Enhanced post-natal growth is associated with elevated blood pressure in young Senegalese adults

Background Evidence suggests that intrauterine growth restriction followed by rapid post-natal growth is associated with high blood pressure. We assessed the effect of early size and post-natal growth on blood pressure in a population from West Africa, where fetal growth retardation and childhood malnutrition are common. Methods A total of 1288 Senegalese subjects were followed from infancy to young adulthood (mean age 17.9 years). Adult systolic blood pressure (SBP) was regressed on infant and adult anthropometric characteristics. Results In unadjusted analyses, infant size was positively associated with adult SBP (1.1 +/- 03; P = 0.001 for weight; 0.7 +/- 0.3; P = 0.04 for length). With adjustment for current size, the regression coefficients for infant size were reversed (-0.2 +/- 0.3; P = 0.51 for weight; -0.3 +/- 0.3; P = 0.35 for length). SBP increased by 4.1 and 2.9 mmHg for 1 standard deviation (SD) increase in current weight or height, respectively. No interaction between infant size and current size was found in the overall models (P = 0.11 for weight, P = 0.95 for height), but this term interacted with sex for weight effect. A negative interaction was found in males (-0.9 +/- 0.4; P = 0.02) but not in females (0.3 +/- 0.4; P = 0.46). The association of current weight with SBP was stronger in lighter weight male infants. Conclusions These findings support the hypothesis that subjects who were small in early life and experienced enhanced post-natal growth have higher levels of SBP, even in low-income settings

Active malaria morbidity management has limited impact on height status of preschool senegalese children

Although infections contribute to growth faltering in preschool children, malaria prevention seems to have limited impact on height status. In 2002-2003, a malaria intermittent preventive treatment (IPT) trial was conducted in Senegal, including randomly selected preschool children from 11 villages, A rapid decrease in stunting prevalence (from 28.3 to 16.3%; P < 0.0001) was reported in both intervention and placebo groups. During this 15-mo period, both groups of children benefited from active detection and prompt treatment of malaria attacks. In this study, we investigated whether management of malaria morbidity could explain the improvement of height status. An anthropometric survey, conducted in September 2004 in the area, included 929 2- to 5-y-old children, Some 539 children, previously included in the 2002-2003 IPT trial, benefited from active malaria morbidity management and formed the malaria trial group. The remaining 390 children constituted the control group. Mean height-for-age and stunting prevalence in September 2004 were compared between groups adjusting for age and mother's activity. Mean height-for-age Z-scores did not differ between trial (-1.17 +/- 0.93) and control children (-1.24 +/- 1.00; P = 0.25). Only 36- to 47-mo-old malaria trial children had a lower prevalence of stunting than controls of similar age (19.4 vs. 28.7%; P = 0.044). Compared with the usually slow progression of height status related to better living conditions, it seems very likely that the rapid improvement observed among IPT study children resulted from the trial. These findings suggest that improved health services provided by the trial may also have benefited children not included living in study villages. J. Nutr. 140: 625-629, 2010

Breast-feeding : early influences on later health

The importance of breast-feeding for infant and child health and survival in less developed countries has been the subject of a number of studies over the last 25 years.1_9 However, the epidemic of AIDS in low-income countries, together with the discovery of an important risk of mother-to-child transmission of HIV-1 through breast-milk,10 has prompted renewed interest in this subject. Indeed, in order to weigh the mortality risks associated with different infant feeding practices against the risk of mother-to-child transmission of the virus, it is essential to have precise estimates of relative risk of death of non-breastfed infants within narrow age intervals

Relation entre l'état nutritionnel et le paludisme chez les jeunes enfants d'Afrique sub-saharienne vivant en zone de transmission saisonnière du paludisme

En Afrique, malnutrition et paludisme sont des causes considérables de mortalité chez les jeunes enfants. Pour comprendre l'interaction liant ces deux affections, nous avons analysé, par une approche épidémiologique et immunologique, des données collectées lors d'un essai évaluant l'efficacité d'un traitement préventif intermittent (TPI) contre le paludisme chez des enfants de moins cinq ans. Nos résultats suggèrent que la sensibilisation au paludisme et les services médicaux assortis à l'essai semblent améliorer le statut en taille des enfants. Nos travaux concernant l'effet de la malnutrition sur la morbidité palustre des enfants, indiquent d'une part, que l'émaciation diminue le risque de survenue d'une crise palustre, et d'autre part que, le taux d'anticorps (IgG) spécifiques est plus faible chez les enfants retardés en taille. L'ensemble de ces résultats souligne l'importance d'intégrer l'état nutritionnel des enfants dans les interventions de lutte contre le paludismeIn Africa, malnutrition and malaria remain major causes of childhood mortality. To better understand the interaction between these two affections, we have analysed data collected during an intermittent preventive treatment (IPT) of malaria trial conducted on preschool children. Our findings suggest that advertising on malaria and the basic medical services offered during the trial may have improved the height status of the children. We also investigated the impact of malnutrition on susceptibility to malaria. Our results show that, on one hand, wasting was associated with a decreased risk of having a subsequent clinical malaria attack and on the other hand, that specific antibodies (IgG) levels were significantly lower in stunted children compared to well-nourished ones. Altogether, these findings highlight the importance of integrating children nutritional status when defining malaria control interventions, particularly in the development of a malaria vaccineMONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF

Acceptabilité et faisabilité des recommandations de l'OMS pour l'alimentation des enfants nés de mères infectées par le VIH au cours de la première année de postpartum, au Burkina Faso

Depuis 2001, pour prévenir la transmission mère-enfant (TME) du VIH, l OMS recommande aux mères infectées d éviter l allaitement si l alimentation artificielle est acceptable, faisable, accessible financièrement, durable et sûre, sinon, l allaitement exclusif suivi d un sevrage rapide à 6 mois est recommandé. Cette recherche qui combine les approches qualitatives et quantitatives a montré la faible acceptabilité de ces deux options au sein d une cohorte de mères participant à une étude sur la prévention de la TME du VIH au Burkina Faso. L alimentation artificielle n était pratiquée que par 10% des femmes mais dans des conditions de faisabilité et de sécurité satisfaisantes. Les autres mères ont rencontré de grandes difficultés à allaiter exclusivement, pratique contraire à la norme culturelle et mal acceptée par l entourage. Leur perception d un risque élevé de transmission par le lait maternel était une source d angoisse supplémentaire. Malgré la fourniture d un aliment de complément fortifié après 6 mois, 50% des enfants non allaités ne couvraient pas leur besoin en énergie, conséquence d une consommation trop faible d aliment fortifié et de lait, associée à de mauvaises pratiques d alimentation. Cependant, la croissance pondérale jusqu à 24 mois était relativement satisfaisante. La nouvelle stratégie de l OMS qui recommande depuis 2010 l allaitement prolongé jusqu à 12 mois postpartum sous couverture antirétrovirale est une avancée majeure pour les nombreuses femmes au sud qui ne peuvent renoncer à l allaitement faute d alternative acceptable. Il est cependant crucial que le soutien à l alimentation artificielle soit maintenu pour les femmes qui le souhaitentPARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF

Enhanced post-natal growth is associated with elevated blood pressure in young Senegalese adults

Background Evidence suggests that intrauterine growth restriction followed by rapid post-natal growth is associated with high blood pressure. We assessed the effect of early size and post-natal growth on blood pressure in a population from West Africa, where fetal growth retardation and childhood malnutrition are common. Methods A total of 1288 Senegalese subjects were followed from infancy to young adulthood (mean age 17.9 years). Adult systolic blood pressure (SBP) was regressed on infant and adult anthropometric characteristics. Results In unadjusted analyses, infant size was positively associated with adult SBP (1.1 +/- 03; P = 0.001 for weight; 0.7 +/- 0.3; P = 0.04 for length). With adjustment for current size, the regression coefficients for infant size were reversed (-0.2 +/- 0.3; P = 0.51 for weight; -0.3 +/- 0.3; P = 0.35 for length). SBP increased by 4.1 and 2.9 mmHg for 1 standard deviation (SD) increase in current weight or height, respectively. No interaction between infant size and current size was found in the overall models (P = 0.11 for weight, P = 0.95 for height), but this term interacted with sex for weight effect. A negative interaction was found in males (-0.9 +/- 0.4; P = 0.02) but not in females (0.3 +/- 0.4; P = 0.46). The association of current weight with SBP was stronger in lighter weight male infants. Conclusions These findings support the hypothesis that subjects who were small in early life and experienced enhanced post-natal growth have higher levels of SBP, even in low-income settings

Acceptability and feasibility of infant-feeding options : experiences of HIV-infected mothers in the World Health Organization Kesho Bora mother-to-child transmission prevention (PMTCT) trial in Burkina Faso

In Burkina Faso, prolonged breastfeeding with introduction of ritual fluids from birth is a deep-seated norm. We explored HIV-infected mothers' views and experiences of the acceptability and feasibility of the World Health Organization's recommended infant-feeding options within a mother-to-child-transmission prevention trial. A qualitative study was conducted on 17 formula-feeding and 19 breastfeeding mothers, from a larger cohort of 51 eligible HIV-infected women, consenting to participate in separate focus group discussions in early post-partum. Mothers opted for breastfeeding essentially out of fear of family rejection. Most of them were afraid of denigration for disrespecting tradition if they formula-fed or being suspected of HIV infection. Achieving exclusive breastfeeding remained a difficult challenge as they engaged in a continuous struggle with close elders to avoid fluid feeding. Additional stress and fatigue were fed by their perception of a high transmission risk through breast milk. Exclusive formula-feeding seemed easier to implement, especially as formula was provided free of charge. Formula-feeding mothers more frequently had a supportive partner, a strong personality and lived in better socio-economic conditions than breastfeeding mothers (76% had education and electricity supply vs. 42%, respectively). Exclusive breastfeeding for the first 6 months remains the most appropriate option for many HIV-infected mothers in sub-Saharan Africa. Its acceptability and feasibility urgently need to be improved by promoting it as the best feeding option for all infants. Other crucial interventions are the promotion of voluntary counselling and testing for couples, and greater partner involvement in infant-feeding counselling