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Kakwangire P, Atukunda P, Ngari M, Westerberg AC, Iversen PO, Muhoozi G. Long-term effects on depressive symptoms among Ugandan mothers - Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting. J Affect Disord 2024; 351:598-606. [PMID: 38307132 DOI: 10.1016/j.jad.2024.01.263] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda. METHODS The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESD). RESULTS For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference - 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference - 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESD. We did not find any baseline characteristics associated with maternal depression. LIMITATIONS The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms. CONCLUSION Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.
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Affiliation(s)
- Paul Kakwangire
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
| | - Prudence Atukunda
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya and Department of Public Health, School of Health & Human Sciences, Pwani University, Kilifi, Kenya
| | - Ane C Westerberg
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital - Rikshospitalet, Oslo, Norway; School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway; Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Grace Muhoozi
- Department of Family Life and Consumer Studies (Home Economics), Kyambogo University, Kampala, Uganda.
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Budambula V, Ngari M, Budambula NLM, Ahmed AA, Were T. Nutritional status of people who inject drugs in Coastal Kenya: a cross-sectional study. BMC Nutr 2024; 10:55. [PMID: 38576036 PMCID: PMC10996164 DOI: 10.1186/s40795-024-00851-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Despite documentation on injection drug use (IDU) in Kenya, the nutritional status of people who inject drugs (PWIDs) is under-explored. Elsewhere studies report under-nutrition among PWIDs which is attributed to food insecurity; competing priorities between drugs and food supply; chaotic lifestyle; reduced food intake; substance use induced malnutrition due to inflammation and comorbidities. METHODS This was a cross-sectional study that sought to assess the nutritional status of PWIDs in Coastal Kenya. We recruited 752 participants of whom 371(49%) were on IDUs and 75 non-IDUs and 306 non-drug users using respondent driven sampling, traditional snowball, makeshift outreach and purposive sampling methods. RESULTS More than one half of the participants (56%) had BMI classified as normal while 35% had BMI < 18.5. The proportion with BMI < 18.5 was higher among IDUs (46%) compared to the non-IDUs (33%) and non-drug users (23%) at P < 0.001. Using the mid upper arm circumference (MUAC), 17% were classified as underweight and the proportion was lowest (11%) among non- drugs users compared to 22% among IDUs (P < 0.001). However, the IDUs had lower proportion of overweight (8.1%) compared to 55% among the non- drug users. The proportion with low waist-for-hip ratio was highest among the IDUs (74%) while high waist-for-hip ratio was lowest in the same group of IDUs (11%) at P < 0.001. One half (50%), of the participants had no signs of anaemia, (47%) had mild/moderate anaemia while 21 (2.8%) had severe anaemia. However, IDUs were more likely to be overweight based on waist circumference as a parameter. The IDUs had the highest proportion (54%) of mild to moderate anaemia compared to non-IDUs (37%) and 40% non- drug users (P < 0.001). In the multivariable models, IDUs (aRRR 2.83 (95%CI 1.84‒4.35)) and non-IDUs (aRRR 1.42 (95%CI 1.07‒1.88)) compared to non- drug users were positively associated with BMI < 18.5. Being an IDU was positively associated with mild or moderate anaemia (aRRR 1.65 (95%CI 1.13‒2.41)) while non-IDUs were positively associated with severe anaemia (aRRR 1.69 (95%CI 1.16‒2.48)). CONCLUSION A significant proportion of the participants were under-nourished with those injecting drugs bearing the heaviest brunt. Being an IDU was positively associated with the low BMI, MUAC, waist for hip ratio and mild or moderate anaemia but high waist circumference. People who inject drugs have high risk for under-nutrition and should be targeted with appropriate interventions.
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Affiliation(s)
- Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, P. O. Box 90420-80100, Kenya.
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
| | | | | | - Tom Were
- Department of Microbiology and Parasitology, Masinde Muliro University of Science and Technology, Kakamega, Kenya
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Kakwangire P, Muhoozi G, Ngari M, Matovu N, Westerberg AC, Iversen PO, Atukunda P. 8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting. Pediatrics 2024; 153:e2023063352. [PMID: 38505933 DOI: 10.1542/peds.2023-063352] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Nutrition and stimulation interventions promote early childhood development, but little is known about their long-term benefits in low- and middle-income countries. We conducted a follow-up study of a cluster-randomized maternal education trial performed in children aged 6 to 8 months to assess the sustainability of developmental benefits after 8 years. METHODS The education intervention lasted 6 months and consisted of nutrition, hygiene, sanitation, and child stimulation aspects. We assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention after 8 years. The original trial included 511 mother-child pairs (intervention, n = 263; control, n = 248), whereas in the current study, 361 (71%; intervention, n = 185; control, n = 176) pairs were available for analyses. RESULTS The intervention group scored higher than the controls (all P < .001) on all 5 KABC-II subscales and on the KABC-II global score (mean difference: 14; 95% confidence interval, 12-16; P < .001). For all 5 Test of Variables of Attention variables, the intervention group scored higher than the controls on both the visual and auditory tasks (all P < .05). Because the intervention was delivered as a package, a limitation is that we cannot pinpoint the individual contribution of each component (nutrition, hygiene, and stimulation) to the developmental benefits. CONCLUSIONS The intervention group consistently scored markedly higher on both neuropsychological tests. Thus, even 8 years after the original maternal education intervention, the developmental benefits that we observed at child age of 1, 2, and 3 years, were sustained.
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Affiliation(s)
- Paul Kakwangire
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
| | - Grace Muhoozi
- Department of Nutritional Sciences and Dietetics, Kyambogo University, Kampala, Uganda
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya and Department of Public Health, School of Health & Human Sciences, Pwani University, Kilifi, Kenya
| | - Nicholas Matovu
- Centre for Public Health, Institute of Clinical Sciences Block B, Queen's University, Belfast, UK
| | - Ane Cecilie Westerberg
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Prudence Atukunda
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Shawon RA, Denno D, Tickell KD, Atuhairwe M, Bandsma R, Mupere E, Voskuijl W, Mbale E, Ahmed T, Chisti MJ, Saleem AF, Ngari M, Diallo AH, Berkley J, Walson J, Means AR. Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings: a hospital-based cross-sectional study. BMJ Open 2024; 14:e078404. [PMID: 38458789 DOI: 10.1136/bmjopen-2023-078404] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES This study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings. DESIGN AND SETTING We used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries. PARTICIPANTS A total of 2796 children aged 2-23 months hospitalised between November 2016 and January 2019 with pneumonia, diarrhoea or severe malnutrition (SM) and without HIV infection were included in this study. PRIMARY OUTCOME MEASURES We identified children treated with full, partial or non-adherent initial inpatient care according to site-specific standard-of-care guidelines for pneumonia, diarrhoea and SM within the first 24 hours of admission. Correlates of guideline non-adherence were identified using generalised estimating equations. RESULTS Fully adherent care was delivered to 32% of children admitted with diarrhoea, 34% of children with pneumonia and 28% of children with SM when a strict definition of adherence was applied. Non-adherence to recommendations was most common for oxygen and antibiotics for pneumonia; fluid, zinc and antibiotics for diarrhoea; and vitamin A and zinc for SM. Non-adherence varied by site. Pneumonia guideline non-adherence was more likely among patients with severe disease (OR 1.82; 95% CI 1.38, 2.34) compared with non-severe disease. Diarrhoea guideline non-adherence was more likely among lower asset quintile groups (OR 1.16; 95% CI 1.01, 1.35), older children (OR 1.10; 95% CI 1.06, 1.13) and children presenting with wasting (OR 6.44; 95% CI 4.33, 9.57) compared with those with higher assets, younger age and not wasted. CONCLUSIONS Non-adherence to paediatric guidelines was common and associated with older age, disease severity, and comorbidities, and lower household economic status. These findings highlight opportunities to improve guidelines by adding clarity to specific recommendations.
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Affiliation(s)
- Riffat Ara Shawon
- Epidemiology, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | - Donna Denno
- Global Health, University of Washington, Seattle, Washington, USA
- Pediatrics, University of Washington, Seattle, Washington, USA
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Kirkby D Tickell
- Epidemiology, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Michael Atuhairwe
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Uganda-Case Western Reserve University Research Collaboration, Makerere University, Kampala, Uganda
| | - Robert Bandsma
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Centre for Global Child Health, Toronto, Ontario, Canada
| | - Ezekiel Mupere
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Uganda-Case Western Reserve University Research Collaboration, Makerere University, Kampala, Uganda
- Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Wieger Voskuijl
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Kamuzu University for Health Sciences, Blantyre, Malawi
| | - Emmie Mbale
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Department of Pediatrics, University of Malawi, Blantyre, Malawi
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - James Berkley
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Judd Walson
- Epidemiology, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
- Pediatrics, University of Washington, Seattle, Washington, USA
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Mbuthia N, Kagwanja N, Ngari M, Boga M. General ward nurses detection and response to clinical deterioration in three hospitals at the Kenyan coast: a convergent parallel mixed methods study. BMC Nurs 2024; 23:143. [PMID: 38429750 PMCID: PMC10905788 DOI: 10.1186/s12912-024-01822-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND In low and middle-income countries like Kenya, critical care facilities are limited, meaning acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to deterioration. METHODS This convergent parallel mixed methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the vital signs 24 h before a cardiac arrest (death) occurred was retrieved from patients' medical records. In-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards. RESULTS This study reviewed 405 patient records and found most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 h prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points, i.e. four hourly. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs linked to limited availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers. CONCLUSION The study showed that nurses did not consistently monitor and record vital signs in the general wards. They also worked in suboptimal ward environments that do not support their ability to promptly detect and respond to clinical deterioration. The findings illustrate the importance of implementation of standardised systems for patient assessment and alert mechanisms for deterioration response. Furthermore, creating a supportive work environment is imperative in empowering nurses to identify and respond to patient deterioration. Addressing these issues is not only beneficial for the nurses but, more importantly, for the well-being of the patients they serve.
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Affiliation(s)
- Nickcy Mbuthia
- Department of Medical Surgical Nursing, School of Health Sciences, Kenyatta University, Nairobi, Kenya.
| | - Nancy Kagwanja
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Mwanamvua Boga
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
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Mwangome M, Ngari M, Brals D, Bawhere P, Kabore P, McGrath M, Berkley JA. Stunting in the first year of life: Pathway analysis of a birth cohort. PLOS Glob Public Health 2024; 4:e0002908. [PMID: 38363746 PMCID: PMC10871522 DOI: 10.1371/journal.pgph.0002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
Malnutrition among infants aged below 6 months has been largely overlooked creating gaps in our understanding of factors underlying stunting in early infancy. Recent evidence suggests that pre-natal and early childhood factors may contribute more to driving childhood stunting than previously appreciated. The study was set up to examine pathways including parental and household characteristics, birth size and gestation, and illness in infancy with stunting at birth and months 3, 6 and 12 using an a priori hypothesized framework. It was a secondary analysis of a birth cohort of 1017 infants recruited from four health facilities in Burkina Faso and followed up for one year. Structural equation models (SEM) were generated to explore pathways to stunting at birth and months 3, 6 and 12. The prevalence of being stunted at birth and months 3, 6 and 12 was 7.4%, 23%, 20% and 18% respectively. The fractions of month 12 stunting attributable to being stunted at birth, months 3 and 6 were 11% (95%CI 5.0‒16%), 32% (95%CI 22‒41%) and 40% (95%CI 31‒49%) respectively. In the structural equation model, male sex and maternal characteristics had direct effects on stunting at birth and at 3 months, but not subsequently. Premature birth, twin birth and being stunted at a previous time point were directly associated with stunting at months 3, 6 and 12. Both maternal and paternal characteristics were directly associated with preterm birth. Non-exclusive breastfeeding had borderline positive direct effect on stunting at month 6 but not at month 12. The direct and indirect pathways identified in this study highlight the complex interlinks between child, maternal, paternal and household characteristics. Interventions tackling preterm birth, in utero growth, exclusive breastfeeding and maternal wellbeing may reduce stunting in the first year of life.
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Affiliation(s)
- Martha Mwangome
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Daniella Brals
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Paluku Bawhere
- School of Public Health, Center of Research in Epidemiology Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Kabore
- Africa Regional office, World Health Organisation, Brazzaville, Republic of Congo
| | - Marie McGrath
- Emergency Nutrition Network (ENN), Kidlington, Oxfordshire, United Kingdom
| | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Centre for Clinical Vaccinology & Tropical Medicine, University of Oxford, Oxford, United Kingdom
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Massara P, Asrar A, Bourdon C, Ngari M, Keown-Stoneman CDG, Maguire JL, Birken CS, Berkley JA, Bandsma RHJ, Comelli EM. New approaches and technical considerations in detecting outlier measurements and trajectories in longitudinal children growth data. BMC Med Res Methodol 2023; 23:232. [PMID: 37833647 PMCID: PMC10576311 DOI: 10.1186/s12874-023-02045-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Growth studies rely on longitudinal measurements, typically represented as trajectories. However, anthropometry is prone to errors that can generate outliers. While various methods are available for detecting outlier measurements, a gold standard has yet to be identified, and there is no established method for outlying trajectories. Thus, outlier types and their effects on growth pattern detection still need to be investigated. This work aimed to assess the performance of six methods at detecting different types of outliers, propose two novel methods for outlier trajectory detection and evaluate how outliers affect growth pattern detection. METHODS We included 393 healthy infants from The Applied Research Group for Kids (TARGet Kids!) cohort and 1651 children with severe malnutrition from the co-trimoxazole prophylaxis clinical trial. We injected outliers of three types and six intensities and applied four outlier detection methods for measurements (model-based and World Health Organization cut-offs-based) and two for trajectories. We also assessed growth pattern detection before and after outlier injection using time series clustering and latent class mixed models. Error type, intensity, and population affected method performance. RESULTS Model-based outlier detection methods performed best for measurements with precision between 5.72-99.89%, especially for low and moderate error intensities. The clustering-based outlier trajectory method had high precision of 14.93-99.12%. Combining methods improved the detection rate to 21.82% in outlier measurements. Finally, when comparing growth groups with and without outliers, the outliers were shown to alter group membership by 57.9 -79.04%. CONCLUSIONS World Health Organization cut-off-based techniques were shown to perform well in few very particular cases (extreme errors of high intensity), while model-based techniques performed well, especially for moderate errors of low intensity. Clustering-based outlier trajectory detection performed exceptionally well across all types and intensities of errors, indicating a potential strategic change in how outliers in growth data are viewed. Finally, the importance of detecting outliers was shown, given its impact on children growth studies, as demonstrated by comparing results of growth group detection.
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Affiliation(s)
- Paraskevi Massara
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Arooj Asrar
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada
| | - Moses Ngari
- Kenya Medical Research Institute (KEMRI)/ Wellcome Trust Research Programme, Kilifi, Kenya
| | - Charles D G Keown-Stoneman
- Li KaShing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jonathon L Maguire
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Li KaShing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Child Health Evaluative Services, Hospital for Sick Children, Toronto, Canada
| | - James A Berkley
- Kenya Medical Research Institute (KEMRI)/ Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Robert H J Bandsma
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada.
| | - Elena M Comelli
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Joannah and Brian Lawson Center for Child Nutrition, University of Toronto, Toronto, Canada.
