The association between dietary diversity and development among children under 24 months in rural Uganda: analysis of a cluster-randomised maternal education trial.

OBJECTIVE: To assess the association between dietary diversity and development among children under 24 months in rural Uganda and to establish other factors that could be associated with development among these children. DESIGN: A secondary data analysis of a cluster-randomised controlled maternal education trial (n 511) was conducted on a sub-sample of 385 children. We used adjusted ORs (AORs) to assess the associations of dietary diversity scores (DDS) and other baseline factors assessed at 6-8 months with child development domains (communication, fine motor, gross motor, personal-social and problem solving) at 20-24 months of age. SETTING: Rural areas in Kabale and Kisoro districts of south-western Uganda. PARTICIPANTS: Children under 24 months. RESULTS: After multivariable analysis, DDS at 6-8 months were positively associated with normal fine motor skills development at 20-24 months (AOR = 1·18; 95 % CI 1·01, 1·37; P = 0·02). No significant association was found between DDS and other development domains. Children who were not ill at 6-8 months had higher odds of developing normal communication (AOR = 1·73; 95 % CI 1·08, 2·77) and gross motor (AOR = 1·91; 95 % CI 1·09, 3·36) skills than sick children. Girls had lower odds of developing normal gross motor skills compared with boys (AOR = 0·58; 95 % CI 0·33, 0·98). Maternal/caregiver nutritional education intervention was positively associated with development of gross motor, fine motor and problem-solving skills (P-values < 0·05). CONCLUSIONS: We found an association between child DDS at 6-8 months and improvement in fine motor skills development at 20-24 months. Child illness status, maternal/caregiver nutritional education intervention and sex were other significant baseline predictors of child development at 20-24 months.

The association of urine markers of iodine intake with development and growth among children in rural Uganda: a secondary analysis of a randomised education trial.

OBJECTIVE: We examined associations of urine iodide excretion, proxy for iodine intake, with child development and growth. DESIGN: This is a secondary analysis of a 1:1 cluster-randomised trial with a 6-month nutrition/stimulation/hygiene education intervention among mothers of children aged 6-8 months to improve child development and growth. Development was assessed using Bayley Scales of Infant and Toddler Development-III (BSID-III) and Ages and Stages Questionnaire (ASQ), whereas anthropometry was used to assess growth. Urine iodide concentration (UIC) and urine iodide/creatinine ratio (ICR) were measured. SETTING: The current study was conducted in southern Uganda. PARTICIPANTS: We randomly selected 155 children from the 511 enrolled into the original trial and analysed data when they were aged 20-24 and 36 months. RESULTS: Median UIC for both study groups at 20-24 and 36 months were similar (P > 0·05) and within the normal range of 100-199 µg/l (0·79-1·60 µmol/l), whereas the intervention group had significantly higher ICR at 20-24 months. The BSID-III cognitive score was positively associated (P = 0·028) with ICR at 20-24 months in the intervention group. The ASQ gross motor score was negatively associated (P = 0·020) with ICR at 20-24 months among the controls. ICR was not significantly associated with anthropometry in the two study groups at either time-point. CONCLUSIONS: Following the intervention, a positive association was noted between ICR and child's cognitive score at 20-24 months, whereas no positive association with ICR and growth was detected. Iodine sufficiency may be important for child's cognitive development in this setting.

Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow-up of a cluster-randomised controlled trial.

OBJECTIVE: To examine the effect of a nutrition and hygiene education intervention on oral health behaviour and whether early onset of caries was related to child growth in rural Uganda. METHODS: Follow-up study of a cluster-randomised controlled trial conducted between October 2013 and January 2015. Data were available from 399 mother/child pairs (203 in the intervention and 198 in the control group) of the original trial (78%) when the children were 36 months old. Oral health behaviour was evaluated using questionnaires. Photographs of the maxillary anterior teeth were examined for unmistakably carious lesions, and 115 water samples from the study area were analysed for fluoride concentration. RESULTS: The frequency of cleaning of the child's teeth at 36 months was about twice as high in the intervention as in the control group (84.3% vs. 46.6%; P = 0.0001). Cavitated carious lesions occurred more frequently in the control than the intervention group (27.8% vs. 18.2%; P = 0.04). Extraction of 'false teeth' (ebiino), a painful and crude traditional operation, was profoundly reduced in the intervention group (8.9% vs. 24.7%; P = 0.001). There was no evidence of association between the occurrence of caries and child growth. CONCLUSIONS: The education intervention improved oral hygiene practices and reduced the development and progression of caries and extraction of ebiino. Early childhood caries was not clearly associated with child growth.

