Child mortality in relation to HIV infection, nutritional status, and socio-economic background.

Background: The aims of this study were to examine the impact of child HIV infection on mortality and to identify nutritional and sociodemographic factors that increase the risk of child mortality independent of human immunodeficiency virus (HIV) infection.

Methods: We conducted a prospective study in Dar es Salaam, Tanzania, among 687 children 6-60 months of age who were admitted to hospital with pneumonia. After discharge, children were followed up every 2 weeks during the first year and every 4 months thereafter.

Human immunodeficiency virus infection, diarrheal disease and sociodemographic predictors of child growth.

Aim: To compare growth patterns between human immunodeficiency virus (HIV)-infected and -uninfected preschool children. To examine the associations between diarrheal and respiratory infections, sociodemographic factors and growth.

Methods: A longitudinal study was conducted among 524 children who were 6-60 mo of age at recruitment.

Malaria parasitaemia in relation to HIV status and vitamin A supplementation among pre-school children.

Objectives: To ascertain whether malaria parasitaemia in children is associated with HIV status. To examine the effect of vitamin A supplementation on malaria parasitaemia in children.

Methods: We studied the cross-sectional associations between HIV status and malaria parasitaemia among 546 children 6-60 months of age who participated in a double-blind, randomized clinical trial of vitamin A supplementation.

Verbal autopsy in establishing cause of perinatal death.

Introduction: Perinatal mortality is a sensitive indicator of health status of a community and is also highly amenable to intervention. The causes of perinatal deaths in developing countries are often difficult to establish. Verbal autopsy has been used in several countries for children and adults, but seldom for perinatal cause.

Vitamin A supplements ameliorate the adverse effect of HIV-1, malaria, and diarrheal infections on child growth.

Objective: Evidence from animal experiments and observational studies in humans suggests that vitamin A plays a fundamental role in physical growth. However, results from vitamin A supplementation trials in children are inconsistent; whereas some did not find an overall effect on growth, others found benefits only among specific groups, including children with low concentrations of serum retinol or short duration of breastfeeding. The apparent lack of an overall effect of vitamin A on growth could be attributed to context-specific distribution of conditions that affect both growth and the response to supplementation, eg, baseline vitamin A status, deficiency of other nutrients (fat, zinc), and the presence of infectious diseases.

Vitamin A supplementation and other predictors of anemia among children from Dar Es Salaam, Tanzania.

The associations of hemoglobin, hematocrit, and packed cell volume with socioeconomic factors, malaria, human immunodeficiency virus (HIV) infection, and nutritional status were examined among 687 children admitted to hospital with pneumonia participating in a double blind, placebo-controlled trial of vitamin A supplementation. Children were randomized to receive 2 doses of vitamin A (200,000 IU) or placebo at baseline, and additional doses at 4 and 8 months after discharge from hospital. Hemoglobin levels were measured at enrollment and, on a subset of 161 children, during follow-up.

Vitamin A supplements and diarrheal and respiratory tract infections among children in Dar es Salaam, Tanzania.

Objective: To determine the effect of vitamin A supplementation on the risk of diarrhea and of acute respiratory infection.

Design: Double-blind, randomized, placebo-controlled trial.

Setting: Dar-es-Salaam, Tanzania.

Prevalence of HIV type 1 infection, associated clinical features and mortality among hospitalized children in Dar es Salaam, Tanzania.

The aim of this study was to determine the prevalence of HIV-1 infection, the clinical spectrum of HIV-1-associated conditions and HIV-1-associated mortality among children hospitalized in the medical paediatric wards at Muhimbili Medical Centre (MMC), Dar es Salaam, Tanzania. All children admitted to the medical paediatric wards of MMC between August 1995 and January 1996 were eligible for the study. Testing for HIV antibodies was done using 2 consecutive enzyme linked immunosorbent assays (ELISAs).

Detection of congenital malaria by polymerase-chain-reaction methodology in Dar es Salaam, Tanzania.

The examination of congenital malaria was performed by Giemsa staining and polymerase-chain-reaction (PCR) methodology. We randomly selected 298 neonates who had been admitted to Muhimbili Medical Center (MMC) at Dar es Salaam, Tanzania. One baby among all the enrolled neonates was recognized as having a congenital malaria infection, which gave a prevalence of 0.

A high prevalence of metabolic bone disease in exclusively breastfed very low birthweight infants in Dar-es-Salaam, Tanzania.

Metabolic bone disease (MBD), or rickets, is common in very low birthweight infants. A descriptive, cross-sectional, hospital-based study was carried out at Muhimbili Medical Centre, Dar-es-Salaam from 15 April to 30 June, 1995 to discover the magnitude, contributory factors, morbidity and suitable biochemical diagnostic tests for MBD. One hundred infants with a postnatal age of 6-12 weeks, whose birthweights were 1500 g or less were studied.