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Wen B, Farooqui A, Bourdon C, Tarafdar N, Ngari M, Chimwezi E, Thitiri J, Mwalekwa L, Walson JL, Voskuijl W, Berkley JA, Bandsma RHJ. Intestinal disturbances associated with mortality of children with complicated severe malnutrition. Commun Med (Lond) 2023; 3:128. [PMID: 37773543 PMCID: PMC10541881 DOI: 10.1038/s43856-023-00355-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Children admitted to hospital with complicated severe malnutrition (CSM) have high mortality despite compliance with standard WHO management guidelines. Limited data suggests a relationship between intestinal dysfunction and poor prognosis in CSM, but this has not been explicitly studied. This study aimed to evaluate the role of intestinal disturbances in CSM mortality. METHODS A case-control study nested within a randomized control trial was conducted among children hospitalized with CSM in Kenya and Malawi. Children who died (cases, n = 68) were compared with those who were discharged, propensity matched to the cases on age, HIV and nutritional status (controls, n = 68) on fecal metabolomics that targeted about 70 commonly measured metabolites, and enteropathy markers: fecal myeloperoxidase (MPO), fecal calprotectin, and circulating intestinal fatty acid binding protein (I-FABP). RESULTS The fecal metabolomes of cases show specific reductions in amino acids, monosaccharides, and microbial fermentation products, when compared to controls. SCFA levels did not differ between groups. The overall fecal metabolomics signature moderately differentiates cases from controls (AUC = 0.72). Enteropathy markers do not differ between groups overall, although serum I-FABP is elevated in cases in a sensitivity analysis among non-edematous children. Integrative analysis with systemic data suggests an indirect role of intestinal inflammation in the causal path of mortality. CONCLUSIONS Intestinal disturbances appear to have an indirect association with acute mortality. Findings of the study improve our understanding of pathophysiological pathways underlying mortality of children with CSM.
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Affiliation(s)
- Bijun Wen
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
| | - Amber Farooqui
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
| | - Celine Bourdon
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Nawar Tarafdar
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Laura Mwalekwa
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Paediatrics, Coast General Hospital, Mombasa, Kenya
| | - Judd L Walson
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, WA, USA
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences (formerly College of Medicine), Blantyre, Malawi
| | - James A Berkley
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert H J Bandsma
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada.
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.
- Department of Biomedical Sciences, Kamuzu University of Health Sciences (formerly College of Medicine), Blantyre, Malawi.
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Jelagat J, Budambula NLM, Ngari M, Budambula V. Polydrug Use among Students in a Public University in a Lower Middle-Income Country. Biomed Res Int 2023; 2023:8085588. [PMID: 37560202 PMCID: PMC10409583 DOI: 10.1155/2023/8085588] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023]
Abstract
Recreational drug use among students in tertiary institutions remains a public health concern. Despite documentation of drug use in Kenyan universities, most of the studies are based on self-reported history which is prone to social desirability bias. It is in this context that we sought to establish lifetime and current drug use among university students. The study investigated self-reported and confirmed drug use. Using proportionate to size and snowball sampling methods, 380 respondents were enrolled from three university campuses. Actual drug use was confirmed qualitatively using a 6 panel plus alcohol saliva test kit. The study participants' median (IQR) age was 22 (20-23) years, and 262 (69%) were male; 328 (86%) were degree-level students, while 127 (33%) were in their fourth year and above. A total of 221 (58%) students reported a lifetime ever use of drugs, while 193 (51%) tested positive for at least one drug. Alcohol, tobacco products (cotinine), marijuana, and amphetamine or khat were the most preferred drugs. The usage was either solely, concurrently, or simultaneously. Having multiple sexual partners compared to students with no sexual partner (adjusted risk ratio (aRR) of 2.33 (95% CI 1.45, 3.76)) and residing in Mishomoroni and Kisauni (aRR 1.50 (95% CI 1.08, 2.09)) were associated with risk of testing positive for any drug. Having one (aRR of 1.54 (95% CI 1.05, 2.26)) and multiple sexual partners (aRR 2.03 (95% CI 1.27, 3.25) and residing in Mishomoroni and Kisauni (aRR 1.48 (95% CI 1.05, 2.08)) were associated with self-reported drug use. One out of two students was currently using drugs. Irrespective of the method used to record data, alcohol, tobacco products, marijuana, and amphetamine or khat were the most preferred drugs. The usage was solely, concurrently, or simultaneously. Future interventions should focus on continuing students, students' residences, and those who are sexually active.
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Affiliation(s)
- Joan Jelagat
- Department of Environment and Health Sciences, Technical University of Mombasa, Kenya
| | | | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kenya
| | - Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, Kenya
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Ahmed SM, Brintz BJ, Talbert A, Ngari M, Pavlinac PB, Platts-Mills JA, Levine AC, Nelson EJ, Walson JL, Kotloff KL, Berkley JA, Leung DT. Derivation and external validation of a clinical prognostic model identifying children at risk of death following presentation for diarrheal care. PLOS Glob Public Health 2023; 3:e0001937. [PMID: 37368867 DOI: 10.1371/journal.pgph.0001937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Diarrhea continues to be a leading cause of death for children under-five. Amongst children treated for acute diarrhea, mortality risk remains elevated during and after acute medical management. Identification of those at highest risk would enable better targeting of interventions, but available prognostic tools lack validation. We used clinical and demographic data from the Global Enteric Multicenter Study (GEMS) to build clinical prognostic models (CPMs) to predict death (in-treatment, after discharge, or either) in children aged ≤59 months presenting with moderate-to-severe diarrhea (MSD), in Africa and Asia. We screened variables using random forests, and assessed predictive performance with random forest regression and logistic regression using repeated cross-validation. We used data from the Kilifi Health and Demographic Surveillance System (KHDSS) and Kilifi County Hospital (KCH) in Kenya to externally validate our GEMS-derived CPM. Of 8060 MSD cases, 43 (0.5%) children died in treatment and 122 (1.5% of remaining) died after discharge. MUAC at presentation, respiratory rate, age, temperature, number of days with diarrhea at presentation, number of people living in household, number of children <60 months old living in household, and how much the child had been offered to drink since diarrhea started were predictive of death both in treatment and after discharge. Using a parsimonious 2-variable prediction model, we achieved an area under the ROC curve (AUC) of 0.84 (95% CI: 0.82, 0.86) in the derivation dataset, and an AUC = 0.74 (95% CI 0.71, 0.77) in the external dataset. Our findings suggest it is possible to identify children most likely to die after presenting to care for acute diarrhea. This could represent a novel and cost-effective way to target resources for the prevention of childhood mortality.
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Affiliation(s)
- Sharia M Ahmed
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Ben J Brintz
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Alison Talbert
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Patricia B Pavlinac
- Department of Global Health, Global Center for Integrated Health of Women, Adolescents and Children (Global WACh), University of Washington, Seattle, WA, United States of America
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, United States of America
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Eric J Nelson
- Department of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James A Berkley
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, United States of America
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Mwakutwaa AS, Ngugi HN, Ndenga BA, Krystosik A, Ngari M, Abubakar LU, Yonge S, Kitron U, LaBeaud AD, Mutuku FM. Pupal productivity of larval habitats of Aedes aegypti in Msambweni, Kwale County, Kenya. Parasitol Res 2023; 122:801-814. [PMID: 36683088 PMCID: PMC9988718 DOI: 10.1007/s00436-022-07777-0] [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: 10/04/2022] [Accepted: 12/30/2022] [Indexed: 01/24/2023]
Abstract
Aedes aegypti is an important vector of several arboviruses including dengue and chikungunya viruses. Accurate identification of larval habitats of Ae. aegypti is considered an essential step in targeted control. This study determined Ae. aegypti productivity in selected larval habitats in Msambweni, Kwale County, Kenya. Three sequential larval habitat surveys were conducted. The first survey was habitat census (baseline) through which 83 representative larval habitats were identified and selected. The second and third surveys involved estimating daily productivity of the 83 selected larval habitats for 30 consecutive days during a wet and a dry season, respectively. Of 664 larval habitats examined at baseline, 144 larval habitats (21.7%) were found to be infested with Ae. aegypti larvae. At baseline, majority (71%) of the pupae were collected from two (2/6) larval habitat types, tires and pots. Multivariate analysis identified habitat type and the habitat being movable as the predictors for pupal abundance. During the 30-day daily pupal production surveys, only a few of the habitats harbored pupae persistently. Pupae were found in 28% and 12% of the larval habitats during the wet and dry seasons, respectively. In the wet season, drums, tires, and pots were identified as the key habitat types accounting for 85% of all pupae sampled. Three habitats (all drums) accounted for 80% of all the pupae collected in the dry season. Predictors for pupal productivity in the wet season were habitat type, place (whether the habitat is located at the back or front of the house), habitat purpose (use of the water in the habitat), and source of water. Although the multivariate model for habitat type did not converge, habitat type and habitat size were the only significant predictors during the dry season. Drums, pots, and tires were sources of more than 85% of Ae. aegypti pupae, reinforcing the "key container concept." Targeting these three types of habitats makes epidemiological sense, especially during the dry season.
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Affiliation(s)
- Alawih S. Mwakutwaa
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Harun N. Ngugi
- Department of Biological Sciences, Chuka University, Chuka, Kenya
| | - Bryson A. Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Amy Krystosik
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA USA
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Laila U. Abubakar
- Department of Pure and Applied Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Shadrack Yonge
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Uriel Kitron
- Department of Environmental Sciences, Emory University, Atlanta, GA USA
| | - A. Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA USA
| | - Francis M. Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
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Aguayo GA, Zhang L, Vaillant M, Ngari M, Perquin M, Moran V, Huiart L, Krüger R, Azuaje F, Ferdynus C, Fagherazzi G. Correction: Machine learning for predicting neurodegenerative diseases in the general older population: a cohort study. BMC Med Res Methodol 2023; 23:32. [PMID: 36721092 PMCID: PMC9887909 DOI: 10.1186/s12874-023-01854-3] [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: 02/01/2023] Open
Affiliation(s)
- Gloria A. Aguayo
- grid.451012.30000 0004 0621 531XDeep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Lu Zhang
- grid.451012.30000 0004 0621 531XBioinformatics Platform, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Michel Vaillant
- grid.451012.30000 0004 0621 531XCompetenceCenter for Methodology and Statistics, Translational Medicine Operations Hub, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Moses Ngari
- grid.451012.30000 0004 0621 531XCompetenceCenter for Methodology and Statistics, Translational Medicine Operations Hub, Luxembourg Institute of Health, Strassen, Luxembourg ,grid.33058.3d0000 0001 0155 5938KEMRI/ Wellcome Trust Research Programme, Kilifi, Kenya
| | - Magali Perquin
- grid.451012.30000 0004 0621 531XDepartment of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Valerie Moran
- grid.451012.30000 0004 0621 531XDepartment of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg ,grid.432900.c0000 0001 2215 8798Living Conditions Department, Luxembourg Institute of Socio-Economic Research, Esch-Sur-Alzette, Luxembourg
| | - Laetitia Huiart
- grid.451012.30000 0004 0621 531XDepartment of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Rejko Krüger
- grid.16008.3f0000 0001 2295 9843LCSB, Luxembourg Centre for System Biomedicine, University of Luxembourg, Esch-Sur-Alzette, Luxembourg ,grid.418041.80000 0004 0578 0421Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg ,grid.451012.30000 0004 0621 531XTransversal Translational Medicine, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Francisco Azuaje
- grid.451012.30000 0004 0621 531XBioinformatics Platform, Luxembourg Institute of Health, Strassen, Luxembourg ,grid.498322.6Genomics England, London, UK
| | - Cyril Ferdynus
- Methodological Support Unit, Félix Guyon University Hospital Center, Saint-Denis, La Réunion France
| | - Guy Fagherazzi
- grid.451012.30000 0004 0621 531XDeep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Talbert A, Ngari M, Obiero C, Nyaguara A, Mwangome M, Mturi N, Ouma N, Otiende M, Berkley J. Trends in inpatient and post-discharge mortality among young infants admitted to Kilifi County Hospital, Kenya: a retrospective cohort study. BMJ Open 2023; 13:e067482. [PMID: 36631234 PMCID: PMC9835934 DOI: 10.1136/bmjopen-2022-067482] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To describe admission trends and estimate inpatient and post-discharge mortality and its associated exposures, among young infants (YI) admitted to a county hospital in Kenya. DESIGN Retrospective cohort study. SETTING Secondary level hospital. PARTICIPANTS YI aged less than 60 days admitted to hospital from January 2009 to December 2019: 12 271 admissions in 11 877 individuals. YI who were resident within a Kilifi Health and Demographic Surveillance System (KHDSS): n=3625 with 4421 admissions were followed-up for 1 year after discharge. PRIMARY AND SECONDARY OUTCOME MEASURES Inpatient and 1-year post-discharge mortality, the latter in KHDSS residents. RESULTS Of 12 271 YI admissions, 4421 (36%) were KHDSS-resident. Neonatal sepsis, preterm complications and birth asphyxia accounted for 83% of the admissions. The proportion of YI among under-5s admissions increased from 19% in 2009 to 34% in 2019 (Ptrend=0.02). Inpatient case fatality was 16%, with 66% of the deaths occurring within 48 hours of admission. The introduction of free maternity care in 2013 was not associated with a change in admissions or inpatient mortality among YI. During 1-year post-discharge, 208/3625 (5.7%) YI died, 64.3 (95% CI 56.2 to 73.7) per 1000 infant-years. 49% of the post-discharge deaths occurred within 1 month of discharge, and 49% of post-discharge deaths occurred at home. Both inpatient and post-discharge deaths were associated with low admission weight. Inpatient mortality was associated with clinical signs of disease severity, while post-discharge mortality was associated with the length of hospitalisation, leaving against advice and referral to a specialised hospital. CONCLUSIONS YIs accounted for an increasing proportion of paediatric admissions and their overall mortality remains high. Post-discharge mortality accounts for a lower proportion of deaths but mortality rate is higher than among children aged 2-59 months. Services to address post-discharge mortality are needed and should focus on infants at higher risk.
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Affiliation(s)
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christina Obiero
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Amek Nyaguara
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Neema Mturi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Nelson Ouma
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, Oxfordshire, UK
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14
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Aguayo GA, Zhang L, Vaillant M, Ngari M, Perquin M, Moran V, Huiart L, Krüger R, Azuaje F, Ferdynus C, Fagherazzi G. Machine learning for predicting neurodegenerative diseases in the general older population: a cohort study. BMC Med Res Methodol 2023; 23:8. [PMID: 36631766 PMCID: PMC9832793 DOI: 10.1186/s12874-023-01837-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In the older general population, neurodegenerative diseases (NDs) are associated with increased disability, decreased physical and cognitive function. Detecting risk factors can help implement prevention measures. Using deep neural networks (DNNs), a machine-learning algorithm could be an alternative to Cox regression in tabular datasets with many predictive features. We aimed to compare the performance of different types of DNNs with regularized Cox proportional hazards models to predict NDs in the older general population. METHODS We performed a longitudinal analysis with participants of the English Longitudinal Study of Ageing. We included men and women with no NDs at baseline, aged 60 years and older, assessed every 2 years from 2004 to 2005 (wave2) to 2016-2017 (wave 8). The features were a set of 91 epidemiological and clinical baseline variables. The outcome was new events of Parkinson's, Alzheimer or dementia. After applying multiple imputations, we trained three DNN algorithms: Feedforward, TabTransformer, and Dense Convolutional (Densenet). In addition, we trained two algorithms based on Cox models: Elastic Net regularization (CoxEn) and selected features (CoxSf). RESULTS 5433 participants were included in wave 2. During follow-up, 12.7% participants developed NDs. Although the five models predicted NDs events, the discriminative ability was superior using TabTransformer (Uno's C-statistic (coefficient (95% confidence intervals)) 0.757 (0.702, 0.805). TabTransformer showed superior time-dependent balanced accuracy (0.834 (0.779, 0.889)) and specificity (0.855 (0.0.773, 0.909)) than the other models. With the CoxSf (hazard ratio (95% confidence intervals)), age (10.0 (6.9, 14.7)), poor hearing (1.3 (1.1, 1.5)) and weight loss 1.3 (1.1, 1.6)) were associated with a higher DNN risk. In contrast, executive function (0.3 (0.2, 0.6)), memory (0, 0, 0.1)), increased gait speed (0.2, (0.1, 0.4)), vigorous physical activity (0.7, 0.6, 0.9)) and higher BMI (0.4 (0.2, 0.8)) were associated with a lower DNN risk. CONCLUSION TabTransformer is promising for prediction of NDs with heterogeneous tabular datasets with numerous features. Moreover, it can handle censored data. However, Cox models perform well and are easier to interpret than DNNs. Therefore, they are still a good choice for NDs.
