152 results on '"Chasekwa, Bernard"'
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2. Quality of vital event data for infant mortality estimation in prospective, population-based studies: an analysis of secondary data from Asia, Africa, and Latin America
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Erchick, Daniel J., Subedi, Seema, Verhulst, Andrea, Guillot, Michel, Adair, Linda S., Barros, Aluísio J. D., Chasekwa, Bernard, Christian, Parul, da Silva, Bruna Gonçalves C., Silveira, Mariângela F., Hallal, Pedro C., Humphrey, Jean H., Huybregts, Lieven, Kariuki, Simon, Khatry, Subarna K., Lachat, Carl, Matijasevich, Alicia, McElroy, Peter D., Menezes, Ana Maria B., Mullany, Luke C., Perez, Tita Lorna L., Phillips-Howard, Penelope A., Roberfroid, Dominique, Santos, Iná S., ter Kuile, Feiko O., Ravilla, Thulasiraj D., Tielsch, James M., Wu, Lee S. F., and Katz, Joanne
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- 2023
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3. The gut microbiome and early-life growth in a population with high prevalence of stunting
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Robertson, Ruairi C., Edens, Thaddeus J., Carr, Lynnea, Mutasa, Kuda, Gough, Ethan K., Evans, Ceri, Geum, Hyun Min, Baharmand, Iman, Gill, Sandeep K., Ntozini, Robert, Smith, Laura E., Chasekwa, Bernard, Majo, Florence D., Tavengwa, Naume V., Mutasa, Batsirai, Francis, Freddy, Tome, Joice, Stoltzfus, Rebecca J., Humphrey, Jean H., Prendergast, Andrew J., and Manges, Amee R.
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- 2023
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4. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting
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Ashorn, Per, Black, Robert E, Lawn, Joy E, Ashorn, Ulla, Klein, Nigel, Hofmeyr, G Justus, Temmerman, Marleen, Askari, Sufia, Ohuma, Eric O, Moller, Ann-Beth, Bradley, Ellen, Chakwera, Samuel, Hussain-Alkhateeb, Laith, Lewin, Alexandra, Okwaraji, Yemisrach B, Retno Mahanani, Wahyu, White Johansson, Emily, Lavin, Tina, Estevez Fernandez, Diana, Gatica Domínguez, Giovanna, de Costa, Ayesha, Cresswell, Jenny A, Krasevec, Julia, Blencowe, Hannah, Requejo, Jennifer, Moran, Allisyn C, Pingray, Veronica, Cormick, Gabriela, Gibbons, Luz, Belizan, José, Guevel, Carlos, Warrilow, Kara, Gordon, Adrienne, Flenady, Vicki, Sexton, Jessica, Lawford, Harriet, Paixao, Enny S., Rocha Falcão, Ila, Lima Barreto, Mauricio, Lisonkova, Sarka, Wen, Qi, Mardones, Francisco, Caulier-Cisterna, Raúl, Acuña, José, Velebil, Petr, Jirova, Jitka, Horváth-Puhó, Erzsébet, Sørensen, Henrik Toft, Sakkeus, Luule, Abuladze, Liili, Gissler, Mika, Moradi-Lakeh, Maziar, Heidarzadeh, Mohammad, Khalili, Narjes, A. Yunis, Khalid, Al Bizri, Ayah, Nakad, Pascale, Devi Karalasingam, Shamala, R Jeganathan, J Ravichandran, binti Baharum, Nurakman, Suárez-Idueta, Lorena, Barranco Flores, Arturo, Gonzalez Roldan, Jesus F, Lopez Alvarez, Sonia, van Dijk, Aimée E., Broeders, Lisa, Huicho, Luis, Quezada Pinedo, Hugo G, Cajachagua-Torres, Kim N, Carrillo-Larco, Rodrigo M, Tarazona Meza, Carla Estefania, Guzman-Vilca, Wilmer Cristobal, Olukade, Tawa O., Ali, Hamdy A., Alyafei, Fawziya, AlQubaisi, Mai, Alturk, Mohamad R, Kim, Ho Yeon, Cho, Geum Joon, Razaz, Neda, Söderling, Jonas, Smith, Lucy K, Kurinczuk, Jennifer J, Matthews, Ruth J, Manktelow, Bradley N, Draper, Elizabeth S, Fenton, Alan C, Lowry, Estelle, Rowland, Neil, Wood, Rachael, Monteath, Kirsten, Pereyra, Isabel, Pravia, Gabriella, Davis, Celina, Clarke, Samantha, Wu, Lee S.F., Yoshida, Sachiyo, Bahl, Rajiv, Grandi, Carlos, Labrique, Alain B, Rashid, Mabhubur, Ahmed, Salahuddin, Roy, Arunangshu D., Haque, Rezwanul, Shaikh, Saijuddin, Baqui, Abdullah H., Saha, Samir K., Khanam, Rasheda, Rahman, Sayedur, Shapiro, Roger, Zash, Rebecca, Silveira, Mariângela F., Buffarini, Romina, Kolsteren, Patrick, Lachat, Carl, Huybregts, Lieven, Roberfroid, Dominique, Zeng, Lingxia, Zhu, Zhonghai, He, Jianrong, Qui, Xiu, Gebreyesus, Seifu H., Tesfamariam, Kokeb, Bekele, Delayehu, Chan, Grace, Baye, Estifanos, Workneh, Firehiwot, Asante, Kwaku P., Boanmah-Kaali, Ellen, Adu-Afarwuah, Seth, Dewey, Kathryn G., Gyaase, Stephaney, Wylie, Blair J., Kirkwood, Betty R., Manu, Alexander, Thulasiraj, Ravilla D, Tielsch, James, Chowdhury, Ranadip, Taneja, Sunita, Babu, Giridhara R, Shriyan, Prafulla, Maleta, Kenneth, Mangani, Charles, Acevedo-Gallegos, Sandra, Rodriguez-Sibaja, Maria J., Khatry, Subarna K., LeClerq, Steven C., Mullany, Luke C., Jehan, Fyezah, Ilyas, Muhammad, Rogerson, Stephen J., Unger, Holger W., Ghosh, Rakesh, Musange, Sabine, Ramokolo, Vundli, Zembe-Mkabile, Wanga, Lazzerini, Marzia, Mohamed, Rishard, Wang, Dongqing, Fawzi, Wafaie W., Minja, Daniel T.R., Schmiegelow, Christentze, Masanja, Honorati, Smith, Emily, Lusingu, John P.A., Msemo, Omari A., Kabole, Fathma M., Slim, Salim N., Keentupthai, Paniya, Mongkolchati, Aroonsri, Kajubi, Richard, Kakuru, Abel, Waiswa, Peter, Walker, Dilys, Hamer, Davidson H., Semrau, Katherine E.A., Chaponda, Enesia B., Chico, R. Matthew, Banda, Bowen, Musokotwane, Kebby, Manasyan, Albert, Pry, Jake M., Chasekwa, Bernard, Humphrey, Jean, Shamim, Abu Ahmed, Christian, Parul, Ali, Hasmot, Klemm, Rolf D.W., Massie, Alan B., Mitra, Maithili, Mehra, Sucheta, Schulze, Kerry J., Shamim, Abu Amed, Sommer, Alfred, Ullah, Barkat, West, Keith P., Jr, Begum, Nazma, Chowdhury, Nabidul Haque, Islam, Shafiqul, Mitra, Dipak Kumar, Quaiyum, Abdul, Diseko, Modiegi, Makhema, Joseph, Cheng, Yue, Guo, Yixin, Yuan, Shanshan, Roro, Meselech, Shikur, Bilal, Goddard, Frederick, Haneuse, Sebastien, Hunegnaw, Bezawit, Berhane, Yemane, Worku, Alemayehu, Kaali, Seyram, Arnold, Charles D., Jack, Darby, Amenga-Etego, Seeba, Hurt, Lisa, Shannon, Caitlin, Soremekun, Seyi, Bhandari, Nita, Martines, Jose, Mazumder, Sarmila, Ana, Yamuna, R, Deepa, Hallamaa, Lotta, Pyykkö, Juha, Lumbreras-Marquez, Mario I., Mendoza-Carrera, Claudia E., Hussain, Atiya, Karim, Muhammad, Kausar, Farzana, Mehmood, Usma, Nadeem, Naila, Nisar, Muhammad Imran, Sajid, Muhammad, Mueller, Ivo, Ome-Kaius, Maria, Butrick, Elizabeth, Sayinzoga, Felix, Mariani, Ilaria, Urassa, Willy, Theander, Thor, Deloron, Phillippe, Nielsen, Birgitte Bruun, Muhihi, Alfa, Noor, Ramadhani Abdallah, Bygbjerg, Ib, Moeller, Sofie Lykke, Aftab, Fahad, Ali, Said M., Dhingra, Pratibha, Dhingra, Usha, Dutta, Arup, Sazawal, Sunil, Suleiman, Atifa, Mohammed, Mohammed, Deb, Saikat, Kamya, Moses R., Nakalembe, Miriam, Mulowooz, Jude, Santos, Nicole, Biemba, Godfrey, Herlihy, Julie M., Mbewe, Reuben K., Mweena, Fern, Yeboah-Antwi, Kojo, Bruce, Jane, Chandramohan, Daniel, Prendergast, Andrew, Idueta, Lorena Suárez, Hazel, Elizabeth, Erchick, Daniel J, Yargawa, Judith, Katz, Joanne, Lee, Anne C C, Diaz, Mike, Salasibew, Mihretab, Hayashi, Chika, and Borghi, Elaine
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- 2023
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5. Associations between maternal obesity and infectious morbidity in Zimbabwean infants
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Althaus, Thomas, Chasekwa, Bernard, Robertson, Ruairi C., Ntozini, Robert, Greenland, Katie, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2022
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6. Implementation and maintenance of infant dietary diversity in Zimbabwe: contribution of food and water insecurity
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Koyratty, Nadia, Mbuya, Mduduzi N. N., Jones, Andrew D., Schuster, Roseanne C., Kordas, Katarzyna, Li, Chin-Shang, Tavengwa, Naume V., Majo, Florence D., Chasekwa, Bernard, Ntozini, Robert, Humphrey, Jean H., and Smith, Laura E.
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- 2022
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7. Maternal inflammatory and microbial drivers of low birthweight in low- and middle-income countries.
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Broad, Jonathan, Robertson, Ruairi C., Evans, Ceri, Perussolo, Jeniffer, Lum, Gina, Piper, Joe D., Loucaides, Eva, Ziruma, Asaph, Chasekwa, Bernard, Ntozini, Robert, Bourke, Claire D., and Prendergast, Andrew J.
