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  • 1. Alfvén, T.
    et al.
    Axelson, H.
    Rand, A. L.
    Peterson, S. S.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Dödligheten minskar, men fortfarande dör 7 miljoner barn varje år2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 1-2, p. 28-30Article in journal (Refereed)
  • 2. Alfvén, Tobias
    et al.
    Axelson, Henrik
    Lindstrand, Ann
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Ake
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Dödligheten minskar, men fortfarande dör 7 miljoner barn varje år2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 1-2, p. 28-30Article in journal (Other academic)
    Abstract [sv]

    Millenniemål 4 lyder: »Barnadödligheten under de fem första levnadsåren ska minska med två tredjedelar till 2015 jämfört med år 1990«.

    Barnadödligheten minskar i ­stora delar av världen, men inte i tillräckligt snabb takt för att uppnå målet. Den skiljer sig också kraftigt mellan länder och mellan olika grupper inom länderna.

    Sex dödsorsaker står för mer än 90 procent av alla dödsfall före 5 års ålder: neonatal mortalitet, lunginflammation, diarré, ­malaria, mässling och HIV/aids. ­Undernäring beräknas vara ­delorsak till cirka en tredjedel av dessa dödsfall.

    Vi har kunskap och metoder att med kostnadseffektiva lösningar reducera barnadödligheten med två tredjedelar. Fortsatt inter­nationellt samarbete, utökade ­resurser samt lokal, nationell po­litisk vilja krävs för att lyckas.

  • 3.
    Andersson, Cecilia
    et al.
    Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.
    Carlsson, Annelie
    Department of Paediatrics, Lund University, Skåne University Hospital SUS, Lund, Sweden.
    Cilio, Corrado
    Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.
    Cedervall, Elisabeth
    Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden.
    Ivarsson, Sten-Anders
    Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.
    Jonsdottir, Berglind
    Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.
    Jönsson, Björn
    Department of Paediatrics, Ystad Hospital, Ystad, Sweden.
    Larsson, Karin
    Department of Paediatrics, Kristianstad Hospital, Kristianstad, Sweden.
    Neiderud, Jan
    Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden.
    Lernmark, Åke
    Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.
    Elding Larsson, Helena
    Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.
    Glucose tolerance and beta-cell function in islet autoantibody-positive children recruited to a secondary prevention study2013In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 14, no 5, p. 341-349Article in journal (Refereed)
    Abstract [en]

    AIMS: Children with type 1 diabetes (T1D) risk and islet autoantibodies are recruited to a secondary prevention study. The aims were to determine metabolic control in relation to human leukocyte antigen (HLA) genetic risk and islet autoantibodies in prepubertal children.

    METHODS: In 47 healthy children with GADA and at least one additional islet autoantibody, intravenous glucose tolerance test (IvGTT) and oral glucose tolerance test (OGTT) were performed 8-65 d apart. Hemoglobin A1c, plasma glucose as well as serum insulin and C-peptide were determined at fasting and during IvGTT and OGTT.

    RESULTS: All children aged median 5.1 (4.0-9.2) yr had autoantibodies to two to six of the beta-cell antigens GAD65, insulin, IA-2, and the three amino acid position 325 variants of the ZnT8 transporter. In total, 20/47 children showed impaired glucose metabolism. Decreased (≤ 30 μU/mL insulin) first-phase insulin response (FPIR) was found in 14/20 children while 11/20 had impaired glucose tolerance in the OGTT. Five children had both impaired glucose tolerance and FPIR ≤ 30 μU/mL insulin. Number and levels of autoantibodies were not associated with glucose metabolism, except for an increased frequency (p = 0.03) and level (p = 0.01) of ZnT8QA in children with impaired glucose metabolism. Among the children with impaired glucose metabolism, 13/20 had HLA-DQ2/8, compared to 9/27 of the children with normal glucose metabolism (p = 0.03).

    CONCLUSION: Secondary prevention studies in children with islet autoantibodies are complicated by variability in baseline glucose metabolism. Evaluation of metabolic control with both IvGTT and OGTT is critical and should be taken into account before randomization. All currently available autoantibody tests should be analyzed, including ZnT8QA.

  • 4. Asling-Monemi, K
    et al.
    Pena, R
    Ellsberg, MC
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Violence against women increases the risk of infant and child mortality: acase-referent study in Nicaragua.2003In: Bull World Health Organ, Vol. 81, p. 10-Article in journal (Refereed)
  • 5. Baqui, AH
    et al.
    Zaman, K
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    El Arifeen, S
    Yunus, M
    Begum, N
    Black, RE
    Simultaneous weekly supplementation of iron and zinc is associated withlower morbidity due to diarrhea and acute lower respiratory infection inBangladeshi infants.2003In: J Nutr, Vol. 133, p. 4150-Article in journal (Refereed)
  • 6.
    Bergström, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Skeen, Sarah
    Duc, Duong M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Blandon, Elmer Zelaya
    Estabrooks, Carole
    Gustavsson, Petter
    Hoa, Dinh Thi Phuong
    Kallestal, Carina
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nga, Nguyen Thu
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pervin, Jesmin
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Rahman, Anisur
    Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Squires, Janet E.
    Tomlinson, Mark
    Waiswa, Peter
    Wallin, Lars
    Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings2015In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 10, article id 120Article in journal (Refereed)
    Abstract [en]

    Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

  • 7.
    Bergström, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tomlinson, M.
    Squires, J.
    Duong, Duc
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hoa, D. P.
    Källestål, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pervin, J.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nga, Nguyen Thu
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rahman, A.
    Waiswa, P.
    Zelaya, E.
    Estabrooks, C.
    Wallin, L.
    The context assessment for community health tool: investigating why what works where2013In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 18, no SI, p. 203-204Article in journal (Other academic)
  • 8.
    Bhattacharya, Prosun
    et al.
    KTH-International Groundwater Arsenic Research Group, Department of Land and Water Resources Engineering, Royal Institute of Technology (KTH), Stockholm, Sweden.
    Hossain, Mohammed
    NGO Forum for Drinking Water Supply and Sanitation, Dhaka, Bangladesh.
    Rahman, Shamsun Naima
    KTH-International Groundwater Arsenic Research Group, Department of Land and Water Resources Engineering, Royal Institute of Technology (KTH), Stockholm, Sweden.
    Robinson, Clare
    NGO Forum for Drinking Water Supply and Sanitation, Dhaka, Bangladesh.
    Nath, Bibhash
    School of Geosciences, University of Sydney, Sydney, Australia.
    Rahman, Marina
    NGO Forum for Drinking Water Supply and Sanitation, Dhaka, Bangladesh.
    Islam, M Mainul
    NGO Forum for Drinking Water Supply and Sanitation, Dhaka, Bangladesh.
    Von Brömssen, Mattias
    Ramboll Sweden AB, Stockholm, Sweden.
    Ahmed, Kazi Matin
    Department of Geology, University of Dhaka, Curzon Hall Campus, Dhaka, Bangladesh.
    Jacks, Gunnar
    KTH-International Groundwater Arsenic Research Group, Department of Land and Water Resources Engineering, Royal Institute of Technology (KTH), Stockholm, Sweden.
    Chowdhury, Dulaly
    ICDDR, B: Centre for Health and Population Research, Dhaka, Bangladesh.
    Rahman, Mahfuzar
    ICDDR, B: Centre for Health and Population Research, Dhaka, Bangladesh.
    Jakariya, Mohammed
    NGO Forum for Drinking Water Supply and Sanitation, Dhaka, Bangladesh.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Vahter, Marie
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Temporal and seasonal variability of arsenic in drinking water wells in Matlab, southeastern Bangladesh: A preliminary evaluation on the basis of a 4 year study2011In: Journal of Environmental Science and Health. Part A: Toxic/Hazardous Substances and Environmental Engineering, ISSN 1093-4529, E-ISSN 1532-4117, Vol. 46, no 11, p. 1177-1184Article in journal (Refereed)
    Abstract [en]

    Temporal and seasonal variability of As concentrations in groundwater were evaluated in As-affected areas of Matlab, southeastern Bangladesh. Groundwater samples from 61 randomly selected tubewells were analyzed for As concentrations over a period of three years and four months (from July 2002 to November 2005) and monitored seasonally (three times a year). The mean As concentrations in the sampled tubewells decreased from 153 to 123 μg/L during July 2002 to November 2005. Such changes were pronounced in tubewells with As concentration >50 μg/L than those with As concentrations <50 μg/L. Similarly, individual wells revealed temporal variability, for example some wells indicated a decreasing trend, while some other wells indicated stable As concentration during the monitoring period. The mean As concentrations were significantly higher in Matlab North compared with Matlab South. The spatial variations in the mean As concentrations may be due to the differences in local geological conditions and groundwater flow patterns. The variations in mean As concentrations were also observed in shallow (<40 m) and deep (>40 m) wells. However, to adequately evaluate temporal and seasonal variability of As concentration, it is imperative to monitor As concentrations in tubewells over a longer period of time. Such long-term monitoring will provide important information for the assessment of human health risk and the sustainability of safe drinking water supplies.