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Affiliation(s)
- Gloria A. Aguayo
- grid.451012.30000 0004 0621 531XDeep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Lu Zhang
- grid.451012.30000 0004 0621 531XBioinformatics Platform, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Michel Vaillant
- grid.451012.30000 0004 0621 531XCompetence Center for Methodology and Statistics, Translational Medicine Operations Hub, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Moses Ngari
- grid.451012.30000 0004 0621 531XCompetence Center for Methodology and Statistics, Translational Medicine Operations Hub, Luxembourg Institute of Health, Strassen, Luxembourg ,grid.33058.3d0000 0001 0155 5938KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Magali Perquin
- grid.451012.30000 0004 0621 531XDepartment of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Valerie Moran
- grid.451012.30000 0004 0621 531XDepartment of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg ,grid.432900.c0000 0001 2215 8798Living Conditions Department, Luxembourg Institute of Socio-Economic Research, Esch-Sur-Alzette, Luxembourg
| | - Laetitia Huiart
- grid.451012.30000 0004 0621 531XDepartment of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Rejko Krüger
- grid.16008.3f0000 0001 2295 9843LCSB, Luxembourg Centre for System Biomedicine, University of Luxembourg, Esch-Sur-Alzette, Luxembourg ,grid.418041.80000 0004 0578 0421Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg ,grid.451012.30000 0004 0621 531XTransversal Translational Medicine, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Francisco Azuaje
- grid.451012.30000 0004 0621 531XBioinformatics Platform, Luxembourg Institute of Health, Strassen, Luxembourg ,grid.498322.6Genomics England, London, UK
| | - Cyril Ferdynus
- Methodological Support Unit, Félix Guyon University Hospital Center, Saint-Denis, La Réunion France
| | - Guy Fagherazzi
- grid.451012.30000 0004 0621 531XDeep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Agoti CN, Curran MD, Murunga N, Ngari M, Muthumbi E, Lambisia AW, Frost SDW, Blacklaws BA, Nokes DJ, Drumright LN. Differences in epidemiology of enteropathogens in children pre- and post-rotavirus vaccine introduction in Kilifi, coastal Kenya. Gut Pathog 2022; 14:32. [PMID: 35915480 PMCID: PMC9340678 DOI: 10.1186/s13099-022-00506-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Kenya introduced Rotarix® (GlaxoSmithKline Biologicals, Rixensart, Belgium) vaccination into its national immunization programme beginning July 2014. The impact of this vaccination program on the local epidemiology of various known enteropathogens is not fully understood. Methods We used a custom TaqMan Array Card (TAC) to screen for 28 different enteropathogens in 718 stools from children aged less than 13 years admitted to Kilifi County Hospital, coastal Kenya, following presentation with diarrhea in 2013 (before vaccine introduction) and in 2016–2018 (after vaccine introduction). Pathogen positivity rate differences between pre- and post-Rotarix® vaccination introduction were examined using both univariate and multivariable logistic regression models. Results In 665 specimens (92.6%), one or more enteropathogen was detected, while in 323 specimens (48.6%) three or more enteropathogens were detected. The top six detected enteropathogens were: enteroaggregative Escherichia coli (EAggEC; 42.1%), enteropathogenic Escherichia coli (EPEC; 30.2%), enterovirus (26.9%), rotavirus group A (RVA; 24.8%), parechovirus (16.6%) and norovirus GI/GII (14.4%). Post-rotavirus vaccine introduction, there was a significant increase in the proportion of samples testing positive for EAggEC (35.7% vs. 45.3%, p = 0.014), cytomegalovirus (4.2% vs. 9.9%, p = 0.008), Vibrio cholerae (0.0% vs. 2.3%, p = 0.019), Strongyloides species (0.8% vs. 3.6%, p = 0.048) and Dientamoeba fragilis (2.1% vs. 7.8%, p = 0.004). Although not reaching statistical significance, the positivity rate of adenovirus 40/41 (5.8% vs. 7.3%, p = 0.444), norovirus GI/GII (11.2% vs. 15.9%, p = 0.089), Shigella species (8.7% vs. 13.0%, p = 0.092) and Cryptosporidium spp. (11.6% vs. 14.7%, p = 0.261) appeared to increase post-vaccine introduction. Conversely, the positivity rate of sapovirus decreased significantly post-vaccine introduction (7.8% vs. 4.0%, p = 0.030) while that of RVA appeared not to change (27.4% vs. 23.5%, p = 0.253). More enteropathogen coinfections were detected per child post-vaccine introduction compared to before (mean: 2.7 vs. 2.3; p = 0.0025). Conclusions In this rural Coastal Kenya setting, childhood enteropathogen infection burden was high both pre- and post-rotavirus vaccination introduction. Children who had diarrheal admissions post-vaccination showed an increase in coinfections and changes in specific enteropathogen positivity rates. This study highlights the utility of multipathogen detection platforms such as TAC in understanding etiology of childhood acute gastroenteritis in resource-limited regions. Supplementary Information The online version contains supplementary material available at 10.1186/s13099-022-00506-z.
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Njunge JM, Tickell K, Diallo AH, Sayeem Bin Shahid ASM, Gazi MA, Saleem A, Kazi Z, Ali S, Tigoi C, Mupere E, Lancioni CL, Yoshioka E, Chisti MJ, Mburu M, Ngari M, Ngao N, Gichuki B, Omer E, Gumbi W, Singa B, Bandsma R, Ahmed T, Voskuijl W, Williams TN, Macharia A, Makale J, Mitchel A, Williams J, Gogain J, Janjic N, Mandal R, Wishart DS, Wu H, Xia L, Routledge M, Gong YY, Espinosa C, Aghaeepour N, Liu J, Houpt E, Lawley TD, Browne H, Shao Y, Rwigi D, Kariuki K, Kaburu T, Uhlig HH, Gartner L, Jones K, Koulman A, Walson J, Berkley J. The Childhood Acute Illness and Nutrition (CHAIN) network nested case-cohort study protocol: a multi-omics approach to understanding mortality among children in sub-Saharan Africa and South Asia. Gates Open Res 2022; 6:77. [PMID: 36415883 PMCID: PMC9646488 DOI: 10.12688/gatesopenres.13635.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 08/10/2023] Open
Abstract
Introduction: Many acutely ill children in low- and middle-income settings have a high risk of mortality both during and after hospitalisation despite guideline-based care. Understanding the biological mechanisms underpinning mortality may suggest optimal pathways to target for interventions to further reduce mortality. The Childhood Acute Illness and Nutrition (CHAIN) Network ( www.chainnnetwork.org) Nested Case-Cohort Study (CNCC) aims to investigate biological mechanisms leading to inpatient and post-discharge mortality through an integrated multi-omic approach. Methods and analysis; The CNCC comprises a subset of participants from the CHAIN cohort (1278/3101 hospitalised participants, including 350 children who died and 658 survivors, and 270/1140 well community children of similar age and household location) from nine sites in six countries across sub-Saharan Africa and South Asia. Systemic proteome, metabolome, lipidome, lipopolysaccharides, haemoglobin variants, toxins, pathogens, intestinal microbiome and biomarkers of enteropathy will be determined. Computational systems biology analysis will include machine learning and multivariate predictive modelling with stacked generalization approaches accounting for the different characteristics of each biological modality. This systems approach is anticipated to yield mechanistic insights, show interactions and behaviours of the components of biological entities, and help develop interventions to reduce mortality among acutely ill children. Ethics and dissemination. The CHAIN Network cohort and CNCC was approved by institutional review boards of all partner sites. Results will be published in open access, peer reviewed scientific journals and presented to academic and policy stakeholders. Data will be made publicly available, including uploading to recognised omics databases. Trial registration NCT03208725.
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Affiliation(s)
- James M. Njunge
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kirkby Tickell
- Global Health and Epidemiology, University of Washington, Seattle, Seattle, USA
| | - Abdoulaye Hama Diallo
- Department of Public Health, Faculty of Health Sciences, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Md. Amran Gazi
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ali Saleem
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Karachi, Pakistan
| | - Zaubina Kazi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Karachi, Pakistan
| | - Syed Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Karachi, Pakistan
| | - Caroline Tigoi
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Emily Yoshioka
- Global Health and Epidemiology, University of Washington, Seattle, Seattle, USA
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Moses Mburu
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Narshion Ngao
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bonface Gichuki
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elisha Omer
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Wilson Gumbi
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Bandsma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Biomedical Sciences, University of Malawi College of Medicine, Blantyre, Malawi
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Wieger Voskuijl
- Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Centre for Global Child Health & Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Thomas N. Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Macharia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | | | | | - Rupasri Mandal
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David S. Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Hang Wu
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lei Xia
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Michael Routledge
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, China
| | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Camilo Espinosa
- Departments of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Nima Aghaeepour
- Departments of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Yan Shao
- Wellcome Sanger Institute, Hinxton, UK
| | - Doreen Rwigi
- The Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kevin Kariuki
- The Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Timothy Kaburu
- The Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Holm H. Uhlig
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Department of Paediatrics and Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lisa Gartner
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kelsey Jones
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
| | - Albert Koulman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge, UK
| | - Judd Walson
- Global Health and Epidemiology, University of Washington, Seattle, Seattle, USA
| | - James Berkley
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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17
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Mwamuye IC, Karanja S, Msanzu JB, Adem A, Kerich M, Ngari M. Factors associated with poor outcomes among people living with HIV started on anti-retroviral therapy before and after implementation of “test and treat” program in Coastal Kenya. PLoS One 2022; 17:e0270653. [PMID: 36129876 PMCID: PMC9491584 DOI: 10.1371/journal.pone.0270653] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To determine the factors associated with poor outcomes among people living with HIV (PLHIV) started on anti- retroviral therapy before and after implementation of “Test and treat” program in 18 facilities in Coastal Kenya. Methods A retrospective cohort study design was used to study PLHIV aged > 15 years and started on ART in the periods of April to August 2016, and April to August 2017, then followed up for 24 months. Primary outcome was retention defined as being alive and on ARVs after 24 months. Death and loss to follow-up were considered as poor outcomes. Kaplan–Meier survival methods were used to describe time to primary outcome. Cox proportional regression analysis was used to determine factors associated with poor outcomes. Results 86 patients (470 before test and treat, and 316 after test and treat cohorts) were enrolled. Overall, the median [IQR] age was 39.3 [32.5–47.5] years and 539 (69%) were female. After 24 months, retention rates for the before (68%) and after (64%) test and start groups were similar (absolute difference: -4.0%, 95%CI: -11-3.1, P = 0.27). There were 240(31%, 95%CI 27 to 34%) PLHIV with poor outcomes, 102 (32%) and 138 (29%) occurred among the test and treat group, and delayed treatment patients respectively. In multivariable regression model, test and treat had no significant effect on risk of poor outcomes (aHR = 1.17, 95%CI 0.89–1.54). Increasing age (aHR = 0.98, 95%CI 0.97–0.99), formal employment (aHR = 0.42, 95%CI 0.23–0.76) and not being employed (aHR = 0.53, 95%CI 0.34–0.81) were negatively associated with poor outcomes. The risk of poor outcomes was higher among males compared to female patients (aHR = 1.37, 95%CI 1.03–1.82) and among divorced/separated patients compared to the married (aHR = 1.44, 95%CI 1.04–1.99). Conclusion Retention patterns for the “test and treat” cohort were comparable to those who started ART before “test and treat”. Patients who are males, young, divorced/separated, with poor socio-economic status had higher risks for poor clinical outcomes. Interventions targeting PLHIV who are young, male and economically disadvantaged provide an opportunity to improve the long-term outcomes.
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Affiliation(s)
- Isaac Chome Mwamuye
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
- * E-mail:
| | - Simon Karanja
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | | | - Aggrey Adem
- Technical University of Mombasa, Mombasa, Kenya
| | - Mary Kerich
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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18
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Engh MS, Muhoozi GKM, Ngari M, Skaare AB, Westerberg AC, Iversen PO, Brusevold IJ, Atukunda P. Long-Term Effects of a Randomized Maternal Education Trial in Rural Uganda: Implications for Child Oral Health. Am J Trop Med Hyg 2022; 107:939-947. [PMID: 36067985 DOI: 10.4269/ajtmh.22-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/04/2022] [Indexed: 11/07/2022] Open
Abstract
The aim was to examine oral health among 5-6-year-old children whose mothers participated in a 6 months' cluster-randomized education trial in rural Uganda starting when their children were 6-8 months old. The education focused on nutrition, oral hygiene, and child stimulation. In the current follow-up study, 357/511 (70%) children from the original trial were available for data collection (200 in the intervention and 157 in the control group). Molar caries was assessed on intraoral photographs. Children and/or caregivers answered a WHO health questionnaire for collection of oral data. Dental practices were compared between the intervention and control group using multilevel mixed effect logistic regression accounting for clustering. The children in the intervention group had less caries compared with the control group: 41% versus 60% (odds ratio [OR] 0.46; 95% confidence intervals [CI] 0.24-0.86, P = 0.02). The use of toothbrush to clean teeth was more frequent in the intervention than in the control group: 66% versus 38% (OR 3.39; 95% CI 1.54-7.45, P = 0.003), as was high teeth-cleaning frequency: 74% versus 62% (OR 1.72; 95% CI 1.09-2.69, P = 0.02). Self-reported problems such as toothache (10% versus 19%), difficulty biting (12% versus 24%) and chewing food (8.5% versus 18%) were significantly less frequent among children in the intervention compared with the control group. No significant differences were found in dietary habits. Our data shows that an educational intervention adjusted to a low-resource setting, provided in infancy, resulted in improved oral hygiene and reduced development of dental caries among children aged 5-6 years.
