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1.
Int J Tuberc Lung Dis ; 26(9): 826-834, 2022 09 01.
Article in English | MEDLINE | ID: mdl-35996288

ABSTRACT

BACKGROUND: India has the highest prevalence of multidrug-resistant TB (MDR-TB) globally. Vitamin D deficiency is potentially an important risk factor for MDR-TB.METHODS: We conducted a case-control study of 90 newly diagnosed adult MDR-TB cases, 180 household controls and 82 non-household controls in Mumbai, India. Serum 25-hydroxyvitamin D (25(OH)D), anthropometry, clinical status and history, dietary data and sociodemographic data were collected from each participant. Interferon-gamma release assay (IGRA) was also performed in controls to assess latent TB. Multivariable regression was performed to estimate associations between 25(OH)D vs. case status and IGRA positivity.RESULTS: Mean participant age was 33.8 ± 12.0 years; 72.8% had 25(OH)D <20 ng/ml. Mean 25(OH)D was significantly (P < 0.05) lower in cases (12.5 ± 7.9) than both household (17.5 ± 11.2) and non-household controls (16.4 ± 9.1). In multivariable models, 25(OH)D concentration was inversely associated with MDR-TB case status among cases and household controls (OR 0.95 per 1 ng/ml, 95% CI 0.92-0.99; P = 0.015), and among cases and non-household controls (OR 0.94 per 1 ng/ml, 95% CI 0.89-1.00; P = 0.033); 53.6% of controls were IGRA-positive. 25(OH)D status was not associated with IGRA positivity.CONCLUSION: Vitamin D status was independently associated with MDR-TB case status. Research should evaluate the effectiveness of vitamin D supplementation in prevention and adjunctive treatment of MDR-TB.


Subject(s)
Tuberculosis, Multidrug-Resistant , Tuberculosis, Pulmonary , Vitamin D Deficiency , Adult , Case-Control Studies , Humans , Middle Aged , Risk Factors , Tuberculosis, Multidrug-Resistant/complications , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiology , Vitamin D , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/drug therapy , Vitamin D Deficiency/epidemiology , Young Adult
2.
Eur J Clin Nutr ; 72(1): 130-135, 2018 01.
Article in English | MEDLINE | ID: mdl-28876332

ABSTRACT

BACKGROUND/OBJECTIVES: Zinc (Zn) supplementation adversely affects iron status in animal and adult human studies, but few trials have included young infants. The objective of this study was to determine the effects of Zn and multivitamin (MV) supplementation on infant hematologic and iron status. SUBJECTS/METHODS: In a double-blind RCT, Tanzanian infants were randomized to daily, oral Zn, MV, Zn and MV or placebo treatment arms at the age of 6 weeks of life. Hemoglobin concentration (Hb) and red blood cell indices were measured at baseline and at 6, 12 and 18 months of age. Plasma samples from 589 infants were examined for iron deficiency (ID) at 6 months. RESULTS: In logistic regression models, Zn treatment was associated with greater odds of ID (odds ratio (OR) 1.8 (95% confidence interval (CI) 1.0-3.3)) and MV treatment was associated with lower odds (OR 0.49 (95% CI 0.3-0.9)). In Cox models, MV was associated with a 28% reduction in risk of severe anemia (hazard ratio (HR)=0.72 (95% CI 0.56-0.94)) and a 26% reduction in the risk of severe microcytic anemia (HR=0.74 (0.56-0.96)) through 18 months. No effects of Zn on risk of anemia were seen. Infants treated with MV alone had higher mean Hb (9.9 g/dl (95% CI 9.7-10.1)) than those given placebo (9.6 g/dl (9.4-9.8)) or Zn alone (9.6 g/dl (9.4-9.7)). CONCLUSIONS: MV treatment improved iron status in infancy, whereas Zn worsened iron status but without an associated increase in risk for anemia. Infants in long-term Zn supplementation programs at risk for ID may benefit from screening and/or the addition of a MV supplement.


