| 1. |
- Assey, Vincent D., et al.
(author)
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Improved salt iodation methods for small-scale salt producers in low-resource settings in Tanzania
- 2009
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 9, s. 187-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Universal salt iodation will prevent iodine deficiency disorders (IDD). Globally, salt-iodation technologies mostly target large and medium-scale salt-producers. Since most producers in low-income countries are small-scale, we examined and improved the performance of hand and knapsack-sprayers used locally in Tanzania. METHODS: We studied three salt facilities on the Bagamoyo coast, investigating procedures for preparing potassium-iodate solution, salt spraying and mixing. Different concentrations of solution were prepared and tested using different iodation methods, with the aim of attaining correct and homogeneous iodine levels under real-life conditions. Levels achieved by manual mixing were compared to those achieved by machine mixing. RESULTS: The overall median iodation level in samples of salt iodated using previously existing methods was 10.6 ppm (range 1.1 - 110.0 ppm), with much higher levels in the top than the bottom layers of the salt bags, p < 0.0001. Experimentation using knapsack-sprayers and manual mixing led to the reliable achievement of levels (60.9 ppm +/- 7.4) that fell within the recommended range of 40 - 80 ppm. The improved methods yielded homogenous iodine concentrations in all layers of salt-bags (p = 0.58) with 96% of the samples (n = 45) falling within 40 - 80 ppm compared to only 9% (n = 45) before the experiment and training (p < 0.0001). For knapsack-spraying, a machine mixer improved the iodine levels and homogeneity slightly compared to manual mixing (p = 0.05). CONCLUSION: Supervised, standardized salt iodation procedures adapted to local circumstances can yield homogeneous iodine levels within the required range, overcoming a major obstacle to universal salt iodation.
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| 2. |
- Assey, Vincent D, et al.
(author)
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Tanzania national survey on iodine deficiency : impact after twelve years of salt iodation.
- 2009
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 55, s. 295-295
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Journal article (peer-reviewed)abstract
- BACKGROUND: In many low-income countries, children are at high risk of iodine deficiency disorders, including brain damage. In the early 1990s, Tanzania, a country that previously suffered from moderate to severe iodine deficiency, adopted universal salt iodation (USI) as an intervention strategy, but its impact remained unknown. METHODS: We report on the first national survey in mainland Tanzania, conducted in 2004 to assess the extent to which iodated salt was used and its apparent impact on the total goitre prevalence (TGP) and urinary iodine concentrations (UIC) among the schoolchildren after USI was initiated. In 2004, a cross-sectional goitre survey was conducted; covering 140,758 schoolchildren aged 6 - 18 years were graded for goitre according to new WHO goitre classification system. Comparisons were made with district surveys conducted throughout most of the country during the 1980s and 90s. 131,941 salt samples from households were tested for iodine using rapid field test kits. UIC was determined spectrophotometrically using the ammonium persulfate digestion method in 4523 sub-sampled children. RESULTS: 83.6% (95% CI: 83.4 - 83.8) of salt samples tested positive for iodine. Whereas the TGP was about 25% on average in the earlier surveys, it was 6.9% (95%CI: 6.8-7.0) in 2004. The TGP for the younger children, 6-9 years old, was 4.2% (95%CI: 4.0-4.4), n = 41,965. In the 27 goitre-endemic districts, TGP decreased from 61% (1980s) to 12.3% (2004). The median UIC was 204 (95% CF: 192-215) microg/L. Only 25% of children had UIC <100 microg/L and 35% were > or = 300 microg/L, indicating low and excess iodine intake, respectively. CONCLUSION: Our study demonstrates a marked improvement in iodine nutrition in Tanzania, twelve years after the initiation of salt iodation programme. The challenge in sustaining IDD elimination in Tanzania is now two-fold: to better reach the areas with low coverage of iodated salt, and to reduce iodine intake in areas where it is excessive. Particular attention is needed in improving quality control at production level and perhaps the national salt iodation regulations may need to be reviewed.