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Affiliation(s)
- Marit S Engh
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Grace K M Muhoozi
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya; KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anne B Skaare
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway.,Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway.,Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Ingvild J Brusevold
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Prudence Atukunda
- Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
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19
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Njunge JM, Tickell K, Diallo AH, Sayeem Bin Shahid ASM, Gazi MA, Saleem A, Kazi Z, Ali S, Tigoi C, Mupere E, Lancioni CL, Yoshioka E, Chisti MJ, Mburu M, Ngari M, Ngao N, Gichuki B, Omer E, Gumbi W, Singa B, Bandsma R, Ahmed T, Voskuijl W, Williams TN, Macharia A, Makale J, Mitchel A, Williams J, Gogain J, Janjic N, Mandal R, Wishart DS, Wu H, Xia L, Routledge M, Gong YY, Espinosa C, Aghaeepour N, Liu J, Houpt E, Lawley TD, Browne H, Shao Y, Rwigi D, Kariuki K, Kaburu T, Uhlig HH, Gartner L, Jones K, Koulman A, Walson J, Berkley J. The Childhood Acute Illness and Nutrition (CHAIN) network nested case-cohort study protocol: a multi-omics approach to understanding mortality among children in sub-Saharan Africa and South Asia. Gates Open Res 2022; 6:77. [PMID: 36415883 PMCID: PMC9646488 DOI: 10.12688/gatesopenres.13635.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 02/15/2024] Open
Abstract
Introduction: Many acutely ill children in low- and middle-income settings have a high risk of mortality both during and after hospitalisation despite guideline-based care. Understanding the biological mechanisms underpinning mortality may suggest optimal pathways to target for interventions to further reduce mortality. The Childhood Acute Illness and Nutrition (CHAIN) Network ( www.chainnnetwork.org) Nested Case-Cohort Study (CNCC) aims to investigate biological mechanisms leading to inpatient and post-discharge mortality through an integrated multi-omic approach. Methods and analysis; The CNCC comprises a subset of participants from the CHAIN cohort (1278/3101 hospitalised participants, including 350 children who died and 658 survivors, and 270/1140 well community children of similar age and household location) from nine sites in six countries across sub-Saharan Africa and South Asia. Systemic proteome, metabolome, lipidome, lipopolysaccharides, haemoglobin variants, toxins, pathogens, intestinal microbiome and biomarkers of enteropathy will be determined. Computational systems biology analysis will include machine learning and multivariate predictive modelling with stacked generalization approaches accounting for the different characteristics of each biological modality. This systems approach is anticipated to yield mechanistic insights, show interactions and behaviours of the components of biological entities, and help develop interventions to reduce mortality among acutely ill children. Ethics and dissemination. The CHAIN Network cohort and CNCC was approved by institutional review boards of all partner sites. Results will be published in open access, peer reviewed scientific journals and presented to academic and policy stakeholders. Data will be made publicly available, including uploading to recognised omics databases. Trial registration NCT03208725.
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Affiliation(s)
- James M. Njunge
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kirkby Tickell
- Global Health and Epidemiology, University of Washington, Seattle, Seattle, USA
| | - Abdoulaye Hama Diallo
- Department of Public Health, Faculty of Health Sciences, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Md. Amran Gazi
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ali Saleem
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Karachi, Pakistan
| | - Zaubina Kazi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Karachi, Pakistan
| | - Syed Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Karachi, Pakistan
| | - Caroline Tigoi
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Emily Yoshioka
- Global Health and Epidemiology, University of Washington, Seattle, Seattle, USA
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Moses Mburu
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Narshion Ngao
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bonface Gichuki
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elisha Omer
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Wilson Gumbi
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benson Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Bandsma
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Biomedical Sciences, University of Malawi College of Medicine, Blantyre, Malawi
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Wieger Voskuijl
- Amsterdam UMC location, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Centre for Global Child Health & Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Thomas N. Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alex Macharia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | | | | | - Rupasri Mandal
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David S. Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Hang Wu
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lei Xia
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Michael Routledge
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, China
| | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Camilo Espinosa
- Departments of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Nima Aghaeepour
- Departments of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Yan Shao
- Wellcome Sanger Institute, Hinxton, UK
| | - Doreen Rwigi
- The Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kevin Kariuki
- The Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Timothy Kaburu
- The Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Holm H. Uhlig
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Department of Paediatrics and Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Lisa Gartner
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Kelsey Jones
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Gastroenterology Department, Great Ormond Street Hospital for Children, London, UK
| | - Albert Koulman
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge, UK
| | - Judd Walson
- Global Health and Epidemiology, University of Washington, Seattle, Seattle, USA
| | - James Berkley
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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20
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Crane RJ, Parker EP, Fleming S, Gwela A, Gumbi W, Ngoi JM, de Laurent ZR, Nyatichi E, Ngari M, Wambua J, Uhlig HH, Berkley JA. Cessation of exclusive breastfeeding and seasonality, but not small intestinal bacterial overgrowth, are associated with environmental enteric dysfunction: A birth cohort study amongst infants in rural Kenya. EClinicalMedicine 2022; 47:101403. [PMID: 35497062 PMCID: PMC9046123 DOI: 10.1016/j.eclinm.2022.101403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Environmental Enteric Dysfunction (EED) is a chronic intestinal inflammatory disorder of unclear aetiology prevalent amongst children in low-income settings and associated with stunting. We aimed to characterise development of EED and its putative risk factors amongst rural Kenyan infants. METHODS In a birth cohort study in Junju, rural coastal Kenya, between August 2015 and January 2017, 100 infants were each followed for nine months. Breastfeeding status was recorded weekly and anthropometry monthly. Acute illnesses and antibiotics were captured by active and passive surveillance. Intestinal function and small intestinal bacterial overgrowth (SIBO) were assessed by monthly urinary lactulose mannitol (LM) and breath hydrogen tests. Faecal alpha-1-antitrypsin, myeloperoxidase and neopterin were measured as EED biomarkers, and microbiota composition assessed by 16S sequencing. FINDINGS Twenty nine of the 88 participants (33%) that underwent length measurement at nine months of age were stunted (length-for-age Z score <-2). During the rainy season, linear growth was slower and LM ratio was higher. In multivariable models, LM ratio, myeloperoxidase and neopterin increased after cessation of continuous-since-birth exclusive breastfeeding. For LM ratio this only occurred during the rainy season. EED markers were not associated with antibiotics, acute illnesses, SIBO, or gut microbiota diversity. Microbiota diversified with age and was not strongly associated with complementary food introduction or linear growth impairment. INTERPRETATION Our data suggest that intensified promotion of uninterrupted exclusive breastfeeding amongst infants under six months during the rainy season, where rainfall is seasonal, may help prevent EED. Our findings also suggest that therapeutic strategies directed towards SIBO are unlikely to impact on EED in this setting. However, further development of non-invasive diagnostic methods for SIBO is required. FUNDING This research was funded in part by the Wellcome Trust (Research Training Fellowship to RJC (103376/Z/13/Z)). EPKP was supported by the MRC/DfID Newton Fund (MR/N006259/1). JAB was supported by the MRC/DFiD/Wellcome Trust Joint Global Health Trials scheme (MR/M007367/1) and the Bill & Melinda Gates Foundation (OPP1131320). HHU was supported by the NIHR Oxford Biomedical Research Centre (IS-BRC-1215-20008).
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Affiliation(s)
- Rosie J. Crane
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LG, UK
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
- Corresponding author at: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LG, UK.
| | - Edward P.K. Parker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Simon Fleming
- Royal Cornwall Hospitals NHS Trust, Treliske, Truro TR1 3LQ, UK
| | - Agnes Gwela
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
| | - Wilson Gumbi
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
| | - Joyce M. Ngoi
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, PO Box LG54, Accra, Ghana
| | | | - Emily Nyatichi
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, P.O Box 43640 – 00100, Nairobi, Kenya
| | - Juliana Wambua
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
| | - Holm H. Uhlig
- Translational Gastroenterology Unit, University of Oxford, Oxford OX3 9DU, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK
| | - James A. Berkley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LG, UK
- KEMRI Wellcome Trust Research Programme, PO Box 80108-230, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, P.O Box 43640 – 00100, Nairobi, Kenya
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21
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Gonzales GB, Njunge JM, Gichuki BM, Wen B, Ngari M, Potani I, Thitiri J, Laukens D, Voskuijl W, Bandsma R, Vanmassenhove J, Berkley JA. The role of albumin and the extracellular matrix on the pathophysiology of oedema formation in severe malnutrition. EBioMedicine 2022; 79:103991. [PMID: 35398787 PMCID: PMC9014367 DOI: 10.1016/j.ebiom.2022.103991] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 12/22/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND While fluid flows in a steady state from plasma, through interstitium, and into the lymph compartment, altered fluid distribution and oedema can result from abnormal Starling's forces, increased endothelial permeability or impaired lymphatic drainage. The mechanism of oedema formation, especially the primary role of hypoalbuminaemia, remains controversial. Here, we explored the roles of albumin and albumin-independent mechanisms in oedema formation among children with severe malnutrition (SM). METHODS We performed secondary analysis of data obtained from two independent clinical trials in Malawi and Kenya (NCT02246296 and NCT00934492). We then used an unconventional strategy of comparing children with kwashiorkor and marasmus by matching (discovery cohort, n = 144) and normalising (validation cohort, n = 98, 2 time points) for serum albumin. Untargeted proteomics was used in the discovery cohort to determine plausible albumin-independent mechanisms associated with oedema, which was validated using enzyme-linked immunosorbent assay and multiplex assays in the validation cohort. FINDINGS We demonstrated that low serum albumin is necessary but not sufficient to develop oedema in SM. We further found that markers of extracellular matrix (ECM) degradation rather than markers of EG degradation distinguished oedematous and non-oedematous children with SM. INTERPRETATION Our results show that oedema formation has both albumin-dependent and independent mechanisms. ECM integrity appears to have a greater role in oedema formation than EG shedding in SM. FUNDING Research Foundation Flanders (FWO), Thrasher Foundation (15122 and 9403), VLIR-UOS-Ghent University Global Minds Fund, Bill & Melinda Gates Foundation (OPP1131320), MRC/DfID/Wellcome Trust Global Health Trials Scheme (MR/M007367/1), Canadian Institutes of Health Research (156307), Wellcome Trust (WT083579MA).
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Affiliation(s)
- Gerard Bryan Gonzales
- Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherland,Department of Internal Medicine and Paediatrics, Laboratory of Gastroenterology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,VIB-UGent Center for Inflammation Research, Ghent, Belgium,Corresponding author at: Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherland.
| | - James M. Njunge
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya,Corresponding author at: The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
| | - Bonface M Gichuki
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bijun Wen
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Isabel Potani
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada,Kamuzu University of Health Sciences (Former College of Medicine), Blantyre, Malawi
| | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Debby Laukens
- Department of Internal Medicine and Paediatrics, Laboratory of Gastroenterology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,Kamuzu University of Health Sciences (Former College of Medicine), Blantyre, Malawi,Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherland,Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, the Netherland
| | - Robert Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada,Kamuzu University of Health Sciences (Former College of Medicine), Blantyre, Malawi
| | - Jill Vanmassenhove
- Department of Internal Medicine and Paediatrics, Renal Division, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya,Nuffield Department of Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
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22
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Wen B, Njunge JM, Bourdon C, Gonzales GB, Gichuki BM, Lee D, Wishart DS, Ngari M, Chimwezi E, Thitiri J, Mwalekwa L, Voskuijl W, Berkley JA, Bandsma RHJ. Systemic inflammation and metabolic disturbances underlie inpatient mortality among ill children with severe malnutrition. Sci Adv 2022; 8:eabj6779. [PMID: 35171682 PMCID: PMC8849276 DOI: 10.1126/sciadv.abj6779] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Children admitted to hospital with an acute illness and concurrent severe malnutrition [complicated severe malnutrition (CSM)] have a high risk of dying. The biological processes underlying their mortality are poorly understood. In this case-control study nested within a multicenter randomized controlled trial among children with CSM in Kenya and Malawi, we found that blood metabolomic and proteomic profiles robustly differentiated children who died (n = 92) from those who survived (n = 92). Fatalities were characterized by increased energetic substrates (tricarboxylic acid cycle metabolites), microbial metabolites (e.g., propionate and isobutyrate), acute phase proteins (e.g., calprotectin and C-reactive protein), and inflammatory markers (e.g., interleukin-8 and tumor necrosis factor-α). These perturbations indicated disruptions in mitochondria-related bioenergetic pathways and sepsis-like responses. This study identified specific biomolecular disturbances associated with CSM mortality, revealing that systemic inflammation and bioenergetic deficits are targetable pathophysiological processes for improving survival of this vulnerable population.
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Affiliation(s)
- Bijun Wen
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
| | - James M. Njunge
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Celine Bourdon
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Gerard Bryan Gonzales
- Nutrition, Metabolism and Genomics Group, Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Bonface M. Gichuki
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dorothy Lee
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
| | | | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Laura Mwalekwa
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Paediatrics, Coast General Hospital, Mombasa, Kenya
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, Netherlands
- Department of Pediatrics, the College of Medicine, University of Malawi, Blantyre, Malawi
| | - James A. Berkley
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert HJ Bandsma
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Translational medicine, Hospital for Sick Children, Toronto, Canada
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Department of Pediatrics, the College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Biomedical Sciences, the College of Medicine, University of Malawi, Blantyre, Malawi
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Katana GG, Ngari M, Maina T, Sanga D, Abdullahi OA. Tuberculosis poor treatment outcomes and its determinants in Kilifi County, Kenya: a retrospective cohort study from 2012 to 2019. Arch Public Health 2022; 80:48. [PMID: 35123570 PMCID: PMC8818215 DOI: 10.1186/s13690-022-00807-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. The study aimed to evaluate proportion of poor TB treatment outcomes (PTO) and its determinants during six-months of treatment at Kilifi County, Kenya. Methods We conducted a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful treatment (cured or completed treatment). We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO. Results We included 14,706 TB patients, their median (IQR) age was 37
(28–50) years and 8,791 (60%) were males. A total of 13,389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4,242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 78,882 person-months of follow-up, 2,408 (16%) patients had PTO: 1,074 (7.3%) deaths, 776 (5.3%) LTFU, 415 (2.8%) transferred out, 103 (0.7%) treatment failure and 30 (0.2%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P = 0.03). Over two-thirds 1,734 (72%) poor outcomes occurred within first three months of follow-up. In the first three months of TB treatment, overweight ((aHR 0.85 (95%CI 0.73–0.98), HIV infected not on ARVS (aHR 1.72 (95% CI 1.28–2.30)) and year of starting treatment were associated with PTO. However, in the last three months of treatment, elderly age ≥50 years (aHR 1.26 (95%CI 1.02–1.55), a retreatment patient (aHR 1.57 (95%CI 1.28–1.93), HIV infected not on ARVs (aHR 2.56 (95%CI 1.39–4.72), other underlying medical conditions (aHR 2.24 (95%CI 1.41–3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70–0.97)) was negatively associated with PTO. Conclusions Over two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Interventions targeting HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00807-4.
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24
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Phyllys K, Ziro OW, Kissinger G, Ngari M, Budambula NLM, Budambula V. Poly-drug use among female and male commercial sex workers visiting a drop in centre in Mombasa County, Kenya. PLOS Glob Public Health 2022; 2:e0001247. [PMID: 36962634 PMCID: PMC10045590 DOI: 10.1371/journal.pgph.0001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022]
Abstract
The relationship between commercial sex work and drug use is complex and the two exacerbate each other. In Kenya, Mombasa County has one of the highest populations of drug users and commercial sex workers. Despite documentation of drug use among sex workers, most of the studies are based on self-reported history which is prone to social desirability and memory recall biases. It is in this context that we sought to establish actual drug use is this sub-population. A cross-sectional study was conducted to determine self-reported and confirmed drug use among 224 commercial sex workers accessing services at Mvita Drop-in. Actual drug use was determined qualitatively using 6 panel plus alcohol Saliva Test kit. The overall prevalence of self-reported and confirmed current use for at least one drug was 98% and 99% respectively. Regardless of the technique used, alcohol and tobacco products were the most consumed substances. Alcohol use increased significantly with age (P = 0.03). Risk of cigarette use and testing positive for cotinine was higher among those age 18 to 35 years compared to >35years at P = 0.001 and P = 0.002 respectively. Poly-drug use was common with 98% testing positive for more than one drug. The reason for drug use was sex work related pressure (88%) with 60% of the respondents reporting they cannot transact this business without drugs. Almost every commercial sex worker is a poly-drug user. We recommend targeted interventions for commercial sex workers.
