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Peer Reviewed

Title: Impact of Plasmodium falciparum infection on the frequency of moderate to severe anaemia in children below 10 years of age in Gabon.
Author: Bouyou-Akotet MK; Dzeing-Ella A; Kendjo E; Etoughe D; Ngoungou EB; Planche T; Koko J; Kombila M
Source: Malaria Journal. 2009 Jul 20;8(1):166.
Abstract: ABSTRACT: BACKGROUND: Improving the understanding of childhood malarial anaemia may help in the design of appropriate management strategies. METHODS: A prospective observational study was conducted over a two-year period to assess the burden of anaemia and its relationship to Plasmodium falciparum infection and age in 8,195 febrile Gabonese children. RESULTS: The proportion of children with anaemia was 83.6% (n=6830), higher in children between the ages of six and 23 months. Those under three years old were more likely to develop moderate to severe anaemia (68%). The prevalence of malaria was 42.7% and P. falciparum infection was more frequent in children aged 36-47 months (54.5%). The proportion of anaemic children increased with parasite density (p<0.01). Most of infected children were moderately to severely anaemic (69.5%, p<0.01). Infants aged from one to 11 months had a higher risk of developing severe malarial anaemia. In children over six years of age, anaemia occurrence was high (>60%), but was unrelated to P. falciparum parasitaemia. CONCLUSION: Malaria is one of the main risk factors for childhood anaemia which represents a public health problem in Gabon. The risk of severe malarial anaemia increases up the age of three years. Efforts to improve strategies for controlling anaemia and malaria are needed.
Language: English
Keywords:
GABON | RESEARCH REPORT | PROSPECTIVE STUDIES | CHILDREN | MALARIA | ANEMIA | PREVALENCE | FEVER | RISK FACTORS | AGE FACTORS | HEMOGLOBIN LEVEL | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Measurement | Body Temperature | Physiology | Biology | Health | Hemic System
Document Number: 342284

Peer Reviewed

Title: Comparison of CD4 cell count, viral load, and other markers for the prediction of mortality among HIV-1-infected Kenyan pregnant women.
Author: Brown ER; Otieno P; Mbori-Ngacha DA; Farquhar C; Obimbo EM; Nduati R; Overbaugh J; John-Stewart GC
Source: Journal of Infectious Diseases. 2009 May 1;199(9):1292-300.
Abstract: BACKGROUND: There are limited data regarding the relative merits of biomarkers as predictors of mortality or time to initiation of antiretroviral therapy (ART). METHODS: We evaluated the usefulness of the CD4 cell count, CD4 cell percentage (CD4%), human immunodeficiency virus type 1 (HIV-1) load, total lymphocyte count (TLC), body mass index (BMI), and hemoglobin measured at 32 weeks' gestation as predictors of mortality in a cohort of HIV-1-infected women in Nairobi, Kenya. Sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic (ROC) curve (AUC) were determined for each biomarker separately, as well as for the CD4 cell count and the HIV-1 load combined. RESULTS: Among 489 women with 10,150 person-months of follow-up, mortality rates at 1 and 2 years postpartum were 2.1% (95% confidence interval [CI], 0.7%-3.4%) and 5.5% (95% CI, 3.0%-8.0%), respectively. CD4 cell count and CD4% had the highest AUC value (>0.9). BMI, TLC, and hemoglobin were each associated with but poorly predictive of mortality (PPV, <7%). The HIV-1 load did not predict mortality beyond the CD4 cell count. CONCLUSIONS: The CD4 cell count and CD4% measured during pregnancy were both useful predictors of mortality among pregnant women. TLC, BMI, and hemoglobin had a limited predictive value, and the HIV-1 load did not predict mortality any better than did the CD4 cell count alone.
Language: English
Keywords:
KENYA | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | IMMUNOLOGIC FACTORS | BODY WEIGHT | HEMOGLOBIN LEVEL | RISK FACTORS | AIDS | MORTALITY | ANTIRETROVIRAL THERAPY | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Immunity | Immune System | Physiology | Biology | Hemic System | Health | Population Dynamics | HIV
Document Number: 342360

Peer Reviewed

Title: Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia.
Author: Chi BH; Cantrell RA; Zulu I; Mulenga LB; Levy JW; Tambatamba BC; Reid S; Mwango A; Mwinga A; Bulterys M; Saag MS; Stringer JS
Source: International Journal of Epidemiology. 2009 Jun;38(3):746-56.
Abstract: BACKGROUND: High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. METHODS: We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (> or =95%), suboptimal (80-94%) and poor (<80%). RESULTS: Overall, 27 115 treatment-naive adults initiated and continued ART for > or =12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9-1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4-2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/microl vs 217 cells/microl; P < 0.001), 24 months (213 cells/microl vs 246 cells/microl; P < 0.001), 30 months (226 cells/microl vs 261 cells/microl; P < 0.001) and 36 months (245 cells/microl vs 275 cells/microl; P < 0.01) when compared with those above this threshold. CONCLUSIONS: MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | IMMUNOLOGICAL EFFECTS | PHARMACY DISTRIBUTION | MORTALITY | HEMOGLOBIN LEVEL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | HIV | Behavior | Immunity | Immune System | Physiology | Biology | Nonclinical Distribution | Distributional Activities | Population Dynamics | Demographic Factors | Population | Hemic System
Document Number: 342460

5.
Peer Reviewed

Title: Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia.
Author: Kidanto HL; Mogren I; Lindmark G; Massawe S; Nystrom L
Source: South African Medical Journal. 2009 Feb;99(2):98-102.
Abstract: OBJECTIVE: To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. DESIGN: A cross-sectional study. SETTING: Labour Ward, Muhimbili National Hospital, Dar es Salaam, Tanzania. METHODS: The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measured. Data on socio-demographic characteristics, iron supplementation, malaria prophylaxis, blood transfusion during current pregnancy, and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal--Hb > or = 11.0 g/dl; mild--Hb 9.0-10.9 g/dl; moderate--Hb 7.0-8.9 g/dl; and severe--Hb < 7.0 g/dl. Logistic regression analysis was performed to estimate the severity of anaemia. The following outcome measures were used: preterm delivery (<37 weeks), Apgar score, stillbirth, early neonatal death, low birth weight (LBW) (<2500 g) and very low birth weight (VLBW) (<1500 g). RESULTS: A total of 1174 anaemic and 547 non-anaemic women were enrolled. Their median age was 24 years (range 14-46 years) and median parity was 2 (range 0-17). The prevalence of anaemia and severe anaemia was 68% and 5.8%, respectively. The risk of preterm delivery increased significantly with the severity of anaemia, with odds ratios of 1.4, 1.4 and 4.1 respectively for mild, moderate and severe anaemia. The corresponding risks for LBW and VLBW were 1.2 and 1.7, 3.8 and 1.5, and 1.9 and 4.2 respectively. CONCLUSION: The risks of preterm delivery and LBW increased in proportion to the severity of maternal anaemia.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | PREGNANT WOMEN | HEMOGLOBIN LEVEL | ANEMIA | PREMATURE BIRTH | LOW BIRTH WEIGHT | RISK FACTORS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Hemic System | Physiology | Biology | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Birth Weight | Body Weight | Health
Document Number: 341326

