Five-years Of Age Research Articles

An overview of diarrhea among infants and under-five in Punjab-Pakistan

BackgroundDiarrhea, pneumonia, malnutrition, tuberculosis, measles, and fever are the leading causes of mortality in children under five-years of age (0–59 months), whereas diarrhea alone is the world's second-biggest cause of mortality in this population. This study is particularly important for Pakistan as it focuses on one of the main causes of infant mortality, diarrhea, which is a major challenge for Pakistan to achieve the Sustainable Development Goals to reduce infant mortality to 12/1000 live births by 2030. AimThis study was planned to investigate the various household, parental, environmental, and child-related factors causing diarrheal diseases in children aged 0–59 months in Punjab Pakistan. MethodsThe study used the data of 38,405 households from the Multiple Indicator Cluster Survey (MICS) 2017–18, directed by the Punjab Bureau of Statistics. Comprehensive descriptive statistics, i.e., cross-tabulations and logistic regression were used for the detailed analysis. FindingsThe results showed that infants are more probable to get diarrhea than older children. A wide range of influences were found to affect the probability of a child getting diarrhea, including child-specific, mother-specific and environment-specific ones. One prominent finding was that, at the mother level, the education of the mother played a significant role in reducing diarrhea among children under five-years of age (0–59 months). DiscussionThe results of the study contribute to the literature by highlighting that it is an interplay of factors that result in diarrhea. Hence, improving the source of drinking water, e.g., tap water and bottled water, can decrease the occurrence of diarrhea, especially in poor households. It was also revealed that households with a toilet facility of flush have less probability of their children being diagnosed with diarrhea than toilet facilities in open drains and fields. On the child level, results suggested that birth order matters as well, with the firstborn child having a lower probability of contracting diarrhea than siblings born after. Application to practiceInterventions targeting infants and mothers of infants aimed at reducing diarrhea are expected to be very effective to reduce child mortality, one of the main child health challenges faced by Pakistan.

Development of a predictive algorithm to identify pre-school children at risk for behavior changes associated with sleep-related breathing disorders

Study objectivesChildren with late-onset (2–5 years) or persistent (3 months–5 years) sleep-related breathing disorder (SRBD) have an increased risk of behavior problems compared to children with no or early-onset SRBD. We sought to determine whether a combination of urine metabolites and sleep questionnaires could identify children at risk for SRBD-associated behavior problems. MethodsUrine and data were analyzed from the Edmonton site of the CHILD birth cohort study. We measured urine metabolites (random, mid-stream) at age three-years among a sub-cohort of participants (n = 165). Random Forest with a Boruta wrapper was used to identify important metabolites (creatinine-corrected, z-scores) for late/persistent SRBD versus no/early SRBD (reference). An algorithm was subsequently generated to predict late/persistent SRBD in children with a history of snoring using a metabolite composite score (z-scores < or ≥ 0) plus the SDBeasy score defined as [age (yrs.) of most recent positive SRBD]2 – [age (yrs.) first reported ever snoring]2. ResultsOf the 165 children with SRBD data, 40 participants had late/persistent SRBD. Seven urinary metabolites in addition to the SDBeasy score were confirmed as important for late/persistent SRBD (AUC = 0.87). Among children with an ever-snoring history and a metabolite composite score ≥0, those with SDBeasy score ≥3 were over 13-fold more likely to have late/persistent SRBD (OR 13.7; 95%CI: 3.0, 62.1; p = 0.001). This algorithm has a Sensitivity of 69.6%, Specificity of 85.7% and a positive likelihood ratio (+LR) of 4.9. ConclusionsWe developed a predictive algorithm using a combination of questionnaires and urine metabolites at age three-years to identify children with late/persistent SRBD by five-years of age.

