Neonatal mortality remains high in Tanzania, where progress toward Sustainable Development Goal 3.2 is constrained by a severe shortage of trained workforce. To achieve the goal, Tanzania, with approximately two million annual births, aims to reduce neonatal mortality from 24 to fewer than 12 deaths per 1,000 live births by 2030. In 2020, only five neonatologists, including expatriates, were available nationwide. To fill this gap, the MSc Neonatology subspecialty program was established at Muhimbili University of Health and Allied Sciences in 2021. This study describes the processes and investment involved in establishing neonatal subspecialty training in Tanzania and examines short-term achievements. A retrospective review of documents related to the program’s development, implementation, and evaluation was conducted. Curriculum development and implementation were funded by The Else Kröner-Fresenius-Stiftung through the German Society of Tropical Pediatrics and International Child Health. The curriculum was developed using Kern’s six-step model, with input from national stakeholders and neonatology experts, and aligned with African neonatal subspecialty training standards. The program was accredited by the Tanzania Commission for Universities in April 2021, with the first cohort enrolling in October 2021. Program evaluation was conducted by an independent assessor using Organization for Economic Co-operation and Development/Development Assistance Committee (OECD/DAC) standards, drawing on quantitative and qualitative data from multiple stakeholders. By December 2024, eight fellows had enrolled in the program. Five had graduated, and two more completed their training in 2025. All graduates returned to their base hospitals, increasing the number of neonatologists by 50

Post-discharge mortality (PDM), defined as deaths that occur in the weeks and months after hospital discharge, remains a critical, yet under-recognized, contributor to high childhood mortality rates in sub-Saharan Africa. However, a comprehensive understanding of effective interventions to prevent PDM is lacking. The aim for the present study was to evaluate the efficacy of published interventions to prevent PDM among neonates and children aged 0-18 years in sub-Saharan Africa. A systematic review was conducted to assess the efficacy of interventions for preventing PDM. The CABI Global Health, Cochrane Reviews, Cochrane Trials, ProQuest Dissertations and Theses, Embase, PubMed, and Web of Science databases were searched without language restriction. Publications that involved interventions for preventing PDM, included children, and were conducted in sub-Saharan Africa were included in the present study. Of 4,893 publications screened, 17 were included, with 12,938 participants in total (10.6% experienced PDM). The most common interventions included supplemental feeding programs, kangaroo mother care, antibiotic use, and micronutrient supplementation. Effectiveness varied within and between intervention types. Only two interventions resulted in statistically significant reductions in PDM: vitamin A supplementation for children with pneumonia (hazard ratio: 0.51; 95% CI: 0.29-0.90; low quality of evidence) and linkage to services for children with sickle cell disease (adjusted hazard ratio: 0.26; 95% CI: 0.08-0.83; low quality of evidence). No single intervention type provided consistent benefits across studies. Most interventions targeted children with specific diagnoses; however, some strategies addressed social determinants of health. Future research must prioritize cost-effective, scalable strategies across diverse sub-Saharan African settings to accelerate the prevention of PDM among children.

Despite notable global reductions in infant and under-five mortality over the last two decades, about half of the remaining neonatal deaths occur among low birth weight (LBW) infants. We conducted a prospective study to characterize the mortality risk and morbidity of moderately LBW (MLBW; 1500–2499 g birth weight) infants during the first year of life in India, Malawi, and Tanzania. The multi-site Low Birthweight Infant Feeding Exploration (LIFE) study was conducted from September 2019 to July 2021 and followed a cohort of MLBW infants from India, Malawi, and Tanzania from birth to 52 weeks of age. At follow-up visits conducted at 1, 2, 4, 6, 10, 14, 18, 26, 39, and 52 weeks of age, mothers/caregivers were asked to recall the presence of diarrhea, fever, acute respiratory infections, and convulsions during the past week, and infant weight and length were assessed. Generalized estimating equations (GEE) were used to evaluate study site and sociodemographic risk factors for infant morbidity and mortality, and also to assess the relationship between infant morbidity and anthropometric measures. A total of 1,121 MLBW infants were included in the analysis and 47 (4.2

