13. Otros

Ramya Ambikapathi, Margaret N Kosek, Gwenyth O Lee, Maribel Paredes Olortegui, Benjamin Zaitchik, Pablo Penataro Yori, Aubrey Bauck and Laura E Caulfield.

Public Health Nutrition: 24(11), 3477–3487

Abstract

Objective:
In 2011–2012, severe El Nino Southern Oscillation (ENSO) conditions (La Nina) led to massive flooding and temporarily displacement in the Peruvian Amazon. Our aims were to examine the impact of this ENSO exposure on child diets, in particular: (1) frequency of food consumption patterns, (2) the amount of food consumed (g/d), (3) dietary diversity (DD), (4) consumption of donated foods, among children aged 9–36 months living in the outskirts of City of Iquitos in the Amazonian Peru.

Design:
This was a longitudinal study that used quantitative 24-h recall dietary data collection from children aged 9–36 months from 2010 to 2014 as part of the MAL-ED birth cohort study.

Setting:
Iquitos, Loreto, Peru.

Participants:
Two hundred and fifty-two mother–child dyads.

Results:
The frequency of grains, rice, dairy and sugar in meals reduced by 5–7 %, while the frequency of plantain in meals increased by 24 % after adjusting for covariates. ENSO exposure reduced girl’s intake of plantains and sugar. Despite seasonal fluctuations in the availability of fruits, vegetables and fish, DD remained constant across seasons and as children aged. However, DD was significantly reduced under moderate La Nina conditions by 0·32 ( ˜ P < 0·05) food groups. Adaptive social strategies such as consumption of donated foods were significantly higher among households with girls.

Conclusions:
This is the first empirical study to show differential effect of the ENSO on the dietary patterns of children, highlighting differences by gender. Public health nutrition programmes should be climate- and gender-sensitive in their efforts to safeguard the diets of vulnerable populations.

Saba Rouhani,1, Nicholas W. Griffin, Pablo Peñataro Yori, Maribel Paredes Olortegui, Mery Siguas Salas, Dixner Rengifo Trigoso, Lawrence H. Moulton, Eric R. Houpt, Michael J. Barratt, Margaret N. Kosek, and Jeffrey I. Gordon.

Clinical Infectious Diseases 2020;71(4):1000–7

Background.
Campylobacter infection is associated with impaired growth of children, even in the absence of symptoms. To examine the underlying mechanisms, we evaluated associations between ampylobacter infection, linear growth, and fecal microbial community features in a prospective birth cohort of 271 children with a high burden of diarrhea and stunting in the Amazonian lowlands of Peru.

Methods.
Campylobacter was identified using a broadly reactive, genus-specific enzyme-linked immunosorbent assay. 16S rRNAbased analyses were used to identify bacterial taxa in fecal samples at ages 6, 12, 18, and 24 months (N = 928). Associations between infection, growth, and gut microbial community composition were investigated using multiple linear regression adjusting for withinchild correlations, age, and breastfeeding. Indicator species analyses identified taxa specifically associated with Campylobacter burden.

Results.
Ninety-three percent (251) of children had Campylobacter present in asymptomatic fecal samples during the follow-up period. A 10% increase in the proportion of stools infected was associated with mean reductions of 0.02 length-for-age z scores (LAZ) at 3, 6, and 9 months thereafter (P < .01). We identified 13 bacterial taxa indicative of cumulative Campylobacter burden and 14 taxa significantly associated with high or low burden of enteroaggregative Escherichia coli, norovirus, or Giardia.

Conclusions.
Campylobacter infection is common in this cohort and associated with changes in microbial community composition. These results support the notion that disruptions to the fecal microbiota may help explain the observed effects of asymptomatic
infections on growth in early life

Ben Pascoe, Francesca Schiaffino, Susan Murray, Guillaume Méric, Sion C. Bayliss, Matthew D. Hitchings, Evangelos Mourkas, Jessica K. Calland, Rosa Burga, Pablo Peñataro Yori, Keith A. Jolley, Kerry K. Cooper, Craig T. Parker, Maribel Paredes Olortegui, Margaret N. Kosek, Samuel K. Sheppard.

PLoS Negl Trop Dis 14(8): e0008533.

Abstract
Campylobacter is the leading bacterial cause of gastroenteritis worldwide and its incidencethe is especially high in low- and middle-income countries (LMIC). Disease epidemiology in LMICs is different compared to high income countries like the USA or in Europe. Children in LMICs commonly have repeated and chronic infections even in the absence of symptoms, which can lead to deficits in early childhood development. In this study, we sequenced and characterized C. jejuni (n = 62) from a longitudinal cohort study of children under the age of 5 with and without diarrheal symptoms, and contextualized them within a global C. jejuni genome collection. Epidemiological differences in disease presentation were reflected in the genomes, specifically by the absence of some of the most common global diseasecausing lineages. As in many other countries, poultry-associated strains were likely a major source of human infection but almost half of local disease cases (15 of 31) were attributable to genotypes that are rare outside of Peru. Asymptomatic infection was not limited to a single (or few) human adapted lineages but resulted from phylogenetically divergent strains suggesting an important role for host factors in the cryptic epidemiology of campylobacteriosis in LMICs.