  • 9.
    Cazottes, Isabelle
    et al.
    Saint Laurent, Gaillac, France.
    Costello, Anthony
    UCL Institute for Global Health, London, UK.
    Davis, Jessica
    Women´s and Children´s Health Knowledge Hub, The Macfalane Burnet Institute for Medical Research and Public Health Ltd, London, UK.
    George, Asha
    Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    Houeto, David
    Contonou, Benin.
    Howard-Grabman, Lisa
    Training Resources Group, Inc, Arlington, VA, USA.
    Jones, Eleri
    London School of Economics, London, UK.
    coast, Ernestina
    London School of Economics, London, UK.
    Mbizo, Mike
    UZ-UCSF Programme on Women´s Health, Dept of Obst and Gyn, Univ of Zimbawe Medical School, Avondale, Harare, Zimbabwe.
    Mercer, Raul
    Centre for Research in Population Health, Hospital Durand, Buenos Aires, Argentina.
    Pasha, Omrana
    Dept of Community Health Sciences and Family Meicine, Aga Khan University, Karchi, Pakistan.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Prost, Audrey
    UCL Institute for Global Health, Institute of Child Health UCL, London, UK.
    Santarelli, Carlo
    Enfants du Monde, Grand-Saconnex, Switzerland.
    Capello, Cecilia
    Enfants du Monde, Grand-Saconnex, Sweitzerland.
    Soerachman, Rachmalina
    National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia.
    WHO recommendation on community mobilization through facilitated participatory learning and action cycles with women´s groups for maternal and newborn health2014Report (Refereed)
  • 10.
    Chopra, Mickey
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Doherty, Tanya
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Goga, A.
    Jackson, D.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Survival of infants in the context of prevention of mother to child HIV transmission in South Africa2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 5, p. 694-698Article in journal (Refereed)
    Abstract [en]

    Aim: We sought to study the survival of newborn children according to HIV status of the mother, that of the child and the timing of infection. Methods: This is a prospective cohort study of 883 mothers (665 HIV-positive and 218 HIV-negative) and their infants. Data were collected using semi-structured questionnaires during home visits between the antenatal period and 36 weeks post-delivery. Infant HIV status was determined at 3, 24 and 36 weeks by HIV DNA PCR. Results: The majority (81.3%) of infected infants who died were infected by 3 weeks of age. Of the HIV-exposed infants who died, 19 (28.4%) died before 6 weeks and 38 (56.7%) died by 12 weeks. The hazard ratio (HR) of mortality at 36 weeks of age in HIV-infected infants compared with exposed but negative infants was 8.9 (95% CI: 6.7-11.8). There was no significant difference in 36 week survival rates between HIV-non-exposed and HIV-exposed but negative infants (HR: 0.7; 95% CI: 0.3-1.5). The infant being HIV-positive at age 3 weeks (HR: 32 95% CI: 14.0-73.1) and rural site (HR: 4.4 95% CI: 1.2-23.4) were the two independent risk factors for infant death amongst HIV-exposed infants. Conclusion: The prognosis for infants with early HIV infection was very poor in this cohort. A greater focus on prevention of early infection, earlier screening for HIV infection and access to antiretrovirals for eligible infants is recommended.

  • 11.
    Christian, Parul
    et al.
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    Lee, Sun Eun
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    Donahue Angel, Moira
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    Adair, Linda S
    Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
    Arifeen, Shams E
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
    Ashorn, Per
    Department of International Health, University of Tampere, School of Medicine, Finland.
    Barros, Fernando C
    Programa de Pós-graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Brazil.
    Fall, Caroline Hd
    MRC Lifecourse Epidemiology Unit, Southampton General Hospital, UK.
    Fawzi, Wafaie W
    Departments of Global Health and Population, Nutrition, and Epidemiology, Harvard School of Public Health, Boston, MA, USA.
    Hao, Wei
    Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
    Hu, Gang
    Pennington Biomedical Research Center, Baton Rouge, LA, USA.
    Humphrey, Jean H
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    Huybregts, Lieven
    Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
    Joglekar, Charu V
    Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, India.
    Kariuki, Simon K
    Center for Global Health Research, KEMRI, Kisumu, Kenya.
    Kolsteren, Patrick
    Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
    Krishnaveni, Ghattu V
    Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, India.
    Liu, Enqing
    Tianjin Women‘s and Children‘s Health Center, Tianjin, China.
    Martorell, Reynaldo
    Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
    Osrin, David
    Institute for Global Health, UCL Institute of Child Health, London, UK.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ramakrishnan, Usha
    Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
    Richter, Linda
    Human Sciences Research Council and the Developmental Pathways for Health Research Programme, University of the Witwatersrand, Johannesburg, South Africa.
    Roberfroid, Dominique
    Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
    Sania, Ayesha
    Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
    Ter Kuile, Feiko O
    KEMRI/CDC Research and Public Health Collaboration, Kisumu, Kenya.
    Tielsch, James
    Department of Global Health, George Washington University, School of Public Health and Health Services, Washington, DC, USA.
    Victora, Cesar G
    Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brazil.
    Yajnik, Chittaranjan S
    Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, India.
    Yan, Hong
    Department of Public Health, Xi’an Jiaotong University College of Medicine, Shaanxi, China.
    Zeng, Lingxia
    Department of Public Health, Xi’an Jiaotong University College of Medicine, Shaanxi, China.
    Black, Robert E
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries2013In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 42, no 5, p. 1340-1355Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain.

    METHODS:

    Using extant longitudinal birth cohorts (n = 19) with data on birthweight, gestational age and child anthropometry (12-60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth.

    RESULTS:

    We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5-3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively.

    CONCLUSIONS:

    This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.

  • 12.
    Contreras, Mariela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Blandón, Elmer
    Asociación para el Desarrollo Económico y Social de El Espino (APRODESE), Chinandega, Nicaragua.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hjern, Anders
    Centre for Health Equity Studies, Karolinska Institute/Stockholm University, Sweden.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Socio-economic resources, young child feeding practices, consumption of highly processed snacks and sugar-sweetened beverages: a population-based survey in rural northwestern Nicaragua2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1, p. 25-Article in journal (Refereed)
    Abstract [en]

    Background

    Socio-economic resources may be associated with infant feeding in complex patterns in societies undergoing a nutrition transition. This study evaluates associations of housing quality, food security and maternal education to the World Health Organization (WHO) feeding recommendations and to consumption of highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs) in rural Nicaragua.

    Methods

    Data were collected from May to November 2009, with mothers of 0- to 35-month-olds being asked about young child feeding using a food frequency questionnaire. A validated questionnaire was used to assess household food insecurity and data were collected on maternal education and housing quality. Pearson’s chi-squared test was used to compare proportions and determine associations between the resources and young child feeding. The three socio-economic resources and other confounders were introduced to multivariate logistic regression analyses to assess the independent contribution of the resources to the feeding practices and consumption of HP snacks and SSBs.

    Results

    Mothers with the lowest education level were more likely to be exclusively breastfeeding (EBF) their infants (OR not EBF: 0.19; 95% CI: 0.07, 0.51), whilst mothers of 6- to 35-month-olds in the lowest education category had more inadequate dietary diversity (DD) (OR for not meet DD: 2.04; 95% CI: 1.36, 3.08), were less likely to consume HP snacks (OR for HP snacks: 0.47; 95% CI: 0.32, 0.68) and SSBs (OR for SSBs: 0.68; 95% CI: 0.46, 0.98), compared to mothers with the highest level of education. Similarly, children residing in households with the highest food insecurity were also more prone to have inadequate dietary diversity (OR for not meet DD: 1.47; 95% CI: 1.05, 2.05). The odds for double burden of suboptimal feeding (concurrent inadequate diet and consumption of HP snacks/SSBs) were significantly lower in children of least educated mothers (OR: 0.64; 95% CI: 0.44, 0.92).

    Conclusions

    Higher level of education was associated with both more and less adherence to the WHO recommended feeding practices as well as with more consumption of HP snacks and SSBs. Regardless of educational strata, the children in the community were exposed to suboptimal feeding practices conducive to both under- as well as overnutrition.

