Browsing by Author "Ausman, Lynne M."

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    Child stunting starts in utero: Growth trajectories and determinants in Ugandan infants
    (Maternal & Child Nutrition, 2022) Namirembe, Grace; Ghosh, Shibani; Ausman, Lynne M.; Shrestha, Robin; Zaharia, Sonia; Bashaasha, Bernard; Kabunga, Nassul; Agaba, Edgar; Mezzano, Julieta; Webb, Patrick
    Childhood stunting remains a public health burden worldwide. Although many studies have examined early life and in‐utero risk factors; most have been observational and have used analytic techniques that make inferences limited to population means, thereby obscuring important within‐group variations. This study addressed that important gap. Using data from a birth cohort of Ugandan infants (n = 4528), we applied group‐based trajectory modelling to assess diverse patterns of growth among children from birth to 1‐year old. A multinomial regression model was conducted to understand the relationship between risk factors and observed patterns across groups. We found that the onset of stunting occurred before birth and followed four distinct growth patterns: chronically stunted (Group 1), recovery (Group 2), borderline stunted (Group 3) and normal (Group 4). The average lengthfor‐ age z‐score (LAZ) at birth was −2.6, −3.9, −0.6 and 0.5 for Groups 1–4, respectively. Although both Groups 1 and 2 were stunted at birth, stunting persisted in Group 1 while children in Group 2 recovered by the fourth month. Group 3 exhibited mild stunting while Group 4 was normal. Wasting and underweight were observed in all groups, with the highest prevalence of underweight in Group 1. Wasting gradually increased among children born already stunted (Groups 1 and 2). This showed the importance of distinguishing children by their growth patterns rather than aggregating them and only comparing population averages against global growth standards. The design of nutrition interventions should consider the differential factors and potential for growth gains relative to different risks within each group.
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    Unsafe Drinking Water Is Associated with Environmental Enteric Dysfunction and Poor Growth Outcomes in Young Children in Rural Southwestern Uganda
    (The American journal of tropical medicine and hygiene, 2018) Lauer, Jacqueline M.; Duggan, Christopher P.; Ausman, Lynne M.; Griffiths, Jeffrey K.; Webb, Patrick; Bashaasha, Bernard; Agaba, Edgar; Turyashemererwa, Florence M.; Ghosh, Shibani
    Environmental enteric dysfunction (EED), a subclinical disorder of the small intestine, and poor growth are associated with living in poor water, sanitation, and hygiene (WASH) conditions, but specific risk factors remain unclear. Nested within a birth cohort study, this study investigates relationships among water quality, EED, and growth in 385 children living in southwestern Uganda. Water quality wasassessed using a portable water quality testwhen children were 6 months, and safe water was defined as lacking Escherichia coli contamination. Environmental enteric dysfunction was assessed using the lactulose:mannitol (L:M) test at 12–16 months. Anthropometry and covariate data were extracted from the cohort study, and associations were assessed using linear and logistic regression models. Less than half of the households (43.8%) had safe water, and safe versus unsafe water did not correlate with improved versus unimproved water source. In adjusted linear regression models, children from households with safe water had significantly lower logtransformed (ln) L:M ratios (β: −0.22, 95% confidence interval (CI): −0.44, −0.00) and significantly higher length-for-age (β: 0.29, 95% CI: 0.00, 0.58) and weight-for-age (β: 0.20, 95% CI: 0.05, 0.34) Z-scores at 12–16 months. Furthermore, in adjusted linear regression models, ln L:M ratios at 12–16 months significantly decreased with increasing length-for-age Z-scores at birth, 6 months, and 9 months (β: −0.05,95%CI: −0.10, −0.004; β: −0.06,95%CI: −0.11, −0.006; and β: −0.05, 95%CI: −0.09, −0.005, respectively). Overall, our data suggest that programs seeking to improve nutrition should address poor WASH conditions simultaneously, particularly related to household drinking water quality.