SARS-CoV-2 infection and antibody seroprevalence in routine surveillance patients, healthcare workers and general population in Kita region, Mali: an observational study 2020–2021

Objective: To estimate the degree of SARS-CoV-2 transmission among healthcare workers (HCWs) and general population in Kita region of Mali. Design: Routine surveillance in 12 health facilities, HCWs serosurvey in five health facilities and community serosurvey in 16 villages in or near Kita town, Mali. Setting: Kita region, western Mali; local health centres around the central (regional) referral health centre. Participants: Patients in routine surveillance, HCWs in local health centres and community members of all ages in populations associated with study health centres. Main outcome measures: Seropositivity of ELISA test detecting SARS-CoV-2-specific total antibodies and real-time RT-PCR confirmed SARS-CoV-2 infection. Results: From 2392 routine surveillance samples, 68 (2.8%, 95% CI: 2.2% to 3.6%) tested positive for SARS-CoV-2 by RT-PCR. The monthly positivity rate was 0% in June–August 2020 and gradually increased to 6% by December 2020 and 6.2% by January 2021, then declined to 5.5%, 3.3%, 3.6% and 0.8% in February, March, April and May 2021, respectively. From 397 serum samples collected from 113 HCWs, 175 (44.1%, 95% CI: 39.1% to 49.1%) were positive for SARS-CoV-2 antibodies. The monthly seroprevalence was around 10% from September to November 2020 and increased to over 40% from December 2020 to May 2021. For community serosurvey in December 2020, overall seroprevalence of SARS-CoV-2 antibodies was 27.7%. The highest age-stratified seroprevalence was observed in participants aged 60–69 years (45.5%, 95% CI: 32.3% to 58.6%). The lowest was in children aged 0–9 years (14.0%, 95% CI: 7.4% to 20.6%). Conclusions: SARS-CoV-2 in rural Mali is much more widespread than assumed by national testing data and particularly in the older population and frontline HCWs. The observation is contrary to the widely expressed view, based on limited data, that COVID-19 infection rates were lower in 2020–2021 in West Africa than in other settings

Association between asymptomatic infections and linear growth in 18–24-month-old Malawian children

Inadequate diet and frequent symptomatic infections are considered major causes of growth stunting in low-income countries, but interventions targeting these risk factors have achieved limited success. Asymptomatic infections can restrict growth, but little is known about their role in global stunting prevalence. We investigated factors related to length-for-age Z-score (LAZ) at 24 months by constructing an interconnected network of various infections, biomarkers of inflammation (as assessed by alpha-1-acid glycoprotein [AGP]), and growth (insulin-like growth factor 1 [IGF-1] and collagen X biomarker [CXM]) at 18 months, as well as other children, maternal, and household level factors. Among 604 children, there was a continuous decline in mean LAZ and increased mean length deficit from birth to 24 months. At 18 months of age, the percentage of asymptomatic children who carried each pathogen was: 84.5% enterovirus, 15.5% parechovirus, 7.7% norovirus, 4.6% rhinovirus, 0.6% rotavirus, 69.6% Campylobacter, 53.8% Giardia lamblia, 11.9% malaria parasites, 10.2% Shigella, and 2.7% Cryptosporidium. The mean plasma IGF-1 concentration was 12.5 ng/ml and 68% of the children had systemic inflammation (plasma AGP concentration >1 g/L). Shigella infection was associated with lower LAZ at 24 months through both direct and indirect pathways, whereas enterovirus, norovirus, Campylobacter, Cryptosporidium, and malaria infections were associated with lower LAZ at 24 months indirectly, predominantly through increased systemic inflammation and reduced plasma IGF-1 and CXM concentration at 18 months.publishedVersionPeer reviewe

Testing the effects of mass drug administration of azithromycin on mortality and other outcomes among 1–11-month-old infants in Mali (LAKANA) : study protocol for a cluster-randomized, placebo-controlled, double-blinded, parallel-group, three-arm clinical trial

