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Women with female genital schistosomiasis (FGS) have been found to have genital symptoms and a threefold higher risk of HIV infection. Despite WHO recommendations, regular antischistosomal mass drug administration (MDA) has not yet been implemented in South Africa possibly because of the lack of updated epidemiological data. To provide data for future prevention efforts against FGS and HIV, this study explored Schistosoma haematobium prevalence in girls and young women and the effects of antischistosomal MDA, respectively. Urinary schistosomiasis and genital symptoms were investigated in 70 randomly selected secondary schools in three districts within KwaZulu-Natal and 18 primary schools. All study participants were treated for schistosomiasis, and schools with the highest urinary prevalence were followed up after 1 and 4 years of MDA. At baseline, urine analysis data showed that most schools were within the moderate-risk prevalence category where biennial antischistosomal MDA is recommended, as per WHO guidelines. Young women had high prevalence of genital symptoms (36%) after correcting for sexually transmitted infections. These symptoms may be caused by infection with schistosomes. However, FGS cannot be diagnosed by urine analysis alone. In KwaZulu-Natal rural schools, this study suggests that antischistosomal MDA with praziquantel could prevent genital symptoms in more than 200,000 young women. Furthermore, it is feasible that more than 5,000 HIV infections could be prevented in adolescent girls and young women by treatment and prevention of FGS.

The dearth of locally developed measures of language makes it difficult to detect language and communication problems among school-age children in sub-Saharan African settings. We sought to describe variability in vocabulary acquisition as an important element of global cognitive functioning. Our primary aims were to establish the psychometric properties of an expressive vocabulary measure, examine sources of variability, and investigate the measure’s associations with non-verbal reasoning and educational achievement. The study included 308 boys and girls living in a predominantly rural district in Kenya. The developed measure, the Kilifi Naming Test (KNT), had excellent reliability and acceptable convergent validity. However, concurrent validity was not adequately demonstrated. In the final regression model, significant effects of schooling and area of residence were recorded. Contextual factors should be taken into account in the interpretation of test scores. There is need for future studies to explore the concurrent validity of the KNT further.

The dearth of locally developed measures of language makes it difficult to detect language and communication problems among school-age children in sub-Saharan African settings. We sought to describe variability in vocabulary acquisition as an important element of global cognitive functioning. Our primary aims were to establish the psychometric properties of an expressive vocabulary measure, examine sources of variability, and investigate the measure’s associations with non-verbal reasoning and educational achievement. The study included 308 boys and girls living in a predominantly rural district in Kenya. The developed measure, the Kilifi Naming Test (KNT), had excellent reliability and acceptable convergent validity. However, concurrent validity was not adequately demonstrated. In the final regression model, significant effects of schooling and area of residence were recorded. Contextual factors should be taken into account in the interpretation of test scores. There is need for future studies to explore the concurrent validity of the KNT further.

PR, IFPRI3; DCA; CRP4; ISI; Capacity Strengthening; B Promoting healthy food systems; E Building Resilience, PHND; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Evidence on the association between feeding practices, iron deficiency, anaemia, stunting, and impaired psychomotor development during infancy is limited. This study assessed the association between psychomotor development with early feeding practices, growth, iron status, and anaemia. Methods: This was cross-sectional baseline data of a randomised controlled trial which included 6-month-old infants and their mothers or primary caregivers (n = 750) in a peri-urban community in the North West province of South Africa. The Kilifi Developmental Inventory and a parent rating scale were used to assess psychomotor development. Feeding practices and anthropometric measurements were based on the World Health Organisation (WHO) guidelines. Anaemia and iron status were determined by blood sample analysis.

