COVID-19 concerns among caregivers and vitamin A supplementation coverage among children aged 6–59 months in four countries in Western sub-Saharan Africa

Abstract Objective: To assess child vitamin A supplementation (VAS) coverage in 2019 and 2020 and explore key factors, including COVID-19 concerns, that influenced VAS status in four sub-Saharan African countries. Design: Data from eight representative household surveys were used to assess VAS coverage. Multivariable logistic regression models examined the effect of rural/urban residence, child sex and age, caregiver education, COVID-19 concern and household wealth on VAS status. Setting: Nine (2019) and 12 (2020) districts in Burkina Faso, Côte d’Ivoire, Guinea and Mali. Participants: 28 283 caregivers of children aged 6–59 months. Results: Between 2019 and 2020, VAS coverage increased in Burkina Faso (82·2–93·1 %), Côte d’Ivoire (90·3–93·3 %) and Mali (76·1–79·3 %) and decreased in Guinea (86·0 % to 81·7 %). Rural children had a higher likelihood of VAS uptake compared with urban children in Burkina Faso (adjusted OR (aOR) = 4·22; 95 % CI: 3·11, 5·72), Côte d’Ivoire (aOR = 5·19; 95 % CI: 3·10, 8·70) and Mali (aOR = 1·41; 95 % CI: 1·15, 1·74). Children aged 12–59 months had a higher likelihood of VAS uptake compared with children aged 6–11 months in Côte d’Ivoire (aOR = 1·67; 95 % CI: 1·12, 2·48) and Mali (aOR = 1·74; 95 % CI: 1·34, 2·26). Moderate-to-high COVID-19 concern was associated with a lower likelihood of VAS uptake in Côte d’Ivoire (aOR = 0·55; 95 % CI: 0·37, 0·80). Conclusion: The increase in VAS coverage from 2019 to 2020 suggests that COVID-19 concerns may not have limited VAS uptake in some African countries, though geographic inequities should be considered

The efficacy and acceptability of prenatal Corn Soya Blend Plus dietary supplementation among women in rural Cambodia

Corn Soya Blend (CSB) Plus is a micronutrient-fortified dietary supplement designed for women in Cambodia and elsewhere to help meet their nutritional needs in pregnancy, though little is known about its acceptance and ability to improve pregnancy outcomes. This research utilized a mixed methods approach to investigate the efficacy and acceptability of prenatal supplementation with CSB Plus among rural Cambodian women. A cluster-randomized trial was conducted in 75 villages in Kampong Chhnang Province, in which 547 women received the food supplement (treatment) on a monthly basis from the first trimester until delivery or continued their normal diet (control). Participants included women receiving antenatal care at a health facility in the first trimester. The primary outcome was birth weight and secondary outcomes were low birth weight (< 2500 grams), small for gestational age, birth length and head circumference, preterm birth (< 37 weeks), maternal weight gain, and anemia prevalence at 24-28, 30-32, and 36-38 weeks gestation. Cluster-adjusted linear mixed effect and logistic regression models were used to examine group differences. Acceptability of CSB Plus was investigated through structured interviews to understand consumption preferences and practices and six focus group discussions to explore perceptions, attitudes, and behaviors related to supplement utilization. CSB Plus resulted in a non-significant 46 g increase in birth weight (95% CI: -31, 123) and did not increase maternal weight gain or other measures of birth size. However, maternal anemia at 36-38 weeks (OR: 0.51; 95% CI: 0.34, 0.77) and preterm birth (OR: 0.33; 95% CI: 0.12, 0.89) were lower in the CSB Plus group. A significantly higher rate of fetal loss occurred in the treatment group. Acceptability was influenced by the product’s organoleptic qualities, family support, peer influences, trust in the provider of the supplement, and attitudes related to nutrition and weight in pregnancy. Acceptance was lower among first-time mothers, mainly due to fears of a large baby and resulting delivery complications. The findings of this research provide insight that can be used to guide future policy and programming decisions on the provision of Corn Soya Blend Plus and other prenatal dietary supplements in the Cambodian context.Land and Food Systems, Faculty ofGraduat

The Effects of Community Home Visit and Peer Group Nutrition Intervention Delivery Platforms on Nutrition Outcomes in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

Weak delivery systems reduce the potential of evidence-supported interventions to improve nutrition. We synthesized the evidence for the effectiveness of nutrition-specific intervention delivery platforms for improving nutrition outcomes in low and middle-income countries (LMIC). A systematic literature search for studies published from 1997 to June 2018 resulted in the inclusion of 83 randomized controlled trials (RCTs), quasi-randomized, and controlled before–after studies across a variety of delivery platforms. In this paper, we report on meta-analysed outcomes for community health worker (CHW) home visits and mother/peer group delivery platforms. Compared to care as usual, CHW home visits increased early initiation of breastfeeding (EIBF) (OR: 1.50; 95% CI: 1.12, 1.99; n = 10 RCTs) and exclusive breastfeeding (EBF) (OR: 4.42; 95% CI: 2.28, 8.56; n = 9 RCTs) and mother/peer groups were effective for improving children’s minimum dietary diversity (OR: 2.34; 95% CI: 1.17, 4.70; n = 4) and minimum meal frequency (OR: 2.31; 95% CI: 1.61, 3.31; n = 3). Pooled estimates from studies using both home visit and group platforms showed positive results for EIBF (OR: 2.13; 95% CI: 1.12, 4.05; n = 9), EBF (OR: 2.43; 95% CI: 1.70, 3.46; n = 12), and &lt; 5 wasting (OR: 0.77; 95% CI: 0.67, 0.89; n = 4). Our findings underscore the importance of interpersonal community platforms for improving infant and young child feeding practices and children’s nutritional status in LMICs

