Relationship between changing malaria burden and low birth weight in sub-Saharan Africa: A difference-in-differences study via a pair-of-pairs approach

Background:According to the World Health Organization (WHO), in 2018, an estimated 228 million malaria cases occurred worldwide with most cases occurring in sub-Saharan Africa. Scale-up of vector control tools coupled with increased access to diagnosis and effective treatment has resulted in a large decline in malaria prevalence in some areas, but other areas have seen little change. Although interventional studies demonstrate that preventing malaria during pregnancy can reduce the rate of low birth weight (i.e. child’s birth weight <2500 g), it remains unknown whether natural changes in parasite transmission and malaria burden can improve birth outcomes.Methods:We conducted an observational study of the effect of changing malaria burden on low birth weight using data from 18,112 births in 19 countries in sub-Saharan African countries during the years 2000–2015. Specifically, we conducted a difference-in-differences study via a pair-of-pairs matching approach using the fact that some sub-Saharan areas experienced sharp drops in malaria prevalence and some experienced little change.Results:A malaria prevalence decline from a high rate (Plasmodium falciparum parasite rate in children aged 2-up-to-10 (i.e. PfPR2-10) > 0.4) to a low rate (PfPR2-10 < 0.2) is estimated to reduce the rate of low birth weight by 1.48 percentage points (95% confidence interval: 3.70 percentage points reduction, 0.74 percentage points increase), which is a 17% reduction in the low birth weight rate compared to the average (8.6%) in our study population with observed birth weight records (1.48/8.6 ≈ 17%). When focusing on first pregnancies, a decline in malaria prevalence from high to low is estimated to have a greater impact on the low birth weight rate than for all births: 3.73 percentage points (95% confidence interval: 9.11 percentage points reduction, 1.64 percentage points increase).Conclusions:Although the confidence intervals cannot rule out the possibility of no effect at the 95% confidence level, the concurrence between our primary analysis, secondary analyses, and sensitivity analyses, and the magnitude of the effect size, contribute to the weight of the evidence suggesting that declining malaria burden can potentially substantially reduce the low birth weight rate at the community level in sub-Saharan Africa, particularly among firstborns. The novel statistical methodology developed in this article–a pair-of-pairs approach to a difference-in-differences study–could be useful for many settings in which different units are observed at different times.Funding:Ryan A. Simmons is supported by National Center for Advancing Translational Sciences (UL1TR002553). The funder had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

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All Nets are Equal, But Some Nets are More Equal Than Others

Outlooks on Pest Management ◽

10.1564/v31_feb_01 ◽

2020 ◽

Vol 31 (1) ◽

pp. 2-4

Author(s):

Mark Rowland

Keyword(s):

Sub Saharan Africa ◽

World Health ◽

Insecticide Treated Nets ◽

Comparative Performance ◽

Malaria Burden ◽

Test Product ◽

Dramatic Decline ◽

The World ◽

Sub Saharan ◽

Health Organization

Much of the dramatic decline in malaria in sub-Saharan Africa since 2000 is due to the massive investment in long-lasting insecticide treated nets (LLIN). According to the latest figures from the World Health Organization (WHO), over half of Africa's population now has access to LLIN, increasing from 33% in 2010 to 57% in 2019 (WHO 2019). In 2018 alone, 197 million LLINs were delivered to Africa by manufacturers. Despite this, LLIN coverage has improved only marginally since 2015. The malaria burden worldwide has fallen only slightly from an estimated 231 million cases of malaria in 2017 to 228 million in 2018, and is at a standstill in Africa. WHO policy is to assess candidate 2nd-in-class products for entomological efficacy only. Due to the significant variation in the specifications of the candidates, to generate the required assurance of comparative performance to 1st in class, WHO has designed a non-inferiority trial design to demonstrate whether each candidate 2nd-in-class test product is no worse in experimental hut trials.

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Protocol for a scoping review of neonatal emollient therapy and massage practices throughout sub-Saharan Africa

Gates Open Research ◽

10.12688/gatesopenres.13359.1 ◽

2021 ◽

Vol 5 ◽

pp. 142

Author(s):

Keona J.H. Blanks ◽

Milton W. Musaba ◽

Lily Ren ◽

Kathy Burgoine ◽

David Mukunya ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Scoping Review ◽