  • 13.
    Contreras, Mariela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Zelaya Blandón, Elmer
    Asociación para el Desarrollo Económico y Social de El Espino (APRODESE).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua2016In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 12, no 1, p. 164-176Article in journal (Refereed)
    Abstract [en]

    Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar-sweetened beverages (SSBs). All households with at least one child 0- to 35-month-old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0- to 1-month-olds and continued to be prevalent (60%) in the second year, while only 34% of the 0- to 5-month-olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6- to 11-month-old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6- to 8-month-olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long-term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.

  • 14.
    Contreras, Mariela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Zelaya Blandón, Elmer
    Asociación para el Desarrollo Económico y Social de El Espino (APRODESE).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hjern, Anders
    Centre for Health Equity Studies, Karolinska Institute/Stockholm University.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Socio-economic resources and child under- and over-nutrition: a population-based survey in rural NicaraguaManuscript (preprint) (Other academic)
  • 15.
    Contreras, Mariela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Zelaya, E.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Infant And Young Child Feeding Practices And Nutritional Status In Nicaragua: Associations With Housing Quality, Food Security And Maternal Education2013In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 63, no Suppl. 1, p. 702-703Article in journal (Other academic)
  • 16.
    Contreras, Mariela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Zelaya, E.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Snacking And Infant Young Child Feeding Practices In A Rural Area Of Nicaragua2013In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 63, no Suppl. 1, p. 702-702Article in journal (Other academic)
  • 17.
    Dalmar, Abdirisak Ahmed
    et al.
    Benadir Univ, Fac Med, Mogadishu, Somalia..
    Hussein, Abdullahi Sheik
    Benadir Univ, Fac Med, Mogadishu, Somalia..
    Walhad, Said Ahmed
    Amoud Univ, Coll Hlth Sci, Borama, Somaliland, Somalia..
    Ibrahim, Abdirashid Omer
    Amoud Univ, Coll Hlth Sci, Borama, Somaliland, Somalia..
    Abdi, Abshir Ali
    East Africa Univ, Fac Med, Bosasso, Somalia..
    Ali, Mohamed Khalid
    East Africa Univ, Fac Med, Bosasso, Somalia..
    Ereg, Derie Ismail
    Univ Hargeisa, Coll Med, Hargeisa, Somalia..
    Egal, Khadra Ali
    Univ Hargeisa, Coll Med, Hargeisa, Somalia..
    Shirwa, Abdulkadir Mohamed
    Galkayo Univ, Coll Med, Galkayo, Somalia..
    Aden, Mohamed Hussain
    Puntland Univ Sci & Technol, Med Coll, Galkayo, Somalia..
    Yusuf, Marian Warsame
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Abdi, Yakoub Aden
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Freij, Lennart
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Johansson, Annika
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Mohamud, Khalif Bile
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Abdulkadir, Yusuf
    Somali Swedish Researchers Assoc, Stockholm, Sweden..
    Emmelin, Maria
    Lund Univ, Unit Social Med & Global Hlth, Lund, Sweden..
    Eriksen, Jaran
    Karolinska Inst, Div Clin Pharmacol, Stockholm, Sweden..
    Erlandsson, Kerstin
    Dalarna Univ, Falun, Sweden..
    Gustafsson, Lars L.
    Karolinska Inst, Div Clin Pharmacol, Stockholm, Sweden..
    Ivarsson, Anneli
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    Klingberg-Allvin, Marie
    Dalarna Univ, Falun, Sweden..
    Kinsman, John
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    Källestål, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Osman, Fatumo
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Sahlen, Klas-Goran
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    Wall, Stig
    Umea Univ, Unit Epidemiol & Global Hlth, Umea, Sweden..
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1348693Article in journal (Refereed)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 18.
    Doherty, Tanya
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Chopra, Mickey
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nkonki, Lungiswa
    Jackson, Debra
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    A Longitudinal Qualitative Study of Infant-Feeding Decision Making and Practices among HIV-Positive Women in South Africa2006In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 136, no 9, p. 2421-2426Article in journal (Refereed)
    Abstract [en]

    This study examined the challenges that HIV-positive women face at different stages of early infant feeding using a longitudinal, qualitative design. The study explored factors influencing infant-feeding decision-making and behavior of HIV positive mothers and identified characteristics of women and their environments that contributed to success in maintaining exclusivity of their infant feeding practices. The study was undertaken at 3 sites in South Africa. Participants consisted of a purposive sample of 27 women who had a positive HIV test result during antenatal care and were intending to either exclusively breast-feed or exclusively formula-feed their infants. Women were interviewed once antenatally and at 1, 4, 6, and 12 wk postpartum. Just under one-half of the women who initiated breast-feeding maintained exclusivity and over two-thirds of the women who initiated formula-feeding maintained exclusivity. Key characteristics of women who achieved success in exclusivity included the ability to resist pressure from the family to introduce other fluids and to recall key messages on mother-to-child transmission risks and mixed feeding. Among women who maintained exclusive breast-feeding, a strong belief in the benefits of breast-feeding and a supportive home environment was important. For women using formula milk, having resources such as electricity, a kettle, and flask made feeding at night easier. Support for infant feeding that extends beyond the antenatal period is important to enable mothers to cope with new challenges and pressures at critical times during the early postpartum period.

  • 19.
    Ekström, Eva-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Eneroth, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    El Arifeen, Shams
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Efficacy of micronutrient supplement intake in increasing hemoglobin in pregnancy: dose-effect comparisons with multiple micronutrient in the MINIMat trial in rural Bangladesh2013In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 27, no S1, p. 845.25-Article in journal (Other academic)
  • 20.
    Ekström, Eva-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lindström, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Raqib, Rubhana
    El Arifeen, Shams
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Brismar, Kerstin
    Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Effects of prenatal micronutrient and early food supplementation on metabolic status of the offspring at 4.5 years of age. The MINIMat randomized trial in rural Bangladesh.2016In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 5, p. 1656-1667Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fetal nutritional insults may alter the later metabolic phenotype. We hypothesized that early timing of prenatal food supplementation and multiple micronutrient supplementation (MMS) would favourably influence childhood metabolic phenotype.

    METHODS: Pregnant women recruited 1 January to 31 December 2002 in Matlab, Bangladesh, were randomized into supplementation with capsules of either 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, and randomized to food supplementation (608 kcal) either with early invitation (9 weeks' gestation) or usual invitation (at 20 weeks). Their children (n = 1667) were followed up at 4.5 years with assessment of biomarkers of lipid and glucose metabolism, inflammation and oxidative stress.

    RESULTS: Children in the group with early timing of food supplementation had lower cholesterol (difference -0.079 mmol/l, 95% confidence interval (CI) -0.156; -0.003), low-density lipoprotein (LDL) (difference -0.068 mmol/l, 95% CI -0.126; -0.011) and ApoB levels (difference -0.017 g/l, 95% CL -0.033; -0.001). MMS supplementation resulted in lower high-density lipoprotein (HDL) (difference -0.028 mmol/l, 95% CL -0.053; -0.002), lower glucose (difference -0.099 mmol/l, 95% CL -0.179; -0.019) and lower insulin-like growth factor 1 (IGF-1) (difference on log scale -0.141 µg/l, 95% CL -0.254; -0.028) than 60 mg iron and 400 μg folic acid. There were no effects on markers of inflammation or oxidative stress.

    CONCLUSIONS: Findings suggest that in a population where malnutrition is prevalent, nutrition interventions during pregnancy may modify the metabolic phenotype in the young child that could have consequences for later chronic disease risks.

  • 21.
    Eneroth, Hanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    El Arifeen, Shams
    Child Health Unit, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Infant anaemia is associated with infection, low birthweight and iron deficiency in rural Bangladesh2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 2, p. 220-225Article in journal (Refereed)
    Abstract [en]

    Aim: To estimate the prevalence of infant anaemia and its association with iron deficiency, growth, infection and other micronutrient deficiencies. Methods: Using data from MINIMat, a randomized maternal food and micronutrient supplementation trial, we assessed the associations between anaemia (haemoglobin < 105 g/L) in 580 infants at 6 months and deficiencies of iron, vitamin A, vitamin B12, zinc and folate, infection and anthropometric indices. Variables associated with anaemia in bivariate analyses were evaluated in logistic regression models, adjusting for potential confounders. Results: Anaemia was found in 46% of the infants, and among these, 28% had iron deficiency (plasma ferritin <9 μg/L). Elevated C-reactive protein (>10mg/L) (OR = 2.7, 95% CI: 1.6, 4.7), low birthweight (OR = 2.3, 95% CI: 1.5, 3.5) and iron deficiency (OR = 2.2, 95% CI: 1.4, 3.6) were independently associated with increased risk for anaemia. We also observed a seasonal variation in anaemia not mediated through the other factors studied. Conclusion: In a cohort in rural Bangladesh, anaemia at age 6 months was common and associated with infection, low birthweight and iron deficiency.

