Infant feeding modalities addressed in two different ways in Eastern Uganda

<p>Abstract</p> <p>Background</p> <p>Durations of exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) from two different assessments, among the same mother-infant population, were investigated to determine the degree to which the assessments yielded overlapping results.</p> <p>Methods</p> <p>Thirty Ugandan mother-infant pairs were followed up weekly from birth to three months of age with weekly short-time feeding recall: the 24-hour recall asked prior to the 1-week recall. In addition, at week 6 and 12 dietary recalls since-birth were conducted. Variables for the duration of EBF and PBF were created from the short-time feeding recalls and the dietary recalls since-birth, respectively. Mean durations of EBF and PBF from the two assessments were compared with Kaplan Meier analysis at week 6 and 12. Reproducibility of dietary recall instruments was also assessed.</p> <p>Results</p> <p>At six weeks postpartum the mean durations of EBF were 0.50 weeks (95% CI: 0, 1.02) according to the weekly short-time recalls and 1.51 weeks (95% CI: 0.66, 2.35) according to the recall since-birth (Mantel-Cox test, p = 0.049). The mean durations of PBF were 4.07 weeks (95% CI: 3.38, 4.77) according to the frequent short-time recalls and 4.50 weeks (95% CI: 3.93, 5.07) according to the recall since-birth, (Mantel-Cox-test, p = 0.82). At twelve weeks the mean durations of EBF were 0.5 weeks (95% CI: 0, 1.1) according to the weekly short-time recalls and 1.4 weeks (95% CI: 0.1, 2.7) according to the recall since-birth (Mantel-Cox-test, p = 0.15). The mean durations of PBF were 5.2 weeks (95% CI: 3.9, 6.5) according to the weekly short-time recalls and 6.6 weeks (95% CI: 5.4, 7.8) according to recall since-birth (Mantel-Cox-test, p = 0.20). Reports of feeding categories and early feeding practices showed high reproducibility.</p> <p>Conclusion</p> <p>Comparing duration of EBF and PBF in this group of mother-infant pairs showed overlapping results from the weekly short-time assessment and the recall since-birth at twelve weeks, with the latter yielding slightly longer duration of the respective feeding modalities. The retrospective recall since-birth could be assessed as a cost-reducing tool compared to the frequent follow-up addressing duration of respective infant feeding modalities for evaluation of programmes promoting safer infant feeding practices.</p> <p>Trial registration</p> <p>The study was part of formative studies for the ongoing study PROMISE EBF registered at <url>http://clinicaltrials.gov</url>, NCT00397150.</p

Malaria Parasitaemia among Infants and Its Association with Breastfeeding Peer Counselling and Vitamin A Supplementation: A Secondary Analysis of a Cluster Randomized Trial

Background: Malaria is the second highest contributor to the disease burden in Africa and there is a need to identify low cost prevention strategies. The objectives of this study were to estimate the prevalence of malaria parasitaemia among infants and to measure the association between peer counselling for exclusive breastfeeding (EBF), vitamin A supplementation, anthropometric status (weight and length) and malaria parasitaemia. Methods: A cluster randomized intervention trial was conducted between 2006 and 2008 where 12 of 24 clusters, each comprising one or two villages, in Eastern Uganda were allocated to receive peer counselling for EBF. Women in their third trimester of pregnancy (based on the last normal menstrual period) were recruited in all 24 clusters and followed up until their children’s first birthday. Blood was drawn from 483 infants between 3 and 12 months of age, to test for malaria parasitaemia. Results: The prevalence of malaria parasitaemia was 11% in the intervention areas and 10% in the control areas. The intervention did not seem to decrease the prevalence of malaria (PR 1.7; 95% CI: 0.9, 3.3). After controlling for potential confounders, infants not supplemented with Vitamin A had a higher prevalence for malaria compared to those who had been supplemented (PR 6.1; 95% CI: 2.1, 17.6). Among children supplemented with vitamin A, every unit increase in lengthfor- age Z (LAZ) scores was associated with a reduced prevalence in malaria (PR 0.5; 95% CI:0.4, 0.6). There was no association between LAZ scores and malaria among children that had not been supplemented. Conclusion: Peer counselling for exclusive breastfeeding did not decrease the prevalence of malaria parasitaemia. Children that had not received Vitamin A supplementation had a higher prevalence of malaria compared to children that had been supplemented

