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1.
Health Secur ; 18(S1): S105-S112, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32004125

RESUMO

Long-standing cultural, economic, and political relationships among Benin, Nigeria, and Togo contribute to the complexity of their cross-border connectivity. The associated human movement increases the risk of international spread of communicable disease. The Benin and Togo ministries of health and the Nigeria Centre for Disease Control, in collaboration with the Abidjan Lagos Corridor Organization (a 5-country intergovernmental organization) and the US Centers for Disease Control and Prevention, sought to minimize the risk of cross-border outbreaks by defining and implementing procedures for binational and multinational public health collaboration. Through 2 multinational meetings, regular district-level binational meetings, and fieldwork to characterize population movement and connectivity patterns, the countries improved cross-border public health coordination. Across 3 sequential cross-border Lassa fever outbreaks identified in Benin or Togo between February 2017 and March 2019, the 3 countries improved their collection and sharing of patients' cross-border travel histories, shortened the time between case identification and cross-border information sharing, and streamlined multinational coordination during response efforts. Notably, they refined collaborative efforts using lessons learned from the January to March 2018 Benin outbreak, which had a 100% case fatality rate among the 5 laboratory-confirmed cases, 3 of whom migrated from Nigeria across porous borders when ill. Aligning countries' expectations for sharing public health information would assist in reducing the international spread of communicable diseases by facilitating coordinated preparedness and responses strategies. Additionally, these binational and multinational strategies could be made more effective by tailoring them to the unique cultural connections and population movement patterns in the region.

2.
MMWR Morb Mortal Wkly Rep ; 69(1): 10-13, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917781

RESUMO

Tailoring communicable disease preparedness and response strategies to unique population movement patterns between an outbreak area and neighboring countries can help limit the international spread of disease. Global recognition of the value of addressing community connectivity in preparedness and response, through field work and visualizing the identified movement patterns, is reflected in the World Health Organization's declaration on July 17, 2019, that the 10th Ebola virus disease (Ebola) outbreak in the Democratic Republic of the Congo (DRC) was a Public Health Emergency of International Concern (1). In March 2019, the Infectious Diseases Institute (IDI), Uganda, in collaboration with the Ministry of Health (MOH) Uganda and CDC, had previously identified areas at increased risk for Ebola importation by facilitating community engagement with participatory mapping to characterize cross-border population connectivity patterns. Multisectoral participants identified 31 locations and associated movement pathways with high levels of connectivity to the Ebola outbreak areas. They described a major shift in the movement pattern between Goma (DRC) and Kisoro (Uganda), mainly through Rwanda, when Rwanda closed the Cyanika ground crossing with Uganda. This closure led some travelers to use a potentially less secure route within DRC. District and national leadership used these results to bolster preparedness at identified points of entry and health care facilities and prioritized locations at high risk further into Uganda, especially markets and transportation hubs, for enhanced preparedness. Strategies to forecast, identify, and rapidly respond to the international spread of disease require adapting to complex, dynamic, multisectoral cross-border population movement, which can be influenced by border control and public health measures of neighboring countries.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Migração Humana/estatística & dados numéricos , Participação da Comunidade , República Democrática do Congo/epidemiologia , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Ruanda/epidemiologia , Uganda/epidemiologia
3.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917783

RESUMO

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Vigilância em Saúde Pública/métodos , República Democrática do Congo/epidemiologia , Humanos , Ruanda/epidemiologia , Sudão do Sul/epidemiologia , Fatores de Tempo , Uganda/epidemiologia
4.
AMIA Jt Summits Transl Sci Proc ; 2019: 325-334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31258985

RESUMO

The use of diagnosis (DX) data is crucial to secondary use of electronic health record (EHR) data, yet accessible structured DX data often lack in accuracy. DX descriptions associated with structured DX codes vary even after recording biopsy results; this may indicate poor data quality. We hypothesized that biopsy reports in cancer care charts do not improve intrinsic DX data quality. We analyzed DX data for a manually well-annotated cohort of patients with brain neoplasms. We built statistical models to predict the number of fully-accurate (i.e., correct neoplasm type and anatomical location) and inaccurate DX (i.e. type or location contradicts cohort data) descriptions. We found some evidence of statistically larger numbers of fully-accurate (RR=3.07, p=0.030) but stronger evidence of much larger numbers of inaccurate DX (RR=12.3, p=0.001 and RR=19.6, p<0.0001) after biopsy result recording. Still, 65.9% of all DX records were neither fully-accurate nor fully-inaccurate. These results suggest EHRs must be modified to support more reliable DX data recording and secondary use of EHR data.