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Affiliation(s)
- Kemunto Phyllys
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Onesmus Wanje Ziro
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - George Kissinger
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
| | | | - Valentine Budambula
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
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25
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Maina T, Willetts A, Ngari M, Osman A. Tuberculosis infection among youths in overcrowded university hostels in Kenya: a cross-sectional study. Trop Med Health 2021; 49:100. [PMID: 34961552 PMCID: PMC8714442 DOI: 10.1186/s41182-021-00391-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) remains a top global health problem and its transmission rate among contacts is higher when they are cohabiting with a person who is sputum smear-positive. Our study aimed to describe the prevalence of TB among student contacts in the university and determine factors associated with TB transmission. Methods We performed a cross-sectional study with an active contact case finding approach among students receiving treatment at Kilifi County Hospital from January 2016 to December 2017. The study was conducted in a public university in Kilifi County, a rural area within the resource-limited context of Kenya. The study population included students attending the university and identified as sharing accommodation or off-campus hostels, or a close social contact to an index case. The index case was defined as a fellow university student diagnosed with TB at the Kilifi County Hospital during the study period. Contacts were traced and tested for TB using GeneXpert. Results Among the 57 eligible index students identified, 51 (89%) agreed to participate. A total of 156 student contacts were recruited, screened and provided a sputum sample. The prevalence of TB (GeneXpert test positive/clinical diagnosis) among all contacts was 8.3% (95% CI 4.5–14%). Among the 8.3% testing positive 3.2% (95% CI 1.0–7.3%) were positive for GeneXpert only. Sharing a bed with an index case was the only factor significantly associated with TB infection. No other demographic or clinical factor was associated with TB infection. Conclusion Our study identified a high level of TB transmission among university students who had contact with the index cases. The study justifies further research to explore the genetic sequence and magnitude of TB transmission among students in overcrowded university in resource limited contexts.
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Affiliation(s)
- Teresia Maina
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya
| | - Annie Willetts
- Institute of Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Moses Ngari
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya.,Clinical Research Department, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Abdullahi Osman
- Department of Public Health, School of Health and Human Sciences, Pwani University, P.O Box 196-80108, Kilifi, Kenya.
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26
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Wen B, Brals D, Bourdon C, Erdman L, Ngari M, Chimwezi E, Potani I, Thitiri J, Mwalekwa L, Berkley JA, Bandsma RHJ, Voskuijl W. Predicting the risk of mortality during hospitalization in sick severely malnourished children using daily evaluation of key clinical warning signs. BMC Med 2021; 19:222. [PMID: 34538239 PMCID: PMC8451091 DOI: 10.1186/s12916-021-02074-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite adherence to WHO guidelines, inpatient mortality among sick children admitted to hospital with complicated severe acute malnutrition (SAM) remains unacceptably high. Several studies have examined risk factors present at admission for mortality. However, risks may evolve during admission with medical and nutritional treatment or deterioration. Currently, no specific guidance exists for assessing daily treatment response. This study aimed to determine the prognostic value of monitoring clinical signs on a daily basis for assessing mortality risk during hospitalization in children with SAM. METHODS This is a secondary analysis of data from a randomized trial (NCT02246296) among 843 hospitalized children with SAM. Daily clinical signs were prospectively collected during ward rounds. Multivariable extended Cox regression using backward feature selection was performed to identify daily clinical warning signs (CWS) associated with time to death within the first 21 days of hospitalization. Predictive models were subsequently developed, and their prognostic performance evaluated using Harrell's concordance index (C-index) and time-dependent area under the curve (tAUC). RESULTS Inpatient case fatality ratio was 16.3% (n=127). The presence of the following CWS during daily assessment were found to be independent predictors of inpatient mortality: symptomatic hypoglycemia, reduced consciousness, chest indrawing, not able to complete feeds, nutritional edema, diarrhea, and fever. Daily risk scores computed using these 7 CWS together with MUAC<10.5cm at admission as additional CWS predict survival outcome of children with SAM with a C-index of 0.81 (95% CI 0.77-0.86). Moreover, counting signs among the top 5 CWS (reduced consciousness, symptomatic hypoglycemia, chest indrawing, not able to complete foods, and MUAC<10.5cm) provided a simpler tool with similar prognostic performance (C-index of 0.79; 95% CI 0.74-0.84). Having 1 or 2 of these CWS on any day during hospitalization was associated with a 3 or 11-fold increased mortality risk compared with no signs, respectively. CONCLUSIONS This study provides evidence for structured monitoring of daily CWS as recommended clinical practice as it improves prediction of inpatient mortality among sick children with complicated SAM. We propose a simple counting-tool to guide healthcare workers to assess treatment response for these children. TRIAL REGISTRATION NCT02246296.
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Affiliation(s)
- Bijun Wen
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Daniella Brals
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Celine Bourdon
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Lauren Erdman
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Clinical Research Department, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emmanuel Chimwezi
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Department of Paediatrics, Kamuzu University of Health Sciences, formerly College of Medicine, University of Malawi, Blantyre, Malawi
| | - Isabel Potani
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Paediatrics, Kamuzu University of Health Sciences, formerly College of Medicine, University of Malawi, Blantyre, Malawi
| | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Clinical Research Department, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Laura Mwalekwa
- Clinical Research Department, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Paediatrics, Coast General Hospital, Mombasa, Kenya
| | - James A Berkley
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Clinical Research Department, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Paediatrics, Coast General Hospital, Mombasa, Kenya.,Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert H J Bandsma
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Department of Paediatrics, Kamuzu University of Health Sciences, formerly College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Biomedical Sciences, Kamuzu University of Health Sciences, formerly College of Medicine, University of Malawi, Blantyre, Malawi
| | - Wieger Voskuijl
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Centres, Amsterdam, The Netherlands. .,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya. .,Department of Paediatrics, Kamuzu University of Health Sciences, formerly College of Medicine, University of Malawi, Blantyre, Malawi. .,Amsterdam Center for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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27
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Atukunda P, Ngari M, Chen X, Westerberg AC, Iversen PO, Muhoozi G. Longitudinal assessments of child growth: A six-year follow-up of a cluster-randomized maternal education trial. Clin Nutr 2021; 40:5106-5113. [PMID: 34461584 PMCID: PMC7613314 DOI: 10.1016/j.clnu.2021.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/29/2021] [Accepted: 08/14/2021] [Indexed: 11/29/2022]
Abstract
Background & aims Child growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60−72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6−8 months old with data collection at 20−24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation. Methods We measured growth using anthropometry converted to z-scores according to WHO guidelines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care). Results Of the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60−72 months, except that children in the intervention group had lower (P = 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60−72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60−72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings. Conclusion In this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition. Trial registration Clinical Trials (clinical trials.gov) ClinicalTrials.gov ID NCT 02098031.
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Affiliation(s)
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya; KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Xi Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway; Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
| | - Per O Iversen
- Department of Nutrition, University of Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway; Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa.
| | - Grace Muhoozi
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda.
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28
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Mwangome M, Ngari M, Bahwere P, Kabore P, McGrath M, Berkley JA. Growth monitoring and mortality risk in low birthweight infants: a birth cohort study in Burkina Faso. Gates Open Res 2021; 5:82. [PMID: 38544843 PMCID: PMC10967696 DOI: 10.12688/gatesopenres.13231.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 04/21/2024] Open
Abstract
Background: Wasting and underweight in infancy is an increasingly recognised problem but consensus on optimum assessment is lacking. In particular, there is uncertainty on how to interpret anthropometry among low birth weight (LBW) infants who may be growing normally. This research aimed to determine growth of infants from birth to two months (around age of vaccination) and the mortality risk of underweight LBW infants compared to normal birth weight (NBW) infants at two and six months age. Methods: A secondary analysis of a birth cohort of 1103 infants in Burkina Faso was conducted. Anthropometry was performed monthly from 0 to 12 months. We assessed associations with mortality using Cox proportional hazards models and assessed discriminatory values using area under receiver operating characteristics curves. Results: Eighty-six (7.8%) children died by age one year, 26/86 (30%) and 51/86 (59%) within two and six months, respectively. At age two months, weight gain since birth did not better discriminate mortality risk than current weight-for-age (P=0.72) or mid-upper arm circumference (P=0.21). In total, 227 (21%) LBW infants had increased risk of mortality: adjusted hazards ratio (aHR) 3.30 (95%CI 2.09 to 4.90). Among infants who were underweight at two and six months, LBW infants (64% and 49%, respectively) were not at reduced risk of death compared to NBW infants (aHR 2.63 (95%CI 0.76 to 9.15) and 2.43 (95%CI 0.74 to 7.98), respectively). Conclusion: Assessing weight gain since birth does not offer advantages over immediate anthropometry for discriminating mortality risk. LBW infants who are later identified as underweight require care to help prevent mortality.
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Affiliation(s)
- Martha Mwangome
- The Childhood Acute Illness and Nutrition Network,, CHAIN, Nairobi, P.O Box 43640-00100,, Kenya
- Clinical, KEMRI/Wellcome Trust Research Program, Kilifi, Kilifi, 80108, Kenya
| | - Moses Ngari
- The Childhood Acute Illness and Nutrition Network,, CHAIN, Nairobi, P.O Box 43640-00100,, Kenya
- Clinical, KEMRI/Wellcome Trust Research Program, Kilifi, Kilifi, 80108, Kenya
| | - Paluku Bahwere
- School of Public Health, Center of Research in Epidemiology Biostatistics and Clinical Research,, Université Libre de Bruxelles,, Brussels,, Belgium, Belgium
- Valid International, N/A, 35 Leopold Street, Oxford,, Oxford, OX4 1TW,, UK
| | - Patrick Kabore
- Africa Regional office,, World Health Organisation,, Brazzaville,, Republic of Congo, Congo
| | - Marie McGrath
- Emergency Nutrition Network, 69 High Street, Marlborough House, Kidlington, Oxfordshire, OX5 2DN, UK
| | - James A. Berkley
- Clinical, KEMRI/Wellcome Trust Research Program, Kilifi, Kilifi, 80108, Kenya
- Centre for Clinical Vaccinology & Tropical Medicine, University of Oxford,, Churchill Hospital Old Road,, Headington Oxford, OX3 7LE, UK
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29
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Obiero CW, Mturi N, Mwarumba S, Ngari M, Newton CR, van Hensbroek MB, Berkley JA. Clinical features of bacterial meningitis among hospitalised children in Kenya. BMC Med 2021; 19:122. [PMID: 34082778 PMCID: PMC8176744 DOI: 10.1186/s12916-021-01998-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days. METHODS We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1. RESULTS Among 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77-92) and specificity of 38% (95% CI 37-38). Exclusion of 'fever without malaria parasitaemia' reduced sensitivity to 58% (95% CI 48-68) and increased specificity to 80% (95% CI 79-80). IMCI signs had a sensitivity of 80% (95% CI 70-87) and specificity of 62% (95% CI 61-63). CONCLUSIONS A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.
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Affiliation(s)
- Christina W Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya.
- Department of Global Health, Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands.
| | - Neema Mturi
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
| | - Salim Mwarumba
- Department of Microbiology, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Charles R Newton
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - James A Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230 80108, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Mwangome M, Ngari M, Bahwere P, Kabore P, McGrath M, Berkley JA. Growth monitoring and mortality risk in low birthweight infants: a birth cohort study in Burkina Faso. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13231.1] [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: Wasting and underweight in infancy is an increasingly recognised problem but consensus on optimum assessment is lacking. In particular, there is uncertainty on how to interpret anthropometry among low birth weight (LBW) infants who may be growing normally. This research aimed to determine growth of infants from birth to two months (around age of vaccination) and the mortality risk of underweight LBW infants compared to normal birth weight (NBW) infants at two and six months age. Methods: A secondary analysis of a birth cohort of 1103 infants in Burkina Faso was conducted. Anthropometry was performed monthly from 0 to 12 months. We assessed associations with mortality using Cox proportional hazards models and assessed discriminatory values using area under receiver operating characteristics curves. Results: Eighty-six (7.8%) children died by age one year, 26/86 (30%) and 51/86 (59%) within two and six months, respectively. At age two months, weight gain since birth did not better discriminate mortality risk than current weight-for-age (P=0.72) or mid-upper arm circumference (P=0.21). In total, 227 (21%) LBW infants had increased risk of mortality: adjusted hazards ratio (aHR) 3.30 (95%CI 2.09 to 4.90). Among infants who were underweight at two and six months, LBW infants (64% and 49%, respectively) were not at reduced risk of death compared to NBW infants (aHR 2.63 (95%CI 0.76 to 9.15) and 2.43 (95%CI 0.74 to 7.98), respectively). Conclusion: Assessing weight gain since birth does not offer advantages over immediate anthropometry for discriminating mortality risk. LBW infants who are later identified as underweight require care to help prevent mortality.
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Iversen PO, Ngari M, Westerberg AC, Muhoozi G, Atukunda P. Child stunting concurrent with wasting or being overweight: A 6-y follow up of a randomized maternal education trial in Uganda. Nutrition 2021; 89:111281. [PMID: 34090214 PMCID: PMC7613431 DOI: 10.1016/j.nut.2021.111281] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
Objectives There is paucity of longitudinal data on combined anthropometric deficiencies in children. Herein, we present data on child stunting concurrent with wasting or being overweight among children in a 6-y follow-up study of a maternal education trial in rural Uganda. Methods We previously performed a randomized controlled trial where half of 511 mothers of 6- to 8-mo children were given a 6-mo education concerning nutrition, hygiene, and child stimulation. Anthropometry and prevalence of stunting with wasting or being overweight were determined. We applied multilevel mixed-effect logistic regression models and χ2 statistic to assess the effects of the intervention and trend in prevalence over time, respectively. Results Complete data sets were obtained from 307 of 511 children (60%). The prevalence of stunting and wasting or being overweight was <7% both, and did not change significantly over time. Notably, the prevalence of concurrent stunting and being overweight was significantly reduced in the intervention group compared with the controls among children age 36 mo and 60 to 72 mo, with corresponding odds ratios at 0.24 (95% confidence interval, 0.06−0.90) and 0.10 (95% confidence interval, 0.01−0.82), respectively. Conclusions The prevalence of stunting concurrent with wasting or being overweight remained low during the observation period. The intervention may have reduced concurrent stunting and being overweight over time.
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Affiliation(s)
- Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Hematology, Oslo University Hospital, Oslo, Norway.