Personal air pollutant exposure monitoring in South African children in the VHEMBE birth cohort

The burden of disease associated with environmental exposures disproportionately impacts residents of low- and middle-income countries. Children living in rural regions of these countries may experience higher exposure to insecticides from indoor residual spraying used for malaria control and household air pollution. This study evaluated environmental exposures of children living in a rural region of South Africa. Quantifying exposure levels and identifying characteristics that are associated with exposure in this geographic region has been challenging due to limitations with available monitoring techniques. Wearable passive samplers have recently been shown to be a convenient and reliable tool for assessing personal exposures. In this study, a passive sampler wristband, known as Fresh Air wristband, was worn by 49 children (five-years of age) residing in the Limpopo province of South Africa. The study leveraged ongoing research within the Venda Health Examination of Mothers, Babies, and their Environment (VHEMBE) birth cohort. A wide range of chemicals (35 in total) were detected using the wristbands, including polycyclic aromatic hydrocarbons (PAHs), organochlorine pesticides, phthalates, and organophosphate esters (OPEs) flame retardants. Higher concentrations of PAHs were observed among children from households that fell below the food poverty threshold, did not have access to electric cookstoves/burners, or reported longer times of cooking or burning materials during the sampling period. Concentrations of p,p′-DDD and p,p′-DDT were also found to be elevated for children from households falling below the food poverty threshold as well as for children whose households were sprayed for malaria control within the previous 1.5 years. This study demonstrates the feasibility of using passive sampler wristbands as a non-invasive method for personal exposure assessment of children in rural regions of South Africa to complex mixtures environmental contaminants derived from a combination of sources. Future studies are needed to further identify and understand the effects of airborne environmental contaminants on childhood development and strategies to mitigate exposures.

Free sugars and early childhood caries development: a prospective cohort study.

To investigate the impact of giving children younger than 2years foods and beverages with free sugars on the prevalence of early childhood caries at 5years. The study group consisted of 208 children (105 boys and 103 girls) with a complete set of data on nursing, diet and caries from birth to 5years. We collected feeding habits and dietary data through structured questionnaires at 6, 12, 18 and 24months and the presence of decayed (d), missed (m) and filled (f) teeth was scored according to the WHO criteria at fiveyears of age. We processed data with chi-square tests and expressed as relative risk (RR) with 95% confidence intervals. At the age of 5years, 22% of the children had caries. Intake of fruit juice with meals (RR 2.3) and cookies or biscuits at 24months of age (RR 2.4), as well as fast food consumption at least once every week (RR 2.9), more than doubled the risk for early childhood caries (p < 0.05). Within the limitations of the present study, we found a relationship between consumption of free sugars early in life and dental caries prevalence at 5years. It therefore seems important to embrace and emphasise the current sugar recommendations in primary and dental care to educate caregivers to avoid serving free sugars to their children before the age of 2years.

Evaluation of Nutritional Status of Children below 5 Years of Age for Valuation of Rickets Caused by Nutritional Deficiency

Aim: To determine the nutritional status of children under five-years of age, the factors related to it and the degree of malnutrition. Study Design: A cross-sectional study. Place and Duration: In the department of Paediatrics, Hayatabad Medical Complex, Peshawar for the duration of six months from July, 2021 to Dec, 2021. Methods: Using a non-probability-based convenient sampling technique, approximately 130 children under the age of five were selected. The nutritional status and physical development of children was assessed with simple anthropometric technique. A partially pre-tested organised survey form was given to collect the data by face-to-face interviews with the mothers of the children. SPSS version 22.0 was applied for data collection and to estimate percentages and numbers. Results: Of 130 children, 80(61.5%) were male and 50(38.5%) were female. According to the classification of Gómez's, 102 children had Malnutrition out of 130 children; 55 (42.3%) had grade I, and 24 (18.5%) had grade II and 23 (17.7%) had grade III malnutrition. Of 80 children, 32.3% had mild stunned growth, 16.9% moderate stunned growth, and 12.3% severe stunned growth. When status of immunization was calculated, 32 (24.6%) were nonimmunized, partially immunization was seen in 65 (50%) children and fully immunization in 33 (25.4%) cases. Of the 98 uneducated mothers, 60(63.2%) had malnourished children, 70(71.4%) had Kwashiorkor, and 28(28.6) had marasmus. Of 130 children, 90 were breastfed and children on bottle-fed were 40. Conclusions: The malnutrition rate was augmented among children &lt;5 years of age (78.6%) due to inadequate eating habits. Accompanying influences were insufficient immunization and illiterate mothers. The education regarding health counting adequate weaning, exclusive breastfeeding, family planning and routine immunization via schedule of EPI should be encouraged. Keywords: Nutritional status, Child, Risk factors, Protein and Energy malnutrition.