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MIDDLE-income countries ,PREMATURE labor ,COMMUNICABLE diseases ,GREY literature ,BIRTH weight - Abstract
Low birthweight (LBW) is when an infant is born too soon or too small, and it affects one in seven infants in low- and middle-income countries. LBW has a significant impact on short-term morbidity and mortality, and it impairs long-term health and human capital. Antenatal microbial and inflammatory exposure may contribute to LBW. Ovid-Medline, Embase and Cochrane databases were searched for English-language articles evaluating inflammatory, microbial or infective causes of LBW, small-for-gestational age, intra-uterine growth restriction or prematurity. Inclusion criteria were human studies including published data; conference abstracts and grey literature were excluded. A narrative synthesis of the literature was conducted. Local infections may drive the underlying causes of LBW: for example, vaginitis and placental infection are associated with a greater risk of prematurity. Distal infection and inflammatory pathways are also associated with LBW, with an association between periodontitis and preterm delivery and environmental enteric dysfunction and reduced intra-uterine growth. Systemic maternal infections such as malaria and HIV are associated with LBW, even when infants are exposed to HIV but not infected. This latter association may be driven by chronic inflammation, co-infections and socio-economic confounders. Antimicrobial prophylaxis against other bacteria in pregnancy has shown minimal impact in most trials, though positive effects on birthweight have been found in some settings with a high infectious disease burden. Maternal inflammatory and infective processes underlie LBW, and provide treatable pathways for interventions. However, an improved understanding of the mechanisms and pathways underlying LBW is needed, given the impact of LBW on life-course. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Associations between biomarkers of environmental enteric dysfunction and oral rotavirus vaccine immunogenicity in rural Zimbabwean infants
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Church, James A, Rukobo, Sandra, Govha, Margaret, Gough, Ethan K, Chasekwa, Bernard, Lee, Benjamin, Carmolli, Marya P, Panic, Gordana, Giallourou, Natasa, Ntozini, Robert, Mutasa, Kuda, McNeal, Monica M, Majo, Florence D., Tavengwa, Naume V., Swann, Jonathan R., Moulton, Lawrence H, Kirkpatrick, Beth D, Humphrey, Jean H, and Prendergast, Andrew J
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- 2021
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9. Early child development in children who are HIV-exposed uninfected compared to children who are HIV-unexposed: observational sub-study of a cluster-randomized trial in rural Zimbabwe
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Ntozini, Robert, Chandna, Jaya, Evans, Ceri, Chasekwa, Bernard, Majo, Florence D., Kandawasvika, Gwendoline, Tavengwa, Naume V., Mutasa, Batsirai, Mutasa, Kuda, Moulton, Lawrence H., Humphrey, Jean H., Gladstone, Melissa J., and Prendergast, Andrew J.
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Clinical trials -- Research -- Comparative analysis ,Infants -- Comparative analysis -- Research ,HIV -- Research ,Sanitation -- Research -- Comparative analysis ,Pregnant women -- Research -- Comparative analysis ,Health - Abstract
Introduction: Exposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV-exposed uninfected (CHEU) and children who were HIV-unexposed (CHU) recruited to the SHINE trial in rural Zimbabwe. Methods: SHINE was a community-based cluster-randomized trial of improved infant feeding and/or improved water, sanitation and hygiene. Pregnant women were enrolled between 2012 and 2015. We assessed ECD in a sub-study at 24 months of age, between 2016 and 2017, using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social development); MacArthur-Bates Communicative Development Inventory (CDI) (assessing vocabulary and grammar); A-not-B test (assessing object permanence); and a self-control task. Mothers and infants were tested longitudinally for HIV. We used generalized estimating equations to compare ECD scores between CHEU and CHU, accounting for the cluster-randomized design. Primary results were adjusted for trial-related factors that could affect measurement reliability of ECD: study nurse, age of child, calendar month of birth, sex and randomized arm. Results: A total of 205 CHEU and 1175 CHU were evaluated. Mean total MDAT score was 90.6 (SD 8.7) in CHEU compared to 92.4 (9.1) in CHU (adjusted mean difference -1.3, 95% CI: -2.3, -0.3), driven mostly by differences in gross motor (-0.5, 95% CI: -0.9, -0.2) and language scores (-0.6, 95% CI: -1.1, -0.1). There was evidence that fine motor scores were lower in CHEU (adjusted mean difference -0.4, 95% CI: -0.8, 0.0) but no evidence of a difference in social scores (0.1, 95% CI: -0.2, 0.4). Mean MacArthur-Bates CDI vocabulary score was 57.9 (SD 19.2) in CHEU compared to 61.3 (18.8) in CHU (adjusted mean difference -2.9 words, 95% CI: -5.7, -0.1). Object permanence and self-control scores were similar between groups. Conclusions: CHEU in rural Zimbabwe had total child development and vocabulary scores that were approximately 0.15 standard deviations lower than CHU at two years of age. More detailed and specific studies are now needed to unravel the reasons for developmental delay in CHEU and the likelihood that these delays persist in the longer term. Keywords: child development; language; motor; self-control; HIV-exposed uninfected; Zimbabwe, 1 | INTRODUCTION The increasing coverage of prevention of mother-to-child transmission (PMTCT) interventions in sub-Saharan Africa has dramatically reduced the number of children with HIV infection. However, this success has [...]
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- 2020
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10. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial
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Humphrey, Jean H, Jones, Andrew D, Manges, Amee, Mangwadu, Goldberg, Maluccio, John A, Mbuya, Mduduzi N N, Moulton, Lawrence H, Ntozini, Robert, Prendergast, Andrew J, Stoltzfus, Rebecca J, Tielsch, James M, Chasokela, Cynthia, Chigumira, Ancikaria, Heylar, William, Hwena, Preston, Kembo, George, Majo, Florence D, Mutasa, Batsirai, Mutasa, Kuda, Rambanepasi, Philippa, Sauramba, Virginia, Tavengwa, Naume V, Van Der Keilen, Franne, Zambezi, Chipo, Chidhanguro, Dzivaidzo, Chigodora, Dorcas, Chipanga, Joseph F, Gerema, Grace, Magara, Tawanda, Mandava, Mandava, Mavhudzi, Tafadzwa, Mazhanga, Clever, Muzaradope, Grace, Mwapaura, Marian T, Phiri, Simon, Tengende, Alice, Banda, Cynthia, Chasekwa, Bernard, Chidamba, Leah, Chidawanyika, Theodore, Chikwindi, Elisha, Chingaona, Lovemore K, Chiorera, Courage K, Dandadzi, Adlight, Govha, Margaret, Gumbo, Hlanai, Gwanzura, Karen T, Kasaru, Sarudzai, Makasi, Rachel, Matsika, Alois M, Maunze, Diana, Mazarura, Exevia, Mpofu, Eddington, Mushonga, Johnson, Mushore, Tafadzwa E, Muzira, Tracey, Nembaware, Netsai, Nkiwane, Sibongile, Nyamwino, Penias, Rukobo, Sandra D, Runodamoto, Thompson, Seremwe, Shepherd, Simango, Pururudzai, Tome, Joice, Tsenesa, Blessing, Amadu, Umali, Bangira, Beauty, Chiveza, Daniel, Hove, Priscilla, Jombe, Horaiti A, Kujenga, Didymus, Madhuyu, Lenin, Makoni, Prince M, Maramba, Naume, Maregere, Betty, Marumani, Ellen, Masakadze, Elisha, Mazula, Phathisiwe, Munyanyi, Caroline, Musanhu, Grace, Mushanawani, Raymond C, Mutsando, Sibongile, Nazare, Felicia, Nyarambi, Moses, Nzuda, Wellington, Sigauke, Trylife, Solomon, Monica, Tavengwa, Tendai, Biri, Farisai, Chafanza, Misheck, Chaitezvi, Cloud, Chauke, Tsundukani, Chidzomba, Collen, Dadirai, Tawanda, Fundira, Clemence, Gambiza, Athanasios C, Godzongere, Tatenda, Kuona, Maria, Mafuratidze, Tariro, Mapurisa, Idah, Mashedze, Tsitsi, Moyo, Nokuthula, Musariri, Charles, Mushambadope, Matambudzo, Mutsonziwa, Tawanda R, Muzondo, Augustine, Mwareka, Rudo, Nyamupfukudza, Juleika, Saidi, Baven, Sakuhwehwe, Tambudzai, Sikalima, Gerald, Tembe, Jenneth, Chekera, Tapiwanashe E, Chihombe, Owen, Chikombingo, Muchaneta, Chirinda, Tichaona, Chivizhe, Admire, Hove, Ratidzai, Kufa, Rudo, Machikopa, Tatenda F, Mandaza, Wilbert, Mandongwe, Liberty, Manhiyo, Farirai, Manyaga, Emmanuel, Mapuranga, Peter, Matimba, Farai S, Matonhodze, Patience, Mhuri, Sarah, Mike, Joice, Ncube, Bekezela, Nderecha, Walter T S, Noah, Munyaradzi, Nyamadzawo, Charles, Penda, Jonathan, Saidi, Asinje, Shonhayi, Sarudzai, Simon, Clemence, Tichagwa, Monica, Chamakono, Rachael, Chauke, Annie, Gatsi, Andrew