Increase In Mid-upper Arm Circumference Research Articles

Mid-Upper Arm Circumference Is a Strong Predictor of Mortality Among Ugandan Adults With HIV-Associated Cryptococcal Meningitis: A Prospective Cohort Study.

Mortality among adults diagnosed with HIV-associated cryptococcal meningitis remains high (24%-40%). We hypothesized that nutritional state, as measured by mid-upper arm circumference (MUAC), is a potentially modifiable risk factor for mortality. Ugandan adults hospitalized with HIV-associated cryptococcal meningitis had MUAC measurements performed at baseline. We compared MUAC measurements with baseline clinical and demographic variables and investigated associations with survival using Cox regression. Of 433 participants enrolled, 41% were female, the median CD4 T-cell count (interquartile range [IQR]) was 15 (6-41) cells/μL, and 37% were antiretroviral therapy naïve. The median MUAC (IQR) was 24 (22-26) cm, the median weight (IQR) was 53 (50-60) kg, and MUAC correlated with weight (Pearson r = 0.6; P < .001). Overall, 46% (200/433) died during the 18-week follow-up. Participants in the lowest MUAC quartile (≤22 cm) had the highest mortality: 39% (46/118) at 2 weeks and 62% (73/118) at 18 weeks. A baseline MUAC ≤22 cm was associated with an 82% increased risk of 18-week mortality as compared with participants with an MUAC >22 cm (unadjusted hazard ratio, 1.82; 95% CI, 1.36-2.42; P < .001). Following adjustment for antiretroviral therapy status, CD4 count, hemoglobin, amphotericin dose, and tuberculosis status, the adjusted hazard ratio was 1.84 (95% CI, 1.27-2.65; P < .001). As a continuous variable, 18-week mortality was reduced by 10% for every 1-cm increase in MUAC. CSF Th17 immune responses were positively associated with MUAC quartile. MUAC measurement is a simple bedside tool that can identify adults with HIV-associated cryptococcal meningitis at high risk for mortality for whom an enhanced bundle of care, including nutritional supplementation, should be further investigated.

The Effect of Semangit Tempeh Cookies on MUAC, Hb, and Serum Ferritin in Pregnant Women with CED

This study aimed to analyze the effect of semangit tempeh cookies on Mid-Upper Arm Circumference (MUAC), Hemoglobin (Hb), and Serum Ferritin (SF) of pregnant women with Chronic Energy Deficiency (CED) in Lebak, Banten. The study included 47 pregnant women with MUAC&lt;23.5 cm who were divided into Control Group (CG) (n=22) and Intervention Group (TSG) (n=25). The mean increase in MUAC in the intervention group was 0.72±0.97 cm, while that in the control group was 0.75±1.23 cm (p&gt;0.05), and there was an increase in hemoglobin levels of 0.84 mg/dL in the control group and 0.18 mg in the intervention group. The level of adherence to consumption of semangit tempeh cookies in the intervention group was lower than in the control group (p&gt;0.05). The supplemental feeding of semangit tempeh cookies to pregnant women in intervention group did not have a significant effect on MUAC, Hb and serum ferritin compared to control group.

Outcomes of a food voucher program and factors associated with the recovery rate of children with moderate acute malnutrition in Far North Cameroon