Very Low Birth Weight ◽

Skin Care ◽

Sub Saharan Africa ◽

Skin Barrier Function ◽

Neonatal Skin ◽

Care Practices ◽

Sub Saharan

Background: Serious infections and other complications from very low birth weight and prematurity are the leading causes of death for neonates worldwide. Infections partly result from the compromised skin barrier function in preterm neonates. Optimal skin care practices for neonates, especially in settings with limited access to adequate hygienic conditions, hold potential to reduce infection and avoid these preventable preterm neonatal deaths. The purpose of this protocol is to support a scoping review of neonatal skin care, emollient therapy and massage practices throughout sub-Saharan Africa. Protocol: The proposed review will follow a methodological framework consisting of the following five steps: (i) identifying the research question, (ii) identifying relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating and summarizing the results. In addition, we will reflect on the implications of the findings for the feasibility and design of randomized controlled trials to examine the impact of emollient therapy on survival, growth, infection and neurodevelopment of very low birth weight infants in sub-Saharan Africa. We will search domestic and international databases for literature published in English between January 1, 2000, and July 12, 2021. Articles will be chosen based on standardized inclusion criteria. The primary criteria for inclusion will be a report on skin care practices administered to neonates in Africa. Conclusions: Documentation of common neonatal skin care practices throughout Africa has the potential to highlight opportunities for skin care intervention and future research on neonatal skin care practices in sub-Saharan Africa, and support the development of future emollient intervention trials for preterm and low birthweight neonates in low- and middle-income countries.

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BCG vaccination is associated with reduced malaria prevalence in children under the age of 5 years in sub-Saharan Africa

BMJ Global Health ◽

10.1136/bmjgh-2019-001862 ◽

2019 ◽

Vol 4 (6) ◽

pp. e001862 ◽

Cited By ~ 8

Author(s):

Mike LT Berendsen ◽

Sjors WL van Gijzel ◽

Jeroen Smits ◽

Quirijn de Mast ◽

Peter Aaby ◽

...

Keyword(s):

Malaria Prevalence ◽

Sub Saharan Africa ◽

Cluster Sampling ◽

Bcg Vaccination ◽

Malaria Burden ◽

Specific Effects ◽

Effective Interventions ◽

Sub Saharan ◽

Ssa Countries ◽

Transmission Reservoir

IntroductionMalaria continues to be a major cause of morbidity and mortality in sub-Saharan Africa (SSA) without effective interventions. Bacillus Calmette-Guérin (BCG) vaccine possesses protective non-specific effects, which extend beyond protection against tuberculosis. This study explores whether BCG is associated with protection against malaria in children under the age of 5 years in SSA.MethodsWe used data from the Demographic Health Survey programme, including 34 206 children from 13 SSA countries. BCG status was taken from vaccination cards when present; if not, mother’s recall was used. Presence of malaria was defined as a positive rapid diagnostic test. Maternally reported presence or absence of fever in the previous 2 weeks defined symptomatic status. Multilevel logistic regression was used to account for the two-stage cluster sampling method.ResultsOf the 34 206 children, 12 325 (36.0%) children were malaria positive and 29 766 (87.0%) were BCG vaccinated. After correction for relevant child, maternal and household factors, BCG vaccination was associated with a lower malaria prevalence (adjusted OR (aOR)=0.94, 95% CI 0.90 to 0.98), especially among children of whom BCG information was retrieved from a vaccination card (aORcard=0.88, 95% CI 0.82 to 0.94). Restricting the analysis to children from regions with suboptimal BCG coverage increased the association (aORcard=0.81, 95% CI 0.73 to 0.89). We observed an increasingly beneficial association with each month of age of the child (aORcard=0.996, 95% CI 0.993 to 0.999). BCG associations were similar for asymptomatic (aORcard=0.86, 95% CI 0.81 to 0.92) and symptomatic (aORcard=0.89, 95% CI 0.78 to 1.01) malaria.ConclusionsBCG vaccination is associated with protection against malaria. This protection is highest in regions with suboptimal BCG coverage. These results indicate a possible role for timely BCG vaccination in the protection of malaria and its elimination by reducing the transmission reservoir. If confirmed in further research, our findings have substantial implications for global efforts to reduce malaria burden.

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A multi-year analysis of kangaroo mother care outcomes in low birth weight babies at a Nyakahanga Hospital in rural Tanzania

African Health Sciences ◽

10.4314/ahs.v20i1.56 ◽

2020 ◽

Vol 20 (1) ◽

pp. 498-508

Author(s):

