Browsing by Author "Ahmed, S."
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Item Antenatal multiple micronutrient supplementation: call to action for change in recommendation(ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 2019-11-05) Ahmed, S.; Bourassa, M.W.; Osendarp, S.J.M; Adu-Afarwuah, S.; Ajello, C.; Bergeron, G.; Black, R.; Christian, P.; Cousens, S.; de Pee, S.; Dewey, K.G.; Arifeen, S.E.; Engle-Stone, R.; Fleet, A.; Gernand, A.D.; Hoddinott, J.; Klemm, R.; Kraemer, K.; Kupka, R.; McLean, E.; Moore, S.E.; Neufeld, L.M.; Persson, L-A.; Rasmussen, K.M.; Shankar, A.H.; Smith, E.; Sudfeld, C.R.; Udomkesmalee, E.; Vosti, S.A.We appreciate the comments by Devakumar et al .1 and agree that there are still some unanswered questions regarding the long‐term impact of multiple micronutrient supplementation (MMS) during pregnancy. However, in their assessment, Devakumar and colleagues ignore the significant benefits shown in the individual patient data (IPD) meta‐analysis, which strongly influenced our task force's conclusions. Rather, their comments focus only on the birth size data from the Cochrane reviews.2, 3 In the IPD meta‐analysis, which included data from nearly 113,000 pregnancies, the authors found that, in addition to reducing the risk of low birthweight, MMS significantly reduces the risk of preterm birth (RR = 0.93 (0.87–0.98), random effects).2 The Cochrane review also states that MMS “probably led to a slight reduction in preterm births” on the basis of data from 91,425 participants with moderate quality evidence (RR = 0.95 (0.90–1.01)Item Cohort Profile: The Alliance for Maternal and Newborn Health Improvement (AMANHI) biobanking study(International Journal of Epidemiology, 2022) Aftab, F.; Ahmed, S.; Ali, S.M.; Ame, S.M; Bahl, R.; Baqui, A.H.; Chowdhury, N.H.; Deb, S.; Dhingra, U.; Dutta, A.; Hasan, T.; Hotwani, A.; Ilyas, M.; Javaid, M.; Jehan, F.; Juma, M.H.; Khalid, F.; Khanam, R.; Manu, A.A.; Mehmood, U.; Minckas, N.; Mitra, D.K.; Nisar, I.; Polasek, O.; Rahman, S.; Rudan, I.; Sajid, M.; Sazawal, S.; Yoshida, S.Item Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub Saharan Africa: A population-based prospective cohort study in 8 countries(PLOS, 2021) Aftab, F.; Ahmed, I.; Ahmed, S.; Ali, S.M.; Amenga-Etego, S.; Ariff, S.; Bahl, R.; Baqui, A.H.; Begum, N.; Bhutta, Z.A.; Biemba, G.; Cousens, S.; Das, V.; Deb, S.; Dhingra, U.; Dutta, A.; Edmond, K.; Esamai, F.; Ghosh, A.K.; Gisore, P.; Grogan, C.; Hamer, D.H.; Herlihy, J.; Hurt, L.; Ilyas, M.; Jehan, F.; Juma, M.H.; Kalonji, M.; Khanam, R.; Kirkwood, B.R.; Kumar, A.; Kumar, A.; Kumar, V.; Manu, A.; Marete, I.; Mehmood, U.; Minckas, N.; Mishra, S.; Mitra, D.K.; Moin, M.I.; Muhammad, K.; Newton, S.; Ngaima, S.; Nguwo, A.; Nisar, M.I.; Otomba, J.; Quaiyum, M.A.; Sarrassat, S.; SazawalI, S.; Semrau, K.E.; Shannon, C.; Singh, V.P.; Soofi, S.; Soremekun, S.; Suleiman, A.M.; Sunday, V.; Dilip, T.R.; Tshefu, A.; Wasan, Y.; Yeboah-Antwi, K.; Yoshida, S.; Zaidi, A.K.Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn out comes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths.Item How biotic, abiotic, and functional variables drive belowground soil carbon stocks along stress gradient in the Sundarbans Mangrove Forest?(Journal of Environmental Management, 2023) Ahmed, S.; Sarker, S.K.; Naabeh, C.S.S.Mangrove forests, some of the most carbon-dense ecosystems on Earth, play an important role in climate change mitigation through storing carbon in the soil. However, increasing anthropogenic pressures and sea level rise are likely to alter mangrove forest structure and functions, including the major source of carbon in mangrove eco systems — below-ground soil carbon stocks (BSCS). Although estimating soil carbon stocks has been a popular practice in the mangroves, but poorly understood the (I) the linkage between BSCS and key ecosystem drivers (i. e., biotic, abiotic, and functional) and in (II) determining the pathways of how BSCS and multiple forest variables interact along stress gradients. This lack of understanding limits our ability to predict ecosystem carbon dy namics under future changes in climate. Here, we aimed to understand how abiotic factors (such as salinity, canopy gap fraction, nutrients, and soil pH), biotic factors (e.g., structural parameters, canopy packing, and leaf area index, LAI), and forest functional variables (e.g., growth and aboveground biomass stocks, AGB) affect BSCS (i.e., soil organic carbon, SOC, and root carbon, RC) using spatiotemporal data collected from the Sundarbans Mangrove Forest (SMF) in Bangladesh. We observed that BSCS decreased significantly with increasing salinity (e. g., from 70.6 Mg C ha− 1 in the low-saline zone to 44.6 Mg C ha− 1 in the high-saline zone). In contrast, the availability of several macronutrients (such as nitrogen, phosphorous, and potassium), LAI, species diversity, AGB, and growth showed a significant positive effect on SOC and RC. Stand properties, including tree height, basal area, density, canopy packing, and structural diversity, had a non-significant but positive impact on RC, while tree height and basal area significantly influenced SOC. Pathway analysis showed that salinity affects BSCS variability directly and indirectly by regulating stand structure and restricting nutrients and forest functions, although basal area, nutrients, and LAI directly enhance RC stocks. Our results indicate that an increase in nutrient content, canopy density, species diversity, and leaf area index can enhance BSCS, as they improve forest functions and contribute to a better understanding of the underlying mechanisms.Item Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries(Annals of the New York Academy of Sciences, 2019-05-27) Adu-Afarwuah, S.; Bourassa, M.W.; Osendarp, S.J.M.; Ahmed, S.; Ajello, C.; Bergeron, G.; Black, R.; Christian, P.; Cousens, S.; de Pee, S.; Dewey, K.G.; Arifeen, S.E.; Engle-Stone, R.; Fleet, A.; Gernand, A.D.; Hoddinott, j; Klemm, R.; Kraemer, k; Kupka, R.; McLean, E.; Moore, S.E.; Neufeld, L.M.; Persson, L.A.; Rasmussen, K.M.; Shankar, A.H.; Smith, E.; Sudfeld, C.R.; Udomkesmalee, E.; Vosti, S.A.Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.