Search

Background The infodemic accompanying the COVID-19 pandemic has led to an overwhelming amount of information, including questions, concerns and misinformation. Pandemic fatigue has been identified as a concern from early in the pandemic. With new and ongoing health emergencies in 2022, it is important to understand how pandemic fatigue is being discussed and expressed by users on digital channels. Methods This paper describes the collection of publicly available data over a 3-month period from multiple online sources using Meltwater, CrowdTangle to source data from Twitter, Facebook, Instagram, YouTube, TikTok, Pinterest, Product Reviews, Twitch, blogs & forums. A comprehensive search strategy was developed and tested. A total of 1,484,042 social media posts were identified during the time-period that included the defined search terms for pandemic fatigue. These data were initially sorted by highest levels of engagement and from this dataset, analysts reviewed the mentions to isolate and remove irrelevant content and identify dominant narratives. A thematic analysis was carried out on these narratives to identify themes related to expression of pandemic fatigue. Two researchers reviewed the data and themes. Results The thematic analysis of narratives identified six main themes relating to expression of pandemic fatigue, and one theme of counter narratives against pandemic fatigue. Data volume increased concurrent with the time of the mpox emergency announcement. Emergent themes showed the different ways users expressed pandemic fatigue and how it was interlaced with issues of trust, preventative measure acceptance and uptake, misinformation, and being overwhelmed with multiple or sustained emergencies. Conclusions This paper has identified the different ways users express pandemic fatigue on digital channels over a 3-month period. Better understanding the implications of the infodemic ecosystem on user’s perceptions, questions, and concerns regarding pandemic and more broadly emergency fatigue is vital in identifying relevant interventions and, in the longer term, strengthening the global architecture for health emergency preparedness, prevention, readiness and resilience, as evidenced in this paper. There are clear pathways for further research, including incorporating additional languages and reviewing these themes over longer time periods.

Background Vaccine hesitancy is one of the many factors impeding efforts to control the COVID-19 pandemic. Exacerbated by the COVID-19 infodemic, misinformation has undermined public trust in vaccination, led to greater polarization, and resulted in a high social cost where close social relationships have experienced conflict or disagreements about the public health response. Objective The purpose of this paper is to describe the theory behind the development of a digital behavioral science intervention—The Good Talk!—designed to target vaccine-hesitant individuals through their close contacts (eg, family, friends, and colleagues) and to describe the methodology of a research study to evaluate its efficacy. Methods The Good Talk! uses an educational serious game approach to boost the skills and competences of vaccine advocates to have open conversations about COVID-19 with their close contacts who are vaccine hesitant. The game teaches vaccine advocates evidence-based open conversation skills to help them speak with individuals who have opposing points of view or who may ascribe to nonscientifically supported beliefs while retaining trust, identifying common ground, and fostering acceptance and respect of divergent views. The game is currently under development and will be available on the web, free to access for participants worldwide, and accompanied by a promotional campaign to recruit participants through social media channels. This protocol describes the methodology for a randomized controlled trial that will compare participants who play The Good Talk! game with a control group that plays the widely known noneducational game Tetris. The study will evaluate a participant’s open conversation skills, self-efficacy, and behavioral intentions to have an open conversation with a vaccine-hesitant individual both before and after game play. Results Recruitment will commence in early 2023 and will cease once 450 participants complete the study (225 per group). The primary outcome is improvement in open conversation skills. Secondary outcomes are self-efficacy and behavioral intentions to have an open conversation with a vaccine-hesitant individual. Exploratory analyses will examine the effect of the game on implementation intentions as well as potential covariates or subgroup differences based on sociodemographic information or previous experiences with COVID-19 vaccination conversations. Conclusions The outcome of the project is to promote more open conversations regarding COVID-19 vaccination. We hope that our approach will encourage more governments and public health experts to engage in their mission to reach their citizens directly with digital health solutions and to consider such interventions as an important tool in infodemic management. International Registered Report Identifier (IRRID) PRR1-10.2196/40753

Background An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. Objective In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. Methods An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health–implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. Results The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. Conclusions Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

