39 research outputs found
Exploring linear growth retardation in Rwandan children: Ecological and biological factors
No full textBackground: Stunted linear growth and anaemia are major public health concerns in low-income countries, with a disproportionate global burden affecting Sub-Saharan Africa. In Rwanda, stunting among children under five years of age is still high (38%) and it affects more boys compared to girls (43% vs. 33%). However, no studies have tried to explain the causes of this sex disparity so far. Furthermore, anaemia prevalence hits its peak at infancy, with 72% and 61% of children being anaemic at 6-8 and 9-11 months of age, respectively. Little is known about the causes of anaemia including the contribution of iron deficiency. Therefore, understanding the context-specific factors of poor linear growth and anaemia is key to targeting evidence-based interventions for accelerating the reduction in the magnitude of these two forms of undernutrition. Our research aimed to explore the aetiology of stunted linear growth and anaemia in the Rwandan context.Methods: We analysed cross-sectional data of 1228 children aged 6-23 months from eight districts with a high burden of malnutrition in Rwanda collected in 2014-2015 as the baseline survey of a nutrition program. Then we conducted a longitudinal study on 192 mother-child pairs living in a rural area of one district of these eight districts. From birth to 1 year of age, anthropometric measures, morbidity, and feeding data were collected monthly. The child’s length and its potential predictors were analysed using a linear mixed model. We stratified the analysis by age ranges of 0-5, 6-12, and 0-12 months to consider the differences in the start of feeding practices. In the longitudinal study, we, further, measured haemoglobin concentration and collected blood samples from the mother-child pairs at birth and at 4 and 12 months post-partum. Ferritin, sTfR, CRP, and AGP concentrations were measured using a sandwich ELISA technique. Haemoglobin and ferritin values were adjusted for altitude and inflammation, respectively. Finally, in a methodological study, we used a convenience sample of 13 pairs of mothers and babies aged 2 to 4 months who were exclusively breastfed and healthy to assess breastmilk intake using the deuterium dose-to-mother technique.Results: The findings from the analysis of the cross-sectional data confirmed that stunting significantly affected more boys than girls, with a prevalence of 43.3% vs. 28.0%, respectively. Being fed porridge as first weaning food as opposed to cow’s milk was a significant factor for stunting in boys solely (PR=1.44, 95% CI=1.07-1.94, p-interaction=0.048) while discontinued breastfeeding was a significant factor in girls only (PR=1.49, 95% CI=1.05-2.11, p-interaction=0.017). The results from the longitudinal study showed that children were already born with length deficits of -1.4 cm, which gradually deteriorated to -2.7 cm at 12 months of age. Significant predictors of decelerated linear growth were late initiation of breastfeeding (-0.73 cm, 95% CI: -1.45, -0.01) in the age range of 6-12 months, high breastfeeding frequency (-0.01 cm per additional feed, 95% CI: -0.02, -0.00) from 0-5 and 0-12 months, and early introduction of complementary feeding (-0.69 cm, 95% CI: -0.90, -0.49) from 0-12 months. Moreover, the duration (days) of diarrhoea or malaria illnesses significantly predicted decreased linear growth depending on the age range. Meal frequency, dietary diversity, and acceptable diet did not significantly predict linear growth. Conversely, the study confirmed a strong positive effect of birth weight and birth length on postnatal linear growth. We saw that at 4 months of age, anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) occurred in 73%, 10%, and 8%, respectively while at 12 months of age, anaemia reduced to 48% and both ID and IDA increased to 28% and 18%, respectively. At 4 and 12 months of age, ID contributed 10% and 36.5% to anaemia cases, respectively. Dietary iron intake tended to significantly predict iron deficiency (PR=0.79, 95% CI: 0.62, 1.03), but not anaemia or iron-deficiency anaemia at 12 months of age. However, the duration of being ill with malaria was significantly associated with anaemia (PR=1.05, 95% CI: 1.00-1.10), ID (PR=1.09, 95% CI: 1.04-1.15), as well as with IDA (PR=1.15, 95% CI: 1.06-1.25). In addition, the presence of inflammation predicted anaemia (PR=1.01, 95% CI: 1.01-1.10). Iron deficiency at 12 months of age occurred less often when children had higher body iron reserves at 4 months of age (PR=0.73, 95% CI: 0.59, 0.89). Lastly, the findings from a small methodological study showed that the mean breastmilk intake based on saliva samples was significantly higher than that based on urine samples (854.5 g/day vs. 812.8 g/day, p=0.029).Conclusions: Stunted linear growth among boys is higher than among girls in Rwanda and