Linda A Winkler ◽

Agnes Stypulkowski ◽

Shana Noon ◽

Theophila Babwanga ◽

Jesca Lutahoire

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Rural Areas ◽

Urban Areas ◽

Very Low Birth Weight ◽

Kangaroo Mother Care ◽

Sub Saharan Africa ◽

Low Resource ◽

Popu Lations ◽

Sub Saharan

Background: Kangaroo Mother Care (KMC) requires few specialized resources, reduces mortality, and can be implemented in low resource environments. It is now recommended for implementation around the globe. Objectives: This paper discusses KMC use with low birth weight newborns at a Tanzania hospital providing valuable outcomes assessment of KMC use in rural areas of sub-Saharan Africa. Methods: The research used retrospective records (136 Low Birth Weight (LBW) and 33 Very Low Birth Weight (VLBW) ne- onates) supplemented by observations. Data included weights (longitudinal), survival period, and cause of death if it occurred. This hospital’s KMC use and study data began when the mother-baby dyad was referred, usually birth day. Results: This KMC group demonstrated 70% survival, but 77% of deaths occur within 24 hours. After the first 24 hours, KMC survival rate was 92%. Even VLBW neonates (<1000 g) had 37.5% survival among the KMC program. Prematurity and respi- ratory distress caused nearly half of the deaths, but hypothermia (19% of deaths) and infection were factors also. Conclusion: Our study indicates the value of KMC in rural low resource environments. Results are comparable to KMC pro- grams in urban areas where newborns begin KMC after stabilization and better than outcomes reported for comparable popu- lations not practicing KMC in rural sub-Saharan Africa. Keywords: Kangaroo mother care; low birth weight; neonatal mortality; premature infant.

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Prevalence of low birth weight and its associated factor at birth in Sub-Saharan Africa: A generalized linear mixed model

PLoS ONE ◽

10.1371/journal.pone.0248417 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248417

Author(s):

Zemenu Tadesse Tessema ◽

Koku Sisay Tamirat ◽

Achamyeleh Birhanu Teshale ◽

Getayeneh Antehunegn Tesema

Keyword(s):

Decision Making ◽

Birth Weight ◽

Low Birth Weight ◽

Associated Factors ◽

Sub Saharan Africa ◽

Healthcare Decision ◽

Data Set ◽

Mixed Effect ◽

Healthcare Decision Making ◽

Sub Saharan

Background Low birth weight (LBW) is one of the major determinants of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and illnesses in future lives. Though studies were conducted to assess the magnitude and associated factors of low birth weight, most of the studies were at a single center and little information on the regional level. Hence, this study assessed the prevalence and associated factors of low birth weight in Sub-Saharan countries. Method This study was based on secondary data sources from 35 Sub-Saharan countries’ Demography and Health Survey (DHS). For this study, we used the Kids Record (KR file) data set. In the KR file, all under-five children who were born in the last five years preceding the survey in the selected enumeration area who had birth weight data were included for the study. To identify determinants of low birth weight multivariable mixed-effect logistic regression model fitted. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤0.05 in the multivariable model were used to declare significant factors associated with low birth weight at birth. Result The pooled prevalence of newborn babies’ low birth weight measured at birth in Sub-Saharan Africa was 9.76% with (95% CI: 9.63% to 9.89%). Female child, women not participated in healthcare decision making, and wider birth intervals, divorced/ separated women, and twin pregnancies associated with increased occurrences of low birth weight, while some level of woman and husband education, antenatal care visits, older maternal age, and multiparity associated with reduced occurrence low birth weight. Conclusion This study revealed that the magnitude of low birth weight was high in sub-Saharan Africa countries. Therefore, the finding suggests that more emphasis is important for women with a lack of support, multiples, and healthcare decision-making problems.

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Mobile Communication Technology and National Identity in Sub-Saharan Africa

10.31219/osf.io/k4djn ◽

2021 ◽

Author(s):

Donghyun Danny Choi ◽

Benjamin Laughlin ◽

Anna Schultz

Keyword(s):

National Identity ◽

Mobile Internet ◽

Sub Saharan Africa ◽

Difference In Differences ◽

Percentage Points ◽

Negative Effect ◽

Sub Saharan ◽

Survey Interviews ◽

Mobile Communication Technology ◽

Media And Communication

We examine how the expansion of mobile internet infrastructure affects national identity in sub-Saharan Africa. In diverse societies where elections are contested along ethno-communal lines, we argue that access to mobile internet undermines national identity because it facilitates voter exposure to the polarizing tendencies of internet-based social media and communication platforms. Applying a difference-in-differences design on mobile coverage maps and geocoded survey data of more than 50,000 African citizens, we show that access to mobile internet reduces identification with the nation by up to 5--7 percentage points. To establish support for our electoral mechanism, we exploit as-if random variation in the timing of individuals' survey interviews relative to presidential elections, during which we argue divisive and polarizing forces are at their peak. Our analysis shows that electoral proximity intensifies the negative effect of mobile internet. These findings highlight how technological innovations can inhibit the process of state-building in diverse societies.

