Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial.

Importance: Micronutrient deficiencies occur early in human immunodeficiency virus (HIV) infection, and supplementation with micronutrients may be beneficial; however, its effectiveness has not been investigated early in HIV disease among adults who are antiretroviral therapy (ART) naive.

Objective: To investigate whether long-term micronutrient supplementation is effective and safe in delaying disease progression when implemented early in adults infected with HIV subtype C who are ART-naive.

Design, Setting, And Participants: Randomized clinical trial of supplementation with either daily multivitamins (B vitamins and vitamins C and E), selenium alone, or multivitamins with selenium vs placebo in a factorial design for 24 months.

Vitamin D status and TB treatment outcomes in adult patients in Tanzania: a cohort study.

Objectives: Vitamin D is an immunomodulator and can alter response to tuberculosis (TB) treatment, though randomised trials have been inconclusive to date. We present one of the first comprehensive analysis of the associations between vitamin D status and TB treatment, T-cell counts and nutritional outcomes by HIV status.

Design: Cohort study.

Effect of zinc supplementation on duration of hospitalization in Tanzanian children presenting with acute pneumonia.

Background: Zinc supplementation prevents incident pneumonia in children; however, the effect for pneumonia treatment remains unclear.

Methods: A randomized, double-blind, placebo-controlled trial of zinc supplements (daily 25 mg) adjunct to antibiotic treatment of radiology-confirmed acute pneumonia was conducted among hospitalized children (6-36 months) in Dar es Salaam, Tanzania.

Results: The trial was stopped early due to low enrollment, primarily owing to exclusion of children outside the age range and >3 days of prior illness.

The contribution of preterm birth and intrauterine growth restriction to infant mortality in Tanzania.

Background: Our objectives were to examine the associations of neonatal and infant mortality with preterm birth and intrauterine growth restriction (IUGR), and to estimate the partial population attributable risk per cent (pPAR%) of neonatal and infant mortality due to preterm birth and IUGR.

Methods: Participants were HIV-negative pregnant women and their infants enrolled in Dar es Salaam, Tanzania. Gestational age calculated from date of last menstrual period was used to define preterm, and small for gestational age (SGA) was used as proxy for IUGR.

Nutritional Status and Other Baseline Predictors of Mortality among HIV-Infected Children Initiating Antiretroviral Therapy in Tanzania.

Background: We assembled a prospective cohort of 3144 children less than 15 years of age initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania.

Methods: The relationships of nutritional status and other baseline characteristics in relation to mortality were examined using Cox proportional hazards model.

Results: Compared with children with weight for age (WAZ) > -1, those with WAZ ≤ -2 to < -3 had a nearly double risk of death (relative risk [RR], 1.

Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania.

Introduction: Anaemia is prevalent among children born to HIV-positive women, and it is associated with adverse effects on cognitive and motor development, growth, and increased risks of morbidity and mortality.

Objective: To examine the effect of daily multivitamin supplementation on haematologic status and mother-to-child transmission (MTCT) of HIV through breastfeeding.

Methods: A total of 2387 infants born to HIV-positive women from Dar es Salaam, Tanzania were enrolled in a randomized, double-blind, placebo-controlled trial, and provided a daily oral supplement of multivitamins (vitamin B complex, C and E) or placebo at age 6 weeks for 24 months.

Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries.

Background: Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain.

Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis.

Objectives: To summarise evidence on the associations of maternal anaemia and prenatal iron use with maternal haematological and adverse pregnancy outcomes; and to evaluate potential exposure-response relations of dose of iron, duration of use, and haemoglobin concentration in prenatal period with pregnancy outcomes.

Design: Systematic review and meta-analysis

Data Sources: Searches of PubMed and Embase for studies published up to May 2012 and references of review articles.

Study Selection Criteria: Randomised trials of prenatal iron use and prospective cohort studies of prenatal anaemia; cross sectional and case-control studies were excluded.

Maternal iron and folic acid supplementation is associated with lower risk of low birth weight in India.

Improving maternal nutrition is an important step toward reducing low birth weight (LBW) and its sequelae. In India, an estimated 7.5 million babies are born each year with LBW, which accounts for more than one-third of the global burden.

Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies.

Background: Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.

Methods: Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America.

Effect of multivitamin supplementation on measles vaccine response among HIV-exposed uninfected Tanzanian infants.

Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.

Weight change at 1 mo of antiretroviral therapy and its association with subsequent mortality, morbidity, and CD4 T cell reconstitution in a Tanzanian HIV-infected adult cohort.

Background: The development of low-cost point-of-care technologies to improve HIV treatment is a major focus of current research in resource-limited settings.

Objective: We assessed associations of body mass index (BMI; in kg/m(2)) at antiretroviral therapy (ART) initiation and weight change after 1 mo of treatment with mortality, morbidity, and CD4 T cell reconstitution.

Design: A prospective cohort of 3389 Tanzanian adults initiating ART enrolled in a multivitamin trial was followed at monthly clinic visits (median: 19.

Prevalence and risk factors for vitamin D deficiency among Tanzanian HIV-exposed uninfected infants.

Vitamin D is essential for bone development and may also play an integral role in control of intracellular pathogens. Serum 25-hydroxyvitamin D levels were assessed at 6 months of age for 191 HIV-exposed uninfected infants enrolled in a trial of multivitamins (not including vitamin D) in Tanzania. A total of 66 infants (34.

Changing patterns of social inequalities in anaemia among women in India: cross-sectional study using nationally representative data.

Objectives: To examine the patterns of social inequalities in anaemia over time among women of reproductive age in India.

Design: Repeated cross-sectional study using nationally representative data from the 1998/1999 and 2005/2006 National Family Health Surveys of India. Multivariate modified Poisson regression models were used to assess trends and social inequalities in anaemia.

Multivitamin supplements have no effect on growth of Tanzanian children born to HIV-infected mothers.

Growth faltering and micronutrient deficiencies commonly coexist in HIV-exposed children in sub-Saharan Africa, and correcting deficiencies, such as those of vitamins B-complex, C, and E, may improve HIV-related endpoints and child growth. We therefore examined the effect of daily oral supplementation of vitamins B-complex, C, and E on growth among 2341 children born to HIV-infected mothers in Tanzania. HIV-infected women pregnant at ≤32 wk of gestation were enrolled in the study.

The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries.

Background: Child stunting, wasting, and underweight have been individually associated with increased mortality. However, there has not been an analysis of the mortality risk associated with multiple anthropometric deficits.

Objective: The objective was to quantify the association between combinations of stunting, wasting, and underweight and mortality among children <5 y of age.

Incident tuberculosis and risk factors among HIV-infected children in Tanzania.

Objective: To describe the burden of pediatric tuberculosis (TB) in a HIV-infected population and explore the demographic and clinical factors associated with the occurrence of pediatric TB.

Design: Longitudinal analysis of a cohort of HIV-infected children.

Methods: The endpoint of the study was clinically diagnosed TB.

Association of serum albumin concentration with mortality, morbidity, CD4 T-cell reconstitution among tanzanians initiating antiretroviral therapy.

Background: Prospective studies of serum albumin concentration measurement as a low-cost predictor of human immunodeficiency virus (HIV) disease progression are needed for individuals initiating antiretroviral therapy (ART) in resource-limited settings.

Methods: Serum albumin concentration was measured at ART initiation for 2145 adults in Tanzania who were enrolled in a trial examining the effect of multivitamins on HIV disease progression. Participants were prospectively followed for mortality, morbidity, and anthropometric outcomes at monthly visits (median follow-up duration, 21.

Dietary patterns, nutrient intake, and sociodemographic characteristics in HIV-infected Tanzanian pregnant women.

Routinely collected dietary intakes were available for 925 HIV-infected pregnant women participating in a longitudinal clinical trial of vitamin supplementation in Dar es Salaam, Tanzania. Information on sociodemographic and economic characteristics was recorded. Dietary macronutrient intakes were computed and analyzed using the Tanzania Food Composition Tables.

Stunting and wasting are associated with poorer psychomotor and mental development in HIV-exposed Tanzanian infants.

Infants born to HIV-infected women are at increased risk of impaired neurodevelopment, but little research has attempted to identify modifiable risk factors. The objective of this prospective cohort analysis was to identify maternal, socioeconomic, and child correlates of psychomotor and mental development in the first 18 mo of life among Tanzanian infants born to HIV-infected women. We hypothesized that child HIV infection, morbidity, and undernutrition would be associated with lower developmental status when taking into consideration maternal health and socioeconomic factors.

Effect of multivitamin supplements on weight gain during pregnancy among HIV-negative women in Tanzania.

Multivitamin supplementation has been shown to reduce the risk of low birthweight. This effect could be mediated through gestational weight gain. However, the effect of multivitamin supplementation on weight gain during pregnancy has not been fully studied.

Vitamin D status and incidence of pulmonary tuberculosis, opportunistic infections, and wasting among HIV-infected Tanzanian adults initiating antiretroviral therapy.

Background: Maintaining vitamin D sufficiency may decrease the incidence of pulmonary tuberculosis and other infectious diseases. We present the first prospective study of vitamin D among human immunodeficiency virus (HIV)-infected adults receiving antiretrovirals in sub-Saharan Africa.

Methods: Serum 25-hydroxyvitamin D (25(OH)D) level was assessed at antiretroviral therapy (ART) initiation for 1103 HIV-infected adults enrolled in a trial of multivitamins (not including vitamin D) in Tanzania.