Nutrition, hygiene, and stimulation education to improve growth, cognitive, language, and motor development among infants in Uganda: A cluster-randomized trial.

Stunting is associated with impaired cognitive and motor function. The effect of an education intervention including nutrition, stimulation, sanitation, and hygiene on child growth and cognitive/language/motor development, delivered to impoverished mothers in Uganda, was assessed. In a community-based, open cluster-randomized trial, 511 mother/children dyads aged 6-8 months were enrolled to an intervention (n = 263) or control (n = 248) group. The primary outcome was change in length-for-age z-score at age 20-24 months. Secondary outcomes included anthropometry and scores on the 2 developmental scales: Bayley Scales of Infant and Toddler Development-III and the Ages and Stages Questionnaire. There was no evidence of a difference in mean length-for-age z-score at 20-24 months between the 2 study groups: 0.10, 95% CI [-0.17, 0.36], p = .49. The intervention group had higher mean composite development scores than the controls on Bayley Scales of Infant and Toddler Development-III, the mean difference being 15.6, 95% CI [10.9, 20.2], p = .0001; 9.9, 95% CI [6.4, 13.2], p = .0001; and 14.6, 95% CI [10.9, 18.2], p = .0001, for cognitive, language, and motor composite scores, respectively. The mean difference in scores from the Ages and Stages Questionnaire were 7.0, 95% CI [2.9, 11.3], p = .001; 5.9, 95% CI [1.2, 10.3], p = .01; 4.2, 95% CI [1.7, 6.7], p = .001; 8.9, 95% CI [5.3, 12.3], p = .0001; and 4.4, 95% CI [0.0, 8.8], p = .05, for communication, gross motor, fine motor, problem solving, and personal-social development, respectively. The intervention education delivered to mothers promoted early development domains in cognitive, language, and motor development but not linear growth of small children in impoverished rural communities in Uganda. Our study showed that child development may be improved with a relatively low cost intervention strategy. This trial was registered at ClinicalTrials.gov as NCT02098031.

The health Oriented pedagogical project (HOPP) - a controlled longitudinal school-based physical activity intervention program.

BACKGROUND: The prevalence of non-communicable diseases (NCDs) is increasing worldwide, also among children. Information about primary prevention of NCD's is increasing; however, convincing strategies among children is needed. The present paper describes the design and methods in the Health Oriented Pedagogical Project (HOPP) study. The main objective is to evaluate the effects of a school-based physical activity intervention program on cardio-metabolic risk factors. Secondary objectives include assessment of physical, psychological and academic performance variables. METHODS: The HOPP study is a 7 years longitudinal large-scale controlled intervention in seven elementary schools (n = 1545) with two control schools (n = 752); all aged 6-11 years at baseline. The school-based physical activity intervention program includes an increase in physical activity (PA) of 225 min/week as an integrated part of theoretical learning, in addition to the curriculum based 90 min/week of ordinary PA. Primary outcomes include cardio-metabolic risk factors measured as PA level, BMI status, waist circumference, muscle mass, percent fat, endurance test performance, total serum cholesterol, high-density lipoprotein (HDL), non-HDL, micro C-reactive protein (mCRP) and long-term blood sugar (HbA1c). In addition, secondary outcomes include anthropometric growth measures, physical fitness, quality of life (QoL), mental health, executive functions, diet and academic performance. DISCUSSION: HOPP will provide evidence of effects on cardio-metabolic risk factors after a long-term PA intervention program in elementary schoolchildren. School-based PA intervention programs may be an effective arena for health promotion and disease prevention. TRIAL REGISTRATION: The study is registered in Clinical trials (ClinicalTrials.gov Identifier: NCT02495714 ) as of June 20th - 2015, retrospectively registered. The collection of baseline values was initiated in mid-January 2015.

Growth, metabolic markers, and cognition in 8-year old children born prematurely, follow-up of a randomized controlled trial with essential fatty acids.

