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Wafaie W Fawzi - One of the best experts on this subject based on the ideXlab platform.

  • effect of zinc and Multivitamin supplementation on the growth of tanzanian children aged 6 84 wk a randomized placebo controlled double blind trial
    The American Journal of Clinical Nutrition, 2016
    Co-Authors: Lindsey M Locks, Rodrick Kisenge, Roland Kupka, Said Aboud, Wafaie W Fawzi, Christopher Duggan, Molin Wang, Christine Mcdonald, Karim Manji
    Abstract:

    BACKGROUND Poor child growth increases risks of mortality and morbidity. Micronutrient supplements have the potential to improve child growth. OBJECTIVE We assessed the effect of daily zinc, Multivitamin (vitamins C, E, and B-complex), and zinc and Multivitamin (Zn+MV) supplementation on growth in infants in Tanzania. DESIGN In this randomized, 2 × 2 factorial, double-blind trial, 2400 infants were randomly assigned to receive zinc, Multivitamins, Zn+MVs, or a placebo at 6 wk of age and were followed up for 18 mo with monthly growth measurements. Mixed-effects models with restricted cubic splines for the mean change in anthropometric z scores were fit for each group. Likelihood ratio tests were used to compare the effect of supplements on growth trajectories. Cox proportional hazards models were used to compare incidences of stunting, wasting, and underweight. RESULTS Children in all groups experienced growth faltering. At 19 mo of age, prevalences of stunting, wasting, and underweight were 19.8%, 6.0%, and 10.8%, respectively. Changes in weight-for-age z scores (WAZs) and weight-for-height z scores (WHZs) were significantly different across the 4 groups (P < 0.001 for both). The mean ± SE decline in the WAZ from baseline to the end of follow-up in the Zn+MV group was significantly less than in the placebo group (-0.36 ± 0.04 compared with -0.50 ± 0.04; P = 0.020), whereas the decline in the WHZ was significantly greater in the zinc-only group than in the placebo group (-0.57 ± 0.07 compared with -0.35 ± 0.07; P = 0.021). Supplements did not have a significant effect on mean change in the height-for-age z score or on rates of stunting, wasting, or underweight. CONCLUSIONS Although there were small but significant improvements in the WAZ in the Zn+MV group, daily zinc supplementation alone, Multivitamin supplementation alone, and the combined Zn+MV did not reduce the incidences of underweight, stunting, or wasting in Tanzanian infants. Alternative approaches to prevent growth faltering should be pursued. This trial was registered at clinicaltrials.gov as NCT00421668.

  • effect of Multivitamin supplements on weight gain during pregnancy among hiv negative women in tanzania
    Maternal and Child Nutrition, 2015
    Co-Authors: Freeman T Changamire, Paul Petraro, Willy Urassa, Ramadhani S Mwiru, Gernard I Msamanga, Donna Spiegelman, Karen E Peterson, Wafaie W Fawzi
    Abstract:

    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. The objective of this study was to examine the effects of Multivitamins on pregnancy weight gain. We enrolled 8468 HIV-negative women from Dar es Salaam Tanzania in a randomized placebo-controlled trial of Multivitamins on birth outcomes. Women were randomly assigned to receive either a daily oral dose of Multivitamin tablets or a placebo and were weighed every 4 weeks from enrolment until the last visit before delivery. Intent-to-treat analyses were carried out to examine the effects of Multivitamins on pregnancy weight gain. Multivariate linear and binomial regression models with the log-link function were used to examine the association of weight gain during pregnancy to birthweight. The overall total weight gain was 253 g (SE: 69 P: 0.0003) more while the overall 4 weekly weight gain was 59 g greater (SE: 18 P: 0.005) among women who received Multivitamins compared to placebo. Women in the lowest quartile of gestational weight gain had babies with an average birthweight of 3030 g (SD: 524) while women in the highest quartile had babies weighing 3246 g (SD: 486) on average. Prenatal Multivitamin supplements increased gestational weight gain which was a significant predictor of birthweight.

  • maternal Multivitamin supplementation reduces the risk of diarrhoea among hiv exposed children through age 5 years
    International Health, 2014
    Co-Authors: Gernard I Msamanga, Donna Spiegelman, Wafaie W Fawzi, Karim Manji, Nasim Khavari, Hongyu Jiang, Christopher Duggan
    Abstract:

    BACKGROUND: The aim of this study was to determine whether maternal vitamin supplementation affects long-term mortality and morbidity of children born to HIV-infected mothers. METHODS: In total 1078 HIV-infected pregnant woman were enrolled in a double-blind 2x2 factorial randomised placebo-controlled trial in Tanzania. Data were collected for 874 children at monthly clinic visits through a median age of 51 months. RESULTS: Maternal receipt of Multivitamins (HR=0.93; 95% CI: 0.70-1.22) or vitamin A (HR=1.00; 95% CI: 0.76-1.32) did not affect all-cause child mortality through age 5 years. Among HIV-negative children maternal Multivitamin supplementation was associated with a lower mortality rate up to 5 years (HR=0.60; 95% CI: 0.38-0.95) primarily in children <2 years of age. Maternal vitamin A supplementation did not significantly affect child mortality up to 5 years (HR=0.76; 95% CI: 0.48-1.20). Children born to mothers who received Multivitamins had a lower risk of all types of diarrhoea (RR=0.86; 95% CI: 0.75-0.98) through 5 years of age. The reduced risk of watery diarrhoea persisted in children from 2-5 years of age (RR=0.71; 95% CI: 0.54-0.95). CONCLUSIONS: Maternal vitamin supplementation during pregnancy and lactation may be associated with long-lasting affects in HIV-exposed children [ClinicalTrials.gov Identifier: NCT00197743]. (c) The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions please e-mail: journals.permissions@oup.com.