Peer Reviewed

Title: Immunohaematological reference values in human immunodeficiency virus-negative adolescent and adults in rural northern Tanzania.
Author: Ngowi BJ; Mfinanga SG; Bruun JN; Morkve O
Source: BMC Infectious Diseases. 2009;9:1.
Abstract: BACKGROUND: The amount of CD4 T cells is used for monitoring HIV progression and improvement, and to make decisions to start antiretroviral therapy and prophylactic drugs for opportunistic infections. The aim of this study was to determine normal reference values for CD4 T cells, lymphocytes, leucocytes and haemoglobin level in healthy, HIV negative adolescents and adults in rural northern Tanzania. METHODS: A cross sectional study was conducted from September 2006 to March 2007 in rural northern Tanzania. Participants were recruited from voluntary HIV counselling and testing clinics. Patients were counselled for HIV test and those who consented were tested for HIV. Clinical screening was done, and blood samples were collected for CD4 T cell counts and complete blood cell counts. RESULTS: We enrolled 102 participants, forty two (41.2%) males and 60 (58.8%) females. The mean age was 32.6 +/- 95% CI 30.2-35.0. The mean absolute CD4 T cell count was 745.8 +/- 95% CI 695.5-796.3, absolute CD8 T cells 504.6 +/- 95% CI 461.7-547.5, absolute leukocyte count 5.1 +/- 95% CI 4.8-5.4, absolute lymphocyte count 1.8 +/- 95% CI 1.7-1.9, and haemoglobin level 13.2 +/- 95% CI 12.7-13.7. Females had significantly higher mean absolute CD4 T cell count (p = 0.008), mean absolute CD8 T cell count (p = 0.009) and significantly lower mean haemoglobin level than males (p = 0.003) CONCLUSION: Immunohaematological values found in this study were different from standard values for western countries. Females had significantly higher mean CD4 T cell counts and lower mean haemoglobin levels than males. This raises the issue of the appropriateness of the present reference values and guidelines for monitoring HIV/AIDS patients in Tanzania.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | ADOLESCENTS | ADULTS | RURAL POPULATION | PREVALENCE | HEMATOLOGICAL EFFECTS | IMMUNITY, CELLULAR | CROSS SECTIONAL ANALYSIS | HEMOGLOBIN LEVEL | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Hemic System | Physiology | Biology | Immunity | Immune System
Document Number: 330363

Title: Influence of inflammation as measured by alpha-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women.
Author: Rawat R; Stoltzfus RJ; Ntozini R; Mutasa K; Iliff PJ; Humphrey JH
Source: European Journal of Clinical Nutrition. 2009 Jun;63(6):787-93.
Abstract: OBJECTIVES: The acute phase response (APR) influences indicators of iron status. A recent WHO/CDC consultation recommended concurrent measurement of alpha-1-acid-glycoprotein (AGP) in surveys to control for the APR, and aid in interpreting iron status. They proposed further exploratory analyses using AGP. We examined whether the APR (measured by AGP) influences the expected relationships between iron status indicators in an HIV-infected population. SUBJECTS: We measured hemoglobin (Hb), serum ferritin (SF), transferrin receptor (TfR), erythropoietin (EPO) and AGP in a cross-sectional survey of 643 HIV-positive Zimbabwean women. RESULTS: SF was significantly higher in APR-positive (AGP>1 g/l) women (P<0.001), in whom there was no association between SF and Hb. TfR was inversely associated with Hb, in both APR-positive and APR-negative women (P<0.001). However, among anemic women (Hb<110 g/l), APR-positive women had marginally lower TfR concentrations (P=0.053). There was no difference in EPO response to decreasing Hb among APR-positive and APR-negative women. CONCLUSIONS: AGP captured the influence of the APR on iron indicators and their relationships with each other. The APR influenced SF and its relationship with Hb as expected. TfR behaved unexpectedly. Although TfR has been promoted as an iron indicator that is uninfluenced by the APR, TfR concentrations were depressed among anemic APR-positive women. Because TfR reflects iron deficiency and erythropoietic activity, pro-inflammatory cytokines associated with the APR may be inhibiting erythropoiesis, which is reflected by lower TfR concentrations. We support the WHO/CDC recommendation that AGP is a useful indicator to assess the influence of the APR on iron status indicators.
Language: English
Keywords:
ZIMBABWE | RESEARCH REPORT | POSTPARTUM WOMEN | PERSONS LIVING WITH HIV/AIDS | DEFICIENCY DISEASES | IRON | METABOLIC EFFECTS | ANEMIA | HIV INFECTIONS | HEMOGLOBIN LEVEL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Puerperium | Reproduction | Viral Diseases | Diseases | Nutrition Disorders | Metals | Vitamins and Minerals | Physiology | Biology | Hemic System
Document Number: 342647

Title: Nutrition intervention and adequate hygiene practices to improve iron status of vulnerable preschool Burkinabe children.
Author: Sanou D; Turgeon-O'Brien H; Desrosiers T
Source: Nutrition. 2009 Jul 21;
Abstract: OBJECTIVE: To determine the impact of an intervention that combined an increase in dietary and bioavailable iron intakes and an improvement in hygiene behaviors on the iron status of preschool children from Burkina Faso. METHODS: Thirty-three orphans and vulnerable children from 11 families who were 1-6 y old, were non-anemic, or had mild to moderate anemia were enrolled in an 18-wk trial. Using the probability approach for planning diets in an assisted-living facility, bioavailable iron intake was increased from 0.4 to 0.9mg/d by increasing the amounts of meat and citrus fruits and by adding iron-rich condiments to the diet, for an estimated cost of U.S. $0.59/mo. Hygiene behaviors were modified by implementing hand-washing before meals and by the use of individual plates for meals. Iron status indicators were measured twice and means at enrollment and after intervention were compared. RESULTS: After intervention, hemoglobin concentration increased from 98.7 to 103.8g/L (P=0.006). There was a decrease in total iron binding capacity (107 to 91mumol/L, P=0.05) and a marginal increase in transferrin saturation (13% to 17%, P=0.06). Significant improvement was not observed for serum ferritin concentration or prevalence of depleted iron stores, likely due to the confounding effect of infection. Anemia and iron-deficiency anemia were decreased from 64% to 30% and from 61% to 30%, respectively. CONCLUSION: Dietary modification associated with adequate hygiene behaviors could be a relevant strategy to control iron deficiency and anemia in areas where infection is a major health problem.
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | SAMPLING STUDIES | ORPHANS AND VULNERABLE CHILDREN | CHILD NUTRITION | INTERVENTIONS | DIET | IRON | ANEMIA | PREVALENCE | HYGIENE | HEMOGLOBIN LEVEL | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Family and Household | Sociocultural Factors | Nutrition | Health | Programs | Organization and Administration | Metals | Vitamins and Minerals | Physiology | Biology | Diseases | Measurement | Public Health | Hemic System
Document Number: 342282

Peer Reviewed

Title: Factors associated with anaemia in HIV-infected individuals in southern India.
Author: Subbaraman R; Devaleenal B; Selvamuthu P; Yepthomi T; Solomon SS; Mayer KH; Kumarasamy N
Source: International Journal of STD and AIDS. 2009 Jul;20(7):489-92.
Abstract: Anaemia accelerates disease progression and increases mortality among HIV-infected individuals. Few studies have characterized this problem in developing countries. Haemoglobin values of adults presenting to an HIV tertiary care center in India between 1996 and 2007 were collected (n = 6996). Multivariate logistic regression analysis was performed to examine associations among anaemia, HIV progression and co-morbidities. Overall, anaemia prevalence was 41%. Twenty percent of patients with CD4 counts >500 cells/microL were anaemic, compared with 64% of those with CD4 counts <100 cells/microL (P < 0.001). In multivariate analysis, CD4 count <100 cells/microL (odds ratio [OR]:5.0, confidence interval [CI]:4.0-6.3), underweight body mass index (OR:4.8, CI:3.6-6.5), female gender (OR:3.1, CI:2.8-3.6) and tuberculosis (TB) (OR:1.6, CI:1.4-1.8) were significantly associated with anaemia. In this setting, management of anaemia should focus on antiretroviral therapy, nutritional supplementation and TB control. The high anaemia prevalence among patients meeting criteria for antiretroviral therapy highlights the need for increased access to non-zidovudine nucleoside reverse transcriptase inhibitors in developing countries.
Language: English
Keywords:
INDIA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | ANEMIA | PREVALENCE | HEMOGLOBIN LEVEL | IMMUNOLOGICAL EFFECTS | INFECTIONS | BODY WEIGHT | MALNUTRITION | ANTIRETROVIRAL THERAPY | Asia, Southern | Asia | Developing Countries | HIV Infections | Viral Diseases | Diseases | Measurement | Research Methodology | Hemic System | Physiology | Biology | Immunity | Immune System | Nutrition Disorders | HIV
Document Number: 342828

10.

