Birth weight and gestational age distributions in a rural Kenyan population.

BACKGROUND: With the increased availability of access to prenatal ultrasound in low/middle-income countries, there is opportunity to better characterize the association between fetal growth and birth weight across global settings. This is important, as fetal growth curves and birthweight charts are often used as proxy health indicators. As part of a randomized control trial, in which ultrasonography was utilized to establish accurate gestational age of pregnancies, we explored the association between gestational age and birthweight among a cohort in Western Kenya, then compared our results to data reported by the INTERGROWTH-21st study. METHODS: This study was conducted in 8 geographical clusters across 3 counties in Western Kenya. Eligible subjects were nulliparous women carrying singleton pregnancies. An early ultrasound was performed between 6 + 0/7 and 13 + 6/7 weeks gestational age. At birth, infants were weighed on platform scales provided either by the study team (community births), or the Government of Kenya (public health facilities). The 10th, 25th, median, 75th, and 90th BW percentiles for 36 to 42 weeks gestation were determined; resulting percentile points were plotted, and curves determined using a cubic spline technique. A signed rank test was used to quantify the comparison of the percentiles generated in the rural Kenyan sample with those of the INTERGROWTH-21st study. RESULTS: A total of 1291 infants (of 1408 pregnant women randomized) were included. Ninety-three infants did not have a measured birth weight. The majority of these were due to miscarriage (n = 49) or stillbirth (n = 27). No significant differences were found between subjects who were lost to follow-up. Signed rank comparisons of the observed median of the Western Kenya data at 10th, 50th, and 90th birthweight percentiles, as compared to medians reported in the INTERGROWTH-21st distributions, revealed close alignment between the two datasets, with significant differences at 36 and 37 weeks. Limitations of the current study include small sample size, and detection of potential digit preference bias. CONCLUSIONS: A comparison of birthweight percentiles by gestational age estimation, among a sample of infants from rural Kenya, revealed slight differences as compared to those from the global population (INTERGROWTH-21st). TRIAL REGISTRATION: This is a single site sub-study of data collected in conjunction with the Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas (ASPIRIN) Trial, which is listed at  ClinicalTrials.gov ,  NCT02409680 (07/04/2015).

Visible-Light Induced Self-Powered Sensing Platform Based on a Photofuel Cell.

A self-powered sensing system possesses the capacity of harvesting energy from the environment and has no requirement for external electrical power supply during the chemical sensing of analytes. Herein, we design an enzyme-free self-powered sensing platform based on a photofuel cell (PFC) driven by visible-light, using glucose as a model analyte. The fabricated PFC consists of a Ni(OH)2/CdS/TiO2 photoanode and a hemin-graphene (HG) nanocomposite coated cathode in separated chambers. Under visible-light irradiation, glucose in the anodic chamber is facilely oxidized on Ni(OH)2/CdS/TiO2 while H2O2 in the cathodic chamber is catalytically reduced by HG, which generates a certain cell output sensitive to the variation of glucose concentration. Thus, a PFC based self-powered sensor is realized for glucose detection. Compared to the existing enzymatic self-powered glucose sensors, our proposed PFC based strategy exhibits much lower detection concentration. Moreover, it avoids the limitation of conventional enzyme immobilized electrodes and has the potential to develop high-performance self-powered sensors with broader analyte species.

A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia.

BACKGROUND: The Global Network for Women's and Children's Health Research is one of the largest international networks for testing and generating evidence-based recommendations for improvement of maternal-child health in resource-limited settings. Since 2009, Global Network sites in six low and middle-income countries have collected information on antenatal care practices, which are important as indicators of care and have implications for programs to improve maternal and child health. We sought to: (1) describe the quantity of antenatal care attendance over a four-year period; and (2) explore the quality of coverage for selected preventative, screening, and birth preparedness components. METHODS: The Maternal Newborn Health Registry (MNHR) is a prospective, population-based birth and pregnancy outcomes registry in Global Network sites, including: Argentina, Guatemala, India (Belgaum and Nagpur), Kenya, Pakistan, and Zambia. MNHR data from these sites were prospectively collected from January 1, 2010 - December 31, 2013 and analyzed for indicators related to quantity and patterns of ANC and coverage of key elements of recommended focused antenatal care. Descriptive statistics were generated overall by global region (Africa, Asia, and Latin America), and for each individual site. RESULTS: Overall, 96% of women reported at least one antenatal care visit. Indian sites demonstrated the highest percentage of women who initiated antenatal care during the first trimester. Women from the Latin American and Indian sites reported the highest number of at least 4 visits. Overall, 88% of women received tetanus toxoid. Only about half of all women reported having been screened for syphilis (49%) or anemia (50%). Rates of HIV testing were above 95% in the Argentina, African, and Indian sites. The Pakistan site demonstrated relatively high rates for birth preparation, but for most other preventative and screening interventions, posted lower coverage rates as compared to other Global Network sites. CONCLUSIONS: Results from our large, prospective, population-based observational study contribute important insight into regional and site-specific patterns for antenatal care access and coverage. Our findings indicate a quality and coverage gap in antenatal care services, particularly in regards to syphilis and hemoglobin screening. We have identified site-specific gaps in access to, and delivery of, antenatal care services that can be targeted for improvement in future research and implementation efforts. TRIAL REGISTRATION: Registration at Clinicaltrials.gov (ID# NCT01073475).

Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision.

BACKGROUND: Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children's Health study area in Kenya revealed that up to 70% of newborns did not have exact weights measured and recorded by the end of the first week of life; nearly all of these infants were born outside health facilities. METHODS: To more completely obtain accurate birth weights for all infants, regardless of delivery site, village elders were engaged to assist in case finding for pregnancies and births. All elders were provided with weighing scales and mobile phones as tools to assist in subject enrollment and data recording. Subjects were instructed to bring the newborn infant to the home of the elder as soon as possible after birth for weight measurement.The proportion of pregnancies identified before delivery and the proportion of births with weights measured were compared before and after provision of weighing scales and mobile phones to village elders. Primary outcomes were the percent of infants with a measured birth weight (recorded within 7 days of birth) and the percent of women enrolled before delivery. RESULTS: The recorded birth weight increased from 43 ± 5.7% to 97 ± 1.1. The birth weight distributions between infants born and weighed in a health facility and those born at home and weighed by village elders were similar. In addition, a significant increase in the percent of subjects enrolled before delivery was found. CONCLUSIONS: Pregnancy case finding and acquisition of birth weight information can be successfully shifted to the community level.

Graphene-doped Bi2S3 nanorods as visible-light photoelectrochemical aptasensing platform for sulfadimethoxine detection.

Bismuth sulphide (Bi2S3) nanorods doped with graphene (G) were synthesized and explored as photoactive materials for constructing a photoelectrochemical (PEC) aptasensor for sulfadimethoxine (SDM) detection. The formation of Bi2S3 nanorods and G nanosheets was observed by scanning electron microscopy (SEM) and further characterized by X-ray diffraction (XRD) spectroscopy. The PEC measurements indicated that the photocurrent response of Bi2S3 was obviously improved by doping suitable amount of G. The G-Bi2S3 composite coated electrode was utilized for fabricating a PEC aptasensor by covalently immobilizing a 5'-amino-terminated SDM aptamer on the electrode surface. Based on the specific interaction between SDM and the aptamer, a PEC sensor responsive to SDM was obtained. Under optimal conditions, the proposed sensor showed a linear photocurrent response to SDM in the concentration range of 1.0-100nM, with a low detection limit (3S/N) of 0.55nM. Moreover, the sensor showed high sensitivity, stability and reproducibility. The potential applicability of the PEC aptasensor was confirmed by detecting SDM in veterinary drug formulation and milk.

A label-free photoelectrochemical aptasensor based on nitrogen-doped graphene quantum dots for chloramphenicol determination.

A photoelectrochemical (PEC) sensing platform for chloramphenicol (CAP) detection was constructed using nitrogen-doped graphene quantum dots (N-GQDs) as transducer species and label-free aptamer as biological recognition element. N-GQDs, synthesized via a facile one-step hydrothermal method, were explored to achieve highly efficient photon-to-electricity conversion under visible light irradiation. The obtained N-GQDs were characterized by transmission electron microscopy (TEM), which displayed a narrow size distribution with a mean diameter of 2.14 nm. The X-ray photoelectron spectroscopic (XPS) and Fourier transform infrared spectroscopic (FT-IR) analysis confirmed that nitrogen was successfully doped in GQDs. The UV-visible absorption spectra indicated that nitrogen doping obviously enhanced the absorption of GQDs in visible light region. As a result, the PEC activity of GQDs was promoted by nitrogen doping. Additionally, the π-conjugated structure of N-GQDs provided an excellent platform for aptamer immobilization via π-π stacking interaction. Such an aptamer/N-GQDs based sensor showed a linear PEC response to CAP concentration in the range of 10-250 nM with a detection limit (3 S/N) of 3.1 nM. The developed PEC aptasensor exhibited high sensitivity and selectivity, good reproducibility and high stability.