OBJECTIVES:This study aimed to assess the prevalence of depression and anxiety and to identify factors associated with these conditions among caregivers of children and adolescents with epilepsy attending the paediatric neurology clinic at Muhimbili National Hospital (MNH) in Tanzania. DESIGN:A hospital-based cross-sectional study. SETTING:The paediatric neurology clinic of a national referral hospital in Dar es Salaam, Tanzania. PARTICIPANTS:427 caregivers of children with epilepsy (CWE) were consecutively enrolled. Eligibility criteria included being 18 years or older and having provided care for the child for at least 6 months. Caregivers unable to read and write in Swahili or previously diagnosed with a mental illness before assuming the caregiving role were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES:Primary outcomes were the prevalence of depression (assessed with the Patient Health Questionnaire-9 (PHQ-9), cut-off ≥10), anxiety (assessed with the Generalised Anxiety Disorder-7 tool (GAD-7), cut-off ≥10), and their co-occurrence. Secondary outcomes were the factors associated with these conditions, analysed using logistic regression and reported as adjusted odds ratios (aORs). RESULTS:Depression was observed in 74 (17.3%, 95% CI: 13.8 to 21.3) participants and anxiety was found in 74 caregivers (17.3%,95% CI: 14.1 to 20.8). 38 (9.0%, 95% CI: 6.3 to 11.7) participants had concurrent depression and anxiety. Factors associated with depression were having a child: less than 5 years old (adjusted OR (aOR)=6.56, p=0.012), epilepsy duration of more than 5 years (aOR=2.80, p=0.048), history of epilepsy-related injuries (aOR=2.64, p=0.015) and three or more admissions (aOR=2.56, p=0.046). Caregivers whose children had not started school or were in primary school had lower odds of depression compared with counterparts in secondary school (aOR=0.02, p=0.003) and (aOR=0.03, p=0.005), respectively. Caregivers' anxiety was associated with having a child with: another comorbidity (aOR=1.93, p=0.020), a history of epilepsy-related injuries (aOR=2.37, p=0.030), three or more admissions (aOR=2.98, p=0.015) and caregiver age between 41 to 50 years (aOR=3.06, p=0.042). CONCLUSION:Depression and anxiety are prevalent among caregivers of CWE. The findings indicate a need for the integration of mental health services within paediatric neurology clinics to support caregiver well-being.

Post-discharge mortality is increasingly recognized as a major contributor to the high burden of childhood mortality in sub-Saharan Africa. Accurate identification of children at risk for post-discharge mortality is critically important to inform interventions to reduce deaths following hospital discharge. Our objective was to describe the current state of development, validation, or implementation for risk assessment tools for post-hospital discharge mortality (PDM) in sub-Saharan Africa. We conducted a systematic review of publications on risk assessment tools for PDM among children aged 0-18 years in sub-Saharan Africa. We searched CABI Global Health, Cochrane Reviews, Cochrane Trials, ProQuest Dissertations and Theses, Embase, PubMed, and Web of Science with no date or language restriction. We included publications if they described a tool/model with weights assigned to variables to quantify risk of PDM, included children, and were conducted in sub-Saharan Africa. We determined the level of evidence for tools using the Evidence-Based-Medicine Working Group hierarchy. Of 4,893 publications screened, 289 full texts were reviewed, and seven publications that reported 23 risk assessment tools for PDM among children in sub-Saharan Africa were identified. These studies enrolled 49,669 total participants (3.6%, n = 1,795 experienced PDM). There was substantial heterogeneity in identified risk factors, although all identified malnutrition as a risk factor for PDM. All risk assessment tools had fair (i.e., area under the receiver operating characteristic curve [AUC] ≥0.70) or good (AUC ≥ 0.80) discriminatory value in internal validation. Only two risk assessment tools had been externally validated, and none were implemented. Existing risk assessment tools to identify children at risk for PDM in sub-Saharan Africa lack broad validation and implementation. Malnutrition is a common risk factor for PDM. Further studies are needed to validate and implement such tools to reduce PDM among children.