UNLABELLED: The study is a follow-up of a randomized, double-blinded, placebo-controlled trial of supplementation with docosahexaenoic acid (DHA) and arachidonic acid (AA) to 129 very low birth weight (VLBW; birth weight <1500 g) infants fed human milk. The main hypothesis was that supplementation would affect growth, metabolic markers, and cognitive function. The secondary aim was to describe predictors of metabolic markers and cognitive status at follow-up. Ninety-eight children met for 8-year follow-up with anthropometric measures, blood biomarkers, and cognitive testing. The intervention group had significantly lower insulin-like growth factor-1 (IGF-1) at 8 years, whereas no differences in growth or intelligence quotient (IQ) were found. For the total cohort, weight gain during first year of life was neither associated with BMI, metabolic markers, nor IQ at follow-up. Blood DHA at 8 years was positively associated with IQ. CONCLUSIONS: The study is the first long-term follow-up of a randomized controlled trial with essential fatty acids investigating growth, metabolic factors, and IQ. IGF-1 levels were significantly lower in the intervention group at 8 years. First-year growth was not associated with BMI, metabolic markers, or IQ at follow-up. Current DHA status was a significant predictor of higher IQ at follow-up. WHAT IS KNOWN: • Preterm children have increased risk of lower intelligence quotient (IQ), reduced growth, and abnormal metabolic status. • Early intake of docosahexaenoic acid (DHA) and arachidonic acid (AA), as well as early growth pattern, may influence both IQ and metabolic status. What is New: • Early intervention with DHA and AA led to reduced insulin-like growth factor-1 in blood at 8 years of age. • Weight gain during first year of life was neither associated with impaired metabolic markers nor improved IQ at follow-up. • Current DHA status was a significant predictor of higher IQ at 8 years, also when maternal education and birth weight were included in the model.

Enhanced feeding and diminished postnatal growth failure in very-low-birth-weight infants.

OBJECTIVE: The aim of the present study was to determine whether an increased supply of energy, protein, essential fatty acids, and vitamin A reduces postnatal growth failure in very-low-birth-weight infants. METHODS: Fifty infants with birth weight <1500 g were randomized to an intervention (n = 24) or a control (n = 26) feeding protocol within 24 hours after birth. Forty-four infants were included in the final analysis. This study was discontinued because of an increased occurrence of septicemia in the intervention group. RESULTS: The intervention group had a lower mean birth weight (P = 0.03) and a higher proportion of infants small-for-gestational age (P = 0.04) than the control group. Other baseline characteristics were similar. The median (interquartile range) energy and protein supplies during the first 4 weeks of life were higher in the intervention group: 139 (128-145) versus 126 (121-128) kcal · kg · day (P < 0.001) and 4.0 (3.9-4.2) versus 3.2 (3.1-3.3) g · kg · day (P < 0.001). The infants in the intervention group regained birth weight faster (P = 0.001) and maintained their z scores for weight and head circumference from birth to 36 weeks' postmenstrual age (both P < 0.001). The median (interquartile range) growth velocity was 17.4 (16.3-18.6) g · kg · day in the intervention group and 13.8 (13.2-15.5) g · kg · day in the control group (P < 0.001). In line with the improved growth in the intervention group, the proportion of growth-restricted infants was 11 of 23 both at birth and at 36 weeks' postmenstrual age, whereas this proportion increased among the controls from 4 of 21 to 13 of 21 (P = 0.04). CONCLUSIONS: Enhanced supply of energy, protein, essential fatty acids, and vitamin A caused postnatal growth along the birth percentiles for both weight and head circumference.

Long-term effects on depressive symptoms among Ugandan mothers - Findings from a follow-up of a cluster-randomized education trial in a rural low-resource setting.

INTRODUCTION: Depression is increasingly affecting mothers in poor countries such as Uganda. Various interventions have been implemented to tackle this problem, but their sustainability is under-researched. Here we present follow-up data on maternal depression six years after a cluster-randomized controlled maternal education trial in rural Uganda. METHODS: The intervention lasted six months and consisted of nutrition, hygiene, sanitation and child stimulation education, delivered to 511 mothers of 6 to 8 months' old children. Six years later we assessed maternal depressive symptoms using two psychometric tools; the Beck Depression Inventory II (BDI-II) and Center for Epidemiologic Studies Depression scale (CESD). RESULTS: For this follow-up study, data was available from 307/511 (60 %) mothers. Intention-to-treat analyses adjusting for clustering showed that the intervention mothers had non-significantly less depression symptoms (absolute score difference - 2; 95 % CI -5 to 0; p = 0.07) on BDI-II, and borderline significantly less depression symptoms (absolute score difference - 3; 95 % CI -5 to 0; p = 0.05) on CES-D compared to the controls. For categorized depression scores, the control mothers had significantly higher proportion of women classified in the worse depression categories for both BDI-II and CESD. We did not find any baseline characteristics associated with maternal depression. LIMITATIONS: The BDI-II and CES-D tools are both self-reported and we cannot rule out the possibility of social desirability bias in reporting of depression symptoms. CONCLUSION: Six years after the maternal education trial, some benefits on maternal mental health were sustained. More studies are warranted on sustainability and scale-up of such interventions.