F, Hwena, Blessing, Jawi, Hillary, Kaisa, Benjamin, Kamutanho, Sithembile, Kaswa, Tapiwa, Kayeruza, Paradhi, Lunga, Juliet, Magogo, Nomatter, Manyeruke, Daniel, Mazani, Patricia, Mhuriyengwe, Fungai, Mlambo, Farisai, Moyo, Stephen, Mpofu, Tawanda, Mugava, Mishelle, Mukungwa, Yvonne, Muroyiwa, Fungai, Mushonga, Eddington, Nyekete, Selestino, Rinashe, Tendai, Sibanda, Kundai, Chemhuru, Milton, Chikunya, Jeffrey, Chikwavaire, Vimbai F, Chikwiriro, Charity, Chimusoro, Anderson, Chinyama, Jotam, Gwinji, Gerald, Hoko-Sibanda, Nokuthula, Kandawasvika, Rutendo, Madzimure, Tendai, Maponga, Brian, Mapuranga, Antonella, Marembo, Joana, Matsunge, Luckmore, Maunga, Simbarashe, Muchekeza, Mary, Muti, Monica, Nyamana, Marvin, Azhuda, Efa, Bhoroma, Urayai, Biriyadi, Ailleen, Chafota, Elizabeth, Chakwizira, Angelline, Chamhamiwa, Agness, Champion, Tavengwa, Chazuza, Stella, Chikwira, Beauty, Chingozho, Chengeto, Chitabwa, Abigail, Dhurumba, Annamary, Furidzirai, Albert, Gandanga, Andrew, Gukuta, Chipo, Macheche, Beauty, Marihwi, Bongani, Masike, Barbara, Mutangandura, Eunice, Mutodza, Beatrice, Mutsindikwa, Angeline, Mwale, Alice, Ndhlovu, Rebecca, Nduna, Norah, Nyamandi, Cathrine, Ruvata, Elias, Sithole, Babra, Urayai, Rofina, Vengesa, Bigboy, Zorounye, Micheal, Bamule, Memory, Bande, Michael, Chahuruva, Kumbirai, Chidumba, Lilian, Chigove, Zvisinei, Chiguri, Kefas, Chikuni, Susan, Chikwanda, Ruvarashe, Chimbi, Tarisai, Chingozho, Micheal, Chinhamo, Olinia, Chinokuramba, Regina, Chinyoka, Chiratidzo, Chipenzi, Xaviour, Chipute, Raviro, Chiribhani, Godfrey, Chitsinga, Mary, Chiwanga, Charles, Chiza, Anamaria, Chombe, Faith, Denhere, Memory, Dhamba, Ephania, Dhamba, Miriam, Dube, Joyas, Dzimbanhete, Florence, Dzingai, Godfrey, Fusira, Sikhutele, Gonese, Major, Gota, Johnson, Gumure, Kresencia, Gwaidza, Phinias, Gwangwava, Margret, Gwara, Winnet, Gwauya, Melania, Gwiba, Maidei, Hamauswa, Joyce, Hlasera, Sarah, Hlukani, Eustina, Hotera, Joseph, Jakwa, Lovemore, Jangara, Gilbert, Janyure, Micheal, Jari, Christopher, Juru, Duvai, Kapuma, Tabeth, Konzai, Paschalina, Mabhodha, Moly, Maburutse, Susan, Macheka, Chipo, Machigaya, Tawanda, Machingauta, Florence, Machokoto, Eucaria, Madhumba, Evelyn, Madziise, Learnard, Madziva, Clipps, Madzivire, Mavis, Mafukise, Mistake, Maganga, Marceline, Maganga, Senzeni, Mageja, Emmanuel, Mahanya, Miriam, Mahaso, Evelyn, Mahleka, Sanelisiwe, Makanhiwa, Pauline, Makarudze, Mavis, Makeche, Constant, Makopa, Nickson, Makumbe, Ranganai, Mandire, Mascline, Mandiyanike, Eunice, Mangena, Eunice, Mangiro, Farai, Mangwadu, Alice, Mangwengwe, Tambudzai, Manhidza, Juliet, Manhovo, Farai, Manono, Irene, Mapako, Shylet, Mapfumo, Evangelista, Mapfumo, Timothy, Mapuka, Jane, Masama, Douglas, Masenge, Getrude, Mashasha, Margreth, Mashivire, Veronica, Matunhu, Moses, Mavhoro, Pazvichaenda, Mawuka, Godfrey, Mazango, Ireen, Mazhata, Netsai, Mazuva, David, Mazuva, Mary, Mbinda, Filomina, Mborera, John, Mfiri, Upenyu, Mhandu, Florence, Mhike, Chrispen, Mhike, Tambudzai, Mhuka, Artwell, Midzi, Judith, Moyo, Siqondeni, Mpundu, Michael, Msekiwa, Nicholas, Msindo, Dominic, Mtisi, Choice, Muchemwa, Gladys, Mujere, Nyadziso, Mukaro, Ellison, Muketiwa, Kilvera, Mungoi, Silvia, Munzava, Esline, Muoki, Rosewita, Mupura, Harugumi, Murerwa, Evelyn, Murisi, Clarieta, Muroyiwa, Letwin, Muruvi, Musara, Musemwa, Nelson, Mushure, Christina, Mutero, Judith, Mutero, Philipa, Mutumbu, Patrick, Mutya, Cleopatra, Muzanango, Lucia, Muzembi, Martin, Muzungunye, Dorcus, Mwazha, Valeliah, Ncube, Thembeni, Ndava, Takunda, Ndlovu, Nomvuyo, Nehowa, Pauline, Ngara, Dorothy, Nguruve, Leonard, Nhigo, Petronella, Nkiwane, Samukeliso, Nyanyai, Luckson, Nzombe, Judith, Office, Evelyn, Paul, Beatrice, Pavari, Shambadzirai, Ranganai, Sylvia, Ratisai, Stella, Rugara, Martha, Rusere, Peter, Sakala, Joyce, Sango, Prosper, Shava, Sibancengani, Shekede, Margaret, Shizha, Cornellious, Sibanda, Tedla, Tapambwa, Neria, Tembo, John, Tinago, Netsai, Tinago, Violet, Toindepi, Theresa, Tovigepi, John, Tuhwe, Modesta, Tumbo, Kundai, Zaranyika, Tinashe, Zaru, Tongai, Zimidzi, Kamurayi, Zindo, Matilda, Zindonda, Maria, Zinhumwe, Nyaradzai, Zishiri, Loveness, Ziyambi, Emerly, Zvinowanda, James, Bepete, Ekenia, Chiwira, Christine, Chuma, Naume, Fari, Abiegirl, Gavi, Samson, Gunha, Violet, Hakunandava, Fadzai, Huku, Constance, Hungwe, Given, Maduke, Grace, Manyewe, Elliot, Mapfumo, Tecla, Marufu, Innocent, Mashiri, Chenesai, Mazenge, Shellie, Mbinda, Euphrasia, Mhuri, Abigail, Muguti, Charity, Munemo, Lucy, Musindo, Loveness, Ngada, Laina, Nyembe, Dambudzo, Taruvinga, Rachel, Tobaiwa, Emma, Banda, Selina, Chaipa, Jesca, Chakaza, Patricia, Chandigere, Macdonald, Changunduma, Annie, Chibi, Chenesai, Chidyagwai, Otilia, Chidza, Elika, Chigatse, Nora, Chikoto, Lennard, Chingware, Vongai, Chinhamo, Jaison, Chinhoro, Marko, Chiripamberi, Answer, Chitavati, Esther, Chitiga, Rita, Chivanga, Nancy, Chivese, Tracy, Chizema, Flora, Dera, Sinikiwe, Dhliwayo, Annacolleta, Dhononga, Pauline, Dimingo, Ennia, Dziyani, Memory, Fambi, Tecla, Gambagamba, Lylian, Gandiyari, Sikangela, Gomo, Charity, Gore, Sarah, Gundani, Jullin, Gundani, Rosemary, Gwarima, Lazarus, Gwaringa, Cathrine, Gwenya, Samuel, Hamilton, Rebecca, Hlabano, Agnes, Hofisi, Ennie, Hofisi, Florence, Hungwe, Stanley, Hwacha, Sharai, Hwara, Aquiiline, Jogwe, Ruth, Kanikani, Atanus, Kuchicha, Lydia, Kutsira, Mitshel, Kuziyamisa, Kumbulani, Kuziyamisa, Mercy, Kwangware, Benjamin, Lozani, Portia, Mabuto, Joseph, Mabuto, Vimbai, Mabvurwa, Loveness, Machacha, Rebecca, Machaya, Cresenzia, Madembo, Roswitha, Madya, Susan, Madzingira, Sheneterai, Mafa, Lloyd, Mafuta, Fungai, Mafuta, Jane, Mahara, Alfred, Mahonye, Sarudzai, Maisva, Admire, Makara, Admire, Makover, Margreth, Mambongo, Ennie, Mambure, Murenga, Mandizvidza, Edith, Mangena, Gladys, Manjengwa, Elliot, Manomano, Julius, Mapfumo, Maria, Mapfurire, Alice, Maphosa, Letwin, Mapundo, Jester, Mare, Dorcas, Marecha, Farai, Marecha, Selina, Mashiri, Christine, Masiya, Medina, Masuku, Thembinkosi, Masvimbo, Priviledge, Matambo, Saliwe, Matarise, Getrude, Matinanga, Loveness, Matizanadzo, John, Maunganidze, Margret, Mawere, Belinda, Mawire, Chipiwa, Mazvanya, Yulliana, Mbasera, Maudy, Mbono, Magret, Mhakayakora, Cynthia, Mhlanga, Nompumelelo, Mhosva, Bester, Moyo, Nomuhle, Moyo, Over, Moyo, Robert, Mpakami, Charity, Mpedzisi, Rudo, Mpofu, Elizabeth, Mpofu, Estery, Mtetwa, Mavis, Muchakachi, Juliet, Mudadada, Tsitsi, Mudzingwa, Kudakwashe, Mugwira, Mejury, Mukarati, Tarsisio, Munana, Anna, Munazo, Juliet, Munyeki, Otilia, Mupfeka, Patience, Murangandi, Gashirai, Muranganwa, Maria, Murenjekwa, Josphine, Muringo, Nothando, Mushaninga, Tichafara, Mutaja, Florence, Mutanha, Dorah, Mutemeri, Peregia, Mutero, Beauty, Muteya, Edina, Muvembi, Sophia, Muzenda, Tandiwe, Mwenjota, Agnes, Ncube, Sithembisiwe, Ndabambi, Tendai, Ndava, Nomsa, Ndlovu, Elija, Nene, Eveln, Ngazimbi, Enniah, Ngwalati, Atalia, Nyama, Tafirenyika, Nzembe, Agnes, Pabwaungana, Eunica, Phiri, Sekai, Pukuta, Ruwiza, Rambanapasi, Melody, Rera, Tambudzai, Samanga, Violet, Shirichena, Sinanzeni, Shoko, Chipiwa, Shonhe, More, Shuro, Cathrine, Sibanda, Juliah, Sibangani, Edna, Sibangani, Nikisi, Sibindi, Norman, Sitotombe, Mercy, Siwawa, Pearson, Tagwirei, Magret, Taruvinga, Pretty, Tavagwisa, Antony, Tete, Esther, Tete, Yeukai, Thandiwe, Elliot, Tibugari, Amonilla, Timothy, Stella, Tongogara, Rumbidzai, Tshuma, Lancy, Tsikira, Mirirayi, Tumba, Constance, Watinaye, Rumbidzayi, Zhiradzango, Ethel, Zimunya, Esther, Zinengwa, Leanmary, Ziupfu, Magret, Ziyambe, Job, Church, James A, Desai, Amy, Fundira, Dadirai, Gough, Ethan, Kambarami, Rukundo A, Matare, Cynthia R, Malaba, Thokozile R, Mupfudze, Tatenda, Ngure, Francis, Smith, Laura E, Curtis, Val, Dickin, Katherine L, Habicht, Jean-Pierre, Masimirembwa, Collen, Morgan, Peter, Pelto, Gretel H, Sheffner-Rogers, Corinne, Thelingwani, Roslyn, Turner, Paul, Zungu, Lindiwe, Makadzange, Tariro, Mujuru, Hilda A, Nyachowe, Chandiwana, Chakadai, Rugare, Chanyau, Gabriel, Makamure, Mary G, Chiwariro, Humphrey, Mtetwa, Tambudzai, Maguwu, Lisbern, Nyadundu, Simon, Moyo, Tshebukani, Chayima, Beauty, Mvindi, Lucy, Rwenhamo, Pauline, Muzvarwandoga, Shamiso, Chimukangara, Rumbidzai, Njovo, Handrea, Makoni, Talent, Majo, Florence, Chasokela, Cynthia M, and Manges, Amee R
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- 2019
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11. Inflammation and epithelial repair predict mortality, hospital readmission, and growth recovery in complicated severe acute malnutrition.
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Sturgeon, Jonathan P., Tome, Joice, Dumbura, Cherlynn, Majo, Florence D., Ngosa, Deophine, Mutasa, Kuda, Zyambo, Kanekwa, Besa, Ellen, Chandwe, Kanta, Kapoma, Chanda, Mwapenya, Benjamin, Nathoo, Kusum J., Bourke, Claire D., Ntozini, Robert, Chasekwa, Bernard, Smuk, Melanie, Bwakura-Dangarembizi, Mutsa, Amadi, Beatrice, Kelly, Paul, and Prendergast, Andrew J.
