A Review of 2011 for PLoS Computational Biology

A Review of 2011 for <em>PLoS Computational Biology</em

“Because of mchango, I give my baby gripe water so he sleeps and stops crying”: Exclusive breastfeeding and parents’ concerns about colic-like symptoms in infants under 6 months in Lake Zone, Tanzania

Background Effective social and behavior change strategies for exclusive breastfeeding (EBF) rely on understanding how families interpret infant behavior and provide care. Little research thoroughly explores household use of non-prescribed medicine for infants under 6 months in rural Tanzania, which can interrupt EBF and may have other harmful unintended effects. Aim To explore parents’ use of non-prescribed medicine in response to infants’ colic-like symptoms during the EBF period. Methods We conducted thematic analysis of a series of qualitative, semi-structured interviews with 36 mothers and 30 fathers of infants 0-6 months in Lake Zone, Tanzania. Here, we focus on emergent themes related to concerns about colic-like symptoms and global implications for public health practitioners. Results Parents reported concerns about excessive crying and perceived infant abdominal pain, attributed to a potentially serious disease state locally known as mchango. Most parents gave non-prescribed medicines (e.g. gripe water, oral traditional medicine, and/or other commercial medicines) to treat or prevent mchango and associated symptoms, often including infant crying. After receiving supportive counselling on soothing techniques, most were willing to avoid giving non-prescribed medicines. Some reported continued challenges attributed to mchango symptoms, namely inconsolable crying. Conclusion While symptoms of mchango reported in this study overlapped with colic symptoms, literature in Tanzania suggests, in some cases, mchango is perceived to have spiritual origins and potentially be dangerous if left untreated. Empathetic counseling can offer parents knowledge and skills to manage colic-like symptoms without using non-prescribed medicines. Health workers need clear messages and training on risks of non-prescribed medicines and Tanzanian legislation banning its promotion and distribution

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Facilitating Text & Data Mining

Presentation delivered at Text and Data Mining Symposium held at the University of Cambridge