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| 3. |
- Dapi N., Léonie, 1971-
(author)
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Socioeconomic and sex differences in adolescents’ dietary intake, anthropometry and physical activity in Cameroon, Africa
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Background: People in Cameroon are experiencing a dietary transition characterized by changing from traditional food habits to increased intake of highly processed sweet and fatty food. The rapid change in food pattern combined with an increased sedentary lifestyle has resulted in a rather high prevalence of obesity, hypertension, cardiovascular diseases and type 2 diabetes. Nutritional intake is important during adolescence for growth spurt, health, cognitive development and performance in school. Objective: The aim of this thesis was to assess dietary intake, anthropometry and physical activity of adolescents according to sex and socioeconomic status (SES) and to investigate food perceptions of adolescents living in urban and rural areas of Cameroon. Methods: Girls and boys, 12-16 years of age, were randomly selected from schools in urban and rural areas. Food frequency questionnaire, 24-hour dietary and physical activity recalls, anthropometric measurements, qualitative interviews and a background questionnaire were used for data collection. Results: The proportion of overweight was three times higher in girls (14%) compared to boys (4%). Stunting and underweight were more common among boys (15% and 6%) than girls (5% and 1%). The prevalence of stunting was two times higher among the urban adolescents with low SES (12%) compared to those with high SES (5%). The rural adolescents had the highest proportion of stunting but more muscle that the urban adolescents. The rural adolescents ate in order to live and to maintain health. Urban adolescents with low SES ate in order to maintain health, while those with high SES ate for pleasure. More than 30% of the adolescents skipped breakfast in the urban area. Urban adolescents with high SES and girls reported a more frequent consumption of in-between meals and most food groups compared to the rural adolescents, boys and those with low SES. Over 55% of the adolescents had a protein intake below 10% of the energy (E%). Twenty-six percent of the adolescents had fat intake below 25 E%, and 25% had fat intake above 35 E%. A large proportion of the adolescents had an intake of micronutrients below the estimated average recommendation. Boys and the adolescents with low SES reported a higher energy expenditure and physical activity level than girls and the adolescents with high SES, respectively. Both under- and over-reporting of energy intake were common among the adolescents. Conclusions: The present study showed that nutrient inadequacy, stunting, underweight, as well as overweight and obesity were common among the adolescents in Cameroon. Therefore an intervention program targeting both under- and overnutrition among school adolescents is needed. Sex and socioeconomic differences also need to be considered.
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| 4. |
- Doherty, Tanya, et al.
(author)
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Early cessation of breastfeeding amongst women in South Africa : an area needing urgent attention to improve child health
- 2012
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In: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 12, s. 105-
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Journal article (peer-reviewed)abstract
- Background: Breastfeeding is a critical component of interventions to reduce child mortality. Exclusive breastfeeding practice is extremely low in South Africa and there has been no improvement in this over the past ten years largely due to fears of HIV transmission. Early cessation of breastfeeding has been found to have negative effects on child morbidity and survival in several studies in Africa. This paper reports on determinants of early breastfeeding cessation among women in South Africa.Methods: This is a sub group analysis of a community-based cluster-randomized trial (PROMISE EBF) promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008 (ClinicalTrials.gov no: NCT00397150). Infant feeding recall of 22 food and fluid items was collected at 3, 6, 12 and 24 weeks postpartum. Women's experiences of breast health problems were also collected at the same time points. 999 women who ever breastfed were included in the analysis. Univariable and multivariable logistic regression analysis adjusting for site, arm and cluster, was performed to determine predictors of stopping breastfeeding by 12 weeks postpartum.Results: By 12 weeks postpartum, 20% of HIV-negative women and 40% of HIV-positive women had stopped all breastfeeding. About a third of women introduced other fluids, most commonly formula milk, within the first 3 days after birth. Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks (Adjusted odds ratio, AOR 5.6, 95% CI 3.4 - 9.5 and AOR 4.1, 95% CI 1.6 - 10.8, respectively). Also important was self-reported breast health problems associated with a 3-fold risk of stopping breastfeeding (AOR 3.1, 95% CI 1.7 - 5.7) and the mother having her own income doubled the risk of stopping breastfeeding (AOR 1.9, 95% CI 1.3 - 2.8).Conclusion: Early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.
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| 5. |
- Doherty, Tanya, et al.
(author)
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Severe events in the first 6 months of life in a cohort of HIV-unexposed infants from South Africa : effects of low birthweight and breastfeeding status
- 2014
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In: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 19:10, s. 1162-1169
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Journal article (peer-reviewed)abstract
- OBJECTIVE:To report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa.METHODS:South African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother-infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate.RESULTS:Seventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.2-5.1) and low birthweight (HR 2.4; 95% CI 1.3-4.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1-0.7).CONCLUSIONS:A strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants.
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| 6. |
- Engebretsen, Ingunn Marie S, et al.
(author)
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Early infant feeding practices in three African countries : the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors.
- 2014
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In: International Breastfeeding Journal. - : Springer Science and Business Media LLC. - 1746-4358. ; 9
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Journal article (peer-reviewed)abstract
- BACKGROUND: Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO. We report its impact on early infant feeding practices from the PROMISE-EBF trial.METHODS: PROMISE-EBF was a cluster randomised behaviour change intervention trial of exclusive breastfeeding (EBF) promotion by peer counsellors in Burkina Faso, Uganda and South Africa implemented during 2006-2008 among 2579 mother-infant pairs. Counselling started in the last pregnancy trimester and mothers were offered at least five postnatal visits. Early infant feeding practices: use of prelacteal feeds (any foods or drinks other than breast milk given within the first 3 days), expressing and discarding colostrum, and timing of initiation of breastfeeding are presented by trial arm in each country. Prevalence ratios (PR) with 95% confidence intervals (95%CI) are given.RESULTS: The proportion of women who gave prelacteal feeds in the intervention and control arms were, respectively: 11% and 36%, PR 0.3 (95% CI 0.2, 0.6) in Burkina Faso, 13% and 44%, PR 0.3 (95% CI 0.2, 0.5) in Uganda and 30% and 33%, PR 0.9 (95% CI 0.6, 1.3) in South Africa. While the majority gave colostrum, the proportion of those who expressed and discarded it in the intervention and control arms were: 8% and 12%, PR 0.7 (95% CI 0.3, 1.6) in Burkina Faso, 3% and 10%, PR 0.3 (95% CI 0.1, 0.6) in Uganda and 17% and 16%, PR 1.1 (95% CI 0.6, 2.1) in South Africa. Only a minority in Burkina Faso (<4%) and roughly half in South Africa initiated breastfeeding within the first hour with no large or statistically significant differences between the trial arms, whilst in Uganda the proportion of early initiation of breastfeeding in the intervention and control arms were: 55% and 41%, PR 0.8 (95% CI 0.7, 0.9).CONCLUSIONS: The PROMISE-EBF trial showed that the intervention led to less prelacteal feeding in Burkina Faso and Uganda. More children received colostrum and started breastfeeding early in the intervention arm in Uganda. Late breastfeeding initiation continues to be a challenge. No clear behaviour change was seen in South Africa.TRIAL REGISTRATION: NCT00397150.