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway
| | - Grace Muhoozi
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda
| | - Prudence Atukunda
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Obiero CW, Mturi N, Mwarumba S, Ngari M, Newton C, Boele van Hensbroek M, Berkley JA. Clinical features to distinguish meningitis among young infants at a rural Kenyan hospital. Arch Dis Child 2021; 106:130-136. [PMID: 32819909 PMCID: PMC7841476 DOI: 10.1136/archdischild-2020-318913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Detection of meningitis is essential to optimise the duration and choice of antimicrobial agents to limit mortality and sequelae. In low and middle-income countries most health facilities lack laboratory capacity and rely on clinical features to empirically treat meningitis. OBJECTIVE We conducted a diagnostic validation study to investigate the performance of clinical features (fever, convulsions, irritability, bulging fontanel and temperature ≥39°C) and WHO-recommended signs (drowsiness, lethargy, unconsciousness, convulsions, bulging fontanel, irritability or a high-pitched cry) in discriminating meningitis in young infants. DESIGN Retrospective cohort study. SETTING Kilifi County Hospital. PATIENTS Infants aged <60 days hospitalised between 2012 and 2016. MAIN OUTCOME MEASURE Definite meningitis defined as positive cerebrospinal fluid (CSF) culture, microscopy or antigen test, or leucocytes ≥0.05 x 10∧9/L. RESULTS Of 4809 infants aged <60 days included, 81 (1.7%) had definite meningitis. WHO-recommended signs had sensitivity of 58% (95% CI 47% to 69%) and specificity of 57% (95% CI 56% to 59%) for definite meningitis. Addition of history of fever improved sensitivity to 89% (95% CI 80% to 95%) but reduced specificity to 26% (95% CI 25% to 27%). Presence of ≥1 of 5 previously identified signs had sensitivity of 79% (95% CI 69% to 87%) and specificity of 51% (95% CI 50% to 53%). CONCLUSIONS Despite a lower prevalence of definite meningitis, the performance of previously identified signs at admission in predicting meningitis was unchanged. Presence of history of fever improves the sensitivity of WHO-recommended signs but loses specificity. Careful evaluation, repeated assessment and capacity for lumbar puncture and CSF microscopy to exclude meningitis in most young infants with potential signs are essential to management in this age group.
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Affiliation(s)
- Christina W Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Global Health, University of Amsterdam Faculty of Medicine, Amsterdam, Noord-Holland, The Netherlands
| | - Neema Mturi
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salim Mwarumba
- Department of Microbiology, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Charles Newton
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
| | - Michael Boele van Hensbroek
- Department of Global Health, University of Amsterdam Faculty of Medicine, Amsterdam, Noord-Holland, The Netherlands
| | - James Alexander Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
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Karisa J, Muriu S, Omuoyo D, Karia B, Ngari M, Nyamwaya D, Rono M, Warimwe G, Mwangangi J, Mbogo CM. Urban Ecology of Arboviral Mosquito Vectors Along the Kenyan Coast. J Med Entomol 2021; 58:428-438. [PMID: 32623459 PMCID: PMC7613328 DOI: 10.1093/jme/tjaa136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Indexed: 05/04/2023]
Abstract
The purpose of this study was to determine the ecology of the common arboviral mosquito vectors in Mombasa, Kilifi and Malindi urban areas of coastal Kenya. Mosquito larvae were collected using standard dippers and pipettes. Egg survivorship in dry soil was evaluated by collecting soil samples from dry potential larval developmental sites, re-hydrating them for hatching and rearing of the eventual larvae to adults. Adult mosquitoes were collected with CDC light traps and BG-Sentinel traps. All blood-fed females were tested for bloodmeal origin. Mosquitoes were screened for arboviruses using RT-qPCR. Overall, the predominant species were Culex quinquefasciatus (Say) 72.4% (n = 2,364) and Aedes aegypti (L.), 25.7%, (n = 838). A total of 415 larval developmental sites were identified indoors (n = 317) and outdoors (n = 98). The most productive larval developmental sites, both indoors and outdoors, were assorted small containers, water tanks, drainages, drums, and jerricans. Overall, 62% (n = 18) of the soil samples collected were positive for larvae which were used as a proxy to measure the presence of eggs. The mosquitoes fed on humans (29.8%) and chickens (3.7%). Of 259 mosquitoes tested for viral infection, 11.6% were positive for Flavivirus only. The most productive larval developmental sites for arboviral vectors indoors were small containers, water tanks, jerricans, and drums whereas small containers, water tanks, drainage channels, buckets, tires, and water troughs were the productive larval developmental sites outdoors.
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Affiliation(s)
- Jonathan Karisa
- Department of Biological Sciences, Pwani University, Kilifi, Kenya
- Bioscience Research Centre (PUBReC), Pwani University, Kilifi, Kenya
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Simon Muriu
- Department of Biological Sciences, Pwani University, Kilifi, Kenya
- Bioscience Research Centre (PUBReC), Pwani University, Kilifi, Kenya
| | - Donwilliams Omuoyo
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Boniface Karia
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Moses Ngari
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Doris Nyamwaya
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Martin Rono
- Department of Biological Sciences, Pwani University, Kilifi, Kenya
- Bioscience Research Centre (PUBReC), Pwani University, Kilifi, Kenya
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - George Warimwe
- Bioscience Research Centre (PUBReC), Pwani University, Kilifi, Kenya
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Joseph Mwangangi
- Department of Biological Sciences, Pwani University, Kilifi, Kenya
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Public Health Department, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Charles M Mbogo
- Center for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Public Health Department, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
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Masraf H, Azemeraw T, Molla M, Jones CI, Bremner S, Ngari M, Berkley JA, Kivaya E, Fegan G, Tamiru A, Kelemework A, Lang T, Newport MJ, Davey G. Excess mortality among people with podoconiosis: secondary analysis of two Ethiopian cohorts. Trans R Soc Trop Med Hyg 2020; 114:1035-1037. [PMID: 33236119 PMCID: PMC7738655 DOI: 10.1093/trstmh/traa150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/18/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background While morbidity attributable to podoconiosis is relatively well studied, its pattern of mortality has not been established. Methods We compared the age-standardised mortality ratios (SMRs) of two datasets from northern Ethiopia: podoconiosis patients enrolled in a 1-y trial and a Health and Demographic Surveillance System cohort. Results The annual crude mortality rate per 1000 population for podoconiosis patients was 28.7 (95% confidence interval [CI] 17.3 to 44.8; n=663) while that of the general population was 2.8 (95% CI 2.3 to 3.4; n=44 095). The overall SMR for the study period was 6.0 (95% CI 3.6 to 9.4). Conclusions Podoconiosis patients experience elevated mortality compared with the general population and further research is required to understand the reasons.
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Affiliation(s)
- Hannah Masraf
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
| | | | - Meseret Molla
- School of Public Health, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia
| | - Christopher Iain Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, UK
| | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Esther Kivaya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Greg Fegan
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Swansea University Medical School, Swansea, UK
| | - Abreham Tamiru
- International Orthodox Christian Charities Podoconiosis Project, Debre Markos, Ethiopia
| | - Abebe Kelemework
- International Orthodox Christian Charities Podoconiosis Project, Debre Markos, Ethiopia
| | - Trudie Lang
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Melanie J Newport
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK.,School of Public Health, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia
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Munyao V, Karisa J, Munyao CM, Ngari M, Menza N, Peshu N, Rono M, Mbogo C, Mwangangi J. Surveillance of Culicine Mosquitoes in Six Villages of Taita-Taveta County, Kenya, With Host Determinations From Blood-Fed Females. J Med Entomol 2020; 57:1972-1982. [PMID: 32533693 PMCID: PMC7613318 DOI: 10.1093/jme/tjaa109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Indexed: 06/11/2023]
Abstract
Culicine mosquitoes are vectors of human disease-causing pathogens like filarial worms and several arthropod-borne viruses (arboviruses). Currently, there has been an increase in emerging and re-emerging vector-borne diseases along coastal Kenya, which has been of major concern in public health. This study aimed at determining culicine mosquito species abundance, diversity and their host feeding preferences in Taita-Taveta County, Coastal Kenya. Entomological sampling was done during the long-wet season (March and May) and long dry season (June to October) 2016-2018. Mosquito sampling was done using CDC light traps and Backpack aspiration for indoor and outdoor environments. All culicine mosquitoes collected were identified morphologically and categorized according to their physiological status. Blood fed culicine mosquitoes were tested for bloodmeal sources using ELISA. In total, 3,278 culicine mosquitoes were collected, of which 738 (22.5 %) were found indoors and 2,540, (77.5 %) outdoors. The mosquitoes consisted of 18 species belonging to four genera: Aedes (7), Culex (8), Mansonia (2), and Coquillettidia (1). Overall, there was high mosquito species diversity (H) in outdoors (H = 2.4339) than in indoors (H = 2.2523), whereas even distribution (EH) was higher in indoors (EH = 0.9064) than outdoors (EH = 0.8266). Majorly the bloodmeals identified were from multiple host sources with (51.6%), single hosts (41.3%), and unidentified (7.2%). This study has demonstrated a high diversity of culicine mosquitoes with relaxed feeding tendencies. These mosquitoes are contributing to mosquito biting nuisance and the likelihood of exposure of populations to diseases of public health.
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Affiliation(s)
- Vanessa Munyao
- Department of Medical Laboratory Sciences, Kenyatta University, Nairobi, Kenya
- Kenya Medical Research Institute (KEMRI), Center for Geographic Medicine Coast, Kilifi, Kenya
| | - Jonathan Karisa
- Kenya Medical Research Institute (KEMRI), Center for Geographic Medicine Coast, Kilifi, Kenya
- Pwani University Bioscience Research Centre (PUBreC), Kilifi, Kenya
| | | | - Moses Ngari
- Kenya Medical Research Institute (KEMRI), Center for Geographic Medicine Coast, Kilifi, Kenya
| | - Nelson Menza
- Department of Medical Laboratory Sciences, Kenyatta University, Nairobi, Kenya
| | - Norbert Peshu
- Kenya Medical Research Institute (KEMRI), Center for Geographic Medicine Coast, Kilifi, Kenya
| | - Martin Rono
- Kenya Medical Research Institute (KEMRI), Center for Geographic Medicine Coast, Kilifi, Kenya
- Pwani University Bioscience Research Centre (PUBreC), Kilifi, Kenya
| | - Charles Mbogo
- Kenya Medical Research Institute (KEMRI), Center for Geographic Medicine Coast, Kilifi, Kenya
| | - Joseph Mwangangi
- Kenya Medical Research Institute (KEMRI), Center for Geographic Medicine Coast, Kilifi, Kenya
- Pwani University Bioscience Research Centre (PUBreC), Kilifi, Kenya
- KEMRI, Center for Vector Disease Control, Kwale, Kenya
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van den Brink DA, de Meij T, Brals D, Bandsma RHJ, Thitiri J, Ngari M, Mwalekwa L, de Boer NKH, Wicaksono A, Covington JA, van Rheenen PF, Voskuijl WP. Prediction of mortality in severe acute malnutrition in hospitalized children by faecal volatile organic compound analysis: proof of concept. Sci Rep 2020; 10:18785. [PMID: 33154417 PMCID: PMC7645771 DOI: 10.1038/s41598-020-75515-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 09/08/2020] [Indexed: 11/08/2022] Open
Abstract
Children with severe acute malnutrition (SAM) display immature, altered gut microbiota and have a high mortality risk. Faecal volatile organic compounds (VOCs) reflect the microbiota composition and may provide insight into metabolic dysfunction that occurs in SAM. Here we determine whether analysis of faecal VOCs could identify children with SAM with increased risk of mortality. VOC profiles from children who died within six days following admission were compared to those who were discharged alive using machine learning algorithms. VOC profiles of children who died could be separated from those who were discharged with fair accuracy (AUC) = 0.71; 95% CI 0.59-0.87; P = 0.004). We present the first study showing differences in faecal VOC profiles between children with SAM who survived and those who died. VOC analysis holds potential to help discover metabolic pathways within the intestinal microbiome with causal association with mortality and target treatments in children with SAM.Trial Registration: The F75 study is registered at clinicaltrials.gov/ct2/show/NCT02246296.
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Affiliation(s)
- Deborah A van den Brink
- Department of Paediatrics, Centre for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
| | - Tim de Meij
- Department of Paediatric Gastroenterology, Emma, Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Daniella Brals
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Robert H J Bandsma
- Department of Paediatrics, Centre for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Division of Gastroenterology, Hepatology and Nutrition and Translational Medicine Program, Hospital for Sick Children, Toronto, Canada
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
- KEMRI/Welcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
- KEMRI/Welcome Trust Research Programme, Kilifi, Kenya
| | | | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | | | - Patrick F van Rheenen
- Department of Paediatrics, Centre for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wieger P Voskuijl
- Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya.
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.
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Wen B, Bourdon C, Gonzales G, Lee D, Njunge J, Ngari M, Chimwezi E, Thitiri J, Mwalekwa L, Voskuijl W, Berkley J, Bandsma R. Metabolomic Profiles Associated with Mortality of Children with Complicated Severe Malnutrition: A Nested Case-Control Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa053_126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Children hospitalized with complicated severe malnutrition (CSM) have unacceptably high mortality rates despite receiving standard nutritional and medical treatment. The underlying pathology of the poor prognosis is not well understood. Growing evidence indicates presence of metabolic dysfunction in CSM. Yet, it is unclear whether and how metabolic dysfunction contributes the poor prognosis. This study aimed to identify metabolic signatures and pathways associated with CSM mortality.
Methods
A case-control study was performed on CSM patients enrolled to a multicenter (one Malawi and two Kenya hospitals) randomized control trial (NCT02246296). A total of 90 death cases and 90 discharged controls that were propensity score matched by age, HIV and mid-upper arm circumferences were included in the study. Targeted metabolomics was performed on their serum samples collected at admission and on day 3 of hospitalization. In particular, 206 metabolites, including amino acids, acylcarnitines, lipids and organic acids were quantified by LC-MS/MS.
Results
Discriminant analysis (PLS-DA) showed that metabolomic signatures at admission could differentiate cases from controls, with a cross-validated classification error rate of 21.8%. An increase of homovanillic, isobutyric and propionic acids, and decrease of lipids lysoPC a C18:2, lysoPC a C20:4, PC ae C42:2, SM C26:0, and SM C26:1 were the top 8 significant features characterizing the admission metabolomes of cases. Notably, cases with higher levels of isobutyrate, a microbial fermentation product, had significantly shorter survival time, implying a role of gut integrity in mortality. Pathway analysis revealed that metabolites of the tricarboxylic acid (TCA) cycle pathway differentiated cases from controls. Analysis of day 3 samples showed metabolic differences in response to treatment, especially in the recovery rate of lipids, between cases and controls.
Conclusions
CSM non-survivors have metabolomes distinct from survivors indicating perturbations in mitochondrial function and nutrition utilization. Perturbed metabolites identified shed light on biological mechanisms of mortality and may serve as targets of nutritional or therapeutic interventions to improve CSM survival.
Funding Sources
Bill and Melinda Gates Foundation, Thrasher Research Fund, and RESTRACOMP Graduate Scholarship.
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Affiliation(s)
- Bijun Wen
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto
| | - Celine Bourdon
- Translational Medicine Program, The Hospital for Sick Children, Canada
| | | | - Dorothy Lee
- Translational Medicine Program, The Hospital for Sick Children, Canada
| | - James Njunge
- The Childhood Acute Illness & Nutrition Network (CHAIN), Kenya
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kenya
| | | | | | | | - Wieger Voskuijl
- Global Child Health Group, Emma Children's Hospital, University of Amsterdam, The Netherlands
| | | | - Robert Bandsma
- Translational Medicine Program, The Hospital for Sick Children, Canada
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Gitaka J, Kamita M, Mureithi D, Ndegwa D, Masika M, Omuse G, Ngari M, Makokha F, Mwaura P, Mathai R, Muregi F, Mwau M. Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach. BMJ Open 2020; 10:e030823. [PMID: 32234736 PMCID: PMC7170570 DOI: 10.1136/bmjopen-2019-030823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/17/2019] [Accepted: 03/06/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use. METHODS AND ANALYSIS The study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs. ETHICS AND DISSEMINATION Approvals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.