A randomized trial of vitamin A supplements in relation to mortality among human immunodeficiency virus-infected and uninfected children in Tanzania.

Objectives: To determine whether vitamin A supplements result in reduced mortality among HIV-infected and uninfected children.

Design: Randomized, double blind, placebo-controlled trial.

Methods: Starting in April, 1993, we randomized 687 children age 6 months to 5 years who were admitted to the hospital with pneumonia.

Vitamin A supplementation and severity of pneumonia in children admitted to the hospital in Dar es Salaam, Tanzania.

Vitamin A deficiency and acute lower respiratory tract infections coexist as important public health problems in many developing countries. We carried out a randomized, double-blind, placebo-controlled trial to examine whether large doses of vitamin A given to Tanzanian children who are admitted to the hospital with nonmeasles pneumonia would reduce the severity of respiratory disease. Six hundred eighty-seven children were randomly assigned to receive either placebo or vitamin A [200 000 IU (60 mg retinol equivalents) for children > 1 y of age and 100000 IU (30 mg retinol equivalents) for infants] on the day of admission and another dose on the following day.

Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania.

Background: In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women.

Methods: In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 2x2 factorial design.

Intestinal parasites and HIV infection in Tanzanian children with chronic diarrhea.

Objective: To determine whether specific intestinal parasites are associated with HIV infection in Tanzanian children with chronic diarrhea.

Design: A prospective, cross-sectional study.

Setting: Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.

Nosocomial bacterial infections among children with severe protein energy malnutrition.

The incidence of hospital acquired acute bacterial infections among 164 severely malnourished children admitted to the paediatric wards at the Muhimbili Medical Centre in Dar es Salaam were studied. On admission, ninety two per cent of the patients had at least one form of bacterial infection. During the subsequent two weeks hospital stay, 49% of the patients acquired a new infection.

Neonatal tetanus despite protective serum antitoxin concentration.

Using the ELISA technique to estimate serum antibodies against tetanus toxin, seven neonates with clinical tetanus were found to have antibody levels 4-13 times higher than the presumed minimum protective level of 0.01 IU/ml. All but one of their mothers had been vaccinated with tetanus toxoid in pregnancy.

Prevalence of HIV infection in healthy subjects and groups of patients in Tanzania.

During 1986 sera from 2508 individuals representing various groups of healthy subjects and patients in Dar es Salaam (the capital city of Tanzania), Bukoba (the capital of Kagera region in the northwest corner of Tanzania), Arusha (in the northeast of Tanzania) and Mbeya (in the southwest of Tanzania) were screened for antibodies to HIV by enzyme-linked immunosorbent assay (ELISA). All ELISA-positive sera were also tested by Western blot analysis. In Dar es Salaam HIV antibodies were demonstrated in 3.

Tetanus neonatorum--experience with intrathecal serotherapy at Muhimbili Medical Centre, Dar es Salaam, Tanzania.

In an attempt to lower the mortality rate of neonatal tetanus a study was undertaken to determine whether intrathecal serotherapy influences mortality from this disease. Sixty-six babies with tetanus neonatorum were studied. The mortality rate among babies who received intrathecal anti-tetanus serum (ATS) was 45% compared with 82% in the control group given intramuscular ATS (P congruent to 0.

Peripheral lymphadenopathy in children in Dar es Salaam, Tanzania. A study from biopsy material.

Children are commonly brought to the primary physician because of palpable peripheral lymph nodes. In order to determine the common causes 257 excisional peripheral lymph node biopsies of children between four days and 15 years of age were analysed. The diagnoses made were: tuberculous lymphadenitis (67.

Intrauterine growth of live-born Tanzanian infants.

The incidence of low birthweight infants, the effect of intrauterine growth retardation on anthropometric measurements, and local standards of intrauterine growth curves for weight, crown-heel length and head circumference together with curves of body measurement ratios of weight/length, weight/head circumference and weight/length x head circumference are presented for the population of Dar es Salaam (Tanzania). Acomparison is made with a standard composed for a Caucasian community with completely different socio-economic and nutritional status. From 28 to 34 weeks of gestation weight gain in Dar es Salaam foetuses was reduced, while length and head circumference were relatively less affected.

Factors associated with low birth weight in the population of Dar es Slaaam, Tanzania.

Factors associated with low birthweight in Dar es Salaam have been evaluated. The incidence of low birthweight is higher among female infants and infants belonging to parents of a low socioeconomic status. Primiparity, short stature of the mother, a multiple pregnancy, "toxaemia" of pregnancy are some of the factors influencing the growth velocity of the foetus leading to an increased indidence of small-for-dates infants.