Peer Reviewed

Title: Treatment of menorrhagia with the levonorgestrel releasing intrauterine system: effects on ovarian function and uterus.
Author: Tasci Y; Caglar GS; Kayikcioglu F; Cengiz H; Yagci B; Gunes M
Source: Archives of Gynecology and Obstetrics. 2009 Jul;280(1):39-42.
Abstract: PURPOSE: To determine the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) on ovarian functions, uterine and fibroid volume. METHODS: In this prospective study, LNG-IUS was inserted to 46 women with menorrhagia. The patients were evaluated for serum levels of hemoglobin, FSH, LH and estradiol, ovarian volume, uterine and fibroid volume and Kupperman index scores at the time of insertion, at 6th and 12th months. RESULTS: Serum FSH levels increased in 69% of the device users, the increase of serum FSH levels were statistically significant (P = 0.021). Regression analysis showed significant association between FSH levels and age of the patient (P = 0.001). There were no statistically significant differences in ovarian and uterine volumes. A statistically significant decrease in myoma volumes were observed (P = 0.04). CONCLUSION: The application of LNG-IUS in reproductive age women seems to decrease fibroid size and increase hemoglobin levels without any significant dysfunction on ovaries.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | MENORRHAGIA | TREATMENT | IUD, HORMONE RELEASING | LEVONORGESTREL | OVARIAN EFFECTS | UTERINE EFFECTS | FIBROIDS | HEMOGLOBIN LEVEL | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Menstruation Disorders | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Ovary | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Uterus | Neoplasms, Benign | Neoplasms | Hemic System
Document Number: 341969

11.

Peer Reviewed

Title: Impact of HIV-1 infection on the hematological recovery after clinical malaria.
Author: Van Geertruyden JP; Mulenga M; Chalwe V; Michael N; Moerman F; Mukwamataba D; Colebunders R; D'alessandro U
Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):200-5.
Abstract: BACKGROUND: Anemia is the most frequent cytopenia in HIV-infected individuals and is often associated with malaria. OBJECTIVE: To assess the impact of HIV-1 on the hematological recovery after a clinical malaria episode. METHODS: In Ndola, Zambia, a region with high malaria and HIV prevalence, hemoglobin (Hb) was measured in 634 malaria patients 14 and 45 days after antimalarial treatment. Risk factors for hematological recovery were analyzed in a multivariate linear regression model. RESULTS: At enrollment, HIV-1-infected malaria patients had lower Hb compared with HIV-1 uninfected (122.7 vs 136.0 g/L; P < 0.001). In both groups, mean Hb was significantly lower at day 14 posttreatment than day 0 (P < 0.0001) and significantly higher at day 45 than at day 14 (HIV-1 negative: P = 0.0001; HIV-1 infected: P = 0.005). HIV-1 was a risk factor for a larger Hb decrease until day 14 (P < 0.001) and slower recovery until day 45 (P = 0.048). When considering the whole 45-day follow-up period, mean Hb increased in the HIV-1-negative group (+3.54 g/L; 95% confidence interval: 1.37 to 5.70; P = 0.001) but not in the HIV-1-infected group (-0.72 g/L; 95% confidence interval: -3.85 to +2.40; P = 0.64). HIV-1 infection as such (P < 0.0001), not CD4 cell count (P = 0.46), was an independent risk factor for a slower hematological recovery. CONCLUSIONS: HIV-1-infected malaria patients had a slower hematological recovery after successful parasite clearance. Malaria preventive measures should be targeted to this high-risk group.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | MALARIA | HIV INFECTIONS | HEMATOLOGICAL EFFECTS | ANEMIA | RISK FACTORS | HEMOGLOBIN LEVEL | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Parasitic Diseases | Hemic System | Physiology | Biology
Document Number: 330368

12.

Peer Reviewed

Title: Markers for predicting mortality in untreated HIV-infected children in resource-limited settings: A meta-analysis.
Author: Cross Continents Collaboration for Kids (3Cs4kids) Analysis and Writing Committee
Source: AIDS. 2008 Jan 2;22(1):97-105.
Abstract: The objectives were to evaluate the prognostic value of selected laboratory and growth markers on the short-term risk of mortality in untreated HIV-infected children in resource-limited settings. A meta-analysis of individual longitudinal data on children aged 12 months onwards from 10 studies (nine African, one Brazilian in the 3Cs4kids collaboration). Methods: The risk of death within 12 months based on age and the most recent measurements of laboratory and growth markers was estimated using Poisson regression models, adjusted for cotrimoxazole prophylaxis use and study effects. A total of 2510 children contributed 357 deaths during 3769 child-years-at-risk, with 81% follow-up occurring after start of cotrimoxazole. At first measurement, median age was 4.0 years (interquartile range, 2.2-7.0 years), median CD4% was 15% and weight-for-age z-score -1.9. CD4% and CD4 cell count were the strongest predictors of mortality, followed by weight-for-age and haemoglobin. After adjusting for these markers,the effects of total lymphocyte count and BMI-for-age were relatively small. Young children who were both severely malnourished and anaemic had high mortality regardless of CD4 values, particularly those aged 1-2 years. By contrast, high CD4% or CD4 cell count values predicted low mortality level amongst either children older than 5 years or those younger with neither severe malnutrition nor anaemia. CD4 measurements are the most important indicator of mortality and wider access to affordable tests is needed in resource-limited settings. Evaluation of antiretroviral initiation in children also needs to consider weight-for-age and haemoglobin. Prevention and treatment of malnutrition and anaemia is integral to HIV paediatric care and could improve survival. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | METHODOLOGICAL STUDIES | ESTIMATION TECHNIQUES | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | EVALUATION INDEXES | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | GROWTH | RISK ASSESSMENT | LABORATORY EXAMINATIONS AND DIAGNOSES | HEMOGLOBIN LEVEL | HIV INFECTIONS | Research Methodology | Studies | Data Analysis | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Mortality | Population Dynamics | Child Development | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hemic System | Physiology
Document Number: 322744

13.