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Affiliation(s)
- Jesse Gitaka
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Moses Kamita
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Dominic Mureithi
- Department of Animal Health and Production, Maasai Mara University, Narok, Kenya
| | - Davies Ndegwa
- Department of Medical Laboratory Sciences, Kenya Medical Training College, Nairobi, Kenya
| | - Moses Masika
- Department of Medical Microbiology, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Geoffrey Omuse
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - Moses Ngari
- Clinical Trial Facility, KEMRI/Wellcome Trust, Kilifi, Kenya
| | - Francis Makokha
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Peter Mwaura
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Ronald Mathai
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Francis Muregi
- Research and Innovation, Mount Kenya University, Thika, Kenya
| | - Matilu Mwau
- Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Nairobi, Kenya
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Njunge JM, Gwela A, Kibinge NK, Ngari M, Nyamako L, Nyatichi E, Thitiri J, Gonzales GB, Bandsma RHJ, Walson JL, Gitau EN, Berkley JA. Biomarkers of post-discharge mortality among children with complicated severe acute malnutrition. Sci Rep 2019; 9:5981. [PMID: 30979939 PMCID: PMC6461700 DOI: 10.1038/s41598-019-42436-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 04/01/2019] [Indexed: 12/22/2022] Open
Abstract
High mortality after discharge from hospital following acute illness has been observed among children with Severe Acute Malnutrition (SAM). However, mechanisms that may be amenable to intervention to reduce risk are unknown. We performed a nested case-control study among HIV-uninfected children aged 2-59 months treated for complicated SAM according to WHO recommendations at four Kenyan hospitals. Blood was drawn from 1778 children when clinically judged stable before discharge from hospital. Cases were children who died within 60 days. Controls were randomly selected children who survived for one year without readmission to hospital. Untargeted proteomics, total protein, cytokines and chemokines, and leptin were assayed in plasma and corresponding biological processes determined. Among 121 cases and 120 controls, increased levels of calprotectin, von Willebrand factor, angiotensinogen, IL8, IL15, IP10, TNFα, and decreased levels of leptin, heparin cofactor 2, and serum paraoxonase were associated with mortality after adjusting for possible confounders. Acute phase responses, cellular responses to lipopolysaccharide, neutrophil responses to bacteria, and endothelial responses were enriched among cases. Among apparently clinically stable children with SAM, a sepsis-like profile is associated with subsequent death. This may be due to ongoing bacterial infection, translocated bacterial products or deranged immune response during nutritional recovery.
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Affiliation(s)
- James M Njunge
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Agnes Gwela
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Moses Ngari
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lydia Nyamako
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emily Nyatichi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gerard Bryan Gonzales
- Department of Gastroenterology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Inflammation Research Centre, Flemish Institute for Biotechnology, Ghent, Belgium
| | - Robert H J Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Judd L Walson
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Departments of Global Health, Medicine, Paediatrics and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Evelyn N Gitau
- African Population and Health Research Centre, Nairobi, Kenya
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ngari M, Abdullahi O, Sanga D, Katana G, Willetts A. PO 8417 RISING TRENDS IN TB MORTALITY AMID DECLINE IN CASES NOTIFIED IN A RURAL COUNTY IN KENYA: COHORT STUDY. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.89] [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: 11/03/2022] Open
Abstract
BackgroundDespite introduction of rapid and accurate diagnostic tools and aggressive treatment for tuberculosis (TB), it is still a global health problem. In 2016, globally, 1.7 million people died of TB, 95% from resource-poor countries. This study aimed to estimate changing trends in all-cause mortality rate and identify features associated with mortality among suspected TB patients on treatment.MethodsA cohort study of patients registered in a TB surveillance system from 2012 to 2016 and followed up for six months during TB treatment. The outcome was all-cause mortality within six months of TB treatment. The exposures examined were demographic and clinical features at the time of starting TB treatment.ResultsA total of 10,717 participants, median (IQR) age 33 (24–45) years, of which 3163 (30%) were HIV-infected were included in the analyses. During follow-up of 5175.5 person-years (PY), 585/10,717 (5.5%) participants died; mortality rate was 12.2 (95% CI 11.3,13.3) deaths per 100PY. The yearly mortality rate increased from 7.79 (95% CI 6.35, 9.54) in 2012 to 17.73 (95% CI 14.93, 21.06) in 2016 per 100PY (Ptrend <0.001) but the number of suspected-TB notifications declined from 2610 (24%) in 2012 to 1689 (16%) in 2016 (Ptrend=0.02). 77% of all deaths occurred by month three. Mortality among HIV-infected participants was higher (325/3163; 10.3%) than among HIV-non-infected participants (251/7413; 3.4%; p<0.001). Old age, being a female, type of TB diagnosis used, body mass index (BMI) <18.5, HIV status and year of diagnosis were associated with mortality in the multivariate regression model.ConclusionThis large population level TB study identifies an alarming trend of patients dying within months of starting treatment. These early deaths could be due to late diagnosis and multidrug-resistance. The study warrants further investigation to go beyond already established indicators which remained constant (including HIV co-infection), to explore host, disease or health system related factors that may explain the observed trend.
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Mwangome M, Ngari M, Bwahere P, Kabore P, McGrath M, Kerac M, Berkley JA. Anthropometry at birth and at age of routine vaccination to predict mortality in the first year of life: A birth cohort study in BukinaFaso. PLoS One 2019; 14:e0213523. [PMID: 30921335 PMCID: PMC6438502 DOI: 10.1371/journal.pone.0213523] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 10/18/2018] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The World Health Organization currently defines severe acute malnutrition (SAM) in infants aged under 6 months of age using weight-for-length Z score (WLZ). Given widespread use of mid-upper arm circumference (MUAC) for identifying SAM in older children and weight-for-age (WAZ) for growth monitoring, there is increasing debate about the optimal anthropometric criteria to best identify infants u6m at-risk of mortality. OBJECTIVE To determine the discriminatory value for mortality during the first 12 months of life of anthropometry taken at birth and at age two months (approximate age of routine vaccination). DESIGN Data were analyzed from a birth cohort recruited between April and December of 2004 at four health facilities within Bansalogho District in Burkina Faso. Infants were followed up for 12 months. Mortality risks were estimated using hazards ratios (HR). Discriminatory value was assessed using receiver operating characteristic curves. RESULTS Of 1,103 infants, 227 (21%) were low birthweight (LBW). During 12 months, 86 (7.8%) infants died; 38 (44%) among the LBW group. At birth, MUAC<9.0cm, weight<2.5kg, length<44.2cm and incalculable WLZ were associated with mortality. Sixty (70%) deaths occurred after the age of two months; 26 (43%) among LBW infants. At age two months, any MUAC <11.5cm, weight <3.8kg (WAZ<-3) and length <52.4cm (LAZ<-3) were associated with risk of mortality. WLZ was not associated with mortality at any threshold. Birth weight did not modify the effect of the association between month two MUAC and one-year mortality (P = 0.33). CONCLUSION Infants at heightened risk of mortality and are better identified during early infancy by MUAC or WFA than by WLZ. LBW infants with low anthropometry at the age of routine immunizations remain at elevated risk than normal birth weight (NBW)infants and require intervention. Effectiveness, cost-effectiveness and coverage of applying proposed thresholds should be investigated as a priority to inform policy and practice.
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Affiliation(s)
- Martha Mwangome
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Paluku Bwahere
- School of Public Health, Center of Research in Epidemiology Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium
- Valid International, Oxford, United Kingdom
| | - Patrick Kabore
- Africa Regional office, World Health Organisation, Brazzaville, Republic of Congo
| | | | - Marko Kerac
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Centre for Clinical Vaccinology & Tropical Medicine, University of Oxford, Oxford, United Kingdom
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Bandsma RHJ, Voskuijl W, Chimwezi E, Fegan G, Briend A, Thitiri J, Ngari M, Mwalekwa L, Bandika V, Ali R, Hamid F, Owor B, Mturi N, Potani I, Allubha B, Muller Kobold AC, Bartels RH, Versloot CJ, Feenstra M, van den Brink DA, van Rheenen PF, Kerac M, Bourdon C, Berkley JA. A reduced-carbohydrate and lactose-free formulation for stabilization among hospitalized children with severe acute malnutrition: A double-blind, randomized controlled trial. PLoS Med 2019; 16:e1002747. [PMID: 30807589 PMCID: PMC6390989 DOI: 10.1371/journal.pmed.1002747] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 01/18/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Children with medically complicated severe acute malnutrition (SAM) have high risk of inpatient mortality. Diarrhea, carbohydrate malabsorption, and refeeding syndrome may contribute to early mortality and delayed recovery. We tested the hypothesis that a lactose-free, low-carbohydrate F75 milk would serve to limit these risks, thereby reducing the number of days in the stabilization phase. METHODS AND FINDINGS In a multicenter double-blind trial, hospitalized severely malnourished children were randomized to receive standard formula (F75) or isocaloric modified F75 (mF75) without lactose and with reduced carbohydrate. The primary endpoint was time to stabilization, as defined by the World Health Organization (WHO), with intention-to-treat analysis. Secondary outcomes included in-hospital mortality, diarrhea, and biochemical features of malabsorption and refeeding syndrome. The trial was registered at clinicaltrials.gov (NCT02246296). Four hundred eighteen and 425 severely malnourished children were randomized to F75 and mF75, respectively, with 516 (61%) enrolled in Kenya and 327 (39%) in Malawi. Children with a median age of 16 months were enrolled between 4 December 2014 and 24 December 2015. One hundred ninety-four (46%) children assigned to F75 and 188 (44%) to mF75 had diarrhea at admission. Median time to stabilization was 3 days (IQR 2-5 days), which was similar between randomized groups (0.23 [95% CI -0.13 to 0.60], P = 0.59). There was no evidence of effect modification by diarrhea at admission, age, edema, or HIV status. Thirty-six and 39 children died before stabilization in the F75 and in mF75 arm, respectively (P = 0.84). Cumulative days with diarrhea (P = 0.27), enteral (P = 0.42) or intravenous fluids (P = 0.19), other serious adverse events before stabilization, and serum and stool biochemistry at day 3 did not differ between groups. The main limitation was that the primary outcome of clinical stabilization was based on WHO guidelines, comprising clinical evidence of recovery from acute illness as well as metabolic stabilization evidenced by recovery of appetite. CONCLUSIONS Empirically treating hospitalized severely malnourished children during the stabilization phase with lactose-free, reduced-carbohydrate milk formula did not improve clinical outcomes. The biochemical analyses suggest that the lactose-free formulae may still exceed a carbohydrate load threshold for intestinal absorption, which may limit their usefulness in the context of complicated SAM. TRIAL REGISTRATION ClinicalTrials.gov NCT02246296.
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Affiliation(s)
- Robert H. J. Bandsma
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Nutrition Sciences, University of Toronto, Toronto, Canada
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Groningen, the Netherlands
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
| | - Wieger Voskuijl
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
- Department of Paediatrics and Child Health College of Medicine, University of Malawi, Blantyre, Malawi
- Global Child Health Group, Emma Children’s Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Emmanuel Chimwezi
- Department of Paediatrics and Child Health College of Medicine, University of Malawi, Blantyre, Malawi
| | - Greg Fegan
- Swansea Trials Unit, Swansea University Medical School, Swansea, United Kingdom
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
- University of Tampere School of Medicine, Center for Child Health Research, Tampere, Finland
| | | | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Victor Bandika
- Department of Paediatrics, Coast General Hospital, Mombasa, Kenya
| | - Rehema Ali
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Fauzat Hamid
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Betty Owor
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Neema Mturi
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Isabel Potani
- Department of Paediatrics and Child Health College of Medicine, University of Malawi, Blantyre, Malawi
| | - Benjamin Allubha
- Department of Paediatrics and Child Health College of Medicine, University of Malawi, Blantyre, Malawi
| | - Anneke C. Muller Kobold
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, the Netherlands
| | - Rosalie H. Bartels
- Global Child Health Group, Emma Children’s Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Christian J. Versloot
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Groningen, the Netherlands
| | - Marjon Feenstra
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Groningen, the Netherlands
| | - Deborah A. van den Brink
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Groningen, the Netherlands
| | - Patrick F. van Rheenen
- University of Groningen, University Medical Center Groningen, Department of Pediatrics, Groningen, the Netherlands
| | - Marko Kerac
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, Canada
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
| | - James A. Berkley
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
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Talbert A, Ngari M, Bauni E, Mwangome M, Mturi N, Otiende M, Maitland K, Walson J, Berkley JA. Mortality after inpatient treatment for diarrhea in children: a cohort study. BMC Med 2019; 17:20. [PMID: 30686268 PMCID: PMC6348640 DOI: 10.1186/s12916-019-1258-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/10/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is an increasing recognition that children remain at elevated risk of death following discharge from health facilities in resource-poor settings. Diarrhea has previously been highlighted as a risk factor for post-discharge mortality. METHODS A retrospective cohort study was conducted to estimate the incidence and demographic, clinical, and biochemical features associated with inpatient and 1-year post-discharge mortality amongst children aged 2-59 months admitted with diarrhea from 2007 to 2015 at Kilifi County Hospital and who were residents of Kilifi Health and Demographic Surveillance System (KHDSS). Log-binomial regression was used to identify risk factors for inpatient mortality. Time at risk was from the date of discharge to the date of death, out-migration, or 365 days later. Post-discharge mortality rate was computed per 1000 child-years of observation, and Cox proportion regression used to identify risk factors for mortality. RESULTS Two thousand six hundred twenty-six child KHDSS residents were admitted with diarrhea, median age 13 (IQR 8-21) months, of which 415 (16%) were severely malnourished and 130 (5.0%) had a positive HIV test. One hundred twenty-one (4.6%) died in the hospital, and of 2505 children discharged alive, 49 (2.1%) died after discharge: 21.4 (95% CI 16.1-28.3) deaths per 1000 child-years. Admission with signs of both diarrhea and severe pneumonia or severe pneumonia alone had a higher risk of both inpatient and post-discharge mortality than admission for diarrhea alone. There was no significant difference in inpatient and post-discharge mortality between children admitted with diarrhea alone and those with other diagnoses excluding severe pneumonia. HIV, low mid-upper arm circumference (MUAC), and bacteremia were associated with both inpatient and post-discharge mortality. Signs of circulatory impairment, sepsis, and abnormal electrolytes were associated with inpatient but not post-discharge mortality. Prior admission and lower chest wall indrawing were associated with post-discharge mortality but not inpatient mortality. Age, stuntedness, and persistent or bloody diarrhea were not associated with mortality before or after discharge. CONCLUSIONS Our results accentuate the need for research to improve the uptake and outcomes of services for malnutrition and HIV as well as to elucidate causal pathways and test interventions to mitigate these risks.
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Affiliation(s)
- Alison Talbert
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.,The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
| | - Evasius Bauni
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya
| | - Martha Mwangome
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.,The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
| | - Neema Mturi
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya
| | - Mark Otiende
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya
| | - Kathryn Maitland
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.,Wellcome Trust Centre for Clinical Tropical Medicine, Imperial College, London, UK
| | - Judd Walson
- The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, USA
| | - James A Berkley
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.,The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, USA.,Center for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
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Molla M, Ngari M, Berkley JA, Njuguna P, Fegan G, Lang T, Newport MJ, Enquoselassie F, Davey G. Lymphoedema management in podoconiosis - Authors reply. Lancet Glob Health 2018; 6:e963. [PMID: 30103995 PMCID: PMC7613508 DOI: 10.1016/s2214-109x(18)30330-9] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 12/04/2022]
Affiliation(s)
- Meseret Molla
- Centre for Environmental and Developmental Studies and School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A Berkley
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford
| | | | - Greg Fegan
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Swansea University Medical School, Swansea, UK
| | - Trudie Lang
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford
| | - Melanie J Newport
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Fikre Enquoselassie
- Centre for Environmental and Developmental Studies and School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Centre for Environmental and Developmental Studies and School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.