Schistosomiasis and soil-transmitted helminthiasis are among the most prevalent neglected tropical diseases and may lead to severe consequences. We assessed the extent of co-infection between Schistosoma haematobium and the soil-transmitted helminths (STHs) Ascaris lumbricoides and Trichuris trichiura in schoolgirls in the rural areas of KwaZulu-Natal, South Africa. We also explored if S. haematobium can serve as a predictor for soil-transmitted helminths in this area. From 15 selected schools, 726 primary schoolgirls aged 10–12 years provided both urine and stool samples. The samples were examined for the presence of eggs using the urine sedimentation technique for S. haematobium and the Kato Katz technique for STHs. Pearson’s chi-square test was used to calculate the association and Spearman’s rank correlation was used for the correlation analysis. There was a highly significant correlation between S. haematobium and STHs at a school level (Spearman’s correlation coefficient =0.93; p<0.001). The prevalences were found to be 36.9% and 38.8% for S. haematobium and STHs, respectively. A significant association was found between S. haematobium and STHs (odds ratio =2.05; confidence interval =1.58–2.93; p<0.001). Indirect indicators of urogenital schistosomiasis (e.g. water contact and haematuria) were significantly associated with A. lumbricoides and T. trichiura infection. We have demonstrated a highly significant correlation and overall association between urogenital schistosomiasis and A. lumbricoides and T. trichiura. We cautiously suggest that all S. haematobium endemic areas should be treated for STH infections.

Both Fe deficiency and poor n-3 fatty acid status have been associated with behavioural changes in children. In the present study, we investigated the effects of Fe and DHA+EPA supplementation, alone or in combination, on physical activity during school days and on teacher-rated behaviour in healthy Fe-deficient school children. In a 2×2 factorial design, children (n 98, 6-11 years) were randomly assigned to receive (1) Fe (50mg) plus DHA (420mg)+EPA (80mg), (2) Fe plus placebo, (3) placebo plus DHA+EPA or (4) placebo plus placebo as oral supplements (4d/week) for 8·5 months. Physical activity was measured during four school days at baseline and endpoint using accelerometers, and data were stratified into morning class time (08.00-10.29 hours), break time (10.30-11.00 hours) and after-break class time (11.01-12.00 hours) for analysis. Classroom behaviour was assessed at endpoint using Conners' Teacher Rating Scales. DHA+EPA supplementation decreased physical activity counts during morning class time, increased sedentary physical activity, and decreased light- and moderate-intensity physical activities. Consistently, DHA+EPA supplementation increased sedentary physical activity and decreased light-intensity physical activity during after-break class time. Even though there were no treatment effects found on teacher-rated behaviour, lower physical activity during morning class time was associated with lower levels of teacher-rated hyperactivity and oppositional behaviour at endpoint. Despite a positive association between Fe status and physical activity during break time at baseline, Fe supplementation did not affect physical activity during break time and class time. Our findings suggest that DHA+EPA supplementation may decrease physical activity levels during class time, and further indicate that accelerometry might be a useful tool to assess classroom behaviour in healthy children

The Kilifi Developmental Inventory (KDI) is a tool developed in Kenya for the assessment of psychomotor development in infants and young children. We developed age-appropriate standards against which the developmental progress of individual children could be tracked. The current report is based on three studies completed among 1428 children aged between 5 and 36 months and living within rural and urban locations at the Coast of Kenya. We identified age-appropriate cut-offs and expected ranges of performance to facilitate the identification and monitoring of children with impaired psychomotor development.

Both Fe deficiency and poor n-3 fatty acid status have been associated with behavioural changes in children. In the present study, we investigated the effects of Fe and DHA+EPA supplementation, alone or in combination, on physical activity during school days and on teacher-rated behaviour in healthy Fe-deficient school children. In a 2 × 2 factorial design, children (n 98, 6-11 years) were randomly assigned to receive (1) Fe (50 mg) plus DHA (420 mg)+EPA (80 mg), (2) Fe plus placebo, (3) placebo plus DHA+EPA or (4) placebo plus placebo as oral supplements (4 d/week) for 8·5 months. Physical activity was measured during four school days at baseline and endpoint using accelerometers, and data were stratified into morning class time (08.00-10.29 hours), break time (10.30-11.00 hours) and after-break class time (11.01-12.00 hours) for analysis. Classroom behaviour was assessed at endpoint using Conners' Teacher Rating Scales. DHA+EPA supplementation decreased physical activity counts during morning class time, increased sedentary physical activity, and decreased light- and moderate-intensity physical activities. Consistently, DHA+EPA supplementation increased sedentary physical activity and decreased light-intensity physical activity during after-break class time. Even though there were no treatment effects found on teacher-rated behaviour, lower physical activity during morning class time was associated with lower levels of teacher-rated hyperactivity and oppositional behaviour at endpoint. Despite a positive association between Fe status and physical activity during break time at baseline, Fe supplementation did not affect physical activity during break time and class time. Our findings suggest that DHA+EPA supplementation may decrease physical activity levels during class time, and further indicate that accelerometry might be a useful tool to assess classroom behaviour in healthy children.