  • 22.
    Eriksson, Leif
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Huy, Tran Q
    Nursing office, Department of Medical Services Administration, Ministry of Health Vietnam.
    Duc, Duong M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Hanoi School of Public Health, Hanoi, Vietnam.
    Ekholm Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hoa, Dinh P
    Hanoi School of Public Health, Vietnam.
    Thuy, Nguyen T
    Vietnam Sweden Uong Bi General Hospital, Quang Ninh, Vietnam.
    Nga, Nguyen Thu
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Vietnam Sweden Uong Bi General Hospital, Quang Ninh, Vietnam.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden..
    Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to impove neonatal survival in Quang Ninh province, Vietnam2016In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Background

    Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health – Knowledge Into Practice trial evaluated facilitation of community groups (2008–2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30–0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention.

    Methods

    Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models.

    Results

    To ensure eight active facilitators over 3 years, 11 Women’s Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19–0.73) than control communes (n = 46).

    Conclusions

    This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups’ work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

  • 23.
    Eriksson, Leif
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nga, Nguyen Thu
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hoa, Dinh P.
    Hanoi School of Public Health, Hanoi, Vietnam.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet and Clinical Research Utilization (CRU), Karolinska University Hospital, Stockholm, Sweden.
    Newborn care and knowledge translation - perceptions among primary health care staff in northern Vietnam2011In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 6, p. 29-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nearly four million neonatal deaths occur annually in the world despite existing evidence-based knowledge with the potential to prevent many of these deaths. Effective knowledge translation (KT) could help to bridge this know-do gap in global health. The aim of this study was to explore aspects of KT at the primary healthcare level in a northern province in Vietnam. METHODS: Six focus-group discussions were conducted with primary healthcare staff members who provided neonatal care in districts that represented three types of geographical areas existing in the province (urban, rural, and mountainous). Recordings were transcribed verbatim, translated into English, and analyzed using content analysis. RESULTS: We identified three main categories of importance for KT. Healthcare staff used several channels for acquisition and management of knowledge (1), but none appeared to work well. Participants preferred formal training to reading guideline documents, and they expressed interest in interacting with colleagues at higher levels, which rarely happened. In some geographical areas, traditional medicine (2) seemed to compete with evidence-based practices, whereas in other areas it was a complement. Lack of resources, low frequency of deliveries and, poorly paid staff were observed barriers to keeping skills at an adequate level in the healthcare context (3). CONCLUSIONS: This study indicates that primary healthcare staff work in a context that to some extent enables them to translate knowledge into practice. However, the established and structured healthcare system in Vietnam does constitute a base where such processes could be expected to work more effectively. To accelerate the development, thorough considerations over the current situation and carefully targeted actions are required.

  • 24.
    Eriksson, Leif
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nga, Nguyen Thu
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Wallin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Evidence-based practice in neonatal health: knowledge among primary health care staff in northern Viet Nam2009In: Human Resources for Health, ISSN 1478-4491, E-ISSN 1478-4491, Vol. 7, p. 36-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An estimated four million deaths occur each year among children in the neonatal period. Current evidence-based interventions could prevent a large proportion of these deaths. However, health care workers involved in neonatal care need to have knowledge regarding such practices before being able to put them into action.The aim of this survey was to assess the knowledge of primary health care practitioners regarding basic, evidence-based procedures in neonatal care in a Vietnamese province. A further aim was to investigate whether differences in level of knowledge were linked to certain characteristics of community health centres, such as access to national guidelines in reproductive health care, number of assisted deliveries and geographical location. METHODS: This cross-sectional survey was completed within a baseline study preparing for an intervention study on knowledge translation (Implementing knowledge into practice for improved neonatal survival: a community-based trial in Quang Ninh province, Viet Nam, the NeoKIP project, ISRCTN44599712). Sixteen multiple-choice questions from five basic areas of evidence-based practice in neonatal care were distributed to 155 community health centres in 12 districts in a Vietnamese province, reaching 412 primary health care workers. RESULTS: All health care workers approached for the survey responded. Overall, they achieved 60% of the maximum score of the questionnaire. Staff level of knowledge on evidence-based practice was linked to the geographical location of the CHC, but not to access to the national guidelines or the number of deliveries at the community level. Two separated geographical areas were identified with differences in staff level of knowledge and concurrent differences in neonatal survival, antenatal care and postnatal home visits. CONCLUSION: We have identified a complex pattern of associations between knowledge, geography, demographic factors and neonatal outcomes. Primary health care staff knowledge regarding neonatal health is scarce. This is a factor that is possible to influence and should be considered in future efforts for improving the neonatal health situation in Viet Nam.

  • 25.
    Frith, Amy L
    et al.
    School of Health Sciences and Human Performance, Ithaca College, New York, USA.
    Naved, Ruchira T
    International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Frongillo, Edward A
    Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, USA.
    Early prenatal food supplementation ameliorates the negative association of maternal stress with birth size in a randomised trial2015In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 11, no 4, p. 537-549Article in journal (Refereed)
    Abstract [en]

    Low birthweight increases the risk of infant mortality, morbidity and poor development. Maternal nutrition and stress influence birth size, but their combined effect is not known. We hypothesised that an early-invitation time to start a prenatal food supplementation programme could reduce the negative influence of prenatal maternal stress on birth size, and that effect would differ by infant sex. A cohort of 1041 pregnant women, who had delivered an infant, June 2003–March 2004, was sampled from among 3267 in the randomised controlled trial, Maternal Infant Nutritional Interventions Matlab, conducted in Matlab, Bangladesh. At 8 weeks gestation, women were randomly assigned an invitation to start food supplements (2.5 MJ d−1; 6 days a week) either early (∼9 weeks gestation; early-invitation group) or at usual start time for the governmental programme (∼20 weeks gestation; usual-invitation group). Morning concentration of cortisol was measured from one saliva sample/woman at 28–32 weeks gestation to assess stress. Birth-size measurements for 90% of infants were collected within 4 days of birth. In a general linear model, there was an interaction between invitation time to start the food supplementation programme and cortisol with birthweight, length and head circumference of male infants, but not female infants. Among the usual-invitation group only, male infants whose mothers had higher prenatal cortisol weighed less than those whose mothers had lower prenatal cortisol. Prenatal food supplementation programmes that begin first trimester may support greater birth size of male infants despite high maternal stress where low birthweight is a public health concern.

  • 26. Frith, Amy L.
    et al.
    Naved, Ruchira T.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Rasmussen, Kathleen M.
    Frongillo, Edward A.
    Early Participation in a Prenatal Food Supplementation Program Ameliorates the Negative Association of Food Insecurity with Quality of Maternal-Infant Interaction2012In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 142, no 6, p. 1095-1101Article in journal (Refereed)
    Abstract [en]

    Food insecurity is detrimental to child development, yet little is known about the combined influence of food insecurity and nutritional interventions on child development in low-income countries. We proposed that women assigned to an early invitation time to start a prenatal food supplementation program could reduce the negative influence of food insecurity on maternal-infant interaction. A cohort of 180 mother-infant dyads were studied (born between May and October 2003) from among 3267 in the randomized controlled trial Maternal Infant Nutritional Interventions Mat lab, which was conducted in Mat lab, Bangladesh. At 8 wk gestation, women were randomly assigned an invitation time to start receiving food supplements (2.5 MJ/d; 6 d/wk) either early (similar to 9 wk gestation; early-invitation group) or at the usual start time (similar to 20 wk gestation; usual-invitation group) for the government program. Maternal-infant interaction was observed in homes with the use of the Nursing Child Assessment Satellite Training Feeding Scale, and food-insecurity status was obtained from questionnaires completed when infants were 3.4-4.0 mo old. By using a general linear model for maternal-infant interaction, we found a significant interaction (P = 0.012) between invitation time to start a prenatal food supplementation program and food insecurity. Those in the usual-invitation group with higher food insecurity scores (i.e., more food insecure) had a lower quality of maternal-infant interaction, but this relationship was ameliorated among those in the early-invitation group. Food insecurity limits the ability of mothers and infants to interact well, but an early invitation time to start a prenatal food supplementation program can support mother-infant interaction among those who are food insecure.

