ABSTRACT
Objectives: Primary outcome was change in composition of gut microbiome, after 3 weeks and 4 months. Secondary outcomes were changes in faecal calprotectin, treated diarrhoea, anaemia, iron status and systemic inflammation. Methods: We performed two randomized controlled trials in 6-month-old Kenyan infants consuming home-fortified maize porridge daily for four months. 1) infants received an MNP containing 2.5 mg iron as NaFeEDTA (+2.5 mgFeMNP) or the identical MNP without iron (-2.5 mgFeMNP). 2) a different MNP containing 12.5 mg iron as ferrous fumarate (+12.5 mgFeMNP) or the identical MNP without iron (-12.5 mgFeMNP). Results: We enrolled 117 infants, and 101 infants completed the studies between March 2010 and September 2012. Baseline prevalence of anaemia and systemic inflammation were 67.3% and 29.7%, respectively. At baseline, 63% of the total microbial 16S rRNA could be assigned to Bifidobacteriaceae; using qPCR, Salmonella was detected in 22.8% of infants, B. cereus in 38.6%, S. aureus in 71.3%, C. difficile in 53.5%, and C. perfringens in 86.1%. Body iron stores increased in the +12.5 mgFeMNP (p=0.001), but not in the +2.5 mgFeMNP. Using pyrosequencing, +FeMNPs increased enterobacteria, especially Escherichia/Shigella (p=0.048), the enterobacteria/ bifidobacteria ratio (p=0.020), and Clostridium (p=0.03) compared to -FeMNPs; +FeMNPs also increased faecal calprotectin (p=0.002). Most of these effects were confirmed using qPCR, and many were statistically stronger in ±12.5 mgFeMNP study than in ±2.5 mgFeMNP study. During the trial, 27.3% of infants in the +12.5 mgFeMNP group required treatment for diarrhoea vs. 8.3% in the -12.5 mgFeMNP group (p=0.092). Conclusions: In rural Africa where infectious disease burden is high, provision of iron-containing MNPs to infants increases gut inflammation and modifies the gut microbiome toward a potentially more pathogenic profile.
ABSTRACT
Abstract:There is increasing evidence of an association between female genital Schistosoma haematobium infection and HIV. In KwaZulu-Natal; we aimed to explore girls' water contact practice and to determine whether a study exclusively on girls would be manageable and welcomed. Three primary schools that had participated in a parasite control programme eight years prior were approached. Subject to consent; girls aged 9 to 12 years were interviewed on water-body contact; symptoms and household composition. Urine samples were analysed for S. haematobium infection eggs. Good dialogue was achieved in all schools and 95 consented to had an S. haematobium infection; geometric mean intensity 10.5 ova per 10 ml urine. Only 12participation; 43 had ever been treated for S. haematobium. Water-body contact was significantly associated with S. haematobium (OR 2.8; 95 CI 1.3-5.9; p= 0.008); however; S. haematobium was also found in 20 of girls who claimed to never have had water-body contact. Sixty-four percent thought they had no choice but to use unprotected water; 21 had no mother in the household; and being an orphan increased the risk of having S. haematobium. The community welcomed the study. Prevalence levels in South Africa are so high that some communities are eligible for WHO-recommended regular mass treatment