Prevalence and factors associated with malnutrition among under 5-year-old children hospitalized in three public hospitals in South Africa

Background: Malnutrition is a significant risk factor for ill health among children under five-years of age and the consequences are significant.Aim: To determine the prevalence and factors associated with malnutrition among under-5-year-old hospitalized children. Setting: Sebokeng regional and Kopanong and Heidelberg district hospitals, Sedibeng district, South Africa.Methods: A cross-sectional study of 306 hospitalized under-5-year-old children. Information on socio-demography, feeding practices, immunisation and clinical problems were obtained from caregivers and medical records. Anthropometric measurements were also performed. Results: Most participants were male (59.8%), 12 months old (52.9%), had normal birth weights (80.0%), comes from a household with a monthly income R2000 (about150 US dollars) (50.3%), up-to-date immunization (97.4%), breastfed for 6months (57.4%) and cared for by the mother (92.5%). Most participants were fed 3-4 meals/day (66.7%) and at most, one snack/day (63.4%). Acute malnutrition accounted for 9.5% (n=29) of admissions. Among these, 82.8% (n=24) had severe acute malnutrition. On test of association, monthly household income (p0.01), mother’s and father’s employment status (p0.01 p0.01), breastfeeding history (p0.01) and having diarrhoea in index admission (p0.01) were significantly associated with malnutrition admission. In multivariate regression analyses, not being breastfed (OR=3.9; 95%CI: 1.23–12.29; p=0.02) and diarrhoea at index admission were independently associated with malnutrition (OR=23.3; 95%CI: 6.85–79.43; p0.01).Conclusion: A significant proportion of participants had malnutrition and were subjected to suboptimal feeding practices. Healthcare providers in primary care need to entrench dietary education and anthropometric screening in all clinic-visits for children 5year old, particularly when they present with diarrhoea or are not being breastfed.

Moderating the Risk for Attention Deficits in Children with Pre-Adoptive Adversity: The Protective Role of Shorter Duration of out of Home Placement and Children's Enhanced Error Monitoring.

Early institutional-deprivation has been found to increase risk for inattention/hyperactivity (ADHD). Notably, studies suggest that children with a history of adversity evidencing an enhanced ERP (the error-related-negativity; ERN) may be protected against attention problems. However, such protective effects of the ERN have been studied in children whom typically experienced residential instability. It is unknown whether error-monitoring is similarly protective for children with stable post-deprivation placements. The present study examined the protective effect of the ERN in a sample of children who experienced at least 3-years of stable, relatively enriched caregiving after being internationally-adopted as infants/toddlers from institutional-care. We included two groups of children adopted internationally before age three, one group adopted from institutional-care (PI:n = 80) and one comparison group adopted from foster-care (FC;n = 44). A second comparison group consisted of non-adopted children (NA;n = 48) from demographically comparable families. At five-years of age, we assessed child ADHD symptoms (parent-report) and behavioral performance and neural correlates of error-monitoring (Go/No-Go task). PI children displayed lower Go/No-Go accuracy relative to FC children, and higher levels of ADHD symptoms relative to NA controls. In both FC and PI groups, longer duration of pre-adoptive out-of-home placement was associated with inattention, especially for children with deficits in error-monitoring. Enhancing cognitive control in the form of error monitoring might be a useful intervention target to protect children from some of the negative outcomes associated with adverse early care. Furthermore, results underscore that regardless of type of pre-adoptive care, we should aim to place children in stable/permanent homes as early as possible.

