scholarly journals Effects of Anaemia and Iron Supplementation on Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1115-1115
Author(s):  
Michael Zimmermann ◽  
Nicole Stoffel ◽  
Mary Uyoga ◽  
Simon Karanja
Keyword(s):  
Birth Cohort ◽  
Low Income ◽  
Iron Supplementation ◽  
Randomised Trial ◽  
Low Income Countries ◽  
Birth Cohort Study ◽  
Measles Vaccine ◽  
Vaccine Response ◽  
The Impact

Abstract Objectives Vaccines often underperform in low-income countries. Iron deficiency anaemia (IDA) may impair adaptive immunity and is common among African infants at time of vaccination. Our objective was to assess whether IDA impairs vaccine response and whether iron supplementation improves vaccine response. Methods We performed two studies in southern Kenya. In study 1, we followed a birth cohort to age 18 mo and assessed whether IDA at time of vaccination with pentavalent, 10-valent pneumococcal and measles vaccines predicted vaccine response. Primary outcomes were serum IgG and seroconversion at age 24wk and 18 mo. Study 2 was a randomised trial cohort follow-up in children who received 5 mg iron daily or no iron for 4 mo starting at age 7.5 mo and received measles vaccine at 9 and 18 mo; primary outcomes were IgG, seroconversion and avidity assessed at 11.5 mo and 4.5y. Results Study 1 ran from August 2013 to May 2017; 573 infants were enrolled and 303 completed the study. Controlling for sex, birthweight, anthropometrics and maternal antibodies, haemoglobin at time of vaccination was the strongest positive predictor of: (A) anti-diphtheria and anti-pertussis IgG at 24wk and 18 mo; (B) anti-pertussis filamentous hemagglutinin IgG at 24wk; and (C) anti-pneumococcus-S19 IgG at 18 mo (for all, P < 0.05). IDA and serum transferrin receptor at vaccination were the strongest predictors of seroconversion against diphtheria and pneumococcus-S19 at 18 mo (P < 0.05 for all). Study 2 ran from October 2014 to March 2019; 155 infants were recruited, 127 and 88 were assessed at age 11.5 mo and 4.5y. Infants who received iron at time of measles vaccination had higher anti-measles IgG (P = 0.0415), seroconversion (P = 0.0531) and IgG avidity (P = 0.0425) at 11.5 mo. Conclusions To our knowledge these are the first prospective data from Africa assessing the impact of IDA at vaccination on vaccine response. IDA at time of vaccination is associated with decreased response to diphtheria, pertussis and pneumococcal vaccines. Primary response to measles vaccine is increased by iron supplementation. Because anaemia is common in African infants and because the vaccine-preventable disease burden is high, if IDA reduces immunogenicity of childhood vaccines its prevention could have major benefits. Funding Sources Bill and Melinda Gates Foundation; ETH Zurich; DSM Nutrition; The Philhuman Foundation

scholarly journals A populational-based birth cohort study in a low-income urban area in Rio de Janeiro, Brazil: implementation and description of the characteristics of the study

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Renata Saraiva Pedro ◽  
Marilia Sá Carvalho ◽  
Vania Reis Girianelli ◽  
Luana Santana Damasceno ◽  
Izabel Leal ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Cohort ◽  
Low Income ◽  
Rio De Janeiro ◽  
Birth Cohort Study ◽  
Clinical Aspects ◽  
Emerging Pathogens ◽  
Entomological Surveillance ◽  
Key Sites

Abstract: A comprehensive cohort study including an entomological surveillance component can contribute to our knowledge of clinical aspects and transmission patterns of arbovirosis. This article describes the implementation of a populational-based birth cohort study that included an entomological surveillance component, and its associated challenges in a low-income community of Rio de Janeiro, Brazil. The participants were recruited in two periods: from 2012 to 2014, and from 2015 to 2017. The children had scheduled pediatric consultations and in case of fever. Epidemiological, clinical data and biological samples were collected at pediatric visits. Active febrile surveillance was performed by telephone calls, social networking, message apps, and household visits. A total of 387 newborns and 332 new children were included during the first and second recruitment periods, respectively. By July 2017, there were 451 children on follow-up. During the study, 2,759 pediatric visits were performed: 1,783 asymptomatic and 976 febrile/rash consultations. The number of febrile or rash consultations increased 3.5-fold after the use of media tools for surveillance. No temporal pattern, seasonality or peak of febrile cases was observed during the study period. A total of 10,105 adult mosquitoes (including 3,523 Aedes spp. and 6,582 Culex quinquefasciatus) and 46,047 Aedes eggs were collected from households, schools, and key sites. Although challenging, this structured sentinel populational-based birth cohort is relevant to the knowledge of risks and awareness of emerging pathogens.