Peer Reviewed

Title: Factors associated with haemoglobin concentration among Timor-Leste children aged 6-59 months.
Author: Agho KE; Dibley MJ; D'Este C; Gibberd R
Source: Journal of Health, Population and Nutrition. 2008 Jun;26(2):200-209.
Abstract: The study was conducted to assess the prevalence of and factors associated with haemoglobin (Hb) concentrations among children aged 6-59 months in Timor-Leste. The 2003 Demographic and Health Survey was a multi-stage cluster survey of 4,320 households from four different geographic regions in Timor-Leste. In total, 4,514 children aged 6-59 months were included in the analysis. The prevalence of anaemia (Hb concentration <11.0g/dL) was 38.2% (638/1,668) for children aged 6-23 months and 22.6% (644/2,846) for older children (p<0.001). Girls had a higher mean Hb concentration than boys (11.9g/dL vs 11.7g/ dL, p<0.006) and children who had diarrhoea in the previous two weeks had a lower Hb concentration than children without diarrhoea (11.5g/dL vs 11.9g/dL, p<0.001). Children from the richest and middleclass households had a lower average Hb concentration than those from the poorest households (11.8g/ dL, 11.7g/dL vs 12.0g/dL, p<0.001). Children of mothers with some secondary or more education had a lower mean Hb concentration than children of mothers with completed primary, some primary and no education (11.7 g/dL vs 11.9 g/dL, 11.8 g/dL, and 11.9 g/dL, p=0.002). Children from severely-anaemic mothers had a lower mean Hb concentration than children from moderately-, mild and not anaemic mothers (10.5 g/dL vs 11.1 g/dL, 11.6 g/dL, 12.0 g/dL, p<0.001). After backward stepwise hierarchical multiple regression, wasting, male sex, recent diarrhoea, household wealth index (richest and middle-class), maternal educational status (some secondary or more and some primary), and maternal anaemic status were significantly associated with a lower Hb concentration in children and increased age of child and duration of breastfeeding (6 months) with a higher Hb concentration. Anaemia-prevention programmes among children in Timor-Leste should focus on those children aged less than two years, children with recent diarrhoea, wasted children, high socioeconomic status, and anaemic mothers. (author's)
Language: English
Keywords:
SRI LANKA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | EPIDEMIOLOGIC METHODS | MULTIVARIATE ANALYSIS | CHILDREN | PREVALENCE | HEMOGLOBIN LEVEL | HUMAN GEOGRAPHY | ANEMIA | DIARRHEA | SEX FACTORS | SOCIOECONOMIC STATUS | EDUCATIONAL STATUS | MATERNAL HEALTH | Developing Countries | Asia, Southern | Asia | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Measurement | Hemic System | Physiology | Biology | Geography | Social Sciences | Science | Sociocultural Factors | Diseases | Socioeconomic Factors | Economic Factors | Health
Document Number: 327785

14.

Peer Reviewed

Title: Predictors of serum ferritin and haemoglobin during pregnancy, in a malaria-endemic area of western Kenya.
Author: Alusala DN; Estambale BB; Magnussen P; Friis H; Luoba AI
Source: Annals of Tropical Medicine and Parasitology. 2008 Jun;102(4):297-308.
Abstract: 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 enrolment. 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 (less than 7.0 g haemoglobin/dl). The geometric mean serum ferritin concentration recorded was 18.9 mg/litre, and 32.3% of the subjects evaluated had low serum concentrations of ferritin (less than 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. (author's)
Language: English
Keywords:
KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | SURVEYS | PREGNANT WOMEN | GESTATIONAL AGE | IRON | DEFICIENCY DISEASES | PREVALENCE | HEMOGLOBIN LEVEL | MALARIA | TRANSMISSION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Sampling Studies | Studies | Population Characteristics | Demographic Factors | Population | Fetus | Pregnancy | Reproduction | Metals | Vitamins and Minerals | Physiology | Biology | Nutrition Disorders | Diseases | Measurement | Hemic System | Parasitic Diseases | Infections
Document Number: 327216

15.

Peer Reviewed

Title: High-dose amphotericin B with flucytosine for the treatment of cryptococcal meningitis in HIV-infected patients: a randomized trial.
Author: Bicanic T; Wood R; Meintjes G; Rebe K; Brouwer A; Loyse A
Source: Clinical Infectious Diseases. 2008 Jul 1;47(1):123-30.
Abstract: BACKGROUND: The standard therapy for human immunodeficiency virus (HIV)-associated cryptococcal meningitis of amphotericin B (AmB; 0.7 mg/kg per day) plus flucytosine frequently takes >2 weeks to sterilize the cerebral spinal fluid, and acute mortality remains high. A dosage range for AmB of 0.7-1 mg/kg per day is noted in current guidelines, but there are no data comparing 0.7 mg/kg per day with 1 mg/kg per day. METHODS: Sixty-four HIV-seropositive, antiretroviral therapy-naive patients in Cape Town, South Africa, who experienced their first episode of cryptococcal meningitis during the period May 2005-June 2006 were randomized to receive either (1) AmB, 0.7 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 1; 30 patients); or (2) AmB, 1 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 2; 34 patients). Regimens were given for 2 weeks, followed by treatment with oral fluconazole. The primary outcome measure was early fungicidal activity, as determined by results of serial, quantitative cerebral spinal fluid cryptococcal cultures. Secondary outcome measures were safety and mortality. The median duration of follow-up was 1 year. RESULTS: Early fungicidal activity was significantly greater for group 2 than for group 1 (mean +/- SD, -0.56 +/- 0.24 vs. -0.45 +/- 0.16 log cfu/mL of cerebral spinal fluid per day; P = .02). The incidence of renal impairment did not significantly differ between the 2 groups. Anemia was associated with female sex and, less strongly, with membership in group 2. Renal impairment and anemia reversed after the regimen was switched to fluconazole. Two- and 10-week mortality rates were 6% and 24%, respectively, with no difference between groups. CONCLUSIONS: AmB, 1 mg/kg per day, plus flucytosine is more rapidly fungicidal than is standard-dose AmB plus flucytosine. Because of its size, this study provides limited data on any difference in toxicity between the regimens, but toxicities were manageable and reversible. CLINICAL TRIALS REGISTRATION NUMBER: ISRCTN68133435 (http://www.controlled-trials.com). (author's)
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | MENINGITIS | DRUGS | TREATMENT | ADMINISTRATION AND DOSAGE | HEMOGLOBIN LEVEL | SEX FACTORS | ANEMIA | RENAL EFFECTS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hemic System | Population Characteristics | Demographic Factors | Population | Urogenital Effects | Urogenital System
Document Number: 328366

16.