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PATIENT readmissions ,VASCULAR endothelial growth factors ,ENDOTHELIAL growth factors ,HOSPITAL admission & discharge ,FATTY acid-binding proteins - Abstract
Severe acute malnutrition (SAM) is the most high-risk form of undernutrition, particularly when children require hospitalization for complications. Complicated SAM is a multisystem disease with high inpatient and postdischarge mortality, especially in children with comorbidities such as HIV; however, the underlying pathogenesis of complicated SAM is poorly understood. Targeted multiplex biomarker analysis in children hospitalized with SAM (n = 264) was conducted on plasma samples, and inflammatory markers were assessed on stool samples taken at recruitment, discharge, and 12 to 24 and 48 weeks after discharge from three hospitals in Zimbabwe and Zambia. Compared with adequately nourished controls (n = 173), we found that at baseline, complicated SAM was characterized by systemic, endothelial, and intestinal inflammation, which was exacerbated by HIV infection. This persisted over 48 weeks despite nutritional recovery and was associated with children's outcomes. Baseline plasma concentrations of vascular endothelial growth factor, glucagon-like peptide-2, and intestinal fatty acid–binding protein were independently associated with lower mortality or hospital readmission over the following 48 weeks. Following principal components analysis of baseline biomarkers, higher scores of a component representing growth factors was associated with greater weight-for-height z score recovery and lower mortality or hospital readmission over the 48 weeks. Conversely, components representing higher gut and systemic inflammation were associated with higher mortality or hospital readmission. These findings highlight the interplay between inflammation, which damages tissues, and growth factors, which mediate endothelial and epithelial regeneration, and support further studies investigating interventions to reduce inflammation and promote epithelial repair as an approach to reducing mortality and improving nutritional recovery. Editor's summary: Complicated severe acute malnutrition (SAM) is associated with high mortality even after recovery of nutrition, but the underlying pathophysiology is still poorly understood. Here, Sturgeon and colleagues studied blood, urine, and stool samples from 264 children with SAM from hospitalization to 48 weeks after hospital discharge to better understand the disease. Principal components analyses and structural equation modeling revealed that SAM was characterized by inflammation, endothelial activation, and enteropathy that persisted over the 48 weeks after discharge and that were associated with higher mortality and hospital readmission. Conversely, growth factors indicative of endothelial and epithelial repair were associated with reduced mortality and hospital readmission over 48 weeks. These findings suggest that interventions to decrease inflammation and promote epithelial repair may be beneficial for the treatment of SAM. —Melissa L. Norton [ABSTRACT FROM AUTHOR]
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- 2024
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12. Intestinal Damage and Inflammatory Biomarkers in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Zimbabwean Infants
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Prendergast, Andrew J, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, and Humphrey, Jean H.
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- 2017
13. Cytomegalovirus Acquisition and Inflammation in Human Immunodeficiency Virus–Exposed Uninfected Zimbabwean Infants
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Evans, Ceri, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2017
14. Inflammation, cytomegalovirus and the growth hormone axis in HIV-exposed uninfected Zimbabwean infants
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Evans, Ceri, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2020
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15. Enteropathogens and Rotavirus Vaccine Immunogenicity in a Cluster Randomized Trial of Improved Water, Sanitation and Hygiene in Rural Zimbabwe
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Church, James A., Rogawski McQuade, Elizabeth T., Mutasa, Kuda, Taniuchi, Mami, Rukobo, Sandra, Govha, Margaret, Lee, Benjamin, Carmolli, Marya P., Chasekwa, Bernard, Ntozini, Robert, McNeal, Monica M., Moulton, Lawrence H., Kirkpatrick, Beth D., Liu, Jie, Houpt, Eric R., Humphrey, Jean H., Platts-Mills, James A., and Prendergast, Andrew J.
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- 2019
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16. Neonatal mortality risk of vulnerable newborns : a descriptive analysis of subnational, population‐based birth cohorts for 238 143 live births in low‐ and middle‐income settings from 2000 to 2017
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Hazel, Elizabeth A., Erchick, Daniel J., Katz, Joanne, Lee, Anne C. C., Diaz, Michael, Wu, Lee S. F., West, Keith P., Shamim, Abu Ahmed, Christian, Parul, Ali, Hasmot, Baqui, Abdullah H., Saha, Samir K., Ahmed, Salahuddin, Roy, Arunangshu Dutta, Silveira, Mariângela F., Buffarini, Romina, Shapiro, Roger, Zash, Rebecca, Kolsteren, Patrick, Lachat, Carl, Huybregts, Lieven, Roberfroid, Dominique, Zhu, Zhonghai, Zeng, Lingxia, Gebreyesus, Seifu H., Hadush, Kokeb Tesfamariam, Adu‐Afarwuah, Seth, Dewey, Kathryn G., Gyaase, Stephaney, Poku‐Asante, Kwaku, Boamah Kaali, Ellen, Jack, Darby, Ravilla, Thulasiraj, Tielsch, James, Taneja, Sunita, Chowdhury, Ranadip, Ashorn, Per, Maleta, Kenneth, Ashorn, Ulla, Mangani, Charles, Mullany, Luke C., Khatry, Subarna K., Ramokolo, Vundli, Zembe‐Mkabile, Wanga, Fawzi, Wafaie W., Wang, Dongqing, Schmiegelow, Christentze, Minja, Daniel, Msemo, Omari Abdul, Lusingu, John P. A., Smith, Emily R., Masanja, Honorati, Mongkolchati, Aroonsri, Keentupthai, Paniya, Kakuru, Abel, Kajubi, Richard, Semrau, Katherine, Hamer, Davidson H., Manasyan, Albert, Pry, Jake M., Chasekwa, Bernard, Humphrey, Jean, Black, Robert E., Klemm, Rolf D. W., Massie, Allan B., Mitra, Maithilee, Mehra, Sucheta, Schulze, Kerry J., Sommer, Alfred, Ullah, Md. Barkat, Labrique, Alain B., Rashid, Mabhubur, Shaikh, Saijuddin, Begum, Nazma, Chowdhury, Nabidul Haque, Islam, Md. Shafiqul, Khanam, Rasheda, Mitra, Dipak Kumar, Quaiyum, Abdul, Diseko, Modiegi, Makhema, Joseph, Cheng, Yue, Roro, Meselech, Endris, Bilal Shikur, Arnold, Charles D., Bahl, Rajiv, Bhandari, Nita, Martines, Jose, Mazumder, Sarmila, Hallamaa, Lotta, Pyykkö, Juha, Urassa, Willy, Deloron, Phillippe, Bygbjerg, Ib Christian, Moeller, Sofie Lykke, Theander, Thor Grundtvig, Muhihi, Alfa, Noor, Ramadhani Abdallah, Kamya, Moses R., Nakalembe, Miriam, Biemba, Godfrey, Herlihy, Julie M., Mbewe, Reuben K., Mweena, Fern, Yeboah‐Antwi, Kojo, Prendergast, Andrew, Lawn, Joy E., Blencowe, Hannah, Ohuma, Eric, Okwaraji, Yemi, Yargawa, Judith, Bradley, Ellen, and Idueta, Lorena Suarez
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OUTCOMES ,UMBILICAL-CORD ,PRETERM ,MATERNAL MULTIPLE MICRONUTRIENT ,INFANT-MORTALITY ,CHLORHEXIDINE ,low-and middle-income countries ,paediatrics ,neonatal ,obstetrics and gynaecology ,FOR-GESTATIONAL-AGE ,Medicine and Health Sciences ,SOUTHERN NEPAL ,small-for-gestational age ,WEIGHT ,PREGNANT-WOMEN - Abstract
Objective: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low-and middle-income countries (LMICs). Design: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. Setting: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. Population: Live birth neonates. Methods: We categorically defined five vulnerable newborn types based on size (large-or appropriate-or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. Main Outcome Measures: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. Results: There were 238 143 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.8, interquartile range [IQR] 2.0–3.2), PT + LGA (median RR 7.3, IQR 2.3–10.4), PT + AGA (median RR 6.0, IQR 4.4–13.2) and PT + SGA (median RR 10.4, IQR 8.6–13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. Conclusions: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.
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- 2023
17. Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia.
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Bwakura-Dangarembizi, Mutsa, Dumbura, Cherlynn, Ngosa, Deophine, Majo, Florence D., Piper, Joe D., Sturgeon, Jonathan P., Nathoo, Kusum J., Amadi, Beatrice, Norris, Shane, Chasekwa, Bernard, Ntozini, Robert, Wells, Jonathan C., Kelly, Paul, and Prendergast, Andrew J.
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HIV infection complications ,MALNUTRITION treatment ,BODY composition ,HOSPITALS ,SKINFOLD thickness ,CONFIDENCE intervals ,TIME ,LEAN body mass ,PATIENT readmissions ,RISK assessment ,MALNUTRITION ,BIOELECTRIC impedance ,WASTING syndrome ,RESEARCH funding ,STATISTICAL models ,CHILD mortality ,ADIPOSE tissues ,PROPORTIONAL hazards models ,DISCHARGE planning ,EDEMA ,DISEASE complications - Abstract
HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z -score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference −1·49, 95 % CI (−2·01, −0·97)) and impedance index Z -scores (–0·13, 95 % CI (−0·24, −0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (–1·47, 95 % CI (−1·97, −0·97)) and impedance index Z -scores (–0·23, 95 % CI (−0·36, −0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children. [ABSTRACT FROM AUTHOR]
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- 2023
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18. Head circumferences of children born to HIV-infected and HIV-uninfected mothers in Zimbabwe during the preantiretroviral therapy era
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Evans, Ceri, Chasekwa, Bernard, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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- 2016
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19. Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial.
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Chasekwa, Bernard, Ntozini, Robert, Church, James A, Majo, Florence D, Tavengwa, Naume, Mutasa, Batsirai, Noble, Christie, Koyratty, Nadia, Maluccio, John A, Prendergast, Andrew J, Humphrey, Jean H, Smith, Laura E, and Team, for the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial
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NEONATAL death , *PREGNANT women , *PREMATURE infants , *NEONATAL mortality , *PERINATAL death , *SMALL for gestational age - Abstract
Background Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g). Methods The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and 27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth. Results The prevalence of adverse birth outcomes was: miscarriage: 5.0% [95% confidence interval (CI), 4.4, 5.7]; stillbirth: 2.3% (95% CI 1.9, 2.7); preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); and neonatal mortality: 31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births. Conclusions Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthened management of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles. [ABSTRACT FROM AUTHOR]
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- 2022
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20. The Impact of Improved Water, Sanitation, and Hygiene on Oral Rotavirus Vaccine Immunogenicity in Zimbabwean Infants: Substudy of a Cluster-randomized Trial
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Church, James A, Rukobo, Sandra, Govha, Margaret, Lee, Benjamin, Carmolli, Marya P, Chasekwa, Bernard, Ntozini, Robert, Mutasa, Kuda, McNeal, Monica M, Majo, Florence D, Tavengwa, Naume V, Moulton, Lawrence H, Humphrey, Jean H, Kirkpatrick, Beth D, and Prendergast, Andrew J
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Male ,Rotavirus ,Zimbabwe ,infants ,Vaccination ,Rotavirus Vaccines ,Hygiene ,Rotavirus Infections ,WASH ,Immunogenicity, Vaccine ,Pregnancy ,Water Quality ,Africa ,Humans ,Female ,Sanitation ,oral vaccine ,Articles and Commentaries - Abstract
Background Oral vaccines have lower efficacy in developing compared to developed countries. Poor water, sanitation, and hygiene (WASH) may contribute to reduced oral vaccine immunogenicity. Methods We conducted a cluster-randomized 2 × 2 factorial trial in rural Zimbabwe. Pregnant women and their infants were eligible if they lived in clusters randomized to (1) standard of care (52 clusters); (2) improved infant feeding (53 clusters); (3) WASH: ventilated improved pit latrine, 2 hand-washing stations, liquid soap, chlorine, infant play space, and hygiene counseling (53 clusters); or (4) feeding plus WASH (53 clusters). This substudy compared oral rotavirus vaccine (RVV) seroconversion (primary outcome), and seropositivity and geometric mean titer (GMT) (secondary outcomes), in WASH vs non-WASH infants by intention-to-treat analysis. Results We included 801 infants with documented RVV receipt and postvaccine titer measurements (329 from 84 WASH clusters; 472 from 102 non-WASH clusters); 328 infants with prevaccination titers were included in the primary outcome. Thirty-three of 109 (30.3%) infants in the WASH group seroconverted following rotavirus vaccination, compared to 43 of 219 (19.6%) in the non-WASH group (absolute difference, 10.6% [95% confidence interval {CI}, .54%–20.7%]; P = .031). In the WASH vs non-WASH groups, 90 of 329 (27.4%) vs 107 of 472 (22.7%) were seropositive postvaccination (absolute difference, 4.7% [95% CI, –1.4% to 10.8%]; P = .130), and antirotavirus GMT was 18.4 (95% CI, 15.6–21.7) U/mL vs 14.9 (95% CI, 13.2–16.8) U/mL (P = .072). Conclusions Improvements in household WASH led to modest but significant increases in seroconversion to RVV in rural Zimbabwean infants. Clinical Trials Registration NCT01824940., Oral vaccines have lower efficacy in developing compared to developed countries. In a substudy of a cluster-randomized trial, improvements in household water, sanitation, and hygiene led to modest increases in seroconversion to oral rotavirus vaccine among rural Zimbabwean infants.