5.
J Nutr ; 149(7): 1260-1270, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31006806

RESUMO

BACKGROUND: Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. OBJECTIVE: We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. METHODS: Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. RESULTS: Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6%; iron by ferritin, 4.0%; iron by transferrin receptor, 4.7%; folate, 2.5%; vitamin B-12, 35.4%; vitamin A, 6.7%; vitamin E, 57.7%; vitamin D, 64.0%; zinc, 13.4%; and iodine, 2.6%. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7-13.7% higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7-16.6% lower, for the MM group compared with the IFA group, with a 15-38% lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. CONCLUSIONS: Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.

6.
Am J Emerg Med ; 36(11): 2134.e1-2134.e2, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30194019

RESUMO

Dysphagia lusoria is a rare disease due to an aberrant right subclavian artery that passes posteriorly between the esophagus and the spine. David Bayford coined the term itself meaning "freak or jest of nature" in 1761 describing a case in which the patient had long term dysphagia that eventually led to death. Most cases of dysphagia are due to an aberrant right subclavian artery running posterior to and causing esophageal compression, but only 20-40% of aberrant arteries actually lead to trachea-esophageal symptoms, including dysphagia. The majority of patients with an aberrant right subclavian artery are asymptomatic. Treatment for dysphagia lusoria varies depending on the severity of the symptoms. Dietary modifications are recommended in patients with mild to moderate symptoms while vascular reconstruction is necessary for patients with severe symptoms. We present a 44-year-old female who was diagnosed with dysphagia lusoria due to a right-sided aortic arch and aberrant left subclavian artery (ALSA) with aneurysmal dilation. Right aortic arch with ALSA is an uncommon arch anomaly, and only occurs in about 0.05% of the population. Prior case reports of dysphagia lusoria differ in that they did not report patients with an uncommon presentation of dysphagia lusoria with aneurysmal dilatation nor was the patient diagnosed in the emergency department.


Assuntos
Aorta Torácica/anormalidades , Anormalidades Cardiovasculares/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico , Corpos Estranhos/complicações , Artéria Subclávia/anormalidades , Anormalidades Múltiplas/diagnóstico por imagem , Adulto , Aorta Torácica/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Estenose Esofágica/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Sensação , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
J Travel Med ; 25(1)2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30137586

RESUMO

HIGHLIGHT: The body of knowledge needed to effectively practice travel medicine has expanded since the 1990s, as migrants begin to comprise an increasing proportion of the world's population. We describe the unique needs of migrants and provide resources available to migration health practitioners. As the number of the world's migrants grows, collaboration across disciplines is key to achieving high-quality migration health practices.


Assuntos
Dinâmica Populacional/tendências , Migrantes/estatística & dados numéricos , Medicina de Viagem/tendências , Viagem/tendências , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Saúde Global , Humanos
8.
Am J Emerg Med ; 36(7): 1324.e1-1324.e2, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29703563

RESUMO

Refractory ventricular fibrillation occurs when there are three or more episodes of ventricular fibrillation within a 24-hour period. We report the first case of a 35-year-old woman without prior medical or family cardiac history who sustained refractory ventricular fibrillation while taking Lamictal for bipolar depression. She presented to the Emergency Department (ED) after a syncopal episode at work. She then sustained a cardiac arrest and required defibrillation in the ED multiple times due to recurrent ventricular fibrillation. The patient received a Subcutaneous Implantable Cardio-Defibrillator and was discharged home. There was no identifiable cardiac or medical cause of her ventricular fibrillation and the electrophysiologist suspected Lamictal caused her refractory ventricular fibrillation.