BackgroundResearch on moderate acute malnutrition (MAM) is limited, despite its high prevalence. This study examined outcomes of bi-weekly locally available foods provided via a food voucher program (FVP) on nutritional recovery [mid-upper arm circumference (MUAC) ≥ 125 mm] from MAM (defined as MUAC between 115 and 124 mm) and identified the factors associated with recovery rate in Kaélé health district, Far North Region of Cameroon.MethodsThis was a prospective study with 474 MAM children aged 6–59 months. Food voucher distribution and MUAC screening were conducted at 6 bi-weekly visits or until the child was recovered. Time to recovery was evaluated with multivariate Cox proportional regression hazard models with associations quantified using adjusted hazard ratio (aHR). The trend for MUAC, including its determinants, was examined with multivariate linear mixed effect models.ResultsThe recovery rate was 78.3% by 6 weeks after the first food basket; 3.4% remained MAM, and 5.9% were transferred for treatment for severe acute malnutrition (SAM defined as MUAC < 115 mm). Boys were 34% more likely to recover from MAM than girls [aHR = 1.34, 95%CI (1.09, 1.67)]. Children aged 24–53 months were 30% more likely to recover than those aged 6–11 months [aHR = 1.30, 95%CI (0.99, 1.70)]. A one unit increase in weight-for-height Z-score (WHZ) was associated with 1.89-fold greater likelihood of recovery [aHR = 1.89, 95%CI (1.66, 2.14)]. Male children had on average 1.82 mm greater increase in MUAC than female children (p < 0.001). One unit increase in WHZ was associated with 3.42 mm increase in MUAC (p = 0.025). Children aged 12–23 and 24–53 months had 1.03 mm and 2.44 mm, respectively, greater increase in MUAC over the program than children aged 6–11 months (all p < 0.01).ConclusionThe recovery rate of MAM children treated with the FVP met the Sphere standards for targeted supplementary feeding programs (> 75%). Child’s WHZ, gender and age were significant factors associated with MUAC increase and recovery from MAM in the FVP. These findings indicate the FVP approach shows promise as an effective alternative treatment for MAM with consideration of associated factors and merits further evaluation.

Newly developed care food enhances grip strength in older adults with dysphagia: a preliminary study.

Maintaining total muscle mass in the older adults with swallowing difficulty (dysphagia) is important for preserving swallowing function. Increasing protein intake can help sustain lean body mass in the older adults. The aim of this study was to evaluate the effect of various high-protein texture-modified foods (HPTMFs) on muscle mass and perform dietary assessment in ≥ 65-yrs-old patients with dysphagia. Participants (n = 10) received the newly developed HPTMFs (average 595.23 ± 66.75 kcal/day of energy, 54.22 ± 6.32 g/day of protein) for 10 days. Relative hand-grip strength (RHS), mid-upper arm circumference (MUAC), body composition, mini nutritional assessment (MNA), mini dietary assessment (MDA), and Euro Quality-of-Life questionnaire 5-dimensional classification (EQ-5D) were assessed. After 10 days, an increase in MUAC (26.36 ± 2.35 cm to 28.50 ± 3.17 cm, P = 0.013) and RHS (0.38 ± 0.24 kg/kg body weight to 0.42 ± 0.22 kg/kg body weight, P = 0.046) was observed. Although MNA, MDA, EQ-5D, subjective health status, muscle mass, and calf circumference showed a tendency to increase after intervention, no significant differences were found. These results suggest that the HPTMFs can be used for improving the nutritional and health status in patients with dysphagia.

ANTHROPOMETRIC PARAMETER COMPARISON BETWEEN AUTISTIC AND NORMAL HEALTHY CHILDREN

Aim: The aim of this study was to assess and compare the differences in anthropometric measures between autistic and healthy children. The differences in anthropometric measures between autistic males and females were also assessed and compare. Method: Purposive/deliberate or snowball sampling method was used due to limited availability of autism centers and obtain-ability of the consent of caregivers, parent and directors of these centers. This study was carried out in autism centers, primary and secondary schools across Port Harcourt, Rivers State, Nigeria with a total number of 100 subjects (children and adolescents); 50 normal healthy subjects (comprised of 37 males and 13 females) and 50 subjects with autism (comprised of 37 males and 13 females) within the ages of 5 to 18 years. The measured parameters include; height, weight, body mass index (BMI), craniofacial circumference (CFC) and Mid-Upper Arm Circumference (MUAC). The data collected was analyzed using descriptive statistics and independent sample T-test with p-value at 0.05. Result: A statistical difference in BMI and MUAC between normal and autistic female children was obtained (t-value = -4.390 and -9.875 and at p-value =0.012 and 0.001 respectively), no statistical difference in CFC between normal and autistic female children with a t-value of 0.544 at a p-value of 0.615. Also, there was a statistical difference in BMI and MUAC between normal and autistic female adolescents (t-value = 3.361 and -2.965 and at p-value =0.003 and 0.008 respectively). There were significant differences in both parameters at p&lt;0.05 significance level whilst there was no significant differences in the craniofacial circumference (CFC). This is the same for the female adolescents with autism. In comparison of mean differences in body mass index (BMI), mid-upper arm circumference (MUAC) and craniofacial circumference (CFC) of male and female children with autism, there was a significant difference in MUAC between male and female children with autism with a t-value of -2.597 at p-values of 0.02 respectively and for male and female adolescents with autism, there was a significant difference in BMI between male and female children with autism with a t-value of -2.136 at p-values of 0.041 respectively. Conclusion: The increase in fat component which is more predominant in females is a factor responsible for the increase in MUAC and BMI in the study, due to increased carbohydrate and fat intake as well as sedentary life style. The crainofacial circumference and its variance significantly increased especially in male adolescents, suggesting the relative overgrowth of the brain in a substantial percentage of adolescents in Port Harcourt with autism. KEYWORDS: Autism, Mid Upper Arm Circumference, Craniofacial Circumference, Children, Adolescents