  • effect of Multivitamin supplementation on the neurodevelopment of hiv exposed tanzanian infants a randomized double blind placebo controlled clinical trial
    Journal of Tropical Pediatrics, 2014
    Co-Authors: Karim Manji, Rodrick Kisenge, Roland Kupka, Said Aboud, Ronald J Bosch, Wafaie W Fawzi, David C Bellinger, Christine Mcdonald, Christopher Duggan
    Abstract:

    Background: Micronutrient deficiencies and in utero exposure to HIV may impair infant neurodevelopment. Objective: To evaluate the effect of daily Multivitamin supplementation on the cognitive, language and motor development of HIV-exposed Tanzanian infants. Methods: A total of 2387 infants were randomized to receive daily oral supplementation of Multivitamins (B-complex, C and E) or placebo from age 6 weeks for 24 months. The cognitive, language and motor scales of the Bayley Scales of Infant and Toddler Development, third edition, were administered to a subset of 206 infants at age 15 months. Results: Multivitamin supplementation did not improve measures of cognitive development, expressive or receptive language or gross motor capabilities. There was a trend toward improved fine motor skills among infants randomized to the Multivitamin group (difference in mean score = 0.38; 95% CI = −0.01, 0.78, p = 0.06). Conclusion: Daily provision of Multivitamins to HIV-exposed infants does not substantially improve developmental outcomes at age 15 months.

  • Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania
    Journal of the International AIDS Society, 2013
    Co-Authors: Christopher Duggan, James Okuma, Rodrick Kisenge, Roland Kupka, Said Aboud, Karim P Manji, Ronald J Bosch, Wafaie W Fawzi
    Abstract:

    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. Among them, 2008 infants provided blood samples and had haemoglobin concentrations measured at baseline and during a follow-up period. Anaemia was defined as haemoglobin concentrations B11 g/dL and severe anaemia B8.5 g/dL. Results: Haemoglobin concentrations among children in the treatment group were significantly higher than those in the placebo group at 12 (9.77 vs. 9.64 g/dL, p0.03), 18 (9.76 vs. 9.57 g/dL, p0.004), and 24 months (9.93 vs. 9.75 g/dL, p0.02) of follow-up. Compared to those in the placebo group, children in the treatment group had a 12% lower risk of anaemia (hazard ratio (HR): 0.88; 95% CI: 0.790.99; p0.03). The treatment was associated with a 28% reduced risk of severe anaemia among children born to women without anaemia (HR: 0.72; 95% CI: 0.560.92; p0.008), but not among those born to women with anaemia (HR: 1.10; 95% CI: 0.791.54; p0.57; p for interaction0.007). One thousand seven hundred fifty three infants who tested HIV-negative at baseline and had HIV testing during follow-up were included in the analysis for MTCT of HIV. No association was found between Multivitamin supplements and MTCT of HIV. Conclusions: Multivitamin supplements improve haematologic status among children born to HIV-positive women. Further trials focusing on anaemia among HIV-exposed children are warranted in the context of antiretroviral therapy.

Donna Spiegelman - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness of a Multivitamin supplementation program among hiv infected adults in tanzania
    AIDS, 2019
    Co-Authors: Christopher R. Sudfeld, Donna Spiegelman, Ellen Hertzmark, Ashley L Buchanan, Nzovu Ulenga, Expeditho Mtisi, Aisa Muya, David Sando, Ester Mungure, Mucho Mizinduko
    Abstract:

    OBJECTIVE The objective of this study was to assess the effectiveness of a routine Multivitamin supplementation program for adults living with HIV in Tanzania. DESIGN We conducted a retrospective cohort study of 67 707 adults enrolled in the Dar es Salaam HIV care and treatment program during 2004-2012. METHODS The Dar es Salaam HIV care and treatment program intended to provide all adult patients with Multivitamin supplements (vitamins B-complex, C, and E) free of charge; however, intermittent stockouts and other implementation issues did not afford universal coverage. We use Cox proportional hazard models to assess the time-varying association of Multivitamin supplementation with mortality and clinical outcomes. RESULTS The study cohort contributed 41 540 and 129 315 person-years of follow-up time to the antiretroviral therapy (ART)-naive and ART-experienced analyses, respectively. Among 48 207 ART-naive adults, provision of Multivitamins reduced the risk of mortality [adjusted hazard ratio (aHR): 0.69; 95% confidence interval (CI): 0.59-0.81], incident tuberculosis (TB) (aHR: 0.83; 0.76-0.91), and meeting ART eligibility criteria (aHR: 0.78; 95% CI: 0.73-0.83) after adjustment for time-varying confounding. Among 46 977 ART-experienced patients, Multivitamins reduced mortality (hazard ratio: 0.86; 95% CI: 0.80-0.92), incident TB (aHR: 0.78; 95% CI: 0.73-0.84), and immunologic failure (aHR: 0.70; 95% CI: 0.67-0.73). The survival benefits associated with provision Multivitamins appeared to be greatest during the first year of ART and declined over time (P value <0.001). CONCLUSION Multivitamin supplementation appears to be a simple, effective, safe, and scalable program to improve survival, reduce incidence of TB, and improve treatment outcomes for adult HIV patients in Tanzania.