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Synergism in Antiplasmodial Activities of Artemether and Lumefantrine in Combination with Securidaca longipedunculata Fresen (Polygalaceae)

Plants ◽

10.3390/plants11010047 ◽

2021 ◽

Vol 11 (1) ◽

pp. 47

Author(s):

Douglas O. Ochora ◽

Esezah K. Kakudidi ◽

Jane Namukobe ◽

Perpetua Ipulet ◽

Dancan M. Wakoli ◽

...

Keyword(s):

Drug Combination ◽

Ex Vivo ◽

Malaria Prevalence ◽

Sub Saharan Africa ◽

Cross Resistance ◽

Field Isolates ◽

Malaria Burden ◽

Inhibition Concentration ◽

Sub Saharan ◽

Emergence Of Resistance

Malaria is the most lethal parasitic disease in the world. The frequent emergence of resistance by malaria parasites to any drug is the hallmark of sustained malaria burden. Since the deployment of artemisinin-based combination therapies (ACTs) it is clear that for a sustained fight against malaria, drug combination is one of the strategies toward malaria elimination. In Sub-Saharan Africa where malaria prevalence is the highest, the identification of plants with a novel mechanism of action that is devoid of cross-resistance is a feasible strategy in drug combination therapy. Thus, artemether and lumefantrine were separately combined and tested with extracts of Securidaca longipedunculata, a plant widely used to treat malaria, at fixed extract–drug ratios of 4:1, 3:1, 1:1, 1:2, 1:3, and 1:4. These combinations were tested for antiplasmodial activity against three strains of Plasmodium falciparum (W2, D6, and DD2), and seven field isolates that were characterized for molecular and ex vivo drug resistance profiles. The mean sum of fifty-percent fractional inhibition concentration (FIC50) of each combination and singly was determined. Synergism was observed across all fixed doses when roots extracts were combined with artemether against D6 strain (FIC50 0.403 ± 0.068) and stems extract combined with lumefantrine against DD2 strain (FIC50 0.376 ± 0.096) as well as field isolates (FIC50 0.656 ± 0.067). Similarly, synergism was observed in all ratios when leaves extract were combined with lumefantrine against W2 strain (FIC50 0.456 ± 0.165). Synergism was observed in most combinations indicating the potential use of S. longipedunculata in combination with artemether and lumefantrine in combating resistance.

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Faktor Risiko Stunting pada anak di Negara Berkembang

Amerta Nutrition ◽

10.20473/amnt.v3i3.2019.122-129 ◽

2019 ◽

Vol 3 (3) ◽

pp. 122

Author(s):

Indah Budiastutik ◽

Muhammad Zen Rahfiludin

Keyword(s):

Developing Countries ◽

Birth Weight ◽

Low Birth Weight ◽

Exclusive Breastfeeding ◽

Maternal Education ◽

Linear Growth ◽

Sub Saharan Africa ◽

Child Stunting ◽

Sub Saharan ◽

Health Organization

Background: The problem of stunting occurs in developing countries including Indonesia. In Indonesia the prevalence of child stunting is 30.8%, still above the world prevalence, which is 22.2%. The prevalence of stunting in sub-Saharan Africa is 34.5%, in Ethiopia is 52.4%, and the prevalence of stunting in Congo is 40%. While WHO stipulates that nutrition problems should not exceed 20%. Stunting could inhibit linear growth, development and degenerative diseases later in adulthood.Objective: This review discussed the risk factors of child stunting in developing countries.Discusion: One of the causes of increased stunting in children was due to inadequate nutritional intake in a long period. Stunting was often not realized by parents and only visible after the age of 2 due to low stature. Based on the results of the literature review the likelihood of stunting in developing country were: 16.43 times morelikely due to low birth length, 3.27 times higher due to maternal education, 2.45 times higher if the children were living in rural area, 4.5 times higher due to low birth weight, no risk Antenatal Care increase the risk 3.4 times, 6.38 times higher due to no immunization, and no exclusive breastfeeding increase the risk of stunting 4.0 times.Conclusion: The risk factor for child stunting in developing countries are exclusive breastfeeding, socioeconomic, low birth weight, length of birth, low maternal education, infectious disease.ABSTRAKLatar Belakang: Masalah stunting (stunting) yang terjadi di Negara Berkembang seperti Indonesia masih tinggi yaitu 30,8% masih di atas dunia yaitu 22,2%. Stunting di sub sahara Afrika 34,5%, di Ethiopia 52,4%, prevalensi stunting di Congo 40%. Word Health Organization sudah menentukan bahwa terjadinya masalah gizi suatu negara sebaiknya kurang dari 20%. Stunting memiliki risiko gangguan pertumbuhan, perkembangan dan penyakit degeneratif pada usia dewasa nanti.Tujuan: Review ini bertujuan untuk mengidentifikasi faktor risikos apa saja yang dapat menentukan terjadinya stunting anak di Negara berkembang.Ulasan: Berdasarkan dari beberapa hasil penelitian menyebutkan bahwa salah satu penyebab stunting pada anak adalah karena tidak terpenuhinya gizi yang baik pada kurun waktu yang panjang dan sering kali tidak disadari oleh orang tuanya sehingga setelah anak usia di atas 2 tahun baru terlihat bahwa anaknya mengalami stunting. Berdasarkan hasil literatur review menunjukkan bahwa faktor risiko terjadinya stunting adalah panjang lahir berisiko 16,43 kali, pendidikan ibu yang rendah berisiko 3,27 kali, serta anak yang tinggal di desa berisiko 2,45 kali, BBLR berisiko 4,5 kali, tidak ANC berisiko 3,4 kali, tidak imunisasi berisiko 6,38 kali, dan tidak ASI Eksklusif berisiko 4,0 kali adalah merupakan faktor risiko stunting anak di negara berkembang.Kesimpulan: Hasil sintesis ini secara konsisten yang menjadi faktor risikos terjadinya stunting pada anak di negara berkembang adalah tidak diberikan ASI eksklusif, sosial ekonomi, berat bayi lahir rendah, panjang lahir, pendidikan ibu rendah, penyakit infeksi.