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- 2019
21. Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children.
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Dunne, Thomas Frederick, Chandna, Jaya, Majo, Florence, Tavengwa, Naume, Mutasa, Batsirai, Chasekwa, Bernard, Ntozini, Robert, Prendergast, Andrew J., Humphrey, Jean H., and Gladstone, Melissa J.
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FISHER exact test ,RURAL children ,INFANT nutrition ,LOW-income housing ,TEST validity ,HOUSING stability ,FOOD security - Abstract
Introduction: Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. Methods: A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. Findings: Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. Interpretation: Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood. [ABSTRACT FROM AUTHOR]
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- 2022
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22. Heat treatment of expressed breast milk is a feasible option for feeding hiv-exposed, uninfected children after 6 months of age in rural Zimbabwe
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Mbuya, Mduduzi N.N., Humphrey, Jean H., Majo, Florence, Chasekwa, Bernard, Jenkins, Alison, Israel-Ballard, Kiersten, Muti, Monica, Paul, Keriann H., Madzima, Rufaro C., Moulton, Lawrence H., and Stoltzfus, Rebecca J.
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HIV infection -- Research ,Children -- Food and nutrition ,Children -- Health aspects ,Breast feeding -- Methods ,Breast feeding -- Research ,Disease transmission -- Research ,Disease transmission -- Prevention ,Food/cooking/nutrition - Abstract
In the context of a prevention of mother to child transmission of HIV program promoting exclusive breast-feeding (EBF) to 6 mo and offering HIV-PCR testing at ~6 mo, we ascertained the feasibility of expressing and heat-treating (EHT) all breast milk fed to HIV-exposed, uninfected infants following 6 mo of EBF. Twenty mother-baby pairs were enrolled from a hospital in rural Zimbabwe. Research nurses provided lactation, EHT, and complementary feeding counseling through 21 home visits conducted over an 8-wk period and collected quantitative and qualitative data on the mothers' EHT experiences, children's diets, and anthropometric measurements. Mothers kept daily logs of EHT volumes and direct breast-feeding episodes. Mothers successfully initiated and sustained EHT for 4.5 mo (range, 1-11 mo), feeding 426 [+ or -] 227 mL/d (mean [+ or -] SD). By wk 2 of follow-up, children were receiving EHT and Nutributter-enriched complementary foods that satisfied 100% of their energy requirements. During the 8-wk follow-up period, no growth faltering was experienced [changes in weight-for-age, weight-for-length, and length-for-age Z scores = +0.03 [+ or -] 0.50; +0.77 [+ or -] 1.59; and +0.02 [+ or -] 0.85 (mean [+ or -] SD), respectively]. Stigma was not a major deterrent, likely due to a social marketing campaign for EBF that promoted EHT as a practice to sustain breast-feeding for all women. This study provides evidence that resource-poor rural women can initiate and sustain EHT given family and health systems support. EHT provides a strategy for improving the diets of HIV-exposed but uninfected children after direct breast-feeding has ceased. doi: 10.3945/jn.110.122457.
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- 2010
23. Maternal Decision-Making Autonomy, Mental Health, Gender Norm Attitudes, and Social Support During Pregnancy Predict Child Care-Giving and Stunting in Rural Zimbabwe
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Matare, Cynthia, Tome, Joice, Makasi, Rachel, Dickin, Katherine, Pelto, Gretel, Constas, Mark, Chasekwa, Bernard, Mbuya, Mduduzi, Ntozini, Robert, Prendergast, Andrew, Humphrey, Jean, and Stoltzfus, Rebecca
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- 2020
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24. Traditional Oral Remedies and Perceived Breast Milk Insufficiency Are Major Barriers to Exclusive Breastfeeding in Rural Zimbabwe1-3
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Desai, Amy, Mbuya, Mduduzi N.N., Chigumira, Ancikaria, Chasekwa, Bernard, Humphrey, Jean H., Moulton, Lawrence H., Pelto, Gretel, Gerema, Grace, and Stoltzfus, Rebecca J.
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- 2014
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25. Reply to Correspondence: is the strength of association between indicators of dietary quality and the nutritional status of children being underestimated?
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Jones, Andrew D., Mbuya, Mduduzi N.N., Ickes, Scott B., Heidkamp, Rebecca A., Smith, Laura E., Chasekwa, Bernard, Menon, Purnima, Zongrone, Amanda A., and Stoltzfus, Rebecca J.
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- 2014
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26. World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings
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Jones, Andrew D., Ickes, Scott B., Smith, Laura E., Mbuya, Mduduzi N.N., Chasekwa, Bernard, Heidkamp, Rebecca A., Menon, Purnima, Zongrone, Amanda A., and Stoltzfus, Rebecca J.
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- 2014
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27. Stunting Status and Exposure to Infection and Inflammation in Early Life Shape Antibacterial Immune Cell Function Among Zimbabwean Children.
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Mutasa, Kuda, Tome, Joice, Rukobo, Sandra, Govha, Margaret, Mushayanembwa, Patience, Matimba, Farai S., Chiorera, Courage K., Majo, Florence D., Tavengwa, Naume V., Mutasa, Batsirai, Chasekwa, Bernard, Humphrey, Jean H., Ntozini, Robert, Prendergast, Andrew J., and Bourke, Claire D.
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STUNTED growth ,CELL physiology ,CLINICAL trial registries ,BACTERIAL antigens ,SALMONELLA typhimurium ,INFLAMMATION - Abstract
Background: Children who are stunted (length-for-age Z-score<-2) are at greater risk of infectious morbidity and mortality. Previous studies suggest that stunted children have elevated inflammatory biomarkers, but no studies have characterised their capacity to respond to new infections (i.e., their immune function). We hypothesised that antibacterial immune function would differ between stunted and non-stunted children and relate to their health and environment during early life. Methods: We enrolled a cross-sectional cohort of 113 HIV-negative children nested within a longitudinal cluster-randomised controlled trial of household-level infant and young child feeding (IYCF) and water, sanitation and hygiene (WASH) interventions in rural Zimbabwe (SHINE; Clinical trials registration: NCT01824940). Venous blood was collected at 18 months of age and cultured for 24 h without antigen or with bacterial antigens: heat-killed Salmonella typhimurium (HKST) or Escherichia coli lipopolysaccharide (LPS). TNFα, IL-6, IL-8, IL-12p70, hepcidin, soluble (s)CD163, myeloperoxidase (MPO) and IFNβ were quantified in culture supernatants by ELISA to determine antigen-specific immune function. The effect of stunting status and early-life exposures (anthropometry, inflammation at 18 months, maternal health during pregnancy, household WASH) on immune function was tested in logit and censored log-normal (tobit) regression models. Results: Children who were stunted (n = 44) had higher proportions (86.4% vs. 65.2%; 88.6% vs. 73.4%) and concentrations of LPS-specific IL-6 (geometric mean difference (95% CI): 3.46 pg/mL (1.09, 10.80), p = 0.035) and IL-8 (3.52 pg/mL (1.20, 10.38), p = 0.022) than non-stunted children (n = 69). Bacterial antigen-specific pro-inflammatory cytokine concentrations were associated with biomarkers of child enteropathy at 18 months and biomarkers of systemic inflammation and enteropathy in their mothers during pregnancy. Children exposed to the WASH intervention (n = 33) produced higher LPS- (GMD (95% CI): 10.48 pg/mL (1.84, 60.31), p = 0.008) and HKST-specific MPO (5.10 pg/mL (1.77, 14.88), p = 0.003) than children in the no WASH group (n = 80). There was no difference in antigen-specific immune function between the IYCF (n = 55) and no IYCF groups (n = 58). Conclusions: Antibacterial immune function among 18-month-old children in a low-income setting was shaped by their stunting status and prior exposure to maternal inflammation and household WASH. Heterogeneity in immune function due to adverse exposures in early life could plausibly contribute to infection susceptibility. [ABSTRACT FROM AUTHOR]
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- 2022
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28. Recovery of children following hospitalisation for complicated severe acute malnutrition.
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Bwakura‐Dangarembizi, Mutsa, Dumbura, Cherlynn, Amadi, Beatrice, Chasekwa, Bernard, Ngosa, Deophine, Majo, Florence D., Sturgeon, Jonathan P., Chandwe, Kanta, Kapoma, Chanda, Bourke, Claire D., Robertson, Ruairi C., Nathoo, Kusum J., Ntozini, Robert, Norris, Shane A., Kelly, Paul, and Prendergast, Andrew J.