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| 7. |
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| 8. |
- Fantahun, Mesganaw, 1958-
(author)
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Mortality and survival from childhood to old age in rural Ethiopia
- 2008
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Doctoral thesis (other academic/artistic)abstract
- This thesis examines ways of establishing cause of death, assessing trends in mortality, and identifying factors that affect mortality and survival among the different population groups in rural and semi-urban Ethiopia. These data are important for health care planning; however, such vital data are unavailable in many developing countries. The study was conducted in Butajira Rural Health Program Demographic Surveillance Site, Ethiopia, where data collection on vital events and related research has been conducted for the last 20 years. This thesis used a cohort and a case referent study preceded by Focus Group Discussion. It also employed a verbal autopsy procedure to identify causes of death. The cohort component used 18 years of surveillance data (1987-2004). The prospective case referent study, carried out in the years 2003-2005, was used to complement the mortality analysis and focused particularly on issues related to household decision making, social capital, and economic status. The main subgroups included were children under-five years old, adults 15-64, and the elderly 65 years and above. Cause of death was ascertained using the Physicians’ Review and InterVA methods. Food shortage and epidemics affected the modest downward trend of mortality. There was a general similarity between the Physicians’ Review and InterVA methods in identifying the major causes of death. About 60% of the deaths were due to pneumonia/sepsis, pulmonary tuberculosis, malaria, and diarrhoea disease/malnutrition. The InterVA method was cheaper and more consistent. Higher rates of HIV/AIDS (11%), tuberculosis (18%), and cardiovascular (9%) mortality were noted in urban areas compared to rural areas. Consistent higher mortality was found in rural areas. Women were disadvantaged by residence and advanced age. Place of residence, illiteracy, widowhood, and not owning a house affected men and women differently, indicating a possible need for gender-specific interventions. Children and women survival is affected by household decision-making; this means efforts to improve women’s involvement in household decision-making (women empowerment) might improve child and women survival in poor settings. Many factors that significantly affect mortality can only be controlled by concerted efforts to improve health and overall development.
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| 9. |
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| 10. |
- Kasenga, Fyson, 1963-
(author)
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Making it happen : prevention of mother to child transmission of HIV in rural Malawi
- 2009
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Doctoral thesis (other academic/artistic)abstract
- The devastating consequences of HIV/AIDS have caused untold harm and human suffering globally. Over 33 million people worldwide are estimated to be living with HIV and AIDS and a majority of these are in sub-Saharan Africa. Women and children are more infected particularly in sub-Saharan countries. Globally, an estimated number of 370 000 children were newly infected in 2007, mainly through mother to child transmission (MTCT). Implementation of prevention of mother to child transmission (PMTCT) programmes has been introduced in many sub-Saharan countries during the last years. Operational research was conducted to study the demand and adherence of key components within a PMTCT Programme among women in rural Malawi. This study was carried out at Malamulo SDA Hospital in rural Malawi and employed a mixture of both quantitative and qualitative approaches. Data sources included antenatal care (ANC), PMTCT and delivery registers, structured questionnaires, in-depth interviews with HIV positive women in the programme and focus group discussions with community members, health care workers and traditional birth attendants. Over the three year period of the study (January 2005 to December 2007), three interventions were introduced in the antenatal care (ANC) at the hospital at different times. These were HIV testing integrated in the ANC clinic in March 2005, opt-out testing in January 2006 and free maternal services in October 2006. A steady increase of the service uptake as interventions were being introduced was observed over time. HIV testing was generally accepted by the community and women within the programme. However, positive HIV tests among pregnant women were also experienced to cause conflicts and fear within the family. Although hospital deliveries were recognised to be safe and clean, home deliveries were common. Lack of transport, spouse support and negative attitudes among staff were some of the underlying factors. Further study on the quality of care offered in the presence of increased service uptake is required. Community sensitisation on free maternal care and male involvement should be strengthened to enable full utilisation of services. Additionally, service providers at facility and community levels, policy makers at all levels and the communities should see themselves as co-workers in development to reduce preventable maternal and infant mortality including MTCT of HIV.
