TWO YEAR NEUROLOGICAL OUTCOMES OF VERY LOW BIRTH WEIGHT INFANTS

Background: High risk newborns such as the Very Low Birth Weight (VLBW) require long term follow up to ascertain their subsequent survival and quality of life (based on neurological intactness). Though such data is now standard in the developed world, little is known in published literature about the situation in resource constrained countries.Objective: To describe the neurological outcomes of VLBW infants evaluated at two years of age.Design: Longitudinal descriptive survey.Setting: Kenyatta National Hospital’s Newborn Unit during the year 2002.Subjects: One hundred and twenty infants born weighing 1000 grams and 1500 grams followed up until the age of 24 months.Results: Of the 120 infants evaluated, 14 (11.7%; 95% Cl 6.2-17.1) had cerebral palsy, 11 (9.2%; 95% Cl 4.8-16.9) were delayed on cognitive assessment while 32 (26.7%; 95% Cl 9.3-38.1) were found tohave functional disabilities. The factors associated with functional disability in the cohort included; neonatal illness (P = 0.005, 95% Cl 1.26<2.43<4.69), exclusive use of breast milk in the first month (P = 0.02, 95% Cl 1.10<2.04<3.78), neonatal weight gain less than 15 grams/kg/day (P = 0.014, 95% Cl1.13<2.24<4.42), history of re-hospitalisation (P<0.001, 95% Cl 1.72<3.33<6.34) and weight less than the third percentile at two years (P = 0.019, 95%1.09<2.22<4.53).Conclusions: Neurological dysfunction was more frequent in this cohort than presently reported from other centres. The cross-tabulations indicate that history of neonatal illness, choice of early nutrition, slower growth and post discharge morbidity were associated with subsequent neurological dysfunction. The factors associated with developmental delay in this cohort should be explored further in order to determine the manipulations required in the newborn period forimprovement of neurological outcomes among these high risk infants

Designing snacks to address micronutrient deficiencies in rural Kenyan schoolchildren

Three snacks were designed to improve nutrient intakes among school-age children living in rural Kenya. Snacks containing animal-source foods (milk and meat) provided more nutrients than an equicaloric vegetarian snack. The vegetarian snack provided extra vitamin A (primarily from fortified cooking fat; the milk snack was rich in calcium, vitamin A, and vitamin B-12; and the meat snack supplied vitamin B-12, iron, and zinc. When changes in intakes from baseline to the feeding period were compared across the 4 groups, total energy intake increased the most for children in the meat group and the least for children in the control group. Differences in energy intakes across the 3 feeding groups were primarily caused by decreases in home intake for the vegetarian and milk snack groups. It is important to evaluate the change in home intakes as well as intakes from the foods provided by the study when evaluating the effect of feeding programs on nutrient adequacy

Meat supplementation improves growth, cognitive, and behavioral outcomes in Kenyan children

A randomized, controlled school feeding study was conducted in rural Embu District, Kenya to test for a causal link between animal-source food intake and changes in micronutrient nutrition and growth, cognitive, and behavioral outcomes. Twelve primary schools were randomly assigned to 1 of 4 groups. Children in Standard I classes received the local plant-based dish githerias a midmorning school snack supplemented with meat, milk, or fat added to equalize energy content in all feedings. The Control children received no feedings but participated in data collection. Main outcome measures assessed at baseline and longitudinally were 24-h food intake recall, anthropometry, cognitive function, physical activity, and behaviors during school free play. For cognitive function, the Meat group showed the steepest rate of increase on Raven's Progressive Matrices scores and in zone-wide school end-term total and arithmetic test scores. The Plain githeri and Meat groups performed better over time than the Milk and Control groups (P <0.02-0.03) on arithmetic tests. The Meat group showed the greatest increase in percentage time in high levels of physical activity and in initiative and leadership behaviors compared with all other groups. For growth, in the Milk group only younger and stunted children showed a greater rate of gain in height. The Meat group showed near doubling of upper midarm muscle area, and the Milk group a smaller degree of increase. This is the first randomized, controlled feeding study to examine the effect of meat-vs. milk-vs. plant-based snacks on functional outcomes in children

School snacks containing animal source foods improve dietary quality for children in rural Kenya