Cognitive development among children in a low-income setting: Cost-effectiveness analysis of a maternal nutrition education intervention in rural Uganda.

Inadequate nutrition and insufficient stimulation in early childhood can lead to long-term deficits in cognitive and social development. Evidence for policy and decision-making regarding the cost of delivering nutrition education is lacking in low and middle-income countries (LMIC). In rural Uganda, we conducted a cluster-randomized controlled trial (RCT) examining the effect of a maternal nutrition education intervention on developmental outcomes among children aged 6-8 months. This intervention led to significantly improved cognitive scores when the children reached the age of 20-24 months. When considering the potential for this intervention's future implementation, the desired effects should be weighed against the increased costs. This study therefore aimed to assess the cost-effectiveness of this education intervention compared with current practice. Health outcome data were based on the RCT. Cost data were initially identified by reviewing publications from the RCT, while more detailed information was obtained by interviewing researchers involved in processing the intervention. This study considered a healthcare provider perspective for an 18-months' time horizon. The control group was considered as the current practice for the future large-scale implementation of this intervention. A cost-effectiveness analysis was performed, including calculations of incremental cost-effectiveness ratios (ICERs). In addition, uncertainty in the results was characterized using one-way and probabilistic sensitivity analyses. The ICER for the education intervention compared with current practice was USD ($) 16.50 per cognitive composite score gained, with an incremental cost of $265.79 and an incremental cognitive composite score of 16.11. The sensitivity analyses indicated the robustness of these results. The ICER was sensitive to changes in cognitive composite score and the cost of personnel. The education intervention can be considered cost-effective compared with the current practice. The outcome of this study, including the cost analysis, health outcome, cost-effectiveness, and sensitivity analysis, can be useful to inform policymakers and stakeholders about effective resource allocation processes in Uganda and possibly other LMIC.

Protocol for a 20-year follow-up after a randomized controlled trial of a Mediterranean diet in pregnancy: maternal and offspring risk factors for cardiovascular disease.

Background: An inadequate maternal diet during pregnancy can impair offspring health and may increase the risk of cardiovascular disease later in life. The purpose of the proposed study is to assess the risk factors associated with cardiovascular disease in both mothers and their offspring 20 years following their participation in a Mediterranean diet intervention trial during pregnancy. Methods: The "Cardiovascular Risk Reduction Diet In Pregnancy" (CARRDIP) study was a randomized controlled trial performed between 1999 and 2001. The participants were randomized to adhere to either a Mediterranean diet or their regular diet during pregnancy. An extensive amount of data such as diet information, ultrasound measurements, anthropometry, and biomarkers from these mothers during pregnancy and their offspring in the neonatal period were collected. The mother-offspring pairs (n = 269) from the CARRDIP study will be invited to participate in a clinical examination and blood sample collection. This follow-up study, conducted 20 years after the original CARRDIP study, will investigate cardiovascular risk factors in mothers and offspring. The primary outcome will be the blood pressure of the offspring. In addition, the study will explore various aspects of cardiovascular health, including metabolic and inflammatory status, clinical history, and body composition of the participants. Discussion: Previous studies investigating the effects of nutrition during pregnancy on maternal and offspring health have been either observational studies, animal studies, or randomized controlled trials with a follow-up period of less than 5 years. This project aims to study the long-term effects of dietary intervention during pregnancy on maternal and offspring cardiovascular risk markers. Clinical Trial Registration: Clinicaltrials.gov, identifier (NCT05030922).

Long-Term Effects of a Randomized Maternal Education Trial in Rural Uganda: Implications for Child Oral Health.