this seems to be most strongly related to the nutritional quality of foods during the complementary feeding period. However, children in Rwanda are already born with a length deficit, which gradually deteriorates with the child’s age without any signs of catch-up growth during infancy. Late initiation of breastfeeding, high breastfeeding frequency, early introduction to complementary feeding, and the duration of diarrhoea and malaria illnesses are significant correlates of decelerated linear growth. However, none of the indicators of complementary feeding practices is significantly related to linear growth, anaemia, ID, and IDA. However, dietary iron intake is weakly associated with iron deficiency, but not with anaemia or iron deficiency anaemia. The duration of malaria infection significantly predicts anaemia, iron deficiency, and iron deficiency anaemia at 12 months of age.Considering these findings, prenatal interventions seem to be crucial to ensure that children are born with adequate body dimensions and iron reserves, which should give a strong foundation to sustain postnatal growth and iron status. Moreover, improving the quality of complementary foods is central to prevent any deterioration of their nutritional status from 6 months of age onwards. However, to make dietary interventions effective, infectious diseases must be controlled
Motivators of couple HIV counseling and testing (CHCT) uptake in a rural setting in Uganda
No full textAbstract Background Couple HIV Counseling and Testing (CHCT) is one of the key preventive strategies used to reduce the spread of HIV. In Uganda, HIV prevalence among married/living together is 7.2% among women and 7.6% among men. CHCT can help ease disclosure of HIV-positive status, which in turn may help increase opportunities to get social support and reduce new infections. The uptake of CHCT among attendees of health facilities in rural Uganda is as high as 34%. The purpose of this study was to explore the motivators of CHCT uptake in Mukono district, a rural setting in Uganda. Methods The study was conducted in two sub-counties in a rural district (Mukono district) about 28 km east of the capital Kampala, using a descriptive and explorative qualitative research design. Specifically, we conducted focus group discussions and key informant interviews with HIV focal persons, village health team (VHT) members, religious leaders and political leaders. We also interviewed persons in couple relationships. Data was analysed using NVivo 8 software. Ethical clearance was received from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. Results The study was conducted from June 2013 to July 2013 We conducted 4 focus group discussions, 10 key informant interviews and interviewed 53 persons in couple relationships. None of the participants were a couple. The women were 68% (36/53) and 49% (26/53) of them were above 29 years old. The motivators of CHCT uptake were; perceived benefit of HIV testing, sickness of a partner or child in the family and suspicion of infidelity. Other important motivators were men involvement in antenatal care (ANC) attendance and preparation for marriage. Conclusion The motivators for CHCT uptake included the perceived benefit of HIV testing, sickness of a partner or child, preparation for marriage, lack of trust among couples and men involvement in antenatal care. Greater attention to enhancers of CHCT programming is needed in trying to strengthen its uptake
The role of community health workers in COVID-19 home-based care: lessons learned from Rwanda
No full textInvestment in the health system is essential for effective pandemic response: Despite Rwanda’s rapid implementation of control measures to manage the COVID-19 pandemic, the country faced several challenges in the early stages, due to inadequate infrastructure and a shortage of trained staff. A home-based care approach alleviated the facility-based care burden during the pandemic: Implemented in September 2020, this key strategy engaged community health workers (CHWs) to provide health education and monitor patients with mild COVID-19 symptoms. The integration of medical doctors (MDs) into home-based care teams strengthened the COVID-19 response in Rwanda: Operation Save the Neighbour, launched in 2021, integrated MDs into home-based care teams. This improved the quality of care provided to COVID-19 patients, enhanced patient monitoring, and offered additional support to CHWs at household level. The provision of continuous support to CHWs contributed to overcoming challenges in implementing home-based care models: CHWs played a critical role in community mobilization and surveillance. However, they faced significant challenges, including fear, anxiety, and overwhelming workloads. To support these frontline workers, ongoing training and an adequate supply of resources, including personal protective equipment (PPE), are required