The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months.

The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.

Weight, height, and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross-sectional study.

We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia. A cross‐sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight, and midupper arm circumference (MUAC). Hb levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, and height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% confidence interval, CI, [0.08, 0.15], P < .001). Each kilogram of increase in the body weight showed an increase in Hb levels (0.02 g dl, 95% CI [0.01, 0.03], P = .001). With an each centimetre of increase in height, Hb increased by 0.01 g dl (95% CI [0.00, 0.02], P = .022). There was a consistent association between three measures of somatic growth and anaemia in the study population. It is likely that life‐course exposures from conception onwards contribute to this, and the public health implications are that preventing anaemia is a challenge that requires a multifaceted interventional approach. Understanding the importance of the timing of these life exposures will help design interventions that can achieve optimal results.

An Agricultural and Finance Intervention Improved Dietary Intake and Nutritional Status of Children Living in HIV-affected Households in Western Kenya (P10-129-19)

ObjectivesTo test whether an intervention that was shown previously to have improved food security, dietary intake of adults, and HIV health outcomes also improved dietary intake and nutritional status of children living in HIV-affected households. MethodsThe study was conducted in the Nyanza Region, Kenya where two health facilities were randomly assigned as intervention or control arms. The intervention included a human-powered water pump, a microfinance loan to purchase farm commodities, and training in sustainable farming practices and financial management. One hundred children (6 to 60 months of age) were enrolled in each arm from households with HIV-infected adults 18 to 49 years old on antiretroviral therapy and with access to surface water and land. Children were assessed beginning in April 2012 and every three months for one year. Data were collected on dietary intake, height, weight, and mid-upper arm circumference (MUAC). The difference in differences from first visit and in linear trends over visits were tested using fixed-effects regression models. ResultsCompared to the control arm, children in the intervention arm had a larger increase in weight at the 12-month visit (β: 0.42, 95% CI: 0.08, 0.76) and increase in MUAC at the 6-month visit (β: 0.28, 95% CI: 0.08, 0.49), with no difference in changes in height over time. Compared to the control arm, the intervention arm had a larger increasing linear trend over time in intake of staples (β: 0.22, 95% CI: 0.02, 0.44), fruits and vegetables (β: 0.42, 95% CI: 0.10, 0.75), and meat (β: 0.07, 95% CI: 0.03, 0.12), and a larger decreasing linear trend in intake of condiments (β: -0.16, 95% CI: -0.23, -0.09) and tea (β: -0.12, 95% CI: -0.19, -0.05), with no differences in intake of eggs, dairy and fat over time. ConclusionsThis intervention that improved food security, dietary intake, and HIV health outcomes of HIV-infected adults also improved dietary intake and nutritional status of children living in those households. Multisectoral agricultural and financial interventions have the potential to improve the nutritional status of HIV-affected children in rural Kenya and should be further explored. Funding SourcesNational Institute of Mental Health.

