Browsing by Author "Westreich, D."
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Item Intermittent Preventive Therapy in Pregnancy and Incidence of Low Birth Weight in Malaria-Endemic Countries(American Journal of Public Health, 2018-01) Cates, J.E.; Westreich, D.; Unger, H.W.; Bauserman, M.; Adair, L.; Cole, S.R.; Meshnick, S.; Rogerson, S.J.; Briand, V.et.al.Objectives: To estimate the impact of hypothetical antimalarial and nutritional interventions (which reduce the prevalence of low midupper arm circumference [MUAC]) on the incidence of low birth weight (LBW). Methods: We analyzed data from 14 633 pregnancies from 13 studies conducted across Africa and the Western Pacific from 1996 to 2015. We calculated population intervention effects for increasing intermittent preventive therapy in pregnancy (IPTp), full coverage with bed nets, reduction in malaria infection at delivery, and reductions in the prevalence of low MUAC. Results: We estimated that, compared with observed IPTp use, administering 3 or more doses of IPTp to all women would decrease the incidence of LBW from 9.9% to 6.9% (risk difference = 3.0%; 95% confidence interval = 1.7%, 4.0%). The intervention effects for eliminating malaria at delivery, increasing bed net ownership, and decreasing low MUAC prevalence were all modest. Conclusions: Increasing IPTp uptake to at least 3 doses could decrease the incidence of LBW in malaria-endemic countries. The impact of IPTp on LBW was greater than the effect of prevention of malaria, consistent with a nonmalarial effect of IPTp, measurement error, or selection bias. (Am J Public Health. Published online ahead of print January 18, 2018: e1-e8. doi:10.2105/AJPH.2017.304251).Item Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific(BioMed Central Ltd., 2016) Unger, H.W.; Cates, J.E.; Briand, V.; Fievet, N.; Valea, I.; Tinto, H.; D'Alessandro, U.; Landis, S.H.; Adu-Afarwuah, S.; Dewey, K.G.; Ter Kuile, F.; Dellicour, S.; Ouma, P.; Slutsker, L.; Terlouw, D.J.; Kariuki, S.; Ayisi, J.; Nahlen, B.; Desai, M.; Madanitsa, M.; Kalilani-Phiri, L.; Ashorn, P.; Maleta, K.; Mueller, L.; Stanisic, D.; Schmiegelow, C.; Lusingu, J.; Westreich, D.; Van Eijk, A.M.; Meshnick, S.; Rogerson, S.Purpose The Maternal Malaria and Malnutrition (M3) initiative has pooled together 13 studies with the hope of improving understanding of malaria-nutrition interactions during pregnancy and to foster collaboration between nutritionists and malariologists. Participants Data were pooled on 14â €..635 singleton, live birth pregnancies from women who had participated in 1 of 13 pregnancy studies. The 13 studies cover 8 countries in Africa and Papua New Guinea in the Western Pacific conducted from 1996 to 2015. Findings to date Data are available at the time of antenatal enrolment of women into their respective parent study and at delivery. The data set comprises essential data such as malaria infection status, anthropometric assessments of maternal nutritional status, presence of anaemia and birth weight, as well as additional variables such gestational age at delivery for a subset of women. Participating studies are described in detail with regard to setting and primary outcome measures, and summarised data are available from each contributing cohort. Future plans This pooled birth cohort is the largest pregnancy data set to date to permit a more definite evaluation of the impact of plausible interactions between poor nutritional status and malaria infection in pregnant women on fetal growth and gestational length. Given the current comparative lack of large pregnancy cohorts in malaria-endemic settings, compilation of suitable pregnancy cohorts is likely to provide adequate statistical power to assess malaria-nutrition interactions, and could point towards settings where such interactions are most relevant. The M3 cohort may thus help to identify pregnant women at high risk of adverse outcomes who may benefit from tailored intensive antenatal care including nutritional supplements and alternative or intensified malaria prevention regimens, and the settings in which these interventions would be most effective.