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| 11. |
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| 12. |
- Kukka, Antti, 1988-
(author)
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Surviving Birth and Thriving : Identifying infants at risk of death and disability in low- and middle-income countries
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Background: Ending preventable newborn deaths is an unfinished global health agenda. Infants surviving birth have a right to thrive and to reach their full developmental potential. The aim of this thesis was to evaluate methods for identification of infants in need of neonatal resuscitation and at risk of disability in low- and middle-income countries.Paper I was an observational study conducted in Pokhara, Nepal, comparing the heart rate in the first 3 minutes in infants who were quietly breathing (n=54) versus crying (n=1155) immediately after birth. The median heart rate did not differ between the two groups, but both bradycardia and tachycardia were more common among non-crying but breathing newborns.Paper II was a systematic review and meta-analysis of studies examining the incidence and outcomes of intrapartum-related neonatal encephalopathy in low- and middle-income countries. Altogether 53 articles were identified. The incidence ranged from 1.5 to 20.3 per 1000 live births (5 studies), the mean neonatal mortality was 19.3 % (45 studies, 3307 infants), and the incidence of combined outcome of death or moderate to severe disability at follow-up was 44.6 % (19 studies, 1595 children).Paper III evaluated the feasibility of smartphone-aided remote General Movements Assessment for identification of children at risk of cerebral palsy in Kathmandu, Nepal. Children surviving birth asphyxia or neonatal seizures were filmed by parents using the NeuroMotion smartphone application at home at 3 months’ age. Altogether 31 children were enrolled, and 16 parents returned at least one video of approved technical quality. Usability of the app was good based on parental survey.In Paper IV, individual (n=4) and group interviews (n=2) were conducted with ten mothers participating in the smartphone aided follow-up of their infants. The data were analysed using deductive qualitative content analysis. The remote follow-up was acceptable with support from the research assistants. Some participants would have preferred a face-to-face evaluation.Conclusion: Not crying at birth is a potential indicator for need of neonatal resuscitation. Infants who survive resuscitation are at risk of intrapartum-related neonatal encephalopathy, which has persistently high burden particularly in low-income countries. All survivors of encephalopathy need follow-up and smartphone-aided remote General Movements Assessment could complement the assessments in settings similar to Kathmandu.
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| 13. |
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| 14. |
- Nankabirwa, Victoria, et al.
(author)
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Child survival and BCG vaccination : a community based prospective cohort study in Uganda.
- 2015
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15
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Journal article (peer-reviewed)abstract
- BACKGROUND: Data on non-specific effects of BCG vaccination in well described, general population African cohorts is scanty. We report the effects of BCG vaccination on post-neonatal infant and post-infancy mortality in a cohort of children in Mbale, Eastern Uganda.METHODS: A community-based prospective cohort study was conducted between January 2006 and February 2014. A total of 819 eligible pregnant women were followed up for pregnancy outcomes and survival of their children up to 5 years of age. Data on the children's BCG vaccination status was collected from child health cards at multiple visits between 3 weeks and 7 years of age. Data was also collected on mothers' residence, age, parity, household income, self-reported HIV status as well as place of birth. Multivariable Cox proportional hazards regression models taking into account potential confounders were used to estimate the association between BCG vaccination and child survival.RESULTS: The neonatal mortality risk was 22 (95% CI: 13, 35), post-neonatal infant mortality 21 (12, 34) per 1,000 live births and the mortality risk among children between 1 and 5 years of age (post-infancy) was 63 (47, 82) per 1,000 live births. The median age at BCG vaccination was 4 days. Out of 819 children, 647 (79%) had received the BCG vaccine by 24 weeks of age. In the adjusted analysis, the rate of post-neonatal death among infants vaccinated with BCG tended to be nearly half of that among those who had not received the vaccine (adjusted HR: 0.47; 95% CI: 0.14, 1.53). BCG vaccination was associated with a lower rate of death among children between 1 and 5 years of age (adjusted HR: 0.26; 95% CI: 0.14, 0.48).CONCLUSION: The risk of early childhood death in Mbale, Uganda is unacceptably high. BCG vaccination was associated with an increased likelihood of child survival.
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| 15. |
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| 16. |
- Nankunda, Jolly, et al.
(author)
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Establishing individual peer counselling for exclusive breastfeeding in Uganda : implications for scaling-up.