William Checkley, Kendra N. Williams, Josiah L. Kephart, Magdalena Fandino-Del-Rio, N. Kyle Steenland, Gustavo F. Gonzales, Luke P. Naeher, Steven A. Harvey, Lawrence H. Moulton, Victor G. Davila-Roman, Dina Goodman, Carla Tarazona-Meza, Catherine H. Miele, Suzanne Simkovich, Marilu Chiang, Ryan T. Chartier, Kirsten Koehler, and the CHAP Trial Investigators.

Rationale:
Approximately 40% of people worldwide are exposed to household air pollution (HAP) from the burning of biomass fuels. Previous efforts to document health benefits of HAP mitigation have been stymied by an inability to lower emissions to target levels.

Objectives:
We sought to determine if a household air pollution intervention with liquefied petroleum gas (LPG) improved cardiopulmonary health outcomes in adult women living in a resource-poor setting in Peru.

Methods: We conducted a randomized controlled field trial in 180 women aged 25–64 years living in rural Puno, Peru. Intervention women received an LPG stove, continuous fuel delivery for 1 year, education, and behavioral messaging, whereas control women were asked to continue their usual cooking practices. We assessed for stove use adherence using temperature loggers installed in both LPG and biomass stoves of intervention households.

Measurements and Main Results:
We measured blood pressure, peak expiratory flow (PEF), and respiratory symptoms using the St. George’s Respiratory Questionnaire at baseline and at 3–4 visits after randomization. Intervention women used their LPG stove exclusively for 98% of days. We did not find differences in average
postrandomization systolic blood pressure (intervention – control 0.7 mm Hg; 95% confidence interval, 22.1 to 3.4), diastolic blood pressure (0.3 mm Hg; 21.5 to 2.0), prebronchodilator peak
expiratory flow/height2 (0.14 L/s/m2; 20.02 to 0.29), postbronchodilator peak expiratory flow/height2 (0.11 L/s/m2; 20.05 to 0.27), or St. George’s Respiratory Questionnaire total score (21.4;
23.9 to 1.2) over 1 year in intention-to-treat analysis. There were no reported harms related to the intervention.

Conclusions:
We did not find evidence of a difference in blood pressure, lung function, or respiratory symptoms during the year-long intervention with LPG

Taryn Clark, Manuela Verastegui, Freddy Tinajeros, Maritza Calderon, Rony Colanzi, and Robert H. Gilman.

Am. J. Trop. Med. Hyg., 103(6), 2020, pp. 2581–2583

Capacity building in public health is an urgent global priority. Recently, there has been an increasing
emphasis on South–South and triangular cooperation. We describe our experience with a public health training collaboration between Peru and Bolivia, with Peru providing capacity building and expertise to Bolivia, while receiving supportive funding and training from the United States. This collaboration has led to a groundswell of research on clinically significant diseases, outreach to more than 800 scientists, several dozen publications, and the start of four institutional review boards. South–South and South–South–North collaborations should publish their experiences, and Northern
funding organizations should consider funding such collaborations.

Jessica D. Brewer, Julianna Shinnick, Karina Román, Maria P. Santos, Valerie A. Paz-Soldan, Alison M. Buttenheim.

Global Health: Science and Practice 2020, volume 8, number 4

Childhood anemia remains a significant driver of morbidity in low- and middle-income countries, including Peru. To identify behavioral challenges to using micronutrient powder (MNP) that is
given to supplement children’s diets and prevent anemia, we applied a behavioral design approach to interviews and focus groups with 129 caregivers in Arequipa, Peru. We examined 3 key points in the decision-making process: accessing MNP through the health system; forming intentions to use MNP; and MNP use at the time of child feeding. Using the NUDGE (Narrow, Understand, Discover, Generate, Evaluate) approach, we identified the following behavioral barriers and facilitators:
(1) caregivers’ experiences with health care providers shaped their motivation to access MNP; (2) caregivers felt accessing MNP at clinics was inconvenient and created hassle factors; (3) caregivers’ mental models about anemia prevention shaped MNP intentions and use; (4) caregivers’ salient negative experiences could have caused them to stop giving MNP; (5) caregivers forgot to
give MNP if they did not have cues to remind them but could be prompted with salient cues; and (6) caregivers were affected by emotional, cognitive, and attentional factors during feeding that
were difficult to anticipate. Our results, based on a behavioral design approach, suggest opportunities to adapt current messaging, counseling, and education around MNP use. Adaptations include
providing culturally relevant messages, leveraging caregivers’ emotional and cognitive states, and encouraging small but impactful changes to feeding routines to address barriers to MNP use.