scholarly journals The Impact of Recycled Neonatal Incubators in Nigeria: A 6-Year Follow-Up Study

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Hippolite Onyejiaka Amadi ◽  
Jonathan C. Azubuike ◽  
Uriah S. Etawo ◽  
Uduak R. Offiong ◽  
Chinyere Ezeaka ◽  
...  
Keyword(s):  
Low Income ◽  
Low Income Countries ◽  
Live Births ◽  
Technical Performance ◽  
Follow Up Study ◽  
Newborn Mortality ◽  
Retrospective Assessment ◽  
Case Files ◽  
The Impact

Nigeria has a record of high newborn mortality as an estimated 778 babies die daily, accounting for a ratio of 48 deaths per 1000 live births. The aim of this paper was to show how a deteriorating neonatal delivery system in Nigeria may have, in part, been improved by the application of a novel recycled incubator technique (RIT). Retrospective assessment of clinical, technical, and human factors in 15 Nigerian neonatal centres was carried out to investigate how the application of RIT impacted these factors. Pre-RIT and post-RIT neonatal mortalities were compared by studying case files. Effect on neonatal nursing was studied through questionnaires that were completed by 79 nurses from 9 centres across the country. Technical performance was assessed based on 10-indices scores from clinicians and nurses. The results showed an increase in neonatal survival, nursing enthusiasm, and practice confidence. Appropriately recycled incubators are good substitutes to the less affordable modern incubators in boosting neonatal practice outcome in low-income countries.

scholarly journals The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Giorgia Gon ◽  
Abdunoor M. Kabanywanyi ◽  
Petri Blinkhoff ◽  
Simon Cousens ◽  
Stephanie J. Dancer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Study Design ◽  
Low Income ◽  
High Volume ◽  
Surface Cleaning ◽  
Low Income Countries ◽  
Training Period ◽  
Future Research ◽  
Environmental Hygiene ◽  
The Impact

Abstract Background Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. Methods This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. Results Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. Conclusions The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

scholarly journals COVID-19 in children treated with immunosuppressive medication for kidney diseases

2020 ◽  
pp. archdischild-2020-320616
Author(s):  
Matko Marlais ◽  
Tanja Wlodkowski ◽  
Samhar Al-Akash ◽  
Petr Ananin ◽  
Varun Kumar Bandi ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Immunosuppressive Therapy ◽  
Low Income ◽  
Kidney Diseases ◽  
Low Income Countries ◽  
Reference Network ◽  
Immunosuppressive Medication ◽  
Immunosuppressive Medications ◽  
Significant Difference ◽  
The Impact

BackgroundChildren are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity.MethodsCross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19.Results113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications.ConclusionsThis global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.

The Study of Asian Women and their Offspring’s Development and Environmental Exposures (SAWASDEE): A northern Thailand birth cohort study (Preprint)

2021 ◽  
Author(s):  
Dana Barr ◽  
Nancy Fiedler ◽  
Tippawan Prapamontol ◽  
Panrapee Suttiwan ◽  
Warangkana Naksen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Cohort ◽  
Prenatal Exposure ◽  
Environmental Exposures ◽  
World Health ◽  
Birth Cohort Study ◽  
Asian Women ◽  
Northern Thailand ◽  
Prospective Longitudinal ◽  
The Impact