  • effect of Multivitamin supplements on weight gain during pregnancy among hiv negative women in tanzania
    Maternal and Child Nutrition, 2015
    Co-Authors: Freeman T Changamire, Paul Petraro, Willy Urassa, Ramadhani S Mwiru, Gernard I Msamanga, Donna Spiegelman, Karen E Peterson, Wafaie W Fawzi
    Abstract:

    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. The objective of this study was to examine the effects of Multivitamins on pregnancy weight gain. We enrolled 8468 HIV-negative women from Dar es Salaam Tanzania in a randomized placebo-controlled trial of Multivitamins on birth outcomes. Women were randomly assigned to receive either a daily oral dose of Multivitamin tablets or a placebo and were weighed every 4 weeks from enrolment until the last visit before delivery. Intent-to-treat analyses were carried out to examine the effects of Multivitamins on pregnancy weight gain. Multivariate linear and binomial regression models with the log-link function were used to examine the association of weight gain during pregnancy to birthweight. The overall total weight gain was 253 g (SE: 69 P: 0.0003) more while the overall 4 weekly weight gain was 59 g greater (SE: 18 P: 0.005) among women who received Multivitamins compared to placebo. Women in the lowest quartile of gestational weight gain had babies with an average birthweight of 3030 g (SD: 524) while women in the highest quartile had babies weighing 3246 g (SD: 486) on average. Prenatal Multivitamin supplements increased gestational weight gain which was a significant predictor of birthweight.

  • maternal Multivitamin supplementation reduces the risk of diarrhoea among hiv exposed children through age 5 years
    International Health, 2014
    Co-Authors: Gernard I Msamanga, Donna Spiegelman, Wafaie W Fawzi, Karim Manji, Nasim Khavari, Hongyu Jiang, Christopher Duggan
    Abstract:

    BACKGROUND: The aim of this study was to determine whether maternal vitamin supplementation affects long-term mortality and morbidity of children born to HIV-infected mothers. METHODS: In total 1078 HIV-infected pregnant woman were enrolled in a double-blind 2x2 factorial randomised placebo-controlled trial in Tanzania. Data were collected for 874 children at monthly clinic visits through a median age of 51 months. RESULTS: Maternal receipt of Multivitamins (HR=0.93; 95% CI: 0.70-1.22) or vitamin A (HR=1.00; 95% CI: 0.76-1.32) did not affect all-cause child mortality through age 5 years. Among HIV-negative children maternal Multivitamin supplementation was associated with a lower mortality rate up to 5 years (HR=0.60; 95% CI: 0.38-0.95) primarily in children <2 years of age. Maternal vitamin A supplementation did not significantly affect child mortality up to 5 years (HR=0.76; 95% CI: 0.48-1.20). Children born to mothers who received Multivitamins had a lower risk of all types of diarrhoea (RR=0.86; 95% CI: 0.75-0.98) through 5 years of age. The reduced risk of watery diarrhoea persisted in children from 2-5 years of age (RR=0.71; 95% CI: 0.54-0.95). CONCLUSIONS: Maternal vitamin supplementation during pregnancy and lactation may be associated with long-lasting affects in HIV-exposed children [ClinicalTrials.gov Identifier: NCT00197743]. (c) The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions please e-mail: journals.permissions@oup.com.

  • Multivitamin supplementation in HIV infected adults initiating antiretroviral therapy in Uganda: the protocol for a randomized double blinded placebo controlled efficacy trial
    BMC Infectious Diseases, 2012
    Co-Authors: David Guwatudde, Amara E. Ezeamama, Rachel Kyeyune, Fred Wabwire-mangen, Danstan Bagenda, Henry Wamani, Ferdinand Mugusi, Donna Spiegelman, Molin Wang, Yukari C. Manabe
    Abstract:

    Background: Use of Multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether Multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA) of micronutrients (including vitamins B-complex, C, and E) in slowing disease progression among HIV-infected adults receiving HAART in Uganda. Methods/Design: We are using a randomized, double-blind, placebo-controlled trial study design. Eligible patients are HIV-positive adults aged at least 18 years, and are randomized to receive either a placebo; or Multivitamins that include a single RDA of the following vitamins: 1.4 mg B1, 1.4 mg B2, 1.9 mg B6, 2.6 mcg B12, 18 mg niacin, 70 mg C, 10 mg E, and 0.4 mg folic acid. Participants are followed for up to 18 months with evaluations at baseline, 6, 12 and 18 months. The study is primarily powered to examine the effects on immune reconstitution, weight gain, and quality of life. In addition, we will examine the effects on other secondary outcomes including the risks of development of new or recurrent disease progression event, including all-cause mortality; ARV regimen change from first- to second-line therapy; and other adverse events as indicated by incident peripheral neuropathy, severe anemia, or diarrhea. Discussions: The conduct of this trial provides an opportunity to evaluate the potential benefits of this affordable adjunct therapy (Multivitamin supplementation) among HIV-infected adults receiving HAART in a developing country setting. Trial registration: Clinical Trial Registration-URL: www.clinicaltrials.gov. Unique identifier: NCT01228578

  • a randomized trial to determine the optimal dosage of Multivitamin supplements to reduce adverse pregnancy outcomes among hiv infected women in tanzania
    The American Journal of Clinical Nutrition, 2010
    Co-Authors: Kosuke Kawai, James Okuma, Eduardo Villamor, Ferdinand Mugusi, Roland Kupka, Said Aboud, Donna Spiegelman, Wafaie W Fawzi
    Abstract:

    BACKGROUND: We previously reported that supplementation with Multivitamins (vitamin B complex vitamin C and vitamin E) at multiples of the Recommended Dietary Allowance (RDA) significantly decreased the risk of adverse pregnancy outcomes among HIV-infected women. The minimum dosage of Multivitamins necessary for optimal benefits is unknown. OBJECTIVE: We investigated the efficacy of Multivitamin supplements at single compared with multiple RDAs on decreasing the risk of adverse pregnancy outcomes among HIV-infected women. DESIGN: We conducted a double-blind randomized controlled trial among 1129 HIV-infected pregnant women in Tanzania. Eligible women between 12 and 27 gestational weeks were randomly assigned to receive daily oral supplements of either single or multiple RDA Multivitamins from enrollment until 6 wk after delivery. RESULTS: Multivitamins at multiple and single doses of the RDA had similar effects on the risk of low birth weight (11.6% and 10.2% respectively; P = 0.75). We found no difference between the 2 groups in the risk of preterm birth (19.3% and 18.4% respectively; P = 0.73) or small-for-gestational-age (14.8% and 12.0% respectively; P = 0.18). The mean birth weights were similar in the multiple RDA (3045 + or - 549 g) and single RDA Multivitamins group (3052 + or - 534 g; P = 0.83). There were no significant differences between the 2 groups in the risk of fetal death (P = 0.99) or early infant death (P = 0.19). CONCLUSION: Multivitamin supplements at a single dose of the RDA may be as efficacious as multiple doses of the RDA in decreasing the risk of adverse pregnancy outcomes among HIV-infected women. This trial was registered at clinicaltrials.gov as NCT00197678.

Said Aboud - One of the best experts on this subject based on the ideXlab platform.

  • the effect of daily zinc and or Multivitamin supplements on early childhood development in tanzania results from a randomized controlled trial
    Maternal and Child Nutrition, 2017
    Co-Authors: Lindsey M Locks, Rodrick Kisenge, Roland Kupka, Said Aboud, Karim P Manji, David C Bellinger, Molin Wang, Christine Mcdonald
    Abstract:

    Impaired childhood development has lifelong consequences for educational attainment and wage-earning potential. Micronutrient supplements have the potential to improve development. The objective of this study was to determine the effect of daily zinc and/or Multivitamin (vitamins C, E and B-complex) supplements on development among Tanzanian infants. In this randomized, 2 × 2 factorial, double-blind trial, 2400 infants were randomized to zinc (Zn), Multivitamins (MV), zinc and Multivitamins (Zn + MV) or placebo at 6 weeks of age. At approximately 15 months, a sub-sample of 247 children underwent developmental assessment using the cognitive, language (receptive and expressive) and motor (fine and gross) scales of the Bayley Scales of Infant and Toddler Development Third Edition (BSID-III). Mean BSID-III scores were compared using univariate and multivariate linear regression models adjusted for child's sex, post-conceptual age and test administrator. Logistic regressions were used to assess odds of low developmental scores. We did not detect a significant difference in mean BSID-III scores in any of the five domains in univariate or multivariate models comparing each of the four treatment groups. We also did not detect a significant difference in mean BSID-III scores when comparing children who received zinc supplements versus those who did not, or in comparisons of children who received Multivitamin supplements versus those who did not. There was no significant difference in odds of a low BSID-III score in any of the five domains in treatment arms either. Because neither daily zinc nor Multivitamin (vitamins B-complex, C and E) supplementation led to improvements in any of the developmental domains assessed using the BSID-III, we recommend pursuing alternative interventions to promote early childhood development in vulnerable populations. © 2016 John Wiley & Sons Ltd

  • effect of zinc and Multivitamin supplementation on the growth of tanzanian children aged 6 84 wk a randomized placebo controlled double blind trial
    The American Journal of Clinical Nutrition, 2016
    Co-Authors: Lindsey M Locks, Rodrick Kisenge, Roland Kupka, Said Aboud, Wafaie W Fawzi, Christopher Duggan, Molin Wang, Christine Mcdonald, Karim Manji
    Abstract:

    BACKGROUND Poor child growth increases risks of mortality and morbidity. Micronutrient supplements have the potential to improve child growth. OBJECTIVE We assessed the effect of daily zinc, Multivitamin (vitamins C, E, and B-complex), and zinc and Multivitamin (Zn+MV) supplementation on growth in infants in Tanzania. DESIGN In this randomized, 2 × 2 factorial, double-blind trial, 2400 infants were randomly assigned to receive zinc, Multivitamins, Zn+MVs, or a placebo at 6 wk of age and were followed up for 18 mo with monthly growth measurements. Mixed-effects models with restricted cubic splines for the mean change in anthropometric z scores were fit for each group. Likelihood ratio tests were used to compare the effect of supplements on growth trajectories. Cox proportional hazards models were used to compare incidences of stunting, wasting, and underweight. RESULTS Children in all groups experienced growth faltering. At 19 mo of age, prevalences of stunting, wasting, and underweight were 19.8%, 6.0%, and 10.8%, respectively. Changes in weight-for-age z scores (WAZs) and weight-for-height z scores (WHZs) were significantly different across the 4 groups (P < 0.001 for both). The mean ± SE decline in the WAZ from baseline to the end of follow-up in the Zn+MV group was significantly less than in the placebo group (-0.36 ± 0.04 compared with -0.50 ± 0.04; P = 0.020), whereas the decline in the WHZ was significantly greater in the zinc-only group than in the placebo group (-0.57 ± 0.07 compared with -0.35 ± 0.07; P = 0.021). Supplements did not have a significant effect on mean change in the height-for-age z score or on rates of stunting, wasting, or underweight. CONCLUSIONS Although there were small but significant improvements in the WAZ in the Zn+MV group, daily zinc supplementation alone, Multivitamin supplementation alone, and the combined Zn+MV did not reduce the incidences of underweight, stunting, or wasting in Tanzanian infants. Alternative approaches to prevent growth faltering should be pursued. This trial was registered at clinicaltrials.gov as NCT00421668.