Introduction: anthropology's queer sensibilities

This special issue addresses vital epistemological, methodological, ethical and political issues at the intersections of queer theory and anthropology as they speak to the study of sexual and gender diversity in the contemporary world. The special issue centres on explorations of anthropology’s queer sensibilities, that is, experimental thinking in ethnographically informed investigations of gender and sexual difference, and related connections, disjunctures and tensions in their situated and abstract dimensions. The articles consider the possibilities and challenges of anthropology’s queer sensibilities that anthropologise queer theory whilst queering anthropology in ethnographically informed analyses. Contributors focus on anthropologising queer theory in research on same-sex desire in the Congo; LGBT migrant and asylum experience in the UK and France; same-sex intimacies within opposite gender oriented sexualities in Kenya and Ghana; secret and ambiguous intimacies and sensibilities beyond an identifiable ‘queer subject’ of rights and recognition in India; migrant imaginings of home in Indonesian lesbian relationships in Hong Kong; and cross-generational perspectives on ‘coming out’ in Taiwan and their implications for theories of kinship and relatedness. An extensive interview with Esther Newton, the prominent figure in gay and lesbian and queer anthropology concludes the collection

International Olympic Committee Consensus Statement: Molecular Basis of Connective Tissue and Muscle Injuries in Sport

Tendon and ligament injures cause significant loss of performance in sport and decreased functional capacity in the workplace. Many of these injures remain difficult to treat, and many individuals have long-term pain and discomfort. Animal studies of growth factor and cell-based therapies have shown promising results, but these treatments also can be misused to enhance athletic performance. The International Olympic Committee (IOC) now has high-level scientific advisors who can advise the IOC as to the use and abuse of these technologies

Need to optimise infant feeding counselling: A cross-sectional survey among HIV-positive mothers in Eastern Uganda

<p>Abstract</p> <p>Background</p> <p>The choice of infant feeding method is important for HIV-positive mothers in order to optimise the chance of survival of their infants and to minimise the risk of HIV transmission. The aim of this study was to investigate feeding practices, including breastfeeding, in the context of PMTCT for infants and children under two years of age born to HIV-positive mothers in Uganda.</p> <p>Methods</p> <p>In collaboration with The Aids Support Organisation Mbale, we conducted a cross-sectional survey involving 235 HIV-positive mothers in Uganda. Infant feeding practices, reasons for stopping breastfeeding, and breast health problems were studied. Breastfeeding duration was analysed using the Kaplan-Meier method based on retrospective recall.</p> <p>Results</p> <p>Breastfeeding was initiated by most of the mothers, but 20 of them (8.5%) opted exclusively for replacement feeding. Pre-lacteal feeding was given to 150 (64%) infants and 65 (28%) practised exclusive breastfeeding during the first three days. One-fifth of the infants less than 6 months old were exclusively breastfed, the majority being complementary fed including breast milk. The median duration of breastfeeding was 12 months (95% confidence interval [CI] 11.5 to 12.5). Adjusted Cox regression analysis indicated that a mother's education, socio-economic status, participation in the PMTCT-program and her positive attitude to breastfeeding exclusively, were all associated with a reduction in breastfeeding duration. Median duration was 3 months (95% CI 0–10.2) among the most educated mothers, and 18 months (95% CI 15.0–21.0) among uneducated mothers. Participation in the PMTCT program and being socio-economically better-off were also associated with earlier cessation of breastfeeding (9 months [95% CI 7.2–10.8] vs. 14 months [95% CI 10.8–17.2] and 8 months [95% CI 5.9–10.1] vs. 17 months [95% CI 15.2–18.8], respectively). The main reasons for stopping breastfeeding were reported as: advice from health workers, maternal illness, and the HIV-positive status of the mother.</p> <p>Conclusion</p> <p>Exclusive breastfeeding was uncommon. Exclusive replacement feeding was practised by few HIV-positive mothers. Well-educated mothers, mothers who were socio-economically better-off and PMTCT-attendees had the shortest durations of breastfeeding. Further efforts are needed to optimise infant feeding counselling and to increase the feasibility of the recommendations.</p

Association of maternal HIV‐1 severity with dental caries: an observational study of uninfected 5‐ to 7‐yr‐old children of HIV‐1‐infected mothers without severe immune suppression