Risk Factors of Acute Respiratory Infections in Children under Five Years Attending the Fishtail Hospital, Pokhara, Nepal

Introduction: Acute Respiratory Infection (ARI) is one of the leading causes of morbidity and mortality in under five-year children. Risk factors include age, sex, socio‐economic status, indoor air pollution, passive smoking, lack of basic health services, and lack of awareness. In this study, we aimed to determine the associated risk factors of ARI in children under five-years of age.&#x0D; Methods: We carried out a hospital-based descriptive cross-sectional study in the peak period of of November 2017 to February 2018. The study was conducted in Fishtail Hospital and Research Center (FHRC), Pokhara, Nepal. Non probability, purposive sampling technique was used and a structural interview was taken for data collection. The tool comprised of two main parts. Part I- questions related to socio-demographic variables of mother and baby. Part II- questions related to risk factors of ARI. The collected data was analyzed using Statistical Package for Social Science (SPSS) software, version 16. The Chi Square statistic is used for testing relationships between categorical variables.&#x0D; Results: In total of 302 children visited to FHRC with the symptoms of ARI, only 188 (63%) were diagnosed as ARI. The most common symptoms were fever (42.2%), cough (35.7%), running nose (34.1%), difficulty in breathing (28.5%) and chest in drawing (11.6%). The age of children with ARI ranged from one to sixty month with the mean age of 21.46 ±13.52. Among 188 children, 51% were males whereas 49%were females. There were no statistically differences of children weight at birth among ARI. Our results revealed environmental and social factors associated with ARI.&#x0D; Conclusions: The risk factors significantly associated with ARI were malnutrition, exposure to wood smoke and mosquito coil and contact with person having ARI. Reducing these conditions may reduce the morbidity and mortality associated with ARI in children.

Description Trend Activities of Family Development Program Bina Keluarga Balita (Poktan BKB) (KKBPK Survey for RPJMN Family 2017)

Being the main pilar of development, there is still a need to develop the qualities of human resource. These qualities of human resources consist of level of health and emotional and spiritual maturities that can be assessed from a child starting from the fetus stage to the age of 6 years old. During this period, a child is in a serious need of nutritious and balanced food, education, and care for various aspects so that her or she can grow and develop optimally through a good family development. The aim of this research was to describe family development program trends throughout the so-called activity group of Bina Keluarga Balita (BKB). Hence, this study used the descriptive quantitative approach. The data were collected from the results of the KKBPK survey on 2017 family RPJMN. The results howed that family knowledge on BKB increased by 43% (in 2017) compared to 41% (in 2016), family parenting experiences in the nurturing children who where under five-years of age and of pre-school ages mostly consisted of distribution of nutritious food, amounting to 72.9% (2015), 70.8% (2016) and 73.4% (2017), accompanying children to play which reached 39.25% (2015), 57.2% (2016) and 63.5% (2017), and giving the opportunity to their children to play with their peers which amounted to 52.2% (2015), 72.0% (2016) and 78.0% (2017). In conclusion, family development trends through the Bina Keluarga Balita activity group showed an increased from year 2015 to 2017. Moreover, the index of parenting experiences and growth and development of children under five years of age and of pre-school ages was 66.7% in year 2017 (index range 0–100), which had fulfilled the strategic planning target.