Subject(s)
Iron Deficiencies , Vitamins/administration & dosage , Zinc/administration & dosage , Zinc/adverse effects , Anemia, Iron-Deficiency/blood , Dietary Supplements , Double-Blind Method , Ferritins/blood , Hemoglobins/analysis , Humans , Infant , Infant Nutritional Physiological Phenomena , Iron/blood , Nutritional Status/drug effects , Placebos , Recommended Dietary Allowances , Risk Factors , Tanzania
3.
Indoor Air ; 27(1): 136-146, 2017 01.
Article in English | MEDLINE | ID: mdl-26880607

ABSTRACT

Low birthweight contributes to as many as 60% of all neonatal deaths; exposure during pregnancy to household air pollution has been implicated as a risk factor. Between 2011 and 2013, we measured personal exposures to carbon monoxide (CO) and fine particulate matter (PM2.5 ) in 239 pregnant women in Dar es Salaam, Tanzania. CO and PM2.5 exposures during pregnancy were moderately high (geometric means 2.0 ppm and 40.5 µg/m3 ); 87% of PM2.5 measurements exceeded WHO air quality guidelines. Median and high (75th centile) CO exposures were increased for those cooking with charcoal and kerosene versus kerosene alone in quantile regression. High PM2.5 exposures were increased with charcoal use. Outdoor cooking reduced median PM2.5 exposures. For PM2.5 , we observed a 0.15 kg reduction in birthweight per interquartile increase in exposure (23.0 µg/m3 ) in multivariable linear regression; this finding was of borderline statistical significance (95% confidence interval 0.30, 0.00 kg; P = 0.05). PM2.5 was not significantly associated with birth length or head circumference nor were CO exposures associated with newborn anthropometrics. Our findings contribute to the evidence that exposure to household air pollution, and specifically fine particulate matter, may adversely affect birthweight.


Subject(s)
Air Pollution, Indoor/analysis , Carbon Monoxide/analysis , Maternal Exposure/statistics & numerical data , Particulate Matter/analysis , Urban Population/statistics & numerical data , Adolescent , Adult , Air Pollution, Indoor/adverse effects , Birth Weight , Cooking/methods , Female , Humans , Infant, Newborn , Linear Models , Male , Maternal Exposure/adverse effects , Multivariate Analysis , Pregnancy , Prospective Studies , Tanzania , Young Adult
4.
J Behav Med ; 39(3): 453-64, 2016 06.
Article in English | MEDLINE | ID: mdl-26733010

ABSTRACT

Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m(2) heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.


Subject(s)
Antiretroviral Therapy, Highly Active , Depression/psychology , HIV Infections/psychology , Health Status Disparities , Social Class , Social Stigma , Social Support , Adult , Cross-Sectional Studies , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Uganda
5.
Eur J Clin Nutr ; 70(4): 456-62, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26626049

ABSTRACT

BACKGROUND/OBJECTIVES: Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal. SUBJECTS/METHODS: In a cross-sectional survey, we randomly selected 500 mother-infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein. RESULTS: The altitude-adjusted prevalence of anemia was 49% among infants 2-6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7-12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 µg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations. CONCLUSIONS: Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.


Subject(s)
Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/epidemiology , Breast Feeding , Iron Deficiencies , Iron/blood , Adult , Anemia, Iron-Deficiency/drug therapy , Biomarkers/blood , C-Reactive Protein/metabolism , Cross-Sectional Studies , Dietary Supplements , Ferritins/blood , Follow-Up Studies , Hemoglobins/metabolism , Humans , Infant , Iron, Dietary/administration & dosage , Linear Models , Longitudinal Studies , Nepal , Prevalence , Receptors, Transferrin/blood , Sample Size , Young Adult
6.
Epidemiol Infect ; 142(7): 1505-9, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24093552

ABSTRACT

Limited studies exist regarding whether incorporating micronutrient supplements during tuberculosis (TB) treatment may improve cell-mediated immune response. We examined the effect of micronutrient supplementation on lymphocyte proliferation response to mycobacteria or T-cell mitogens in a randomized trial conducted on 423 patients with pulmonary TB. Eligible participants were randomly assigned to receive a daily dose of micronutrients (vitamins A, B-complex, C, E, and selenium) or placebo at the time of initiation of TB treatment. We found no overall effect of micronutrient supplements on lymphocyte proliferative responses to phytohaemagglutinin or purified protein derivatives in HIV-negative and HIV-positive TB patients. Of HIV-negative TB patients, the micronutrient group tended to show higher proliferative responses to concanavalin A than the placebo group, although the clinical relevance of this finding is not readily notable. The role of nutritional intervention in this vulnerable population remains an important area of future research.