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Negussie H, Molla M, Ngari M, Berkley JA, Kivaya E, Njuguna P, Fegan G, Tamiru A, Kelemework A, Lang T, Newport MJ, McKay A, Enquoselassie F, Davey G. Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial. Lancet Glob Health 2018; 6:e795-e803. [PMID: 29773516 PMCID: PMC6562300 DOI: 10.1016/s2214-109x(18)30124-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 11/01/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Podoconiosis (also known as endemic, non-filarial elephantiasis) affects about 4 million subsistence farmers in tropical Africa. Poor awareness of the condition and inadequate evidence for the efficacy of treatment mean that no government in an endemic country yet offers lymphoedema management for patients with podoconiosis. Among patients with filarial lymphoedema, trials suggest that limb care is effective in reducing the most disabling sequelae: episodes of acute dermatolymphangioadenitis. We aimed to test the hypothesis that a simple, inexpensive lymphoedema management package would reduce the incidence of acute dermatolymphangioadenitis in adult patients with podoconiosis in northern Ethiopia. METHODS We did a pragmatic randomised controlled trial at health posts and health centres in 18 sub-districts of Aneded woreda (district) in Amhara, northern Ethiopia. Participants were adults aged 18 years and older, had a diagnosis of at least stage 2 podoconiosis (persistent lymphoedema) and a negative antigen test for filariasis, and intended to remain within Aneded woreda for the duration of the trial. Patients were randomly assigned (1:1) to either receive a package containing instructions for foot hygiene, skin care, bandaging, exercises, and use of socks and shoes, with support by lay Community Podoconiosis Agents at monthly meetings (intervention group) or to receive no intervention (control group). Participants were aware of their group assignment, but researchers doing all analyses were masked to treatment group. The primary outcome was incidence of acute dermatolymphangioadenitis episodes in the total period of observation of each participant, measured by use of validated patient self-reported pictorial diaries. This trial was registered with the International Standard Randomised Controlled Trials Number Register, number ISRCTN67805210. FINDINGS Between Dec 1, 2014, and June 30, 2015, 1339 patients were screened, and 696 patients were enrolled and randomly allocated to treatment groups. We allocated 350 patients to the intervention group and 346 patients to the control group. 321 (92%) patients from the intervention group and 329 (95%) patients from the control group provided follow-up results at 12 months. During the 12 months of follow-up, 16 550 new episodes of acute dermatolymphangioadenitis occurred during 765·2 person-years. The incidence of acute dermatolymphangioadenitis was 19·4 episodes per person-year (95% CI 18·9-19·9) in the intervention group and 23·9 episodes per person-year (23·4-24·4) in the control group. The ratio of incidence rate in the intervention group to that of the control group was 0·81 (0·74 to 0·89; p<0·0001), with a rate difference of -4·5 (-5·1 to -3·8) episodes per person-year. No serious adverse events related to the intervention were reported. INTERPRETATION A simple, inexpensive package of lymphoedema self-care is effective in reducing the frequency and duration of acute dermatolymphangioadenitis. We recommend its implementation by the governments of endemic countries. FUNDING Joint Global Health Trials scheme (from the Wellcome Trust, the UK Medical Research Council, and UK Aid).
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Affiliation(s)
- Henok Negussie
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Meseret Molla
- Centre for Environmental and Developmental Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A Berkley
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Esther Kivaya
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Greg Fegan
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Swansea University Medical School, Swansea, UK
| | - Abreham Tamiru
- International Orthodox Christian Charities, Debre Markos, Ethiopia
| | - Abebe Kelemework
- International Orthodox Christian Charities, Debre Markos, Ethiopia
| | - Trudie Lang
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Melanie J Newport
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Andy McKay
- Department of Economics, University of Sussex, Brighton, UK
| | | | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
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46
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Khara T, Mwangome M, Ngari M, Dolan C. Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6-59 months from 84 countries. Matern Child Nutr 2018; 14:e12516. [PMID: 28944990 PMCID: PMC5901398 DOI: 10.1111/mcn.12516] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/27/2017] [Accepted: 08/25/2017] [Indexed: 12/02/2022]
Abstract
Children can be stunted and wasted at the same time. Having both deficits greatly elevates risk of mortality. The analysis aimed to estimate the prevalence and burden of children aged 6-59 months concurrently wasted and stunted. Data from demographic and health survey and Multi-indicator Cluster Surveys datasets from 84 countries were analysed. Overall prevalence for being wasted, stunted, and concurrently wasted and stunted among children 6 to 59 months was calculated. A pooled prevalence of concurrence was estimated and reported by gender, age, United Nations regions, and contextual categories. Burden was calculated using population figures from the global joint estimates database. The pooled prevalence of concurrence in the 84 countries was 3.0%, 95% CI [2.97, 3.06], ranging from 0% to 8.0%. Nine countries reported a concurrence prevalence greater than 5%. The estimated burden was 5,963,940 children. Prevalence of concurrence was highest in the 12- to 24-month age group 4.2%, 95% CI [4.1, 4.3], and was significantly higher among boys 3.54%, 95% CI [3.47, 3.61], compared to girls; 2.46%, 95% CI [2.41, 2.52]. Fragile and conflict-affected states reported significantly higher concurrence 3.6%, 95% CI [3.5, 3.6], than those defined as stable 2.24%, 95% CI [2.18, 2.30]. This analysis represents the first multiple country estimation of the prevalence and burden of children concurrently wasted and stunted. Given the high risk of mortality associated with concurrence, the findings indicate a need to report on this condition as well as investigate whether these children are being reached through existing programmes.
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Affiliation(s)
| | - Martha Mwangome
- KEMRI‐Wellcome Trust Research ProgrammeKEMRI Centre for Geographic Medicine Research‐CoastKilifiKenya
| | - Moses Ngari
- KEMRI‐Wellcome Trust Research ProgrammeKEMRI Centre for Geographic Medicine Research‐CoastKilifiKenya
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47
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Piper JD, Mwarumba S, Ngari M, Mvera B, Morpeth S, Berkley JA. Invasive Cronobacter species infection in infants and children admitted to a rural Kenyan hospital with a high prevalence of malnutrition. Paediatr Int Child Health 2018. [PMID: 29533163 PMCID: PMC6113899 DOI: 10.1080/20469047.2018.1446485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
For children with acute malnutrition, ready-to-use therapeutic foods (RUTF) are lifesaving treatments. In 2012, detailed testing detected Enterobacteriaceae including Cronobacter species at low levels in RUTF from all UNICEF-approved producers. Cronobacter in milk feeds has previously been associated with severe neonatal infections. Thus, given the susceptibility of severely malnourished children to invasive bacterial infections, concerns arose about the potential for Cronobacter infections from RUTF. This led to widespread production and supply problems in emergency feeding programmes. The KEMRI/Wellcome Trust Research Programme has conducted systematic surveillance for invasive bacterial infections among children admitted to Kilifi County Hospital, Kenya since 1998. 65,426 paediatric blood and cerebrospinal fluid cultures from 52,733 admissions resulted in 3953 with growth of a pathogenic organism. From the 60 Enterobacter and Cronobacter isolates, possible Cronobacter species were initially selected from their original API-20E biochemical profile, which was repeated and then confirmed using ID-32E. Only two isolates were consistent with Cronobacter species, neither case had received RUTF. Serious infection due to Cronobacter species does not have a significant burden in this population. This has important implications for the continued supply, manufacture and monitoring of emergency feeds for malnourished children.
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Affiliation(s)
- Joe D. Piper
- Child Health, Blizard Institute, Queen Mary University of London, London, UK,Clinical Research, KEMRI-Wellcome Trust Research Programme CGMRC, Kilifi, Kenya
| | - Salim Mwarumba
- Clinical Research, KEMRI-Wellcome Trust Research Programme CGMRC, Kilifi, Kenya
| | - Moses Ngari
- Clinical Research, KEMRI-Wellcome Trust Research Programme CGMRC, Kilifi, Kenya,Coordination Centre, The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Benedict Mvera
- Clinical Research, KEMRI-Wellcome Trust Research Programme CGMRC, Kilifi, Kenya
| | - Susan Morpeth
- Clinical Research, KEMRI-Wellcome Trust Research Programme CGMRC, Kilifi, Kenya,Middlemore Hospital, Auckland, New Zealand
| | - James A. Berkley
- Clinical Research, KEMRI-Wellcome Trust Research Programme CGMRC, Kilifi, Kenya,Coordination Centre, The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK,Corresponding author.
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48
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Molla M, Negussie H, Ngari M, Kivaya E, Njuguna P, Enqueselassie F, Berkley JA, Davey G. Pragmatism in practice: lessons learned during screening and enrollment for a randomised controlled trial in rural northern Ethiopia. BMC Med Res Methodol 2018. [PMID: 29514613 PMCID: PMC5842624 DOI: 10.1186/s12874-018-0486-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 11/29/2022] Open
Abstract
Background We use the example of the Gojjam Lymphoedema Best Practice Trial (GoLBeT), a pragmatic trial in a remote rural setting in northern Ethiopia, to extract lessons relevant to other investigators balancing the demands of practicality and community acceptability with internal and external validity in clinical trials. Methods We explain in detail the preparation for the trial, its setting in northern Ethiopia, the identification and selection of patients (inclusion and exclusion criterion, identifying and screening of patients at home, enrollment of patients at the health centres and health posts), and randomisation. Results We describe the challenges met, together with strategies employed to overcome them. Conclusions Examples given in the previous section are contextualised and general principles extracted where possible. We conclude that it is possible to conduct a trial that balances approaches that support internal validity (e.g. careful design of proformas, accurate case identification, control over data quality and high retention rates) with those that favour generalisability (e.g. ‘real world’ setting and low rates of exclusion). Strategies, such as Rapid Ethical Assessment, that increase researchers’ understanding of the study setting and inclusion of hard-to-reach participants are likely to have resource and time implications, but are vital in achieving an appropriate balance. Trial registration ISRCTN67805210, registered 24/01/2013.
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Affiliation(s)
- Meseret Molla
- Centre for Environment and Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Henok Negussie
- Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Esther Kivaya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - James A Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK. .,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
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Seale AC, Obiero CW, Jones KD, Barsosio HC, Thitiri J, Ngari M, Morpeth S, Mohammed S, Fegan G, Mturi N, Berkley JA. Should First-line Empiric Treatment Strategies for Neonates Cover Coagulase-negative Staphylococcal Infections in Kenya? Pediatr Infect Dis J 2017; 36:1073-1078. [PMID: 28731901 PMCID: PMC5640986 DOI: 10.1097/inf.0000000000001699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Neonatal mortality remains high in sub-Saharan Africa, and a third of deaths are estimated to result from infection. While coagulase-negative staphylococci (CoNS) are leading neonatal pathogens in resource-rich settings, their role, and the need for early anti-Staphylococcal treatment in empiric antibiotic guidelines, is unknown in sub-Saharan Africa. METHODS We examined systematic clinical and microbiologic surveillance data from all neonatal admissions to Kilifi County Hospital (1998-2013) to determine associated case fatality and/or prolonged duration of admission associated with CoNS in neonates treated according to standard World Health Organization guidelines. RESULTS CoNS was isolated from blood culture in 995 of 9552 (10%) neonates. Case fatality among neonates with CoNS isolated from blood did not differ from other neonatal admissions (P = 0.2), and duration of admission was not prolonged [odds ratio (OR) = 0.9 (0.7-1.0), P = 0.040]. Neonates with CoNS were more likely to have convulsions [OR = 1.4 (1.0-1.8), P = 0.031] but less likely to have impaired consciousness or severe indrawing [OR = 0.8 (0.7-0.9), P = 0.025; OR = 0.9 (0.7-1.0), P = 0.065]. CONCLUSIONS CoNS isolation in blood cultures at admission was not associated with adverse clinical outcomes in neonates treated according to standard World Health Organization guidelines for hospital care in this setting. There is no evidence that first-line antimicrobial treatment guidelines should be altered to increase cover for CoNS infections in neonates in this setting.
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MESH Headings
- Adolescent
- Adult
- Anti-Bacterial Agents/pharmacology
- Anti-Bacterial Agents/therapeutic use
- Bacteremia/drug therapy
- Bacteremia/epidemiology
- Bacteremia/microbiology
- Bacteremia/mortality
- Blood Culture/statistics & numerical data
- Child
- Child, Preschool
- Coagulase
- Empirical Research
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/microbiology
- Infant, Newborn, Diseases/mortality
- Kenya
- Male
- Retrospective Studies
- Staphylococcal Infections/drug therapy
- Staphylococcal Infections/epidemiology
- Staphylococcal Infections/microbiology
- Staphylococcus/drug effects
- Staphylococcus/enzymology
- Young Adult
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Affiliation(s)
- Anna C Seale
- From the *Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Institution, Kilifi, Kenya; †University of Oxford, Oxford, United Kingdom; and ‡London School of Hygiene and Tropical Medicine, and §Imperial College London, London, United Kingdom
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50
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Obiero CW, Seale AC, Jones K, Ngari M, Bendon CL, Morpeth S, Mohammed S, Mturi N, Fegan G, Berkley JA. Should first-line empiric treatment strategies cover coagulase-negative staphylococcal infections in severely malnourished or HIV-infected children in Kenya? PLoS One 2017; 12:e0182354. [PMID: 28787002 PMCID: PMC5546690 DOI: 10.1371/journal.pone.0182354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/21/2016] [Accepted: 07/17/2017] [Indexed: 11/19/2022] Open
Abstract
Background Bloodstream infection is a common cause of morbidity in children aged <5 years in developing countries. In studies reporting bacteremia in Africa, coagulase-negative Staphylococci (CoNS) are commonly isolated. However, it is currently unclear whether children who are highly susceptible to infection because of severe acute malnutrition (SAM) or HIV should be treated with antimicrobials specifically to cover CoNS. We aimed to determine the clinical significance of CoNS amongst children admitted to a rural hospital in Kenya in relation to nutritional and HIV status. Methods Systematically collected clinical and microbiological surveillance data from children aged 6–59 months admitted to Kilifi County Hospital (2007–2013) were analysed. Multivariable regression was used to test associations between CoNS isolation from blood cultures and SAM (MUAC <11.5cm or nutritional oedema (kwashiorkor)), and HIV serostatus; and among children with SAM or HIV, associations between CoNS isolation and mortality, duration of hospitalization and clinical features. Results CoNS were isolated from blood culture in 906/13,315 (6.8%) children, of whom 135/906 (14.9%) had SAM and 54/906 (6.0%) were HIV antibody positive. CoNS isolation was not associated with SAM (MUAC<11.5cm (aOR 1.11, 95% CI 0.88–1.40) or kwashiorkor (aOR 0.84, 95% CI 0.48–1.49)), or a positive HIV antibody test (aOR 1.25, 95% CI 0.92–1.71). Among children with SAM or a positive HIV antibody test, CoNS isolation was not associated with mortality or prolonged hospitalization. Conclusion In a large, systematic study, there was no evidence that antimicrobial therapy should specifically target CoNS amongst children with SAM or HIV-infection or exposure.
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Affiliation(s)
- Christina W. Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail: (CWO); (JAB)
| | - Anna C. Seale
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kelsey Jones
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Moses Ngari
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Charlotte L. Bendon
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom
| | - Susan Morpeth
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shebe Mohammed
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Neema Mturi
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Greg Fegan
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - James A. Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail: (CWO); (JAB)
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