Background: Adolescent childbearing and maternal malnutrition are common in low- and middle-income countries and are associated with increased risk for poor maternal and infant outcomes. Adolescent pregnancy compounded with moderate malnutrition exacerbates outcomes common to both individually. Supplementary foods may be a way to improve outcomes in malnourished adolescent pregnant women. Objective: To retrospectively assess maternal and infant outcomes in moderately malnourished pregnant young adolescents (16-17 YO), older adolescents (18-19 YO), and adults (≥20 YO) in response to one of three nutritional interventions and in a pooled treatment group analysis, and to assess differences in infant outcomes by infant gender. Methods: Height, weight, MUAC, and FH were measured in pregnant women with MUAC >20.6 cm and < 23.0 cm at baseline (N=1828) every 2 weeks over the course of enrollment while receiving either: 1) macro- and micronutrient fortified, peanut-based, ready-to-use supplementary food (RUSF), 2) corn-soy blended flour with a prenatal multiple micronutrient supplement (CSB-UNIMMAP), or 3) corn-soy blended flour with iron and folic acid (CSB-IFA). Each provided approximately double the RDA of most micronutrients, 900 kcal/day and 33-36 g/day protein. Postpartum maternal and infant measurements were taken at delivery, and after 6 and 12 weeks. Maternal age at enrollment variable was transformed from a continuous variable into a categorical variable; young adolescent (16-17 YO), older adolescent (18-19 YO), and adults (≥20 YO). General linear models with normal errors were used to compare: 1. Adolescent maternal and infant outcomes by intervention, 2. Adolescent maternal and infant outcomes by maternal age within each intervention group, 3. Maternal and infant outcomes in a pooled treatment analysis by maternal age, 4. Interaction effects between maternal age and intervention, 5. Infant outcomes by infant gender. If differences between groups were detected, they were tested using the Tukey HSD test (response) or the likelihood ratio-based odds ratios (categorical). Odds ratios were measured using effects likelihood ratio tests via logistic regression. Response variables included in the analyses were BMI and fundal height at enrollment. Results: There were 297 young adolescents, 582 older adolescents, and 949 adults enrolled. Adolescents enrolled in the study at a younger gestational age than the adult mothers. Upon enrollment, BMI was greater and FH was smaller in the adolescent mothers than adults. At delivery, adolescent mothers had gained less weight on treatment, delivered with a lower final MUAC and FH, had increased odds of delivering extremely prematurely, and the greatest odds for delivering before recovery from malnutrition (MUAC ≥23.0 cm). Infants of young adolescent mothers were inferior anthropometrically to infants of the older mothers and had greatest odds of being underweight and stunted through 12 weeks of age. Young adolescents had the greatest odds for delivering LBW infants compared to the adults. Catch up growth was observed in the infants of older adolescents by 12 weeks of age; however, no catch up was observed for the infants of young adolescents. No one intervention was more helpful than another in determining maternal and infant outcomes of the adolescent mothers, and male infants had greater odds of being underweight and stunted at 6 and 12 weeks of age. Conclusions: Although adolescents did not appear to have characteristics of more severe clinical malnutrition, such as lower BMI, lower maternal height, and increased rates of HIV at baseline, maternal and infant outcomes were worse for the adolescent mothers compared to the older, more mature mothers. Adolescents gained less weight during pregnancy and delivered smaller infants that were unable to catch up linearly and with weight gain. Pregnant adolescents, particularly young adolescents, are a high-risk population and public health efforts should be made to delay the age of first pregnancy.

Background Rwanda has made great progress since the genocide in 1994, but is still facing the challenge of reducing the high prevalence of stunted children. Childhood stunting is an indicator for multiple pathological disorders and gives an elevated risk of chronic disease in adulthood. Engaging fathers and a shared responsibility between two partners in childcare could improve children’s health and help decrease stunting among children in rural areas of Rwanda. Aim The aim was to describe at the primary healthcare level in Rwanda, registered nurses' perceptions and experiences of fathers’ engagement in childcare to prevent stunted growth in children. Method A qualitative field study at three community health centers in Huye district with a semi-structured interview form. A qualitative content analysis was made. Findings The perception among nurses was that it was important to engage fathers to prevent stunted growth in children. Fathers' low level of knowledge in childcare, and traditional gender roles were acting as the main barriers of fathers' engagement, communication campaigns and community training were presented as opportunities to improve the level of engagement of the fathers. Conclusion Fathers participate in childcare. Though, the process of changing traditional gender roles is slow. In order to make further progress the nurses has to emphasize communication between spouses and a shared responsibility for the childcare. More attention needs to be paid to sensitization of families as well as healthcare personnel regarding damaging stereotypes in a traditional Rwandan household.

