Cost-effectiveness of invitation to food supplementation early in pregnancy combined with multiple micronutrients on infant survival: analysis of data from MINIMat randomized trial, Bangladesh.

BACKGROUND: Absence of cost-effectiveness (CE) analyses limits the relevance of large-scale nutrition interventions in low-income countries. We analyzed if the effect of invitation to food supplementation early in pregnancy combined with multiple micronutrient supplements (MMS) on infant survival represented value for money compared to invitation to food supplementation at usual time in pregnancy combined with iron-folic acid. METHODS: Outcome data, infant mortality (IM) rates, came from MINIMat trial (Maternal and Infant Nutrition Interventions, Matlab, ISRCTN16581394). In MINIMat, women were randomized to early (E around 9 weeks of pregnancy) or usual invitation (U around 20 weeks) to food supplementation and daily doses of 30 mg, or 60 mg iron with 400 µgm of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 µgm of folic acid. In MINIMat, EMMS significantly reduced IM compared to UFe60F (U plus 60 mg iron 400 µgm Folic acid). We present incremental CE ratios for incrementing UFe60F to EMMS. Costing data came mainly from a published study. RESULTS: By incrementing UFe60F to EMMS, one extra IM could be averted at a cost of US$907 and US$797 for NGO run and government run CNCs, respectively, and at US$1024 for a hypothetical scenario of highest cost. These comparisons generated one extra life year (LY) saved at US$30, US$27, and US$34, respectively. CONCLUSIONS: Incrementing UFe60F to EMMS in pregnancy seems worthwhile from health economic and public health standpoints. TRIAL REGISTRATION: Maternal and Infant Nutrition Interventions, Matlab; ISRCTN16581394 ; Date of registration: Feb 16, 2009.

Equity in adherence to and effect of prenatal food and micronutrient supplementation on child mortality: results from the MINIMat randomized trial, Bangladesh.

BACKGROUND: Evidence is often missing on social differentials in effects of nutrition interventions. We evaluated the adherence to and effect of prenatal food and micronutrient supplementations on mortality before the age of five years in different social groups as defined by maternal schooling. METHODS: Data came from the MINIMat study (Maternal and Infant Nutrition Interventions, Matlab), a randomized trial of prenatal food supplementation (invitation early, about 9 weeks [E], or at usual time, about 20 weeks [U] of pregnancy) and 30 mg or 60 mg iron with 400 µgm folic acid, or multiple micronutrients (Fe30F, Fe60F, MMS) resulting in six randomization groups, EFe30F, UFe30F, EFe60F, UFe60F, EMMS, and UMMS (n = 4436). Included in analysis after omissions (fetal loss and out-migration) were 3625 women and 3659 live births of which 3591 had information on maternal schooling. The study site was rural Matlab, Bangladesh. The main stratifying variable was maternal schooling dichotomized as <6 years and ≥6 years. We used Cox proportional hazard model for survival analyses. RESULTS: Overall, women having <6 years of schooling adhered more to food (81 vs. 69 packets, P=0.0001) but a little less to micronutrient (104 vs. 120 capsules, P = 0.0001) supplementation compared to women having more schooling, adjusted for maternal age (years), parity and body mass index (BMI, kg/m2) at week 8 pregnancy. Children of mothers with ≥6 years of schooling had lower under-five mortality, but the EMMS supplementation reduced the social difference in mortality risk (using standard program and schooling <6 years as reference; standard program and schooling ≥6 years HR 0.54, 95% CI 0.27-1.11; EMMS and schooling ≥6 years HR 0.28, 95% CI 0.12-0.70; EMMS and schooling <6 years HR 0.26, 95% CI 0.11-0.63), adjusted for maternal age (years), parity and body mass index (kg/m2) at week 8 pregnancy. CONCLUSIONS: The combination of an early invitation to prenatal food supplementation and multiple micronutrient supplementation lowered mortality in children before the age of five years and reduced the gap in child survival chances between social groups. The pattern of adherence to the supplementations was complex; women with less education adhered more to food supplementation while those with more education had higher adherence to micronutrients. TRIAL REGISTRATION: ISRCTN16581394.

Impedance Spectroscopy Analysis of PbSe Nanostructures Deposited by Aerosol Assisted Chemical Vapor Deposition Approach.

This research endeavor aimed to synthesize the lead (II) diphenyldiselenophosphinate complex and its use to obtain lead selenide nanostructured depositions and further the impedance spectroscopic analysis of these obtained PbSe nanostructures, to determine their roles in the electronics industry. The aerosol-assisted chemical vapor deposition technique was used to provide lead selenide deposition by decomposition of the complex at different temperatures using the glass substrates. The obtained films were revealed to be a pure cubic phase PbSe, as confirmed by X-ray diffraction analysis. SEM and TEM micrographs demonstrated three-dimensionally grown interlocked or aggregated nanocubes of the obtained PbSe. Characteristic dielectric measurements and the impedance spectroscopy analysis at room temperature were executed to evaluate PbSe properties over the frequency range of 100 Hz-5 MHz. The dielectric constant and dielectric loss gave similar trends, along with altering frequency, which was well explained by the Koops theory and Maxwell-Wagner theory. The effective short-range translational carrier hopping gave rise to an overdue remarkable increase in ac conductivity (σac) on the frequency increase. Fitting of a complex impedance plot was carried out with an equivalent circuit model (Rg Cg) (Rgb Qgb Cgb), which proved that grains, as well as grain boundaries, are responsible for the relaxation processes. The asymmetric depressed semicircle with the center lower to the impedance real axis provided a clear explanation of non-Debye dielectric behavior.

Frequency stable dielectric constant with reduced dielectric loss of one-dimensional ZnO-ZnS heterostructures.

The synthesis of one-dimensional heterostructures having high dielectric constant and low dielectric loss has remained a great challenge. Until now, the dielectric performance of ZnO-ZnS heterostructures was scarcely investigated. In this work, large-scale ZnO-ZnS heterostructures were synthesized by employing the chemical vapor deposition method. High resolution transmission electron microscopy (HRTEM) confirms the formation of heterostructures. X-ray photoelectron spectroscopy (XPS) shows that S atoms fill up the oxygen vacancy (VO) in ZnO, leading to the suppression of charge carrier's movement from ZnO to ZnS; instead there is charge transfer from ZnS to ZnO. Conductivity mismatch between adjacent ZnO and ZnS materials leads to the accumulation of free charges at the interface of the heterostructure and can be considered as a capacitor-like structure. The electrical behaviors of the potential phases of ZnO, ZnS and the ZnO-ZnS heterostructure are well interpreted by a best fitted equivalent circuit model. Each heterostructure acts as a polarization node with a specific flip-flop frequency and all such nodes form continuous transmission of polarization, which jointly increase the dielectric energy-storage performance. The orientational polarization of the polarons and Zn2+-VO dipoles present at the heterostructure interface contributes to the frequency stable dielectric constant at ≥103 Hz. Our findings provide a systematic approach to tailor the electronic transport and dielectric properties at the interface of the heterostructure. We suggest that this approach can be extended for improving the energy harvesting, transformation and storage capabilities of the nanostructures for the development of high-performance energy-storage devices.

Impedance Spectroscopic Study of Nickel Sulfide Nanostructures Deposited by Aerosol Assisted Chemical Vapor Deposition Technique.

This research aims to synthesize the Bis(di-isobutyldithiophosphinato) nickel (II) complex [Ni(iBu2PS2)] to be employed as a substrate for the deposition of nickel sulfide nanostructures, and to investigate its dielectric and impedance characteristics for applications in the electronic industry. Various analytical tools including elemental analysis, mass spectrometry, IR, and TGA were also used to further confirm the successful synthesis of the precursor. NiS nanostructures were grown on the glass substrates by employing an aerosol assisted chemical vapor deposition (AACVD) technique via successful decomposition of the synthesized complex under variable temperature conditions. XRD, SEM, TEM, and EDX methods were well applied to examine resultant nanostructures. Dielectric studies of NiS were carried out at room temperature within the 100 Hz to 5 MHz frequency range. Maxwell-Wagner model gave a complete explanation of the variation of dielectric properties along with frequency. The reason behind high dielectric constant values at low frequency was further endorsed by Koops phenomenological model. The efficient translational hopping and futile reorientation vibration caused the overdue exceptional drift of ac conductivity (σac) along with the rise in frequency. Two relaxation processes caused by grains and grain boundaries were identified from the fitting of a complex impedance plot with an equivalent circuit model (Rg Cg) (Rgb Qgb Cgb). Asymmetry and depression in the semicircle having center present lower than the impedance real axis gave solid justification of dielectric behavior that is non-Debye in nature.

Nanostructured Lead Sulphide Depositions by AACVD Technique Using Bis(Isobutyldithiophosphinato)Lead(II) Complex as Single Source Precursor and Its Impedance Study.

This communication reports the synthesis of bis(diisobutyldithiophosphinato)lead(II) complex and its subsequent application as a single source precursor for the nanostructured deposition of lead sulphide semiconductors and its impedance to explore its scope in the field of electronics. Synthesized complex was characterized by microelemental analysis, nuclear magnetic resonance spectroscopy, infrared spectroscopy and thermogravimetric analysis. This complex was decomposed using the aerosol-assisted chemical vapour deposition technique at different temperatures to grow PbS nanostructures on glass substrates. These nanostructures were analyzed by XRD, SEM, TEM and EDX methods. Impedance spectroscopic measurements were performed for PbS in the frequency range of 40 to 6 MHz at room temperature. In a complex impedance plane plot, two relaxation processes were exhibited due to grains and grain boundaries contribution. A high value of dielectric constant was observed at low frequencies, which was explained on the basis of Koops phenomenological model and Maxwell-Wagner type polarization. Frequency-dependent AC conductivity results were compliant with Jonscher power law, while capacitance-voltage loop had a butterfly shape. These impedance spectroscopic results have corroborated the ferroelectric nature of the resultant PbS nanodeposition.

Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh.

INTRODUCTION: Nutrition interventions may have favourable as well as unfavourable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat), with early prenatal food and micronutrient supplementation, reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) supplement was associated with an increased risk of stunted growth in infancy and early childhood. This unfavourable outcome was not included in the previous cost-effectiveness analysis. The aim of this study is to evaluate whether the MINIMat interventions remain cost-effective in view of both favourable (decreased under-five-years mortality) and unfavourable (increased stunting) outcomes. METHOD: Pregnant women in rural Bangladesh, where food insecurity still is prevalent, were randomized to early (E) or usual (U) invitation to be given food supplementation and daily doses of 30 mg, or 60 mg iron with 400 µg of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 µg of folic acid. E reduced stunting at 4.5 years compared with U, MMS increased stunting at 4.5 years compared with Fe60, while the combination EMMS reduced infant mortality compared with UFe60. The outcome measure used was disability adjusted life years (DALYs), a measure of overall disease burden that combines years of life lost due to premature mortality (under five-year mortality) and years lived with disability (stunting). Incremental cost effectiveness ratios were calculated using cost data from already published studies. RESULTS: By incrementing UFe60 (standard practice) to EMMS, one DALY could be averted at a cost of US$24. CONCLUSION: When both favourable and unfavourable outcomes were included in the analysis, early prenatal food and multiple micronutrient interventions remained highly cost effective and seem to be meaningful from a public health perspective.

Effect of prenatal food supplementation on birth weight: an observational study from Bangladesh.

BACKGROUND: National nutrition programs in Bangladesh have included prenatal food supplementation to reduce maternal and child malnutrition. The knowledge base is weak regarding the effect of prenatal food supplementation on the birth weight (BW) of infants in populations in whom low BW is prevalent and regarding any variation in effect based on maternal nutritional status. OBJECTIVE: We examined whether observational data support an effect of daily prenatal food supplementation on BW by considering the duration of supplementation and whether the effect is modified by maternal postpartum weight (a proxy of prepregnancy weight) groups. DESIGN: A cohort of undernourished pregnant women (n = 777) who received prenatal food supplementation (608 kcal/d) was followed. The association between the uptake of food supplements and BW was analyzed after adjustment for potential confounders (n = 619 with complete information). Differential effects in lower and higher maternal postpartum weight groups were examined. RESULTS: The average BW was 2521 g. On average, the women received daily supplements for 4 mo, which resulted in an increase in BW of 118 g (1.0 g/d). The strongest effect was found for births occurring in January and February. There was a linear dose-response relation between duration of supplementation and BW for women with higher postpartum weights (> or = 42 kg, above the median). In women with lower weights (< 42 kg, below median), a shorter duration of supplementation (< 4 mo) had no such dose-response relation with BW, but there was a linear dose-response relation for longer durations of supplementation. CONCLUSIONS: The association between duration of prenatal food supplementation and BW varies with maternal postpartum weight. A large effect was observed after the season with food insecurity (mid-August to mid-November).

Quality of life among pregnant women with chronic energy deficiency in rural Bangladesh.

Quality of life scores of health conditions are needed for measuring quality adjusted life years (QALY), the most common outcome measure in cost-utility analysis. To measure QALY scores we used EQ-5D and a visual analogue scales (VIS). EQ-5D is a standardised instrument for measuring quality of life using five dimensions applicable to a wide range of health conditions. VAS had the endpoints "full health" and "death". We assessed the scores for chronic energy deficiency (CED) characterised by low body mass index (BMI<18.5), a condition highly prevalent among rural Bangladeshi women. EuroQol (EQ)-5D and VAS were used to measure when the condition was worst and VAS measured the current health status. We interviewed 285 pregnant and postpartum women, with 236 (83%) having complete information. Mean scores for CED when perceived to be most severe were 0.30 (EQ-5D, interquartile range -0.02 to 0.52) and 0.27 (visual analogue scale, interquartile range 0.12-0.39) in scales with scores ranging from -0.54 to 1.00 and from 0 to 1.00, respectively. The mean score for current health status derived from the visual analogue scale was 0.49 (95% CI for mean 0.45-0.52) in a scale with scores ranging from 0 to 1.00. Rural Bangladeshi women attached very low quality of life scores to CED. The scores are comparable to scores attached to severe debilitating conditions like cancer in western countries. If considered in the global perspective, prevention of chronic energy deficiency among women in developing countries should be given high priority.