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MALNUTRITION treatment ,STATURE ,HIV infections ,CONFIDENCE intervals ,NUTRITIONAL assessment ,CONVALESCENCE ,ANTHROPOMETRY ,PATIENT readmissions ,REGRESSION analysis ,FISHER exact test ,MANN Whitney U Test ,DISEASES ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,CHI-squared test ,DATA analysis software ,CEREBRAL palsy ,HOSPITAL care of children ,SECONDARY analysis ,PROPORTIONAL hazards models ,EVALUATION ,CHILDREN - Abstract
Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery and morbidity, in children discharged from hospital following management of complicated SAM in Zambia and Zimbabwe over 52‐weeks posthospitalization. Multivariable Fine‐Gray subdistribution hazard models, with death and loss to follow‐up as competing risks, were used to identify factors associated with hospital readmission; negative binomial regression to assess time to hospitalisation and ordinal logistic regression to model factors associated with nutritional recovery. A total of 649 children (53% male, median age 18.2 months) were discharged to continue community nutritional rehabilitation. All‐cause hospital readmission was 15.4% (95% CI 12.7, 18.6) over 52 weeks. Independent risk factors for time to readmission were cerebral palsy (adjusted subhazard ratio (aSHR): 2.96, 95% CI 1.56, 5.61) and nonoedematous SAM (aSHR: 1.64, 95%CI 1.03, 2.64). Unit increases in height‐for‐age Z‐score (HAZ) (aSHR: 0.82, 95% CI 0.71, 0.95) and enrolment in Zambia (aSHR: 0.52, 95% CI 0.28, 0.97) were associated with reduced subhazard of time to readmission. Young age, SAM at discharge, nonoedematous SAM and cerebral palsy were associated with poor nutritional recovery throughout follow‐up. Collectively, nonoedematous SAM, ongoing SAM at discharge, cerebral palsy and low HAZ are independent risk factors for readmission and poor nutritional recovery following complicated SAM. Children with these high‐risk features should be prioritised for additional convalescent care to improve long‐term outcomes. Key messages: One‐in‐six children managed for SAM were readmitted into hospital over the first year after discharge and one‐in‐eight remained undernourished by 52 weeks of follow‐up.Nonoedematous SAM, ongoing SAM at the time of discharge and underlying cerebral palsy were independent risk factors for hospital readmission and poor nutritional recovery.Low HAZ was a risk factor for hospital readmission and poor nutritional recovery.Postdischarge care should focus on children with disability, nonoedematous SAM at initial hospitalisation and have ongoing SAM at the time of discharge.Stunting should be considered in the management of children with SAM. [ABSTRACT FROM AUTHOR]
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- 2022
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29. Addressing social barriers and closing the gender knowledge gap: exposure to road shows is associated with more knowledge and more positive beliefs, attitudes and social norms regarding exclusive breastfeeding in rural Zimbabwe
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Jenkins, Alison L., Tavengwa, Naume V., Chasekwa, Bernard, Chatora, Kumbirai, Taruberekera, Noah, Mushayi, Wellington, Madzima, Rufaro C., and Mbuya, Mduduzi N.N.
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- 2012
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30. Complementary feeding messages that target cultural barriers enhance both the use of lipid-based nutrient supplements and underlying feeding practices to improve infant diets in rural Zimbabwe
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Paul, Keriann H., Muti, Monica, Chasekwa, Bernard, Mbuya, Mduduzi N.N., Madzima, Rufaro C., Humphrey, Jean H., and Stoltzfus, Rebecca J.
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- 2012
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31. Early Initiation and Exclusivity of Breastfeeding in Rural Zimbabwe: Impact of a Breastfeeding Intervention Delivered by Village Health Workers
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Mbuya, Mduduzi N N, Matare, Cynthia R, Tavengwa, Naume V, Chasekwa, Bernard, Ntozini, Robert, Majo, Florence D, Chigumira, Ancikaria, Chasokela, Cynthia M Z, Prendergast, Andrew J, Moulton, Lawrence H, Stoltzfus, Rebecca J, and Humphrey, Jean H
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Zimbabwe ,early breastfeeding initiation ,village health workers ,infants ,Maternal and Pediatric Nutrition ,exclusive breastfeeding ,breast milk ,Original Research - Abstract
Background Suboptimal breastfeeding contributes to >800,000 global child deaths annually. Optimal breastfeeding includes early initiation (EI) and exclusive breastfeeding (EBF) for the first 6 mo. Objectives We tested the hypothesis that an intervention targeting context and infant age-specific barriers to EI and EBF will achieve a higher EI and EBF prevalence than those of women participating in the concurrently conducted 2015 Zimbabwe Demographic Health Survey (Z-DHS). Methods We designed an intervention to promote EI and EBF, and implemented it within the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Intervention modules were delivered at 4 perinatal time points by government-employed village health workers. We compared EI and EBF prevalence among SHINE women who provided outcomes at 1 mo (n = 2442) and 3 mo (n = 2728), with women in the 2015 Z-DHS. Results In cross-sectional analyses EI prevalence was 86.6% and 64.3% in the SHINE and Z-DHS samples, respectively; absolute difference (95% CI) = 22.4% (17.5%, 27.3%). EBF prevalence was similarly high (>80%) in both surveys during the first month of life; during 1 to
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- 2019
32. Determinants of Urogenital Schistosomiasis Among Pregnant Women and its Association With Pregnancy Outcomes, Neonatal Deaths, and Child Growth.
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Murenjekwa, Wellington, Makasi, Rachel, Ntozini, Robert, Chasekwa, Bernard, Mutasa, Kuda, Moulton, Lawrence H, Tielsch, James M, Humphrey, Jean H, Smith, Laura E, Prendergast, Andrew J, Bourke, Claire D, and SHINE Trial Team
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PREGNANCY outcomes ,PREGNANT women ,NEONATAL death ,GROWTH of children ,SCHISTOSOMIASIS ,RESEARCH ,TREMATODA ,CHILD development ,ANIMAL experimentation ,MICROSCOPY ,RESEARCH methodology ,EVALUATION research ,PERINATAL death ,COMPARATIVE studies ,BIRTH weight ,RESEARCH funding ,HEMATURIA ,URINALYSIS ,PARASITIC diseases in pregnancy ,DISEASE complications - Abstract
Background: Schistosoma haematobium is a parasitic helminth that causes urogenital pathology. The impact of urogenital schistosomiasis during pregnancy on birth outcomes and child growth is poorly understood.Methods: Risk factors for urogenital schistosomiasis were characterized among 4437 pregnant women enrolled in a cluster-randomized community-based trial in rural Zimbabwe. Infection was defined via urine microscopy (≥1 S. haematobium egg) and urinalysis (hematuria). Associations between infection and pregnancy outcomes were assessed in case-control analyses using conditional logistic regression. The association of maternal infection with birthweight and length-for-age Z scores (LAZ) at 1 and 18 months of age were assessed using generalized estimating equations.Results: Urogenital schistosomiasis (egg positive and/or hematuria positive) was detected in 26.8% of pregnant women. Risk factors significantly associated with infection were maternal age, education, marital status, and religion; household drinking water source and latrine; study region; and season. Urogenital schistosomiasis was not significantly associated with adverse pregnancy outcomes (miscarriage, stillbirth, preterm, and small-for-gestational age), birthweight, neonatal death, or LAZ.Conclusions: Including pregnant women in antihelminthic treatment programs would benefit a large number of women in rural Zimbabwe. However, clearance of the low-intensity infections that predominate in this context is unlikely to have additive benefits for pregnancy outcomes or child growth.Clinical Trials Registration: NCT01824940. [ABSTRACT FROM AUTHOR]- Published
- 2021
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33. Measuring wealth in rural communities: Lessons from the Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial
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Chasekwa, Bernard, Maluccio, John A, Ntozini, Robert, Moulton, Lawrence H, Wu, Fan, Smith, Laura E, Matare, Cynthia R, Stoltzfus, Rebecca J, Mbuya, Mduduzi NN, Tielsch, James M, Martin, Stephanie L, Jones, Andrew D, Humphrey, Jean H, Fielding, Katherine, and SHINE Trial Team
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lcsh:R ,lcsh:Medicine ,lcsh:Q ,lcsh:Science - Abstract
BACKGROUND: Poverty and human capital development are inextricably linked and therefore research on human capital typically incorporates measures of economic well-being. In the context of randomized trials of health interventions, for example, such measures are used to: 1) assess baseline balance; 2) estimate covariate-adjusted analyses; and 3) conduct subgroup analyses. Many factors characterize economic well-being, however, and analysts often generate summary measures such as indices of household socio-economic status or wealth. In this paper, a household wealth index is developed and tested for participants in the cluster-randomized Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. METHODS: Building on the approach used in the Zimbabwe Demographic and Health Survey (ZDHS), we combined a set of housing characteristics, ownership of assets and agricultural resources into a wealth index using principal component analysis (PCA) on binary variables. The index was assessed for internal and external validity. Its sensitivity was examined considering an expanded set of variables and an alternative statistical approach of polychoric PCA. Correlation between indices was determined using the Spearman's rank correlation coefficient and agreement between quintiles using a linear weighted Kappa statistic. Using the 2015 ZDHS data, we constructed a separate index and applied the loadings resulting from that analysis to the SHINE study population, to compare the wealth distribution in the SHINE study with rural Zimbabwe. RESULTS: The derived indices using the different methods were highly correlated (r>0.9), and the wealth quintiles derived from the different indices had substantial to near perfect agreement (linear weighted Kappa>0.7). The indices were strongly associated with a range of assets and other wealth measures, indicating both internal and external validity. Households in SHINE were modestly wealthier than the overall population of households in rural Zimbabwe. CONCLUSION: The SHINE wealth index developed here is a valid and robust measure of wealth in the sample.
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- 2018
34. Maternal Capabilities Are Associated with Child Caregiving Behaviors Among Women in Rural Zimbabwe.
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Matare, Cynthia R, Mbuya, Mduduzi N N, Dickin, Katherine L, Constas, Mark A, Pelto, Gretel, Chasekwa, Bernard, Humphrey, Jean H, Stoltzfus, Rebecca J, Team, for the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial, and Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team
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RURAL women ,CHILD psychology ,HAND washing ,SELF-efficacy ,GENDER ,PREGNANT women ,INFANT nutrition ,MENTAL health ,RESEARCH ,CAREGIVERS ,PSYCHOLOGY of mothers ,CHILD development ,RESEARCH methodology ,CHILD behavior ,MEDICAL cooperation ,EVALUATION research ,MOTHERHOOD ,PARENTING ,SOCIOECONOMIC factors ,COMPARATIVE studies ,RESEARCH funding ,RURAL population - Abstract
Background: Young children require high-quality care for healthy growth and development. We defined "maternal capabilities" as factors that influence mothers' caregiving ability (physical and mental health, social support, time, decision-making autonomy, gender norm attitudes, and mothering self-efficacy), and developed survey tools to assess them.Objectives: We hypothesized that mothers with stronger capabilities during pregnancy would be more likely to practice improved care behaviors after their child was born.Methods: We assessed maternal capabilities among 4667 pregnant women newly enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. Several improved child-care practices were promoted until 18 mo postpartum, the trial endpoint. Care practices were assessed by survey, direct observation, or transcription from health records during postpartum research visits. We used logistic regression to determine the predictive association between maternal capabilities during pregnancy and child-care practices.Results: Mothers with more egalitarian gender norm attitudes were more likely to have an institutional delivery [adjusted OR (AOR), 2.06; 95% CI, 1.57-2.69], initiate breastfeeding within 1 h of delivery (AOR, 1.38; 95% CI, 1.03-1.84), exclusively breastfeed (EBF) from birth to 3 mo (AOR, 2.55; 95% CI, 1.95-3.35) and 3-6 mo (AOR, 1.75; 95% CI, 1.36-2.25), and, among households randomized to receive extra modules on sanitation and hygiene, have soap and water at a handwashing station (AOR, 1.76; 95% CI, 1.29-2.39). Mothers experiencing time stress were less likely to EBF from birth to 3 mo (AOR, 0.79; 95% CI, 0.66-0.93). Greater social support was associated with institutional delivery (AOR, 1.53; 95% CI, 1.37-1.98) and, among mothers randomized to receive extra complementary feeding modules, feeding children a minimally diverse diet (AOR, 1.18; 95% CI, 1.01-1.37). Depressed mothers were 37% and 33%, respectively, less likely to have an institutional delivery (AOR, 0.63; 95% CI, 0.44-0.88) and a fully immunized child (AOR, 0.67; 95% CI, 0.50-0.90).Conclusions: Interventions to reduce maternal depression, time stress, inadequate social support, and inequitable gender norms may improve maternal child caregiving. [ABSTRACT FROM AUTHOR]- Published
- 2021
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35. Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia.