Subject(s)
Dietary Supplements , Micronutrients/administration & dosage , T-Lymphocytes/drug effects , Tuberculosis, Pulmonary/diet therapy , Tuberculosis, Pulmonary/immunology , Adult , Antitubercular Agents/administration & dosage , Cells, Cultured , Double-Blind Method , Female , HIV Infections/microbiology , Humans , Lymphocyte Activation/drug effects , Male , Phytohemagglutinins/administration & dosage , T-Lymphocytes/cytology , T-Lymphocytes/immunology , Tanzania/epidemiology , Tuberculin/administration & dosage , Tuberculosis, Pulmonary/virology , Young Adult
7.
HIV Med ; 15(5): 276-85, 2014 May.
Article in English | MEDLINE | ID: mdl-24215465

ABSTRACT

OBJECTIVES: We prospectively investigated fever symptoms and maternal diagnosis of malaria in pregnancy (MIP) in relation to child HIV infection among 2368 pregnant HIV-positive women and their infants, followed up from pregnancy until 6 weeks post-delivery in Tanzania. METHODS: Doctors clinically diagnosed and treated MIP and fever symptoms during prenatal health care. Child HIV status was determined via DNA polymerase chain reaction (PCR). Multivariable logistic regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for HIV mother-to-child transmission (MTCT) by the 6th week of life. RESULTS: Mean gestational age at enrolment was 22.2 weeks. During follow-up, 16.6% of mothers had at least one MIP diagnosis, 15.9% reported fever symptoms and 8.7% had both fever and MIP diagnosis. Eleven per cent of HIV-exposed infants were HIV-positive by 6 weeks. The RR of HIV MTCT was statistically similar for infants whose mothers were ever vs. never clinically diagnosed with MIP (RR 1.24; 95% CI 0.94-1.64), were diagnosed with one vs. no clinical MIP episodes (RR 1.07; 95% CI 0.77-1.48) and had ever vs. never reported fever symptoms (RR 1.04; 95% CI 0.78-1.38) in pregnancy. However, the HIV MTCT risk increased by 29% (95% CI 4-58%) per MIP episode. Infants of women with at least two vs. no MIP diagnoses were 2.1 times more likely to be HIV infected by 6 weeks old (95% CI 1.31-3.45). CONCLUSIONS: Clinical MIP diagnosis, but not fevers, in HIV-positive pregnant women was associated with an elevated risk of early HIV MTCT, suggesting that malaria prevention and treatment in pregnant HIV-positive women may enhance the effectiveness of HIV prevention in MTCT programmes in this setting. Future studies using a laboratory-confirmed diagnosis of malaria are needed to confirm this association.


Subject(s)
HIV Infections/transmission , Infectious Disease Transmission, Vertical/statistics & numerical data , Malaria/epidemiology , Adult , Female , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Multivariate Analysis , Pregnancy , Pregnancy Complications, Infectious/pathology , Pregnancy Complications, Infectious/virology , Prospective Studies , Risk Factors , Tanzania/epidemiology
8.
Eur J Clin Nutr ; 67(7): 708-17, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23612515

ABSTRACT

OBJECTIVE: The determinants of anemia during both pregnancy and postpartum recovery remain incompletely understood in sub-Saharan African women. SUBJECTS/METHODS: In a prospective cohort study among pregnant women, we assessed dietary, biochemical, anthropometric, infectious and sociodemographic factors at baseline. In multivariate Cox proportional hazards models, we examined predictors of incident anemia (hemoglobin <11 g/dl) and iron deficiency anemia (anemia plus mean corpuscular volume <80fL), and recovery from anemia and iron deficiency anemia through 18 months postpartum at antenatal clinics in Dar es Salaam, Tanzania between 2001 and 2005. A total of 2364 non-anemic pregnant women and 4884 anemic women were enrolled between 12 and 27 weeks of gestation. RESULTS: In total, 292 women developed anemia during the postpartum period and 165 developed iron deficiency anemia, whereas 2982 recovered from baseline anemia and 2044 from iron deficiency anemia. Risk factors for postpartum anemia were delivery complications (RR 1.6, 95% confidence interval (CI) 1.13, 2.22) and low postpartum CD4 cell count (RR 1.73, 95% CI 0.96, 3.17). Iron/folate supplementation during pregnancy had a protective relationship with the incidence of iron deficiency anemia. Absence of delivery complications, education status and iron/folate supplementation were positively associated with time to recovery from iron deficiency. CONCLUSION: Maternal nutritional status during pregnancy, prenatal iron/folate supplementation, perinatal care, and prevention and management of infections, such as malaria, are modifiable risk factors for the occurrence of, and recovery from, anemia.