Title: HIV and nutrition among women in Sub-Saharan Africa.
Author: Bradley SE; Mishra V
Source: Calverton, Maryland, Macro International, MEASURE DHS, 2008 Sep. 79 p. (USAID Contract No. GPO-C-00-03-00002-00DHS Analytical Studies No. 16)
Abstract: Background In the absence of antiretroviral therapy (ART), HIV-positive people will lose weight and eventually become wasted or severely underweight. However, levels of obesity and overweight seem to be increasing in several sub-Saharan African countries severely impacted by HIV and with little or no ART available. In many of these countries, HIV prevalence is higher among overweight people than those of normal or below-normal body weight. Objectives To better understand this apparent anomaly, this study investigates the relationship between HIV, body mass index (BMI), and hemoglobin levels (biomarker for anemia) among adult women in sub-Saharan Africa. The study also investigates the relationship between HIV, women's nutritional status, and their breastfeeding mode (exclusive, mixed, or none). Methods The data come from 12 nationally representative Demographic and Health Surveys (DHS) conducted between 2003 and 2006 in Burkina Faso, Cameroon, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Malawi, Niger, Rwanda, Senegal, and Zimbabwe. Because height and weight were not measured for men in the majority of surveys, this study focuses only on women. Blood samples were collected for HIV and anemia testing, following internationally accepted ethical standards and procedures. HIV and anemia test results were linked anonymously to socio-demographic and height and weight data. The study used descriptive and multivariate statistical methods to examine the relationships between HIV status and BMI, hemoglobin concentration, and breastfeeding mode. In multivariate analysis, data from all 12 countries were pooled together and sampling weights were adjusted according to the relative population sizes of the countries. Results HIV and BMI. HIV prevalence is highest among overweight women in 5 of the 12 countries studied, and it is highest among underweight women only in Malawi. In seven countries, the percentage of HIV-negative women who are underweight is greater than the percentage of HIV-positive women who are underweight. Similarly, in half of the countries studied the percentage of HIV-positive women who are overweight is greater than the percentage of HIV-negative women who are overweight. In pooled analysis, HIV-positive vs. HIV-negative status is significantly positively associated with being overweight, and is significantly negatively associated with being underweight. After controlling for wealth and other socio-demographic characteristics, however, the relationship reverses direction, and HIV-positive status becomes significantly positively associated with being underweight. HIV and Anemia. HIV prevalence increases monotonically with severity of anemia for all countries except Ethiopia. In every country studied, the percentage of HIV-positive women who are anemic is much larger than the percentage of HIV-negative women who are anemic. In pooled analysis, HIV-positive status is significantly negatively associated with hemoglobin concentration, and the relationship grows stronger when background characteristics and BMI are controlled for. HIV, Nutrition, and Breastfeeding. Only limited data are available on women's breastfeeding mode by HIV status, due to the small number of women who are HIV-positive and who have children less than six months old at the time of interview. In pooled multivariate models, however, there does not appear to be any negative impact of breastfeeding on the nutritional status of HIV-positive mothers compared with non-breastfeeding HIV-negative mothers. In fact, HIV-positive women who exclusively breastfeed their infants have slightly higher hemoglobin concentrations than HIV-negative women who do not breastfeed, after controlling for BMI and background characteristics. Conclusions HIV is independently associated with poorer nutritional status-particularly low hemoglobin concentration-after controlling for household wealth and other socio-demographic characteristics of the women studied. This study therefore provides evidence to support increasing food security and providing nutritional supplementation to HIV-positive people. At the same time, this study shows that in bivariate analysis HIV is concentrated among overweight women in several sub-Saharan African countries, emphasizing the fact that HIV does not affect only those who "look sick" or appear malnourished. Implications for the general public include both an emphasis for everyone to get tested regardless of how healthy they may look, and for individuals to remember to use protection with every partner even if they appear healthy. Counselors should encourage people to be tested for HIV regardless of their current BMI, and they should consider that clients could be HIV-positive even if they appear overweight. If past trends continue, the proportion of people in sub-Saharan Africa who are either overweight or underweight will grow. This dual burden has particular implications for ART, which is becoming more widely available as many countries work towards scale-up. To address potential problems with ART use in overweight and underweight patients, clinicians should consider their patient's nutritional status, including titrating drug combinations to patient's body weights when possible to limit adverse effects due to nutritional differences.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | PERSONS LIVING WITH HIV/AIDS | WOMEN'S HEALTH | HIV INFECTIONS | PREVALENCE | HEMOGLOBIN LEVEL | BODY WEIGHT | OBESITY | ANEMIA | MALNUTRITION | BREASTFEEDING | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Research Methodology | Economic Development | Economic Factors | Viral Diseases | Diseases | Health | Measurement | Hemic System | Physiology | Biology | Nutrition Disorders | Infant Nutrition | Nutrition
Document Number: 329994

17.

Peer Reviewed

Title: Haptoglobin genotype, anaemia and malaria in Gambian children.
Author: Cox SE; Doherty CP; Atkinson SH; Nweneka CV; Fulford AJ
Source: Tropical Medicine and International Health. 2008 Jan;13(1):76-82.
Abstract: The objective was to retest our previous finding that the haptoglobin (Hp) 22 genotype is associated with seasonal anaemia, and to investigate the role of malaria in this effect. Haemoglobin (Hb) and peripheral parasitaemia were assessed at pre- and post-malarial season cross-sectional surveys in rural Gambian children aged 10-72 months. Between the surveys, active longitudinal surveillance was conducted to detect febrile episodes. Unlike previously, no overall reduction in Hb was observed (Hb = 106.1 vs. 107.2 g/l, P = 0.13, n = 545). However, multi-variable linear regression revealed differences in Hb over the season by Hp and Hb-sickle (HbS) genotype (-2.20 g/l per copy of the Hp2 allele, P = 0.043; HbAS vs. HbAA + 3.13 g/l, P = 0.11, n = 536). There was no effect of malarial episodes during follow-up; this suggests that when effective treatment is given, Hb levels recover. The A61-C Hp promoter SNP, associated with the Hp2 allele, had no effect. The effect of the Hp2 allele appears to be independent of effects on malaria incidence but may affect Hb levels through increased oxidant stress and red cell turnover. This may be supported by our previous observations that the effect of Hp22 was independent of markers of iron status and zinc protoporphyrin measured at the cross-sectional surveys and therefore also of iron availability for erythropoiesis. (author's)
Language: English
Keywords:
GAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | GENETIC TECHNIQUES | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | CHILDREN | RURAL POPULATION | ANEMIA | SEASONAL VARIATION | HEMOGLOBIN LEVEL | FEVER | MALARIA | GENETICS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Studies | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Population Dynamics | Hemic System | Physiology | Biology | Body Temperature | Parasitic Diseases
Document Number: 324684

18.

Title: Antenatal care and pregnancy outcome in Ghana, the importance of women's education.
Author: Fak T; Lartey A
Source: African Journal of Food, Agriculture, Nutrition and Development. 2008 Sep;8(3):291-303.
Abstract: The antenatal characteristics of 503 pregnant women attending maternal and child health clinics in Accra were studied to ascertain the influence of antenatal care on pregnancy outcome. Gestation age of first antenatal care attendance, duration of nutrients supplementation during pregnancy, infant birth-weight and level of education in relation to seeking early antenatal care were studied. A sub-sample comprising 128 were selected for a longitudinal study which assessed monthly haemoglobin concentration of the pregnant women when they reported for antenatal care. Results showed that the level of educational of the pregnant women was important in seeking early antenatal care. Higher educational level associated with early antenatal care attendance. Majority of the subjects attended antenatal care in the 3rd month of pregnancy. The average birth-weight of infants delivered by the 503 pregnant women was 3.02 +or- 0.45 kg and the prevalence of low birth-weight (birth-weight < 2.5 kg) was 8.3%. Pregnant women who sought antenatal care before the end of the 3rd month delivered infants whose birth-weights were significantly better compared to those who sought care later (3.08 +or- 0.44 vs 2.85 +or- 0.46 kg, respectively, P < 0.0001). Those who received antenatal care before the end of the 3rd month had on average 3.2 times (95% CI: 1.9 -5.2, P < 0.0001) better chance of giving birth to a normal weight infant. Pregnant women who received antenatal care and were on multivitamin and mineral supplements for more than 5 months had infants who weighed better than those who received care for lesser duration (3.04 +or- 0.44 vs 2.88 +or- 0.55 kg, respectively P < 0.0001). The longitudinal haemoglobin study showed an average haemoglobin concentration of 11.5 +or- 0.6 g/dL, n = 128. The anaemia rate among the pregnant women ranged from 24 - 38% depending on gestation age. Early antenatal care was associated with significant improvement in haemoglobin concentration (r = +0.35, P < 0.0001, n = 128). It was concluded that early antenatal care is crucial to favourable outcome of pregnancy in this population.
Language: English
Keywords:
GHANA | SUMMARY REPORT | PREGNANT WOMEN | ANTENATAL CARE | PREGNANCY OUTCOMES | MATERNAL HEALTH | HEALTH EDUCATION | BIRTH WEIGHT | HEMOGLOBIN LEVEL | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Education | Body Weight | Physiology | Biology | Hemic System
Document Number: 322506

19.

