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Gaibandha, Bangladesh

Shamim A.A.,JiVitA Project | Merrill R.K.,Catheart Energy Inc.
Journal of Water and Health | Year: 2010

Over the past 30 years, tubewells have become a ubiquitous source of potable groundwater in South Asia. Considered safer than surface water, groundwater naturally contains minerals that may impact human health; however, few data exist on tubewell water mineral content or its association with human nutritional or health conditions. We surveyed iron concentration in tubewell water across a 435 km2, contiguous, rural area in northwestern Bangladesh to map and quantify levels of iron in drinking water. One tubewell was randomly sampled from each of 948 adjacent grid cells 675 m2 in size. Water sampling was standardized and iron concentration measured using a field-based colorimetric kit. The median (interquartile range) concentration of iron in tubewell water was 7.6 (1.6, 17.6) mgl-1. There was high geographic variation (range of 0-46.5 mgl-1), and iron in only 3% of surveyed tubewells fell below the WHO aesthetic cut-off of 0.3 mgl-1 suggesting elevated levels of iron throughout the area. Villagers accurately perceived groundwater iron concentration, based on a 4-point ('none', 'a little', 'medium', 'a lot') scale ( p < 0.001). Water source iron content can be readily quantified in population settings offering the potential to evaluate the health relevance of groundwater iron exposure in rural communities. © IWA Publishing 2010.


Christian P.,Johns Hopkins University | Klemm R.,Johns Hopkins University | Shamim A.A.,JiVitA Project | Ali H.,JiVitA Project | And 7 more authors.
American Journal of Clinical Nutrition | Year: 2013

Background: Micronutrient deficiencies may be related to poor fetal growth and short gestation. Few studies have investigated the contribution of maternal vitamin A deficiency to these outcomes. Objective: In rural northwestern Bangladesh, we examined the effects of weekly antenatal vitamin A and β-carotene supplementation on birth weight, length, circumferential body measures, and length of gestation. Design: With the use of a cluster-randomized, placebo-controlled trial design, pregnant women were enrolled in the first trimester and began receiving their allocated supplements (vitamin A, β-carotene, or placebo) weekly until 3 mo postpartum. Birth anthropometric measures were made at home. Results: Of 13,709 newborns whose birth weight was measured within 72 h of birth, mean (±SD) weight was 2.44 ± 0.42 kg, the prevalence of low birth weight (LBW) was 54.4%, and that of small-for- gestational age (SGA) was 70.5%. Birth weight, length, and chest, head, and arm circumferences did not differ between supplementation and placebo groups nor did rates of LBWand SGA. Mean gestational age at birth was 38.3 ± 2.9 wk, and 25.6% of births occurred before 37 wk. Neither gestational age nor preterm birth rate differed with vitamin A or β-carotene supplementation. Conclusions: In this rural South Asian population with a high burden of LBW and preterm birth but modest levels of maternal vitamin A deficiency, antenatal vitamin A or β-carotene supplementation did not benefit these birth outcomes. Other nutritional and nonnutritional interventions should be examined to reduce risks of these adverse outcomes in rural South Asia. This trial was registered at clinicaltrials. gov as NCT00198822. © 2013 American Society for Nutrition.


Christian P.,Johns Hopkins University | Labrique A.B.,Johns Hopkins University | Ali H.,JiVitA Project | Richman M.J.,University of California at Los Angeles | And 3 more authors.
American Journal of Clinical Nutrition | Year: 2011

Background: Bacterial vaginosis (BV) in pregnancy is linked to preterm birth, but its risk factors are not well understood. Micronutrient deficiencies may be associated with an increased risk of this condition. Objective: We assessed the effect of weekly vitamin A or b-carotene supplementation during pregnancy until 3 mo postpartum on BV risk in rural northeastern Bangladesh. Design: In this cluster-randomized, placebo-controlled trial, 33 clusters (n = 33) were randomly assigned to 3 groups. Women (n = 1812) were examined for BV by using self-administered swabs and the Nugent scoring method in early pregnancy, at 32 wk of gestation, and at 3 mo postpartum. Results: The prevalence of BV in early pregnancy, before supplementation, was 7.6% (95% CI: 6.3%, 9.1%) overall. Neither the prevalence nor the incidence of BV in the third trimester differed by supplement group. However, the prevalence (OR: 0.71; 95% CI: 0.52, 0.98) and incidence (RR: 0.58; 95% CI: 0.41, 0.81) of BVat 3 mo postpartum was lower among women in the vitamin A group (9.1% and 6.7%, respectively) than in the placebo group (12.4% and 11.8%, respectively), but not in the β-carotene group. Both vitamin A and β-carotene reduced the prevalence and incidence of BV at both time points (ie, third trimester and 3 mo postpartum) by 30-40% compared with placebo (all P < 0.05). Conclusions: Weekly vitamin A supplementation reduced the risk of maternal BV in this rural Bangladeshi population. Enhancement of vitamin A status before and during pregnancy may reduce the risk of BV in areas with vitamin A deficiency. This trial is registered at clinicaltrials.gov as NCT00198822. © 2011 American Society for Nutrition.