Evaluation of two methods to measure hemoglobin concentration among women with genetic hemoglobin disorders in Cambodia : a method-comparison study

Background: Genetic hemoglobin (Hb) E variants are common in Cambodia and result in an altered and unstable Hb molecule.We evaluated two methods to measure Hb concentration among individuals with and without Hb variants using a hemoglobinometer (HemoCue®) and a hematology analyzer (Sysmex XT-1800i). Methods: We determined the bias and concordance between the methods among 420 Cambodian women (18–45 y). Results: Bias and concordance appeared similar betweenmethods amongwomenwith no Hb disorders (n=195, bias= 2.5, ρc= 0.68), women with Hb E variants (n= 133, bias= 2.5, ρc =0.78), and women with other Hb variants (n=92, bias=2.7, ρc=0.73). The overall bias was 2.6 g/l, resulting in a difference in anemia prevalence of 11.5% (41% using HemoCue®and 29.5% using Sysmex, p b 0.001). Based on visual interpretation of the concordance plots, the HemoCue® device appears to underestimate Hb concentrations at lower Hb concentrations and to overestimate Hb concentrations at higher Hb concentrations (in comparison to the Sysmex analyzer). Conclusions: Bias and concordance were similar across groups, suggesting the two methods of Hb measurement were comparable.We caution field staff, researchers and policy makers in the interpretation of data and the impact that bias between methods can have on anemia prevalence rates

Karakochuk - BMC Public Health manuscript - Sept 2014 (annex 18a)

Background: Genetic hemoglobin (Hb) E variants are common in Cambodia and result in an altered and unstable Hb molecule. There are no known studies on the accuracy of Hb measurement among individuals with Hb E or other Hb variants. Methods: This method-comparison study evaluates two methods to measure Hb concentration in capillary blood using a hemoglobinometer (HemoCueÒ) and in venous blood using an automated hematology analyzer (Sysmex XT-1800i). We determined the bias and concordance between the two methods among 420 non-pregnant women (18-45 y) in Cambodia using secondary data from a separate trial. Results: Bias and concordance appeared similar between methods among women with no Hb disorders (n=195, bias=2.5, rc=0.68), women with Hb E variants (n=133, bias=2.5, rc=0.78), and women with other Hb variants (n=92, bias=2.7, rc=0.73). Overall, agreement was poor between methods. The overall bias was 2.6 g/L (difference in Hb means between methods), resulting in a difference in anemia prevalence of 11.5% (41% using HemoCueÒ and 29.5% using Sysmex, p<0.001). This changes the WHO anemia severity from a ‘moderate’ to a ‘severe’ public health problem. Based on concordance plots, the HemoCueÒ device appears to underestimate Hb concentrations in capillary blood as compared to Sysmex (venous blood) at lower Hb concentrations, and to overestimate Hb concentrations in capillary blood as compared to Sysmex at higher Hb concentrations. Conclusions: Bias and concordance were similar among all groups, suggesting the two methods of Hb measurement were comparable. We highlight the bias between the two methods to caution field staff, researchers and policy makers in the interpretation of data and the impact that even a small bias between methods can have on anemia prevalence rates

Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries

Abstract Background Vitamin A deficiency (VAD) is a leading contributor to the poor health and nutrition of young children in sub-Saharan Africa. Funding constraints are compelling many countries to shift from longstanding campaigns to integrating vitamin A supplementation (VAS) into routine health services. We assessed child VAS coverage and associated factors for integrated delivery systems in Mozambique, Senegal, and Sierra Leone and for a campaign-based delivery strategy in Tanzania. Methods Data were obtained using representative household surveys administered to primary caregivers of N = 16,343 children aged 6–59 months (Mozambique: N = 1,659; Senegal: N = 7,254; Sierra Leone: N = 4,149; Tanzania: N = 3,281). Single-dose VAS coverage was assessed and bivariate and multivariable associations were examined for child VAS receipt with respect to rural or urban residence; child age and sex; maternal age, education, and VAS program knowledge; and household wealth. Results VAS coverage for children aged 6–59 months was 42.8% (95% CI: 40.2, 45.6) in Mozambique, 46.1% (95% CI: 44.9, 47.4) in Senegal, 86.9% (95% CI: 85.8, 87.9) in Sierra Leone, and 42.4% (95% CI: 40.2, 44.6) in Tanzania and was significantly higher for children 6–11 vs. 24–59 months in Mozambique, Senegal, and Tanzania. In Sierra Leone, children aged 12–23 months (aOR = 1.86; 95% CI: 1.20, 2.86) and 24–59 months (aOR = 1.55; 95% CI: 1.07, 2.25) were more likely to receive VAS, compared to those 6–11 months. Maternal awareness of VAS programs was associated with higher uptake in Mozambique (aOR = 4.00; 95% CI: 2.81, 5.68), Senegal (aOR = 2.72; 95% CI: 2.35, 3.15), and Tanzania (aOR = 14.50; 95% CI: 10.98, 19.17). Increased household wealth was associated with a higher likelihood of child VAS in Senegal and Tanzania. Conclusions Our findings indicate routine delivery approaches for VAS are not achieving the level of coverage needed for public health impact in these settings. Intensive outreach efforts contributed to the higher coverage in Sierra Leone and highlight the importance of reducing the burdens associated with seeking supplementation at health facilities. As countries move towards incorporating VAS into routine health services, the essentiality of informed communities and potential losses for older children and socio-economically disadvantaged populations are key considerations in the sub-Saharan African context

Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries.

OBJECTIVE: To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. METHODS: Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. FINDINGS: Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. CONCLUSION: High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake