Michael C. Latham

Improvements in physical fitness of Kenyan schoolboys infected with hookworm, Trichuris trichiura and Ascaris lumbricoides following a single dose of albendazole

We studied physical fitness with the Harvard step test (HST), in primary schoolboys infected with hookworm (91% baseline prevalence), Trichuris trichiura (94%) and Ascaris lumbricoides (39-40%) who received a single 400 mg dose of albendazole or an identical placebo. Boys were examined, allocated at random to placebo or albendazole groups, treated, and re-examined 7 weeks later. The 2 groups did not differ significantly before treatment in age, anthropometry, haemoglobin levels, prevalence or intensity of the 3 helminth infections, or in initial HST fitness scores and heart rates. Seven weeks after treatment, the albendazole group (n = 18) exhibited significant improvements in fitness scores and heart rates at 1, 2, 3, and 4 min after the HST while in the placebo group (n = 15) these quantities had not changed significantly. After treatment, the albendazole group had significant decreases in the logarithmic egg counts for hookworm (80% reduction in arithmetic means) and A. lumbricoides (100% reduction); T. trichiura egg counts did not change significantly. The placebo group showed a borderline increase in the logarithms of hookworm egg counts and no significant change in T. trichiura and A. lumbricoides egg counts. Multiple regression analysis showed that the significant linear predictors of increase in HST score after treatment were decrease in resting heart rate after treatment, and decreases in hookworm egg counts and logarithms of A. lumbricoides egg counts after treatment. We conclude that single dose treatment with albendazole, despite continual exposure to reinfection, can allow improved physical fitness in schoolboys in areas where soil-transmitted helminths and protein-energy malnutrition are highly prevalent.

Drinking Water Source, Diarrheal Morbidity, and Child Growth in Villages with Both Traditional and Improved Water Supplies in Rural Lesotho, Southern Africa

This study examined the growth and morbidity rates of young children in relation to exclusive and non-exclusive use of improved water supplies in rural Lesotho, southern Africa. Data were collected for 247 children 60 months of age and under between July 1984 and February 1985 in 10 villages that had an improved water supply at least one year prior to investigation. Children whose families relied exclusively on the new water supply for their drinking and cooking needs grew 0.438 cm and 235 g more in six months than children whose families supplemented the new water supply with the use of contaminated traditional water for drinking and cooking. The difference in growth was greater among children over 12 months of age at the start of the evaluation than among infants. This may be explained partly by lower rates for Giardia lamblia, the most commonly identified pathogen in stools in older children. Among infants, similar rates of Campylobacter, the most commonly isolated pathogen among infants, may have prevented larger differences. Results suggest that improved drinking water supplies can benefit preschool childrens health after infancy, but only if they are functioning and utilized exclusively for drinking and cooking purposes.

Appropriate feeding methods for infants of HIV infected mothers in sub-Saharan Africa.

# Appropriate feeding methods for infants of HIV infected mothers in sub-Saharan Africa {#article-title-2} HIV and AIDS have seriously affected women of reproductive age in sub-Saharan Africa. In 1998, an estimated 590 000 infants worldwide acquired HIV-1 from their mothers; 90% of these infants were in Africa.1 Transmission of HIV from mother to child mainly occurs in utero and during delivery, but in a few cases it happens through breast feeding.2 Increased attention is being focused on strategies to prevent vertical transmission of HIV.3 These strategies need to be based on risk assessment and on cost effectiveness analysis. Interventions are aimed at preventing transmission in utero and during delivery or during breast feeding. Here we discuss only the appropriate infant feeding practices for HIV-1 infected mothers living in poor households in sub-Saharan Africa. #### Summary points Concern is increasing over mother to child transmission of HIV in sub-Saharan Africa Decisions about interventions must be based on assessment of risks, costs, and benefits The role of breast feeding in the vertical transmission of HIV has been exaggerated Exclusive breast feeding reduces HIV transmission Promoting infant formula feeding to prevent HIV infection might increase infant morbidity, malnutrition, and mortality More research on alternative infant feeding methods is urgently needed In many African countries, the HIV and AIDS pandemic is a major tragedy of unprecedented proportions that is increasingly affecting mothers and their children. However, even responsible health agencies have tended to exaggerate the role of breast feeding in transmission. It is estimated that in countries with a low seroprevalence of HIV (5% of women infected) fewer than 1% of all infants are likely to become infected through breast feeding, whereas in those with a high prevalence (25% of women infected) fewer than 4% of infants will be affected through lengthy breast feeding.4 If preventing a child from acquiring HIV infection through breast milk were the … Correspondence to: K Zwi, 1/10 Oaks Avenue, Cremorne, NSW 2090, Australia

Current knowledge and future research on infant feeding in the context of HIV: Basic, clinical, behavioral, and programmatic perspectives

In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world.

Parasitic infections, anaemia and nutritional status: a study of their interrelationships and the effect of prophylaxis and treatment on workers in Kwale District, Kenya

A study was conducted between January and August 1979 on 150 male roadworkers in Kwale District in the coastal lowlands of Kenya. At the baseline examination 59% had hookworm (mean of 227 epg +/- 541), 38% had infections of Schistosoma haematobium (mean 52 +/- 82 ova per 10 ml urine), 23% had a blood film positive for malarial parasites, 47% had anaemia (Hb below 13g/dl), and 31% had a percentage weight for height below 80% of a reference value for healthy men. It was found that anaemia was significantly associated with hookworm infections and egg counts. Three interventions were evaluated. These consisted of providing pyrantel pamoate for hookworm to all men, treating the S. haematobium infections with metrifonate, and giving weekly chloroquine prophylaxis for suppression of malaria to one group of men. A final examination conducted 16 weeks later showed a significant improvement in haemoglobin levels in anaemic men treated for hookworm and in those receiving chloroquine compared with those receiving placebos. Multiple regression analyses revealed that both hookworm and S. haematobium egg counts were associated with anaemia at the baseline examinations, that factors related to the treatment of hookworm and prophylaxis for suppression of malaria were related to haemoglobin increases in anaemic men, and that successful treatment of urinary schistosomiasis was associated with weight gain. The feasibility of the interventions was good and the costs moderately low.

Benefit-cost analysis in the nutrition area: A project in the Philippines

Abstract A benefit-cost analysis framework was developed to compare the relative effectiveness ofthree programs designed to eliminate severe vitamin A deficiency. Each program was run in four ecological areas over a 2-year period. Program benefits in terms of reduced mortality, blindness, morbidity and treatment costs, the effectiveness of each program against each type of benefit, and direct and indirect program costs were calculated. The three programs were the distribution twice yearly of a mass dosage vitamin A capsule, vitamin A fortification of monosodium glutamate (MSG), and a public health intervention which used paraprofessionals for an education, sanitation, immunization, and horticulture program. Benefits and costs accruing to children were compared and the resulting benefit-cost ratios showed that the fortification and mass dosage capsule programs had social benefits much greater than their costs. As a result, MSG fortification is being tested in a three-province area in the Philippines and is being considered for national implementation.

Efficacy trials of a micronutrient dietary supplement in schoolchildren and pregnant women in Tanzania

Traditionally, the main strategies used to control micronutrient deficiencies have been food diversification, consumption of medicinal supplements, and food fortification. In Tanzania, we conducted efficacy trials using a dietary supplement as a fourth approach. These were randomized, double-blind, placebo-controlled efficacy trials conducted separately first in children and later in pregnant women. The dietary supplement was a powder used to prepare an orange-flavored beverage. In the school trial, children consumed 25 g per school day attended. In the pregnancy trial, women consumed the contents of two 25-g sachets per day with meals. This dietary supplement, unlike most medicinal supplements, provided 11 micronutrients, including iron and vitamin A, in physiologic amounts. In both trials we compared changes in subjects consuming either the fortified or the nonfortified supplement. Measures of iron and vitamin A status were similar in the groups at the baseline examination, but significantly different at follow-up, always in favor of the fortified groups. Children receiving the fortified supplement had significantly improved anthropometric measures when compared with controls. At four weeks postpartum, the breast milk of a supplemented group of women had significantly higher mean retinol content than did the milk of mothers consuming the nonfortified supplement. The advantages of using a fortified dietary supplement, compared with other approaches, include its ability to control several micronutrient deficiencies simultaneously; the use of physiologic amounts of nutrients, rather than megadoses that require medical supervision; and the likelihood of better compliance than with the use of pills because subjects liked the beverage used in these trials.

Intestinal parasitic infections of men in four regions of rural Kenya

Faecal samples were obtained from 906 men living in four different regions of rural Kenya: the cool Highlands, the humid coastal lowlands, the equatorial Lake Victoria basin and the arid marginal highlands. The prevalence of intestinal parasitic infections is reported and compared, contrasted and discussed in terms of the typical environmental conditions in each region. Almost 70% of men appeared to be infected with intestinal helminths; hookworm was most common. The regional prevalence of hookworm infections appeared to be related to relative humidity.

Unnecessary water supplementation for babies: grandmothers blame clinics.

This study was designed to obtain policy‐and programme‐relevant data on exclusive breastfeeding in Lesotho at a time when global recommendations for exclusive breastfeeding were new. During both phases of field research, conducted in 1991 and 1992, qualitative information was obtained through focus groups and individual interviews with mothers, grandmothers and nurses. This was complemented during the second phase with quantitative data collected through a clinic‐based survey of mothers. The qualitative and the quantitative findings consistently converged, illustrating a culture of infant feeding in which breastfeeding was central, but exclusive breastfeeding was an unknown concept and not practised. Grandmothers seemed to be more in tune with the ideal of exclusive breastfeeding as they had given their young infants thin gruel only occasionally. Contemporary mothers, in contrast, were regularly giving their young infants water. Mothers and grandmothers frequently cited nurses as the source of advice for giving water. Grandmothers were adamant in pointing out that they had never given water to their own young infants and asserted that they avoided giving it to their grandchildren as they considered it unnecessary and harmful. According to the grandmothers, water supplementation was a new practice that had been introduced through the clinics.

Infant Feeding in Urban Kenya: A Pattern of Early Triple Nipple Feeding

Much interset has been shown in the widespread decline in breast feeding. However in many parts of the world the common pattern is less one of early total abandonment of breastfeeding and more one of introducing other foods especially infant formula and cows milk in place of breast milk while breastfeeding continues. When this form of mixed feeding occurs in the 1st 4-6 months of life this too may be a source of serious concern. 2 recent WHO papers describe a typology of 3 phases and 8 stages of breastfeeding situations found in countries around the world. An important problem with the WHO typology is that it classifies countries and communities based entirely on breastfeeding prevalence and duration. This ignores the situation where breastfeeding is prolonges but where these same mothers feed breast milk substitutes to their infants at a dangerously early age while continuing to breastfeed. The data presented here suggest that infant feeding patterns even within a specific group of a well defined population are highly complex. The mixed feeding or triple nipple pattern found to be prevalent in the Nairobi sample and its effects on child health and nutrition need further study. The WHO model may be more useful for industrialized countries. However without inclusion of factors such as age of introduction prevalence and extent of use of breast milk substitutes it is not a helpful classification for many non-industrialized countries.