Assuntos
Eletrocardiografia , Sistema de Condução Cardíaco/efeitos dos fármacos , Lamotrigina/efeitos adversos , Fibrilação Ventricular/induzido quimicamente , Adulto , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Lamotrigina/uso terapêutico , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia
9.
Emerg Infect Dis ; 23(13)2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29155668

RESUMO

Recent multinational disease outbreaks demonstrate the risk of disease spreading globally before public health systems can respond to an event. To ensure global health security, countries need robust multisectoral systems to rapidly detect and respond to domestic or imported communicable diseases. The US Centers for Disease Control and Prevention International Border Team works with the governments of Nigeria, Togo, and Benin, along with Pro-Health International and the Abidjan-Lagos Corridor Organization, to build sustainable International Health Regulations capacities at points of entry (POEs) and along border regions. Together, we strengthen comprehensive national and regional border health systems by developing public health emergency response plans for POEs, conducting qualitative assessments of public health preparedness and response capacities at ground crossings, integrating internationally mobile populations into national health surveillance systems, and formalizing cross-border public health coordination. Achieving comprehensive national and regional border health capacity, which advances overall global health security, necessitates multisectoral dedication to the aforementioned components.


Assuntos
Controle de Doenças Transmissíveis , Doenças Transmissíveis/epidemiologia , Vigilância da População , Surtos de Doenças , Emigração e Imigração , Saúde Global , Humanos , Cooperação Internacional , Nigéria , Vigilância da População/métodos , Vigilância em Saúde Pública , Togo
10.
Pan Afr Med J ; 27(Suppl 1): 12, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28721176

RESUMO

This case study is adapted from events that occurred along the Sierra Leone and Guinea land border during the 2014-2016 Ebola epidemic in West Africa. The response activities involved Sierra Leone and Guinea officials, along with assistance from U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organisation (WHO). This case study builds upon an understanding of basic surveillance systems and outbreak response activities. Through this exercise, students will understand how to incorporate communication and coordination into surveillance and response efforts with counterparts across the border in neighbouring countries. This integration is important to reduce the spread of communicable diseases between neighbouring countries. The time required to complete this case study is 2-3 hours.


Assuntos
Surtos de Doenças/prevenção & controle , Epidemias/prevenção & controle , Epidemiologia/educação , Doença pelo Vírus Ebola/epidemiologia , Comunicação , Métodos Epidemiológicos , Guiné/epidemiologia , Humanos , Cooperação Internacional , Serra Leoa/epidemiologia , Estados Unidos , Organização Mundial da Saúde
11.
Am J Clin Nutr ; 106(Suppl 1): 348S-358S, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28615263

RESUMO

Background: In many settings, populations experience recurrent exposure to inflammatory agents that catalyze fluctuations in the concentrations of acute-phase proteins and certain micronutrient biomarkers such as C-reactive protein (CRP), α-1-acid glycoprotein (AGP), ferritin, and retinol. Few data are available on the prevalence and predictors of inflammation in diverse settings.Objective: We aimed to assess the relation between inflammation (CRP concentration >5 mg/L or AGP concentration >1 g/L) and covariates, such as demographics, reported illness, and anthropometric status, in preschool children (PSC) (age range: 6-59 mo) and women of reproductive age (WRA) (age range: 15-49 y).Design: Cross-sectional data from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project from 29,765 PSC in 16 surveys and 25,731 WRA in 10 surveys were used to model bivariable and multivariable relations.Results: The inflammation prevalence was 6.0-40.2% in PSC and 7.9-29.5% in WRA (elevated CRP) and 21.2-64.3% in PSC and 7.1-26.7% in WRA (elevated AGP). In PSC, inflammation was consistently positively associated with recent fever and malaria but not with other recent illnesses. In multivariable models that were adjusted for age, sex, urban or rural residence, and socioeconomic status, elevated AGP was positively associated with stunting (height-for-age z score <-2) in 7 of 10 surveys. In WRA, elevated CRP was positively associated with obesity [body mass index (in kg/m2) ≥30] in 7 of 9 surveys. Other covariates showed inconsistent patterns of association with inflammation. In a pooled analysis of surveys that measured malaria, stunting was associated with elevated AGP but not CRP in PSC, and obesity was associated with both elevated CRP and AGP in WRA.Conclusions: Recent morbidity and abnormal anthropometric status are consistently associated with inflammation across a range of environments, whereas more commonly collected demographic covariates were not. Because of the challenge of defining a general demographic population or environmental profile that is more likely to experience inflammation, inflammatory markers should be measured in surveys to account for their effects.