Peer Reviewed

Title: Antibodies to pre-erythrocytic Plasmodium falciparum antigens and risk of clinical malaria in Kenyan children.
Author: John CC; Tande AJ; Moormann AM; Sumba PO; Lanar DE
Source: Journal of Infectious Diseases. 2008;197:519-526.
Abstract: IgG antibodies to pre-erythrocytic antigens are involved in prevention of infection and disease in animal models of malaria but have not been associated with protection against disease in human malaria. Levels of IgG antibodies to circumsporozoite protein (CSP), liver-stage antigen type 1 (LSA-1), and thrombospondin-related adhesive protein (TRAP) were measured in 86 children in a malaria-holoendemic area of Kenya. The children were then monitored for episodes of clinical malaria for 52 weeks. Children with high levels of IgG antibodies to CSP, LSA-1, and TRAP had a decreased risk of clinical malaria (adjusted hazard ratio, 0.29; 95% confidence interval 0.10-0.81; P = .02), a lower incidence of clinical malaria (P = .006), protection from clinical malaria with a parasite level of greater than or equal to 4000 parasites/microL (P = .03), and a higher hemoglobin level at enrollment (P = .009), compared with children with lower antibody levels. Protection against malaria morbidity was associated primarily with antibodies to CSP and LSA-1. Kenyan children with high levels of IgG antibodies to the pre-erythrocytic antigens CSP, LSA-1, and TRAP have a lower risk of developing clinical malaria than children without high levels of these antibodies. The decreased risk of clinical malaria may be mediated in part by prevention of high-density parasitemia. (author's)
Language: English
Keywords:
KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | CHILDREN | MALARIA | ANTIBODIES | ANTIGENS | HEMOGLOBIN LEVEL | ANTIMALARIAL DRUGS | ADMINISTRATION AND DOSAGE | PREVENTION AND CONTROL | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Hemic System | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 324555

20.

Peer Reviewed

Title: Cord blood and breast milk iron status in maternal anemia.
Author: Kumar A; Rai AK; Basu S; Dash D; Singh JS
Source: Pediatrics. 2008 Mar;121(3):e673-e677.
Abstract: The purpose of this work was to assess the effect of severe maternal iron-deficiency anemia and nutritional status on cord blood and breast milk iron status. We conducted a prospective observational study over a 6-month period in a teaching hospital in central India. The study population consisted of 55 anemic (hemoglobin: less than 110 g/L) and 20 healthy nonanemic (hemoglobin: greater than or equal to 110 g/L) pregnant women who delivered singleton live births at term gestation. We measured hemoglobin, iron, and ferritin levels in paired maternal and cord blood and iron levels in early (day 3 plus or minus 1) and late (day 15 plus or minus 3) transitional milk. Maternal anthropometry, including weight, height, midarm circumference, triceps skinfold thickness, and placental weight, were recorded. The main outcome measure of the study was to find out the relationship of maternal hemoglobin, iron, ferritin, and anthropometry with hemoglobin, iron, and ferritin in cord blood and iron levels in breast milk. Concentrations of hemoglobin, iron, and ferritin were significantly lower in the cord blood of anemic mothers and showed linear relationships with maternal hemoglobin and ferritin levels. Breast milk iron content was significantly reduced in severely anemic mothers but not in those with mild-to-moderate anemia. Breast milk iron level correlated with maternal hemoglobin and iron levels but not with ferritin levels. Maternal anthropometry had significant correlations with indices of iron nutriture in maternal and cord blood but showed no relationship with breast milk iron content. Placental weight was comparable between anemic and nonanemic mothers. Maternal anemia, particularly the severe type, adversely affects cord blood and breast milk iron status. Maternal nutritional status exerts a significant influence on fetal iron status but has little influence on breast milk iron content. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | ANEMIA | HUMAN MILK | SERUM IRON LEVEL | PREGNANCY COMPLICATIONS | HEMOGLOBIN LEVEL | ANTHROPOMETRY | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Diseases | Lactation | Maternal Physiology | Physiology | Biology | Hemic System | Measurement
Document Number: 324977

21.

Peer Reviewed

Title: Goserelin versus leuprolide before hysterectomy for uterine fibroids.
Author: Lim SS; Sockalingam JK; Tan PC
Source: International Journal of Gynecology and Obstetrics. 2008 May;101(2):178-183.
Abstract: The objective was to compare goserelin and leuprolide given before hysterectomy for symptomatic large fibroid uteri. A randomized study of 66 premenopausal women with fibroid uteri at least 14 weeks of gestation in a gravid uterus. Women were randomized to receive either subcutaneous depot 3.6 mg goserelin or 3.75 mg leuprolide every 4 weeks for a total of 3 doses. Hysterectomy was performed within 1 month of the last dose. A total of 34 women randomized to the goserelin group and 31 women to the leuprolide group were available for analysis. Preoperative hemoglobin level (P=0.89), operative blood loss (P=0.72), and operating time (P=0.39) were not different between the 2 groups. Postoperative hemoglobin was higher in the leuprolide group (P=0.003), but blood transfusion requirement was not different between the groups (P=1.0). Other outcomes and side effects of the drugs were similar. Goserelin and leuprolide administered before hysterectomy for uterine fibroids have similar perioperative outcomes. (author's)
Language: English
Keywords:
MALAYSIA | RESEARCH REPORT | WOMEN | UTERINE EFFECTS | FIBROIDS | DRUGS | ADMINISTRATION AND DOSAGE | GONADOTROPINS | HYSTERECTOMY | HEMOGLOBIN LEVEL | SIDE EFFECTS | Developing Countries | Asia, Southeastern | Asia | Demographic Factors | Population | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Neoplasms, Benign | Neoplasms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormones | Endocrine System | Gynecologic Surgery | Urogenital Surgery | Surgery | Hemic System
Document Number: 325981

22.

Title: Effect of fetal diagnosis on the outcomes of second-trimester pregnancy termination for fetal abnormalities: a pilot study.
Author: Lo TK; Lau WL; Lai FK; Lam HS; Tse HY
Source: Journal of Maternal - Fetal and Neonatal Medicine. 2008 Aug;21(8):523-7.
Abstract: OBJECTIVE: To explore whether the outcomes of second-trimester pregnancy termination for fetal abnormalities are affected by fetal diagnoses. METHODS: This was a retrospective review of cases undergoing second-trimester pregnancy termination for the fetal diagnoses of hemoglobin Barts, trisomy 21, and trisomy 18 during the period from 1999 to 2006. The affected pregnancies were terminated by vaginal misoprostol. The outcome measures were: (1) abortion within 24 hours after misoprostol commencement, (2) histology-confirmed incomplete abortion, and (3) experience of significant side effects during termination (temperature over 39 degrees C or need for metoclopramide for vomiting). RESULTS: One hundred and twenty cases were available for analysis. After adjusting for maternal age, parity, history of cesarean delivery, body mass index, gestation, and fetal hydrops, pregnancy termination for trisomy 21 was associated with a higher risk of incomplete abortion than trisomy 18 and hemoglobin Barts (odds ratio 5.25, 95% confidence interval 1.24-22.19, p = 0.024). The chance of abortion within 24 hours and experience of significant side effects were not found to be associated with fetal diagnosis. CONCLUSIONS: Pregnancy termination for trisomy 21 is associated with a higher risk of incomplete abortion. Fetal diagnosis affects the outcome of pregnancy termination.
Language: English
Keywords:
HONG KONG | RESEARCH REPORT | CLINICAL RESEARCH | PILOT PROJECTS | RETROSPECTIVE STUDIES | FETUS | PREGNANCY, SECOND TRIMESTER | ABORTION | EXAMINATIONS AND DIAGNOSES | CONGENITAL ABNORMALITIES | HEMOGLOBIN LEVEL | MISOPROSTOL | TIME FACTORS | FETAL VIABILITY | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Neonatal Diseases and Abnormalities | Diseases | Hemic System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Population Dynamics | Demographic Factors | Population
Document Number: 329124 Notification

23.