Adequate nutrition is fundamental to the development of a child's full potential. However, the extent to which malnutrition affects developmental and cognitive outcomes in the midst of co-occurring risk factors remains largely understudied. We sought to establish if the effects of nutritional status varied according to diverse background characteristics as well as to compare the relative strength of the effects of poor nutritional status on language skills, motor abilities, and cognitive functioning at school age. This cross-sectional study was conducted among school-age boys and girls resident in Kilifi District in Kenya. We hypothesized that the effects of area of residence, school attendance, household wealth, age and gender on child outcomes are experienced directly and indirectly through child nutritional status. The use of structural equation modeling (SEM) allowed the disaggregation of the total effect of the explanatory variables into direct effects (effects that go directly from one variable to another) and indirect effects. Each of the models tested for the four child outcomes had a good fit. However, the effects on verbal memory apart from being weaker than for the other outcomes, were not mediated through nutritional status. School attendance was the most influential predictor of nutritional status and child outcomes. The estimated models demonstrated the continued importance of child nutritional status at school-age.

Background: Little is known about the combined effects of iron and n−3 (omega-3) fatty acid (FA) supplementation on cognitive performance. The provision of either DHA/EPA or iron alone in rats with combined iron and n−3 FA deficiency has been reported to exacerbate cognitive deficits associated with deficiency. Objective: We investigated the effects of iron and DHA/EPA supplementation, alone and in combination, in children with poor iron and n−3 FA status. Design: In a 2-by-2 factorial trial, children with iron deficiency (ID) (n = 321; aged 6–11 y) were allocated to receive 1) iron (50 mg) plus DHA/EPA (420/80 mg), 2) iron plus placebo, 3) placebo plus a mixture of DHA and EPA (DHA/EPA), or 4) placebo plus placebo as oral supplements (4/wk) for 8.5 mo. Cognition was assessed at baseline and endpoint by using the Hopkins Verbal Learning Test (HVLT) and subscales of the Kaufman Assessment Battery for Children. Results: Both iron and DHA/EPA significantly increased weight-for-age z scores. Iron increased the number of words recalled at HVLT recall 2 (intervention effect: 0.90; 95% CI: 0.18, 1.62), and in anemic children, iron increased scores in the Atlantis Delayed test (1.51; 95% CI: 0.03, 2.99) and HVLT recall 2 (2.02; 95% CI: 0.55, 3.49). DHA/EPA showed no benefit in any of the cognitive tests but decreased Atlantis test scores (−2.48; 95% CI: −3.99, −0.96) in children who were anemic at baseline and decreased Atlantis delayed scores (−0.9; 95% CI: −1.45, −0.36) in girls with ID, whereas boys tended to perform better. Conclusions: In children with poor iron and n−3 FA status, iron supplementation improved verbal and nonverbal learning and memory, particularly in children with anemia. In contrast, DHA/EPA supplementation had no benefits on cognition and impaired working memory in anemic children and long-term memory and retrieval in girls with ID. The trial was registered at clinicaltrials.gov as NCT01092377.

This current pilot trial assessed the feasibility of implementing a point-of-use (PoU) micronutrient fortification in preschool settings. Preschool children (n = 151) aged 36–79 months were randomized into intervention (n = 76) and control (n = 75) groups, both receiving breakfast maize-porridge with added micronutrient or placebo powder for 52 school days. Process evaluation and early childhood development indicators were used to assess trial feasibility. Process evaluation results showed that the implementation components were feasible and could be delivered with high fidelity. The improvement in hemoglobin concentration in intervention and control groups were not significantly different (P = 0.250). There was medium likelihood for practical significance for the two global cognitive scores assessed: non-verbal index (intervention effects: 7.20; 95% confidence interval: 2.60, 11.81; P = 0.002, effect size: 0.55) and mental processing index (intervention effects: 2.73; 95% confidence interval: 0.25, 5.70; P = 0.072, effect size: 0.36) on the Kaufman Assessment Battery for Children, Second Edition. The lessons from this trial could help in planning/implementing future PoU micronutrient fortification trial among South African preschool children.