Description Trend Activities of Family Development Program Bina Keluarga Balita (Poktan BKB) (KKBPK Survey for RPJMN Family 2017)

Being the main pilar of development, there is still a need to develop the qualities of human resource. These qualities of human resources consist of level of health and emotional and spiritual maturities that can be assessed from a child starting from the fetus stage to the age of 6 years old. During this period, a child is in a serious need of nutritious and balanced food, education, and care for various aspects so that her or she can grow and develop optimally through a good family development. The aim of this research was to describe family development program trends throughout the so-called activity group of Bina Keluarga Balita (BKB). Hence, this study used the descriptive quantitative approach. The data were collected from the results of the KKBPK survey on 2017 family RPJMN. The results howed that family knowledge on BKB increased by 43% (in 2017) compared to 41% (in 2016), family parenting experiences in the nurturing children who where under five-years of age and of pre-school ages mostly consisted of distribution of nutritious food, amounting to 72.9% (2015), 70.8% (2016) and 73.4% (2017), accompanying children to play which reached 39.25% (2015), 57.2% (2016) and 63.5% (2017), and giving the opportunity to their children to play with their peers which amounted to 52.2% (2015), 72.0% (2016) and 78.0% (2017). In conclusion, family development trends through the Bina Keluarga Balita activity group showed an increased from year 2015 to 2017. Moreover, the index of parenting experiences and growth and development of children under five years of age and of pre-school ages was 66.7% in year 2017 (index range 0–100), which had fulfilled the strategic planning target.

Antenatal care practices among the women with children under five-years of age in an eastern Nepal village: A cross sectional study

Background: Antenatal care has proven to be an effective way to reduce maternal mortality and save the life of newborn. Nepal also follows the World Health Organization’s recommendations of initiation of four antenatal care visits that has helped in decreasing the maternal mortality of the country. Still, the country has to do a lot in improving the antenatal care provision.Objective: The objective of this study was to find out the antenatal care practices among the women with children less than five years of age in a district of eastern Nepal.Methods: A descriptive cross-sectional study was conducted among residents of Aurabani village of Sunsari district. Non probability convenient sampling technique was used to collect data from 15th January to 30th January, 2015. Data of 100 women having children less than five years of age were collected and analyzed in descriptive and inferential ways.Results: Women with nuclear family are more likely to have antenatal care visits (73.8%) compared to women with joint family (66.7%). The study showed that attendance of antenatal care visits among the educated women was higher (71.8%) than those illiterate (66.7%). In the study, 84.8% of women of primi-gravida completed antenatal care visit which was significantly higher than women with multi gravida (59.3%) (p &lt;0.05). Further, 83.1% of respondents who completed tetanus toxoid injections had not walked &lt;30 meters distance for health services which was significantly higher than those walking &gt;30 meters distance (52.9%). An almost similar trend was found among pregnant women taking iron tablets and vitamin A. Furthermore, walking distance shows stronger association with women taking albendazole during pregnancy (p &lt;0.001).Conclusion: A large percentage of women completed all four recommended antenatal visits. Women and their husbands who were educated placed high importance on antenatal visits. Gravida of the pregnancy was also related to the antenatal care visit. High number of primi-gravida women completed antenatal care visits than women with multigravida. Use of medicines like iron tablets, albendazole tablets, vitamin A and tetanus toxoid injection was directly related with the walking distance to the health center.Journal of Kathmandu Medical CollegeVol. 5, No. 3, Issue 17, Jul.-Sep., 2016, page: 89-94

Burden of invasive pneumococcal disease (IPD) in Sri-Lanka: Deriving a reasonable measure for vaccine introduction decision making

