ABSTRACT
Objectives: To determine the prevalence and risk factors of zinc deficiency among young children in rural south-western Burkina Faso. Methods: We collected socio-economic, demographic, feeding practice and morbidity information from a sample of 473 children 6-18 mo of age residing in southern Orodara health district; and measured plasma zinc concentration (PZC) by ICP-AES and C-reactive protein and alpha-1 acid glycoprotein by ELISA to adjust PZC for inflammation. Zinc deficiency was defined as PZC ˂ 65μg/L. Associations between selected risk factors and low PZC were screened in bivariate analyses and assessed by generalized multivariable logistic regression. Results: Mean adjusted PZC was 68.4±13.1 ug/L, and the prevalence of zinc deficiency was 43.5% [95%CI: 38.4-48.7]. The odds of zinc deficiency was significantly higher in households with no livestock ownership as compared to the two highest quintiles of livestock ownership (OR= 2.4- 2.5, p<0.05) and when more households shared the family compound (OR= 1.8, p<0.026 for 3-4 households as compared to 1 household per compound). Religion was also associated with zinc deficiency, but recent child morbidity history and feeding practices were not. Conclusions: There is a high prevalence of zinc deficiency among young children in rural southwestern Burkina Faso, especially among children living in large family compounds. Homestead livestock rearing and possibly some religious/cultural habits may reduce the risk of zinc deficiency.
ABSTRACT
Objectives: We aimed to assess knowledge, attitudes and practices (KAP) of iron and folic acid (IFA) supplementation among pregnant women and health staff in rural Niger. Methods: KAP were assessed in 4 randomly selected villages in the Zinder region of Niger as part of a formative research study conducted to inform the design of a program to improve antenatal care services. Data collection included home interviews of pregnant women (n=72) and a focus group of 8-10 pregnant women in each village. In 5 randomly selected health centers, we observed 33 antenatal care (ANC) consultations, and interviewed pregnant women and health staff following these observations. Results: Among 72 pregnant women interviewed in their homes, 96% had knowledge of IFA supplements and 97% of these stated at least one health benefit of IFA. However, among those who had already attended at least 1 ANC visit (n=52), only 65 % reported having taken IFA supplements on the day prior the interview. Reported side effects were rare. Among 5 health centers visited, 3 had IFA supplement in stock. Health staff did not provide IFA supplements to the pregnant women during 18 of 33 observed ANC consultations of which only 7 cases could be explained by the lack of IFA supplements in stock. Conclusions: IFA supplements are well known by pregnant women. The supply chain of the health centers should be ensured and health staff retrained for an effective IFA supplementation among pregnant women.
ABSTRACT
Objectives: Zinc supplements may decrease incidence of diarrhea among young children at risk of zinc deficiency. We estimated the cost-effectiveness of three approaches for delivery of preventive and therapeutic zinc supplements in rural Burkina Faso. Methods: Cost estimates were derived from data collected during a community-based randomized zinc trial, information on ongoing child-health days to distribute public health services, and an indepth study of the current health care system. Diarrhea incidence reduction is based on intent-totreat analysis of zinc trial data. Activity-based costing using an ingredients approach accounts for the costs of mutually exclusive inputs related to defined program activities for each approach. Cost-effectiveness is analyzed and compared across an intermittent preventive zinc (IPZ) approach (quarterly delivery of 10-days of 10 mg/d supplements to childrens’ homes), and a therapeutic approach (10-days of 20 mg/d supplements delivered during an ill-child consultation at a local clinic (TZ-CSPS) or via community-based health worker (TZ-CHW)). We assume 81.6% of children are reached with IPZ and .06% and 52% of diarrhea cases treated with TZ-CSPS and TZCHW, respectively. Results: Estimated annual program cost per additional child reached is $3.52 (IPZ), $3.49 (TZCSPS) and $17.59 (TZ-CHW). Cost per death averted in the first program-year is estimated to be $3164 (IPZ), $7363 (TZ-CSPS), and $14068 (TZ-CHW), assuming a diarrhea case fatality rate of 0.3% and 2.64 episodes of diarrhea/child/year. Estimated cases of diarrhea averted per year are 11.5% (IPZ), 0.9% (TZ-CSPS), and 8.2%(TZ-CHW). Conclusions: IPZ is the most cost-effective approach for a zinc program among our study population.
ABSTRACT
Objectives: To assess the effect of three zinc supplementation strategies, provided with diarrhea and malaria treatment, on zinc, iron and vitamin A status. Methods: During a community-based, cluster-randomized, zinc supplementation trial, we collected venous blood at baseline and after 48 weeks in a random subsample of 451 rural Burkinabe children 6-18 mo old assigned to 4 groups: 7 mg zinc/d, ORS+placebo for diarrhea (DPZ); 10 mg zinc/d for 10d/16wks followed by daily placebo, ORS+placebo for diarrhea (IPZ); daily placebo, ORS+20mg zinc/d for 10d for diarrhea (TDZ); no intervention (NI). Supplemented children were treated for fever and malaria. Blood hemoglobin concentration (Hb) was measured by HemoCue®. Plasma zinc concentration (pZn), measured by ICP-AES, and plasma ferritin (pF), transferrin receptor (TfR) and retinol-binding protein (RBP) concentrations, measured by ELISA, were adjusted for inflammation. Results: High baseline rates of anemia (88.5% had Hb<11 g/dL), iron deficiency (50.5% had pF<12 ug/L; 89.9% had TfR>8.3 mg/L ), vitamin A deficiency (48.9% had RBP<0.83 umol/L) and zinc deficiency (43.5% had pZn<65 ug/dL) were not different by group. Over 48 weeks, pZn increased significantly more in DPZ (+5.8±1.9%) than in TDZ (-0.7±1.8%) and NI (-1.7±1.3%) but not than in IPZ (+2.3±1.7%). 48-week changes in Hb, pF, TfR and RBP did not differ by group. Conclusions: Daily preventive, but not intermittent preventive or therapeutic zinc supplementation, increased pZn over 48 weeks. Zinc supplementation with malaria and diarrhea treatment did not affect iron and vitamin A status.