- 2010
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In: Maternal and Child Nutrition. - : Wiley. - 1740-8695 .- 1740-8709. ; 6:1, s. 53-66
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Journal article (peer-reviewed)abstract
- Exclusive breastfeeding remains critical for child survival, potentially reducing childhood morbidity and mortality. In Uganda, 98% of children are ever breastfed, but exclusive breastfeeding levels remain low. Supporting mothers in breastfeeding exclusively can improve breastfeeding practices. This paper describes experiences of establishing individual peer counselling for exclusive breastfeeding in the Uganda site of the Promoting Infant Health and Nutrition in Sub-Saharan Africa: Safety and Efficacy of Exclusive Breastfeeding Promotion in the Era of HIV trial, and highlights some implications for scaling-up. Twelve women were identified by their communities, one from each of 12 clusters. They were trained for 6 days and followed up for 1 year while they counselled mothers. Their knowledge and attitudes towards exclusive breastfeeding were assessed before and immediately after training, and also 10 months into peer counselling. Observations, field notes and records of interactions with peer counsellors were used to record experiences from this intervention. The communities were receptive to peer counselling and women participated willingly. After training and 10 months' follow-up, their knowledge and attitude to exclusive breastfeeding improved. All were retained in the study, and mothers accepted them in their homes. They checked for mothers several times if they missed them on the first attempt. Husbands and grandmothers played key roles in infant feeding decisions. Involving the communities in selection helped to identify reliable breastfeeding peer counsellors who were acceptable to mothers and were retained in the study. Other key issues to consider for scaling-up such interventions include training and follow up of peer counsellors, which led to improved knowledge and attitudes towards exclusive breastfeeding (ClinicalTrials.gov no: NCT00397150).
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| 17. |
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| 18. |
- Peterson, Stefan, et al.
(author)
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Endemic goitre in Guinea
- 1995
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In: The Lancet. ; 345:8948, s. 513-514
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Journal article (peer-reviewed)
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| 19. |
- Rana, Nisha, 1979-
(author)
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Delayed cord clamping in Nepal-Evidence for implementation
- 2019
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Doctoral thesis (other academic/artistic)abstract
- The aims of this thesis were to investigate effects of timing of umbilical cord clamping on newborn health, and on infant outcomes up to 12 months of age in a high-risk population and to explore the context of implementing changed umbilical cord clamping practices in Nepal.A randomised controlled trial with 540 late preterm and term infants born by normal vaginal delivery was set up at a maternity hospital in Kathmandu, Nepal. Infants were enrolled in two parallel groups (1:1 ratio), randomised to early (ECC) (≤60 seconds) or delayed cord clamping (DCC) (≥180 seconds).To get a deeper understanding of barriers and enablers for change in clinical practise in relation to cord clamping, a qualitative study with delivery staff was set up. Focus group discussions and key informant interviews were conducted at two major delivery hospitals in Kathmandu.Paper I showed that DCC was an effective intervention to reduces anaemia at 8 and 12 months of age in a high-risk population, which may have major positive effects on infants’ health and development.Paper II utilised the Ages and Stages Questionnaire (ASQ) to assess neurodevelopment in infants at 12 months of age. The result showed DCC was associated with an improvement of the overall neurodevelopment at 12 months of age as compared to infants in the ECC group.Paper III showed that DCC was not associated with an increased risk of hyperbilirubinemia during the first day of life or risk of jaundice within 4 weeks compared with the ECC group.Paper IV demonstrated how a positive attitude towards DCC and a will to rely on research evidence when striving to do good are facilitators of change in clinical practice. However, the participants in the study were hesitant to apply DCC due to lack of national or institutional protocols and formal training. Consequently, they were forced to take informal decisions and rely on alternate sources of information.In conclusion, delaying umbilical cord clamping for 180 seconds is safe and associated with a significantly reduced risk of anaemia at 8 and 12 months which may have neurodevelopmental effects at a later age and is not associated with an increased risk of hyperbilirubinemia during the first days of life or risk of jaundice within 4 weeks of age. In order to change cord clamping practices to comply with evidence and policies health-care staff needs to be better supported by the governance structures of the health system, with clear and approved guidelines made available and coherent training and support.
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| 20. |
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| 21. |
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| 22. |
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| 23. |
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| 24. |
- Tylleskär, Thorkild, et al.