INTRODUCTION:Innovative interventions will be essential for countries in sub-Saharan Africa to achieve the 2030 Sustainable Development Goal for child mortality. Infections among young infants, including sepsis, meningitis and pneumonia, continue to cause a large burden of morbidity and mortality in low-income and middle-income countries. Zinc is an essential micronutrient with a well-established role in human health and immune system function, and supplementation may improve survival and treatment outcomes for infants with bacterial infections. METHODS AND ANALYSIS:We will conduct an individually randomised, quadruple-blind trial of zinc supplementation among 3250 infants 0-59 days old with clinical severe infection (CSI) in Dar es Salaam, Tanzania. Infants with CSI will be randomised to receive either (1) zinc citrate supplementation consisting of 5 mg elemental zinc taken two times per day for 14 days or (2) a matching placebo supplementation taken two times per day for 14 days. Infants will be followed for 90 days postrandomisation. The coprimary outcomes are (1) infant death (all-cause mortality to 90 days) and (2) treatment failure (composite outcome of death during initial hospitalisation, need for additional respiratory support, use of vasoactive medicines or change of antibiotics). Secondary outcomes include important infant health and nutritional outcomes. ETHICS AND DISSEMINATION:The trial protocol was approved by Harvard T. H. Chan School of Public Health Institutional Review Board, the Muhimbili University of Health and Allied Sciences Institutional Review Board, the National Health Research Ethics Sub-Committee and the Tanzania Medicine and Medical Device Authority. Findings will be disseminated locally, regionally and internationally at scientific conference presentations and as peer-reviewed publications. TRIAL REGISTRATION NUMBER:NCT06102044; ClinicalTrials.gov identifier.

OBJECTIVES:Supplemental zinc during acute diarrhea reduces illness duration but also increases vomiting. In a recent trial, we found that children receiving lower daily doses of zinc (5 mg or 10 mg vs. 20 mg) had lower rates of vomiting with comparable stool output and duration of diarrhea. We performed a secondary analysis to identify sociodemographic and clinical factors associated with vomiting in children with acute diarrhea. METHODS:We performed a secondary data analysis of 4500 children aged 6-59 months with an acute episode of diarrhea (<72 h before enrollment) in a randomized, double-blind controlled trial in India and Tanzania. To identify clinically important risk factors for overall, regimen-related, and regimen-unrelated vomiting, we created log-binomial models with relative risks (RRs) and 95% confidence intervals (CIs). RESULTS:The trial enrolled 4500 children, of whom 1203 (26.7%) had any vomiting. After adjusting for multiple demographic and clinical characteristics, the presence of dehydration (RR: 1.45, 95% CI: 1.10-1.92), being underweight (RR: 1.22, 95% CI: 1.05-1.41), receipt of the rotavirus vaccine (RR: 1.89, 95% CI: 1.69-2.12), and household wealth above the median (RR: 1.17, 95% CI: 1.07-1.29) were factors associated with an increased risk of vomiting. Rotavirus vaccine receipt was nearly 100% concordant with the study site of Tanzania. Older age and lower zinc dosing were associated with a lower risk of vomiting. CONCLUSIONS:Young, underweight, or dehydrated children are more likely to have concurrent vomiting with zinc supplementation. Identification of these factors may allow providers to better monitor such children, thus reducing the chances of recurrent dehydration or inadequate dietary intake.