The aim was to examine oral health among 5-6-year-old children whose mothers participated in a 6 months' cluster-randomized education trial in rural Uganda starting when their children were 6-8 months old. The education focused on nutrition, oral hygiene, and child stimulation. In the current follow-up study, 357/511 (70%) children from the original trial were available for data collection (200 in the intervention and 157 in the control group). Molar caries was assessed on intraoral photographs. Children and/or caregivers answered a WHO health questionnaire for collection of oral data. Dental practices were compared between the intervention and control group using multilevel mixed effect logistic regression accounting for clustering. The children in the intervention group had less caries compared with the control group: 41% versus 60% (odds ratio [OR] 0.46; 95% confidence intervals [CI] 0.24-0.86, P = 0.02). The use of toothbrush to clean teeth was more frequent in the intervention than in the control group: 66% versus 38% (OR 3.39; 95% CI 1.54-7.45, P = 0.003), as was high teeth-cleaning frequency: 74% versus 62% (OR 1.72; 95% CI 1.09-2.69, P = 0.02). Self-reported problems such as toothache (10% versus 19%), difficulty biting (12% versus 24%) and chewing food (8.5% versus 18%) were significantly less frequent among children in the intervention compared with the control group. No significant differences were found in dietary habits. Our data shows that an educational intervention adjusted to a low-resource setting, provided in infancy, resulted in improved oral hygiene and reduced development of dental caries among children aged 5-6 years.

Child saliva microbiota and caries: a randomized controlled maternal education trial in rural Uganda.

Undernutrition is a public health challenge in sub-Saharan countries, including Uganda. In a previous randomized controlled trial (RCT) with a nutrition, hygiene and stimulation education intervention among mothers of 6 months' old children, we found less caries in the intervention group when the children were 36 months of age. We now examined the effects of (i) the intervention on the microbiota, (ii) microbiota on caries, and (iii) the intervention and microbiota on caries. The original RCT comprised 511 mother/child pairs whereas in the current study we had access to data from 344/511 (67%) children aged 36 months. The saliva microbiota was determined using 16S rRNA gene sequencing. Carious lesions (a proxy for dental health) were identified using close-up intra-oral photographs of the upper front teeth. Statistical models were used to determine host-microbiota associations. The intervention had a significant effect on the microbiota, e.g. an increase in Streptococcus abundance and decreases in Alloprevotella and Tannerella. Significant associations between the microbiota and dental caries were identified: Positive associations of Capnocytophaga and Tannerella suggest that these taxa may be deleterious to dental health while negative associations of Granulicatella, Fusobacterium, and Abiotrophia suggest taxa potentially beneficial or benign contributors to dental health. Based on taxonomic profiles, the effects of the intervention and microbiota on dental health may be independent of one another. Educational interventions with emphasis on nutrition and oral hygiene may provide a feasible strategy to decrease progression of childhood caries in low-resource settings.

Attention among very low birth weight infants following early supplementation with docosahexaenoic and arachidonic acid.

AIM: To investigate the effect of supplementation with docosahexaenoic acid (DHA) and arachidonic acid (AA) in early neonatal life on cognitive functions among human milk fed very low birth weight infants (<1500 g) at 20 months chronological age. METHODS: Randomized, double-blinded, placebo-controlled intervention supplementing human milk with 0.5 mL oil (containing 32 mg DHA and 31 mg AA or placebo) per 100 mL milk from 1 week after birth until discharge from hospital (9 weeks on average). The intervention and control group included 44 and 48 children, respectively. Attention capacity was evaluated by two 'free-play' sessions. General cognitive functions were evaluated by the Bayley Mental Development Index (MDI) and an Ages and Stages Questionnaire. RESULTS: The results from the free-play sessions suggested positive effects from supplementation on functions related to attention. Neither the Bayley MDI nor the Ages and Stages Questionnaire showed significant difference between the intervention and control group. Plasma DHA concentration at discharge was positively correlated with both 'Sustained Attention' and the Bayley MDI according to chronological age. CONCLUSION: A positive effect of early supplementation with DHA and AA on 20 months attention capacity was indicated. These findings need further investigation.

Child stunting concurrent with wasting or being overweight: A 6-y follow up of a randomized maternal education trial in Uganda.

OBJECTIVES: There is paucity of longitudinal data on combined anthropometric deficiencies in children. Herein, we present data on child stunting concurrent with wasting or being overweight among children in a 6-y follow-up study of a maternal education trial in rural Uganda. METHODS: We previously performed a randomized controlled trial where half of 511 mothers of 6- to 8-mo children were given a 6-mo education concerning nutrition, hygiene, and child stimulation. Anthropometry and prevalence of stunting with wasting or being overweight were determined. We applied multilevel mixed-effect logistic regression models and χ2 statistic to assess the effects of the intervention and trend in prevalence over time, respectively. RESULTS: Complete data sets were obtained from 307 of 511 children (60%). The prevalence of stunting and wasting or being overweight was <7% both, and did not change significantly over time. Notably, the prevalence of concurrent stunting and being overweight was significantly reduced in the intervention group compared with the controls among children age 36 mo and 60 to 72 mo, with corresponding odds ratios at 0.24 (95% confidence interval, 0.06-0.90) and 0.10 (95% confidence interval, 0.01-0.82), respectively. CONCLUSIONS: The prevalence of stunting concurrent with wasting or being overweight remained low during the observation period. The intervention may have reduced concurrent stunting and being overweight over time.

Longitudinal assessments of child growth: A six-year follow-up of a cluster-randomized maternal education trial.

BACKGROUND & AIMS: Child growth impairments are rampant in sub-Saharan Africa. To combat this important health problem, long-term follow-up studies are needed to examine possible benefits and sustainability of various interventions designed to correct inadequate child growth. Our aim was to perform a follow-up study of children aged 60-72 months whose mothers participated in a two-armed cluster-randomized education intervention trial lasting 6 months in rural Uganda when their children were 6-8 months old with data collection at 20-24 and at 36 months. The education focused on nutrition, hygiene, and child stimulation. METHODS: We measured growth using anthropometry converted to z-scores according to WHO guidelines. We also included assessments of body composition using bioimpedance. We used multilevel mixed effect linear regression models with maximum likelihood method, unstructured variance-covariance structure, and the cluster as a random effect component to compare data from the intervention (receiving the education and routine health care) with the control group (receiving only routine health care). RESULTS: Of the 511 children included in the original trial, data from 166/263 (63%) and 141/248 (57%) of the children in the intervention and control group, respectively, were available for the current follow-up study. We found no significant differences in any anthropometrical z-score between the two study groups at child age of 60-72 months, except that children in the intervention group had lower (P = 0.006) weight-for-height z-score than the controls. There were no significant differences in the trajectories of z-scores or height growth velocity (cm/year) from baseline (start of original trial) to child age of 60-72 months. Neither did we detect any significant difference between the intervention and control group regarding body composition (fat mass, fat free mass, and total body water) at child age 60-72 months. Separate gender analyses had no significant impact on any of the growth or body composition findings. CONCLUSION: In this long-term study of children participating in a randomized maternal education trial, we found no significant impact of the intervention on anthropometrical z-scores, height growth velocity or body composition. TRIAL REGISTRATION: Clinical Trials (clinical trials.gov) ClinicalTrials.gov ID NCT02098031.

Unlocking the potential for achievement of the UN Sustainable Development Goal 2 - 'Zero Hunger' - in Africa: targets, strategies, synergies and challenges.

BACKGROUND: The UN Sustainable Development Goal (SDG) 2 ('Zero Hunger') aims to end all forms of hunger and malnutrition by 2030. Thus, a range of different strategies are needed to facilitate the achievement of SDG 2 to overcome challenges and enable synergies between various SDG targets. OBJECTIVE: The aim of this review is to highlight Africa's progress toward SDG 2, including targets, strategies, synergies and challenges. METHODS: We scrutinized published research articles in peer-reviewed journals, UN reports and in-country Africa reports (between 2015 and 2020) that were relevant to the current topic. RESULTS: Several hunger indicators are showing slow progress or even deterioration in Africa. The prevalence of undernourishment in the general population was 19.1% in 2019 and is expected to increase to 25.7% by 2030. Improvements in child stunting in several regions in Africa are slow, especially in sub-Saharan Africa where about 34% of under-fives were stunted in 2012 and 31% in 2019. In Eastern Africa, stunting prevalence decreased from 38% in 2012 to 34% in 2019. Major drivers of hunger are poor governance and state fragility, war and conflicts, increasing inequality, weak economic development, climate change, biodegradation - and now lately the Covid 19 pandemic - factors that all increase food insecurity. CONCLUSION: Africa is off track to reach SDG - 'Zero Hunger' - by 2030. Current efforts and progress are insufficient. Africa must champion the SDG agenda on a national, regional and global level to facilitate synergies to unlock the potential for reaching 'Zero Hunger' throughout the continent.