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Bwakura-Dangarembizi, Mutsa, Dumbura, Cherlynn, Amadi, Beatrice, Ngosa, Deophine, Majo, Florence D, Nathoo, Kusum J, Mwakamui, Simutanyi, Mutasa, Kuda, Chasekwa, Bernard, Ntozini, Robert, Kelly, Paul, Prendergast, Andrew J, and the HOPE-SAM study team
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MALNUTRITION treatment ,HOSPITALS ,STATISTICS ,CONFIDENCE intervals ,TIME ,MULTIVARIATE analysis ,HIV seroconversion ,ANTIRETROVIRAL agents ,SEVERITY of illness index ,RISK assessment ,DESCRIPTIVE statistics ,CEREBRAL palsy ,ACUTE diseases ,HOSPITAL care of children ,DISCHARGE planning ,CHILD mortality ,LONGITUDINAL method ,PROPORTIONAL hazards models ,EDEMA ,CHILDREN - Abstract
Background Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era. Objectives Our objectives were to ascertain 52-wk mortality in children discharged from hospital for management of complicated SAM, and to identify independent predictors of mortality. Methods A prospective cohort study was conducted in children enrolled from 3 hospitals in Zambia and Zimbabwe between July 2016 and March 2018. The primary outcome was mortality at 52 wk. Univariable and multivariable Cox regression models were used to identify independent risk factors for death, and to investigate whether HIV modifies these associations. Results Of 745 children, median age at enrolment was 17.4 mo (IQR: 12.8, 22.1 mo), 21.7% were HIV-positive, and 64.4% had edema. Seventy children (9.4%; 95% CI: 7.4, 11.7%) died and 26 exited during hospitalization; 649 were followed postdischarge. At discharge, 43.9% had ongoing SAM and only 50.8% of HIV-positive children were receiving ART. Vital status was ascertained for 604 (93.1%), of whom 55 (9.1%; 95% CI: 6.9, 11.7%) died at median 16.6 wk (IQR: 9.4, 21.9 wk). Overall, 20.0% (95% CI: 13.5, 27.9%) and 5.6% (95% CI: 3.8, 7.9%) of HIV-positive and HIV-negative children, respectively, died [adjusted hazard ratio (aHR): 3.83; 95% CI: 2.15, 6.82]. Additional independent risk factors for mortality were ongoing SAM (aHR: 2.28; 95% CI: 1.22, 4.25), cerebral palsy (aHR: 5.60; 95% CI: 2.72, 11.50) and nonedematous SAM (aHR: 2.23; 95% CI: 1.24, 4.01), with no evidence of interaction with HIV status. Conclusions HIV-positive children have an almost 4-fold higher mortality than HIV-negative children in the year following hospitalization for complicated SAM. A better understanding of causes of death, an improved continuum of care for HIV and SAM, and targeted interventions to improve convalescence are needed. [ABSTRACT FROM AUTHOR]
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- 2021
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36. Mortality, Human Immunodeficiency Virus (HIV) Transmission, and Growth in Children Exposed to HIV in Rural Zimbabwe.
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Evans, Ceri, Chasekwa, Bernard, Ntozini, Robert, Majo, Florence D, Mutasa, Kuda, Tavengwa, Naume, Mutasa, Batsirai, Mbuya, Mduduzi N N, Smith, Laura E, Stoltzfus, Rebecca J, Moulton, Lawrence H, Humphrey, Jean H, Prendergast, Andrew J, and Team, for the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial
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HIV prevention , *HIV infection transmission , *ANTHROPOMETRY , *COMPARATIVE studies , *CONFIDENCE intervals , *GROWTH disorders , *HIV , *HIV infections , *HIV-positive persons , *HUMAN growth , *INFANT mortality , *MEDICAL screening , *MOTHERS , *RURAL conditions , *ANTIRETROVIRAL agents , *VERTICAL transmission (Communicable diseases) , *DESCRIPTIVE statistics , *CHILDREN , *FETUS - Abstract
Background Clinical outcomes of children who are human immunodeficiency virus (HIV)–exposed in sub-Saharan Africa remain uncertain. Methods The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial evaluated improved infant and young child feeding (IYCF) and/or improved water, sanitation, and hygiene in 2 rural Zimbabwean districts with 15% antenatal HIV prevalence and > 80% prevention of mother-to-child transmission (PMTCT) coverage. Children born between February 2013 and December 2015 had longitudinal HIV testing and anthropometry. We compared mortality and growth between children who were HIV-exposed and HIV-unexposed through 18 months. Children receiving IYCF were excluded from growth analyses. Results Fifty-one of 738 (7%) children who were HIV-exposed and 198 of 3989 (5%) children who were HIV-unexposed (CHU) died (hazard ratio, 1.41 [95% confidence interval {CI}, 1.02–1.93]). Twenty-five (3%) children who were HIV-exposed tested HIV positive, 596 (81%) were HIV-exposed uninfected (CHEU), and 117 (16%) had unknown HIV status by 18 months; overall transmission estimates were 4.3%–7.7%. Mean length-for-age z score at 18 months was 0.38 (95% CI,.24–.51) standard deviations lower among CHEU compared to CHU. Among 367 children exposed to HIV in non-IYCF arms, 147 (40%) were alive, HIV-free, and nonstunted at 18 months, compared to 1169 of 1956 (60%) CHU (absolute difference, 20% [95% CI, 15%–26%]). Conclusions In rural Zimbabwe, mortality remains 40% higher among children exposed to HIV, vertical transmission exceeds elimination targets, and half of CHEU are stunted. We propose the composite outcome of "alive, HIV free, and thriving" as the long-term goal of PMTCT programs. Clinical Trials Registration NCT01824940. [ABSTRACT FROM AUTHOR]
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- 2021
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37. The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation.
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Fernando, Shamiso, Brown, Tim, Datta, Kavita, Chidhanguro, Dzivaidzo, Tavengwa, Naume V., Chandna, Jaya, Munetsi, Epiphania, Dzapasi, Lloyd, Nyachowe, Chandiwana, Mutasa, Batsirai, Chasekwa, Bernard, Ntozini, Robert, Chibanda, Dixon, and Prendergast, Andrew J.
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PSYCHOTHERAPY ,RURAL women ,PROBLEM-solving therapy ,EDINBURGH Postnatal Depression Scale ,COMMUNITY health workers - Abstract
Background: There is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe. Methods: Rural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test. Results: Ten VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0); p = 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6); p < 0.001] after the 6-week intervention. Conclusion: VHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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38. Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial
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Ntozini, Robert, Marks, Sara J., Mangwadu, Goldberg, Mbuya, Mduduzi N. N., Gerema, Grace, Mutasa, Batsirai, Julian, Timothy R., Schwab, Kellogg J., Humphrey, Jean H., Zungu, Lindiwe I., Chasekwa, Bernard, Helyar, William, Phiri, Simon, Garikai, Alford, Meki, Kwanai, Chimucheka, Norbert, Mapuranga, Antonella, Hoko-Sibanda, Nokuthula, and Chikwavaire, Vimbai F.
- Abstract
Access to water and sanitation are important determinants of behavioral responses to hygiene and sanitation interventions. We estimated cluster-specific water access and sanitation coverage to inform a constrained randomization technique in the SHINE trial. Technicians and engineers inspected all public access water sources to ascertain seasonality, function, and geospatial coordinates. Households and water sources were mapped using open-source geospatial software. The distance from each household to the nearest perennial, functional, protected water source was calculated, and for each cluster, the median distance and the proportion of households within 1500 m of such a water source. Cluster-specific sanitation coverage was ascertained using a random sample of 13 households per cluster. These parameters were included as covariates in randomization to optimize balance in water and sanitation access across treatment arms at the start of the trial. The observed high variability between clusters in both parameters suggests that constraining on these factors was needed to reduce risk of bias
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- 2017
39. Predictors of oral rotavirus vaccine immunogenicity in rural Zimbabwean infants.
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Church, James A., Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Lee, Benjamin, Carmolli, Marya P., Ntozini, Robert, Mutasa, Kuda, McNeal, Monica M., Majo, Florence D., Tavengwa, Naume V., Kirkpatrick, Beth D., Moulton, Lawrence H., Humphrey, Jean H., and Prendergast, Andrew J.
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ROTAVIRUSES , *ORAL vaccines , *ROTAVIRUS vaccines , *INFANTS , *INFANT nutrition , *LOW-income countries - Abstract
Oral rotavirus vaccines (RVV) have poor immunogenicity in low-income countries, for reasons that remain unclear. This study identified the determinants of RVV immunogenicity among infants in rural Zimbabwe. Anti-rotavirus IgA titres were measured among a sub-group of infants enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (NCT01824940). SHINE was a cluster-randomized trial of improved infant and young child feeding, and improved water, sanitation and hygiene (WASH) in two rural Zimbabwean districts. Infants received RVV as part of the national immunisation programme. Among HIV-unexposed infants in the non-WASH trial arms, we evaluated associations between potential risk factors (vaccine schedule and dose, maternal and infant nutritional status, infant diarrhoea, and household environment) and RVV immunogenicity (seroconversion, seropositivity and geometric mean titres) using multivariable regression. Among 219 infants with seroconversion data, 43 (20%) successfully seroconverted and 176 (80%) failed to seroconvert to RVV. Seroconversion was positively associated with a higher length-for-age Z-score (LAZ) around the time of vaccination (adjusted RR 1.27 (95% CI 1.04, 1.55), P = 0.021), and negatively associated with concurrent OPV and RVV administration (adjusted RR 0.36 (0.19, 0.71), P = 0.003). Among 472 infants with post-vaccination titres, a higher LAZ score was associated with increased seropositivity (aRR 1.21 (95% CI 1.06, 1.38), P = 0.004), and higher birthweight was associated with increased IgA titres (0.45 (95%CI 0.18, 1.09) U/mL greater per 100 g gain in birthweight; P = 0.001). Infant ponderal and linear growth were positively associated with RVV immunogenicity, while concurrent administration of OPV was negatively associated with RVV immunogenicity. Together, these findings suggest that improving foetal growth and separating RVV and OPV administration are plausible approaches to increasing RVV immunogenicity. [ABSTRACT FROM AUTHOR]
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- 2020
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40. C reactive protein response after routine vaccination among rural Zimbabwean infants.
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Broad, Jonathan, Church, James, Mutasa, Kuda, Majo, Florence D., Tavengwa, Naume V., Chasekwa, Bernard, Humphrey, Jean H., Ntozini, Robert, and Prendergast, Andrew J.