  • effect of Multivitamin supplementation on the neurodevelopment of hiv exposed tanzanian infants a randomized double blind placebo controlled clinical trial
    Journal of Tropical Pediatrics, 2014
    Co-Authors: Karim Manji, Rodrick Kisenge, Roland Kupka, Said Aboud, Ronald J Bosch, Wafaie W Fawzi, David C Bellinger, Christine Mcdonald, Christopher Duggan
    Abstract:

    Background: Micronutrient deficiencies and in utero exposure to HIV may impair infant neurodevelopment. Objective: To evaluate the effect of daily Multivitamin supplementation on the cognitive, language and motor development of HIV-exposed Tanzanian infants. Methods: A total of 2387 infants were randomized to receive daily oral supplementation of Multivitamins (B-complex, C and E) or placebo from age 6 weeks for 24 months. The cognitive, language and motor scales of the Bayley Scales of Infant and Toddler Development, third edition, were administered to a subset of 206 infants at age 15 months. Results: Multivitamin supplementation did not improve measures of cognitive development, expressive or receptive language or gross motor capabilities. There was a trend toward improved fine motor skills among infants randomized to the Multivitamin group (difference in mean score = 0.38; 95% CI = −0.01, 0.78, p = 0.06). Conclusion: Daily provision of Multivitamins to HIV-exposed infants does not substantially improve developmental outcomes at age 15 months.

  • Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania
    Journal of the International AIDS Society, 2013
    Co-Authors: Christopher Duggan, James Okuma, Rodrick Kisenge, Roland Kupka, Said Aboud, Karim P Manji, Ronald J Bosch, Wafaie W Fawzi
    Abstract:

    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. Among them, 2008 infants provided blood samples and had haemoglobin concentrations measured at baseline and during a follow-up period. Anaemia was defined as haemoglobin concentrations B11 g/dL and severe anaemia B8.5 g/dL. Results: Haemoglobin concentrations among children in the treatment group were significantly higher than those in the placebo group at 12 (9.77 vs. 9.64 g/dL, p0.03), 18 (9.76 vs. 9.57 g/dL, p0.004), and 24 months (9.93 vs. 9.75 g/dL, p0.02) of follow-up. Compared to those in the placebo group, children in the treatment group had a 12% lower risk of anaemia (hazard ratio (HR): 0.88; 95% CI: 0.790.99; p0.03). The treatment was associated with a 28% reduced risk of severe anaemia among children born to women without anaemia (HR: 0.72; 95% CI: 0.560.92; p0.008), but not among those born to women with anaemia (HR: 1.10; 95% CI: 0.791.54; p0.57; p for interaction0.007). One thousand seven hundred fifty three infants who tested HIV-negative at baseline and had HIV testing during follow-up were included in the analysis for MTCT of HIV. No association was found between Multivitamin supplements and MTCT of HIV. Conclusions: Multivitamin supplements improve haematologic status among children born to HIV-positive women. Further trials focusing on anaemia among HIV-exposed children are warranted in the context of antiretroviral therapy.

  • Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants
    Clinical and Vaccine Immunology, 2013
    Co-Authors: Christopher R. Sudfeld, Alex Histed, Simin Nikbin Meydani, Said Aboud, Karim P Manji, Christopher Duggan, Molin Wang, Edward Giovannucci, Wafaie W Fawzi
    Abstract:

    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 8.5 and 12 months of age, and all mothers received high-dose Multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant Multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P>0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P0.032) and greater for infants whose mothers had a CD4 T-cell count of 350 cells/l(P0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P0.031). Maternal CD4 T-cell counts of 350 cells/l(P0.047), as were lower infant height-for-age z-scores (P0.016). Supplementation with Multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under registration no. NCT00197730.)

Gernard I Msamanga - One of the best experts on this subject based on the ideXlab platform.

  • effect of Multivitamin supplements on weight gain during pregnancy among hiv negative women in tanzania
    Maternal and Child Nutrition, 2015
    Co-Authors: Freeman T Changamire, Paul Petraro, Willy Urassa, Ramadhani S Mwiru, Gernard I Msamanga, Donna Spiegelman, Karen E Peterson, Wafaie W Fawzi
    Abstract:

    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. The objective of this study was to examine the effects of Multivitamins on pregnancy weight gain. We enrolled 8468 HIV-negative women from Dar es Salaam Tanzania in a randomized placebo-controlled trial of Multivitamins on birth outcomes. Women were randomly assigned to receive either a daily oral dose of Multivitamin tablets or a placebo and were weighed every 4 weeks from enrolment until the last visit before delivery. Intent-to-treat analyses were carried out to examine the effects of Multivitamins on pregnancy weight gain. Multivariate linear and binomial regression models with the log-link function were used to examine the association of weight gain during pregnancy to birthweight. The overall total weight gain was 253 g (SE: 69 P: 0.0003) more while the overall 4 weekly weight gain was 59 g greater (SE: 18 P: 0.005) among women who received Multivitamins compared to placebo. Women in the lowest quartile of gestational weight gain had babies with an average birthweight of 3030 g (SD: 524) while women in the highest quartile had babies weighing 3246 g (SD: 486) on average. Prenatal Multivitamin supplements increased gestational weight gain which was a significant predictor of birthweight.