The selection of authors for editorials reflects perceptions of expertise and influence. Our objectives were to determine author geographic and gender distribution, determine temporal trends in editorial authorship, and identify factors associated with the inclusion of authors affiliated with low- and middle-income countries (LMICs) in editorials on research conducted in LMICs. We conducted a cross-sectional study of editorials on research in LMICs published in 15 global health, pediatrics, and general medicine journals from 2014 to 2024. To assess temporal changes in authorship, we plotted the proportion of editorial authors affiliated with LMICs and those with female names by year. We used multivariable logistic regression to identify factors associated with the inclusion of one or more LMIC-affiliated authors. There were 107,629 publications and 1,350 editorials on research in LMICs with 2,401 authors. Authors of editorials were most often affiliated with institutions in North America (38.1%) and high-income countries (71.6%). The proportion of authors of editorials affiliated with institutions in high-income countries decreased from 84.9% in 2014 to 65.3% in 2024. Authors of editorials more commonly had male names than female (60.1% versus 38.7%, P <0.001). The proportion of editorial authors with female names increased from 32.1% in 2014 to 48.2% in 2024. Editorials accompanying publications reporting studies with larger sample sizes (aOR = 1.52, 95% CI: 1.03-2.26) and research conducted in sub-Saharan Africa (aOR = 2.84, 95% CI: 1.74-4.68) were more likely to include LMIC-affiliated authors. Additional efforts are needed to include authors affiliated with LMICs in editorials on research conducted in LMICs.

Background and Aims:Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the serious complications that can potentially increase the risk of morbidity, long-term adverse effects and mortality. Despite the advances in the care and increased survival of children post-cardiac surgery, CSA-AKI is still a big problem with considerable morbidity and mortality in high-risk children. Prevention of CSA-AKI is important for survival and minimization of long-term adverse outcomes of children after cardiac surgery. This study aimed to determine the proportion of acute kidney injury, associated risk factors and in-hospital outcomes among children undergoing cardiac surgery at the Jakaya Kikwete Cardiac Institute (JKCI). Methodology:A prospective cohort study was conducted to determine the proportion, risk factors, and in-hospital outcomes among children who developed cardiac surgery-associated acute kidney injury (CSA-AKI) at JKCI. Data collection was done using a structured questionnaire, Intensive care unit (ICU) chart review, and hospital records. Diagnosis of CSA-AKI was done based on KDIGO criteria. Serum creatinine was measured pre-operatively and subsequently, daily up to day seven postoperatively to determine the presence of CSA-AKI. Results:A total of 210 children were recruited into the study, of which 120 (57.1%) were males. The median age of the study participants was 36 months. Of the recruited children, 23 (11.0%) developed cardiac surgery-associated acute kidney injury (CSA-AKI). Intraoperative hypotension [ARR = 2.7; 95% CI 1.37-5.26; p-value = 0.004], intraoperative platelet transfusion [ARR = 2.7; 95% CI 1.37-5.22; p-value = 0.004] and two or more days on mechanical ventilation [ARR = 2.3; 95% CI 1.1-4.71; p-value = 0.019] were found to be significantly associated with CSA-AKI. There were 8 (3.8%) deaths, of these, 7 (87.5%) were from children who developed CSA-AKI. Children who developed CSA-AKI had, on average, a longer ICU stay, with a mean difference of 1.959 days. Conclusion:This study's findings highlighted the prevalence and severity of cardiac surgery associated with acute kidney injury in pediatric patients. The identified risk factors, such as intraoperative hypotension, platelet transfusion, and prolonged mechanical ventilation, provide crucial insights for improving patient outcomes. The study's results also emphasize the need for interventions targeting these modifiable factors to reduce mortality among children undergoing cardiac surgery.