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INFANTS ,VACCINATION ,AICARDI syndrome - Published
- 2023
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41. Neonatal vitamin A supplementation and immune responses to oral polio vaccine in Zimbabwean infants.
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Church, James A, Rukobo, Sandra, Govha, Margaret, Carmolli, Marya P, Diehl, Sean A, Chasekwa, Bernard, Ntozini, Robert, Mutasa, Kuda, Humphrey, Jean H, Kirkpatrick, Beth D, and Prendergast, Andrew J
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ORAL vaccines ,POLIOMYELITIS vaccines ,INFANTS ,IMMUNE response ,VITAMIN A - Abstract
Background Micronutrient deficiencies may contribute to reduced oral vaccine immunogenicity in developing countries. We hypothesised that neonatal vitamin A supplementation (NVAS) would improve oral vaccine responses. Methods We performed a cross-sectional study of infants recruited at birth to the Zimbabwe Vitamin A for Mothers and Babies (ZVITAMBO) trial, a randomised controlled trial of single, high-dose NVAS vs placebo conducted in Zimbabwe between 1997–2001. We measured poliovirus-specific IgA to type 1–3 polio strains by semiquantitative capture ELISA in cryopreserved plasma samples collected at 6 months of age. Results A total of 181 infants fulfilled inclusion criteria, of whom 80 were randomised to NVAS and 101 to placebo. There were no significant differences in baseline characteristics between groups. At 6 months of age, median (IQR) vaccine titres for infants randomised to NVAS vs placebo were 932 (421–3001) vs 1774 (711–5431) for Sabin-1 (p=0.04); 1361 (705–3402) vs 2309 (1081–4283) for Sabin-2 (p=0.15); and 1584 (796–4216) vs 2260 (996–5723) for Sabin-3 (p=0.14), respectively. After adjusting for breast feeding status, birth weight, season and infant sex in a linear regression model, there was only weak evidence of difference in log mean titres between vitamin A and placebo groups for Sabin-1 (p=0.08) and no evidence of difference in log mean titres for Sabin-2 and Sabin-3. Conclusions NVAS did not augment oral polio vaccine responses in Zimbabwean infants. Further research is required to understand the impact of NVAS on responses to other oral vaccines. The trial is registered with clinicaltrials.gov identifier: NCT00198718. [ABSTRACT FROM AUTHOR]
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- 2019
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42. Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene
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Prendergast, Andrew J, Gharpure, Radhika, Mor, Siobhan, Viney, Mark, Dube, Kululeko, Lello, Joanne, Berger, Cedric, Siwila, Joyce, Joyeux, Mathieu, Hodobo, Tinashe, Hurt, Lisa, Brown, Tim, Hoto, Patience, Tavengwa, Naume, Mutasa, Kuda, Craddock, Susan, Chasekwa, Bernard, Robertson, Ruairi C, Evans, Ceri, Chidhanguro, Dzivaidzo, Mutasa, Batsirai, Majo, Florence, Smith, Laura E, Hirai, Mitsuaki, Ntozini, Robert, Humphrey, Jean H, and Berendes, David
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- 2019
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43. Traditional Oral Remedies and Perceived Breast Milk Insufficiency Are Major Barriers to Exclusive Breastfeeding in Rural Zimbabwe123
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Desai, Amy, Mbuya, Mduduzi N.N., Chigumira, Ancikaria, Chasekwa, Bernard, Humphrey, Jean H., Moulton, Lawrence H., Pelto, Gretel, Gerema, Grace, and Stoltzfus, Rebecca J.
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Adult ,Zimbabwe ,Health Knowledge, Attitudes, Practice ,Infant, Newborn ,Infant ,Social Support ,Health Promotion ,Lactation Disorders ,Rural Health ,Social Control, Informal ,Nutrition Surveys ,Community and International Nutrition ,Breast Feeding ,Patient Education as Topic ,Humans ,Patient Compliance ,Female ,Diagnostic Errors ,Infant Nutritional Physiological Phenomena ,Developing Countries ,Medicine, African Traditional - Abstract
Only 5.8% of Zimbabwean infants are exclusively breastfed for the first 6 mo of life despite substantial investment in exclusive breastfeeding (EBF) promotion throughout the country. We conducted a survey of 295 mothers of infants
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- 2014
44. Immune responses to oral poliovirus vaccine in HIV-exposed uninfected Zimbabwean infants.
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Church, James A., Rukobo, Sandra, Govha, Margaret, Carmolli, Marya P., Diehl, Sean A., Chasekwa, Bernard, Ntozini, Robert, Mutasa, Kuda, Humphrey, Jean H., Kirkpatrick, Beth D., and Prendergast, Andrew J.
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- 2017
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45. Acute Illness Is Associated with Suppression of the Growth Hormone Axis in Zimbabwean Infants.
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Jones, Andrew D., Rukobo, Sandra, Chasekwa, Bernard, Mutasa, Kuda, Ntozini, Robert, Mbuya, Mduduzi N. N., Stoltzfus, Rebecca J., Humphrey, Jean H., and Prendergast, Andrew J.
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- 2015
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46. Congenital and Postnatal CMV and EBV Acquisition in HIV-Infected Zimbabwean Infants.
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Gumbo, Hlanai, Chasekwa, Bernard, Church, James A., Ntozini, Robert, Mutasa, Kuda, Humphrey, Jean H., and Prendergast, Andrew J.
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HIV infections , *THERAPEUTICS , *CONGENITAL disorders , *CUCUMBER mosaic virus , *EPSTEIN-Barr virus , *INFANT diseases , *DISEASE progression , *ANTIRETROVIRAL agents - Abstract
Background: HIV-infected infants in sub-Saharan Africa have rapid disease progression. We hypothesized that co-infection with cytomegalovirus (CMV) or Epstein Barr virus (EBV) increases mortality in HIV-infected infants. Methods: 257 antiretroviral therapy-naïve HIV-infected Zimbabwean infants were tested for CMV and EBV at 6 weeks of age by real-time PCR; if positive, birth samples were retrieved where available to distinguish congenital and postnatal infection. The impact of co-infection on mortality through 6 months was estimated using Kaplan-Meier and Cox proportional hazards methods. Results: At 6 weeks, 203/257 (79%) HIV-infected infants were CMV-positive; 27 (11%) had congenital CMV, 108 (42%) postnatal CMV and 68 (26%) indeterminate timing of infection. By 6 months, 37/108 (34%) infants with postnatal CMV versus 16/54 (30%) CMV-negative infants died (adjusted hazard ratio (aHR) 1.1 [95%CI 0.6, 2.2]). At 6 weeks, 33/257 (13%) HIV-infected infants had EBV co-infection; 6 (2%) had congenital EBV, 18 (7%) postnatal EBV and 9 (4%) indeterminate timing of infection. By 6 months, 5/18 (28%) infants with postnatal EBV versus 72/224 (32%) EBV-negative infants died (aHR 0.8 [95%CI 0.3, 2.3]). Conclusions: The vast majority of HIV-infants had acquired CMV by 6 weeks, and EBV co-infection occurred earlier than expected, with one in eight HIV-infected infants positive for EBV by 6 weeks. There was a high prevalence of congenital CMV infection and we identified 6 infants with congenital EBV infection, which has not previously been reported in Africa or in the context of HIV infection. Neither CMV nor EBV co-infection was associated with increased mortality. [ABSTRACT FROM AUTHOR]
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- 2014
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47. Short Report: Dosing of Praziquantel by Height in Sub-Saharan African Adults.
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Palha De Sousa, Chiquita A., Brigham, Tracy, Chasekwa, Bernard, Mbuya, Mduduzi N. N., Tielsch, James M., Humphrey, Jean H., and Prendergast, Andrew J.
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- 2014
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48. Stunting Is Characterized by Chronic Inflammation in Zimbabwean Infants.
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Prendergast, Andrew J., Rukobo, Sandra, Chasekwa, Bernard, Mutasa, Kuda, Ntozini, Robert, Mbuya, Mduduzi N. N., Jones, Andrew, Moulton, Lawrence H., Stoltzfus, Rebecca J., and Humphrey, Jean H.
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INFLAMMATORY mediators ,INFANT diseases ,SOMATOMEDIN ,ENDOCRINE system physiology ,MALNUTRITION ,ZIMBABWEANS ,HEALTH - Abstract
Background: Stunting affects one-third of children in developing countries, but the causes remain unclear. We hypothesized that enteropathy leads to low-grade inflammation, which suppresses the growth hormone-IGF axis and mediates stunting. Methods: We conducted a case-control study of 202 HIV-unexposed Zimbabwean infants who were stunted (height-for-age Z-score (HAZ) <−2; cases) or non-stunted (HAZ >−0.5; controls) at 18 months. We measured biomarkers of intestinal damage (I-FABP), inflammation (CRP, AGP, IL-6) and growth hormone-IGF axis (IGF-1, IGFBP3) in infant plasma at 6 weeks and 3, 6, 12 and 18 months, and in paired maternal-infant plasma at birth. Adjusted mean differences between biomarkers were estimated using regression models. Multivariate odds ratios of stunting were estimated by logistic regression. Results: At birth, cases were shorter (median (IQR) HAZ −1.00 (−1.53, −0.08) vs 0.03 (−0.57, 0.62,); P<0.001) than controls and their mothers had lower levels of IGF-1 (adjusted mean difference (95%CI) −21.4 (−39.8, −3.1) ng/mL). From 6 weeks to 12 months of age, levels of CRP and AGP were consistently higher and IGF-1 and IGFBP3 lower in cases versus controls; IGF-1 correlated inversely with inflammatory markers at all time-points. I-FABP increased between 3–12 months, indicating extensive intestinal damage during infancy, which was similar in cases and controls. In multivariate analysis, higher log
10 levels of CRP (aOR 3.06 (95%CI 1.34, 6.99); P = 0.008) and AGP (aOR 7.87 (95%CI 0.74, 83.74); P = 0.087) during infancy were associated with stunting. There were no associations between levels of I-FABP, IL-6, sCD14 or EndoCAb and stunting. Conclusions: Stunting began in utero and was associated with low maternal IGF-1 levels at birth. Inflammatory markers were higher in cases than controls from 6 weeks of age and were associated with lower levels of IGF-1 throughout infancy. Higher levels of CRP and AGP during infancy were associated with stunting. These findings suggest that an extensive enteropathy occurs during infancy and that low-grade chronic inflammation may impair infant growth. [ABSTRACT FROM AUTHOR]- Published
- 2014
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49. Formative Research on Hygiene Behaviors and Geophagy among Infants and Young Children and Implications of Exposure to Fecal Bacteria.
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Ngure, Francis M., Humphrey, Jean H., Mbuya, Mduduzi N. N., Majo, Florence, Mutasa, Kuda, Govha, Margaret, Mazarura, Exevia, Chasekwa, Bernard, Prendergast, Andrew J., Curtis, Valerie, Boor, Kathyrn J., and Stoltzfus, Rebecca J.
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- 2013
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50. Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures.
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Koyratty, Nadia, Jones, Andrew D., Schuster, Roseanne, Kordas, Katarzyna, Li, Chin-Shang, Mbuya, Mduduzi N. N., Boateng, Godfred O., Ntozini, Robert, Chasekwa, Bernard, Humphrey, Jean H., and Smith, Laura E.
- Published
- 2021
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