Browsing by Author "Bose CL"

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A color-coded tape for uterine height measurement: a tool to identify preterm pregnancies in low resource settings.
(2015) Althabe F; Berrueta M; Hemingway-Foday J; Mazzoni A; Bonorino CA; Gowdak A; Gibbons L; Bellad MB; Metgud MC; Goudar S; Kodkany BS; Derman RJ; Saleem S; Iqbal S; Ala SH; Goldenberg RL; Chomba E; Manasyan A; Chiwila M; Imenda E; Mbewe F; Tshefu A; Lokomba V; Bose CL; Moore J; Meleth S; McClure EM; Koso-Thomas M; Buekens P; Belizán JM; Department of Community Health Sciences, Aga Khan University, Karachi Pakistan.; Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.; Eunice Kennedy Shriver NICHD, Bethesda, Maryland, United States of America.; Department of Obstetrics and Gynecology, Columbia University, New York, New York, United States of America.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of North Carolina, Chapel Hill, North Carolina, United States of America.; University of North Carolina, Chapel Hill, North Carolina, United States of America.; RTI International; Durham, North Carolina, United States of America.; Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.; School of Public Health and Tropical Medicine, Tulane University, Louisiana, United States of America.; KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.; Department of Obstetrics, Sindh Government Qatar Hospital, Karachi Pakistan.; Christiana Care, Newark, Delaware, United States of America.; University Teaching Hospital, Lusaka, Zambia.; Department of Obstetrics, Sobhraj Maternity Hospital, Karachi, Pakistan.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Neonatal mortality associated with preterm birth can be reduced with antenatal corticosteroids (ACS), yet <10% of eligible pregnant women in low-middle income countries. The inability to accurately determine gestational age (GA) leads to under-identification of high-risk women who could receive ACS or other interventions. To facilitate better identification in low-resource settings, we developed a color-coded tape for uterine height (UH) measurement and estimated its accuracy identifying preterm pregnancies. METHODS: We designed a series of colored-coded tapes with segments corresponding to UH measurements for 20-23.6 weeks, 24.0-35.6 weeks, and >36.0 weeks GA. In phase 1, UH measurements were collected prospectively in the Democratic Republic of Congo, India and Pakistan, using distinct tapes to address variation across regions and ethnicities. In phase 2, we tested accuracy in 250 pregnant women with known GA from early ultrasound enrolled at prenatal clinics in Argentina, India, Pakistan and Zambia. Providers masked to the ultrasound GA measured UH. Receiver operating characteristics (ROC) analysis was conducted. RESULTS: 1,029 pregnant women were enrolled. In all countries the tapes were most effective identifying pregnancies between 20.0-35.6 weeks, compared to the other GAs. The ROC areas under the curves and 95% confidence intervals were: Argentina 0.69 (0.63, 0.74); Zambia 0.72 (0.66, 0.78), India 0.84 (0.80, 0.89), and Pakistan 0.83 (0.78, 0.87). The sensitivity and specificity (and 95% confidence intervals) for identifying pregnancies between 20.0-35.6 weeks, respectively, were: Argentina 87% (82%-92%) and 51% (42%-61%); Zambia 91% (86%-95%) and 50% (40%-60%); India 78% (71%-85%) and 89% (83%-94%); Pakistan 63% (55%-70%) and 94% (89%-99%). CONCLUSIONS: We observed moderate-good accuracy identifying pregnancies ≤ 35.6 weeks gestation, with potential usefulness at the community level in low-middle income countries to facilitate the preterm identification and interventions to reduce preterm neonatal mortality. Further research is needed to validate these findings on a population basis.
Diagnostic accuracy of ASQ for screening of neurodevelopmental delays in low resource countries.