Dietary Iron Intake Does Not Predict Anemia, Iron Deficiency or Iron Deficiency Anemia Among 12-month Old Rwandan Children (P10-124-19)
No full textRecapitulating endochondral ossification: a promising route to in vivo bone regeneration
No full textDespite its natural healing potential, bone is unable to regenerate sufficient tissue within critical-sized defects, resulting in a non-union of bone ends. As a consequence, interventions are required to replace missing, damaged or diseased bone. Bone grafts have been widely employed for the repair of such critical-sized defects. However, the well-documented drawbacks associated with autografts, allografts and xenografts have motivated the development of alternative treatment options. Traditional tissue engineering strategies have typically attempted to direct in vitro bone-like matrix formation within scaffolds prior to implantation into bone defects, mimicking the embryological process of intramembranous ossification (IMO). Tissue-engineered constructs developed using this approach often fail once implanted, due to poor perfusion, leading to avascular necrosis and core degradation. As a result of such drawbacks, an alternative tissue engineering strategy, based on endochondral ossification (ECO), has begun to emerge, involving the use of in vitro tissue-engineered cartilage as a transient biomimetic template to facilitate bone formation within large defects. This is driven by the hypothesis that hypertrophic chondrocytes can secrete angiogenic and osteogenic factors, which play pivotal roles in both the vascularization of constructs in vivo and the deposition of a mineralized extracellular matrix, with resulting bone deposition. In this context, this review focuses on current strategies taken to recapitulate ECO, using a range of distinct cells, biomaterials and biochemical stimuli, in order to facilitate in vivo bone formation. Copyright (c) 2014 John Wiley & Sons, Ltd
Maternal factors promoting normal linear growth of children from impoverished Rwandan households: a cross-sectional study
No full textAbstract Background Linear growth faltering remains a pervasive public health concern that affects many children worldwide. This study aimed to investigate possible maternal factors promoting normal linear growth among children aged 6–23 months of age from impoverished Rwandan households. Methods We used a three-stage cluster sampling procedure. The study population consisted of children aged six to 23 months and their mothers who lived in the study districts. A structured questionnaire helped to collect data from 807 selected mother-child dyads. The primary outcome variable was height-for-age Z scores. The main predictors were maternal income-generating activity, maternal education, maternal depression, household decision making, number of ANC visits, use of family planning method, types of family planning, and mode of delivery. We used univariate analysis to establish median, frequencies, and percentages. Furthermore, we used the Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests for bivariate analysis. We included in the final model of robust linear regression for multivariate analysis the potential confounding variables identified as significantly associated with the outcome (child age, participation in works for both parents, good handwashing practice, owning a vegetable garden, and the total number of livestock) along with maternal factors. Results Maternal factors that promoted normal linear growth of children were the presence of maternal income generation activity (β= 0.640 [0.0269 1.253], p value = 0.041), the participation of the mother in the decision-making process of the household (β=0.147 [0.080 0.214], p-value < 0.001), and the higher frequency of consultations with ANC (β=0.189 [0.025 0.354], p-value = 0.024). Additionally, a combination of household decision-making with the number of ANC visits predicted an increase in the linear growth of the child (β=0.032 [0.019 0.045], p-value < 0.001). Conclusion Maternal factors such as maternal income-generating activity, maternal participation in household decision making, and increased number of ANC visits were found to promote normal child linear growth. These results contribute valuable information to the formulation of interventions and policies to improve child nutrition and growth in the community studied
Challenges and responses to infant and young child feeding in rural Rwanda: A qualitative study
No full textBackground: Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6-23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda. Methods: Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti. Results: Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women's heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges. Conclusion: Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.</p
Recapitulating endochondral ossification: a promising route to in vivo bone regeneration.