  • maternal Multivitamin supplementation reduces the risk of diarrhoea among hiv exposed children through age 5 years
    International Health, 2014
    Co-Authors: Gernard I Msamanga, Donna Spiegelman, Wafaie W Fawzi, Karim Manji, Nasim Khavari, Hongyu Jiang, Christopher Duggan
    Abstract:

    BACKGROUND: The aim of this study was to determine whether maternal vitamin supplementation affects long-term mortality and morbidity of children born to HIV-infected mothers. METHODS: In total 1078 HIV-infected pregnant woman were enrolled in a double-blind 2x2 factorial randomised placebo-controlled trial in Tanzania. Data were collected for 874 children at monthly clinic visits through a median age of 51 months. RESULTS: Maternal receipt of Multivitamins (HR=0.93; 95% CI: 0.70-1.22) or vitamin A (HR=1.00; 95% CI: 0.76-1.32) did not affect all-cause child mortality through age 5 years. Among HIV-negative children maternal Multivitamin supplementation was associated with a lower mortality rate up to 5 years (HR=0.60; 95% CI: 0.38-0.95) primarily in children <2 years of age. Maternal vitamin A supplementation did not significantly affect child mortality up to 5 years (HR=0.76; 95% CI: 0.48-1.20). Children born to mothers who received Multivitamins had a lower risk of all types of diarrhoea (RR=0.86; 95% CI: 0.75-0.98) through 5 years of age. The reduced risk of watery diarrhoea persisted in children from 2-5 years of age (RR=0.71; 95% CI: 0.54-0.95). CONCLUSIONS: Maternal vitamin supplementation during pregnancy and lactation may be associated with long-lasting affects in HIV-exposed children [ClinicalTrials.gov Identifier: NCT00197743]. (c) The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions please e-mail: journals.permissions@oup.com.

  • sex differences in the effects of maternal vitamin supplements on mortality and morbidity among children born to hiv infected women in tanzania
    British Journal of Nutrition, 2010
    Co-Authors: Kosuke Kawai, Eduardo Villamor, Gernard I Msamanga, Ronald J Bosch, Ellen Hertzmark, Karim Manji, Wafaie W Fawzi
    Abstract:

    We examined whether there are sex differences in the effect of vitamin supplements on birth outcomes, mortality and morbidity by 2 years of age among children born to HIV-infected women in Tanzania. A randomised placebo-controlled trial was conducted among 959 mother– infant pairs. HIV-infected pregnant women were randomly assigned to receive a daily oral dose of one of four regimens: Multivitamins (vitamins B-complex, C and E), vitamin A plus b-carotene, Multivitamins including vitamin A plus b-carotene or placebo. Supplements were administered during pregnancy and continued after delivery. The beneficial effect of Multivitamins on decreasing the risk of low birth weight was stronger among girls (relative risks (RR) ¼ 0·39, 95 % CI 0·22, 0·67) than among boys (RR ¼ 0·81, 95 % CI 0·44, 1·49; P for interaction ¼ 0·08). Maternal Multivitamin supplements resulted in 32 % reduction in mortality among girls (RR ¼ 0·68, 95 % CI 0·47, 0·97), whereas no effect was found among boys (RR ¼ 1·20, 95 % CI 0·80, 1·78; P for interaction ¼ 0·04). Multivitamins had beneficial effects on the overall risks of diarrhoea that did not differ by sex. Vitamin A plus b-carotene alone increased the risk of HIV transmission, but had no effects on mortality, and we found no sex differences in these effects. Sex differential effects of Multivitamins on mortality may be due to sex-related differences in the immunological or genetic factors. More research is warranted to examine the effect of vitamins by sex and better understand biological mechanisms mediating such effects.

  • Multivitamin supplementation improves hematologic status in HIV-infected women and their children in Tanzania
    The American Journal of Clinical Nutrition, 2007
    Co-Authors: Wafaie W Fawzi, Eduardo Villamor, Gernard I Msamanga, Ferdinand Mugusi, Roland Kupka, Donna Spiegelman, David J Hunter
    Abstract:

    Anemia is a frequent complication among HIV-infected persons and is associated with faster disease progression and mortality. We examined the effect of Multivitamin supplementation on hemoglobin concentrations and the risk of anemia among HIV-infected pregnant women and their children. HIV-1-infected pregnant women (n = 1078) from Dar es Salaam Tanzania were enrolled in a double-blind trial and provided daily supplements of preformed vitamin A and s-carotene Multivitamins (vitamins B C and E) preformed vitamin A and s-carotene + Multivitamins or placebo. All women received iron and folate supplements only during pregnancy according to local standard of care. The median follow-up time for hemoglobin measurement for mothers was 57.3 mo [interquartile range (IQR): 28.6-66.8] and for children it was 28.0 mo (IQR: 5.3-41.7). During the whole period hemoglobin concentrations among women who received Multivitamins were 0.33 g/dL higher than among women who did not receive Multivitamins (P = 0.07). Compared with placebo Multivitamin supplementation resulted in a hemoglobin increase of 0.59 g/dL during the first 2 y after enrollment (P = 0.0002). Compared with placebo the children born to mothers who received Multivitamins had a reduced risk of anemia. In this group the risk of macrocytic anemia was 63% lower than in the placebo group (relative risk: 0.37: 95% CI: 0.18 0.79; P = 0.01). Multivitamin supplementation provided during pregnancy and in the postpartum period resulted in significant improvements in hematologic status among HIV-infected women and their children which provides further support for the value of Multivitamin supplementation in HIV-infected adults. (authors)