Subject(s)
Anemia, Iron-Deficiency/epidemiology , Dietary Supplements , Folic Acid/administration & dosage , Iron, Dietary/administration & dosage , Postpartum Period/blood , Anemia, Iron-Deficiency/blood , CD4 Lymphocyte Count , Diet , Erythrocyte Indices/physiology , Female , HIV Infections , Hemoglobins/metabolism , Humans , Maternal Nutritional Physiological Phenomena , Multivariate Analysis , Pregnancy , Proportional Hazards Models , Prospective Studies , Risk Factors , Socioeconomic Factors , Tanzania/epidemiology
9.
Eur J Clin Nutr ; 66(11): 1265-76, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23031850

ABSTRACT

BACKGROUND/OBJECTIVES: Children born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized. The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months. SUBJECTS/METHODS: Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant's birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight. RESULTS: A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted. CONCLUSIONS: Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women.


Subject(s)
Growth Disorders/etiology , HIV Infections/complications , Infant, Low Birth Weight , Malnutrition/etiology , Premature Birth/epidemiology , Thinness/etiology , Wasting Syndrome/etiology , Adolescent , Adult , Body Height , Body Weight , Double-Blind Method , Educational Status , Female , HIV Infections/epidemiology , HIV Infections/transmission , Humans , Infant , Infant, Newborn , Infant, Premature , Infectious Disease Transmission, Vertical , Male , Prevalence , Proportional Hazards Models , Reference Values , Sex Factors , Socioeconomic Factors , Tanzania/epidemiology , Young Adult
10.
HIV Med ; 13(9): 541-8, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22416813

ABSTRACT

BACKGROUND: Alanine aminotransferase (ALT) is commonly used to measure liver injury in resource-limited settings. Elevations in ALT are predictive of increased mortality from liver disease and may influence the choice of first-line antiretroviral therapy (ART). METHODS: A cross-sectional analysis of the prevalence and predictors of elevated ALT (defined as >40 IU/L) was conducted. ART-naïve, HIV-infected adults with a baseline ALT measurement who were enrolled in any of the 18 HIV Care and Treatment Clinics in Dar es Salaam, Tanzania between November 2004 and December 2009 were included in the study. Median values were calculated and log-binomial regression models were used to examine predictors of elevated ALT. RESULTS: During the study period, 41891 adults had a baseline ALT measurement performed. The prevalence of ALT >40, >120 and >200 IU/L was 13, 1 and 0.3%, respectively. In multivariate analyses, male sex, CD4 T lymphocyte count <200 cells/µL and higher World Health Organization (WHO) clinical stages were associated with a significantly higher risk of ALT >40 IU/L (all P<0.01). Hypertryglyceridaemia, hyperglycaemia and hepatitis B virus (HBV) coinfection (positive for HBV surface antigen) were significantly associated with a higher risk of elevated ALT. Pregnancy, anaemia, low-density lipoprotein cholesterol >130 mg/dL and current tuberculosis treatment were associated with a significantly reduced risk for elevated ALT. CONCLUSIONS: In this HIV-infected, ART-naïve Tanzanian population, extreme elevations in ALT were infrequent but minor elevations were not uncommon. Antiretrovirals with potentially hepatotoxic side effects should be initiated with caution in male patients, and in patients with HBV coinfection, advanced immunosuppression and components of the metabolic syndrome.


Subject(s)
Alanine Transaminase/blood , DNA, Viral/metabolism , HIV Seropositivity/blood , Hepatitis, Viral, Human/blood , Pregnancy Complications, Infectious/blood , RNA, Viral/metabolism , Adult , CD4 Lymphocyte Count , Cross-Sectional Studies , Female , HIV Seropositivity/epidemiology , Hepatitis, Viral, Human/epidemiology , Humans , Male , Middle Aged , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , Prevalence , Risk Factors , Tanzania/epidemiology , Urban Population/statistics & numerical data , Viral Load , Young Adult
11.
East Afr Med J ; 89(6): 183-92, 2012 Jun.
Article in English | MEDLINE | ID: mdl-26856040

