Nutritional status of under fives attending maternal and child health clinics in Dar es Salaam, Tanzania

We designed a study to assess the nutritional status of children under five years of age attending MCH clinics in Dar es Salaam. This was a cross-sectional anthropometric study involving children 6-24 months who from July to August 1993 were attending Magomeni MCH clinic and those aged 18 months to five years who were attending Lugalo and Mwananyamala MCH clinics for routine growth monitoring and for vaccination between May to August 1994. The data collected included age, birth weight, sex, weight, height, breastfeeding status and HIV-1 serostatus. Of the 1854 children enrolled (961 boys and 893 girls) 31.6% were stunted, 14.6% were underweight and 2.9% were wasted. The highest percentage of stunting and wasting was observed between 11 and 25 months and 36 to 40 months. Of the 849 children tested for HIV-1,14 (1.7%) were seropositive and two out of 770 (0.3%) were born with low weight. HIV seropositivity and low birthweight were both associated with stunting and wasting. We conclude that malnutrition is still a sizeable problem among children attending urban MCH clinics in Dar es Salaam especially among those aged less than three years, to whom special malnutrition control strategies should be targeted. There is also a need to identify factors responsible for the observed decline in MCH attendance with age and correct the situation.link_to_subscribed_fulltex

Nutritional status of under fives attending maternal and child health clinics in Dar es Salaam, Tanzania

We designed a study to assess the nutritional status of children under five years of age attending MCH clinics in Dar es Salaam. This was a cross-sectional anthropometric study involving children 6-24 months who from July to August 1993 were attending Magomeni MCH clinic and those aged 18 months to five years who were attending Lugalo and Mwananyamala MCH clinics for routine growth monitoring and for vaccination between May to August 1994. The data collected included age, birth weight, sex, weight, height, breastfeeding status and HIV-1 serostatus. Of the 1854 children enrolled (961 boys and 893 girls) 31.6% were stunted, 14.6% were underweight and 2.9% were wasted. The highest percentage of stunting and wasting was observed between 11 and 25 months and 36 to 40 months. Of the 849 children tested for HIV-1,14 (1.7%) were seropositive and two out of 770 (0.3%) were born with low weight. HIV seropositivity and low birthweight were both associated with stunting and wasting. We conclude that malnutrition is still a sizeable problem among children attending urban MCH clinics in Dar es Salaam especially among those aged less than three years, to whom special malnutrition control strategies should be targeted. There is also a need to identify factors responsible for the observed decline in MCH attendance with age and correct the situation.link_to_subscribed_fulltex

Detection of anti-HIV-1 IgG antibodies in whole saliva by Gacelisa and Western Blot assays

The present study, based on 158 HIV seropositives and 167 HIV seronegatives, demonstrates that saliva collected with the Omni-SAL™device and tested with GACELISA (an IgG antibody capture ELISA) is an effective non-invasive alternative to serum for anti-HIV IgG antibody screening. The study also shows that a conventional serum Western blot kit can be used, with slight modifications, for confirmatory testing of saliva specimens. Collecting saliva with the Omni-SAL™ device had a very good acceptance rate among Tanzanian subjects, and although this diagnostic method is not yet known by the general public, 65% of the study participants preferred to give saliva instead of blood for HIV testing.link_to_subscribed_fulltex

Clinical predictors of HIV-1 infection among preschool children in Dar Es Salaam, Tanzania

Seroprevalence of HIV-1 infection was determined in children aged between eighteen months and five years, attending maternal and child health (MCH) clinics in Dar es Salaam, Tanzania. A total of 889 children were eligible for the study, however seven children could not be enrolled because their mothers/guardians absconded and blood could not be drawn from 21 children due to refusal of mothers/guardians and from another 12 children due to technical reasons. Therefore, the participation rate was 95.5%. Of the 849 children screened, 14 (1.65%) were found to have IgG anti HIV-1 antibodies in their sera. The main clinical features found in children with symptomatic HIV-1 disease were weight loss, generalized lymphadenopathy, recurrent fevers, and prolonged diarrhoea. The utility of clinical features suggestive of HIV-1 infection (according to CDC classification) in identifying HIV-1 infection in children was evaluated and found to have high sensitivity (100%), specificity (96.9%) and negative predictive value (100%), but a low positive predictive value (35%). Marked variations in progression to symptomatic phase were noted, whereby some relatively young children had progressed to symptomatic phase (CDC class P-2A), while some older children were still in the asymptomatic stage (CDC class P-1 C). None of the symptomatic HIV-1 infected children presented with neurological disease, severe opportunistic infections, or malignancies. Although reduced mid-upper arm circumference and weight-for-age were associated with HIV seropositivity, these clinical parameters had low positive predictive values compared to the CDC classification. | Serologic testing of 849 children 18 months-5 years of age attending the Lugalo and Mwananyamala maternal-child health clinics in Dar es Salaam, Tanzania, during May-August 1994 identified 14 cases (1.65%) of HIV infection. The sample represented 95.5% of children making mandatory monthly clinic visits during the 3-month study period. The main clinical symptoms in HIV-infected children were weight loss, generalized lymphadenopathy, recurrent fever, and prolonged diarrhea, all included in the Centers for Disease Control and Prevention (CDC) classification scheme. Children with symptomatic HIV infection were younger than those with asymptomatic infection. None of the children with symptomatic HIV infection presented with neurologic impairment, severe opportunistic infections, or cancers. The clinical features included in the CDC classification for HIV had a 100% sensitivity, a 96.9% specificity, and a 100% negative predictive value, but the positive predictive value was only 35%. Although the model with the best fit included mid-upper arm circumference less than 14 cm and a reduced weight-for-age (odds ratios, 3.8 and 1.9, respectively), the positive predictive values for these two factors were only 4.3% and 4.1%, respectively. The 1.65% HIV seroprevalence rate recorded in this community-based study is lower than the 2.4% rate estimated among newborns in Dar es Salaam, presumably because of high infant mortality and hospitalization among HIV-infected newborns. Use of a simplified version of the CDC classification of HIV infection in children is recommended for routine clinical use in Tanzania.link_to_subscribed_fulltex

Detection of anti-HIV-1 IgG antibodies in whole saliva by gacelisa and western blot assays.

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