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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

Author

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

Published
2023
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3. The gut microbiome and early-life growth in a population with high prevalence of stunting

Author

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.

Published
2023
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5. Associations between biomarkers of environmental enteric dysfunction and oral rotavirus vaccine immunogenicity in rural Zimbabwean infants

Author

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

Published
2021
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6. 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

Author

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.

Subjects
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 [...]

Published
2020
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7. 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

Author

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

Published
2019
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9. 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

Author

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

Subjects
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.

Published
2023

10. Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia.

Author

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.

Subjects
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]

Published
2023
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11. Child Health, Agriculture and Integrated Nutrition (CHAIN): protocol for a randomised controlled trial of improved infant and young child feeding in rural Zimbabwe

Author

Smith, Laura E, primary, Chagwena, Dexter. T, additional, Bourke, Claire, additional, Robertson, Ruairi, additional, Fernando, Shamiso, additional, Tavengwa, Naume V, additional, Cairns, Jill, additional, Ndhlela, Thokozile, additional, Matumbu, Exhibit, additional, Brown, Tim, additional, Datta, Kavita, additional, Mutasa, Batsirai, additional, Tengende, Alice, additional, Chidhanguro, Dzivaidzo, additional, Langhaug, Lisa, additional, Makanza, Maggie, additional, Chasekwa, Bernard, additional, Mutasa, Kuda, additional, Swann, Jonathan, additional, Kelly, Paul, additional, Ntozini, Robert, additional, and Prendergast, Andrew, additional

Published
2022
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13. Stunting Status and Exposure to Infection and Inflammation in Early Life Shape Antibacterial Immune Cell Function Among Zimbabwean Children

Author

Mutasa, Kuda, primary, Tome, Joice, additional, Rukobo, Sandra, additional, Govha, Margaret, additional, Mushayanembwa, Patience, additional, Matimba, Farai S., additional, Chiorera, Courage K., additional, Majo, Florence D., additional, Tavengwa, Naume V., additional, Mutasa, Batsirai, additional, Chasekwa, Bernard, additional, Humphrey, Jean H., additional, Ntozini, Robert, additional, Prendergast, Andrew J., additional, and Bourke, Claire D., additional

Published
2022
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14. Additional file 1 of Implementation and maintenance of infant dietary diversity in Zimbabwe: contribution of food and water insecurity

Author

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.

Abstract

Additional file 1: Table S1. Sensitivity analyses of the association between implementation of minimum infant dietary diversity at 12 months and household-level multidimensional food insecurity and water insecurity. Table S2. Sensitivity analyses of associations of minimum infant dietary diversity maintenance from 12 to 18 months and multidimensional household-level food insecurity and water insecurity.

Published
2022
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15. Recovery of children following hospitalisation for complicated severe acute malnutrition

Author

Bwakura‐Dangarembizi, Mutsa, primary, Dumbura, Cherlynn, additional, Amadi, Beatrice, additional, Chasekwa, Bernard, additional, Ngosa, Deophine, additional, Majo, Florence D., additional, Sturgeon, Jonathan P., additional, Chandwe, Kanta, additional, Kapoma, Chanda, additional, Bourke, Claire D., additional, Robertson, Ruairi C., additional, Nathoo, Kusum J., additional, Ntozini, Robert, additional, Norris, Shane A., additional, Kelly, Paul, additional, and Prendergast, Andrew J., additional

Published
2021
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17. Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial.

Author

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

Subjects
*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]

Published
2022
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18. The Impact of Improved Water, Sanitation, and Hygiene on Oral Rotavirus Vaccine Immunogenicity in Zimbabwean Infants: Substudy of a Cluster-randomized Trial

Author

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

Subjects
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.

Published
2019

19. Maternal fecal microbiome predicts gestational age, birth weight and neonatal growth in rural Zimbabwe.

Author

Gough, Ethan K., primary, Edens, Thaddeus J., additional, Geum, Hyun Min, additional, Baharmand, Iman, additional, Gill, Sandeep K., additional, Robertson, Ruairi C., additional, Mutasa, Kuda, additional, Ntozini, Robert, additional, Smith, Laura E, additional, Chasekwa, Bernard, additional, Majo, Florence D., additional, Tavengwa, Naume V., additional, Mutasa, Batsirai, additional, Francis, Freddy, additional, Carr, Lynnea, additional, Tome, Joice, additional, Stoltzfus, Rebecca J., additional, Moulton, Lawrence H., additional, Prendergast, Andrew J., additional, Humphrey, Jean H., additional, Manges, Amee R., additional, and Team, SHINE Trial, additional

Published
2021
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20. Heat treatment of expressed breast milk is a feasible option for feeding hiv-exposed, uninfected children after 6 months of age in rural Zimbabwe

Author

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.

Subjects
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.

Published
2010

25. Recovery of children following hospitalisation for complicated severe acute malnutrition.

Author

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.

Subjects
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]

Published
2022
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26. Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia

Author

Bwakura-Dangarembizi, Mutsa, primary, Dumbura, Cherlynn, additional, Amadi, Beatrice, additional, Ngosa, Deophine, additional, Majo, Florence D, additional, Nathoo, Kusum J, additional, Mwakamui, Simutanyi, additional, Mutasa, Kuda, additional, Chasekwa, Bernard, additional, Ntozini, Robert, additional, Kelly, Paul, additional, and Prendergast, Andrew J, additional

Published
2021
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28. The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation

Author

Fernando, Shamiso, primary, Brown, Tim, additional, Datta, Kavita, additional, Chidhanguro, Dzivaidzo, additional, Tavengwa, Naume V., additional, Chandna, Jaya, additional, Munetsi, Epiphania, additional, Dzapasi, Lloyd, additional, Nyachowe, Chandiwana, additional, Mutasa, Batsirai, additional, Chasekwa, Bernard, additional, Ntozini, Robert, additional, Chibanda, Dixon, additional, and Prendergast, Andrew J., additional

Published
2021
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31. Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe

Author

Chandna, Jaya, primary, Ntozini, Robert, additional, Evans, Ceri, additional, Kandawasvika, Gwendoline, additional, Chasekwa, Bernard, additional, Majo, Florence D, additional, Mutasa, Kuda, additional, Tavengwa, Naume V, additional, Mutasa, Batsirai, additional, NN Mbuya, Mduduzi, additional, Moulton, Lawrence H, additional, Humphrey, Jean H, additional, Prendergast, Andrew J, additional, and Gladstone, Melissa, additional

Published
2020
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32. Intestinal Damage and Inflammatory Biomarkers in Human Immunodeficiency Virus (HIV)–Exposed and HIV-Infected Zimbabwean Infants

Author

Prendergast, Andrew J, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, and Humphrey, Jean H

Subjects
Inflammation, Male, Zimbabwe, intestinal, Dose-Response Relationship, Drug, Interleukin-6, Lipopolysaccharide Receptors, virus diseases, HIV, Infant, HIV Infections, Fatty Acid-Binding Proteins, mortality, Intestines, Major Articles and Brief Reports, C-Reactive Protein, Case-Control Studies, Sample Size, Africa, Multivariate Analysis, Humans, Female, Biomarkers, Hiv/Aids, Randomized Controlled Trials as Topic
Abstract

Summary HIV-infected Zimbabwean infants had high levels of inflammation, but no biomarker was associated with mortality. HIV-exposed but uninfected infants had higher C-reactive protein than HIV-unexposed infants, but baseline levels of intestinal damage were not related to subsequent HIV acquisition through breastfeeding., Background Disease progression is rapid in human immunodeficiency virus (HIV)–infected infants. Whether intestinal damage and inflammation underlie mortality is unknown. Methods We measured plasma intestinal fatty acid binding protein (I-FABP), soluble CD14 (sCD14), interleukin 6 (IL-6), and C-reactive protein (CRP) at 6 weeks and 6 months of age in 272 HIV-infected infants who either died (cases) or survived (controls), and in 194 HIV-exposed uninfected (HEU) and 197 HIV-unexposed infants. We estimated multivariable odds ratios for mortality and postnatal HIV transmission for each biomarker using logistic regression. Results At 6 weeks, HIV-infected infants had higher sCD14 and IL-6 but lower I-FABP than HIV-exposed and HIV-unexposed infants (P < .001). CRP was higher in HIV-exposed than HIV-unexposed infants (P = .02). At 6 months, HIV-infected infants had highest sCD14, IL-6, and CRP concentrations (P < .001) and marginally higher I-FABP than other groups (P = .07). CRP remained higher in HIV-exposed vs HIV-unexposed infants (P = .04). No biomarker was associated with mortality in HIV-infected infants, or with odds of breast-milk HIV transmission in HIV-exposed infants. Conclusions HIV-infected infants have elevated inflammatory markers by 6 weeks of age, which increase over time. In contrast to adults and older children, inflammatory biomarkers were not associated with mortality. HEU infants have higher inflammation than HIV-unexposed infants until at least 6 months, which may contribute to poor health outcomes.

Published
2017

33. Early Initiation and Exclusivity of Breastfeeding in Rural Zimbabwe: Impact of a Breastfeeding Intervention Delivered by Village Health Workers

Author

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

Subjects
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

Published
2019

34. Measuring wealth in rural communities: Lessons from the Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial

Author

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

Subjects
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.

Published
2018

35. Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene

Author

Prendergast, Andrew J, primary, Gharpure, Radhika, additional, Mor, Siobhan, additional, Viney, Mark, additional, Dube, Kululeko, additional, Lello, Joanne, additional, Berger, Cedric, additional, Siwila, Joyce, additional, Joyeux, Mathieu, additional, Hodobo, Tinashe, additional, Hurt, Lisa, additional, Brown, Tim, additional, Hoto, Patience, additional, Tavengwa, Naume, additional, Mutasa, Kuda, additional, Craddock, Susan, additional, Chasekwa, Bernard, additional, Robertson, Ruairi C, additional, Evans, Ceri, additional, Chidhanguro, Dzivaidzo, additional, Mutasa, Batsirai, additional, Majo, Florence, additional, Smith, Laura E, additional, Hirai, Mitsuaki, additional, Ntozini, Robert, additional, Humphrey, Jean H, additional, and Berendes, David, additional

Published
2019
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36. The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation.

Author

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.

Subjects
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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37. Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial

Author

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

Published
2017

39. Traditional Oral Remedies and Perceived Breast Milk Insufficiency Are Major Barriers to Exclusive Breastfeeding in Rural Zimbabwe123

Author

Desai, Amy, Mbuya, Mduduzi N.N., Chigumira, Ancikaria, Chasekwa, Bernard, Humphrey, Jean H., Moulton, Lawrence H., Pelto, Gretel, Gerema, Grace, and Stoltzfus, Rebecca J.

Subjects
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

Published
2014

45. Formative Research on Hygiene Behaviors and Geophagy among Infants and Young Children and Implications of Exposure to Fecal Bacteria

Author

Ngure, Francis M., primary, Majo, Florence, additional, Mbuya, Mduduzi N. N., additional, Humphrey, Jean H., additional, Govha, Margaret, additional, Chasekwa, Bernard, additional, Mutasa, Kuda, additional, Boor, Kathyrn J., additional, Mazarura, Exevia, additional, Curtis, Valerie, additional, Prendergast, Andrew J., additional, and Stoltzfus, Rebecca J., additional

Published
2013
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47. 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

Author

Jenkins, Alison L., primary, Tavengwa, Naume V., additional, Chasekwa, Bernard, additional, Chatora, Kumbirai, additional, Taruberekera, Noah, additional, Mushayi, Wellington, additional, Madzima, Rufaro C., additional, and Mbuya, Mduduzi N.N., additional

Published
2011
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50. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Protocol for school-age follow-up.

Author

Piper JD, Mazhanga C, Mwapaura M, Mapako G, Mapurisa I, Mashedze T, Munyama E, Kuona M, Mashiri T, Sibanda K, Matemavi D, Tichagwa M, Nyoni S, Saidi A, Mangwende M, Chidhanguro D, Mpofu E, Tome J, Mutasa B, Chasekwa B, Smuk M, Smith LE, Njovo H, Nyachowe C, Muchekeza M, Mutasa K, Sauramba V, Langhaug LF, Tavengwa NV, Gladstone MJ, Wells JC, Allen E, Humphrey JH, Ntozini R, and Prendergast AJ

Abstract

Background : There is a need for follow-up of early-life stunting intervention trials into childhood to determine their long-term impact. A holistic school-age assessment of health, growth, physical and cognitive function will help to comprehensively characterise the sustained effects of early-life interventions. Methods: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe assessed the effects of improved infant and young child feeding (IYCF) and/or improved water, sanitation and hygiene (WASH) on stunting and anaemia at 18 months. Among children enrolled to SHINE, 1,275 have been followed up at 7-8 years of age (1,000 children who have not been exposed to HIV, 268 exposed to HIV antenatally who remain HIV negative and 7 HIV positive children). Children were assessed using the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox, to measure their growth, body composition, cognitive and physical function. In parallel, a caregiver questionnaire assessed household demographics, socioeconomic status, adversity, nurturing, caregiver support, food and water insecurity. A monthly morbidity questionnaire is currently being administered by community health workers to evaluate school-age rates of infection and healthcare-seeking. The impact of the SHINE IYCF and WASH interventions, the early-life 'exposome', maternal HIV, and contemporary exposures on each school-age outcome will be assessed. We will also undertake an exploratory factor analysis to generate new, simpler metrics for assessment of cognition (COG-SAHARAN), growth (GROW-SAHARAN) and combined growth, cognitive and physical function (SUB-SAHARAN). The SUB-SAHARAN toolbox will be used to conduct annual assessments within the SHINE cohort from ages 8-12 years. Ethics and dissemination: Approval was obtained from Medical Research Council of Zimbabwe (08/02/21) and registered with Pan-African Clinical Trials Registry (PACTR202201828512110, 24/01/22). Primary caregivers provided written informed consent and children written assent. Findings will be disseminated through community sensitisation, peer-reviewed journals and stakeholders including the Zimbabwean Ministry of Health and Child Care., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Piper JD et al.)

Published
2023
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