ABSTRACT

OBJECTIVE: To examine the predictors of tuberculosis infection in HIV-exposed children. DESIGN: A longitudinal cohort study nested within a randomised controlled trial. SETTING: Antenatal clinics in Dar-es-Salaam, Tanzania. SUBJECTS: Children born to 875 HIV-infected women in Tanzania. RESULTS: A total of 82 children developed tuberculosis during the follow-up period. In multivariate analyses, HIV infection was associated with a six-fold increase in risk of tuberculosis. Breastfeeding duration, child mid-upper arm circumference, and maternal CD4 T-cell counts were inversely related to risk of tuberculosis. In HIV-infected children, greater number of people eating at the same household meal and child CD8 T-cell counts were associated with increased risk of tuberculosis; higher maternal lymphocyte counts, increased duration of breastfeeding, and lower vitamin E levels were associated with reduced risk of tuberculosis. In HIV-uninfected children, breastfeeding duration and increased child mid-upper arm circumference were associated with reduced risk of tuberculosis. CONCLUSION: Breastfeeding duration, HIV status, maternal and child nutritional and immunological status were important predictors of child tuberculosis. Appropriate infant feeding and nutritional interventions could represent important adjuncts to prevent tuberculosis in children born to HIV-infected women in sub-Saharan Africa.


Subject(s)
HIV Infections/complications , Tuberculosis/epidemiology , Adult , Cohort Studies , Dietary Supplements , Female , HIV Infections/prevention & control , Humans , Incidence , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Male , Nutritional Status , Pregnancy , Pregnancy Complications, Infectious/prevention & control , Risk Factors , Tanzania , Vitamins/therapeutic use , Young Adult
12.
Int J Tuberc Lung Dis ; 15(7): 925-32, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21682966

ABSTRACT

SETTING: Tuberculosis (TB) infected adults attending out-patient TB clinics in Dar es Salaam, Tanzania. OBJECTIVE: To examine the association of anemia with human immunodeficiency virus (HIV) co-infection, indicators of socio-economic status (SES) and anthropometric status in TB-infected adults. DESIGN: Cross-sectional data collection during screening for a clinical trial. RESULTS: Overall, 750 females and 1693 males participated in this study, of whom respectively 49% and 24% were co-infected with HIV-1. Hemoglobin levels were significantly lower in females than in males and in HIV-positive than in HIV-negative participants. HIV co-infection in this antiretroviral-naïve population was also associated with severe anemia (hemoglobin < 85 g/l) in both women (prevalence ratio [PR] = 2.07, 95%CI 1.65-2.59) and men (PR 3.45, 95%CI 2.66-4.47). Although severe anemia was negatively associated with indicators of SES, especially in males, adjustment for SES indicators only marginally changed its association with HIV co-infection. In both sexes, anemia was inversely associated with anthropometric status, independently of HIV infection and SES. CONCLUSION: Among TB-infected adults, anemia is strongly associated with HIV co-infection and anthropometric status, independently of SES indicators. As anemia is a risk factor for morbidity and mortality in both infections, the management of anemia in TB-HIV co-infected patients warrants special attention.


Subject(s)
AIDS-Related Opportunistic Infections/complications , Anemia/epidemiology , HIV Infections/complications , Tuberculosis/complications , AIDS-Related Opportunistic Infections/epidemiology , Adult , Anemia/etiology , Anemia/physiopathology , Anthropometry , Cross-Sectional Studies , Female , HIV Infections/epidemiology , Hemoglobins/metabolism , Humans , Male , Risk Factors , Severity of Illness Index , Sex Factors , Socioeconomic Factors , Tanzania/epidemiology , Tuberculosis/epidemiology , Tuberculosis/etiology , Young Adult
13.
Int J Body Compos Res ; 9(1): 1-10, 2011 Mar 01.
Article in English | MEDLINE | ID: mdl-24244104

ABSTRACT

BACKGROUND: Bioelectrical impedance analysis (BIA) is a simple tool to assess total body water (TBW), from which body composition can be estimated using statistical equations. However, standard BIA equations have not been sufficiently validated during pregnancy, in HIV infection, or in sub-Saharan Africa. We therefore compared TBW estimates from multifrequency BIA with those from the reference method deuterium isotope dilution (Deut) in a cohort of 30 HIV-uninfected and 30 HIV-infected pregnant women from Tanzania. METHODS: We enrolled pregnant women presenting for routine antenatal care and collected data on pregnancy outcomes. At each trimester of gestation and once at 10-wk post-partum, we measured maternal anthropometry, TBWBIA, and TBWDeut. RESULTS: TBWBIA was highly correlated at each time point with TBWDeut among HIV-infected (all P ≤0.001) and HIV-uninfected women (all P <0.0001). During pregnancy, mean TBWBIA progressively underestimated TBWDeut in the overall cohort; trimester-specific differences (mean ±SD) were -1.02 ±2.36 kg, -1.47 ±2.43 kg, and -2.42 ±2.63 kg, respectively. The difference at 10-wk postpartum was small (-0.24 ±2.07 kg). In Bland-Altman and regression models, TBWBIA was subject to a systematic predictive bias at each antenatal and postnatal time point (all P ≤0.038). Among HIV-positive women, TBWDeut measured during the first (P =0.02) and second trimester (P =0.03) was positively related to birthweight. CONCLUSIONS: The validity of current BIA equations to assess TBW during pregnancy and in the postpartum period among women from sub-Saharan Africa remains uncertain. Deuterium dilution may assess aspects of maternal body composition relevant for pregnancy outcomes among HIV-infected women.