  • 27.
    Fulford, A. J. C.
    et al.
    MRC Keneba, MRC Unit, Banjul, The Gambia.
    Moore, S. E.
    MRC Keneba, MRC Unit, Banjul, The Gambia.
    Arifeen, S. E.
    International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka.
    Persson, Lars-Ake
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Neufeld, L. M.
    The Micronutrient Initiative, Elgin St. Suite, Ottawa, ON, Canada.
    Wagatsuma, Y.
    Department of Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.
    Prentice, A. M.
    MRC Keneba, MRC Unit, Banjul, The Gambia.
    Disproportionate early fetal growth predicts postnatal thymic size in humans2013In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752, Vol. 4, no 3, p. 223-231Article in journal (Refereed)
    Abstract [en]

    Prenatal events can affect neonatal thymus size and adult immune function. The causal insults are unknown, although fetal nutrient restriction is suspected. We used ultrasound at three time points during pregnancy (14, 19 and 30 weeks) to measure the growth of six fetal dimensions in rural Bangladeshi women participating in the Maternal and Infant Nutrition Interventions, Matlab study. Postnatal ultrasound was used to calculate thymic index (TI) at birth, 2, 6 and 12 m. Of the 3267 women recruited, 2861 participated by providing data at least at one fetal biometry and one TI time point. Patterns of fetal growth were summarized using principal components calculated from fetal dimension z-scores. Random effects regression, controlling for infant size and season of measurement were used to relate these patterns to TI. We found that smaller leg length relative to head circumference, characteristic of head-sparing growth restriction, was predictive of lower TI. This association was significant at all time points but strongest in earlier pregnancy. Each standard deviation increase in leg-head proportion was associated with an increase in TI of similar to 5%. We conclude that growth patterns typical of poor fetal nutrition are associated with poor thymic development. The greater strength of this association in the first trimester is consistent with a period of vulnerability during the early ontogeny of the thymus and suggests that preventative intervention would need to be given in early pregnancy.

  • 28. Goldin, S
    et al.
    Levin, L
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Hagglof, B
    Child war trauma: a comparison of clinician, parent and child assessments.2003In: Nord J Psychiatry, Vol. 57, p. 173-Article in journal (Refereed)
  • 29.
    Hawkesworth, Sophie
    et al.
    Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
    Wagatsuma, Yukiko
    Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
    Kahn, Ashraf I.
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
    Hawlader, Mohammad D. H.
    Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
    Fulford, Anthony J. C.
    Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
    Arifeen, Shams-El
    International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Moores, Sophie E.
    Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
    Combined Food and Micronutrient Supplements during Pregnancy Have Limited Impact on Child Blood Pressure and Kidney Function in Rural Bangladesh2013In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 143, no 5, p. 728-734Article in journal (Refereed)
    Abstract [en]

    Observational evidence suggests nutritional exposures during in utero development may have long-lasting consequences for health; data from interventions are scarce. Here, we present a trial follow-up study to assess the association between prenatal food and micronutrient supplementation and childhood blood pressure and kidney function. During the MINIMat Trial in rural Bangladesh, women were randomly assigned early in pregnancy to receive an early or later invitation to attend a food supplementation program and additionally to receive either iron and folate or multiple micronutrient tablets daily. The 3267 singleton birth individuals with measured anthropometry born during the trial were eligible for a follow-up study at 4.5 y old. A total of 77% of eligible individuals were recruited and blood pressure, kidney size by ultrasound, and glomerular filtration rate (GFR; calculated from plasma cystatin c) were assessed. In adjusted analysis, early invitation to food supplementation was associated with a 0.72-mm Hg [(95% CI: 0.16, 1.28); P = 0.01] lower childhood diastolic blood pressure and maternal MMS supplementation was associated with a marginally higher [0.87 mm Hg (95% CI: 0.18, 1.56); P = 0.01] childhood diastolic blood pressure. There was also some evidence that a supplement higher in iron was associated with a higher offspring GFR. No other effects of the food or micronutrient interventions were observed and there was no interaction between the interventions on the outcomes studied. These marginal associations and small effect sizes suggest limited public health importance in early childhood.

  • 30. Hawkesworth, Sophie
    et al.
    Wagatsuma, Yukiko
    Kippler, Maria
    Fulford, Anthony J. C.
    Arifeen, Shams E.
    Persson, Lars-Ake
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Moore, Sophie E.
    Vahter, Marie
    Early exposure to toxic metals has a limited effect on blood pressure or kidney function in later childhood, rural Bangladesh2013In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 42, no 1, p. 176-185Article in journal (Refereed)
    Abstract [en]

    Background Chronic exposure to toxic metals such as arsenic and cadmium has been implicated in the development of kidney and cardiovascular diseases but few studies have directly measured exposure during in utero and early child development. Methods We investigated the impact of exposure to arsenic (mainly in drinking water) and cadmium (mainly in rice) during pregnancy on blood pressure and kidney function at 4.5 years of age in rural Bangladesh. The effect of arsenic exposure in infancy was also assessed. Results Within a cohort of 1887 children recruited into the MINIMat study, exposure to arsenic (maternal urinary arsenic, U-As), but not cadmium, during in utero development was associated with a minimal increase in blood pressure at 4.5 years. Each 1 mg/l increase in pregnancy U-As was associated with 3.69 mmHg (95% CI: 0.74, 6.63; P: 0.01) increase in child systolic and a 2.91 mmHg (95% CI: 0.41, 5.42; P: 0.02) increase in child diastolic blood pressure. Similarly, a 1 mg/l increase in child U-As at 18 months of age was associated with a 8.25 mmHg (95% CI: 1.37, 15.1; P: 0.02) increase in systolic blood pressure at 4.5 years. There was also a marginal inverse association between infancy U-As and glomerular filtration rate at 4.5 years (-33.4 ml/min/1.72 m(2); 95% CI: -70.2, 3.34; P: 0.08). No association was observed between early arsenic or cadmium exposure and kidney volume at 4.5 years assessed by ultrasound. Conclusions These modest effect sizes provide some evidence that arsenic exposure in early life has long-term consequences for blood pressure and maybe kidney function.

  • 31.
    Hawlader, Mohammad D H
    et al.
    Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba , Tennodai, Ibaraki, Japan.
    Ma, Enbo
    Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba , Tennodai, Ibaraki, Japan.
    Noguchi, Emiko
    Department of Medical Genetics, Faculty of Medicine, University of Tsukuba , Tennodai, Ibaraki, Japan.
    Itoh, Makoto
    Department of Infection and Immunology, Aichi Medical University School of Medicine , Nagakute, Japan.
    Arifeen, Shams E
    International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) , Mohakhali, Dhaka, Bangladesh.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Moore, Sophie E
    MRC International Nutrition Group, Nutrition and Public Health Intervention Research Unit, Department of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
    Raqib, Rubhana
    International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
    Wagatsuma, Yukiko
    Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tennodai, Ibaraki, Japan.
    Ascaris lumbricoids Infection as a Risk Factor for Asthma and Atopy in Rural Bangladeshi Children.2014In: Tropical Medicine and Health, ISSN 1348-8945, E-ISSN 1349-4147, Vol. 42, no 2, p. 77-85Article in journal (Refereed)
    Abstract [en]

    Controversy persists as to whether helminth infections cause or protect against asthma and atopy. The aim of this study was to investigate the effects of helminth infection on asthma and atopy among Bangladeshi children. A total of 912 children aged 4.5 years (mean = 54.4, range = 53.5-60.8 months) participated in a cross-sectional study nested into a randomized controlled trial in Bangladesh. Ever-asthma, ever-wheezing and current wheezing were identified using the International Study of Asthma and Allergies in Childhood questionnaire. Current helminth infection was defined by the presence of helminth eggs in stools, measured by routine microscopic examination. Repeated Ascaris infection was defined by the presence of anti-Ascaris IgE ≥ 0.70 UA/ml in serum measured by the CAP-FEIA method. Atopy was defined by specific IgE to house dust mite (anti-DP IgE) ≥ 0.70 UA/ml measured by the CAP-FEIA method and/or positive skin prick test (≥ 5 mm). Anti-Ascaris IgE was significantly associated with ever asthma (odds ratio (OR) = 1.86, 95% CI: 1.14-3.04, highest vs. lowest quartile; P for trend 0.016). Anti-Ascaris IgE was also significantly associated with positive anti-DP IgE (OR = 9.89, 95% CI: 6.52-15.00, highest vs. lowest; P for trend < 0.001) and positive skin prick test (OR = 1.69, 95% CI: 1.01-2.81, highest vs. lowest, P for trend 0.076). These findings suggest that repeated Ascaris infection is a risk factor for asthma and atopy in rural Bangladeshi children. Further analysis is required to examine the mechanism of developing asthma and atopy in relation to helminth infection.