BACKGROUND Prenatal exposure to pesticides have been linked to adverse neurodevelopmental outcomes. Gaps exist in the current literature about the timing and magnitude of exposures that result in these adverse outcomes. OBJECTIVE The Study of Asian Women and their Offspring’s Development and Environmental Exposures (SAWASDEE) Cohort was established to investigate the impact of prenatal exposure to pesticides on neurodevelopment during infancy and early childhood in northern Thailand. METHODS Recruitment of this prospective, longitudinal birth cohort began in July 2017 and was completed in June 2019 in Chom Thong and Fang, two farming districts in Chiang Mai Province in northern Thailand. Follow up of the study participants is on-going. During pregnancy, seven questionnaires were administered. Time-resolved biospecimen samples were collected monthly (for urine) and during each trimester (for blood) at antenatal care visits. Medical records were abstracted. Infants were administered the NICU Network Neurobehavioral Scale (NNNS) test at one month of age. We will complete a number of additional exposure related analyses. RESULTS A total of 1298 women were screened and of those 394 women were enrolled. The mean gestational age at enrollment was 9.9 weeks (STD = 2.6). Differences in literacy were observed between Chom Thong and Fang participants. In Fang about 51% reported being able to read in Thai compared to about 95% in Chom Thong. The percentages were comparable for reporting to be able to write in Thai. A total of 322 mother-child pairs completed the NNNS. CONCLUSIONS This longitudinal birth cohort study will inform risk assessment standards for pregnant women in Thailand and other countries. Building awareness of how insecticide exposure during specific windows of pregnancy affects the neurodevelopmental trajectories of children in developing countries is a specific need recognized by the World Health Organization.

Foreign capital inflows and economic growth: the experience of low-income countries in Sub Saharan Africa

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Atif Awad
Keyword(s):  
Low Income ◽  
Foreign Capital ◽  
Ordinary Least Squares ◽  
Capital Inflows ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Content Type ◽  
Long Run ◽  
Foreign Capital Inflows ◽  
The Impact

Purpose This paper aims to investigate the long-run impact of selected foreign capital inflows, including aid, remittances, foreign direct investment (FDI), trade and debt, on the economic growth of 21 low-income countries in the Sub Saharan Africa (SSA) region, during the period 1990–2018. Design/methodology/approach To obtain this objective and for robust analysis, a parametric approach, which was dynamic ordinary least squares, and a non-parametric technique, which was fully modified ordinary least squares, were used. Findings The results of both models confirmed that, in the long run, trade and aid affected the growth rate of the per capita income in these countries in a positive way. However, external debt seemed to have an adverse influence on such growth. Originality/value First, this is the initial study that has addressed this matter across a homogenous group of countries in the SSA region. Second, while most of the previous studies regarding capital inflows into the SSA region have focused on the impact of only one or two aspects of such foreign capital inflows on growth, the present study, instead, examined the impact of five types of foreign capital inflows (aid, remittances, FDI, trade and debt).

scholarly journals Size at birth and height in early adolescence: a prospective birth cohort study

2008 ◽  
Vol 24 (4) ◽  
pp. 871-878 ◽  
Author(s):  
Cora L. P. Araújo ◽  
Pedro C. Hallal ◽  
Gisele A. Nader ◽  
Ana Maria B. Menezes ◽  
Cesar G. Victora
Keyword(s):  
Cohort Study ◽  
Birth Cohort ◽  
Early Adolescence ◽  
Strong Predictor ◽  
Birth Length ◽  
Birth Cohort Study ◽  
Size At Birth ◽  
Prospective Birth Cohort ◽  
Prospective Birth Cohort Study

The aim of this study was to evaluate the association between size at birth (birthweight and birth length) and height in early adolescence in a prospective birth cohort study in Pelotas, Rio Grande do Sul, Brazil. Interviews were carried out in 1993, including measurements of birthweight and length, and in 2004-2005, including measurements of weight and height. This analysis includes 4,452 individuals, with a mean age of 11.3 years (standard deviation - SD = 0.3), representing a follow-up rate of 87.5%. Mean height at 11 years was 145.8 cm (SD = 7.9), or 144.9 cm (SD = 7.7) in boys and 146.8 cm (SD = 7.9) in girls. Birthweight and birth length were positively associated with height in early adolescence in the crude analysis, but after adjustment for confounding and for each other, only the effect of birth length was still significant. A one z-score increase in birth length was associated with a 1.63 cm increase in height at 11 years. The present study shows that birth length is a strong predictor of later height, while the effect of birth weight disappears after adjustment for birth length.

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