14.
East Afr J Public Health ; 8(3): 216-23, 2011 Sep.
Article in English | MEDLINE | ID: mdl-23120960

ABSTRACT

OBJECTIVE: This study was conducted to examine the associations between socioeconomic status, urbanization, and cardio-metabolic risk factors in Tanzania. METHODS: Participants were 209 adults (45-66 years) in Dar es Salaam, Tanzania. A structured questionnaire was used to evaluate socioeconomic status and behavioral characteristics, including income, education, occupation, residence (urban, rural, mixed), dietary factors, and smoking. Blood samples were collected and analyzed to measure lipid profiles and fasting glucose levels. Cardiometabolic risk factors were defined using World Health Organization criteria. RESULTS: Urban residence and higher socioeconomic status were associated with decreased intake of traditional staple food (ugali), and increased consumption of meat products and beverages. Higher socioeconomic status was associated with a significant 3.5-kg/m2 higher BMI (p = 0.0001) and 8 cm higher waist circumference (p < 0.001), and a three-fold increase in the risk of obesity. Urban residence was associated with poorer lipid profile, including significantly higher total cholesterol, increased LDL cholesterol, but lower triglycerides, compared to rural residence. The prevalence of metabolic syndrome was high (38%), and was associated with increased socioeconomic status. CONCLUSION: Urban residence and higher socioeconomic status were important correlates of cardiometabolic risk factors, including obesity and poorer lipid profile. Primary prevention and health screening strategies are needed to target cardiometabolic risk factors in urban areas, to reduce the burden of cardiovascular disease in Tanzania.


Subject(s)
Cardiovascular Diseases/etiology , Metabolic Syndrome/complications , Socioeconomic Factors , Urbanization , Adult , Blood Glucose/analysis , Blood Pressure , Body Mass Index , Cardiovascular Diseases/prevention & control , Cross-Sectional Studies , Diet , Exercise , Female , Health Behavior , Humans , Life Style , Lipids/blood , Logistic Models , Male , Middle Aged , Obesity/complications , Obesity/diagnosis , Residence Characteristics , Risk Factors , Surveys and Questionnaires , Tanzania , Urban Health , Waist Circumference
15.
Int J Tuberc Lung Dis ; 15(10): 1380-9, 2011 Oct.
Article in English | MEDLINE | ID: mdl-22283899

ABSTRACT

BACKGROUND: Patients with tuberculosis (TB) often suffer from profound malnutrition. OBJECTIVE: To examine the patterns and predictors of change in nutritional and hemoglobin status during and after TB treatment. METHODS: A total of 471 human immunodeficiency virus (HIV) positive and 416 HIV-negative adults with pulmonary TB were prospectively followed in Dar es Salaam, Tanzania. All patients received 8 months' TB treatment following enrollment. RESULTS: About 40% of HIV-positive and 47% of HIV-negative TB patients had body mass index (BMI) < 18.5 kg/m 2 at baseline, while about 94% of HIV-positive and 84% of HIV-negative participants were anemic at baseline. Both HIV-positive and HIV-negative patients experienced increases in BMI and hemoglobin concentrations over the course of TB treatment. Among HIV- positive patients, older age, low CD4 cell counts, and high viral load were independently associated with a smaller increase in BMI from baseline to 8 months. Fe- male sex, older age, low CD4 cell counts, previous TB infection and less money spent on food were independently associated with a smaller improvement in hemoglobin levels among HIV-positive patients during treatment. CONCLUSION: HIV-positive TB patients, especially those with low CD4 cell counts, showed poor nutritional recovery during TB treatment. Adequate nutritional support should be considered during TB treatment.