BACKGROUND:The time after hospital discharge carries high rates of mortality in neonates and young children in sub-Saharan Africa. Previous work using logistic regression to develop risk assessment tools to identify those at risk for postdischarge mortality has yielded fair discriminatory value. Our objective was to determine if machine learning models would have greater discriminatory value to identify neonates and young children at risk for postdischarge mortality. METHODS:We conducted a planned secondary analysis of a prospective observational cohort at Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia. We enrolled neonates and young children near the time of discharge. The outcome was 60-day postdischarge mortality. We collected socioeconomic, demographic, clinical, and anthropometric data during hospital admission and used machine learning (ie, eXtreme Gradient Boosting (XGBoost), Hist-Gradient Boost, Support Vector Machine, Neural Network, and Random Forest) to develop risk assessment tools to identify: (1) neonates and (2) young children at risk for postdischarge mortality. RESULTS:A total of 2310 neonates and 1933 young children enrolled. Of these, 71 (3.1%) neonates and 67 (3.5%) young children died after hospital discharge. XGBoost, Hist Gradient Boost, and Neural Network models yielded the greatest discriminatory value (area under the receiver operating characteristic curves range: 0.94-0.99) and fewest features, which included six features for neonates and five for young children. Discharge against medical advice, low birth weight, and supplemental oxygen requirement during hospitalisation were predictive of postdischarge mortality in neonates. For young children, discharge against medical advice, pallor, and chronic medical problems were predictive of postdischarge mortality. CONCLUSIONS:Our parsimonious machine learning-based models had excellent discriminatory value to predict postdischarge mortality among neonates and young children. External validation of these tools is warranted to assist in the design of interventions to reduce postdischarge mortality in these vulnerable populations.

Background Moderate acute malnutrition (MAM) affects over 30 million children aged < 5 years worldwide. MAM may confer a greater risk of developing severe malnutrition and even mortality in children. Assessing risk factors for MAM may allow for earlier recognition of children at risk of deleterious health outcomes. Objective To determine risk factors associated with the prevalence and development of MAM among children aged 6 to 59 months with acute diarrhoea who received treatment with oral rehydration solution and zinc supplementation. Methods We conducted a secondary analysis of data from a randomized, dose-finding trial of zinc among children with acute diarrhoea in India and Tanzania. We used regression models to assess risk factors for prevalent MAM at the start of diarrhoea treatment and to identify risk factors associated with the development of MAM at 60 days. MAM was defined as weight for length (or height) Z score ≤—2 and > -3 or mid-upper arm circumference < 12.5 and ≥ 11.5 cm. Results A total of 4,500 children were enrolled; 593 (13.2%) had MAM at the baseline. MAM at baseline was significantly less common among children in Tanzania than in India (adjusted risk ratio [aRR] 0.37, 95% confidence interval [CI]: 0.30, 0.44, P < 0.001), in children aged 24- < 60 months versus 6- < 12 months (aRR 0.46, 95% CI: 0.38, 0.56, P < 0.001), and in families with household wealth index higher than the median (aRR 0.79, 95% CI: 0.68, 0.92, P = 0.002). Sixty days after outpatient treatment and follow-up, 87 (2.5%) children developed MAM. When compared to children aged 6- < 12 months, children aged 24- < 60 months had a 52% lower risk of developing MAM. Every one unit increase in weight for length (or height) Z score at enrolment was associated with a 93% lower risk of developing MAM during follow-up. Conclusions Among children with diarrhoea, younger children and those from households with lower wealth were at greater risk of MAM. These children may benefit from targeted interventions focusing on feeding (targeted nutrition support for at-risk households) and follow up in order to reduce the occurrence of MAM and its consequences.

