth on weight and height in underweight preschool Filipino children. Methods Underweight preschool Filipino children with severe dental decay had their pulpally involved primary teeth extracted during a stepped wedge cluster randomized clinical trial. Day care centers were randomly divided into two groups; children from Group A day care centers received treatment as soon as practical, whereas children from Group B day care centers were treated four months after Group A. Clinical oral examinations using WHO criteria and the pufa-index were carried out. Anthropometric measurements were done on both groups immediately before treatment of Group A and at follow-up four months later. Height and weight z-scores were calculated using 2006 and 2007 WHO Growth Standards. Multilevel analysis was used to assess the effect of dental extractions on changes in anthropometric measurements after dental treatment. Results Data on 164 children (85 in Group A and 79 in Group B), mean age 59.9 months, were analyzed. Both groups gained weight and height during the trial period. Children in Group A significantly increased their BMI (p < 0.001), and their weight-for-age (p < 0.01) and BMI-for-age z-scores (p < 0.001) after dental treatment, whereas untreated children in Group B did not. Children in Group A had significantly more weight gain (p < 0.01) compared to untreated children in Group B. However, children in Group A had an inverse change in height gain (p < 0.001). Adjustment for the time interval between the two visits had little effect on the results. Conclusions The extraction of severely decayed primary teeth resulted in significant weight gain in underweight Filipino children. Untreated dental decay should be considered an important co-factor affecting child growth and should be considered when planning for interventions to improve child growth. Trial registration ISRCTN90779069 http://www.controlled-trials.com/isrctn/isrctn_loa
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Affiliation(s)
- Bella Monse
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, Gustav Mahlerlaan 3004, Amsterdam, 1081LA, The Netherlands
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