A5090241078- Child Nutrition and Water Access
- Global Maternal and Child Health
- Poverty, Education, and Child Welfare
- Child Nutrition and Feeding Issues
- Infant Nutrition and Health
- Viral gastroenteritis research and epidemiology
- Breastfeeding Practices and Influences
- Food Security and Health in Diverse Populations
- HIV/AIDS Research and Interventions
- Hepatitis Viruses Studies and Epidemiology
- Clinical Nutrition and Gastroenterology
- Child and Adolescent Health
- Gut microbiota and health
- Pediatric health and respiratory diseases
- Vaccine Coverage and Hesitancy
- Congenital Anomalies and Fetal Surgery
- COVID-19 Impact on Reproduction
- Immune responses and vaccinations
- HIV-related health complications and treatments
- Clostridium difficile and Clostridium perfringens research
- Respiratory viral infections research
- Global Health and Epidemiology
- Child and Adolescent Psychosocial and Emotional Development
- Infant Development and Preterm Care
- Maternal Mental Health During Pregnancy and Postpartum
Zvitambo Institute for Maternal and Child Health Research
2010-2024
Johns Hopkins University
2019
Shine Micro (United States)
2019
University of British Columbia
2019
Cornell University
2013-2019
Queen Mary University of London
2019
Middlebury College
2019
University of Michigan
2019
University of Maryland, Baltimore
2008
BackgroundChild stunting reduces survival and impairs neurodevelopment. We tested the independent combined effects of improved water, sanitation, hygiene (WASH), infant young child feeding (IYCF) on anaemia in Zimbabwe.MethodsWe did a cluster-randomised, community-based, 2 × factorial trial two rural districts Zimbabwe. Clusters were defined as catchment area between one four village health workers employed by Zimbabwe Ministry Health Child Care. Women eligible for inclusion if they...
We conducted direct observation of 23 caregiver-infant pairs for 130 hours and recorded wash-related behaviors to identify pathways fecal-oral transmission bacteria among infants. In addition testing fingers, food, drinking water infants, three infants actively ingested 11.3 ± 9.2 (mean SD) handfuls soil two chicken feces 2 1.4 times in 6 hours. Hand washing with soap was not common contaminated Escherichia coli half (12 22) the households. A one-year-old infant ingesting 1 gram a day 20...
Stunting affects one-in-five children globally and is associated with greater infectious morbidity, mortality neurodevelopmental deficits. Recent evidence suggests that the early-life gut microbiome child growth through immune, metabolic endocrine pathways. Using whole metagenomic sequencing, we map assembly of in 335 from rural Zimbabwe 1-18 months age who were enrolled Sanitation, Hygiene, Infant Nutrition Efficacy Trial (SHINE; NCT01824940), a randomized trial improved water, sanitation...
Abstract Background We assessed the impact of water, sanitation, and hygiene (WASH) infant young child feeding (IYCF) interventions on enteric infections in Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial rural Zimbabwe. Methods tested stool samples collected at 1, 3, 6, 12 months age during diarrhea using quantitative molecular diagnostics for 29 pathogens. estimated effects WASH, IYCF, combined WASH + IYCF individual enteropathogen prevalence quantity, total numbers pathogens...
Severe acute malnutrition (SAM) is the most high-risk form of undernutrition, particularly when children require hospitalization for complications. Complicated SAM a multisystem disease with high inpatient and postdischarge mortality, especially in comorbidities such as HIV; however, underlying pathogenesis complicated poorly understood. Targeted multiplex biomarker analysis hospitalized ( n = 264) was conducted on plasma samples, inflammatory markers were assessed stool samples taken at...
BackgroundChildren exposed to HIV have a high prevalence of stunting and anaemia. We aimed test the effect improved infant young child feeding (IYCF) water, sanitation, hygiene (WASH) on linear growth haemoglobin concentrations.MethodsWe did cluster randomised 2 × factorial trial in two districts rural Zimbabwe. Women were eligible for inclusion if they permanently lived clusters (ie, catchment area between one four village health workers employed by Zimbabwean Ministry Health Child Care)...
Environmental enteric dysfunction (EED) is a virtually ubiquitous, but poorly defined, disorder of the small intestine among people living in conditions poverty, which begins early infancy and persists. EED characterized by altered gut structure function, leading to reduced absorptive surface area impaired intestinal barrier function. It hypothesized that recurrent exposure fecal pathogens changes composition microbiota initiate this process, leads self-perpetuating cycle pathology. We view...
BackgroundPreterm birth and low weight (LBW) affect one in ten seven livebirths, respectively, primarily low-income middle-income countries (LMIC) are major predictors of poor child health outcomes. However, both have been recalcitrant to public intervention. The maternal intestinal microbiome may undergo substantial changes during pregnancy influence fetal neonatal LMIC populations.MethodsWithin a subgroup 207 mothers infants enrolled the SHINE trial rural Zimbabwe, we performed shotgun...
Globally, nearly 250 million children (43% of all under 5 years age) are at risk compromised neurodevelopment due to poverty, stunting, and lack stimulation. We tested the independent combined effects improved water, sanitation, hygiene (WASH) infant young child feeding (IYCF) on early development (ECD) among enrolled in Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial rural Zimbabwe.SHINE was a cluster-randomized community-based 2×2 factorial trial. A total 5,280 pregnant women...
Water, sanitation, and hygiene (WaSH) are foundational public health interventions for infectious disease control. Renewed efforts to end open defecation provide universal access safe drinking water, by 2030 being enacted through the Sustainable Development Goals. However, results from clinical trials1Luby SP Rahman M Arnold BF et al.Effects of water quality, handwashing, nutritional on diarrhoea child growth in rural Bangladesh: a cluster randomised controlled trial.Lancet Glob Health....
