Anemia in children younger than 3 years is a public health problem in Peru and worldwide. It is believed that one of the primary causes of anemia is iron deficiency. Numerous studies and reviews have ...reported that iron deficiency limited psychomotor development in children and that, despite the correction of anemia, children with iron deficiency experienced poorer long-term performance in cognitive, social, and emotional functioning. These outcomes were reported in observational studies, follow-up studies, and experimental studies with a control group. Anemia can decrease school performance, productivity in adult life, quality of life, and the general income of affected individuals. Here we describe possible mechanisms underlying the effect of iron deficiency, with or without anemia, on childhood development. The high rate of anemia in this age group is a cause for concern. Moreover, anemia should be prevented in the first year of life to avoid long-term negative effects on individual development.
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To characterize the nutritional status and cardio‐metabolic indicators of two groups of adolescents 14 yrs old, born from prenatal supplemented mothers. Methods: We evaluated a group of ...86 adolescents from mothers that received iron and folic acid (group A), and 75 from mothers that received iron, folic acid and zinc (Group B).
Results
In group A, 16 (18.6%) were overweight and 24.4% were obese; in group B, 15 (20%) were overweight and 16% were obese (NS). Among the overweight and obese children (n=64), mean Hb in group A was 13.5 g/dl and 12.8 g/dl in group B (p=0.007), there were no differences on mean serum zinc, ferritin, PCR, triglycerides, HD cholesterol, glucose, fasting insulin, blood pressure, waist circumference. In group A, 16 (43.2 %), 15 (40.5%) and 5 children (13.5%); in Group B, 13 (48.1%), 8 (29.6%) and 3 children (11.1%) had 1, 2 and 3 or more abnormal cardio metabolic indicators (NS). In 53 (82.8%) children had PCR > 5mg/L, in 56 (87.5%) had HDL cholesterol < 40 mg/dl (NS between groups). Results have shown a high prevalence of overweight and obesity in this population, cardio‐metabolic indicators shown a trend to develop metabolic syndrome. Differences were not associated to group of maternal supplementation. Supported by Nestle Foundation.
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While anemia can be the result of several micronutrient deficiencies, iron deficiency is frequently the cause. Children under the age of 2 are commonly affected by iron deficiency ...anemia, particularly in developing nations where repeated infection can exacerbate existing nutritional deficiency. Iron deficiency during childhood is associated with several negative outcomes, some of which persist beyond repletion. Here we investigated alterations in systemic metabolism and microbial diversity and functionality in a cross‐section of 6 mo and 12 mo anemic and non‐anemic Peruvian infants (n=200). Serum and fecal metabolomes were assessed using
1
H‐NMR and the fecal microbiome by 16S rRNA sequencing. Differences in microbial communities between the ages were as expected, with 6 mo old subjects exhibiting a greater abundance of
Bifidobacteria,
and lower abundance of
Bacteroidetes
and
Clostridia
, in comparison to the 12 mo old subjects. In 6 mo old subjects, we observed few differences in microbial communities and the fecal metabolome between anemic and non‐anemic subjects, though there were suggestions of impaired systemic energy metabolism as indicated by decreased levels of TCA cycle intermediates. In 12 mo old subjects, the structure of the microbial community did not exhibit many differences between anemic and non‐anemic infants. However, the fecal metabolomes suggested changes in community functionality with anemic infants having greater concentrations of both toxic and antioxidant compounds. While the concentrations of many of these compounds are too low to be quantified in blood, these differences have the potential to influence systemic metabolism. Additionally, 12 mo old anemic subjects exhibited expected decreases energy metabolism, and interesting male‐specific changes in amino acid levels were also observed. Considering that a greater proportion of anemia in the 12 mo old male subjects can be attributed to iron deficiency in comparison to the 12 mo old females, these patterns may begin to provide clues regarding why males are at a greater risk of developing IDA. Furthermore, these results highlight metabolic differences in anemia, and suggest how anemia negatively impacts long‐term development, potentially in a sex‐specific manner.
