Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu

Objective To assess the effectiveness of complementary food supplements with protein and multi-micronutrients on hemoglobin and anemia in infants and young children. Methods In 5 poor counties of Gansu, 984 children aged 6-12 months were enrolled and divided into two groups. In addition to the usual home-made complementary food, all the children were fed one sachet of either Formula Ⅰ or Formula Ⅱ supplements each day. Protein and micronutrients were provided in Formula Ⅰ, while the same energy intake was secured in Formula Ⅱ as in Formula Ⅰ. A massive dose of vitamin A was supplemented to all the children every 6 months. Hemoglobin test was done at the same time. Results Prevalence of anemia was about 35% in both Formula Ⅰ and Formula Ⅱ group at baseline, and there were no differences in hemoglobin concentration between the two groups, During the 6-month and 12-month supplementation, hemoglobin of children in Formula Ⅰ group was higher than that in Formula Ⅱ group （P〈0.05）, and hemoglobin increase in Formula Ⅰ group was significantly higher than that in Formula Ⅱ group （P〈0.001）. After 6- and 12-mouth supplementation, the prevalence of anemia in Formula Ⅰ group dropped to 19.1% and 8.2% respectively, and it was 28.0% and 12.4% in Formula 2 group. The prevalence of anemia in Formula Ⅰ group was significantly lower than that in Formula Ⅱ group （P〈0.05）. After adjusting age and hemoglobin level at baseline, the hemoglobin increase at age of 24 months in formula 1 group was higher （10.7 g/L vs 7.9 g/L, P〈0.0001）. Conclusion Micronutrient fortified complementary food supplements, with large-dose vitamin A, is effective for children aged 6-12 months in terms of iron deficiency prevention.

Changes in the epidemiology of hepatitis A in three socio-economic regions of China,1990-2017

Background:Hepatitis A(HepA)vaccination and economic transitions can change the epidemiology of HepA.China's Gross Domestic Product(GDP)per capita was known to be inversely associated with the incidence of HepA,but a deeper understanding of the epidemiology of HepA in different socio-economic regions is lacking.We compare the changing epidemiology of HepA in three socioeconomic-geographic regions of China.Methods:We obtained data on all HepA cases reported through the National Notifiable Disease Reporting System and assessed trends and changes in age-specific incidence rates by age quartile and season.We categorized the country into three regions,the sequential years into five era,compared the incidence,quartile age;seasonal intensity and coverage of HepA of the three regions.Linear regression was peiformed to analyse trends in incidence of HepA and to analyse the association between coverage and incidence.Results:The annual mean incidences of HepA in the eastern,central,and western regions decreased from 63.52/100000,50.57/100000 and 46.39/100000 in 1990-1992 to 1.18/100000,1.05/100000 and 3.14/100000 in 2012-2017,respectively.Decreases in incidence were seen in all age groups in the three regions;the incidence was highest(9.3/100000)in the youngest age group(0-4 years)of the western region,while in the central region,the age group with the highest incidence changed from 0 to 9 years to adults>60 years old.In 2017,the median age of HepA cases was 43 years(Q-Q3:33-55),47 years(Q1-Q3:32-60)and 33 years(Q1-Q3:9-52)in the eastern,central,and western provinces,respectively.Seasonal peaks became smaller or were nearly elimination nationwide,but seasonality persisted in some provinces.After the Expanded Program on Immunization(EPI)included HepA vaccine into the routine schedule in 2007,HepA coverage increased to>80%in the three regions and was negatively association with the HepA incidence.Conclusion:The incidence of HepA decreased markedly between 1990 and 2017.A socioeconomic inequity in coverage of HepA vaccine was almost eliminated after HepA vaccine was introduced into China's EPI system,but inequity in incidence still existed in lower socio-economic developed region.

Compliance among infants exposed to hepatitis B virus in a post-vaccination serological testing program in four provinces in China

Background:Mother to child transmission of hepatitis B virus(HBV)remains the most common form of HBV infection in China.Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine(HepB)series and hepatitis B immunoglobulin.Post-vaccination serological testing(PVST)is utilized to determine an infant's outcome after HBV exposure and completion of HepB series.We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up(LTFU).Methods:We conducted a retrospeaive cohort review of previously collected data in Fujian,Jiangxi,Zhejiang and Chongqing provinces in China from 1 June 2016-31 December 2017.The study population included all HBV-exposed infants and their mothers.SAS software was used for statistical analyses.Bivariate and multivariate regression analyses(presented in odds ratio[OR]with 95%confidence intervals[CI])were used to compare the proportional differences of factors associated with PVST not being completed.Results:Among enrolled 8474 target infants,40%of them transferred out of the study provinces without further information and 4988 were eligible for PVST.We found 20%(994)of infants were not compliant with the testing cascade:55%of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field,16%transferred out after 6 months of age,and 10%of families chose to have independent,confidential PVST completed without reporting results.High PVST noncompliance rates were more likely to be from Fujian(aOR=17.0,95%CI:9.7-29.9),Zhejiang(aOR=5.7,95%Cl:3.2-10.1)and Jiangxi(aOR=1.9,95%CI:1.0-3.4),and from HBV e antigen positive mother(aOR=1.2,95%CI:1.1-1.4).Conclusions:This study found that the LTFU rate reached 20%in PVST program,which was a significant problem.We recommend implementing a national elearonic information system for tracking HBV at risk mother-infant pairs;encourage further research in developing a less invasive means of completing PVST,and take effective measures nationally to reduce HBV stigma.Without reducing the loss to follow up rate among infants eligible for PVST,elimination of vertical HBV transmission will be impossible.