Abstract Introduction Exposure to maternal HIV may affect early child development (ECD), although previous studies have reported heterogeneous findings. We evaluated ECD among children who were HIV‐exposed uninfected (CHEU) and HIV‐unexposed (CHU) recruited the SHINE trial in rural Zimbabwe. Methods was a community‐based cluster‐randomized of improved infant feeding and/or water, sanitation hygiene. Pregnant women enrolled between 2012 2015. assessed sub‐study at 24 months age, 2016 2017,...
Malnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital admission (baseline factors) independently associated inpatient mortality this cohort those most at risk.Observational study 745 aged 0-59 months admitted SAM three hospitals Zimbabwe/Zambia. underwent anthropometry and clinical assessment by a physician within 72 h...
Abstract Children who are HIV-exposed but uninfected have increased infectious mortality compared to HIV-unexposed children, raising the possibility of immune abnormalities following exposure maternal viraemia, dysfunction, and co-infections during pregnancy. In a secondary analysis SHINE trial in rural Zimbabwe we explored biological pathways underlying infant mortality, factors shaping development infants. Maternal inflammation cytomegalovirus viraemia were independently associated with...
Abstract Background Clinical outcomes of children who are human immunodeficiency virus (HIV)–exposed in sub-Saharan Africa remain uncertain. Methods The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial evaluated improved infant and young child feeding (IYCF) and/or water, sanitation, hygiene 2 rural Zimbabwean districts with 15% antenatal HIV prevalence > 80% prevention mother-to-child transmission (PMTCT) coverage. Children born between February 2013 December 2015 had...
Background Environmental enteric dysfunction (EED) may be an important modifiable cause of child stunting. We described the evolution EED biomarkers from birth to 18 months in rural Zimbabwe and tested independent combined effects improved water, sanitation, hygiene (WASH), infant young feeding (IYCF), on EED. Methodology findings The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial was a 2x2 factorial cluster-randomised IYCF WASH stunting anaemia at age. 1169 infants born...
Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk mortality, especially HIV-positive children. Few studies examined mortality in the antiretroviral therapy (ART) era. Our objectives were to ascertain 52-wk children for SAM, and identify independent predictors mortality. A prospective cohort study was conducted enrolled 3 hospitals Zambia Zimbabwe between July 2016 March 2018. The primary outcome at 52 wk. Univariable...
Introduction HIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact improved infant and young child feeding (IYCF) water, sanitation hygiene (WASH) on early development (ECD) outcomes. Methods Sanitation Hygiene Infant Nutrition Efficacy was a cluster randomised 2×2 factorial trial in rural Zimbabwe ClinicalTrials.gov NCT01824940 ). Pregnant women were eligible if they lived study clusters allocated standard-of-care (SOC; 52 clusters); IYCF (20 g...
Oral rotavirus vaccine (RVV) immunogenicity is considerably lower in low- versus high-income populations; however, the mechanisms underlying this remain unclear. Previous evidence suggests that gut microbiota may contribute to differences oral efficacy.
Background Children who are stunted (length-for-age Z-score<-2) at greater risk of infectious morbidity and mortality. Previous studies suggest that children have elevated inflammatory biomarkers, but no characterised their capacity to respond new infections (i.e., immune function). We hypothesised antibacterial function would differ between non-stunted relate health environment during early life. Methods enrolled a cross-sectional cohort 113 HIV-negative nested within longitudinal...
Mortality among children hospitalised for complicated severe acute malnutrition (SAM) remains high despite the implementation of WHO guidelines, particularly in settings HIV prevalence. Children continue to be at risk morbidity, mortality and relapse after discharge from hospital although long-term outcomes are not well documented. Better understanding pathogenesis SAM factors associated with poor may inform new therapeutic interventions.The Health Outcomes, Pathogenesis Epidemiology Severe...
Child stunting remains a poorly understood, prevalent public health problem. Environmental enteric dysfunction (EED) is hypothesized to be an important underlying cause. Within subgroup of 1169 children enrolled in the SHINE (Sanitation Hygiene Infant Nutrition Efficacy) trial rural Zimbabwe, followed longitudinally from birth 18 mo age, we evaluated associations between concentration 11 EED biomarkers and linear growth velocity. At infant ages 1, 3, 6, 12, mo, nurses measured child length...
Abstract Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns factors associated with readmission, nutritional morbidity, in children discharged from SAM Zambia Zimbabwe over 52‐weeks posthospitalization. Multivariable Fine‐Gray subdistribution hazard models, death loss follow‐up as competing risks, were used identify readmission; negative binomial regression assess...
The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is designed to measure the independent and combined effects of improved water, sanitation, hygiene infant feeding on child stunting anemia in Zimbabwe. We developed pilot-tested intervention delivered by 9 village health workers 19 mothers infants aged 7–12 months. Between September 2010 January 2011, maternal knowledge was assessed using mixed methods, nutrient intakes were 24-hour recall. observed positive shifts mothers'...
Abstract Background Oral vaccines have lower efficacy in developing compared to developed countries. Poor water, sanitation, and hygiene (WASH) may contribute reduced oral vaccine immunogenicity. Methods We conducted a cluster-randomized 2 × factorial trial rural Zimbabwe. Pregnant women their infants were eligible if they lived clusters randomized (1) standard of care (52 clusters); (2) improved infant feeding (53 (3) WASH: ventilated pit latrine, hand-washing stations, liquid soap,...