Determinants of growth in HIV-exposed and HIV-uninfected infants in the Kabeho Study

HIV-exposed and HIV-uninfected (HEU) infants may be at increased risk of poor health and growth outcomes. We characterized infant growth trajectories in a cohort of HEU infants to identify factors associated with healthy growth. HIV-positive women participating in prevention of mother-to-child HIV transmission programmes in Kigali, Rwanda, were followed until their infants were 2 years old. Infant anthropometrics were regularly collected. Latent class analysis was used to categorize infant growth trajectories. Multiple logistic regression was used to estimate the odds of infants belonging to each growth trajectory class. On average, this population of HEU infants had moderate linear growth faltering, but only modest faltering in weight, resulting in mean weight-for-length z-score (WLZ) above the World Health Organization (WHO) median. Mean WLZ was 0.53, and mean length-for-age z-score (LAZ) was −1.14 over the first 2 years of life. We identified four unique WLZ trajectories and seven trajectories in LAZ. Low neonatal weight-for-age and a high rate of illness increased the likelihood that infants were in the lightest WLZ class. Shorter mothers were more likely to have infants with linear growth faltering. Female infants who were older at the end of exclusive breastfeeding were more likely to be in the second tallest LAZ class. In conclusion, the current WHO recommendations of Option B+ and extended breastfeeding may induce higher WLZ and lower LAZ early in infancy. However, there is considerable heterogeneity in growth patterns that is obscured by simply analysing average growth trends, necessitating the analysis of growth in subpopulations

Decreased consumption of common weaning foods is associated with poor linear growth among HIV-exposed infants participating in the Kigali antiretroviral and breastfeeding assessment for the elimination of HIV (Kabeho) study

Objective: The World Health Organization recommends that complementary foods that are adequate, safe, and appropriate be introduced to infants at age 6 months. Using an innovative modeling technique, we examine patterns of nutrient intake in HIV-exposed and uninfected (HEU) infants and establish their relationship with growth. Methods: Single-day dietary recalls and anthropometrics were collected every two to 3 months from 543 infants living in Kigali, Rwanda, and attending clinics for the prevention of mother-to-child HIV transmission. A common weaning food index (CWFI) was calculated in grams and nutrient density for infants to reflect the extent to which the infants consumed the weaning foods typical of this population at ages 6 to 10, 11 to 15, and 16 to 20 months. Regressions among the CWFI, length-for-age z-scores (LAZ), and weight-for-length z-scores (WLZ) were conducted to estimate the relationship between the dietary patterns and growth. Results: Mean absolute intake of zinc and calcium from complementary foods was insufficient. Increasing CWFI was related to increasing cow milk consumption. The density CWFI showed a decrease in the density of iron and folate as infants consume more of the weaning foods typical of this population. Density CWFI, breastfeeding, and caloric intake act on early LAZ and WLZ and interact with one another. Among breastfed infants, those who consume little of the common weaning foods and have a high caloric intake develop deficits in LAZ and have an elevated WLZ. Conclusions: A diet that is more dominated by the typical weaning foods of this population may support a healthy growth pattern

Antiretroviral therapy program expansion in Zambezia Province, Mozambique: geospatial mapping of community-based and health facility data for integrated health planning.

OBJECTIVE: To generate maps reflecting the intersection of community-based Voluntary Counseling and Testing (VCT) delivery points with facility-based HIV program demographic information collected at the district level in three districts (Ile, Maganja da Costa and Chinde) of Zambézia Province, Mozambique; in order to guide planning decisions about antiretroviral therapy (ART) program expansion. METHODS: Program information was harvested from two separate open source databases maintained for community-based VCT and facility-based HIV care and treatment monitoring from October 2011 to September 2012. Maps were created using ArcGIS 10.1. Travel distance by foot within a 10 km radius is generally considered a tolerable distance in Mozambique for purposes of adherence and retention planning. RESULTS: Community-based VCT activities in each of three districts were clustered within geographic proximity to clinics providing ART, within communities with easier transportation access, and/or near the homes of VCT volunteers. Community HIV testing results yielded HIV seropositivity rates in some regions that were incongruent with the Ministry of Health's estimates for the entire district (2-13% vs. 2% in Ile, 2-54% vs. 11.5% in Maganja da Costa, and 23-43% vs. 14.4% in Chinde). All 3 districts revealed gaps in regional disbursement of community-based VCT activities as well as access to clinics offering ART. CONCLUSIONS: Use of geospatial mapping in the context of program planning and monitoring allowed for characterizing the location and size of each district's HIV population. In extremely resource limited and logistically challenging settings, maps are valuable tools for informing evidence-based decisions in planning program expansion, including ART

Multidimensional poverty in rural Mozambique: a new metric for evaluating public health interventions.