Support or Funding Information
Support for this project was provided by GAIN.
To develop an indicator of maternal near miss as a proxy for maternal death and to study its association with maternal factors and perinatal outcomes.
In a multicenter cross-sectional study, we ...collected maternal and perinatal data from the hospital records of a sample of women admitted for delivery over a period of two to three months in 120 hospitals located in eight Latin American countries. We followed a stratified multistage cluster random design. We assessed the intra-hospital occurrence of severe maternal morbidity and the latter's association with maternal characteristics and perinatal outcomes.
Of the 97,095 women studied, 2964 (34 per 1000) were at higher risk of dying in association with one or more of the following: being admitted to the intensive care unit (ICU), undergoing a hysterectomy, receiving a blood transfusion, suffering a cardiac or renal complication, or having eclampsia. Being older than 35 years, not having a partner, being a primipara or para > 3, and having had a Caesarean section in the previous pregnancy were factors independently associated with the occurrence of severe maternal morbidity. They were also positively associated with an increased occurrence of low and very low birth weight, stillbirth, early neonatal death, admission to the neonatal ICU, a prolonged maternal postpartum hospital stay and Caesarean section.
Women who survive the serious conditions described could be pragmatically considered cases of maternal near miss. Interventions to reduce maternal and perinatal mortality should target women in these high-risk categories.
ABSTRACT
Objective:
To compare glucose and rice‐based oral rehydration solution with rice‐based oral rehydration solution containing recombinant human lactoferrin and recombinant human lysozyme in ...diarrhea outcomes.
Patients and Methods:
We conducted a randomized, double‐blind controlled trial in children with acute diarrhea and dehydration. One hundred and forty children 5 to 33 months old were block randomized to receive low osmolarity WHO‐ORS (G‐ORS), rice‐based ORS (R‐ORS), or rice‐based ORS plus lactoferrin and lysozyme (Lf/Lz‐R‐ORS). Intake and output were monitored for 48 h in the ORU, with continued monitoring through home and clinic follow‐up for 14 d.
Results:
The G‐ORS and R‐ORS groups did not show any differences in diarrhea outcomes and were therefore combined as the control group. Intent‐to‐treat analysis showed a significant decrease in duration of diarrhea (3.67 d vs 5.21 d, P = 0.05) in the Lf/Lz‐R‐ORS group as compared with the control group and a significant increase in the number of children who achieved 48 h with solid stool, 85% vs 69% (P < 0.05). There were also decreases in volume of diarrhea and the percentage of children who had a new diarrhea episode after achieving the endpoint.
Conclusions:
Addition of recombinant human lactoferrin and lysozyme to a rice‐based oral rehydration solution had beneficial effects on children with acute diarrhea.
To describe the iron status profile and to propose hemoglobin adjustment factors for altitude for children aged 6 to 8 months in Lima, Arequipa, Cusco and Puno.
Cross-sectional study in children aged ...6 to 8 months from four cities. We measured hemoglobin and other iron biomarkers, C-reactive protein (CRP), among others. To estimate the adjustment equation, we applied an exponential regression. We excluded children with iron deficiency (ID) and/or inflammation.
The proportions of ID were higher in Puno and Arequipa, while inflammation did not exceed 19% in any of the cities. Hemoglobin showed an exponential increase at higher altitude. The adjustment equation was: 10.34249 x (1.00007 ^ Alt).
Children residing in Arequipa and Puno showed higher rates of ID and lower iron reserves; furthermore, the increase in hemoglobin by altitude was exponential, showing the need to adjust hemoglobin at altitude.