Treatment programs to prevent perinatal and postnatal HIV-1 transmission have become available in sub-Saharan Africa, leading to an emerging population of HIV-1 exposed uninfected (HEU) children. Exposure to HIV-1 in utero and during breastfeeding may increase the risk of morbidity and mortality in HEU children. This study estimated the association of the severity of maternal HIV-1 infection as assessed by CD4 count and viral load at baseline (7 d postpartum), with dmft count of their 5- to 7-yr-old HEU offspring. A follow-up study was conducted of HIV-1-infected mother–HEU children pairs (n = 164) from the Ugandan site of the ANRS 12341-PROMISE- PEP trial (ClinicalTrials.gov, number NCT00640263). HIV-1-infected mothers were interviewed and the HEU children were examined for caries using the World Health Organization's survey methods for field conditions and the dmft index. Directed acyclic graphs and negative binomial regression were used for analyses. The prevalence of 1 or more dmft was 48%. Negative binomial regression showed no association between the dmft count and maternal CD4 counts 7 d postpartum but a 10% lower dmft count with longer breastfeeding duration was found. Maternal CD4 count at birth was not associated with the dental caries experience in uninfected children born to women without severe immune suppression, while there appeared to be a protective effect of high viral load and breastfeeding duration.publishedVersio

Caries experience by socio-behavioural characteristics in HIV-1-infected and uninfected Ugandan mothers – a multilevel analysis

Objectives To assess caries experience in Ugandan mothers according to HIV status, socio-behavioural-characteristics, gingival bleeding status and to examine whether HIV status impacts the association of socio-behavioural characteristics with caries experience. Third, using multilevel analysis, this study assessed to what extent surface-specific caries experience varied between and within individuals. Materials and methods Caries experience was recorded using the World Health Organization’s Decayed, Missed and Filled Teeth/Surfaces indices from a cohort of 164 HIV-1-infected Ugandan mothers and a cross sectional comparison group of 181 negative controls. Mixed-effects logistic regression was conducted with surface-specific caries experience as the outcome variable. Results The prevalence of caries in HIV-1-infected and uninfected mothers was 81% and 71%, respectively. Significant associations occurred between caries experience at surface level and women’s increasing age (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.1–2.8) and presence of gingival bleeding (OR = 2.0, 95% CI: 1.2–3.2). Intra-class correlation (ICC) coefficient amounted to 0.54 (95% CI 0.48‒0.59). Conclusions Caries prevalence was higher in HIV-1 infected than in uninfected mothers and increased with age and gingival bleeding. ICC indicated that 54% of the variance was attributable to variation between individuals. Socio-demographic differences in dental caries did not vary by HIV-1 status.publishedVersio

Recolonizing carnivores: Is cougar predation behaviorally mediated by bears?

Conservation and management efforts have resulted in population increases and range expansions for some apex predators, potentially changing trophic cascades and foraging behavior. Changes in sympatric carnivore and dominant scavenger populations provide opportunities to assess how carnivores affect one another. Cougars (Puma concolor) were the apex predator in the Great Basin of Nevada, USA, for over 80 years. Black bears (Ursus americanus) have recently recolonized the area and are known to heavily scavenge on cougar kills. To evaluate the impacts of sympatric, recolonizing bears on cougar foraging behavior in the Great Basin, we investigated kill sites of 31 cougars between 2009 and 2017 across a range of bear densities. We modeled the variation in feeding bout duration (number of nights spent feeding on a prey item) and the proportion of primary prey, mule deer (Odocoileus hemionus), in cougar diets using mixed-effects models. We found that feeding bout duration was driven primarily by the size of the prey item being consumed, local bear density, and the presence of dependent kittens. The proportion of mule deer in cougar diet across all study areas declined over time, was lower for male cougars, increased with the presence of dependent kittens, and increased with higher bear densities. In sites with feral horses (Equus ferus), a novel large prey, cougar consumption of feral horses increased over time. Our results suggest that higher bear densities over time may reduce cougar feeding bout durations and influence the prey selection trade-off for cougars when alternative, but more dangerous, large prey are available. Shifts in foraging behavior in multicarnivore systems can have cascading effects on prey selection. This study highlights the importance of measuring the impacts of sympatric apex predators and dominant scavengers on a shared resource base, providing a foundation for monitoring dynamic multipredator/scavenger systems

Effects of complementary feeding on attained height among lower primary school-aged children in Eastern Uganda: A nested prospective cohort study