Model Selection Reveals the Butyrate-Producing Gut Bacterium Coprococcus eutactus as Predictor for Language Development in 3-Year-Old Rural Ugandan Children.

INTRODUCTION: The metabolic activity of the gut microbiota plays a pivotal role in the gut-brain axis through the effects of bacterial metabolites on brain function and development. In this study we investigated the association of gut microbiota composition with language development of 3-year-old rural Ugandan children. METHODS: We studied the language ability in 139 children of 36 months in our controlled maternal education intervention trial to stimulate children's growth and development. The dataset includes 1170 potential predictors, including anthropometric and cognitive parameters at 24 months, 542 composition parameters of the children's gut microbiota at 24 months and 621 of these parameters at 36 months. We applied a novel computationally efficient version of the all-subsets regression methodology and identified predictors of language ability of 36-months-old children scored according to the Bayley Scales of Infant and Toddler Development (BSID-III). RESULTS: The best three-term model, selected from more than 266 million models, includes the predictors Coprococcus eutactus at 24 months of age, Bifidobacterium at 36 months of age, and language development at 24 months. The top 20 four-term models, selected from more than 77 billion models, consistently include C. eutactus abundance at 24 months, while 14 of these models include the other two predictors as well. Mann-Whitney U tests suggest that the abundance of gut bacteria in language non-impaired children (n = 78) differs from that in language impaired children (n = 61). While anaerobic butyrate-producers, including C. eutactus, Faecalibacterium prausnitzii, Holdemanella biformis, Roseburia hominis are less abundant, facultative anaerobic bacteria, including Granulicatella elegans, Escherichia/Shigella and Campylobacter coli, are more abundant in language impaired children. The overall predominance of oxygen tolerant species in the gut microbiota was slightly higher in the language impaired group than in the non-impaired group (P = 0.09). CONCLUSION: Application of the all-subsets regression methodology to microbiota data established a correlation between the relative abundance of the anaerobic butyrate-producing gut bacterium C. eutactus and language development in Ugandan children. We propose that the gut redox potential and the overall bacterial butyrate-producing capacity in the gut are important factors for language development.

First year growth among very low birth weight infants.

AIM: The aim of this study was to describe first-year growth among very low birth weight infants and the effect of growth restriction at hospital discharge on first year growth. METHOD: Anthropometric measures and background information for 118 very low birth weight infants were collected from medical records. Z-scores were calculated based on recent Norwegian growth references. RESULTS: Significant catch-up growth for weight and length was observed during the first year with mean z-score change (SD) of 0.40 (1.05) and 1.01 (1.25) respectively. However, the very low birth weight infants remained lighter and shorter than full-term peers until 12 months corrected age with mean z-score of -0.93 (1.09) and -0.48 (1.06) respectively. Head circumference followed a normal growth pattern after 2 months. Infants discharged from hospital as growth restricted had increased catch-up in weight and length, but remained smaller than infants not subjected to early growth restriction and full-term peers. Multiple regression showed that weight below the 10th percentile at discharge is important for weight and length during the first year of life. CONCLUSION: Very low birth weight infants showed catch-up growth during the first year, but their weight and length remained less than full-term peers. Growth deficiencies were more pronounced among infants subjected to early growth restriction, despite increased catch-up growth.

Aflatoxins: Occurrence, Exposure, and Binding to Lactobacillus Species from the Gut Microbiota of Rural Ugandan Children.

Chronic exposure of children in sub-Saharan Africa to aflatoxins has been associated with low birth weight, stunted growth, immune suppression, and liver function damage. Lactobacillus species have been shown to reduce aflatoxin contamination during the process of food fermentation. Twenty-three Lactobacillus strains were isolated from fecal samples obtained from a cohort of rural Ugandan children at the age of 54 to 60 months, typed by 16S rRNA gene sequencing, and characterized in terms of their ability to bind aflatoxin B1 in vitro. Evidence for chronic exposure of these children to aflatoxin B1 in the study area was obtained by analysis of local foods (maize flour and peanuts), followed by the identification of the breakdown product aflatoxin M1 in their urine samples. Surprisingly, Lactobacillus in the gut microbiota of 140 children from the same cohort at 24 and 36 months showed the highest positive correlation coefficient with stunting among all bacterial genera identified in the stool samples. This correlation was interpreted to be associated with dietary changes from breastfeeding to plant-based solid foods that pose an additional risk for aflatoxin contamination, on one hand, and lead to increased intake of Lactobacillus species on the other.