Provision of a snack at school could help alleviate the micronutrient malnutrition that is common among schoolchildren in developing countries. The Child Nutrition Project was designed to compare the efficacy of three school snacks in improving growth and cognitive function of children in rural Kenya. The snacks provided 20% of the children's energy requirement, and were composed of equicaloric portions of githeri (a vegetable stew) alone (Energy group), githeri plus milk (Milk group) or githeri plus meat (Meat group). A fourth group of children served as Controls. When nutrient intakes from three, 24-h dietary recalls collected before feeding were compared to three, 24-h recalls conducted after feeding began, intakes of vitamin B-12, riboflavin, vitamin A and calcium increased more in the Milk group than in the Control group, whereas intakes of vitamin B-12, vitamin A, calcium, available iron and available zinc increased more than those of Controls for children in the Meat group. At most of the time points examined, total energy intake increased more for the Meat group than for the other two feeding groups, because the additional energy provided by the Milk and Energy snacks was partially balanced by a decrease in the energy content of foods consumed at home. This decrease did not occur to the same extent for the Meat group, so both dietary quantity and dietary quality improved. For the Milk group, only dietary quality improved. For the Energy group, there were no significant changes in the total day's diet compared to the Control group

The Potential of Increased Meat Intake to Improve Iron Nutrition in Rural Kenyan Schoolchildren

Schoolchildren in developing countries often have inadequate intakes of iron, due primarily to poor I bioavailability. Increasing meat in the diet could improve both the amount of iron consumed and its availability. The effect of increases in intakes of meat and ascorbic acid on absorbed iron was investigated by theoretically modifying the habitual diet of rural Kenyan schoolchildren. The projected changes in the amount of absorbed iron and prevalence of inadequate iron intakes were calculated for 78 children (6-9 years of age). The prevalence of inadequate iron intakes decreased from 77% to 54% through the theoretical addition of 50 g beef prevalence or 100 mg ascorbic acid and to 23% through the addition of both to dinner each day. To reduce the of inadequate iron intake to 5%, the addition of 100 g meat plus 150 mg ascorbic acid would be necessary. The combined addition of meat and ascorbic acid to a meal has the potential to reduce the,projected prevalence of inadequate iron intakes among these schoolchildren

COMPARISON OF BLOOD SMEAR MICROSCOPY TO A RAPID DIAGNOSTIC TEST FOR IN-VITRO TESTING FOR P. FALCIPARUM MALARIA IN KENYAN SCHOOL CHILDREN

Objective: To compare the diagnostic performance of microscopy using Giemsastained thick and thin blood smears to a rapid malaria dipstick test (RDT) in detecting P. falciparum malaria in Kenyan school children. Design: Children enrolled in a feeding intervention trial were tested for malaria using microscopy and RDT at baseline, one, and two years. Ongoing morbidity data on study children was collected through interviews with caretakers regarding signs and symptoms and physical inspection. Setting: Rural Embu district, Kenya. The area is considered endemic for malaria, with four rainy seasons/year. Chloroquine resistance was estimated in 80% of patients. Children had a spleen rate of 45%. Subjects: A sample of 515 rural Kenyan primary school children, aged 7-11 years, who were enrolled in a feeding intervention trial from 1998-2001. Main outcome measures: Percent positive and negative P. falciparum malaria status, sensitivity, specifi city, and positive and negative predictive values of RDT. Results and conclusion: For both years, the RDT yielded positive results of 30% in children compared to microscopy (17%). With microscopy as the “gold standard,” RDT yielded a sensitivity of 81.3% in 1998 and 79.3% in 2000. Specifi city was 81.6% in 1998 and 78.3% in 2000. Positive predictive value was 47.3% in 1998 and 42.6% in 2000, and negative predictive value was 95.6% in 1998 and 94.9% in 2000. Rapid diagnostic testing is a valuable tool for diagnosis and can shorten the interval for starting treatment, particularly where microscopy may not be feasible due to resource and distance limitations

Intake of micronutrients high in animal-source foods is associated with better growth in rural Kenyan school children

Observational studies have shown that children in developing countries consuming diets containing high amounts of bioavailable nutrients, such as those found in animal-source foods, grow better. The present study investigated which specific nutrients from the diet of Kenyan school children predicted their growth. The children (n 544, median age 7 years) participated in a 2-year long food supplementation study with animal-source foods. Height gain during the intervention period was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B-12. Weight gain was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B-12. Gain in mid-upper-arm muscle area was positively predicted by average daily intakes of energy from animal-source foods and vitamin B-12. Gain in mid-upper-arm fat area was positively predicted by average daily intakes of energy from animal-source foods. Gain in subscapular skinfold thickness was not predicted by any of the nutrient intakes. Negative predictors of growth were total energy and nutrients that are contained in high amounts in plant foods. The study shows that growth was positively predicted by energy and nutrients that are provided in high amounts and in a bioavailable form in meat and milk, and their inclusion into the diets of children in developing countries should be part of all food-based programmes in order to improve micronutrient status and growth