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Establishing a Twin Registry in Guinea-Bissau

Twin Research and Human Genetics ◽

10.1017/thg.2012.90 ◽

2012 ◽

Vol 16 (1) ◽

pp. 179-184 ◽

Cited By ~ 8

Author(s):

Morten Bjerregaard-Andersen ◽

Margarida A. Gomes ◽

Luis C. Joaquím ◽

Amabelia Rodrigues ◽

Dorte M. Jensen ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Large Scale ◽

Twin Studies ◽

Monozygotic Twin ◽

Sub Saharan Africa ◽

Mortality And Morbidity ◽

Guinea Bissau ◽

Health Project ◽

Sub Saharan

Twins traditionally retain a special status in many African societies. In Guinea-Bissau, twins are often well regarded yet still suffer from a very high mortality, especially in the perinatal and infant period. At the Bandim Health Project, a health and demographic surveillance site, we have recently established one of the first twin registries in Sub-Saharan Africa. Our short-term aim is to describe twin mortality and morbidity in order to design appropriate health interventions. Our long-term goal is a large-scale database to explore the pathogenesis of prevalent diseases; for example, diabetes mellitus, metabolic syndrome, and infectious diseases such as HIV, tuberculosis, and malaria. A major focus area is also the etiology of low birth weight and how epigenetic processes might modulate the consequences of low birth weight in Sub-Saharan Africa. For this, monozygotic twin studies represent a powerful tool. Though twin studies have been carried out by the Bandim Health Project for more than 30 years, the renewed registry described here was officially established in 2009 and includes both a cohort of newborn twins and a cohort of young and adult twins. Currently more than 1,500 twins are being followed in the two cohorts combined. We believe that the registry holds exciting possibilities and will encourage the establishment of further twin registries across the region.

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Impact of Malaria during Pregnancy on Low Birth Weight in Sub-Saharan Africa

Clinical Microbiology Reviews ◽

10.1128/cmr.17.4.760-769.2004 ◽

2004 ◽

Vol 17 (4) ◽

pp. 760-769 ◽

Cited By ~ 231

Author(s):

Helen L. Guyatt ◽

Robert W. Snow

Keyword(s):

Risk Factor ◽

Birth Weight ◽

Infant Mortality ◽

Low Birth Weight ◽

Empirical Data ◽

Placental Malaria ◽

Sub Saharan Africa ◽

Infant Deaths ◽

Malaria During Pregnancy ◽

Sub Saharan

SUMMARY Malaria during pregnancy can result in low birth weight (LBW), an important risk factor for infant mortality. This article reviews the pathological effects of malaria during pregnancy and the implications for the newborn's development and survival. Empirical data from throughout Africa on associations between placental malaria and birth weight outcome, birth weight outcome and infant mortality, and the rates of LBW in areas with various levels of malaria transmission are evaluated to assess the increased risks of LBW and infant mortality associated with malaria. It is estimated that in areas where malaria is endemic, around 19% of infant LBWs are due to malaria and 6% of infant deaths are due to LBW caused by malaria. These estimates imply that around 100,000 infant deaths each year could be due to LBW caused by malaria during pregnancy in areas of malaria endemicity in Africa.

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