Maiza Campos Ponce

: Undernutrition is a major public health challenge in Mozambique, requiring a better understanding of changes in weight and body composition. In the present study, changes in weight and body composition were analyzed in undernourished children, and predictors of these changes were identified during and after hospitalization. A longitudinal cohort study was conducted in Maputo, Mozambique (2018–2020), in children aged 6 to 58 months hospitalized for malnutrition. On hospital admission, clinical data, including anemia, edema, and HIV infection status, were collected. Anthropometric measurements, height, weight, and skinfold thickness, were obtained during hospital and community follow-ups. Stool samples were collected to assess intestinal parasitic infections. Longitudinal linear mixed-effects models were used to identify factors associated with changes in weight and proxies of body composition (sum of skinfolds and percentage body fat [%BF]) over time. A total of 217 children were included, with a mean age of 19.2 ± 8.4 months. On admission, 43.7% (94/215) of patients had kwashiorkor, 88.7% (188/212) had anemia, and 55.8% (121/217) had edema. HIV infection was diagnosed in 25.7% (55/214) of patients, and 26.7% (58/217) were positive for intestinal parasitic infections. HIV infection was a strong predictor associated with lower weight gain and body composition change over time (sum of skinfold and estimated %BF), whereas edema was associated with increased gains ( P P <0.05). HIV infection and edema at admission were major determinants of recovery, emphasizing targeted HIV care and continued edema monitoring.

Background: Ready-to-use therapeutic foods (RUTFs) have been developed to treat severe acute malnutrition (SAM) in children by promoting rapid weight gain, but the long-term effects have been overlooked. Incorporating prebiotic rice bran into RUTF can enhance balanced weight gain. We hypothesized that children receiving RUTF + rice bran would exhibit increased fat-free mass (FFM) and reduced body fat percentage and abdominal adiposity. Methods: A double-blinded randomized controlled trial (ClinicalTrials.gov:NCT05319717) involving 200 children with different degrees of acute malnutrition compared the effectiveness of RUTF with or without rice bran. Children received treatment for 8 weeks, with another 8 weeks of follow-up. Anthropometry, including skinfolds, was collected every 4 weeks. Results: Compliance was similar in both groups (~21%). Children aged 6 to 23 months receiving RUTF + rice bran gained more FFM than those receiving RUTF alone (p = 0.05 at week 8). Over the 8-week treatment, the fat mass index increased in children receiving RUTF (p = 0.02), but not in those receiving RUTF + rice bran (p = 0.48), although the increase in body fat percentage was similar (p = 0.23). The ratio of abdominal to peripheral skinfolds decreased in both groups during treatment but increased during follow-up, though the difference was not statistically significant. In children aged 24 to 59 months, no significant differences in body composition were observed. The fat-free mass index increased in both groups during treatment but declined afterwards, with significant changes noted in the RUTF + rice bran group. Conclusions: The addition of rice bran to RUTF affected body composition changes during treatment only in younger children, where more lean mass was gained and fat mass gain was limited. Differences in intestinal microbiome maturity might underlie this age difference.

During the past two decades, the Afghan government, along with the international community, has developed a system aimed at improving access to essential healthcare services under Afghanistan’s challenging sociopolitical and geographical circumstances. In 31 provinces, nonstate actors competed for fixed-term contracts to implement a predefined package of healthcare services. In three provinces, the government organized the provision of healthcare services. An independent third party monitored service provision, including access to medicines. This study examines the availability of essential medicines in Afghanistan’s public healthcare facilities and how this is shaped by sociopolitical challenges, geographical barriers, and the organization of the healthcare system. Between March and July 2021, enumerators collected data at 885 healthcare facilities across Afghanistan. For our analysis, we combined data on medicine availability and the functioning of the health system with publicly available information about geographical and sociopolitical factors, including security incidents. Using regression analysis, we identified facility-, district-, and provincial-level factors related to medicine availability in public healthcare facilities. On average, 70% of 31 selected essential medicines were available in 2021. The availability of medicines varied significantly between provinces and was considerably higher in those where services were contracted out to nonstate actors (n = 31; 91%) compared to provinces where service provision was organized by the government (n = 3; 9%). The most important drivers of variation in medicine availability included geographical barriers, securing and allocating funds at the provincial level, and organizing and sustaining physical capacity at the facility level. Insecurity was not a key factor driving variation in medicine availability. Despite the sociopolitical challenges in 2021, the availability of essential medicines in public healthcare facilities was relatively high. The results suggest that decentralized procurement of medicines by nonstate actors and timely payment of funds contribute to medicine availability. Strategies to improve medicine availability should target hard-to-reach areas and lower-level facilities.