  • 32.
    Hawlader, Mohammad Delwer Hossain
    et al.
    Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
    Noguchi, Emiko
    Department of Medical Genetics, Faculty of Medicine, University of Tsukuba, Japan.
    El Arifeen, Shams
    International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Moore, Sophie E
    MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK.
    Raqib, Rubhana
    International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
    Wagatsuma, Yukiko
    Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Japan.
    Nutritional status and childhood wheezing in rural Bangladesh2014In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 17, no 7, p. 1570-1577Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To investigate the association between current childhood nutritional status and current wheezing among pre-school children in rural Bangladesh.

    DESIGN:

    Cross-sectional study.

    SETTING:

    Matlab region, rural Bangladesh.

    SUBJECTS:

    Children (n 912) aged 4·5 years. Anthropometric measurements of the mothers and their children were taken during a 1-year period from December 2007 to November 2008. Current wheezing was identified using the International Study of Asthma and Allergies in Childhood questionnaire. Serum total IgE was measured by human IgE quantitative ELISA. IgE specific antibody to dust mites (Dermatophagoides pteronyssinus) was measured by the CAP-FEIA system (Phadia AB, Uppsala, Sweden).

    RESULTS:

    Wheezing at 4·5 years old was significantly associated with stunting (OR = 1·58; 95 % CI 1·13, 2·22) and underweight (OR = 1·39; 95 % CI 1·00, 1·94). The association with stunting remained significant after adjustment for sex, birth weight, birth length, gestational age at birth, mother's parity, maternal BMI, family history of asthma, socio-economic status, season of birth and intervention trial arm (OR = 1·74; 95 % CI 1·19, 2·56).

    CONCLUSIONS:

    Stunting was a significant risk factor for wheezing among rural Bangladeshi children. Further studies will be required to confirm the relationship between nutritional status and allergic illnesses in developing countries.

  • 33.
    Hoa, Dinh P
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nga, Nguyen T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars Ake
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persistent neonatal mortality despite improved under-five survival: a retrospective cohort study in northern Vietnam2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 2, p. 166-170Article in journal (Refereed)
    Abstract [en]

    Aim: To examine trends in neonatal, infant and under-five mortality rates in a northern Vietnamese district during 1970-2000, and to analyze socioeconomic differences in child survival over time.

    Methods: Retrospective interviews with all women aged 15-54 years in Bavi district in Northern Vietnam (n = 14 329) were conducted. Of these women, 13 943 had been pregnant, giving birth to 26 796 children during 1970-2000.

    Results: There was a dramatic reduction in infant and under-five mortality rate (47%) over time. However, the neonatal mortality rate (NMR) showed a very small reduction, thus causing its proportion of the total child mortality to increase. Mortality trends followed the political and socioeconomic development of Vietnam over war, peace and periods of reforms. There were no differences in under-five and neonatal mortalities associated with family economy, while differentials related to mothers' education and ethnicity were increasing.

    Conclusion: Interventions to reduce child mortality should be focused on improving neonatal care. In settings with a rapid economic growth and consequent social change, like in Vietnam, it is important that such interventions are targeted at vulnerable groups, in this case, families with low level of education and belonging to ethnic minorities.

  • 34. Hore, Samar Kumar
    et al.
    Rahman, Mahfuzar
    Yunus, Mohammad
    Das, Chandra Shakhar
    Yeasmin, Sultana
    Ahmad, S. K. Akhtar
    Sayed, Salim Ullah
    Islam, Azm Maidul
    Vahter, Marie
    Persson, Lars Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Detecting arsenic-related skin lesions: Experiences from a large community-based survey in Bangladesh2007In: International Journal of Environmental Health Research, ISSN 0960-3123, E-ISSN 1369-1619, Vol. 17, no 2, p. 141-149Article in journal (Refereed)
    Abstract [en]

    A cross-sectional survey was conducted in Matlab, Bangladesh, to determine the prevalence of skin lesions (a three-step procedure) associated with arsenic exposure and discuss validity and feasibility in relation to recommended screening algorithms. Cases with skin lesions were identified by screening above 4 years of age (n = 166,934). Trained field teams conducted a careful house-to-house screening and identified 1682 individuals with skin lesions, who were referred to physicians for confirmation. Physicians diagnosed 579 cases as probable and documented all these with digital photographs. Two experts inspected all photographs for consensus agreement that was reached for 504 cases. Using the experts' opinions as reference, the positive predictive value of the physicians' diagnosis was 87% (male = 82% vs. female = 94%; p < 0.01). The physicians had difficulties in separating arsenic-induced keratosis from differential diagnoses, while probability for correct diagnosis was high for arsenic-related pigmentation changes. Including information on current arsenic concentration in drinking water (which was masked at time of skin examination) or urine in the diagnostic algorithm should have increased the number of false negative cases. In the present transition of drinking water sources these markers of current exposure levels provide no information on past exposure. A 2 - 3 step procedure with house-to-house screening and clinic-based confirmation of arsenic-induced skin lesions is a feasible approach. Information on arsenic concentration in current water sources or in urine should not have improved the precision in the diagnosis. These results may have policy implications for community screening of arsenic-related skin lesions in Bangladesh and elsewhere.

  • 35. Hyder, SMZ
    et al.
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Chowdhury, AMR
    Lonnerdal, B
    Eskstrom, E-C
    Impact of daily and weekly iron supplementation to women in pregnancy and puerperium on haemoglobin and iron status six weeks postpartum: results from a community-based study in Bangladesh.2003In: Scand J Nutr., Vol. 47, p. 19-Article in journal (Refereed)
  • 36. Hyder, SMZ
    et al.
    Persson, Lars-Åke
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Chowdhury, AMR
    Lönnerdal, B
    Ekström, Eva-Charlotte
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Anaemia and iron deficiency during pregnancy in rural Bangladesh2004In: Public Health Nutr, Vol. 7, no 8, p. 1065-1070Article in journal (Refereed)
  • 37.
    Ijumba, Petrida
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Doherty, Tanya
    Jackson, Debra
    Tomlinson, Mark
    Sanders, David
    Persson, Lars-Ake
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Free formula milk in the prevention of mother-to-child transmission programme: voices of a peri-urban community in South Africa on policy change2013In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 28, no 7, p. 761-768Article in journal (Refereed)
    Abstract [en]

    Background: In 2001, South Africa began implementing the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. This programme included distribution of free formula milk for infants up to 6 months of age at all public health facilities. Effective from 1 January 2011, KwaZulu-Natal became the first province to phase out free formula milk from its PMTCT programme. On 23 August 2011, the South African National Department of Health adopted promotion of exclusive breastfeeding as the national infant feeding strategy and made a decision to withdraw free formula milk from the PMTCT programme.

    Objective: To explore the perceptions and understanding of households at community level on the policy decision to phase out free formula milk from the PMTCT programme in South Africa.

    Methods: An exploratory qualitative study was conducted amongst women enrolled in a community randomized trial known as Good Start III. Focus group discussions were held with grandmothers, fathers and teenage mothers; and in-depth interviews were performed with HIV-positive and HIV-negative mothers. Data were analysed using thematic analysis.

    Results: Identified themes included: (1) variations in awareness and lack of understanding of the basis for the policy change, (2) abuse of and dysfunctional policy as perceived reasons for policy change and (3) proposed strategies for communicating the policy change.

    Conclusion: There is an urgent need to develop a multifaceted communication strategy clearly articulating the reasons for the infant feeding policy change and promoting the new breastfeeding strategy. The communication strategy should take into account inputs from the community. With a supportive environment and one national infant feeding strategy, South Africa has an opportunity to reverse years of poor infant feeding practices and to improve the health of all children in the country.