No full textDespite its natural healing potential, bone is unable to regenerate sufficient tissue within critical-sized defects, resulting in a non-union of bone ends. As a consequence, interventions are required to replace missing, damaged or diseased bone. Bone grafts have been widely employed for the repair of such critical-sized defects. However, the well-documented drawbacks associated with autografts, allografts and xenografts have motivated the development of alternative treatment options. Traditional tissue engineering strategies have typically attempted to direct in vitro bone-like matrix formation within scaffolds prior to implantation into bone defects, mimicking the embryological process of intramembranous ossification (IMO). Tissue-engineered constructs developed using this approach often fail once implanted, due to poor perfusion, leading to avascular necrosis and core degradation. As a result of such drawbacks, an alternative tissue engineering strategy, based on endochondral ossification (ECO), has begun to emerge, involving the use of in vitro tissue-engineered cartilage as a transient biomimetic template to facilitate bone formation within large defects. This is driven by the hypothesis that hypertrophic chondrocytes can secrete angiogenic and osteogenic factors, which play pivotal roles in both the vascularization of constructs in vivo and the deposition of a mineralized extracellular matrix, with resulting bone deposition. In this context, this review focuses on current strategies taken to recapitulate ECO, using a range of distinct cells, biomaterials and biochemical stimuli, in order to facilitate in vivo bone formation. Copyright © 2014 John Wiley & Sons, Ltd.</p
An evaluation of hemoglobin measurement tools and their accuracy and reliability when screening for child anemia in Rwanda: A randomized study
No full textAn evaluation of hemoglobin measurement tools and their accuracy and reliability when screening for child anemia in Rwanda: A randomized study.
No full textBlood hemoglobin (Hb) is a common indicator for diagnosing anemia and is often determined through laboratory analysis of venous samples. One alternative to laboratory-based methods is the handheld HemoCue® Hb 201+ device, which requires a finger prick and wicking of blood into a pretreated cuvette for analysis. An alternative HemoCue® gravity method is being investigated for improved accuracy. Further, recent developments in noninvasive technologies could provide an accurate, rapid, safe, point-of-care option for hemoglobin estimation while addressing some limitations of current tools, but device performance must be assessed in low-resource settings. This study evaluated the performance of two HemoCue® Hb 201+ blood sampling methods and a noninvasive device (Pronto® with DCI-mini™ sensors) in a Rwandan pediatric clinic. Reference hemoglobin values were determined in 132 children 6 to 59 months of age by using a standard hematology analyzer (Sysmex KN21TM). Half were tested using the HemoCue® wicking method; half were tested using the HemoCue® gravity method; and 112 had successful hemoglobin readings with Pronto® DCI-mini™. Statistical analysis was used to assess the level of bias generated by each method and the key drivers of bias. The HemoCue® gravity method was the least biased. The HemoCue® wicking and Pronto® methods biases were inversely related to the Sysmex KN21TM results. Both HemoCue® sampling methods correctly classified patients' anemic status in 80% or more of instances, whereas the Pronto® device had a correct classification rate of only 69%. The HemoCue® gravity method was more accurate than the traditional HemoCue® wicking method in this study, but its accuracy and operational feasibility should be confirmed by future studies. The Pronto® DCI-mini™ devices showed considerable promise but require further improvements in sensitivity and specificity before wider adoption