Mozambique has one of the highest child undernutrition rates in Sub-Saharan Africa. The aim of this study was to characterize the profile of children from 1 to 14 years old hospitalized for undernutrition and to explore associated risk factors. Clinical, demographic, socioeconomic, and environmental data were collected. Anthropometric measurements and stool samples were collected from a child and their caretaker. The wealth index was determined using Principal Components Analysis. A total of 449 children and their caretakers were enrolled. The children had a median age of 1.0 year [IQR: 1.0–2.0], and 53.9% (242/449) were male. Most were admitted with severe undernutrition (35.7%, 159/449 kwashiorkor and 82.0%, 368/449 with −3SD Z-score indexes). The most common co-morbidities were HIV (30.0%, 120/400), diarrhea (20.0%; 80/400), and anemia (12.5%; 50/400). Among the caretakers, 9.5% (39/409) were underweight, 10.1% (40/397) were overweight, and 14.1% (56/397) were obese. Intestinal parasites were found in 24.8% (90/363) children and in 38.5% (77/200) caretakers. The majority of children (60.7%, 85/140) came from low- to middle-wealth households. Most were severely undernourished, suggesting that they seek medical care too late. The finding of overweight/obese caretakers in combination with undernourished children confirms that Mozambique is facing a double burden of malnutrition.

Samenvatting: Het COVID-19-virus kan zowel milde als langdurige en ernstige klachten veroorzaken. Preventieve maatregelen, waaronder vaccins, werden ingezet om (ernstige) ziekte te voorkomen en transmissie terug te dringen. Ondanks de beschikbaarheid van vaccins lag de COVID-19-vaccinatiegraad lager in jongere leeftijdsgroepen. Dit artikel beschrijft de vaccinatiebereidheid, determinanten en beweegredenen van studenten van de Vrije Universiteit Amsterdam (n = 372) ten tijde van de derde COVID-19-golf (voorjaar 2019), voordat het vaccin voor deze groep beschikbaar was. Dit hebben we via een crosssectionele online vragenlijst uitgevraagd en descriptief geanalyseerd. We vonden een hoge vaccinatiebereidheid (84%), waarbij beweegredenen om het vaccin te accepteren overwegend maatschappelijk en om te weigeren (bio)medisch van aard waren. Religie, politieke voorkeur, ouders geboren in Nederland en een vaccinatiebereidheid van naasten lijken verschillend te zijn tussen studenten die vaccinatiebereid zijn vergeleken met studenten die twijfelen of weigeren. Thema’s omtrent bijwerkingen en langetermijneffectiviteit van vaccins lijken ook belangrijk in het maken van een geïnformeerde keuze. Bij toekomstige vaccinatiecampagnes kan deze informatie gebruikt worden om vaccinatietwijfel te reduceren. Dit zou kunnen bijdragen aan de paraatheid voor uitbraken van infectieziekten in Nederland.

It has long been recognized that intestinal parasite infections and undernutrition are closely linked. However, little is known about the role of intestinal parasite infections (IPIs), or parasite clearance, in these processes. The aim of this scoping review was to summarize published evidence on the association between IPIs and body composition. PRISMA guidelines, PubMed/MEDLINE, EMBASE and Cochrane Library databases were searched up until June 2021. Studies reporting on IPIs in relation to (proxies for) body composition were eligible. Study quality and risk of bias were assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Twenty-four studies were included, two Randomized Control Trials (RCTs) and 22 observational. Most observational studies showed IPIs to be associated with lower Body Mass Index (BMI) or being underweight as proxies for body composition. One RCT showed no effect of antiparasitic treatment on body composition, while the other one showed a significant post-treatment increase in body fat, as measured by BMI z-scores and skinfolds. This review lends support to distinct associations between IPIs and body composition. More longitudinal studies are needed using direct measures of body composition to investigate whether weight gained after antiparasitic treatment concerns an increase in body fat or healthy weight gain.