Subject(s)
Anemia/epidemiology , Antitubercular Agents/therapeutic use , Hemoglobins/metabolism , Malnutrition/epidemiology , Nutritional Status , Tuberculosis, Pulmonary/drug therapy , Adult , Anemia/blood , Anemia/diagnosis , Anemia/therapy , Biomarkers/blood , Body Mass Index , Coinfection , Female , HIV Infections/epidemiology , Health Status Indicators , Humans , Linear Models , Male , Malnutrition/diagnosis , Malnutrition/therapy , Multivariate Analysis , Nutritional Support , Prospective Studies , Tanzania/epidemiology , Time Factors , Treatment Outcome , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/epidemiology , Young Adult
16.
Eur J Clin Nutr ; 64(8): 808-17, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20517330

ABSTRACT

BACKGROUND/OBJECTIVES: There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. SUBJECTS/METHODS: This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals. RESULTS: Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01). CONCLUSIONS: Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions.


Subject(s)
Avitaminosis/epidemiology , HIV Infections/blood , Nutritional Status , Vitamin A/blood , Vitamin D/blood , Vitamin E/blood , Adolescent , Adult , Anemia, Iron-Deficiency/epidemiology , Anemia, Iron-Deficiency/etiology , Avitaminosis/blood , Avitaminosis/complications , Blood Sedimentation , CD8-Positive T-Lymphocytes/metabolism , Cell Count , Diet/economics , Female , Gestational Age , HIV Infections/complications , Hemoglobins/metabolism , Humans , Pregnancy , Prevalence , Regression Analysis , Selenium/blood , Tanzania/epidemiology , Vitamin A Deficiency/blood , Vitamin A Deficiency/complications , Vitamin A Deficiency/epidemiology , Vitamin D Deficiency/blood , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology , Vitamin E Deficiency/blood , Vitamin E Deficiency/complications , Vitamin E Deficiency/epidemiology , Young Adult
17.
East Afr J Public Health ; 7(2): 160-4, 2010 Jun.
Article in English | MEDLINE | ID: mdl-21413596

ABSTRACT

BACKGROUND: Human Immunodeficiency Virus type 1 (HIV-1) infection leads to a progressive decline in CD4+ T-lymphocyte (CD4) cells. Initiation of prophylaxis against Opportunistic infections in adults (CD4% used for children) and antiretroviral therapy is usually based on CD4 cell counts, but CD4 cell counts measurement is not affordable in most African countries. OBJECTIVE: To examine whether total lymphocyte counts (TLC) may be used as proxies for low CD4 cell counts. DESIGN: Cross-sectional at baseline when women were pregnant and at least six months postpartum. METHODS: 1,078 HIV-1-infected pregnant women from Dar es Salaam, Tanzania were enrolled in a randomized clinical trial. A series of receiver operator characteristic (ROC) curves were created at baseline and at least 6 months postpartum and among women in WHO Stage 3 and above. The sensitivity and specificity of TLC and hemoglobin in predicting an absolute CD4 count < 200 cells/mm3 were determined for various clinically relevant cut points. RESULTS: TLC was not a good predictor of low CD4 cell counts during pregnancy or at least six months postpartum as exhibited by low ROC Area Under the Curve (AUCs) of .57 and .62 respectively. No other variable had the ability to predict CD4 < 200 cells/mm3. CONCLUSIONS: The use of TLC as a proxy for the estimation of low CD4 cell counts in a population of HIV-1-infected adults from sub-Saharan Africa was not substantiated. Inexpensive methods to quantify CD4 cell counts in Africa are needed.


Subject(s)
CD4-Positive T-Lymphocytes/immunology , HIV Infections/immunology , HIV Infections/virology , Adult , Area Under Curve , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , HIV Infections/drug therapy , HIV-1 , Humans , Lymphocyte Count , Pregnancy , Reproducibility of Results , Sensitivity and Specificity , Tanzania , Young Adult
18.
Eur J Clin Nutr ; 63(3): 332-9, 2009 Mar.
Article in English | MEDLINE | ID: mdl-17940544