BACKGROUND To respond to the need for establishing infodemic management functions at the national public health institute in Germany (Robert Koch Institute; RKI), we explored and assessed available data sources, developed a social listening and integrated analysis framework, and defined when infodemic management functions would activate during emergencies. OBJECTIVE We aimed to establish a framework for social listening and integrated analysis for public health in the German context, using international examples and technical guidance documents for infodemic management. METHODS At the RKI, we 1) identified (potentially) available data sources for social listening and integrated analysis; 2) assessed these data sources for their suitability and usefulness for integrated analysis in addition to an assessment of their risk using RKIs standardised data protection requirement; 3) developed a framework and workflow to combine social listening and integrated analysis to report back actionable infodemic insights for public health communications by the RKI and stakeholders; 4) defined criteria for activating integrated analysis structures in the context of a specific health event or health emergency. RESULTS We identified and assessed 16 different types of data sources for social listening and integrated analysis in three categories: social media and online listening data, RKI-specific data, and infodemic insights. Most data sources can be analysed on a weekly basis to detect current trends and narratives and to inform a timely response through reporting insights that include a risk assessment and scalar judgements of the different narratives and themes. CONCLUSIONS This work identified, assessed, and prioritized a wide range of data sources for social listening and integrated analysis to report actionable infodemic insights, ensuring a valuable first step to establish and operationalise infodemic management at the RKI. This case study also serves as a roadmap for others to follow. Ultimately, once operational, these activities will inform better and targeted public health communication at the RKI, and beyond. CLINICALTRIAL Not applicable.

BACKGROUND An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. OBJECTIVE In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. METHODS An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health–implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. RESULTS The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. CONCLUSIONS Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

BACKGROUND Vaccine hesitancy is one of the many factors impeding efforts to control the COVID-19 pandemic. Exacerbated by the COVID-19 infodemic, misinformation has undermined public trust in vaccination, led to greater polarization, and resulted in a high social cost where close social relationships have experienced conflict or disagreements about the public health response. OBJECTIVE The purpose of this paper is to describe the theory behind the development of a digital behavioral science intervention—The Good Talk!—designed to target vaccine-hesitant individuals through their close contacts (eg, family, friends, and colleagues) and to describe the methodology of a research study to evaluate its efficacy. METHODS The Good Talk! uses an educational serious game approach to boost the skills and competences of vaccine advocates to have open conversations about COVID-19 with their close contacts who are vaccine hesitant. The game teaches vaccine advocates evidence-based open conversation skills to help them speak with individuals who have opposing points of view or who may ascribe to nonscientifically supported beliefs while retaining trust, identifying common ground, and fostering acceptance and respect of divergent views. The game is currently under development and will be available on the web, free to access for participants worldwide, and accompanied by a promotional campaign to recruit participants through social media channels. This protocol describes the methodology for a randomized controlled trial that will compare participants who play The Good Talk! game with a control group that plays the widely known noneducational game Tetris. The study will evaluate a participant’s open conversation skills, self-efficacy, and behavioral intentions to have an open conversation with a vaccine-hesitant individual both before and after game play. RESULTS Recruitment will commence in early 2023 and will cease once 450 participants complete the study (225 per group). The primary outcome is improvement in open conversation skills. Secondary outcomes are self-efficacy and behavioral intentions to have an open conversation with a vaccine-hesitant individual. Exploratory analyses will examine the effect of the game on implementation intentions as well as potential covariates or subgroup differences based on sociodemographic information or previous experiences with COVID-19 vaccination conversations. CONCLUSIONS The outcome of the project is to promote more open conversations regarding COVID-19 vaccination. We hope that our approach will encourage more governments and public health experts to engage in their mission to reach their citizens directly with digital health solutions and to consider such interventions as an important tool in infodemic management. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/40753

In an unprecedented effort of scientific collaboration, researchers across fields are racing to support the response to COVID-19. Making a global impact with AI tools will require scalable approaches for data, model and code sharing; adapting applications to local contexts; and cooperation across borders.

Background An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. Objective The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. Methods As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. Results The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. Conclusions Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.

BACKGROUND An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. OBJECTIVE The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. METHODS As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. RESULTS The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. CONCLUSIONS Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.