Background: Mass drug administration (MDA) of azithromycin (AZI) has been shown to reduce under-5 mortality in some but not all sub-Saharan African settings. A large-scale cluster-randomized trial conducted in Malawi, Niger, and Tanzania suggested that the effect differs by country, may be stronger in infants, and may be concentrated within the first 3 months after treatment. Another study found no effect when azithromycin was given concomitantly with seasonal malaria chemoprevention (SMC). Given the observed heterogeneity and possible effect modification by other co-interventions, further trials are needed to determine the efficacy in additional settings and to determine the most effective treatment regimen. Methods: LAKANA stands for Large-scale Assessment of the Key health-promoting Activities of two New mass drug administration regimens with Azithromycin. The LAKANA trial is designed to address the mortality and health impacts of 4 or 2 annual rounds of azithromycin MDA delivered to 1–11-month-old (29–364 days) infants, in a high-mortality and malaria holoendemic Malian setting where there is a national SMC program. Participating villages (clusters) are randomly allocated in a ratio of 3:2:4 to three groups: placebo (control):4-dose AZI:2-dose AZI. The primary outcome measured is mortality. Antimicrobial resistance (AMR) will be monitored closely before, during, and after the intervention and both among those receiving and those not receiving MDA with the study drugs. Other outcomes, from a subset of villages, comprise efficacy outcomes related to morbidity, growth and nutritional status, outcomes related to the mechanism of azithromycin activity through measures of malaria parasitemia and inflammation, safety outcomes (AMR, adverse and serious adverse events), and outcomes related to the implementation of the intervention documenting feasibility, acceptability, and economic aspects. The enrolment commenced in October 2020 and is planned to be completed by the end of 2022. The expected date of study completion is December 2024. Discussion: If LAKANA provides evidence in support of a positive mortality benefit resulting from azithromycin MDA, it will significantly contribute to the options for successfully promoting child survival in Mali, and elsewhere in sub-Saharan Africa. Trial registration: ClinicalTrials.gov NCT04424511. Registered on 11 June 2020.publishedVersionPeer reviewe

Impact of a conditional cash transfer and of a lipid-based nutrient supplement on child stunting in rural Mali : analysis of a cluster-randomized controlled trial

En 2014, afin de réduire le retard de croissance chez les jeunes enfants en milieu rural à Kayes au Mali, le Programme Alimentaire Mondial a intégré à un programme nutritionsanté préexistant (SNACK) i) un transfert monétaire (TM) aux femmes enceintes et mères d’enfants de moins de deux ans et ii) une supplémentation nutritionnelle à base lipidique (LNS) aux enfants de 6-23 mois; sous condition de fréquenter les centres de santé pendant les 1000 premiers jours (de la conception aux 2 ans de l'enfant). Nous avons évalué l’impact de ces interventions sur la croissance des jeunes enfants, notre critère principal de jugement étant l’indice Taille-pour-Age moyen exprimé en z-scores (TA), ainsi que sur des indicateurs intermédiaires le long des chemins d’impact du programme. Un essai contrôlé randomisé en grappe a été mené, où 76 centres de santé ont été répartis dans 4 bras : 1) SNACK (comparaison), 2) SNACK+TM, 3) SNACK+LNS et 4) SNACK+TM+LNS. Nous avons comparé des échantillons transversaux d'enfants de 12-42 mois enquêtés avant (2013, n=5046) et en fin d’intervention (2016, n=5098). Malgré une amélioration de l’indice TA moyen et une prévalence du retard de croissance (TA< -2) en baisse entre 2013 et 2016 dans les bras 2 (35,6% vs. 31,8%) et 3 (34,6% vs. 29,5%), ces évolutions n’étaient pas statistiquement significatives comparativement au bras SNACK. La combinaison des 2 interventions n’a pas eu d’impact sur la croissance, mais a permis l’amélioration modeste de l’indice moyen Poids-pour-Taille (ß=+0.16 P<0,01). Dans les bras 3 et 4, le suivi de croissance des enfants et certaines connaissances des mères ont été significativement améliorés. Des données sur la mise en œuvre du programme ont identifié plusieurs freins à l’efficacité des interventions, notamment des délais d’approvisionnement et de distribution des intrants dû à des difficultés d’accès géographique, une surcharge de travail des agents de terrain, un montant insuffisant du TM, ainsi qu’un partage du LNS dans le ménage.In 2014, on top of a community health and nutrition program running in the region of Kayes in Mali (SNACK), the World Food Program implemented distributions of i) cash to pregnant and mothers of children aged less than 24 months and ii) Lipid-Based Nutrient Supplements (LNS) to children aged 6-23 months. Both interventions were conditional upon attendance at community health centers (CHCs) for medical follow up throughout the first 1000 days of life (from conception to age 2 of the child). We evaluated the impact of these strategies on children’s anthropometric status, the mean height-for-age z-scores (HAZ) being our primary outcome, as well as on intermediary outcomes along the program’s impact pathways. We conducted a cluster randomized controlled trial, with CHCs randomized in 4 arms: 1) SNACK program only (comparison); 2) SNACK+Cash; 3) SNACK+LNS; 4) SNACK+Cash+LNS. Independent representative samples of 12-42 mo old children were surveyed at baseline (2013, n=5046) and at endline (2016, n=5098). Despite an increase in the mean HAZ and a decrease in stunting rates (HAZ<-2) between 2013 and 2016 in arm 2 (35.6% vs. 31.8%) and in arm 3 (34.6% vs. 29.5%), these changes were not statistically significant as compared with the SNACK arm. Combing the two strategies did not lead to any impact on growth outcomes, however it improved the mean weight-for-height z-scores (ß= +0.16 P<0.01). Attendance at children’s growth monitoring sessions and some of the mothers’ knowledge significantly increased in arms 3 and 4. Data on the program’s implementation suggested several barriers to impact achievement, including irregularity in cash/LNS provisioning and distributions due to low accessibility to CHCs, excessive workload of frontline workers, insufficient amount of cash transfers or sharing of LNS with siblings