  • 38.
    Ijumba, Petrida
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). School of Public health , University of Western Cape .
    Doherty, Tanya
    Medical Research Council/ university of .
    Jackson, Debra
    UNICEF NY. USA..
    Tomlinson, Mark
    Stellenbosch University .
    Sanders, David
    School of public health , University of Western Cape..
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Social circumstances that drive early introduction of formula milk: an exploratory qualitative study in a peri-urban South African community2014In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 10, no 1, p. 102-111Article in journal (Refereed)
    Abstract [en]

    Breastfeeding is widely endorsed as the optimal strategy for feeding newborns and young infants, as well as improving child survival and achieving Millennium Development Goal 4. Exclusive breastfeeding (EBF) for the first 6 months of life is rarely practised in South Africa. Following the 2010 World Health Organization (WHO) infant feeding recommendations (EBF for HIV-positive mothers with maternal or infant antiretroviral treatment), South Africa adopted breastfeeding promotion as a National Infant Feeding Strategy and removed free formula milk from the Prevention of Mother-to-Child Transmission of HIV programme. This study aimed to explore the perceptions of mothers and household members at community level regarding the value they placed on formula feeding and circumstances that drive the practice in a peri-urban community. We conducted in-depth interviews with HIV-positive and HIV-negative mothers in a community-randomised trial (Good Start III). Focus group discussions were held with grandmothers, fathers and teenage mothers. Data were analysed using thematic analysis. The following themes were identified; inadequate involvement of teenage mothers; grandmothers who become replacement mothers; fear of failing to practise EBF for 6 months; partners as formula providers and costly formula milk leading to risky feeding practices. The new South African Infant Feeding Strategy needs to address the gaps in key health messages and develop community-orientated programmes with a focus on teenage mothers. These should encourage the involvement of grandmothers and fathers in decision-making about infant feeding so that they can support EBF for optimal child survival.

  • 39.
    Ijumba, Petrida
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa.
    Doherty, Tanya
    Health Systems Research Unit, Medical Research Council, Tygerberg, South Africa.
    Jackson, Debra
    School of Public Health, University of the Western Cape, Cape Town, South Africa.
    Tomlinson, Mark
    Department of Psychology, Stellenbosch University, South Africa.
    Sanders, David
    School of Public Health, University of the Western Cape, Cape Town, South Africa.
    Swanevelder, Sonja
    Biostatistics Unit, Medical Research Council, Tygerberg, South Africa.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Effect of an integrated community-based package for maternal and newborn care on feeding patterns during the first 12 weeks of life: a cluster-randomized trial in a South African township2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 14, p. 2660-2668Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth, and to study whether the effect differs by maternal HIV status, educational level or household wealth.

    DESIGN: Cluster-randomized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers. Infant feeding data were collected using 24 h recall of nineteen food and fluid items.

    SETTING: A township near Durban, South Africa.

    SUBJECTS: Pregnant women (1894 intervention and 2243 control) aged 17 years or more.

    RESULTS: Twelve weeks after birth, 1629 (intervention) and 1865 (control) mother-infant pairs were available for analysis. Socio-economic conditions differed slightly across intervention groups, which were considered in the analyses. There was no effect on early initiation of breast-feeding. At 12 weeks of age the intervention doubled exclusive breast-feeding (OR=2·29; 95 % CI 1·80, 2·92), increased exclusive formula-feeding (OR=1·70; 95 % CI 1·28, 2·27), increased predominant breast-feeding (OR=1·71; 95 % CI 1·34, 2·19), decreased mixed formula-feeding (OR=0·68; 95 % CI 0·55, 0·83) and decreased mixed breast-feeding (OR=0·54; 95 % CI 0·44, 0·67). The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers (P=0·01), while the effect on mixed formula-feeding was significant only among HIV-positive mothers (P=0·03). The effect on exclusive feeding was not different by household wealth or maternal education levels.

    CONCLUSIONS: A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.

  • 40. Ivarsson, A
    et al.
    Hernell, O
    Nystrom, L
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Children born in the summer have increased risk for coeliac disease.2003In: J Epidemiol Community Health, Vol. 57, p. 36-Article in journal (Refereed)
  • 41. Ivarsson, A
    et al.
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Nystrom, L
    Hernell, O
    The Swedish coeliac disease epidemic with a prevailing twofold higher riskin girls compared to boys may reflect gender specific risk factors.2003In: Eur J Epidemiol, Vol. 18, p. 677-Article in journal (Refereed)
  • 42. Ivarsson, Anneli
    et al.
    Kinsman, John
    Johansson, Karin
    Mohamud, Khalif Bile
    Weinehall, Lars
    Freij, Lennart
    Wall, Stig
    Dalmar, Abdirisak Ahmed
    Ibrahim, Abdirashid Omer
    Hagi, Abdisamad Abikar
    Abdi, Abshir Ali
    Hussein, Abdullahi Sheik
    Shirwa, Abdulkadir Mohamed
    Warsame, Amina
    Ereg, Derie Ismail
    Aden, Mohamed Hussain
    Qasim, Maryan
    Ali, Mohamed Khalid
    Elmi, Abdullahi
    Afrah, Abdullahi Warsame
    Sabtiye, Faduma Omar
    Guled, Fatuma Ege
    Ahmed, Hinda Jama
    Mohamed, Halima
    Tinay, Halima Ali
    Mohamud, Kadigia Ali
    Yusuf, Mariam Warsame
    Omar, Mayeh
    Abdi, Yakoub Aden
    Abdulkadir, Yusuf
    Johansson, Annika
    Kulane, Asli Ali
    Schumann, Barbara
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kalengayi, Faustine Nkulu
    Elgh, Fredrik
    Norstrom, Fredrik
    Lonnberg, Goran
    Norder, Helene
    Schroders, Julia
    Erlandsson, Kerstin
    Edin, Kerstin
    Sahlen, Klas-Goran
    Gustafsson, Lars L.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Eriksson, Malin
    Emmelin, Maria
    Hasselberg, Marie
    Klingberg, Marie
    Preet, Raman
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sjostrom, Urban
    Omar, Saif
    Healing the health system after civil unrest2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 27381Article in journal (Other academic)
  • 43. Jeppsson, A
    et al.
    Tesfu, M
    Persson, LA
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Health care providers´ perceptions on harmful traditional health practices in Ethiopia.2003In: Ethio.J.Health Dev., Vol. 17, p. 35-Article in journal (Refereed)
  • 44.
    Kaime-Atterhög, Wanjiku
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ahlberg, Beth Maina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    “With An Open Heart We Receive the Children”: Caregivers’ strategies for reaching and caring for street children in Kenya2016In: Journal of Social Work, ISSN 1468-0173, E-ISSN 1741-296XArticle in journal (Refereed)
    Abstract [en]

    Summary:

    The aim of the study was to explore how caregivers reach out and care for street children and understand their strategies and implication for outreach to the children, removal from the streets, rehabilitation and reintegration into society..  Data was collected over a period of two years using a semi-structured topic guide from seventy caregivers in 35 organisations in Kenya, identified using the snowball sampling strategy. Information generated was discussed with street children to help modify the interview and observation guides. To record interactions between the children and their caregivers, direct observation, video recording and photography were used at the caregivers’ workplaces on the streets and at institutions of care.

    Findings:

    Two themes were developed from the data, namely, the dedicated caregiver confronting street realities; and making a difference despite the limitations. The way caregivers interacted with the children on the streets and in the institutions greatly influenced the children’s decision to leave the streets, to be initiated into residential care, and attend rehabilitation and reintegration programmes. Children were more positive to caregivers who took time to understand them and were soft in establishing rapport with them.

    Application:

    The results suggest that caregivers’ strategies are potential contributors to declining trends of the street children phenomenon as they influence the children’s decision to leave the streets and undergo rehabilitation at institutions of care. Thus, we recommend the development of educational efforts focusing on helping caregivers develop healthy relationships and positive interactions with the children.

  • 45.
    Kallioinen, Maija
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Khan, Ashraful Islam
    Int Ctr Diarrhoeal Dis Res, Dhaka, Bangladesh.
    Lindström, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Rahman, Anisur
    Int Ctr Diarrhoeal Dis Res, Dhaka, Bangladesh.
    Ekholm Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Prenatal early food and multiple micronutrient supplementation trial reduced infant mortality in Bangladesh, but did not influence morbidity2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 1979-1986Article in journal (Refereed)
    Abstract [en]

    AIM: A previous maternal and infant nutrition intervention in rural Matlab, Bangladesh, showed that prenatal nutrient supplements improved child survival, but had no effect on size at birth. This secondary analysis examined whether prenatal multiple micronutrient supplements (MMS), on their own or combined with an early invitation to receive prenatal food supplements, affected child morbidity.

    METHODS: This randomised trial enrolled 4436 pregnant women from November 2001 to October 2003 and allocated them to early or standard invitations to food supplements, in the ninth and 20th weeks of pregnancy, respectively, and supplements of either the standard 60 mg iron with 400 μg folic acid, 30 mg iron with 400 μg folic acid or MMS. Quasi-Poisson regression was used to analyse morbidity.