Kawasaki has calculated the integral homology groups of weighted projective space, and his results imply the existence of a homotopy equivalence between weighted projective space and a CW-complex, with a single cell in each even dimension less than or equal to that of weighted projective space. When the weights satisfy certain divisibility conditions then the associated weighted projective space is actually homeomorphic to such an minimal CW-complex and such decompositions are well-known in these cases. Otherwise this minimal CW-complex is not a weighted projective space. Our aim is to give an explicit CW-structure on any weighted projective space, using an invariant decomposition of complex projective space with respect to the action of a product of finite cyclic groups. The result has many cells, in both odd and even dimensions; nevertheless, we identify it with a subdivision of the minimal decomposition whenever the weights are divisive. We then extend the decomposition to stunted weighted projective space, defined as the quotient of one weighted projective space by another. Finally, we compute the integral homology groups of stunted weighted projective space, identify generators in terms of cellular cycles, and describe cup products in the corresponding cohomology ring.

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Background: Obesity-related diseases are arising as a major problem among children. inflammation has recently been identified to play an important role in the relationship between obesity.- as well as stunting-related diseases. Objectives: The aim of this study was to assess the association between serum tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations and a variety of cardiometabolic and anthropometric indices of children in a township outside Potchefstroom, South Africa. Methods: Blood samples of 115 girls and 78 boys (mean age 15.6 ± 1.35) in the Physical Activity in the Young (PLAY) study were cross-sectionally analysed. Trained fieldworkers collected the demographic, Tanner growth stage and habitual physical activity information. Physiologists measured the children’s blood pressure. Anthropometric measurements were taken by. trained post-graduate students with level 1 or 2 qualifications in anthropometrics. A standard test battery was administered by trained postgraduate students in Human Movement Science to assess muscular strength. flexibility and endurance of the children. Blood samples were collected, centrifuged and stored frozen until further analyses. Results: Stunted girls had a significantly higher serum TNF-α concentration than the non-stunted girls (p=0.03). The factor analyses showed that the inflammatory. status clustered with the height for age-z-scores (HAZ) scores and the waist-hip-ratio (WHR). The HAZ-score of the over-fat boys (- 1.46) was significantly smaller than the lean boys (- 1.14, p=0.0 1). whereas the over-fat girls had a trend for a smaller HAZ-score (-1.07) than the lean girls (-0.89). No significant differences were found between the over-fat and the lean children-s inflammatory status. TNF-α and CRP levels tended to be higher in the over-fat children than in lean children. The girls' scrum IL-6 and CRP concentrations correlated significantly with their body mass index (BMI) and WHR (p<0.05 )and their TNF-α and IL-6 concentrations correlated significantly with their WHR (p<0.01 and p<0.05, respectively). Conclusion: In comparison to the non-stunted girls, stunted girls had a statistically significantly higher TNF-α concentration. Unusual fat distribution that is found in over-fat and stunted children may be associated with low-grade inflammation in children. More research is needed on these associations with markers of inflammation in a long-term longitudinal study. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007.

Background: Obesity-related diseases are arising as a major problem among children. inflammation has recently been identified to play an important role in the relationship between obesity.- as well as stunting-related diseases. Objectives: The aim of this study was to assess the association between serum tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations and a variety of cardiometabolic and anthropometric indices of children in a township outside Potchefstroom, South Africa. Methods: Blood samples of 115 girls and 78 boys (mean age 15.6 ± 1.35) in the Physical Activity in the Young (PLAY) study were cross-sectionally analysed. Trained fieldworkers collected the demographic, Tanner growth stage and habitual physical activity information. Physiologists measured the children’s blood pressure. Anthropometric measurements were taken by. trained post-graduate students with level 1 or 2 qualifications in anthropometrics. A standard test battery was administered by trained postgraduate students in Human Movement Science to assess muscular strength. flexibility and endurance of the children. Blood samples were collected, centrifuged and stored frozen until further analyses. Results: Stunted girls had a significantly higher serum TNF-α concentration than the non-stunted girls (p=0.03). The factor analyses showed that the inflammatory. status clustered with the height for age-z-scores (HAZ) scores and the waist-hip-ratio (WHR). The HAZ-score of the over-fat boys (- 1.46) was significantly smaller than the lean boys (- 1.14, p=0.0 1). whereas the over-fat girls had a trend for a smaller HAZ-score (-1.07) than the lean girls (-0.89). No significant differences were found between the over-fat and the lean children-s inflammatory status. TNF-α and CRP levels tended to be higher in the over-fat children than in lean children. The girls' scrum IL-6 and CRP concentrations correlated significantly with their body mass index (BMI) and WHR (p<0.05 )and their TNF-α and IL-6 concentrations correlated significantly with their WHR (p<0.01 and p<0.05, respectively). Conclusion: In comparison to the non-stunted girls, stunted girls had a statistically significantly higher TNF-α concentration. Unusual fat distribution that is found in over-fat and stunted children may be associated with low-grade inflammation in children. More research is needed on these associations with markers of inflammation in a long-term longitudinal study. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2007.