Use of a novel supplementary food and measures to control inflammation in malnourished pregnant women in Sierra Leone to improve birth outcomes: study protocol for a prospective, randomized, controlled clinical effectiveness trial

BackgroundThe negative synergy between poor nutritional status and infectious diseases is doubly detrimental in pregnancy. In Sierra Leone, maternal malnutrition is amongst the highest in the world, while maternal mortality is high at 1320/100,000 live births and stunting in under-five is 37.9%, ranked 110/132 worldwide. Maternal malnutrition has been associated with preterm birth, small-for-gestational age infants, and poor maternal outcomes. Infants born prematurely or small-for-gestational age experience higher mortality and are at risk for stunting and decreased cognitive performance. Nutritional interventions alone during pregnancy may not be as effective in the setting of increased inflammation from repeated infections. Interventions are needed to improve maternal outcomes and reduce stunting in this population.Methods/designThis will be a prospective, randomized, controlled clinical effectiveness trial of an improved supplementary food plus anti-infective therapies compared to standard therapy in malnourished pregnant women. Pregnant women will be randomized to receive a low water activity, ready-to-use supplementary food plus five anti-infective interventions or the standard of care which is 3.5 kg corn/ soy blended flour with 350 mL vegetable oil every two weeks. The five anti-infective interventions are 1) insecticide-treated mosquito net at the time of enrollment into the study, 2) sulfadoxine-pyrimethamine given every 4 weeks, beginning at enrollment or at 13 weeks’ gestation, whichever is later, 3)azithromycin at a dose of 1 g given once at enrollment (after first trimester)and again during 28–34 weeks of gestation, 4)single dose 400 mg albendazole given in second trimester, and 5) testing and treatment for bacterial vaginosis at enrollment and again at 28–34 weeks of gestation. Treatment will be provided for the duration of the pregnancy. The primary outcome measure will be birth length. Secondary outcomes in the mothers will include rates of maternal weight gain and increase in mid-upper arm circumference, and time to maternal anthropometric recovery. Secondary outcomes in the infants will include birth weight, birth head circumference, and linear and ponderal growth.DiscussionMalnutrition remains a major problem in the developing world with lasting maternal and infant consequences. Maternal malnutrition has been associated with intrauterine growth retardation, low birth weight (LBW), pre-term delivery and poor cognitive development. Nutritional interventions alone have not been successful in reducing stunting. By bundling nutritional and anti-infective interventions, we aim to reduce intrauterine growth restriction and low birth weight in moderately malnourished pregnant women in Sierra Leone. If successful, this bundle can easily be implemented by governments or non-governmental organizations.Trial registrationClinicaltrials.govNCT03079388; Date: March 5, 2017.

The effect of egg supplementation on growth parameters in children participating in a school feeding program in rural Uganda: a pilot study

ABSTRACTBackground: School feeding programs have gained popularity in developing countries . Eggs are an inexpensive source of micronutrients and high-quality protein. Therefore, the objective of this study was to gain preliminary data regarding the impact of egg supplementation on growth in primary school students participating in a school feeding program in rural Uganda.Methods: Children (ages 6–9; n = 241) were recruited from three different schools located throughout the Kitgum District of Uganda. All participants in the same school received the same dietary intervention: control (no eggs (0 eggs); n = 56), one egg five days per week (1 egg; n = 89), or two eggs five days per week (2 eggs; n = 96). Height, weight, tricep skinfold thickness (TSF), and mid-upper arm circumference (MUAC) were measured monthly over 6 months.Results: Following six months of egg supplementation, participants receiving 2 eggs had a greater increase in height and weight compared to the 0 eggs and 1 egg groups (P < 0.05). In addition, participants receiving 1 egg and 2 eggs had a significantly higher (P < 0.05) increase in MUAC at six months compared to 0 eggs.Conclusion: These results suggest that supplementation with eggs can improve parameters of growth in school-aged children participating in school feeding programs in rural Uganda.Abbreviations: MUAC: Mid-Upper Arm Circumference; TSF: Tricep Skinfold Thickness

A Randomized Controlled Trial Offering Higher- Compared with Lower-Dairy Second Meals Daily in Preschools in Guinea-Bissau Demonstrates an Attendance-Dependent Increase in Weight Gain for Both Meal Types and an Increase in Mid-Upper Arm Circumference for the Higher-Dairy Meal

