Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021

OBJECTIVE

To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021.

DESIGN

Descriptive multi-country secondary data analysis.

SETTING

Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021.

POPULATION

Liveborn infants.

METHODS

Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study.

RESULTS

Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%).

CONCLUSIONS

Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.

Validity of photographs for food portion estimation in a rural West African setting

Objective

To validate food photographs for food portion size estimation of frequently consumed dishes, to be used in a 24-hour recall food consumption study of pregnant women in a rural environment in Burkina Faso. This food intake study is part of an intervention evaluating the efficacy of prenatal micronutrient supplementation on birth outcomes.

Subjects

Women of childbearing age (15–45 years).

Design

A food photograph album containing four photographs of food portions per food item was compiled for eight selected food items. Subjects were presented two food items each in the morning and two in the afternoon. These foods were weighed to the exact weight of a food depicted in one of the photographs and were in the same receptacles. The next day another fieldworker presented the food photographs to the subjects to test their ability to choose the correct photograph.

Results

The correct photograph out of the four proposed was chosen in 55% of 1028 estimations. For each food, proportions of underestimating and overestimating participants were balanced, except for rice and couscous. On a group level, mean differences between served and estimated portion sizes were between −8.4% and 6.3%. Subjects who attended school were almost twice as likely to choose the correct photograph. The portion size served (small vs. largest sizes) had a significant influence on the portion estimation ability.

Conclusions

The results from this study indicate that in a West African rural setting, food photographs can be a valuable tool for the quantification of food portion size on group level.

Enhanced sludge dewatering by electrofiltration. A feasibility study

Sludge treatment is a major issue in today's waste water treatment. One of the problems encountered is the limiting dewaterability of mainly biological sludges, causing high final treatment costs for incineration or landfill. Although during recent years, improvements are realised in the field of dewatering, the actual dry solids content after dewatering remains at a maximum value of about 35%. In order to increase the dry solids content, the technique of electrofiltration was investigated. Electrofiltration is the combination of two known techniques, traditional pressure filtration and electroosmotic/electrophoretic dewatering. Pressure filtration is based on pressure as the driving force for dewatering a sludge. Limitations hereby lie in the clogging of the filter cloth due to the build-up of the filtercake. Electroosmotic/electrophoretic dewatering is based on an electric field to separate sludge colloid particles from the surrounding liquid by placing the sludge liquor between two oppositely charged electrodes. In this case, mobile sludge particles will move to one electrode due to their natural surface charge, and the liquid phase will be collected at the oppositely charged electrode. Combination of both techniques makes it possible to create a more homogeneous filter cake and prevent the filter from clogging, resulting in higher cake dry solids contents and shorter filtration cycles. To investigate the feasibility of this technique for the dewatering of activated sludge, a filter unit was developed for investigations on lab scale. Multiple dewatering tests were performed in which the electric parameters for electrofiltration were varied. It was derived from these experiments that very high filter cake dry solids contents (to more than 60%), and short filtration cycles were attainable by using a relatively small electric DC field. The power consumption was very low compared to the power needed to dewater sludge by thermal drying techniques. For this reason, this technique seems very promising for the dewatering of biological sludges.