BACKGROUND: Poverty is a multidimensional phenomenon and unidimensional measurements have proven inadequate to the challenge of assessing its dynamics. Dynamics between poverty and public health intervention is among the most difficult yet important problems faced in development. We sought to demonstrate how multidimensional poverty measures can be utilized in the evaluation of public health interventions; and to create geospatial maps of poverty deprivation to aid implementers in prioritizing program planning. METHODS: Survey teams interviewed a representative sample of 3,749 female heads of household in 259 enumeration areas across Zambézia in August-September 2010. We estimated a multidimensional poverty index, which can be disaggregated into context-specific indicators. We produced an MPI comprised of 3 dimensions and 11 weighted indicators selected from the survey. Households were identified as "poor" if were deprived in >33% of indicators. Our MPI is an adjusted headcount, calculated by multiplying the proportion identified as poor (headcount) and the poverty gap (average deprivation). Geospatial visualizations of poverty deprivation were created as a contextual baseline for future evaluation. RESULTS: In our rural (96%) and urban (4%) interviewees, the 33% deprivation cut-off suggested 58.2% of households were poor (29.3% of urban vs. 59.5% of rural). Among the poor, households experienced an average deprivation of 46%; thus the MPI/adjusted headcount is 0.27 ( = 0.58×0.46). Of households where a local language was the primary language, 58.6% were considered poor versus Portuguese-speaking households where 73.5% were considered non-poor. Living standard is the dominant deprivation, followed by health, and then education. CONCLUSIONS: Multidimensional poverty measurement can be integrated into program design for public health interventions, and geospatial visualization helps examine the impact of intervention deployment within the context of distinct poverty conditions. Both permit program implementers to focus resources and critically explore linkages between poverty and its social determinants, thus deriving useful findings for evidence-based planning

Ogumaniha Community-Based Voluntary Counseling and Testing Campaigns: Ile, Maganja da Costa and Chinde Districts, October 2011–September 2012.

<p><b>*</b>District Prevalence Estimates are based on the percent of pregnant women testing HIV seropositive at antenatal care clinics (routine PMTCT data) from the districts main health facility for the period October 2011–September 2012.</p><p><b>**</b>Zambézia Province HIV prevalence as reported by INSIDA, 2009¹³.</p><p>Ogumaniha Community-Based Voluntary Counseling and Testing Campaigns: Ile, Maganja da Costa and Chinde Districts, October 2011–September 2012.</p

Map of Chinde.

<p>*<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109653#pone-0109653-g004" target="_blank">Figure 4A</a> shows the geographic locations of communities that reported community-based VCT activities and the percent testing HIV positive, in the time period between October 2011 and September 2012. *<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109653#pone-0109653-g004" target="_blank">Figures 4B</a> shows the geographic locations of where patients live, that were newly enrolled into HIV care and treatment in the same time period between October 2011 and September 2012. The main hospital in the district capital providing ART services is marked with a 10 km radius (green) around the hospital, while the smaller peripheral health facility also currently providing ART services is marked in blue. Persons living in communities designated with a green dot enrolled in the ART site with 10 km radius in green. Persons living in communities designated with a blue dot enrolled in the ART site with a 10 km radius in blue. *<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109653#pone-0109653-g004" target="_blank">Figures 4C</a> shows the locations of health facilities in each district currently providing ART (purple) and those slated for expansion of HIV care and treatment services in 2013 (light purple).</p

Map of Mozambique, Zambézia Province with Districts of Ile, Maganja da Costa, and Chinde Highlighted.

<p>The Provincial Capital of Quelimane and District of Inhassunge also Represented.</p

Map of Maganja da Costa.

<p>*<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109653#pone-0109653-g003" target="_blank">Figure 3A</a> shows the geographic locations of communities that reported community-based VCT activities and the percent testing HIV positive, in the time period between October 2011 and September 2012. *<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109653#pone-0109653-g003" target="_blank">Figures 3B</a> shows the geographic locations of where patients live, that were newly enrolled into HIV care and treatment in the same time period between October 2011 and September 2012. The main hospital in the district capital providing ART services is marked with a 10 km radius (green) around the hospital, while the smaller peripheral health facility also currently providing ART services is marked in blue. Persons living in communities designated with a green dot enrolled in the ART site with 10 km radius in green. Persons living in communities designated with a blue dot enrolled in the ART site with a 10 km radius in blue. *<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0109653#pone-0109653-g003" target="_blank">Figures 3C</a> shows the locations of health facilities in each district currently providing ART (purple) and those slated for expansion of HIV care and treatment services in 2013 (light purple).</p

Decomposition by District and Broken Down by Dimension in the Three Focal Districts, <i>Ogumaniha</i> 2010. Legend:

<p>The adjusted headcount is decomposed by dimension for Morrumbala, Alto Molócuè, Namacurra and all three districts combined. Data that are overlaid include percent of households in the lowest quintile for permanent income wealth and % of households making less than USD$1.25/day. MZN = Metical.</p