ABSTRACT

BACKGROUND/OBJECTIVE: The effect of daily prenatal and postnatal vitamin supplementation on concentrations of breast milk nutrients is not well characterized in HIV-infected women. We examined the impact of vitamin supplementation during pregnancy and lactation on breast milk concentrations of retinol, carotenoids and tocopherols during the first year postpartum among 626 HIV-infected Tanzanian women. SUBJECTS/METHODS: We conducted a randomized, double-blind, placebo-controlled trial. Women were assigned to one of four daily oral supplements: vitamin A+beta-carotene (VA+BC); multivitamins (MV; B, C and E); MV+VA+BC or placebo. Concentrations of breast milk nutrients were determined by high-performance liquid chromatography at birth and every 3 months thereafter. RESULTS: Supplementation with VA+BC increased concentrations of retinol, beta-carotene and alpha-carotene at delivery by 4799, 1791 and 84 nmol l(-1), respectively, compared to no VA+BC (all P<0.0001). MV supplementation did not increase concentrations of alpha-tocopherol or delta-tocopherol at delivery but significantly decreased concentrations of breast milk gamma-tocopherol and retinol. Although concentrations of all nutrients decreased significantly by 3 months postpartum, retinol, alpha-carotene and beta-carotene concentrations were significantly higher among those receiving VA+BC at 3, 6 and 12 months compared to no VA+BC. alpha-Tocopherol was significantly higher, while gamma-tocopherol concentrations were significantly lower, among women receiving MV compared to no MV at 3, 6 and 12 months postpartum. CONCLUSIONS: Sustained supplementation of HIV-infected breastfeeding mothers with MV could be a safe and effective intervention to improve vitamin E concentrations in breast milk. VA+BC supplementation increases concentrations of breast milk retinol but it is not recommended in HIV-infected mothers due to the elevated risk of vertical transmission.


Subject(s)
Dietary Supplements , HIV Infections/complications , Milk, Human/chemistry , Prenatal Care , Vitamins/analysis , Vitamins/pharmacology , Adult , Breast Feeding , Double-Blind Method , Female , Humans , Infectious Disease Transmission, Vertical , Lactation , Pregnancy , Tanzania , Tocopherols/analysis , Vitamin A/analysis , Vitamin B Complex/pharmacology , Young Adult , beta Carotene/analysis
19.
Afr J Reprod Health ; 13(4): 25-36, 2009 Dec.
Article in English | MEDLINE | ID: mdl-20690271

ABSTRACT

This analysis was performed to determine the prevalence of hypertension and association of MAP (mean arterial pressure) with birth outcomes among HIV-infected pregnant women not taking antiretrovirals. HIV-infected pregnant women, enrolled into the HPTN024 trial in Tanzania, Malawi and Zambia were followed up at 26-30, 36 weeks, and delivery. The prevalence of hypertension was <1% at both 20-24 weeks and 26-30 weeks and 1.7% by 36 weeks. A 5 mm Hg elevation in MAP increased the risk of stillbirth at 20-24 weeks by 29% (p = 0.001), 32% (p = 0.001) at 26-30 weeks and of low birth weight (LBW) at 36 weeks by 26% (p = 0.001). MAP was not associated with stillbirth at 36 weeks, LBW prior to 36 weeks, preterm birth, neonatal mortality or the risk of maternal to child transmission (MTCT) of HIV.


Subject(s)
HIV Infections/epidemiology , Hypertension/epidemiology , Pregnancy Complications, Cardiovascular/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Adult , Africa South of the Sahara , Blood Pressure , Body Mass Index , Female , HIV Infections/complications , Humans , Hypertension/complications , Pregnancy , Pregnancy Trimester, Third , Prevalence
20.
Int J STD AIDS ; 19(12): 824-32, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19050213

ABSTRACT

SUMMARY: The aim of this study was to compare the prevalence and factors associated with genital tract infections among HIV-infected pregnant women from African sites. Participants were recruited from Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. Genital tract infections were assessed at baseline. Of 2627 eligible women enrolled, 2292 were HIV-infected. Of these, 47.8% had bacterial vaginosis (BV), 22.4% had vaginal candidiasis, 18.8% had trichomoniasis, 8.5% had genital warts, 2.6% had chlamydia infection, 2.2% had genital ulcers and 1.7% had gonorrhoea. The main factors associated with genital tract infections included genital warts (adjusted odds ratio [AOR] 1.8, 95% CI 1.2-2.7), genital ulcers (AOR 2.4, 95% CI 1.2-5.1) and abnormal vaginal discharge (AOR 2.5, 95% CI 1.9-3.3) for trichomoniasis. BV was the most common genital tract infection followed by candidiasis and trichomoniasis. Differences in burdens and risk factors call for enhanced interventions for identification of genital tract infections among HIV-infected women.


Subject(s)
Genital Diseases, Female/epidemiology , HIV Infections/complications , Pregnancy Complications, Infectious/virology , Adolescent , Adult , Female , Genital Diseases, Female/complications , Genital Diseases, Female/etiology , HIV Infections/virology , Humans , Malawi/epidemiology , Pregnancy , Prevalence , Risk Factors , Tanzania/epidemiology , Young Adult , Zambia/epidemiology
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