(author)
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Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF) : a cluster-randomised trial
- 2011
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In: The Lancet. - 0140-6736 .- 1474-547X. ; 378:9789, s. 420-427
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Journal article (peer-reviewed)abstract
- BackgroundExclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. The effect of breastfeeding counselling by peer counsellors was assessed in Africa.Methods24 communities in Burkina Faso, 24 in Uganda, and 34 in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering team were masked to the intervention allocation. The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. This study is registered withClinicalTrials.gov, numberNCT00397150.Findings2579 mother–infant pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n=402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 (79%) of 392 and 139 (35%) of 402, respectively, in Burkina Faso (prevalence ratio 2·29, 95% CI 1·33–3·92); 323 (82%) of 396 and 161 (44%) of 369, respectively, in Uganda (1·89, 1·70–2·11); and 56 (10%) of 535 and 30 (6%) of 485, respectively, in South Africa (1·72, 1·12–2·63). The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 (77%) and 94 (23%), respectively, in Burkina Faso (3·27, 2·13–5·03); 305 (77%) and 125 (34%), respectively, in Uganda (2·30, 2·00–2·65); and 41 (8%) and 19 (4%), respectively, in South Africa (1·98, 1·30–3·02). At 24 weeks, the prevalences based on 24-h recall were 286 (73%) in the intervention cluster and 88 (22%) in the control cluster in Burkina Faso (3·33, 1·74–6·38); 232 (59%) and 57 (15%), respectively, in Uganda (3·83, 2·97–4·95); and 12 (2%) and two (<1%), respectively, in South Africa (5·70, 1·33–24·26). The prevalences based on 7-day recall were 279 (71%) in the intervention cluster and 38 (9%) in the control cluster in Burkina Faso (7·53, 4·42–12·82); 203 (51%) and 41 (11%), respectively, in Uganda (4·66, 3·35–6·49); and ten (2%) and one (<1%), respectively, in South Africa (9·83, 1·40–69·14). Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 (5%) and 36 (9%), respectively, in Burkina Faso (0·57, 0·27–1·22); 39 (10%) and 32 (9%), respectively, in Uganda (1·13, 0·81–1·59); and 45 (8%) and 33 (7%), respectively, in South Africa (1·16, 0·78–1·75). The prevalence at age 24 weeks in the intervention and control clusters was 26 (7%) and 32 (8%), respectively, in Burkina Faso (0·83, 0·45–1·54); 52 (13%) and 59 (16%), respectively, in Uganda (0·82, 0·58–1·15); and 54 (10%) and 33 (7%), respectively, in South Africa (1·31, 0·89–1·93).InterpretationLow-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings.
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| 25. |
- Tylleskär, Thorkild
(author)
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The causation of konzo : studies on a paralytic disease in Africa
- 1994
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Doctoral thesis (other academic/artistic)abstract
- Epidemics of a permanent, non-progressive spastic paraparesis with sudden onset hasbeen reported from several rural areas of sub-Saharan Africa. Studies in East Africasuggested an association with dietary cyanide intake from unprocessed cassava. InZaire the disease was attributed to an infectious cause as the cyanogenic glucosides inthe cassava consumed were known to be removed by traditional soaking. The aims ofthe thesis were to define the disease entity and elucidate its etiology. A communitybasedsurvey in rural Zaire identified 110 live and 24 dead cases among 6764inhabitants (16/1000). The clinical findings were identical to earlier studies and it wasdecided to name the disease konzo as in the first known report. Annual and monthlyincidence of konzo was associated with almost exclusive consumption of shortsoakedbitter cassava roots. The appearence of konzo coincided with the completionof a tarmac road from the capital, which turned cassava into the main cash crop, andinduced short-cuts in the processing. A processing experiment showed that flour fromshort-soaked roots was high in cyanogens. A higher cyanide intake in affectedcompared to un-affected populations was confirmed by much higher urinarythiocyanate levels, the main metabolite. A low urinary sulphate indicated lowavailability of sulphur, the substrate for detoxification. All three konzo patientsexamined at onset had blood cyanide levels above 4 Ilmolll, versus only 2 out of 23controls (p
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