  • Effect of Maternal Multivitamin Supplementation on the Mental and Psychomotor Development of Children Who Are Born to HIV-1–Infected Mothers in Tanzania
    Pediatrics, 2006
    Co-Authors: Nuala Mcgrath, Gernard I Msamanga, James M. Robins, David C Bellinger, Edward Z Tronick, Wafaie W Fawzi
    Abstract:

    OBJECTIVES. To determine the association between maternal Multivitamin supplementation and the mental and psychomotor development of children who are born to HIV-1–infected mothers in Tanzania, as secondary endpoints in a randomized trial that investigated the effect of maternal Multivitamin supplementation on HIV-1 vertical transmission and progression. METHODS. The Bayley Scales of Infant Development, 2nd Edition, were administered at 6, 12, and 18 months of age to a subset of children ( N = 327). We assessed the effect of vitamin A and Multivitamin (vitamins B, C, and E) supplementation using linear regression models and Cox proportional hazard models for the Mental Development Index, the Psychomotor Development Index, and raw scores separately. RESULTS. Multivitamin supplementation was associated significantly with a mean increase in Psychomotor Development Index score of 2.6 (95% confidence interval: 0.1–5.1). Multivitamins were also significantly protective against the risk for developmental delay on the motor scale (relative risk: 0.4; 95% confidence interval: 0.2–0.7) but not on the Mental Development Index. Vitamin A supplementation had no significant effect on these outcomes. CONCLUSIONS. Maternal Multivitamin supplements provide a low-cost intervention to reduce the risk for developmental delays among infants who are born to HIV-positive mothers in developing countries.

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  • the effect of daily zinc and or Multivitamin supplements on early childhood development in tanzania results from a randomized controlled trial
    Maternal and Child Nutrition, 2017
    Co-Authors: Lindsey M Locks, Rodrick Kisenge, Roland Kupka, Said Aboud, Karim P Manji, David C Bellinger, Molin Wang, Christine Mcdonald
    Abstract:

    Impaired childhood development has lifelong consequences for educational attainment and wage-earning potential. Micronutrient supplements have the potential to improve development. The objective of this study was to determine the effect of daily zinc and/or Multivitamin (vitamins C, E and B-complex) supplements on development among Tanzanian infants. In this randomized, 2 × 2 factorial, double-blind trial, 2400 infants were randomized to zinc (Zn), Multivitamins (MV), zinc and Multivitamins (Zn + MV) or placebo at 6 weeks of age. At approximately 15 months, a sub-sample of 247 children underwent developmental assessment using the cognitive, language (receptive and expressive) and motor (fine and gross) scales of the Bayley Scales of Infant and Toddler Development Third Edition (BSID-III). Mean BSID-III scores were compared using univariate and multivariate linear regression models adjusted for child's sex, post-conceptual age and test administrator. Logistic regressions were used to assess odds of low developmental scores. We did not detect a significant difference in mean BSID-III scores in any of the five domains in univariate or multivariate models comparing each of the four treatment groups. We also did not detect a significant difference in mean BSID-III scores when comparing children who received zinc supplements versus those who did not, or in comparisons of children who received Multivitamin supplements versus those who did not. There was no significant difference in odds of a low BSID-III score in any of the five domains in treatment arms either. Because neither daily zinc nor Multivitamin (vitamins B-complex, C and E) supplementation led to improvements in any of the developmental domains assessed using the BSID-III, we recommend pursuing alternative interventions to promote early childhood development in vulnerable populations. © 2016 John Wiley & Sons Ltd

  • effect of zinc and Multivitamin supplementation on the growth of tanzanian children aged 6 84 wk a randomized placebo controlled double blind trial
    The American Journal of Clinical Nutrition, 2016
    Co-Authors: Lindsey M Locks, Rodrick Kisenge, Roland Kupka, Said Aboud, Wafaie W Fawzi, Christopher Duggan, Molin Wang, Christine Mcdonald, Karim Manji
    Abstract:

    BACKGROUND Poor child growth increases risks of mortality and morbidity. Micronutrient supplements have the potential to improve child growth. OBJECTIVE We assessed the effect of daily zinc, Multivitamin (vitamins C, E, and B-complex), and zinc and Multivitamin (Zn+MV) supplementation on growth in infants in Tanzania. DESIGN In this randomized, 2 × 2 factorial, double-blind trial, 2400 infants were randomly assigned to receive zinc, Multivitamins, Zn+MVs, or a placebo at 6 wk of age and were followed up for 18 mo with monthly growth measurements. Mixed-effects models with restricted cubic splines for the mean change in anthropometric z scores were fit for each group. Likelihood ratio tests were used to compare the effect of supplements on growth trajectories. Cox proportional hazards models were used to compare incidences of stunting, wasting, and underweight. RESULTS Children in all groups experienced growth faltering. At 19 mo of age, prevalences of stunting, wasting, and underweight were 19.8%, 6.0%, and 10.8%, respectively. Changes in weight-for-age z scores (WAZs) and weight-for-height z scores (WHZs) were significantly different across the 4 groups (P < 0.001 for both). The mean ± SE decline in the WAZ from baseline to the end of follow-up in the Zn+MV group was significantly less than in the placebo group (-0.36 ± 0.04 compared with -0.50 ± 0.04; P = 0.020), whereas the decline in the WHZ was significantly greater in the zinc-only group than in the placebo group (-0.57 ± 0.07 compared with -0.35 ± 0.07; P = 0.021). Supplements did not have a significant effect on mean change in the height-for-age z score or on rates of stunting, wasting, or underweight. CONCLUSIONS Although there were small but significant improvements in the WAZ in the Zn+MV group, daily zinc supplementation alone, Multivitamin supplementation alone, and the combined Zn+MV did not reduce the incidences of underweight, stunting, or wasting in Tanzanian infants. Alternative approaches to prevent growth faltering should be pursued. This trial was registered at clinicaltrials.gov as NCT00421668.