BACKGROUND At the beginning of the COVID-19 pandemic, many low-income countries were confronted with a difficult challenge: with little resources and while implementing a stringent lockdown, they had to rapidly train thousands of Community Health Workers (CHW) in rural and remote areas about the new virus and then find a way to continue to support them in providing health services and products. Shortly after the first COVID-19 case was confirmed in Uganda, a local consortium developed a telehealth approach that aimed to inform 3500 CHWs about COVID-19, support them in identifying, referring and caring for possible COVID-19 cases and help them to continue to provide basic health services and products. OBJECTIVE To assess the functioning of the telehealth approach that was set up to support community health workers in rural communities in Uganda with sustaining basic health services and dealing with the COVID-19 pandemic. METHODS For this mixed-method study, we combined analysis of 1) consultation data from the call-center that supported a network of 3500 CHW in 23 districts in rural Uganda, 2) 24 in-depth interviews with purposively selected CHWs and health professionals working at the call center, and 3) two surveys of 150 active CHWs RESULTS Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. The CHWs said there were no signs that people in their communities were suffering from severe health problems due to COVID-19. Because COVID-19 appeared to cause no visible health problems, many people were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful in supporting CHWs in providing regular health services and products in rural communities. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients, adhering to infection prevention and control practices, and communicating product needs. The CHWs felt more informed and less isolated and said the support helped them provide better care and improve the delivery of essential health products. CONCLUSIONS The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities. CLINICALTRIAL Not applicable

Countries across the globe are currently experiencing a third or fourth wave of SARS-CoV-2 infections; therefore, the need for effective vaccination campaigns is higher than ever. However, effectiveness of these campaigns in disease reduction is highly dependent on vaccination uptake and coverage in susceptible populations. Therefore, this systematic review and meta-analysis estimated the vaccination intention and identified determinants of willingness and hesitancy. This study updates the existing body of literature on vaccination willingness, and was conducted according to the PRISMA guidelines. PubMed was searched for publications, selecting only studies published between 20 October 2020 and 1 March 2021, in English, with participants aged >16 years of age. The search identified 411 articles, of which 63 surveys were included that accounted for more than 30 countries worldwide. The global COVID-19 vaccination willingness was estimated at 66.01% [95% CI: 60.76–70.89% I² = 99.4% [99.3%; 99.4%]; τ² = 0.83]. The vaccination willingness varied within as well as between countries. Age, gender, education, attitudes and perceptions about vaccines were most frequently observed to be significantly associated with vaccine acceptance or refusal.

Appropriate feeding in the first 1000 days of a child’s life is critical for their health and growth. We determined associations between adherence to age-appropriate feeding practices and child growth in Cambodia. Children (n = 1079) were included in the first follow-up (FU) data analyses and followed for 30 months (six FUs). Data were analyzed by generalized linear mixed-effect models. Children who adhered to feeding practices on at least three FUs, with an adequate minimal dietary diversity (MDD), a minimal acceptable diet (MAD), and age-appropriate daily feeding (ADF) were less stunted (14.8%, 12.3%, and 6.4%, respectively) than children who never adhered to these indicators (25.2%, 30.1%, and 24.8%, respectively). A higher adherence to MDD and ADF was associated with a higher height-for-age Z-score (HAZ) (β: 0.13, 95% CI: 0.01–0.25 and β: 0.36, 95% CI: 0.22–0.50), while a higher adherence to the MDD and MAD was associated with a higher weight-for-height Z-score (WHZ) (β: 0.19, 95% CI: 0.08–0.30; and β: 0.16, 95% CI: 0.05–0.27). A higher adherence to a minimum meal frequency (MMF) was associated with a lower HAZ (β: −0.99, 95% CI: −1.28–−0.70). Our findings showed that to reduce wasting and stunting in Cambodia, interventions should focus on improving both the quality and quantity of food intake of children under two while targeting the whole complementary feeding period.