Browsing by Author "Shrestha, Robin"

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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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    Implementing a Cold-Chain System for Nutritional Assessment in Rural Uganda; Field Experiences from FtF Nutrition Innovation Lab Cohort Study
    (International Journal of Nutrition, 2018) Agaba, Edgar; Shrestha, Robin; Ghosh, Shibani; Griffiths, Jeffrey K.; Bashaasha, Bernard
    To elaborate on the procedures undertaken to establish blood draws and cold chain for nutrition assessments. Setting: A total of 5,044 birth cohort households were enrolled and assessed using household questionnaires, anthropometry, and blood sampling to assess nutritional issues and exposures to environmental contaminants. The challenge was to obtain, transport, process, store, and analyze tens of thousands of serum samples obtained in sites that were often difficult to reach. Approach: Before enrollment began, 24 healthcare facilities in the North and Southwest of Uganda were assessed for suitability as local nodes for processing and storage. Equipment needs included functional centrifuges, refrigeration, ice machines, and -20oC freezers. Other important physical infrastructure included the presence of backup power (generator or solar generated) in the event of electricity failure. Once samples were obtained, they were transported within 5 hours to the facility laboratories, where serum was separated and aliquoted into properly labelled storage tubes and then frozen. Relevant Changes: At community level, our team visited households or small group of household members close to their homes to reduce on travel time hence contributed to high retention rates. Our immediate testing for anemia and malaria results benefited enrollees and enhanced community acceptance. By using Village Health Teams (VHTs), we could accommodate household preferences for the timing of sample collection. Our engagement with phlebotomists transformed their role from a simple service into active team members. Lessons Learned: Our first lesson was that in our setting, the success of this nutrition biological sampling system required community engagement and acceptance. By combining an immediately actionable set of tests (for anemia and malaria), and visiting cohort households, we greatly enhanced the success of the system.
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    Predictors of low birth weight and preterm birth in rural Uganda: Findings from a birth cohort study
    (PloS one, 2014) Bater, Jorick; Lauer, Jacqueline M.; Ghosh, Shibani; Webb, Patrick; Agaba, Edgar; Bashaasha, Bernard; Turyashemererwa, Florence M.; Shrestha, Robin; Duggan, Christopher P.
    Approximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda. Methods Data were derived from a prospective birth cohort study conducted from 2014–2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses. Results Among infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were �20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended �4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds. Conclusions In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.
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    Young Children Who Eat Animal Sourced Foods Grow Less Stunted: Findings of Contemporaneous and Lagged Analyses from Nepal, Uganda and Bangladesh
    (Research Square, 2020) Zaharia, Sonia; Ghosh, Shibani; Shrestha, Robin; Manohar, Swetha; Thorne-Lyman, Andrew; Bashaasha, Bernard; Kabunga, Nassul; Gurung, Sabi; Namirembe, Grace; Heneveld, Katherine; Liang, Lichen; Webb, Patrick
    In resource constrained countries, animal-sourced foods (ASFs) are an important nutrient-dense source of vitamins, minerals and macronutrients. While several studies have suggested the value of ASFs to child growth, most empirical evidence is based on cross-sectional data which can only provide information about the contemporaneous relationship between diet and anthropometric outcomes. This study uses longitudinal panel data for Nepal, Bangladesh, and Uganda to assess the association between contemporaneous as well as past ASF consumption and linear growth of children aged 6-24 months. Fixed effects models found that ASF consumption was significantly correlated with lower stunting, with a decline in stunting prevalence as high as 10% in Nepali children who had consumed any ASF in the previous year. Consuming two or more ASFs showed an even higher magnitude of association, ranging from a 10% decline in prevalence of stunting associated with lagged consumption in Bangladesh to a 16% decline in Nepal.