PurposeThe lack of evidence on the disease burden has been an obstacle for decision-making on introducing pneumococcal vaccines in Sri-Lanka. Hence, the purpose of this study is to determine the incidence of invasive pneumococcal disease among children under five-years of age in Sri-Lanka's Colombo district. MethodsIn a community-based study, using a sample of 2310 children, we identified syndromes associated with pneumococcal disease (pneumonia, meningitis, sepsis). The estimates of annual cumulative incidence of invasive pneumococcal disease were derived by having applied proportions of laboratory confirmed invasive pneumococcal disease among all-cause syndromes associated with pneumococcal infection obtained from the hospital-based invasive bacterial disease sentinel surveillance and findings of the community-based study to population parameters of the district. The estimates of invasive pneumococcal pneumonia and sepsis based on low-sensitive, culture confirmation were adjusted by a correction factor. ResultsThe annual cumulative incidence of all-cause clinical syndromes associated with pneumococcal disease (pneumonia, meningitis, sepsis) were 1.3, 0.52, 0.39 per 100 children, respectively. The estimate of adjusted, invasive pneumococcal disease cumulative incidence was 206.3 per 100,000 while estimates of pneumococcal pneumonia, meningitis and sepsis cumulative incidence were 147.9, 13.2 and 45.2 per 100,000 under-five children. ConclusionReasonable estimates of invasive pneumococcal disease could be derived by using incidence of clinical syndromes associated with pneumococcal disease obtained from population-based studies and proportion of pneumococcal infection among all-cause clinical syndromes associated with pneumococcal disease generated from hospital-based sentinel surveillance. These estimates may help informed decision-making on introduction of pneumococcal conjugated vaccine.

Risk correlates of acute respiratory infections in children under five years of age in slums of Bankura, West Bengal

Background: Acute respiratory infections (ARI) are the leading cause of mortality and morbidity globally inchildren under five years of age. Objective: To find out prevalence and risk factors of ARI among under fivechildren. Methods: A population based analytical cross-sectional study was conducted in the urban slums ofBankura, West Bengal on the prevalence of ARI and feeding practices, nutrition and immunization among 152children under five years of age. Results: Overall prevalence of ARI was 44.73 percent; 43.47 percent male and45.78 percent female were affected with ARI; half of the infants suffered from ARI (51.21%), it was 45.71percent in 13- 24 months age groups; with increasing age, prevalence of ARI gradually decreased. ARI was seenin 45.76 percent of exclusively breast fed children and 57.89 percent in children with breast feeding less than sixmonths; in bottle fed children ARI prevalence was 47.82 compared to 44.18 percent in breast-fed. Risk of ARIis almost equal in normal participants and undernourished children. ARI cases were seen among 38.73 percentof completely immunization in comparison to 80.00 percent of partially-immunized children (X2=4.97,p=0.026). Conclusion: The present study had identified a high prevalence of ARI in children less than fiveyears of age. In our study population, ARI was significantly associated with immunization status, but not withfeeding practices and nutritional status of the child.

Bilateral implantation of multifocal versus monofocal intraocular lens in children above 5 years of age

To evaluate visual results and complications after bilateral implantation of multifocal versus monofocal intraocular lens (IOL) in children above fiveyears of age. In this prospective non-randomized controlled trial, children with bilateral developmental cataract above fiveyears of age were divided into two groups - Group A implanted with multifocal IOL (both refractive and diffractive) and Group B implanted with monofocal IOL in both eyes. Outcome measures of best corrected visual acuity (BCVA) for distance, distance-corrected near visual acuity (DCNVA), mean refractive spherical equivalent (MRSE), contrast sensitivity, stereopsis and complications such as posterior capsular opacification (PCO) and glare were analyzed using the Mann-Whitney U and the Wilcoxon Signed Rank tests. Forty-two eyes of 21 children (mean age: 7.19years, range: 5-12years) were included in the study. Group A included 14 eyes (seven children) Group B included 28 eyes (14 children). Both groups showed significant improvement in BCVA at oneyear follow-up, but no significant difference was found on comparing contrast sensitivity. Stereopsis was slightly better in Group A (125.71 arc-sec) as compared to Group B (140 arc-sec) (p = 0.280). Most patients in Group A were spectacle-independent for near (71.4%) versus Group B. MRSE at oneyear was 0.21 in Group A and 0.5 in Group B. Incidence of PCO was similar in either groups (35.7%). No intraoperative complication was noted in any child. Multifocal IOL implantation is a viable option in children above fiveyears of age with bilateral cataract.