Background Researchers and healthcare providers have paid little attention to morbidity and unplanned healthcare encounters for children following hospital discharge in low- and middle-income countries. Our objective was to compare symptoms and unplanned healthcare encounters among children aged <5 years who survived with those who died within 60 days of hospital discharge through follow-up phone calls.Methods We conducted a secondary analysis of a prospective observational cohort of children aged <5 years discharged from neonatal and paediatric wards of two national referral hospitals in Dar es Salaam, Tanzania and Monrovia, Liberia. Caregivers of enrolled participants received phone calls 7, 14, 30, 45, and 60 days after hospital discharge to record symptoms, unplanned healthcare encounters, and vital status. We used logistic regression to determine the association between reported symptoms and unplanned healthcare encounters with 60-day post-discharge mortality.Results A total of 4243 participants were enrolled and had 60-day vital status available; 138 (3.3%) died. For every additional symptom ever reported following discharge, there was a 35% greater likelihood of post-discharge mortality (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.10 to 1.66; p=0.004). The greatest survival difference was noted for children who had difficulty breathing (2.1% among those who survived vs 36.0% among those who died, p<0.001). Caregivers who took their child home from the hospital against medical advice during the initial hospitalisation had over eight times greater odds of post-discharge mortality (aOR 8.06, 95% CI 3.87 to 16.3; p<0.001) and those who were readmitted to a hospital had 3.42 greater odds (95% CI 1.55 to 8.47; p=0.004) of post-discharge mortality than those who did not seek care when adjusting for site, sociodemographic factors, and clinical variables.Conclusion Surveillance for symptoms and repeated admissions following hospital discharge by healthcare providers is crucial to identify children at risk for post-discharge mortality.

BackgroundGlobally, moderate wasting affects approximately 33 million children. Complex bidirectional interactions exist between wasting and infection in children. Children who experience both conditions have an increased risk of adverse outcomes including progression to severe wasting and mortality. Breaking the cycle between moderate wasting and infection could help improve growth and survival in these children. The NUTRIMAM trial will aim to investigate the efficacy of a 12-week regimen of three different nutritional interventions in at-risk young children (i.e., children who are moderately wasted and have one/more acute infections) on anthropometric recovery. Further, the study will explore whether recovery can be sustained with a post-intervention package that includes counseling and food vouchers. Sustaining anthropometric recovery beyond supplement administration will have important implications for programs.MethodsNUTRIMAM is a multi-country, multi-center individually randomized, open-label, trial in five countries including Bangladesh, India, Mali, Pakistan, and Tanzania. A total of 6360 moderately wasted children aged 6 to 24 months with acute illness will be enrolled at health centers. Children will be randomly allocated to receive one of three dietary supplements (locally available foods, ready-to-use supplementary foods, or microbiota-directed supplementary foods) for 12 weeks. Anthropometric recovery will be assessed over this period. Participants who recover will then be re-randomized to a post-recovery support intervention comprising either counseling and food vouchers or routine standard of care for recovered children for an additional 12 weeks to determine if this intervention facilitates sustained recovery at 24 weeks.DiscussionChildren who are moderately wasted and have an infection are at higher risk of adverse outcomes. There are very few clinical trials that have been performed among children with moderate wasting with infectious illnesses to investigate if it is possible to break the undernutrition-infection cycle and thereby reduce the risk of nutritional deterioration to severe wasting or mortality and decrease the risk of acute infections. The results of the trial are anticipated to fill important evidence gaps in feeding recommendations for moderately wasted children with acute illness as well as interventions to sustain anthropometric recovery in children beyond the period of the nutritional intervention.Trial registrationISRCTN registry, ISRCTN53213318. Registered on April 03, 2023.

Background: Effective implementation of new curricula requires faculty to be knowledgeable about curriculum goals and have the appropriate pedagogical skills to implement the curriculum, even more so if the new curriculum is being deployed at multiple institutions. In this paper, we describe the process of creating a common faculty development program to train cross-institutional faculty developers to support the implementation of national harmonized medicine and nursing curricula. Methods: A five-step approach was used, including a cross-institutional needs assessment survey for faculty development needs, the development of a generic faculty development program, the identification and training of cross-institutional faculty educators, and the implementation of cross-institutional faculty capacity-building workshops. Results: A list of common cross-cutting faculty development needs for teaching and learning was identified from the needs assessment survey and used to develop an accredited, cross-institutional faculty development program for competency-based learning and assessment. A total of 24 cross-institutional faculty developers were identified and trained in 8 core learning and assessment workshops. A total of 18 cross-institutional and 71 institutional workshops were conducted, of which 1292 faculty members and 412 residents were trained, and three cross-institutional educational research projects were implemented. Conclusion: The success attained in this study shows that the use of cross-institutional faculty developers is a viable model and sustainable resource that can be used to support the implementation of harmonized national curricula.