Assuntos
Anemia/diagnóstico , Biomarcadores/análise , Inflamação/diagnóstico , Reação de Fase Aguda , Adolescente , Adulto , Anemia Ferropriva/diagnóstico , Proteína C-Reativa/análise , Pré-Escolar , Estudos Transversais , Feminino , Ferritinas/análise , Humanos , Lactente , Inflamação/epidemiologia , Pessoa de Meia-Idade , Estado Nutricional , Obesidade , Orosomucoide/análise , Vitamina A/análise , Deficiência de Vitamina A/diagnóstico
12.
Int J Epidemiol ; 44(6): 1862-76, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26275453

RESUMO

BACKGROUND: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40-50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting. METHODS: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy'doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < -2), weight-for-length z-score (WLZ) and wasting (WLZ < -2) in children 6-18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year. RESULTS: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02-0.04/month) in the Plumpy'doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy'doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5-6% (P ≤ 0.01) in those receiving Plumpy'doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27-0.30 cm and 0.07-0.10 (all P < 0.05), respectively, in all four food groups relative to the control. CONCLUSIONS: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age.


Assuntos
Aleitamento Materno , Aconselhamento/métodos , Suplementos Nutricionais , Alimentos Fortificados , Transtornos do Crescimento/prevenção & controle , Transtornos da Nutrição do Lactente/prevenção & controle , População Rural , Bangladesh , Desenvolvimento Infantil , Cicer , Sacarose na Dieta , Feminino , Humanos , Lactente , Lens (Planta) , Masculino , Micronutrientes , Oryza , Óleo de Soja
13.
Environ Res ; 142: 273-80, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26186135

RESUMO

BACKGROUND: Arsenic has immunomodulatory properties and may have the potential to alter susceptibility to infection in humans. OBJECTIVES: We aimed to assess the relation of arsenic exposure during pregnancy with immune function and hepatitis E virus (HEV) infection, defined as seroconversion during pregnancy and postpartum. METHODS: We assessed IgG seroconversion to HEV between 1st and 3rd trimester (TM) and 3 months postpartum (PP) among 1100 pregnancies in a multiple micronutrient supplementation trial in rural Bangladesh. Forty women seroconverted to HEV and were matched with 40 non-seroconverting women (controls) by age, parity and intervention. We assessed urinary inorganic arsenic plus methylated species (∑As) (µg/L) at 1st and 3rd TM and plasma cytokines (pg/mL) at 1st and 3rd TM and 3 months PP. RESULTS: HEV seroconverters' urinary ∑As was elevated throughout pregnancy. Non-seroconverters' urinary ∑As was similar to HEV seroconverters at 1st TM but declined at 3rd TM. The adjusted odds ratio (95% confidence interval) of HEV seroconversion was 2.17 (1.07, 4.39) per interquartile range (IQR) increase in average-pregnancy urinary ∑As. Increased urinary ∑As was associated with increased concentrations of IL-2 during the 1st and 3rd TM and 3 months PP among HEV seroconverters but not non-seroconverters. CONCLUSIONS: The relation of urinary arsenic during pregnancy with incident HEV seroconversion and with IL-2 levels among HEV-seroconverting pregnant women suggests arsenic exposure during pregnancy may enhance susceptibility to HEV infection.


Assuntos
Arsênico/urina , Poluentes Ambientais/urina , Hepatite E/epidemiologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Bangladesh/epidemiologia , Estudos de Casos e Controles , Citocinas/sangue , Suscetibilidade a Doenças , Exposição Ambiental/análise , Feminino , Hepatite E/sangue , Hepatite E/imunologia , Hepatite E/urina , Vírus da Hepatite E/imunologia , Humanos , Imunoglobulina G/sangue , Gravidez/sangue , Gravidez/urina , Primeiro Trimestre da Gravidez/sangue , Primeiro Trimestre da Gravidez/urina , Terceiro Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/urina , Soroconversão , Adulto Jovem
14.
Am J Clin Nutr ; 101(2): 294-301, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25646326