(2023-May-23) Manasyan A; Salas AA; Nolen T; Chomba E; Mazariegos M; Tshefu Kitoto A; Saleem S; Naqvi F; Hambidge KM; Goco N; McClure EM; Wallander JL; Biasini FJ; Goldenberg RL; Bose CL; Koso-Thomas M; Krebs NF; Carlo WA; University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.; Aga Khan University, Karachi, Pakistan.; Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.; Research Triangle Institute, Durham, North Carolina, USA.; The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.; Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA AlbertManasyan@uabmc.edu.; Department of Obstetrics and Gynecology, Columbia University, New York, New York, UK.; University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the).; Psychological Sciences and Health Sciences Research Institute, University of California Merced, Merced, California, USA.; University of Colorado Denver, Denver, Colorado, USA.; University of Zambia, Lusaka, Zambia.; Department of Reproductive, Maternal, Newborn, and Child Health, Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Institute of Nutrition for Central America and Panamá (INCAP), Guatemala City, Panama.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
OBJECTIVE: The Bayley Scales of Infant Development (BSID) is the most used diagnostic tool to identify neurodevelopmental disorders in children under age 3 but is challenging to use in low-resource countries. The Ages and Stages Questionnaire (ASQ) is an easy-to-use, low-cost clinical tool completed by parents/caregivers that screens children for developmental delay. The objective was to determine the performance of ASQ as a screening tool for neurodevelopmental impairment when compared with BSID second edition (BSID-II) for the diagnosis of moderate-to-severe neurodevelopmental impairment among infants at 12 and 18 months of age in low-resource countries. METHODS: Study participants were recruited as part of the First Bites Complementary Feeding trial from the Democratic Republic of Congo, Zambia, Guatemala and Pakistan between October 2008 and January 2011. Study participants underwent neurodevelopmental assessment by trained personnel using the ASQ and BSID-II at 12 and 18 months of age. RESULTS: Data on both ASQ and BSID-II assessments of 1034 infants were analysed. Four of five ASQ domains had specificities greater than 90% for severe neurodevelopmental delay at 18 months of age. Sensitivities ranged from 23% to 62%. The correlations between ASQ communications subscale and BSID-II Mental Development Index (MDI) (r=0.38) and between ASQ gross motor subscale and BSID-II Psychomotor Development Index (PDI) (r=0.33) were the strongest correlations found. CONCLUSION: At 18 months, ASQ had high specificity but moderate-to-low sensitivity for BSID-II MDI and/or PDI <70. ASQ, when administered by trained healthcare workers, may be a useful screening tool to detect severe disability in infants from rural low-income to middle-income settings. TRIAL REGISTRATION NUMBER: NCT01084109.
Junk food use and neurodevelopmental and growth outcomes in infants in low-resource settings.
(2024) Chiwila MK; Krebs NF; Manasyan A; Chomba E; Mwenechanya M; Mazariegos M; Sami N; Pasha O; Tshefu A; Lokangaka A; Goldenberg RL; Bose CL; Koso-Thomas M; Goco N; Do BT; McClure EM; Hambidge KM; Westcott JE; Carlo WA; School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.; University of Colorado School of Medicine, Aurora, CO, United States.; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States.; Department of Obstetrics and Gynecology, Columbia University, New York, NY, United States.; Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States.; Eunice Kennedy Shiver National Institute of Child Health and Human Development, Bethesda, MD, United States.; Global Network, University Teaching Hospital, Lusaka, Zambia.; Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.; Instituto de Nutrición de Centro América y Panamá, Guatemala City, Guatemala.; Research Triangle Institute International, Durham, NC, United States.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings. METHODS: This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants' complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months. RESULTS: 1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes. CONCLUSION: The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period.
The Global Network Neonatal Cause of Death algorithm for low-resource settings.