BACKGROUND:Provision of zinc supplementation to young children has been associated with reduced infectious morbidity and better growth outcomes. However, the metabolic pathways underlying these outcomes are unclear, and metabolomic data from humans undergoing zinc supplementation, particularly infants, are generally lacking.OBJECTIVES:This study aimed to examine the effect of zinc supplementation on metabolic profiles in Tanzanian infants aged 6 wk and 6 mo.METHODS:Blood samples were collected at age 6 wk and 6 mo from 50 Tanzanian infants who were enrolled in a randomized placebo-controlled trial of zinc supplementation (5 mg oral daily). Metabolomic analysis using an ultrahigh-performance liquid chromatography/tandem mass spectroscopy platform was performed to identify potential metabolomic profiles and biomarkers associated with zinc supplementation. Principal component analysis (PCA) was used to summarize metabolomic data from all samples. Two-way repeated measures analysis of variance with compound symmetry covariance structures were used to compare metabolome levels over time between infants in the 2 treatment arms.RESULTS:In PCA, the samples tended to be more separated by child age (6 wk compared with 6 mo) than by zinc supplementation status. We found that zinc supplementation affected a variety of metabolites associated with amino acid, lipid, nucleotide, and xenobiotic metabolism, including indoleacetate in the tryptophan metabolism pathway; 3-methoxytrosine and 4-hydrxoyphenylphruvate in the tyrosine pathway; eicosanedioate, 2-aminooctanoate, and N-acetyl-2-aminooctanoate in the fatty acid pathway; and N6-succinyladenosine in the purine metabolism pathway. Compared to the relatively small number of metabolites associated with zinc supplements, many infant metabolites changed significantly from age 6 wk to 6 mo.CONCLUSIONS:Zinc supplementation, despite having overall clinical benefits, appears to induce limited metabolomic changes in blood metabolites in young infants. Future larger studies may be warranted to further examine metabolic pathways associated with zinc supplementation. The parent trial was registered at clinicaltrials.gov as NCT00421668.

Introduction The immediate period after hospital discharge carries a large burden of childhood mortality in sub-Saharan Africa. Our objective was to derive and internally validate a risk assessment tool to identify neonates discharged from the neonatal ward at risk for 60-day post-discharge mortality.Methods We conducted a prospective observational cohort study of neonates discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania, and John F Kennedy Medical Centre in Monrovia, Liberia. Research staff called caregivers to ascertain vital status up to 60 days after discharge. We conducted multivariable logistic regression analyses with best subset selection to identify socioeconomic, demographic, clinical, and anthropometric factors associated with post-discharge mortality. We used adjusted log coefficients to assign points to each variable and internally validated our tool with bootstrap validation with 500 repetitions.Results There were 2344 neonates discharged and 2310 (98.5%) had post-discharge outcomes available. The median (IQR) age at discharge was 8 (4, 15) days; 1238 (53.6%) were male. In total, 71 (3.1%) died during follow-up (26.8% within 7 days of discharge). Leaving against medical advice (adjusted OR [aOR] 5.62, 95% CI 2.40 to 12.10) and diagnosis of meconium aspiration (aOR 6.98, 95% CI 1.69 to 21.70) conferred the greatest risk for post-discharge mortality. The risk assessment tool included nine variables (total possible score=63) and had an optimism corrected area under the receiver operating characteristic curve of 0.77 (95% CI 0.75 to 0.80). A score of ≥6 was most optimal (sensitivity 68.3% [95% CI 64.8% to 71.5%], specificity 72.1% [95% CI 71.5% to 72.7%]).Conclusions A small number of factors predicted all-cause, 60-day mortality after discharge from neonatal wards in Tanzania and Liberia. After external validation, this risk assessment tool may facilitate clinical decision making for eligibility for discharge and the direction of resources to follow-up high risk neonates.