RESUMO

BACKGROUND: Tocopherols were discovered for their role in animal reproduction, but little is known about the contribution of deficiencies of vitamin E to human pregnancy loss. OBJECTIVE: We sought to determine whether higher first-trimester concentrations of α-tocopherol and γ-tocopherol were associated with reduced odds of miscarriage (pregnancy losses <24 wk of gestation) in women in rural Bangladesh. DESIGN: A case-cohort study in 1605 pregnant Bangladeshi women [median (IQR) gestational age: 10 wk (8-13 wk)] who participated in a placebo-controlled vitamin A- or ß-carotene-supplementation trial was done to assess ORs of miscarriage in women with low α-tocopherol (<12.0 µmol/L) and γ-tocopherol (<0.81 µmol/L; upper tertile cutoff of the γ-tocopherol distribution in women who did not miscarry). RESULTS: In all women, plasma α- and γ-tocopherol concentrations were low [median (IQR): 10.04 µmol/L (8.07-12.35 µmol/L) and 0.66 µmol/L (0.50-0.95 µmol/L), respectively]. In a logistic regression analysis that was adjusted for cholesterol and the other tocopherol, low α-tocopherol was associated with an OR of 1.83 (95% CI: 1.04, 3.20), whereas a low γ-tocopherol concentration was associated with an OR of 0.62 (95% CI: 0.41, 0.93) for miscarriage. Subgroup analyses revealed that opposing ORs were evident only in women with BMI (in kg/m(2)) ≥18.5 and serum ferritin concentration ≤150 µg/L, although low BMI and elevated ferritin conferred stronger risk of miscarriage. CONCLUSIONS: In pregnant women in rural Bangladesh, low plasma α-tocopherol was associated with increased risk of miscarriage, and low γ-tocopherol was associated with decreased risk of miscarriage. Maternal vitamin E status in the first trimester may influence risk of early pregnancy loss. The JiVitA-1 study, from which data for this report were derived, was registered at clinicaltrials.gov as NCT00198822.


Assuntos
Aborto Espontâneo/sangue , Aborto Espontâneo/epidemiologia , Suplementos Nutricionais , Tocoferóis/sangue , Aborto Espontâneo/prevenção & controle , Adulto , Bangladesh/epidemiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Colesterol/sangue , Análise por Conglomerados , Estudos de Coortes , Método Duplo-Cego , Feminino , Ferritinas/sangue , Idade Gestacional , Humanos , Modelos Logísticos , Estado Nutricional , Gravidez , Primeiro Trimestre da Gravidez , Fatores de Risco , População Rural , Fatores Socioeconômicos , Tocoferóis/administração & dosagem , Vitamina E/administração & dosagem , Vitamina E/sangue , Adulto Jovem , alfa-Tocoferol/administração & dosagem , alfa-Tocoferol/sangue , gama-Tocoferol/administração & dosagem , gama-Tocoferol/sangue
15.
Ecol Food Nutr ; 54(1): 74-92, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25427283

RESUMO

Fortified blended foods (FBFs) are widely used to prevent undernutrition in early childhood in food-insecure settings. We field tested enhanced Wheat Soy Blend (WSB++)-a FBF fortified with micronutrients, milk powder, sugar, and oil-in preparation for a complementary food supplement (CFS) trial in rural northwestern Bangladesh. Formative work was conducted to determine the optimal delivery method (cooked vs. not) for this CFS, to examine mothers' child feeding practices with and acceptance of the WSB++, and to identify potential barriers to adherence. Our results suggest WSB++ is an acceptable CFS in rural Bangladesh and the requirement for mothers to cook WSB++ at home is unlikely to be a barrier to its daily use as a CFS in this population.


Assuntos
Atitude , Culinária , Dieta , Comportamento Alimentar , Alimentos Fortificados , Desnutrição/prevenção & controle , Mães , Animais , Bangladesh , Fast Foods , Feminino , Assistência Alimentar , Abastecimento de Alimentos , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Masculino , População Rural , Soja , Triticum
16.
Matern Child Nutr ; 11(4): 583-94, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23647669

RESUMO

Birth size is an important gauge of fetal and neonatal health. Birth size measurements were collected within 72 h of life for 16 290 live born, singleton infants in rural Bangladesh from 2004 to 2007. Gestational age was calculated based on the date of last menstrual period. Newborns were classified as small-for-gestational age (SGA) based on a birthweight below the 10th percentile for gestational age, using three sets of US reference data. Birth size distributions were explored based on raw values as well as after z-score standardisation in reference to World Health Organization (WHO) 2006 growth standards. Mean (SD) birthweight (g), length (cm) and head circumference (cm) measurements, completed within [median (25th, 75th percentile)] 15 (8, 23) h of life, were 2433 (425), 46.4 (2.4) and 32.4 (1.6), respectively. Twenty-two per cent were born preterm. Over one-half (55.3%) of infants were born low birthweight; 46.6%, 37.0% and 33.6% had a weight, length and head circumference below -2 z-scores of the WHO growth standard at birth; and 70.9%, 72.2% and 59.8% were SGA for weight based on Alexander et al., Oken et al. and Olsen et al. references, respectively. Infants in this typical rural Bangladesh setting were commonly born small, reflecting a high burden of fetal growth restriction and preterm birth. Our findings, produced by active birth surveillance, suggest that low birthweight is far more common than suggested by cross-sectional survey estimates. Interventions that improve fetal growth during pregnancy may have the largest impact on reducing SGA rates.


Assuntos
Inquéritos Epidemiológicos/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Adulto , Bangladesh , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Gravidez , Adulto Jovem
17.
JAMA ; 312(24): 2649-58, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25536256

RESUMO

IMPORTANCE: Maternal micronutrient deficiencies may adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia. OBJECTIVE: To assess effects of antenatal multiple micronutrient vs iron-folic acid supplementation on 6-month infant mortality and adverse birth outcomes. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11, 2008. Six-month infant follow-up ended August 30, 2012. Surveillance included 127,282 women; 44,567 became pregnant and were included in the analysis and delivered 28,516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12). INTERVENTIONS: Women were provided supplements containing 15 micronutrients or iron-folic acid alone, taken daily from early pregnancy to 12 weeks postpartum. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth (<37 weeks), and low birth weight (<2500 g). To maintain overall significance of α = .05, a Bonferroni-corrected α = .01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes (.05/5). RESULTS: Among the 22,405 pregnancies in the multiple micronutrient group and the 22,162 pregnancies in the iron-folic acid group, there were 14,374 and 14,142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron-folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95% CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95% CI, 0.81-0.99; P = .02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95% CI, 0.80-0.91; P < .001) and low birth weight (40.2 vs 45.7 per 100 live births; RR, 0.88; 95% CI, 0.85-0.91; P < .001). CONCLUSIONS AND RELEVANCE: In Bangladesh, antenatal multiple micronutrient compared with iron-folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00860470.


Assuntos
Deficiências Nutricionais/tratamento farmacológico , Suplementos Nutricionais , Ácido Fólico/uso terapêutico , Micronutrientes/uso terapêutico , Complicações na Gravidez/tratamento farmacológico , Cuidado Pré-Natal , Administração Oral , Adulto , Bangladesh , Deficiências Nutricionais/complicações , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso , Recém-Nascido , Ferro , Gravidez , Nascimento Prematuro , População Rural , Natimorto , Adulto Jovem
18.
Food Chem Toxicol ; 74: 184-9, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25308602

RESUMO

Aflatoxin B1 is a potent carcinogen, occurring from mold growth that contaminates staple grains in hot, humid environments. In this investigation, aflatoxin B1-lysine albumin biomarkers were measured by mass spectrometry in rural South Asian women, during the first and third trimester of pregnancy, and their children at birth and at two years of age. These subjects participated in randomized community trials of antenatal micronutrient supplementation in Sarlahi District, southern Nepal and Gaibandha District in northwestern Bangladesh. Findings from the Nepal samples demonstrated exposure to aflatoxin, with 94% detectable samples ranging from 0.45 to 2939.30 pg aflatoxin B1-lysine/mg albumin during pregnancy. In the Bangladesh samples the range was 1.56 to 63.22 pg aflatoxin B1-lysine/mg albumin in the first trimester, 3.37 to 72.8 pg aflatoxin B1-lysine/mg albumin in the third trimester, 4.62 to 76.69 pg aflatoxin B1-lysine/mg albumin at birth and 3.88 to 81.44 pg aflatoxin B1-lysine/mg albumin at age two years. Aflatoxin B1-lysine adducts in cord blood samples demonstrated that the fetus had the capacity to convert aflatoxin into toxicologically active compounds and the detection in the same 2-year-old children illustrates exposure over the first 1000 days of life.