Impact d'un transfert monétaire et/ou d'un supplément nutritionnel pour la prévention du retard de croissance du jeune enfant en milieu rural au Mali : analyse d'un essai randomisé par clusters

In 2014, on top of a community health and nutrition program running in the region of Kayes in Mali (SNACK), the World Food Program implemented distributions of i) cash to pregnant and mothers of children aged less than 24 months and ii) Lipid-Based Nutrient Supplements (LNS) to children aged 6-23 months. Both interventions were conditional upon attendance at community health centers (CHCs) for medical follow up throughout the first 1000 days of life (from conception to age 2 of the child). We evaluated the impact of these strategies on children’s anthropometric status, the mean height-for-age z-scores (HAZ) being our primary outcome, as well as on intermediary outcomes along the program’s impact pathways. We conducted a cluster randomized controlled trial, with CHCs randomized in 4 arms: 1) SNACK program only (comparison); 2) SNACK+Cash; 3) SNACK+LNS; 4) SNACK+Cash+LNS. Independent representative samples of 12-42 mo old children were surveyed at baseline (2013, n=5046) and at endline (2016, n=5098). Despite an increase in the mean HAZ and a decrease in stunting rates (HAZ<-2) between 2013 and 2016 in arm 2 (35.6% vs. 31.8%) and in arm 3 (34.6% vs. 29.5%), these changes were not statistically significant as compared with the SNACK arm. Combing the two strategies did not lead to any impact on growth outcomes, however it improved the mean weight-for-height z-scores (ß= +0.16 P<0.01). Attendance at children’s growth monitoring sessions and some of the mothers’ knowledge significantly increased in arms 3 and 4. Data on the program’s implementation suggested several barriers to impact achievement, including irregularity in cash/LNS provisioning and distributions due to low accessibility to CHCs, excessive workload of frontline workers, insufficient amount of cash transfers or sharing of LNS with siblings.En 2014, afin de réduire le retard de croissance chez les jeunes enfants en milieu rural à Kayes au Mali, le Programme Alimentaire Mondial a intégré à un programme nutritionsanté préexistant (SNACK) i) un transfert monétaire (TM) aux femmes enceintes et mères d’enfants de moins de deux ans et ii) une supplémentation nutritionnelle à base lipidique (LNS) aux enfants de 6-23 mois; sous condition de fréquenter les centres de santé pendant les 1000 premiers jours (de la conception aux 2 ans de l'enfant). Nous avons évalué l’impact de ces interventions sur la croissance des jeunes enfants, notre critère principal de jugement étant l’indice Taille-pour-Age moyen exprimé en z-scores (TA), ainsi que sur des indicateurs intermédiaires le long des chemins d’impact du programme. Un essai contrôlé randomisé en grappe a été mené, où 76 centres de santé ont été répartis dans 4 bras : 1) SNACK (comparaison), 2) SNACK+TM, 3) SNACK+LNS et 4) SNACK+TM+LNS. Nous avons comparé des échantillons transversaux d'enfants de 12-42 mois enquêtés avant (2013, n=5046) et en fin d’intervention (2016, n=5098). Malgré une amélioration de l’indice TA moyen et une prévalence du retard de croissance (TA< -2) en baisse entre 2013 et 2016 dans les bras 2 (35,6% vs. 31,8%) et 3 (34,6% vs. 29,5%), ces évolutions n’étaient pas statistiquement significatives comparativement au bras SNACK. La combinaison des 2 interventions n’a pas eu d’impact sur la croissance, mais a permis l’amélioration modeste de l’indice moyen Poids-pour-Taille (ß=+0.16 P<0,01). Dans les bras 3 et 4, le suivi de croissance des enfants et certaines connaissances des mères ont été significativement améliorés. Des données sur la mise en œuvre du programme ont identifié plusieurs freins à l’efficacité des interventions, notamment des délais d’approvisionnement et de distribution des intrants dû à des difficultés d’accès géographique, une surcharge de travail des agents de terrain, un montant insuffisant du TM, ainsi qu’un partage du LNS dans le ménage

