Browsing by Author "Norris, Shane A."

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    Developmental origins of health and disease in Africa - influencing early life
    (Elsevier, 2018) Davies, Justine Ina; Macnab, Andrew John; Byass, Peter; Norris, Shane A.; Nyirenda, Moffat; Singhal, Atul; Sobngwi, Eugene; Daar, Abdallah S.
    It is well established that Africa is undergoing rapid transitions resulting in a triple burden of malnutrition, infectious diseases, and non-communicable diseases (NCDs).1,2 That health systems are unlikely to be able to cope with this burden is also widely noted.1,2 What is less often discussed outside academic circles is the degree to which infectious diseases and malnutrition in Africa are exacerbating the burden of NCDs, and the implications of this exacerbation for individuals and populations.
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    Effectiveness of home-based nutritional counselling and support on exclusive breastfeeding in urban poor settings in Nairobi : a cluster randomized controlled trial
    (BMC (part of Springer Nature), 2017) Kimani-Murage, Elizabeth W.; Griffiths, Paula L.; Wekesah, Frederick Murunga; Wanjohi, Milka; Muhia, Nelson; Muriuki, Peter; Egondi, Thaddaeus; Kyobutungi, Catherine; Ezeh, Alex C.; McGarvey, Stephen T.; Musoke, Rachel N.; Norris, Shane A.; Madise, Nyovani J.
    Background: Exclusive breastfeeding (EBF) improves infant health and survival. We tested the effectiveness of a homebased intervention using Community Health Workers (CHWs) on EBF for six months in urban poor settings in Kenya. Methods: We conducted a cluster-randomized controlled trial in Korogocho and Viwandani slums in Nairobi. We recruited pregnant women and followed them until the infant’s first birthday. Fourteen community clusters were randomized to intervention or control arm. The intervention arm received home-based nutritional counselling during scheduled visits by CHWs trained to provide specific maternal infant and young child nutrition (MIYCN) messages and standard care. The control arm was visited by CHWs who were not trained in MIYCN and they provided standard care (which included aspects of ante-natal and post-natal care, family planning, water, sanitation and hygiene, delivery with skilled attendance, immunization and community nutrition). CHWs in both groups distributed similar information materials on MIYCN. Differences in EBF by intervention status were tested using chi square and logistic regression, employing intention-to-treat analysis. Results: A total of 1110 mother-child pairs were involved, about half in each arm. At baseline, demographic and socioeconomic factors were similar between the two arms. The rates of EBF for 6 months increased from 2% pre-intervention to 55.2% (95% CI 50.4–59.9) in the intervention group and 54.6% (95% CI 50.0–59.1) in the control group. The adjusted odds of EBF (after adjusting for baseline characteristics) were slightly higher in the intervention arm compared to the control arm but not significantly different: for 0–2 months (OR 1.27, 95% CI 0.55 to 2.96; p = 0.550); 0–4 months (OR 1.15; 95% CI 0.54 to 2.42; p = 0.696), and 0–6 months (OR 1.11, 95% CI 0.61 to 2.02; p = 0.718). Conclusions: EBF for six months significantly increased in both arms indicating potential effectiveness of using CHWs to provide home-based counselling to mothers. The lack of any difference in EBF rates in the two groups suggests potential contamination of the control arm by information reserved for the intervention arm. Nevertheless, this study indicates a great potential for use of CHWs when they are incentivized and monitored as an effective model of promotion of EBF, particularly in urban poor settings. Given the equivalence of the results in both arms, the study suggests that the basic nutritional training given to CHWs in the basic primary health care training, and/or provision of information materials may be adequate in improving EBF rates in communities. However, further investigations on this may be needed. One contribution of these findings to implementation science is the difficulty in finding an appropriate counterfactual for community-based educational interventions.
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    Ensuring healthier trajectories that start in early life to assist non-communicable disease prevention in Africa : a life-course approach
    (African Sun Media, 2020) Norris, Shane A.
    Non-communicable diseases are increasing globally, particularly in low- and middle-income countries. For countries on the African continent, this is of particular concern as the combination of a persisting burden of infectious disease coupled with a burgeoning of non-communicable diseases could cripple already strained health care systems. The current paradigm subscribes heavily on detection, treatment and management of patients with non-communicable diseases. This perspective is important, but a more balanced approach that strengthens prevention efforts is also needed.
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    Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations
    (Taylor & Francis Open, 2017) Norris, Shane A.; Daar, Abdallah; Balasubramanian, Dorairajan; Byass, Peter; Kimani-Murage, Elizabeth; Macnab, Andrew; Pauw, Christoff; Singhal, Atul; Yajnik, Chittaranjan; Akazili, James; Levitt, Naomi; Maatoug, Jihene; Mkhwanazi, Nolwazi; Moore, Sophie E.; Nyirenda, Moffat; Pulliam, Juliet R. C.; Rochat, Tamsen; Said-Mohamed, Rihlat; Seedat, Soraya; Sobngwi, Eugene; Tomlinson, Mark; Toska, Elona; Van Schalkwyk, Cari
    Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease.This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.