Background: Despite the fact that Uganda has been a signatory to the global strategy for Infant and Young Children Feeding practices (IYCF) for nearly a decade, the prevalence of stunting among children under five years of age remains tragically high at 17% in Eastern Uganda and twofold higher countrywide. Only 6% of all children aged 6–23 months feed adequately. This study aimed to establish the covariates of complementary feeding (CF) and its effect on attained height among primary school-aged children in Mbale district (Eastern Uganda). Methods: This was a community-based prospective cohort study using data from the PROMISE EBF trial. The main exposure variable was adequate complementary feeding (CF) measured in a parent questionnaire at 18–24 months of age. We defined adequate CF as having received animal food, cereals and fruit, juice and/or vegetables during the 24 hours preceding the interview. An adapted minimum acceptable diet was defined as having been given milk or milk products at least twice a day, an adapted meal frequency of two and solid or semi-solid food from at least four food groups on a 24-hour dietary recall based on modified IYCF criteria. The main outcome variable was attained height [(height-for-age Z score (HAZ)] measured between five and eight years of age using the WHO growth standards. Effects of CF on HAZ were estimated using linear regression analyses with cluster-robust standard errors. Results: A total of 506 children were studied. The majority (85%) were from rural areas and the average age at the end of the study was 6.9 (standard deviation: 0.63) years. Of these, 23.9% were adequately fed and 2.3% received the adapted minimum acceptable diet. Adequate CF was not associated with HAZ (adjusted β = -0.111; 95% CI: -0.363, 0.141; p = 0.374). Factors significantly associated with attained height were baseline HAZ (0.262; 0.152, 0.374; p<0.001) and WHZ (-0.147; -0.243, -0.051; p = 0.004), child’s age (0.454; -0.592, -0.315; p<0.001) and maternal education (0.030; 95% CI: 0.003, 0.057; p = 0.034). Conclusion: Adequate CF at age 18–24 months was worryingly insufficient and not associated with attained HAZ at age 5–8 years. Further strategies need to be considered to improve child nutrition and linear growth in resource-constrained settings.publishedVersio

“I feel good when I drink”—detecting childhood-onset alcohol abuse and dependence in a Ugandan community trial cohort

Background Alcohol, substance use, and mental health disorders constitute major public health issues worldwide, including in low income and lower middle-income countries, and early initiation of use is an important predictor for developing substance use disorders in later life. This study reports on the existence of childhood alcohol abuse and dependence in a sub-study of a trial cohort in Eastern Uganda. Methods The project SeeTheChild—Mental Child Health in Uganda (STC) included a sub-study of the Ugandan site of the study PROMISE SB: Saving Brains in Uganda and Burkina Faso. PROMISE SB was a follow-up study of a trial birth cohort (PROMISE EBF) that estimated the effect that peer counselling for exclusive breast-feeding had on the children’s cognitive functioning and mental health once they reached 5–8 years of age. The STC sub-study (N = 148) used the diagnostic tool MINI-KID to assess mental health conditions in children who scored medium and high (≥ 14) on the Strengths and Difficulties Questionnaire (SDQ) in the PROMISE SB cohort N = (119/148; 80.4%). Another 29/148 (19.6%) were recruited from the PROMISE SB cohort as a comparator with low SDQ scores (< 14). Additionally, the open-ended questions in the diagnostic history were analysed. The MINI-KID comprised diagnostic questions on alcohol abuse and dependence, and descriptive data from the sub-study are presented in this paper. Results A total of 11/148 (7.4%) children scored positive for alcohol abuse and dependence in this study, 10 of whom had high SDQ scores (≥ 14). The 10 children with SDQ-scores ≥ 14 had a variety of mental health comorbidities of which suicidality 3/10 (30.0%) and separation anxiety disorder 5/10 (50.0%) were the most common. The one child with an SDQ score below 14 did not have any comorbidities. Access to homemade brew, carer’s knowledge of the drinking, and difficult household circumstances were issues expressed in the children’s diagnostic histories. Conclusions The discovery of alcohol abuse and dependence among 5–8 year olds in clinical interviews from a community based trial cohort was unexpected, and we recommend continued research and increased awareness of these conditions in this age group. Trial registration Trial registration for PROMISE SB: Saving Brains in Uganda and Burkina Faso: Clinicaltrials.gov (NCT01882335), 20 June 2013. Regrettably, there was a 1 month delay in the registration compared to the commenced re-inclusion in the follow-up study: https://clinicaltrials.gov/ct2/show/NCT01882335?term=saving+brains&draw=2&rank=1publishedVersio