Title: The influence and benefits of controlling for inflammation on plasma ferritin and hemoglobin responses following a multi-micronutrient supplement in apparently healthy, HIV+ Kenyan adults.
Author: Mburu AS; Thurnham DI; Mwaniki DL; Muniu EM; Alumasa F
Source: Journal of Nutrition. 2008 Mar;138:613-619.
Abstract: Hemoglobin and ferritin are important biomarkers of iron status but are both altered by inflammation. We used the inflammation biomarkers C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP) to adjust hemoglobin and ferritin concentrations to clarify interpretation of iron status. Apparently healthy adults who tested positive twice for HIV but who had not reached stage IV or clinical AIDS were randomly allocated to receive a food supplement (n = 17 and 21) or the food plus a micronutrient capsule (MN; 10 men and 34 women, respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP concentrations were measured at baseline and 3 mo and subjects were divided into 4 groups (reference, no inflammation; incubating, raised CRP; early convalescence, raised AGP and CRP; and late convalescence, raised AGP). Correction factors (the ratios of the median for the reference group over each inflammatory group) improved the consistency of the ferritin but not the hemoglobin results. After correction, ferritin (but not hemoglobin) increased in both men (48 microg/L; P = 0.02) and women (12 microg/L; P = 0.04) who received MN but not in the food-only group. However, hemoglobin did improve in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019), but ferritin did not increase in this group. In conclusion, ferritin concentrations were more closely linked to current inflammation than hemoglobin; hence, correction by inflammation biomarkers improved data consistency. However, low hemoglobin concentrations were the consequence of long-term chronic inflammation and improvements in response to MN supplements were only detected in subjects with no inflammation. (author's)
Language: English
Keywords:
KENYA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | ADULTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | HEMOGLOBIN LEVEL | SERUM IRON LEVEL | FOOD SUPPLEMENTATION | VITAMINS AND MINERALS | ADMINISTRATION AND DOSAGE | HISTOCHEMICAL EFFECTS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Hemic System | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Medical Procedures | Medicine | Cytologic Effects
Document Number: 324775

24.
Peer Reviewed

Title: Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women.
Author: Mehta S; Manji KP; Young AM; Brown ER; Chasela C
Source: American Journal of Clinical Nutrition. 2008 Jun;87(6):1639-1649.
Abstract: Poor nutrition may be associated with mother-to-child transmission (MTCT) of HIV and other adverse pregnancy outcomes. The objective was to examine the relation of nutritional indicators with adverse pregnancy outcomes among HIV-infected women in Tanzania, Zambia, and Malawi. Body mass index (BMI; in kg/m2) and hemoglobin concentrations at enrollment and weight change during pregnancy were prospectively related to fetal loss, neonatal death, low birth weight, preterm birth, and MTCT of HIV. In a multivariate analysis, having a BMI less than 21.8 was significantly associated with preterm birth [odds ratio (OR): 1.82; 95% CI: 1.34, 2.46] and low birth weight (OR: 2.09; 95% CI: 1.41, 3.08). A U-shaped relation between weight change during pregnancy and preterm birth was observed. Severe anemia was significantly associated with fetal loss or stillbirth (OR: 3.67; 95% CI: 1.16, 11.66), preterm birth (OR: 2.08; 95% CI: 1.39, 3.10), low birth weight (OR: 1.76; 95% CI: 1.07, 2.90), and MTCT of HIV by the time of birth (OR: 2.26;95%CI: 1.18, 4.34) and by 4-6 wk among those negative at birth (OR: 2.33; 95% CI: 1.15, 4.73). Anemia, poor weight gain during pregnancy, and low BMI in HIV-infected pregnant women are associated with increased risks of adverse infant outcomes and MTCT of HIV. Interventions that reduce the risk of wasting or anemia during pregnancy should be evaluated to determine their possible effect on the incidence of adverse pregnancy outcomes and MTCT of HIV. (author's)
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | MATERNAL NUTRITION | BODY WEIGHT | HEMOGLOBIN LEVEL | HIV INFECTIONS | MOTHER-TO-CHILD TRANSMISSION | FETAL DEATH | NEONATAL MORTALITY | LOW BIRTH WEIGHT | Developing Countries | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Nutrition | Health | Physiology | Biology | Hemic System | Transmission | Infections | Mortality | Population Dynamics | Infant Mortality | Birth Weight
Document Number: 308639

25.
Title: Falciparum malaria in a South African tertiary care hospital.
Author: Mphahlele BJ; Mpe MJ
Source: Polskie Archiwum Medycyny Wewnetrznej. 2008 Jun;118(6):351-5.
Abstract: INTRODUCTION: This study was a retrospective case series over one year. OBJECTIVES: The purpose was to review the clinical presentation, travel history, laboratory findings and outcome of Plasmodium falciparum malaria. PATIENTS AND METHODS: The study was conducted in the medical wards of Dr. George Mukhari Hospital, a teaching hospital in South Africa that serves mainly black patients. Fifty-nine patients were evaluated. The mean age was 34 years. Twenty-three patients (39%) had strictly defined severe malaria. Ninety-eight percent acquired Plasmodium falciparum in Sub-Saharan Africa. The death rate was 1.7%. Virtually all patients had a travel history obtained in the emergency department and the diagnosis was confirmed in all cases within 24 hours of admission. RESULTS: In our study population, the differences in the percent parasitemia, platelet count, haemoglobin and bilirubin were not statistically significant between the cases with severe and those with less severe malaria. CONCLUSIONS: Plasmodium falciparum malaria should not carry a high mortality in adequately equipped centers, when the diagnosis is made early and therapy is instituted promptly.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | BLACKS | MALARIA | TRAVEL AND TOURISM | SIGNS AND SYMPTOMS | PREVALENCE | DEATH RATE | DEMOGRAPHIC FACTORS | HEMOGLOBIN LEVEL | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Ethnic Groups | Cultural Background | Population Characteristics | Population | Parasitic Diseases | Diseases | Behavior | Measurement | Mortality | Population Dynamics | Hemic System | Physiology | Biology
Document Number: 328777

26.

Peer Reviewed

Title: Interethnic differences in carriage of haemoglobin AS and Fcgamma receptor IIa (CD32) genotypes in children living in eastern Sudan.
Author: Nasr A; El Ghazali G; Giha H; Troye-Blomberg M; Berzins K
Source: Acta Tropica. 2008 Feb;105(2):191-195.
Abstract: Fulani and Masaleit, two sympatric ethnic groups in eastern Sudan, are characterized by marked differences in susceptibility to Plasmodium falciparum malaria. It has been suggested that sickle cell trait carriage may protect from the most severe forms of malaria. Previously, we have shown that FcyRIIa polymorphism is associated with the outcome of malaria disease. The present study aimed at determining whether the two tribes differ in the frequency of FcyRIIa and Hb AS genotypes. For this, genotyping of FcyRIIa and Hb AS in 70 Fulani and 70 Masaleit age- and sex-matched subjects was conducted. The frequency of FcyRIIa H/H131 genotype was higher in the Fulani as compared to the Masaleit group (40.0% versus 14.3%; adjusted odd ratio [OR] = 3.05, 95% confidence interval [CI] = 1.19-7.82 and P = 0.02), while the R/R131 genotype was significantly higher in the Masaleit group (14.3% for Fulani versus 45.0% for Masaleit; adjusted OR= 0.26, 95% CI = 0.11-0.64 and P less than 0.01). With regard to FcyRIIa allele frequencies, there were significant differences between the Fulani and Masaleit ethnic groups. Thus, the H131 allele was more frequent than the R131 among Fulani children (0.63 versus 0.37, OR= 3.23, 95% CI = 1.93-5.45 and P less than 0.001). The frequency of the Hb AS genotype was lower in the Fulani compared to the Masaleit group (15.7% versus 30.0%, respectively, adjusted OR= 0.02, CI = 0.01-0.18 and P less than 0.01). These data suggest that FcyRIIa and Hb AS polymorphisms may contribute to the clinical outcome of malaria. We conclude that the H/H131 genotype and H131 allele rather than Hb AS genotype (sickle cell trait patients) appear to associate with the Fulani ethnic group. (author's)
Language: English
Keywords:
SUDAN | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | CLINICAL RESEARCH | GENETIC TECHNIQUES | ETHNIC GROUPS | HEMOGLOBIN LEVEL | CHROMOSOME ABNORMALITIES | IMMUNITY, NATURAL | ANEMIA | CHRONIC DISEASES | Developing Countries | Africa, North | Africa | Comparative Studies | Studies | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cultural Background | Population Characteristics | Demographic Factors | Population | Hemic System | Physiology | Biology | Neonatal Diseases and Abnormalities | Diseases | Immunity | Immune System
Document Number: 325603

27.