(2017-Jun) Garces AL; McClure EM; Pérez W; Hambidge KM; Krebs NF; Figueroa L; Bose CL; Carlo WA; Tenge C; Esamai F; Goudar SS; Saleem S; Patel AB; Chiwila M; Chomba E; Tshefu A; Derman RJ; Hibberd PL; Bucher S; Liechty EA; Bauserman M; Moore JL; Koso-Thomas M; Miodovnik M; Goldenberg RL; RTI International, Durham, NC, USA.; University of Alabama at Birmingham, Birmingham, AL, USA.; Aga Khan University, Karachi, Pakistan.; Indiana University, Indianapolis, IN, USA.; Moi University School of Medicine, Eldoret, Kenya.; Columbia University Medical Center, New York, NY, USA.; Kinshasa School of Public Health, Kinshasa, DRC.; University of Colorado, Denver, CO, USA.; Lata Medical Research Foundation, Nagpur, India.; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; INCAP, Guatemala City, Guatemala.; CIDRZ, Lusaka, Zambia.; KLE University's JN Medical College, Belgaum, India.; Thomas Jefferson University, Philadelphia, PA, USA.; University of Zambia, Lusaka, Zambia.; NICHD, Bethesda, MD, USA.; Boston University, Boston, MA, USA.
AIM: This study estimated the causes of neonatal death using an algorithm for low-resource areas, where 98% of the world's neonatal deaths occur. METHODS: We enrolled women in India, Pakistan, Guatemala, the Democratic Republic of Congo, Kenya and Zambia from 2014 to 2016 and tracked their delivery and newborn outcomes for up to 28 days. Antenatal care and delivery symptoms were collected using a structured questionnaire, clinical observation and/or a physical examination. The Global Network Cause of Death algorithm was used to assign the cause of neonatal death, analysed by country and day of death. RESULTS: One-third (33.1%) of the 3068 neonatal deaths were due to suspected infection, 30.8% to prematurity, 21.2% to asphyxia, 9.5% to congenital anomalies and 5.4% did not have a cause of death assigned. Prematurity and asphyxia-related deaths were more common on the first day of life (46.7% and 52.9%, respectively), while most deaths due to infection occurred after the first day of life (86.9%). The distribution of causes was similar to global data reported by other major studies. CONCLUSION: The Global Network algorithm provided a reliable cause of neonatal death in low-resource settings and can be used to inform public health strategies to reduce mortality.
Theory-driven process evaluation of a complementary feeding trial in four countries.
(2014-Apr) Newman JE; Garces A; Mazariegos M; Michael Hambidge K; Manasyan A; Tshefu A; Lokangaka A; Sami N; Carlo WA; Bose CL; Pasha O; Goco N; Chomba E; Goldenberg RL; Wright LL; Koso-Thomas M; Krebs NF; Statistics and Epidemiology, RTI International, Research Triangle Park, NC 27709, USA, Multidisciplinary Health Institute, Francisco Marroquin University, Guatemala City 01011, Guatemala, Institute for Nutrition of Central America and Panama, Guatemala City 01011, Guatemala, Department of Pediatrics, Section of Nutrition, University of Colorado Denver, Aurora, CO 80045, USA, Centre for Infectious Disease Research in Zambia, Lusaka 34681, Zambia, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo, Department of Community Health Science and Family Medicine, Aga Khan University Medical College, Karachi 74800, Pakistan, Department of Pediatrics/Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL 35233, USA, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA, University Teaching Hospital, Lusaka 34681, Zambia, Obstetrics and Gynecology, Columbia University, New York, NY 10027, USA and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
We conducted a theory-driven process evaluation of a cluster randomized controlled trial comparing two types of complementary feeding (meat versus fortified cereal) on infant growth in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo. We examined process evaluation indicators for the entire study cohort (N = 1236) using chi-square tests to examine differences between treatment groups. We administered exit interviews to 219 caregivers and 45 intervention staff to explore why caregivers may or may not have performed suggested infant feeding behaviors. Multivariate regression analysis was used to determine the relationship between caregiver scores and infant linear growth velocity. As message recall increased, irrespective of treatment group, linear growth velocity increased when controlling for other factors (P < 0.05), emphasizing the importance of study messages. Our detailed process evaluation revealed few differences between treatment groups, giving us confidence that the main trial's lack of effect to reverse the progression of stunting cannot be explained by differences between groups or inconsistencies in protocol implementation. These findings add to an emerging body of literature suggesting limited impact on stunting of interventions initiated during the period of complementary feeding in impoverished environments. The early onset and steady progression support the provision of earlier and comprehensive interventions.