Mother’s health care-seeking behavior for children with acute respiratory infections in a post-earthquake setting

Background Delayed health care-seeking behavior is a causeof high mortality in children due to acute respiratory infections(ARis). Factors that may affect health care-seeking behavior aresocioeconomic status, maternal age, maternal education, parents'perception of illness, child's age, number of children under fiveyears of age in the family, and occurrence of natural disasters. The2006 Central Java earthquake damaged homes and health carefacilities, and led to increased poverty among the residents.Objective To assess the relationship between socioeconomicstatus and mother's health care-seeking behavior for childrenunder five years of age with ARis in a post-earthquake setting.Methods This cross-sectional study used secondary data obtainedfrom the Child Health Need Assessment (CHNA) survey. Logisticregression test was used to analyze variables that may affectmother's health care-seeking behavior for children under fiveyears of age with ARis.Results Of the 665 infants surveyed, 442 infants (66.5%)had ARis. Health care-seeking behavior was good (81.7%)in the majority of mothers. We observed that socioeconomicstatus did not affect maternal health care-seeking behavior forchildren under five with ARis (OR 1.33; 95%CI 0.79 to 2.24;P= 0.26). Maternal age, maternal education, child's age andgender, number of children under five in the family, parents'perceptions of illness and severity of house damage caused by theearthquake also had no effect on maternal health care-seekingbehavior for children with ARis.Conclusion After the 2006 earthquake, we find that socioeconomicstatus, maternal age, maternal education, child age, child gender,number of children under five in the family, parents' perceptionsof illness, and severity of house damage have no effect on mother'shealth care-seeking behavior for their children with ARis.

Association of the ACTN3 Genotype and Physical Functioning with Age in Older Adults

Alpha-actinin-3 (ACTN-3), a structural protein in type II skeletal muscle fibers, is important for maintaining structure of the myofibrillar array. Although not all studies agree, recent data suggest that the R577X variant in the ACTN3 gene explains some of the inter-individual variability in muscle functioning in older adults. PURPOSE: To examine the association of the ACTN3R577X polymorphism with muscle function and physical performance in older adults. METHODS: To determine the association of the R577X polymorphism (RR, RX, & XX groups) with muscle function and physical performance, we measured knee extensor torque, mid-thigh muscle cross-sectional area, muscle quality, short physical performance battery score, and 400-meter walk time at baseline and after five-years of age in white older adults between the ages of 70-79 yr in the Health, Aging and Body Composition (Health ABC) Study cohort (n = 1,367). Incident persistent lower extremity limitation (PLL) over five-years was also assessed. The X-homozygote frequency in the black sub-group was too low to include in the analysis. RESULTS: There were no significant differences between R577X genotype groups in men or women for baseline muscle function or for performance phenotypes, when these data were adjusted for potential confounders. Men who were X-homozygotes had a significantly greater adjusted five-year increase in their 400-meter walk time compared to R-homozygotes (p= 0.008) and heterozygotes (p= 0.075). In women, R-homozygotes had an ∼ 35% lower risk of incident PLL compared to X-homozygotes (HR = 0.65, 95% CI = 0.44 - 0.94), but this association was not observed in men. CONCLUSIONS: The present results indicate the ACTN3R577X polymorphism may influence declines in physical performance with age in older white adults. However, the influence of the ACTN3R577X polymorphism should be interpreted with caution based on the strength of these associations and lack of a replication sample. This research was supported in part by the Intramural Research Program of the NIH, National Institute on Aging. NIA contract #s: N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106.

The Blantyre Integrated Malaria Initiative: a model for effective malaria control.

The Blantyre Integrated Malaria Initiative (BIMI) is a district-wide malaria-control effort, supported jointly by the Government of Malawi and the United States Agency for International Development (USAID). BIMI was established in Blantyre District, Malawi in 1998 to promote sustainable and effective strategies to manage and prevent malaria-related morbidity and mortality. The goal of BIMI is to reduce malaria-related deaths among children under five-years of age by 30% by meeting the four main objectives listed in table 1. The key BIMI interventions and their expected beneficial outcomes are described in table 2. [Table: see text] [Table: see text].