8 results on '"Chasekwa, Bernard"'
Search Results
2. 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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3. 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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4. 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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Male ,Zimbabwe ,Anthropometry ,Infant, Newborn ,HIV ,Infant ,HIV Infections ,Clinical Science: Concise Communication ,Child Development ,children ,Pregnancy ,Child, Preschool ,Africa ,head circumference ,Microcephaly ,Humans ,Female ,Longitudinal Studies ,Pregnancy Complications, Infectious ,Head ,Maternal-Fetal Exchange - Abstract
Objectives: To describe the head growth of children according to maternal and child HIV infection status. Design: Longitudinal analysis of head circumference data from 13 647 children followed from birth in the ZVITAMBO trial, undertaken in Harare, Zimbabwe, between 1997 and 2001, prior to availability of antiretroviral therapy (ART) or cotrimoxazole prophylaxis. Methods: Head circumference was measured at birth, then at regular intervals through 24 months of age. Mean head circumference-for-age Z-scores (HCZ) and prevalence of microcephaly (HCZ
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- 2016
5. 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
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Chandna, Jaya, Ntozini, Robert, Evans, Ceri, Kandawasvika, Gwendoline, Chasekwa, Bernard, Majo, Florence, Mutasa, Kuda, Tavengwa, Naume, Mutasa, Batsirai, Mbuya, Mdhu, Moulton, Lawrence H, Humphrey, Jean H, Prendergast, Andrew, Gladstone, Melissa, and Team, SHINE Trial
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Male ,Rural Population ,Sanitation ,Psychological intervention ,HIV Infections ,Child Development ,0302 clinical medicine ,Pregnancy ,Hygiene ,Cognitive development ,Medicine ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Infant Nutritional Physiological Phenomena ,Original Research ,media_common ,2. Zero hunger ,lcsh:R5-920 ,Health Policy ,Pit latrine ,3. Good health ,HIV-exposed uninfected ,Child, Preschool ,safe drinking water ,Female ,lcsh:Medicine (General) ,Zimbabwe ,Hand washing ,sanitation ,media_common.quotation_subject ,complementary feeding ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Social skills ,Water Supply ,030225 pediatrics ,Environmental health ,Humans ,lcsh:RC109-216 ,early child development ,hand washing ,business.industry ,Drinking Water ,Public Health, Environmental and Occupational Health ,HIV ,Infant ,Child development ,business - Abstract
IntroductionHIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact of improved infant and young child feeding (IYCF) and improved water, sanitation and hygiene (WASH) on early child development (ECD) outcomes.MethodsSanitation Hygiene Infant Nutrition Efficacy was a cluster randomised 2×2 factorial trial in rural Zimbabwe ClinicalTrials.gov NCT01824940). Pregnant women were eligible if they lived in study clusters allocated to standard-of-care (SOC; 52 clusters); IYCF (20 g small-quantity lipid-based nutrient supplement/day from 6 to 18 months, complementary feeding counselling; 53 clusters); WASH (pit latrine, 2 hand-washing stations, liquid soap, chlorine, play space, hygiene counselling; 53 clusters) or IYCF +WASH (53 clusters). Participants and fieldworkers were not blinded. ECD was assessed at 24 months using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social skills); MacArthur Bates Communication Development Inventories (assessing vocabulary and grammar); A-not-B test (assessing object permanence) and a self-control task. Intention-to-treat analyses were stratified by maternal HIV status.ResultsCompared with SOC, children randomised to combined IYCF +WASH had higher total MDAT scores (mean difference +4.6; 95% CI 1.9 to 7.2) and MacArthur Bates vocabulary scores (+8.5 words; 95% CI 3.7 to 13.3), but there was no evidence of effects from IYCF or WASH alone. There was no evidence that that any intervention impacted object permanence or self-control.ConclusionsCombining IYCF and WASH interventions significantly improved motor, language and cognitive development in HIV-exposed children.Trial registration numberNCT01824940.
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- 2020
6. 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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7. 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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8. 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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CYTOMEGALOVIRUSES , *HIV , *INFANT disease prevention , *C-reactive protein , *PUBLIC health - Abstract
Cytomegalovirus (CMV) acquisition and inflammation were evaluated in 231 human immunodeficiency virus (HIV)-exposed uninfected (HEU) and 100 HIV-unexposed Zimbabwean infants aged 6 weeks. The HEU and HIV-unexposed infants had a similarly high prevalence of CMV (81.4% vs 74.0%, respectively; P = .14), but HEU infants had higher CMV loads (P = .005) and >2-fold higher C-reactive protein (CRP) concentrations (P < .0001). The CMV-positive HEU infants had higher CRP than the CMV-negative HEU infants; this association disappeared after adjusting for maternal HIV load. Overall, CMV acquisition is high in early life, but HEU infants have higher CMV loads and a proinflammatory milieu, which may be driven partly by maternal HIV viremia. [ABSTRACT FROM AUTHOR]
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- 2017
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