Intermittent presumptive treatment of malaria to prevent low birth weight in newborns in a cohort of pregnant women from a malaria endemic area.

OBJECTIVE: To determine and describe the patterns of low birth weight in newborns of a cohort of mothers given intermittent presumptive treatment (IPT) for malaria prevention in a malaria endemic area of Kenya. DESIGN: A longitudinal prospective cohort study. SETTING: Got Agulu Health Centre in Usigu Division, Bondo District, Nyanza Province. SUBJECTS: Pregnant women of all parities attending antenatal care services. Only women who gave informed consent for themselves and their newborns after birth were eligible to participate in the study. RESULTS: Parity was highly predictive of birth weight in the study subjects. Primigravidae and secondigravidae had a significantly lower mean birth weight (2952g) than women of higher gravidity (3214g) p-value <0.0001. Regardless of IPT administration, women who became positive for malaria infection at any point during pregnancy delivered 73.7% of the LBW infants. There was no significant difference in mean birth weights between primigravidae and multigravidae who had parasitaemia at baseline and at delivery (means 2906g and 3062g respectively, p=0.11). However, there was a significant difference between the parasitaemia negative primigravidae and multigravidae at baseline and at delivery (means 2952g and 3204g respectively, p=0.006). Infection with helminths did not have an effect on birth weight. Overall, low birth weight was observed in 9% of the newborns and was most commonly found in primigravidae and secondigravidae (14.8% and 13.1% respectively). CONCLUSION: Although many factors have been known to play a role in the causation of low birth weight (LBW <2500g), parity status and malaria infection in malaria endemic areas still play a major role regardless of IPT administration.

Predictors of serum ferritin and haemoglobin during pregnancy, in a malaria-endemic area of western Kenya.

Between 2000 and 2004, a cross-sectional survey was conducted, as part of a prospective cohort study, among the women attending antenatal-care clinics in Bondo district, a malaria-endemic area of western Kenya. The aim was to assess the prevalence of iron deficiency and determine the predictors of haemoglobin and serum ferritin concentrations in the women who had a gestational age between 14 and 24 weeks. A standardized questionnaire was used to collect and store the relevant bio-data for the study. Haemoglobin and ferritin concentrations were evaluated, sickle-cell status was determined, and malarial parasitaemias were detected and evaluated, using blood samples collected at enrollment. Multiple regression analysis was then used to test for significant predictors of the haemoglobin and serum ferritin concentrations. Although 842 women were enrolled in the prospective cohort study, haemoglobin concentrations were evaluated for only 828 of them, serum ferritin levels for 621, and levels of parasitaemia for 812. The mean haemoglobin concentration recorded was 10.9 g/dl. Although 37.9% of the subjects had mild-moderate anaemia (7.0-10.5 g haemoglobin/dl), only 0.5% were severely anaemic (<7.0 g haemoglobin/dl). The geometric mean serum ferritin concentration recorded was 18.9 microg/litre, and 32.3% of the subjects evaluated had low serum concentrations of ferritin (<12 microg/litre). Among the parasitaemic primigravidae (but not the parasitaemic multigravidae), those found positive for sickle-cell trait had significantly lower haemoglobin concentrations than those found negative in a sickling test (P=0.01). Among the pregnant women of Bondo district, gravidity, malarial infection and sickle cell appear to be key predictors of haemoglobin concentration.

The effects of maternal and infant vitamin A supplementation on vitamin A status: a randomised trial in Kenya.

Postpartum vitamin A supplementation of mothers and infants is recommended, but the efficacy has been questioned. In this double-blind, placebo-controlled trial, Kenyan mother-infant pairs were randomised to maternal vitamin A (400,000 IU) or placebo <24 h postpartum, and infant vitamin A (100,000 IU) or placebo at 14 weeks. Milk retinol was determined at weeks 4, 14 and 26, and maternal and infant serum retinol at weeks 14 and 26. Infant retinol stores were assessed at week 26, using a modified relative dose response (MRDR) test. Among 564 women, serum retinol at 36 weeks gestation was 0.81 (SD 0.21) micromol/l, and 33.3% were<0.7 micromol/l. Maternal serum retinol was not different between groups, but milk retinol was higher in the vitamin A group: (0.67 v. 0.60 micromol/l; 0.52 v. 0.44 micromol/l; 0.50 v. 0.44 micromol/l at 4, 14 and 26 weeks, respectively). When expressed per gram fat, milk retinol was higher in the vitamin A group only at 4 weeks. Infant serum retinol was not different between groups. However, although most infants had deficient vitamin A stores (MRDR>0.06%) at 26 weeks, vitamin A to infants, but not mothers, resulted in a lower proportion of infants with deficient vitamin A stores (69 v. 78 %). High-dose postpartum vitamin A supplementation failed to increase serum retinol and infant stores, despite modest effects on milk retinol. Infant supplementation, however, increased stores. There is a need for a better understanding of factors affecting absorption and metabolism of vitamin A.