Background: Controversy remains over the most effective approaches to prevent childhood malnutrition.Objectives: We tested the feasibility and effectiveness of delivering ready-to-use supplementary foods (RUSFs) as a second daily meal in preschool children aged 3–5 y in Guinea-Bissau, and compared RUSFs with different levels of dairy protein.Methods: This study was a 3 mo cluster-randomized controlled pilot trial of 2 RUSFs differing in dairy protein in 533 boys and girls from 9 preschools. Children receiving RUSFs were compared with wait-listed controls, and all students received a daily school lunch. The RUSFs were delivered 5 d/wk for 3 mo and contained 478 kcal and 11.5 g protein per 92-g daily serving. Deliveries included a ready-to-use supplementary food with 15% of protein from dairy sources (RUSF-15%) or one with 33% of protein from dairy sources (RUSF-33%). Intention-to-treat (ITT) and per-protocol analyses (>50 d of RUSF consumption) were conducted. Changes in the weight-for-age z score (WAZ) and height-for-age z score were primary outcomes. Additional outcomes included changes in mid-upper arm circumference (MUAC), hemoglobin, and retinol binding protein.Results: Baseline anthropometry was not different between groups (WAZ, −0.48 ± 1.04) and increased significantly over time (P < 0.01) with no effects of the RUSFs in ITT analyses. However, children consuming RUSFs for >50 d had a significantly greater increase in WAZ relative to the increase in controls (+0.40 and +0.32 for RUSF-15% and RUSF-33%, respectively, compared with +0.24 in controls, P < 0.01 and P < 0.05, respectively). RUSF-33%, but not RUSF-15%, also eliminated a decrease in MUAC observed in controls (−0.01 cm in RUSF-33% compared with −0.34 cm in controls, P < 0.05). The only difference between RUSF-15% and RUSF-33% was a mean decrease in hemoglobin in children receiving RUSF-15% (−0.5 compared with −0.002 g/dL, P = 0.05).Conclusions: Implementation of 2-meal preschool feeding programs is feasible in low-income countries, and there are measurable benefits relative to 1-meal programs in children attending preschool regularly. In addition, MUAC and hemoglobin measurements indicate that meals with 33% compared with 15% of protein from dairy may help prevent wasting and anemia.

A prospective study of arm circumference and risk of death in Bangladesh

Epidemiological studies have observed protective effects of mid-upper arm circumference (MUAC) against all-cause mortality mostly in Western populations. However, evidence on cause-specific mortality is limited. The sample included 19 575 adults from a population-based cohort study in rural Bangladesh, who were followed up for an average of 7.9 years for mortality. Cox proportional hazards regression was used to evaluate the effect of MUAC, as well as the joint effect of body mass index (BMI) and MUAC, on the risk of death from any cause, cancer and cardiovascular disease (CVD). During 154 664 person-years of follow-up, 744 deaths including 312 deaths due to CVD and 125 deaths due to cancer were observed. There was a linear inverse relationship of MUAC with total and CVD mortality. Each 1-cm increase in MUAC was associated a reduced risk of death from any cause [hazard ratio (HR) = 0.85; 95% confidence interval (C), 0.81-0.89) and CVD (HR = 0.87; 95% CI, 0.80-0.94), after controlling for potential confounders. No apparent relationship between MUAC and the risk of death from cancer was observed. Among individuals with a low BMI (<18.5 kg/m(2)), a MUAC less than 24 cm was associated with increased risk for all-cause (HR = 1.81; 95% CI, 1.52-2.17) and CVD mortality (HR = 1.45; 95% CI, 1.11-1.91). MUAC may play a critical role on all-cause and CVD mortality in lean Asians.