Background: To ensure multiple micronutrient powders (MNP) for children have their intended effect, it is important to understand caregivers’ experiences. Objective: We aimed to assess perceptions, ...practices, and preferences relating to the use of MNP among caregivers of children enrolled in a study to compare different MNP dosing schemes in Cajamarca, Peru. Methods: Infants age 6‐11 mo (n=400) were randomly assigned to 6 mo daily, 6 mo intermittent (every other day), 12 mo daily, or 12 mo intermittent MNP supplementation. MNP were provided monthly and field staff conducted home visits twice monthly. Unused MNP sachets were collected throughout and at endline (12 mo) all caregivers were asked about their experiences using MNP. Results: Most (94%) reported being very satisfied with MNP. One quarter (27%) reported difficulties remembering to give the MNP scheme as recommended. The most frequently reported strategies for remembering were keeping the MNP in the kitchen or bedroom. Most (98%) reported that giving their child MNP eventually became part of their regular routine; about half (59%) said that this took a week or less. Adherence was high; 85% of the MNP sachets were used and almost everyone (98%) reported giving all or most of the MNP to their child. Most (95%) reported noticing benefits after giving MNP to their child; increased appetite and increased hemoglobin (as informed by the study nurse) were most common. Caregivers assigned to the daily scheme were over 3 times more likely to say they would select their own scheme, compared to those in the intermittent group (OR: 3.6, 95%CI: 2.3‐5.7). Conclusions: MNP were acceptable and used with high adherence over the long term in this population; daily supplementation was preferred over intermittent.
Grant Funding Source: Supported by the Micronutrient Initiative
OBJECTIVE: To set up a global system for monitoring maternal and perinatal health in 54 countries worldwide. METHODS: The WHO Global Survey for Monitoring Maternal and Perinatal Health was ...implemented through a network of health institutions, selected using a stratified multistage cluster sampling design. Focused information on maternal and perinatal health was abstracted from hospital records and entered in a specially developed online data management system. Data were collected over a two- to three-month period in each institution. The project was coordinated by WHO and supported by WHO regional offices and country coordinators in Africa and the Americas. FINDINGS: The initial survey was implemented between September 2004 and March 2005 in the African and American regions. A total of 131 institutions in seven African countries and 119 institutions in eight Latin American countries participated. CONCLUSION: This project has created a technologically simple and scientifically sound system for large-scale data management, which can facilitate programme monitoring in countries.
ObjectiveThis study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women ...with infection during pregnancy in low-income and middle-income countries (LMIC).DesignWe conducted a 1-week inception hospital-based cohort study.SettingThe study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017.PatientsWe included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up.Main outcome measuresPerinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death).Results1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother’s infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death.ConclusionsOverall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.
Objective
To characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO4) for eclampsia prevention and treatment in a multi‐country network of health facilities ...and compare with international recommendations.
Design
Cross‐sectional survey.
Setting
A total of 147 health facilities in 15 countries across Africa, Latin America and Asia.
Population
Heads of obstetric departments or maternity units.
Methods
Anonymous online and paper‐based survey conducted in 2015.
Main outcome measures
Availability and use of MgSO4; availability of a formal clinical protocol for MgSO4 administration; and MgSO4 dosing regimens for eclampsia prevention and treatment.
Results
Magnesium sulphate and a formal protocol for its administration were reported to be always available in 87.4% and 86.4% of all facilities, respectively. MgSO4 was used for the treatment of mild pre‐eclampsia, severe pre‐eclampsia and eclampsia in 24.3%, 93.5% and 96.4% of all facilities, respectively. Regarding the treatment of severe pre‐eclampsia, 26.4% and 7.0% of all facilities reported using dosing regimens that were consistent with Zuspan and Pritchard regimens, respectively. Across regions, intramuscular maintenance regimens were more commonly used in the African region (45.7%) than in the Latin American (3.0%) and Asian (22.9%) regions, whereas intravenous maintenance regimens were more often used in the Latin American (94.0%) and Asian (60.0%) regions than in the African region (21.7%). Similar patterns were found for the treatment of eclampsia across regions.
Conclusions
The reported clinical use of MgSO4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations.
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MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.
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MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations.
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