Klemm R.D.W.,Johns Hopkins University | Merrill R.D.,Johns Hopkins University | Wu L.,Johns Hopkins University | Shamim A.A.,JiVitA Project | And 4 more authors.
Maternal and Child Nutrition | Year: 2015

Birth size is an important gauge of fetal and neonatal health. Birth size measurements were collected within 72h of life for 16290 live born, singleton infants in rural Bangladesh from 2004 to 2007. Gestational age was calculated based on the date of last menstrual period. Newborns were classified as small-for-gestational age (SGA) based on a birthweight below the 10th percentile for gestational age, using three sets of US reference data. Birth size distributions were explored based on raw values as well as after z-score standardisation in reference to World Health Organization (WHO) 2006 growth standards. Mean (SD) birthweight (g), length (cm) and head circumference (cm) measurements, completed within [median (25th, 75th percentile)] 15 (8, 23) h of life, were 2433 (425), 46.4 (2.4) and 32.4 (1.6), respectively. Twenty-twopercent were born preterm. Over one-half (55.3%) of infants were born low birthweight; 46.6%, 37.0% and 33.6% had a weight, length and head circumference below -2 z-scores of the WHO growth standard at birth; and 70.9%, 72.2% and 59.8% were SGA for weight based on Alexander etal., Oken etal. and Olsen etal. references, respectively. Infants in this typical rural Bangladesh setting were commonly born small, reflecting a high burden of fetal growth restriction and preterm birth. Our findings, produced by active birth surveillance, suggest that low birthweight is far more common than suggested by cross-sectional survey estimates. Interventions that improve fetal growth during pregnancy may have the largest impact on reducing SGA rates. © 2015 John Wiley & Sons, Ltd.


West K.P.,Center for Human Nutrition | Shamim A.A.,Center for Human Nutrition | Mehra S.,Center for Human Nutrition | Labrique A.B.,Center for Human Nutrition | And 11 more authors.
JAMA - Journal of the American Medical Association | Year: 2014

IMPORTANCE: Maternal micronutrient deficienciesmay adversely affect fetal and infant health, yet there is insufficient evidence of effects on these outcomes to guide antenatal micronutrient supplementation in South Asia.OBJECTIVE: To assess effects of antenatal multiple micronutrient vs iron-folic acid supplementation on 6-month infant mortality and adverse birth outcomes.DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized, double-masked trial in Bangladesh, with pregnancy surveillance starting December 4, 2007, and recruitment on January 11,2008.Six-month infant follow-up ended August 30, 2012. Surveillance included 127 282 women; 44 567 became pregnant and were included in the analysis and delivered 28 516 live-born infants. Median gestation at enrollment was 9 weeks (interquartile range, 7-12).INTERVENTIONS: Women were provided supplements containing 15 micronutrients or iron-folic acid alone, taken daily from early pregnancy to 12 weeks postpartum.MAIN OUTCOMES AND MEASURES: The primary outcomewas all-cause infant mortality through 6 months (180 days). Prespecified secondary outcomes in this analysis included stillbirth, preterm birth (<37 weeks), and low birth weight (<2500 g). To maintain overall significance of α =.05, a Bonferroni-corrected α =.01 was calculated to evaluate statistical significance of primary and 4 secondary risk outcomes (.05/5).RESULTS: Among the 22 405 pregnancies in the multiple micronutrient group and the 22 162 pregnancies in the iron-folic acid group, there were 14 374 and 14 142 live-born infants, respectively, included in the analysis. At 6 months, multiple micronutrients did not significantly reduce infant mortality; there were 764 deaths (54.0 per 1000 live births) in the iron-folic acid group and 741 deaths (51.6 per 1000 live births) in the multiple micronutrient group (relative risk [RR], 0.95; 95%CI, 0.86-1.06). Multiple micronutrient supplementation resulted in a non-statistically significant reduction in stillbirths (43.1 vs 48.2 per 1000 births; RR, 0.89; 95%CI, 0.81-0.99; P =.02) and significant reductions in preterm births (18.6 vs 21.8 per 100 live births; RR, 0.85; 95%CI, 0.80-0.91; P <.001) and low birth weight (40.2 vs 45.7 per 100 live births; RR, 0.88; 95%CI, 0.85-0.91; P <.001).CONCLUSIONS AND RELEVANCE: In Bangladesh, antenatal multiple micronutrient compared with iron-folic acid supplementation did not reduce all-cause infant mortality to age 6 months but resulted in a non-statistically significant reduction in stillbirths and significant reductions in preterm births and low birth weight.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00860470.

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