Effects of two micronutrient‐fortified food aid products containing different levels of dairy protein on anthropometric variables in rural pre‐school children in Guinea‐Bissau (804.15)

Food insecurity is widespread in Guinea‐Bissau. We tested the efficacy of two Micronutrient‐Rich Ready to Use Supplementary Foods (MNR‐RUSF) in preschool children aged 3‐5 years over 3 months. 9 preschools (n=421 children) were randomly assigned to one of two interventions (MNR‐RUSF sachets containing 500 kcal with either 15% or 33% of protein from dairy sources, provided 5 mornings/week) or to a control (C) group that received no MNR‐RUSF. Weight, height and mid upper arm circumference (MUAC) were measured at baseline and endline. At baseline, 5.6% of enrollees had weight‐for‐age z scores &lt;‐2 and 7.1% had height‐for‐age z scores &lt;‐2. Both intervention groups had a significant increase in weight over time vs. controls (15% group = 0.77+0.75 kg, 33% group = 0.76+0.78 kg, C = 0.42+0.1.8 kg, p&lt;0.05) but not in height (p=0.34) and changes in these variables were not different between the 15% and 33% groups (p= 0.99 and p=0.38). There was a significant increase in MUAC in both the intervention groups relative to controls, and the 33% group had a greater increase than the 15% group (15% group = ‐0.03±0.68 cm, 33% group = 0.14±0.78 cm, C = ‐0.31±0.67cm, p&lt;0.001). This study is the first to focus on anthropometry in preschool children in Guinea‐Bissau and indicates that, while both standard and high‐dairy MNR‐RUSF products improve weight in preschool populations with a high prevalence of malnutrition, those containing high levels of dairy protein have additional benefits for MUAC.Grant Funding Source: Supported by USDA/FAS under Agreement FFE‐657‐2012/043‐00

Early-Stage Primary School Children Attending a School in the Malawian School Feeding Program (SFP) Have Better Reversal Learning and Lean Muscle Mass Growth Than Those Attending a Non-SFP School1,2

In developing countries, schoolchildren encounter a number of challenges, including failure to complete school, poor health and nutrition, and poor academic performance. Implementation of school feeding programs (SFPs) in less developed countries is increasing and yet there is mixed evidence regarding their positive effects on nutrition, education, and cognition at the population level. This study evaluated cognitive and anthropometric outcomes in entry-level primary school children in Malawi with the aim of generating evidence for the ongoing debate about SFPs in Malawi and other developing countries. A total of 226 schoolchildren aged 6–8 y in 2 rural Malawian public primary schools were followed for one school year. Children attending one school (SFP school) received a daily ration of corn-soy blend porridge, while those attending the other (non-SFP school) did not. Baseline and post-baseline outcomes included the Cambridge Neurological Test Automated Battery cognitive tests of paired associate learning, rapid visual information processing and intra-extra dimensional shift, and anthropometric measurements of weight, height, and mid-upper arm circumference (MUAC). At follow-up, the SFP subcohort had a greater reduction than the non-SFP subcohort in the number of intra-extra predimensional shift errors made (mean 18.5 and 24.9, respectively; P-interaction = 0.02) and also showed an increase in MUAC (from 16.3 to 17.0; P-interaction <0.0001). The results indicate that the SFP in Malawi is associated with an improvement in reversal learning and catch-up growth in lean muscle mass in children in the SFP school compared with children in the non-SFP school. These findings suggest that the Malawian SFP, if well managed and ration sizes are sustained, may have the potential to improve nutritional and cognitive indicators of the most disadvantaged children.

Risk factors for cervical squamous intraepithelial lesions among HIV-1 seropositive women in Dar es Salaam, Tanzania

Objectives: To determine the prevalence and risk factors for cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Dar es Salaam, Tanzania. Methods: Between July 1996 and December 1997 we interviewed 691 HIV-infected women to obtain information about risk factors for SIL. Cervical smears and samples for lymphocyte subsets and sexually transmitted diseases (STD) diagnosis were collected. Results: The prevalence of SIL was 2.9% (20/686) (95% CI=1.7–4.2%). Eleven women had low-grade SIL while nine women had high-grade SIL. The number of lifetime sexual partners and live births was associated with a marginally non-significant increased risk of SIL. The risk of SIL was significantly increased among women with CD4+ cell count <200/mm3 (multivariate odds ratio (OR)=6.15, 95% CI=1.19–41.37) and decreased by 68% for each 5-cm increase in mid-upper arm circumference (multivariate OR=0.32, 95% CI=0.10–0.93). Conclusions: HIV-related immunosuppression and wasting and long-term sexual behavior were the major determinants of SIL in this population.