Infectious Diseases - Research Publications
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ItemNo Preview AvailableIron Supplementation May Selectively Reprofile the Gut Microbiome in Iron-Deficient Bangladeshi Infants(AMER SOC HEMATOLOGY, 2022-11-15)
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ItemNo Preview AvailableAgreement Between Venous and Capillary Haemoglobin Concentrations in Bangladeshi Children (P10-105-19).(Elsevier BV, 2019-06)Objectives: There are concerns that capillary haemoglobin (Hb) concentrations do not agree with venous Hb, which has implications for global estimates of anaemia largely derived from capillary Hb. In children enrolled in the Benefits and Risks of Iron Supplementation in Children (BRISC) trial, we examined differences between Hb concentrations collected from venous and capillary blood samples, and predictors of these differences. Methods: Hb concentrations were measured in 3300 children at 8 months of age. Capillary Hb concentrations were measured during screening of children for inclusion in the trial. Venous Hb was measured up to 10 days after screening, during enrolment. All Hb measurements used the HemoCue® 301. In children who received both capillary and venous measurements, Hb means, standard deviations, and anaemia prevalence statistics were derived. Paired t-tests were used to compare means across groups. Pearson's correlation coefficients and a Bland-Altman plot were used to examine agreement between capillary and venous Hb. A kappa coefficient was used to examine agreement in diagnosis of anaemia between the two methods. Lastly, differences in mean venous and capillary Hb concentrations between phlebotomists were calculated using ANOVA. Results: All 3300 children will have completed baseline Hb measurements by February 2019. The current abstract presents preliminary data up to December 2018 for 2485 children. Venous and capillary Hb concentrations were moderately correlated (r = 0.62). Prevalence of anaemia using venous samples was 44.8% and using capillary samples was 69.5%. Accounting for chance, the % agreement (kappa coefficient) between the methods for diagnosis of anaemia was 34.8%. Mean Hb concentrations were significantly higher in venous than capillary samples (mean ± SD: 11.0 ± 1.0 vs 10.4 ± 1.0 g/dL, P < 0.001). This is confirmed in the Bland-Altman plot. No differences in Hb were observed between phlebotomists. Conclusions: Significant differences exist in the diagnosis of anaemia using capillary vs venous samples. Capillary Hb measurements should not be used as a surrogate for venous Hb as they may incorrectly estimate the prevalence of anaemia. Results indicated that global estimates of anaemia based on capillary Hb may be misrepresenting true estimates. Funding Sources: NHMRC.
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ItemBenefits and Risks of Iron Interventions in Infants in Rural Bangladesh(MASSACHUSETTS MEDICAL SOC, 2021-09-09)BACKGROUND: Universal provision of iron supplements (drops or syrup) or multiple micronutrient powders to young children in low-to-middle-income countries where anemia is prevalent is recommended by the World Health Organization and widely implemented. The functional benefits and safety of these interventions are unclear. METHODS: We conducted a three-group, double-blind, double-dummy, individually randomized, placebo-controlled trial to assess the immediate and medium-term benefits and risks of 3 months of daily supplementation with iron syrup or iron-containing multiple micronutrient powders, as compared with placebo, in 8-month-old children in rural Bangladesh. The primary outcome was cognitive development, as assessed by the cognitive composite score on the Bayley Scales of Infant and Toddler Development, third edition, immediately after completion of the assigned 3-month regimen; scores range from 55 to 145, with higher scores indicating better cognitive performance. Secondary outcomes included the cognitive composite score at 9 months after completion of the assigned regimen; behavioral, language, and motor development, as well as growth and hematologic markers, immediately after completion and at 9 months after completion; and safety. RESULTS: We randomly assigned 3300 infants to receive iron syrup (1101 infants), multiple micronutrient powders (1099), or placebo (1100) daily. After completion of the assigned 3-month regimen, no apparent effect on the cognitive composite score was observed with iron syrup as compared with placebo (mean between-group difference in change in score from baseline, -0.30 points; 95% confidence interval [CI], -1.08 to 0.48) or with multiple micronutrient powders as compared with placebo (mean between-group difference in change in score from baseline, 0.23 points; 95% CI, -0.55 to 1.00). No apparent effect on any other developmental or growth outcome was observed immediately after completion of the assigned regimen or at 9 months after completion. At 9 months after completion of the assigned regimen, the prevalences of anemia, iron deficiency, and iron deficiency anemia increased in all three trial groups but remained lower among the children who received iron syrup or multiple micronutrient powders than among those who received placebo. The risk of serious adverse events and incidence of symptoms of infection were similar in the three trial groups. CONCLUSIONS: In this trial involving infants in Bangladesh, 3 months of daily supplementation with iron syrup or multiple micronutrient powders did not appear to have an effect on child development or other functional outcomes as compared with placebo. (Funded by the National Health and Medical Research Council of Australia; BRISC Australian New Zealand Clinical Trials Registry number, ACTRN12617000660381.).
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ItemImmediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series(ELSEVIER SCI LTD, 2020-11)BACKGROUND: Stay-at-home orders (lockdowns) have been deployed globally to control COVID-19 transmission, and might impair economic conditions and mental health, and exacerbate risk of food insecurity and intimate partner violence. The effect of lockdowns in low-income and middle-income countries must be understood to ensure safe deployment of these interventions in less affluent settings. We aimed to determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh. METHODS: An interrupted time series was used to compare data collected from families in Rupganj upazila, rural Bangladesh (randomly selected from participants in a randomised controlled trial), on income, food security, and mental health a median of 1 year and 2 years before the COVID-19 pandemic to data collected during the lockdown. We also assessed women's experiences of intimate partner violence during the pandemic. RESULTS: Between May 19 and June 18, 2020, we randomly selected and invited the mothers of 3016 children to participate in the study, 2424 of whom provided consent. 2414 (99·9%, 95% CI 99·6-99·9) of 2417 mothers were aware of, and adhering to, the stay-at-home advice. 2321 (96·0%, 95·2-96·7) of 2417 mothers reported a reduction in paid work for the family. Median monthly family income fell from US$212 at baseline to $59 during lockdown, and the proportion of families earning less than $1·90 per day rose from five (0·2%, 0·0-0·5) of 2422 to 992 (47·3%, 45·2-49·5) of 2096 (p<0·0001 comparing baseline with lockdown period). Before the pandemic, 136 (5·6%, 4·7-6·6) of 2420 and 65 (2·7%, 2·1-3·4) of 2420 families experienced moderate and severe food insecurity, respectively. This increased to 881 (36·5%, 34·5-38·4) of 2417 and 371 (15·3%, 13·9-16·8) of 2417 during the lockdown; the number of families experiencing any level of food insecurity increased by 51·7% (48·1-55·4; p<0·0001). Mothers' depression and anxiety symptoms increased during the lockdown. Among women experiencing emotional or moderate physical violence, over half reported it had increased since the lockdown. INTERPRETATION: COVID-19 lockdowns present significant economic, psychosocial, and physical risks to the wellbeing of women and their families across economic strata in rural Bangladesh. Beyond supporting only the most socioeconomically deprived, support is needed for all affected families. FUNDING: National Health and Medical Research Council, Australia.