    RESULTS: There were 3560 single live births and 3516 had morbidity data. The incidence rates of fever, diarrhoea and acute lower respiratory tract infection were 15.3, 3.6 and 2.3 episodes per person-year, respectively. The separate or combined interventions had no effect on morbidity up to 24 months.

    CONCLUSION: Early invitations to prenatal food supplements or prenatal MMS had no effect on common infections in rural Bangladesh, suggesting that earlier findings on improved child survival were not mediated by an effect on child morbidity.

  • 46.
    Khan, Ashraful
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hawkesworth, Sophie
    Hawlader, Mohammad Delwer Hossain
    Arifeen, Shams
    Moore, Sophie
    Hills, Andrew
    Wells, Jonathan
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kabir, Iqbal
    Body composition of Bangladeshi children: comparison and development of  leg-to-leg bioelectrical impedance equation2012In: Journal of Health, Population and Nutrition, ISSN 1606-0997, E-ISSN 2072-1315, Vol. 30, no 3, p. 281-290Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the validity of the Tanita TBF 300A leg-to-leg bioimpedance analyzer for estimating fat-free mass (FFM) in Bangladeshi children aged 4-10 years and to develop novel prediction equations for use in this population, using deuterium dilution as the reference method. Two hundred Bangladeshi children were enrolled. The isotope dilution technique with deuterium oxide was used for estimation of total body water (TBW).  FFM estimated by Tanita was compared to results of deuterium oxide dilution technique. Novel prediction equations were created for estimating FFM, using linear regression models, fitting child height and impedance as predictors.  There was a significant difference in FFM and BF% (percentage of body fat) between methods (p<0.01), Tanita under-estimating TBW in boys (p=0.001) and under-estimating BF% in girls (p<0.001). A basic linear regression model with height and impedance explained 83% of the variance in FFM estimated by deuterium oxide dilution. The best fit equation to predict FFM from linear regression modeling was achieved by adding weight, sex and age to the basic model, bringing the adjusted R2 to 89% (standard error=0.90, p<0.001). These data suggest Tanita analyzer may be a valid field assessment technique in Bangladeshi children when using population-specific prediction equations such as the ones developed here. 

  • 47.
    Khan, Ashraful Islam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hawkesworth, Sophie
    Medical Research Council – International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Arifeen, Shams
    International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
    Moore, Sophie E
    Medical Research Council – International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
    Frongillo, Edward A
    Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
    Yunus, Md
    International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kabir, Iqbal
    International Center for Diarrhoeal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
    Effects of exclusive breastfeeding intervention on child growth and body composition: the MINIMat trial, Bangladesh2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 8, p. 815-823Article in journal (Refereed)
    Abstract [en]

    AIM:

    Exclusive breastfeeding (EBF) for 6 months is recommended for optimal infant health, but the evidence for longer-term impacts is weak. We examined whether randomization to receive EBF counselling (BFC) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition.

    METHODS:

    In the Maternal and Infant Nutrition Interventions in Matlab trial, 4436 pregnant women were randomized to six equally sized, food and micronutrient groups. Of these, 3214 were randomized during the last trimester of pregnancy to receive either BFC or the usual/standard health message (UHM). Their infants were extensively followed up, with anthropometric measurements between 0 and 54 months and assessment of body composition at 54 months.

    RESULTS:

    The mean duration of EBF in the BFC group was 111 days compared to 76 days in the UHM group (mean difference: 35.0 days, 95% CI 30.6-39.5, p < 0.001). There was no difference in growth trajectories between the BFC and UHM groups and no difference in body composition at 54 months. Children exposed to prenatal multiple micronutrients (vs 60 mg iron and folate) combined with BFC (vs UHM), however, had slower linear growth (mean difference -0.17 SD score, p < 0.01).

    CONCLUSION:

    Exclusive breastfeeding counselling resulted in neither differential growth trajectories in infancy and childhood, nor body composition differences at 54 months. The combination of prenatal multiple micronutrient supplementation (MMS) and BFC was unfavourable for linear growth during 0-54 months, which raises questions about possible negative effects of MMS.

  • 48.
    Khan, Ashraful Islam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kabir, Iqbal
    International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Bangladesh.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Åsling-Monemi, Kajsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Alam, Dewan Shamsul
    International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Bangladesh.
    Frongillo, Edward A
    Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA.
    Yunus, Md
    International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Bangladesh.
    Arifeen, Shams
    International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Bangladesh.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh2011In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 10, p. 134-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offspring's growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes.

    METHODS:

    In the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab), Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 ug folic acid (Fe30F), 60 mg Fe and 400 ug folic acid (Fe60F) or MMS combined with either an early (immediately after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community) program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54 months, and 2735 children were available for analysis at 54 months.

    RESULTS:

    There were no differences in characteristics of mothers and households among the different intervention groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the proportion of stunting from early infancy up to 54 months for boys (p=0.01), but not for girls (p=0.31). MMS resulted in more stunting than standard Fe60F (p=0.02). There was no interaction between the food and micronutrient supplementation on the growth outcome.

    CONCLUSIONS:

    Early food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal growth suggest programming effects in early fetal life. The study is registered as an International Standard Randomized Controlled Trial, number ISRCTN16581394.

  • 49.
    Khan, Ashraful
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kabir, Iqbal
    Hawkesworth, Sophie
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Arifeen, Shams
    Frongillo, Edward
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Early invitation to food and/or multiple micronutrient supplementation in pregnancy does not affect body composition in offspring at 54 months: follow-up of the MINIMat randomized trial, Bangladesh2015In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 11, no 3, p. 385-397Article in journal (Refereed)
    Abstract [en]

    Growth patterns in early life are associated with later health. The effect of nutrition during in utero development on later body composition is unclear. We evaluated whether prenatal early invitation to food and/or multiple micronutrient supplementation (MMS) in pregnancy has an effect on offspring body composition at 54 months of age. In Maternal and Infant Nutrition Interventions in Matlab trial (ISRCTN16581394) in Bangladesh, 4436 pregnant women were randomised into six equally sized groups: double-masked supplementation with capsules of either 30mg Fe and 400g folic acid, or 60mg Fe and 400g folic acid, or MMS (15 micronutrients), was combined with a randomised early invitation (around 9 weeks) or a usual invitation (around 20 weeks) to start food supplementation (608kcal 6 days per week). At 54 months, the body composition of the offspring was assessed by leg-to-leg bioelectrical impedance analysis. Of the 3267 live singletons with birth anthropometry, 2290 children were measured at 54 months, representing 70% of the live births. There was no interaction between the food and micronutrient supplementation on body composition outcomes. There were no significant differences in a range of anthropometric and body composition measurements, including weight, height, mid-upper arm circumference, head circumference, skinfold thickness, and fat mass and fat-free mass between the different prenatal food and micronutrient groups using an intention-to-treat analysis. This analysis shows that early invitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age.

  • 50. Kippler, Maria
    et al.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lönnerdal, Bo
    Goessler, Walter
    Åkesson, Agneta
    El Arifeen, Shams
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Vahter, Marie
    Influence of iron and zinc status on cadmium accumulation in Bangladeshi women2007In: Toxicology and Applied Pharmacology, ISSN 0041-008X, E-ISSN 1096-0333, Vol. 222, no 2, p. 221-226Article in journal (Refereed)
    Abstract [en]

    Cadmium is a widespread environmental contaminant present in food. The absorption in the intestine increases in individuals with low iron stores, but the effect of zinc deficiency is not clear. The aim of the present study was to assess the influence of iron and zinc status on cadmium accumulation in pregnant Bangladeshi women. We measured cadmium in urine from 890 women using inductively coupled plasma mass spectrometry (ICPMS). Further, we also measured ferritin and zinc in plasma. The median cadmium concentration in urine was 0.59 μg/L (adjusted to mean specific gravity of 1.012 g/mL). Analysis of covariance (ANCOVA) showed that urinary cadmium was associated with plasma ferritin and plasma zinc via a significant interaction between dichotomized plasma ferritin and plasma zinc. The analysis was adjusted for age and socioeconomic status. Women with low iron stores and adequate zinc status had significantly higher urinary cadmium compared to women with both adequate iron stores and zinc status. There was no difference in urinary cadmium between women with both low iron stores and zinc status compared to those with both adequate iron stores and zinc status. In conclusion, low iron stores were associated with increased cadmium accumulation, but only at adequate zinc status.

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