Conditional cash transfer and/or lipid-based nutrient supplement targeting the first 1000 d of life increased attendance at preventive care services but did not improve linear growth in young children in rural Mali: Results of a cluster-randomized controlled trial

PRIFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for allPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

The ‘Minimum Dietary Diversity for Women’ (MDD-W) Indicator is related to household food insecurity and farm production diversity: Evidence from rural Mali

With the aim of contributing to this emerging literature, we investigated: (i) how MDD-W is linked to household food insecurity based on the Household Food Insecurity Access Scale (HFIAS) and on the Household Hunger Scale (HHS); (ii) how MDD-W is linked to farm production diversity; and (iii) whether contextual factors such as household wealth status modify these relationships. As a secondary objective, we also checked whether all of these associations held, or not, when the number of food groups consumed was used as a continuous variable, in order to conclude on the cost of dichotomization.PRIFPRI3; CRP4; G Cross-cutting gender themePHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) Indicator Is Related to Household Food Insecurity and Farm Production Diversity : Evidence from Rural Mali

International audienceBackground: The popularity of nutrition-sensitive interventions calls for high-quality monitoring and evaluation tools. In this context, the Minimum Dietary Diversity for Women of Reproductive Age (MDD-W), validated as a proxy of micronutrient adequacy, does fill a gap. However, because it is a newly endorsed indicator, information on its linkages with other dimensions of food and nutrition security is still scarce.Objective: The objective of this study was to investigate whether the MDD-W is related to household food insecurity and farm production diversity.Methods: A cross-sectional survey on a representative sample of 5046 women of reproductive age was conducted in the region of Kayes, Mali, in 2013. Dietary diversity was assessed through qualitative 24-h recall, and MDD-W was computed. MDD-W equaled 1 if the women consumed at least 5 different food groups and 0 otherwise. Food insecurity was measured using the Household Food Insecurity Access Scale and the Household Hunger Scale (HHS), and a farm production diversity score (FPDS) was calculated based on a count of food crops/livestock groups produced. Logistic regressions were used to assess the relation between MDD-W and the indicators of household food security.Results: Only 27% of women reached the MDD-W. These women consumed animal source foods and/or vitamin A-rich vegetables and fruits more frequently than did other women. Women from extremely food insecure households (moderate to severe hunger according to the HHS) were less likely to reach the MDD-W (OR: 0.70; 95% CI: 0.50, 0.97). One more group in the FPDS increased the odds of attaining the MDD-W (OR: 1.12; 95% CI: 1.06, 1.18).Conclusion: In the rural region of Kayes, Mali, women's dietary diversity, as measured by the MDD-W, was associated with household-level food security indicators

Association between prenatal provision of lipid-based nutrient supplements and caesarean delivery: Findings from a randomised controlled trial in Malawi.

In populations with a high prevalence of childhood and adolescent undernutrition, supplementation during pregnancy aiming at improving maternal nutritional status and preventing fetal growth restriction might theoretically lead to cephalopelvic disproportion and delivery complications. We investigated whether the prenatal provision of small-quantity lipid-based nutrient supplements (SQ-LNS) was associated with an increased risk of caesarean section (CS) or other delivery complications. Pregnant Malawian women were randomised to receive daily i) iron-folic acid (IFA) capsule (control), ii) multiple micronutrient (MMN) capsule of 18 micronutrients (second control), or iii) SQ-LNS with similar micronutrients as MMN, plus four minerals and macronutrients contributing 118 kcal. We analysed the associations of SQ-LNS, CS, and other delivery complications using log-binomial regressions. Among 1391 women enrolled, 1255 had delivery information available. The incidence of CS and delivery complications was 6.3% and 8.2%, respectively. The incidence of CS was 4.0%, 6.0%, and 8.9% (p = 0.017) in the IFA, MMN, and LNS groups, respectively. Compared to the IFA group, the relative risk (95% confidence interval) of CS was 2.2 (1.3-3.8) (p = 0.006) in the LNS group and 1.5 (0.8-2.7) (p = 0.200) in the MMN group. We found no significant differences for other delivery complications. Provision of SQ-LNS to pregnant women may have increased the incidence of CS. The baseline rate was, however, lower than recommended. It is unclear if the higher CS incidence in the SQ-LNS group resulted from increased obstetric needs or more active health seeking and a better supply of services. Trial registered at clinicaltrials.gov, NCT01239693