BACKGROUND The COVID-19 pandemic has been accompanied by an infodemic: excess information, including false or misleading information, in digital and physical environments during an acute public health event. This infodemic is leading to confusion and risk-taking behaviors that can be harmful to health, as well as to mistrust in health authorities and public health responses. The World Health Organization (WHO) is working to develop tools to provide an evidence-based response to the infodemic, enabling prioritization of health response activities. OBJECTIVE In this work, we aimed to develop a practical, structured approach to identify narratives in public online conversations on social media platforms where concerns or confusion exist or where narratives are gaining traction, thus providing actionable data to help the WHO prioritize its response efforts to address the COVID-19 infodemic. METHODS We developed a taxonomy to filter global public conversations in English and French related to COVID-19 on social media into 5 categories with 35 subcategories. The taxonomy and its implementation were validated for retrieval precision and recall, and they were reviewed and adapted as language about the pandemic in online conversations changed over time. The aggregated data for each subcategory were analyzed on a weekly basis by volume, velocity, and presence of questions to detect signals of information voids with potential for confusion or where mis- or disinformation may thrive. A human analyst reviewed and identified potential information voids and sources of confusion, and quantitative data were used to provide insights on emerging narratives, influencers, and public reactions to COVID-19–related topics. RESULTS A COVID-19 public health social listening taxonomy was developed, validated, and applied to filter relevant content for more focused analysis. A weekly analysis of public online conversations since March 23, 2020, enabled quantification of shifting interests in public health–related topics concerning the pandemic, and the analysis demonstrated recurring voids of verified health information. This approach therefore focuses on the detection of infodemic signals to generate actionable insights to rapidly inform decision-making for a more targeted and adaptive response, including risk communication. CONCLUSIONS This approach has been successfully applied to identify and analyze infodemic signals, particularly information voids, to inform the COVID-19 pandemic response. More broadly, the results have demonstrated the importance of ongoing monitoring and analysis of public online conversations, as information voids frequently recur and narratives shift over time. The approach is being piloted in individual countries and WHO regions to generate localized insights and actions; meanwhile, a pilot of an artificial intelligence–based social listening platform is using this taxonomy to aggregate and compare online conversations across 20 countries. Beyond the COVID-19 pandemic, the taxonomy and methodology may be adapted for fast deployment in future public health events, and they could form the basis of a routine social listening program for health preparedness and response planning.

The COVID-19 pandemic is the first to unfold in the highly digitalized society of the 21st century and is therefore the first pandemic to benefit from and be threatened by a thriving real-time digital information ecosystem. For this reason, the response to the infodemic required development of a public health social listening taxonomy, a structure that can simplify the chaotic information ecosystem to enable an adaptable monitoring infrastructure that detects signals of fertile ground for misinformation and guides trusted sources of verified information to fill in information voids in a timely manner. A weekly analysis of public online conversations since 23 March 2020 has enabled the quantification of running shifts of public interest in public health-related topics concerning the pandemic and has demonstrated the frequent resumption of information voids relevant for public health interventions and risk communication in an emergency response setting.

As the COVID-19 pandemic evolves, the accompanying infodemic is being amplified through social media and has challenged effective response. The WHO Early AI-supported Response with Social Listening (EARS) is a platform that summarizes real-time information about how people are talking about COVID-19 in public spaces online in 20 pilot countries and in four languages. The aim of the platform is to better integrate social listening with other data sources and analyses that can inform infodemic response.

Background The COVID-19 pandemic has been accompanied by an infodemic: excess information, including false or misleading information, in digital and physical environments during an acute public health event. This infodemic is leading to confusion and risk-taking behaviors that can be harmful to health, as well as to mistrust in health authorities and public health responses. The World Health Organization (WHO) is working to develop tools to provide an evidence-based response to the infodemic, enabling prioritization of health response activities. Objective In this work, we aimed to develop a practical, structured approach to identify narratives in public online conversations on social media platforms where concerns or confusion exist or where narratives are gaining traction, thus providing actionable data to help the WHO prioritize its response efforts to address the COVID-19 infodemic. Methods We developed a taxonomy to filter global public conversations in English and French related to COVID-19 on social media into 5 categories with 35 subcategories. The taxonomy and its implementation were validated for retrieval precision and recall, and they were reviewed and adapted as language about the pandemic in online conversations changed over time. The aggregated data for each subcategory were analyzed on a weekly basis by volume, velocity, and presence of questions to detect signals of information voids with potential for confusion or where mis- or disinformation may thrive. A human analyst reviewed and identified potential information voids and sources of confusion, and quantitative data were used to provide insights on emerging narratives, influencers, and public reactions to COVID-19–related topics. Results A COVID-19 public health social listening taxonomy was developed, validated, and applied to filter relevant content for more focused analysis. A weekly analysis of public online conversations since March 23, 2020, enabled quantification of shifting interests in public health–related topics concerning the pandemic, and the analysis demonstrated recurring voids of verified health information. This approach therefore focuses on the detection of infodemic signals to generate actionable insights to rapidly inform decision-making for a more targeted and adaptive response, including risk communication. Conclusions This approach has been successfully applied to identify and analyze infodemic signals, particularly information voids, to inform the COVID-19 pandemic response. More broadly, the results have demonstrated the importance of ongoing monitoring and analysis of public online conversations, as information voids frequently recur and narratives shift over time. The approach is being piloted in individual countries and WHO regions to generate localized insights and actions; meanwhile, a pilot of an artificial intelligence–based social listening platform is using this taxonomy to aggregate and compare online conversations across 20 countries. Beyond the COVID-19 pandemic, the taxonomy and methodology may be adapted for fast deployment in future public health events, and they could form the basis of a routine social listening program for health preparedness and response planning.

Background: An infodemic is an overabundance of information—some accurate and some not—that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. Objective: A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. Methods: A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. Results: The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. Conclusions: The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives., peer-reviewed

Background: Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. Methods: This is a prospective observational study, nested to the CAP trial. Anthropometric measurements before and during pregnancy and dietary intake using 24-h recall during pregnancy were assessed. The Intake Distribution Estimation software (PC-SIDE) was used to evaluate nutrient intake adequacy taking the Estimated Average Requirement (EAR) as a cut-off point. Results: Three hundred twelve women who had pre-eclampsia in their last pregnancy and delivered in hospitals from South Africa and Zimbabwe were assessed. 73.7 and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) whereas the prevalence of underweight was virtually non-existent. The majority of women had inadequate intakes of micronutrients. Considering food and beverage intake only, none of the micronutrients measured achieved the estimated average requirement. Around 60% of pregnant women reported taking folic acid or iron supplements in South Africa, but almost none did so in Zimbabwe. Conclusion: We found a high prevalence of overweight and obesity and high micronutrient intake inadequacy in pregnant women who had the previous pregnancy complicated with pre-eclampsia. The obesity figures and micronutrient inadequacy are issues of concern that need to be addressed. Pregnant women have regular contacts with the health system; these opportunities could be used to improve diet and nutrition. Fil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. University of Cape Town; Sudáfrica Fil: Betrán, Ana Pilar. World Health Organization; Suiza Fil: Harbron, Janetta. University of Cape Town; Sudáfrica Fil: Dannemann Purnat, Tina. World Health Organization; Dinamarca Fil: Parker, Catherine. University of Fort Hare; Sudáfrica. Walter Sisulu University; Sudáfrica. University of the Witwatersrand; Sudáfrica Fil: Hall, David. Stellenbosch University; Sudáfrica Fil: Seuc, Armando H.. Instituto Nacional de Higiene; Cuba Fil: Roberts, James M.. University of Pittsburgh; Estados Unidos Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Hofmeyr, G. Justus. University of the Witwatersrand; Sudáfrica. Walter Sisulu University; Sudáfrica. University of Fort Hare; Sudáfrica

Background Epidemiological findings suggest that the link between poverty and pre-eclampsia might be dietary calcium deficiency. Calcium supplementation has been associated with a modest reduction in pre-eclampsia, and also in blood pressure (BP). Methods This exploratory sub-study of the WHO Calcium and Pre-eclampsia (CAP) trial aims to determine the effect of 500 mg/day elemental calcium on the blood pressure of non-pregnant women with previous pre-eclampsia. Non-pregnant women with at least one subsequent follow-up trial visit at approximately 12 or 24 weeks after randomization were included. Results Of 836 women randomized by 9 September 2014, 1st visit data were available in 367 women of whom 217 had previously had severe pre-eclampsia, 2nd visit data were available in 201 women. There was an overall trend to reduced BP in the calcium supplementation group (1-2.5 mmHg) although differences were small and not statistically significant. In the subgroup with previous severe pre-eclampsia, the mean diastolic BP change in the calcium group (-2.6 mmHg) was statistically larger than in the placebo group (+0.8 mmHg), (mean difference -3.4, 95% CI -0.4 to -6.4; p = 0.025). The effect of calcium on diastolic BP at 12 weeks was greater than in those with non-severe pre-eclampsia (p = 0.020, ANOVA analysis). Conclusions There is an overall trend to reduced BP but only statistically significant in the diastolic BP of women with previous severe pre-eclampsia. This is consistent with our hypothesis that this group is more sensitive to calcium supplementation, however results need to be interpreted with caution. Fil: Hofmeyr, G. J.. University of the Witwatersrand; Sudáfrica Fil: Seuc, A. H.. World Health Organization; Suiza Fil: Betrán, A. P.. World Health Organization; Suiza Fil: Purnat, T. D.. World Health Organization; Dinamarca Fil: Ciganda, Álvaro. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Munjanja, S. P.. University of Zimbabwe; Zimbabue Fil: Manyame, S.. University of Zimbabwe; Zimbabue Fil: Singata, M.. Fort Hare University; Sudáfrica Fil: Fawcus, S.. University of Cape Town; Sudáfrica. Mowbray Maternity Hospital; Sudáfrica Fil: Frank, K.. University of the Witwatersrand; Sudáfrica Fil: Hall, D. R.. Stellenbosch University; Sudáfrica. Tygerberg Hospital; Sudáfrica Fil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Roberts, J. M.. University of Pittsburgh; Estados Unidos Fil: Bergel, Eduardo F.. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Drebit, S.K.. University of British Columbia; Canadá Fil: von Dadelszen, P.. University of British Columbia; Canadá Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Calcium and Pre-eclampsia Study Group. No especifica