  • effect of Multivitamin supplementation on the neurodevelopment of hiv exposed tanzanian infants a randomized double blind placebo controlled clinical trial
    Journal of Tropical Pediatrics, 2014
    Co-Authors: Karim Manji, Rodrick Kisenge, Roland Kupka, Said Aboud, Ronald J Bosch, Wafaie W Fawzi, David C Bellinger, Christine Mcdonald, Christopher Duggan
    Abstract:

    Background: Micronutrient deficiencies and in utero exposure to HIV may impair infant neurodevelopment. Objective: To evaluate the effect of daily Multivitamin supplementation on the cognitive, language and motor development of HIV-exposed Tanzanian infants. Methods: A total of 2387 infants were randomized to receive daily oral supplementation of Multivitamins (B-complex, C and E) or placebo from age 6 weeks for 24 months. The cognitive, language and motor scales of the Bayley Scales of Infant and Toddler Development, third edition, were administered to a subset of 206 infants at age 15 months. Results: Multivitamin supplementation did not improve measures of cognitive development, expressive or receptive language or gross motor capabilities. There was a trend toward improved fine motor skills among infants randomized to the Multivitamin group (difference in mean score = 0.38; 95% CI = −0.01, 0.78, p = 0.06). Conclusion: Daily provision of Multivitamins to HIV-exposed infants does not substantially improve developmental outcomes at age 15 months.

  • Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania
    Journal of the International AIDS Society, 2013
    Co-Authors: Christopher Duggan, James Okuma, Rodrick Kisenge, Roland Kupka, Said Aboud, Karim P Manji, Ronald J Bosch, Wafaie W Fawzi
    Abstract:

    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. Among them, 2008 infants provided blood samples and had haemoglobin concentrations measured at baseline and during a follow-up period. Anaemia was defined as haemoglobin concentrations B11 g/dL and severe anaemia B8.5 g/dL. Results: Haemoglobin concentrations among children in the treatment group were significantly higher than those in the placebo group at 12 (9.77 vs. 9.64 g/dL, p0.03), 18 (9.76 vs. 9.57 g/dL, p0.004), and 24 months (9.93 vs. 9.75 g/dL, p0.02) of follow-up. Compared to those in the placebo group, children in the treatment group had a 12% lower risk of anaemia (hazard ratio (HR): 0.88; 95% CI: 0.790.99; p0.03). The treatment was associated with a 28% reduced risk of severe anaemia among children born to women without anaemia (HR: 0.72; 95% CI: 0.560.92; p0.008), but not among those born to women with anaemia (HR: 1.10; 95% CI: 0.791.54; p0.57; p for interaction0.007). One thousand seven hundred fifty three infants who tested HIV-negative at baseline and had HIV testing during follow-up were included in the analysis for MTCT of HIV. No association was found between Multivitamin supplements and MTCT of HIV. Conclusions: Multivitamin supplements improve haematologic status among children born to HIV-positive women. Further trials focusing on anaemia among HIV-exposed children are warranted in the context of antiretroviral therapy.

  • Multivitamin supplements have no effect on growth of tanzanian children born to hiv infected mothers
    Journal of Nutrition, 2013
    Co-Authors: Roland Kupka, James Okuma, Rodrick Kisenge, Said Aboud, Karim P Manji, Ronald J Bosch, Wafaie W Fawzi, Christopher Duggan
    Abstract:

    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. Children were randomized at age 6 wk to receive Multivitamins or placebo until age 104 wk. All women received the same types of vitamins pre- and postnatally. At 6 wk, 256 children (11.1%) were HIV infected and the mean (SD) Z-scores for length for age (LAZ), weight for length (WLZ), and weight for age (WAZ) were −0.39 ± 1.20, −0.21 ± 1.23, and −0.52 ± 1.11, respectively. There was no overall treatment effect on LAZ, WLZ, or WAZ profiles during the follow-up (P ≥ 0.15). There was no treatment effect from 6 to 104 wk on LAZ [(95% CI: −0.14, 0.13); P = 0.94], WLZ [(95% CI: −0.17, 0.13); P = 0.78], or WAZ [(95% CI: −0.15, 0.16); P = 0.97] or on the incidence of growth failure, defined as respective Z-scores < −2 (P ≥ 0.29). Among the subgroup of HIV-uninfected children, there was no treatment effect from 6 to 104 wk on LAZ, WLZ, and WAZ (P ≥ 0.71) or on the incidence of growth failure (P ≥ 0.16). Multivitamin supplements had no effect on growth among children born to HIV-infected women who were themselves receiving Multivitamins.

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