Peer Reviewed

Title: Predictors of mortality in patients initiating antiretroviral therapy in Durban, South Africa.
Author: Ojikutu BO; Zheng H; Walensky RP; Lu Z; Losina E
Source: South African Medical Journal. 2008 Mar;98(3):204-208.
Abstract: Objective. To identify predictors of mortality in patients initiating antiretroviral therapy (ART) in Durban, South Africa. Design. We conducted a retrospective cohort study analysing data on patients who presented to McCord Hospital, Durban, and started ART between 1 January 1999 and 29 February 2004. We performed univariate and multivariate analysis and constructed Kaplan-Meier curves to assess predictors. Results. Three hundred and nine patients were included. Forty-nine (16%) had died by the conclusion of the study. In univariate analysis, the strongest predictors of mortality were a CD4 cell count <50/�l (hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.96 - 7.14), a haemoglobin concentration Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | MULTIVARIATE ANALYSIS | PERSONS LIVING WITH HIV/AIDS | AIDS | ANTIRETROVIRAL THERAPY | IMMUNITY, CELLULAR | CAUSES OF DEATH | HEMOGLOBIN LEVEL | CANDIDIASIS | MENINGITIS | ORAL EFFECTS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Data Analysis | HIV Infections | Viral Diseases | Diseases | HIV | Immunity | Immune System | Physiology | Biology | Mortality | Population Dynamics | Demographic Factors | Population | Hemic System | Bacterial and Fungal Diseases | Infections | Central Nervous System Effects | Central Nervous System
Document Number: 330636

28.

Title: Diarrhea and fever as risk factors for anemia among children under age five living in urban slum areas of Indonesia.
Author: Semba RD; de Pee S; Ricks MO; Sari M; Bloem MW
Source: International Journal of Infectious Diseases. 2008;12:62-70.
Abstract: The objectives were to characterize diarrhea and fever as risk factors for anemia among children in developing countries. We characterized risk factors for anemia in a sample of 32 873 children, aged 6-59 months, from poor families in urban slum areas of Indonesia from 2000 to 2003. The prevalence of anemia was 58.7%. In separate multivariate models, after adjusting for age, sex, stunting, maternal age and education, and weekly per capita household expenditure, current diarrhea (OR 1.20, 95% CI 1.07-1.35, p = 0.002), current fever (OR 1.44, 95% CI 1.18-1.75, p < 0.0001), and a history of diarrhea in the previous seven days (OR 1.12, 95% CI 1.03-1.23, p = 0.024) were associated with an increased risk of anemia. Diarrhea and fever are important risk factors for anemia among young children living in urban slum communities in Indonesia. (author's)
Language: English
Keywords:
INDONESIA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | MULTIVARIATE ANALYSIS | CHILDREN | FEVER | DIARRHEA | RISK FACTORS | ANEMIA | HEMOGLOBIN LEVEL | PREVALENCE | Developing Countries | Asia, Southeastern | Asia | Research Methodology | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Body Temperature | Physiology | Biology | Diseases | Hemic System | Measurement
Document Number: 323229

29.

Title: Laboratory characteristics of HIV-1 clade C-infected long-term non-progressors at a tertiary human immunodeficiency virus care centre in South India [letter]
Author: Shanmugasundaram U; Murugavel KG; Shankar EM; Balakrishnan P; Solomon S; Kumarasamy N
Source: Journal of Medical Microbiology. 2008 Jul;57(Pt 7):913-5.
Abstract: The AIDS pandemic is particularly serious in India, where HIV-1 clade C is widely distributed (Sheppard et al., 1993). Attempts to generate a vaccine seem to have challenged the scientific community for over 25 years since the discovery of HIV-1. Conceptually, the generation of any successful vaccine requires the understanding of features consistent to the virus, and would depend on multiple factors, including viral and host immunogenetic features, as exemplified by HIV-1 infection. The preliminary characteristics necessary to define LTNPs in third-world countries, especially in the Indian scenario, are inadequate. Therefore, we studied the virological, microbiological and immunological characteristics of LTNPs (n=12) and progressors (n=12) with HIV-1 clade C infection at Y R Gaitonde Centre for AIDS Research and Education (YRG CARE), a tertiary HIV referral centre in Chennai, South India. Since 1993, the centre has provided medical and psychosocial care to over 11,000 HIV-infected individuals in the region, and has been conducting vaccine and clinical trials in the south of India since 2001, and is funded by the National Institutes of Health and other organizations in the United States. YRG CARE's clinical and research laboratory has been participating in the external quality assessment programmes of the UK-National External Quality Assessment Scheme for immunophenotyping, National Serology Reference Laboratory, Australia, and the College of American Pathologists, USA, and has been certified with Good Clinical Laboratory Practices compliance since 2001. (excerpt)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | EPIDEMIOLOGY | IMMUNOLOGICAL EFFECTS | HEMOGLOBIN LEVEL | BODY WEIGHT | HEMATOLOGICAL EFFECTS | Developing Countries | Asia, Southern | Asia | Research Methodology | Viral Diseases | Diseases | Public Health | Health | Immunity | Immune System | Physiology | Biology | Hemic System
Document Number: 328342

30.
Title: Epidemiological correlates of nutritional anemia among children (6-35 months) in rural Wardha, Central India.
Author: Sinha N; Deshmukh PR; Garg BS
Source: Indian Journal of Medical Sciences. 2008 Feb;62(2):45-54.
Abstract: Nutritional anemia is associated with impaired performance of a range of mental and physical functions in children, along with increased morbidity. Iron supplementation at a later age may not reverse the adverse effects. National Nutritional Anemia Control Program was launched in India in 1970, but it failed to make any impact. The present study was undertaken to find out prevalence of anemia and its correlates in rural Wardha in children 6-35 months of age. Seven hundred seventy-two children between 6 months and 35 months of age were studied for anemia by cluster-sampling method. The hemoglobin was estimated in the child by 'Filter paper cyanmethemoglobin method.' Pre-designed and pre-tested questionnaire was used to collect data on socio-demographic and other variables. Data was analyzed by SPSS 12.0.1. Mean hemoglobin level was 98.5 plus or minus 12.9 gm/L. Prevalence of anemia was 80.3%. Only 1.3% children had severe anemia (hemoglobin less than 70 gm/L). The univariate analysis showed that anemia is significantly associated with age of the child, education of mother and father, occupation of father, socioeconomic status, birth order and nutritional status as measured by weight for age. The final model suggested that only educational status of the mother, occupation of the father, birth order and nutritional status of the child were significantly associated with anemia. For short-term impact, appropriate nutritional interventions remain the only operational intervention as only the nutritional status (weight for age) is a modifiable factor. But for long-term sustained impact, policy makers need to focus on improving maternal education and reducing family size. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | QUESTIONNAIRES | CHILD | PARENTS | ANEMIA | PREVALENCE |