Assuntos
Aflatoxina B1/análise , Aflatoxinas/análise , Biomarcadores/análise , Carcinógenos/análise , Lisina/análise , Albumina Sérica/análise , Adolescente , Adulto , Aflatoxina B1/sangue , Aflatoxinas/sangue , Bangladesh , Biomarcadores/sangue , Criança , Pré-Escolar , Estudos de Coortes , Exposição Ambiental/análise , Feminino , Humanos , Lactente , Recém-Nascido , Lisina/sangue , Nepal , Gravidez , Adulto Jovem
19.
PLoS One ; 9(4): e94243, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24710082

RESUMO

This analysis was conducted to explore the association between 5 birth size measurements (weight, length and head, chest and mid-upper arm [MUAC] circumferences) as dependent variables and 10 maternal factors as independent variables using canonical correlation analysis (CCA). CCA considers simultaneously sets of dependent and independent variables and, thus, generates a substantially reduced type 1 error. Data were from women delivering a singleton live birth (n = 14,506) while participating in a double-masked, cluster-randomized, placebo-controlled maternal vitamin A or ß-carotene supplementation trial in rural Bangladesh. The first canonical correlation was 0.42 (P<0.001), demonstrating a moderate positive correlation mainly between the 5 birth size measurements and 5 maternal factors (preterm delivery, early pregnancy MUAC, infant sex, age and parity). A significant interaction between infant sex and preterm delivery on birth size was also revealed from the score plot. Thirteen percent of birth size variability was explained by the composite score of the maternal factors (Redundancy, RY/X = 0.131). Given an ability to accommodate numerous relationships and reduce complexities of multiple comparisons, CCA identified the 5 maternal variables able to predict birth size in this rural Bangladesh setting. CCA may offer an efficient, practical and inclusive approach to assessing the association between two sets of variables, addressing the innate complexity of interactions.


Assuntos
Peso ao Nascer , Mães/estatística & dados numéricos , População Rural/estatística & dados numéricos , Estatística como Assunto , Bangladesh , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Nascimento Prematuro/fisiopatologia , Análise de Regressão , Fatores Socioeconômicos , Adulto Jovem
20.
Public Health Nutr ; 16(8): 1354-61, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23469947

RESUMO

OBJECTIVE: The objective of the current analysis was to explore the association of multiple micronutrients with Hb concentration among pregnant women in a South Asian setting, a topic that has not been adequately explored. DESIGN: Sociodemographic, anthropometric and micronutrient status (plasma ferritin, transferrin receptor, retinol, a- and g-tocopherol, folate, vitamin B12, Zn) and Hb concentration were assessed at early pregnancy. SETTING: The biochemical sub-study was nested within a double-blind, placebo-controlled, community-based vitamin A and b-carotene supplementation trial in rural north-western Bangladesh (JiVitA). All assessments were conducted before trial supplementation was initiated. SUBJECTS: A systematic sample of 285 women was selected from those enrolled in the biochemical sub-study. RESULTS: Seventeen per cent of women were mildly anaemic; moderate and severe anaemia was uncommon (2.1 %). a-Tocopherol, vitamin B12 and Zn deficiencies were common (43.5%, 19.7% and 14.7%, respectively); however, vitamin A, folate and Fe deficiencies were comparatively rare (7.4%, 2.8% and ,1%,respectively). Plasma Zn, vitamin B12 and a-tocopherol were positively associated and plasma g-tocopherol was negatively associated with Hb (P < 0.05) after adjustment for gestational age, inflammation status, season and nutritional status measured by mid-upper arm circumference. CONCLUSIONS: Among pregnant women in rural Bangladesh with minimal Fe deficiency, plasma Zn, vitamin B12, and a- and g-tocopherol concentrations were associated with Hb concentration. Appreciating the influence on Hb of micronutrients in addition to those with known associations with anaemia, such as Fe, folate, and vitamin A, is important when addressing anaemia in similar settings.


Assuntos
Anemia/epidemiologia , Hemoglobinas/metabolismo , Gravidez , Vitamina B 12/sangue , Zinco/sangue , alfa-Tocoferol/sangue , gama-Tocoferol/sangue , Adulto , Anemia/sangue , Bangladesh/epidemiologia , Análise por Conglomerados , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Ferritinas/sangue , Humanos , Ferro na Dieta/sangue , Micronutrientes/sangue , Micronutrientes/deficiência , Estado Nutricional , Prevalência , População Rural , Fatores Socioeconômicos , Inquéritos e Questionários , Saúde da Mulher , Adulto Jovem
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