ObjectiveTo assess the association between breastfeeding competency, as determined by Latch, Audible swallowing, Type of nipple, Comfort, and Hold (LATCH) and Preterm Infant Breastfeeding Behavior Scale (PIBBS) scores, and exclusive breastfeeding and growth among infants with low birth weight (LBW) in India, Malawi, and Tanzania.Study designWe conducted LATCH and PIBBS assessments among mother-infant dyads enrolled in the Low Birthweight Infant Feeding Exploration (LIFE) observational study of infants with moderately LBW (1500g-2499g) in India, Malawi, and Tanzania. We analyzed feeding and growth patterns among this cohort.ResultsWe observed 988 infants. We found no association between LATCH or PIBBS scores and rates of exclusive breastfeeding at 4 or 6 months. Higher week 1 LATCH and PIBBS scores were associated with increased likelihood of regaining birth weight by two weeks of age [LATCH: aRR 1.42 (95% CI 1.15, 1.76); PIBBS: aRR 1.15 (95% CI 1.07, 1.23); adjusted for maternal age, parity, education, residence, delivery mode, LBW type, number of offspring, and site]. Higher PIBBS scores at 1 week were associated with improved weight gain velocity (weight-for-age z-score change) at 1, 4, and 6 months [adjusted beta coefficient (95% CI): 1 month 0.04 (0.01, 0.06); 4 month 0.04 (0.01, 0.06); and 6 month 0.04 (0.00, 0.08)].ConclusionAlthough week 1 LATCH and PIBBS scores were not associated with rates of exclusive breastfeeding, these scores were positively associated with growth metrics among infants with LBW, suggesting that these tools may be useful to identify dyads who would benefit from early lactation support.

Background: In 2012, the Muhimbili University of Health and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania.Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis.Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed.Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions' capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.

Background Low birthweight (LBW) infants are at increased risk of morbidity and mortality. Exclusive breastfeeding up to six months is recommended to help them thrive through infection prevention, growth improvements, and enhancements in neurodevelopment. However, limited data exist on the feeding experiences of LBW infants, their caregivers and key community influencers. The qualitative component of the Low Birthweight Infant Feeding Exploration (LIFE) study aimed to understand practices, facilitators, and barriers to optimal feeding options in the first six months for LBW infants in low-resource settings. Methods This study was conducted in four sites in India, Malawi, and Tanzania from July 2019 to August 2020. We conducted 37 focus group discussions with mothers and family members of LBW infants and community leaders and 142 in-depth interviews with healthcare providers, government officials, and supply chain and donor human milk (DHM) experts. Data were analyzed using a framework approach. Results All participants believed that mother’s own milk was best for LBW infants. Direct breastfeeding was predominant and feeding expressed breast milk and infant formula were rare. DHM was a new concept for most. Adequate maternal nutrition, lactation support, and privacy in the facility aided breastfeeding and expression, but perceived insufficient milk, limited feeding counseling, and infant immaturity were common barriers. Most believed that DHM uptake could be enabled through community awareness by overcoming misconceptions, safety concerns, and perceived family resistance. Conclusion This study fills an evidence gap in LBW infant feeding practices and their facilitators and barriers in resource-limited settings. LBW infants face unique feeding challenges such as poor latching and tiring at the breast. Similarly, their mothers are faced with numerous difficulties, including attainment of adequate milk supply, breast pain and emotional stress. Lactation support and feeding counseling could address obstacles faced by mothers and infants by providing psychosocial, verbal and physical support to empower mothers with skills, knowledge and confidence and facilitate earlier, more and better breast milk feeding. Findings on DHM are critical to the future development of human milk banks and highlight the need to solicit partnership from stakeholders in the community and health system.