Papers by Morten Sodemann
Acta Paediat, 2007
To evaluate the impact of promotion of exclusive breastfeeding on infant health in Guinea-Bissau,... more To evaluate the impact of promotion of exclusive breastfeeding on infant health in Guinea-Bissau, West Africa, where mortality rates are high, breastfeeding is widely practiced but exclusive breastfeeding is rare. At the Bandim Health Project in Guinea Bissau, West Africa, a birth cohort of 1721 infants were randomized to receive health education: promotion of exclusive breastfeeding for the first 4-6 months of life according to WHO recommendations at the time of the study. All children were followed from birth to 6 months of age. Introduction of both water and weaning food was significantly delayed in the intervention group. However we found no beneficial health effects of the intervention; there was no reduction in mortality in the intervention group compared with the control group (mortality rate ratio: 1.86 (0.79-4.39)), weight at 4-6 months of age was significantly lower in the intervention group (7.10 kg vs. 7.25 kg; Wilcoxon two-sample test: p=0.03). There was no difference in diarrhoea morbidity and hospitalization rates. Although mothers were sensitive to follow new breastfeeding recommendations, it had no beneficial impact on infant health in this society with traditional, intensive breastfeeding. There seems to be little reason to discourage local practices as long as there are no strong data justifying such a change.
Vaccine, Jan 19, 2005
Several studies have suggested that routine childhood immunisations may have non-specific effects... more Several studies have suggested that routine childhood immunisations may have non-specific effects on mortality. To examine which disease categories might be affected, we investigated whether immunisation status had an impact on the case fatality for hospitalised children. Between 1990 and 1996, the Bandim Health Project maintained a register of all children from the study area hospitalised at the paediatric ward of the central hospital in Bissau, Guinea-Bissau. The study included 2079 hospitalised children aged 1.5-17 months coming from the Bandim study area. Among children whose vaccination card had been seen at admission, the case fatality ratio for measles-vaccinated children versus measles-unvaccinated children was 0.51 (0.27-0.98), the beneficial effect being significantly stronger for girls than for boys (test of interaction, p=0.050). The protective effect of measles vaccine remained unchanged when hospitalised measles cases were excluded from the analysis (0.49 (0.26-0.94)). The effect of measles vaccine was strongest for children with pneumonia (MR=0.28 (0.07-0.91)) and presumptive malaria (MR=0.40 (0.13-1.18)). For measles-vaccinated children, the female to male case fatality ratio was 0.54 (0.28-0.97). Among children having received diphtheria-tetanus-pertussis (DTP) and oral polio (OPV) as the last vaccines, girls had higher case fatality than boys, the mortality ratio being 1.63 (1.03-2.59). The female to male ratios were significantly inversed for DTP and OPV versus measles vaccine (test of interaction, p=0.003). These results remained unchanged if 1-month post-discharge deaths were included in the analysis, and in multivariate analyses controlling for determinants of mortality. In conclusion, measles vaccine was associated with reduced mortality from diseases other than measles, the beneficial effect being stronger for girls than for boys. On the other hand, DTP and OPV vaccine were associated with higher case fatality for girls than for boys. Understanding the divergent non-specific effects of common vaccines may contribute to better child survival in developing countries.
American Journal of Respiratory and Critical Care Medicine, Feb 1, 2009
Rationale: Vitamin D has been shown to be involved in the host immune response toward Mycobacteri... more Rationale: Vitamin D has been shown to be involved in the host immune response toward Mycobacterium tuberculosis. Objectives: To test whether vitamin D supplementation of patients with tuberculosis (TB) improved clinical outcome and reduced mortality. Methods: We conducted a randomized, double-blind, placebocontrolled trial in TB clinics at a demographic surveillance site in Guinea-Bissau. We included 365 adult patients with TB starting antituberculosis treatment; 281 completed the 12-month followup. The intervention was 100,000 IU of cholecalciferol or placebo at inclusion and again 5 and 8 months after the start of treatment.
The Pan African medical journal, 2016
Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-... more Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV is crucial and can increase insight into the HIV epidemic in Africa. We used data from two retrospective HIV surveys conducted in Guinea-Bissau from 1993 to 1996 (1996 cohort) and from 2004 to 2007 (2006 cohort). Multivariate logistical models were used to investigate the relationships between HIV risk and circumcision status, timing, method of circumcision, and socio-demographic factors. MC was protective against HIV infection in both cohorts, with adjusted odds ratios (AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We observed that post-pubertal (≥13 years) circumcision provided the highest level of HIV risk reduction in both cohorts compared to non-circumcised. However, the diffe...
Ann Trop Paediat, 2001
In community-based studies conducted from 1991 to 1997 in Guinea-Bissau, West Africa, stool speci... more In community-based studies conducted from 1991 to 1997 in Guinea-Bissau, West Africa, stool specimens from children aged less than 5 years with diarrhoea were routinely examined for enteric parasites. Cryptosporidium parvum, found in 7.7% of 4,922 samples, was the second most common parasite, exceeded only by Giardia lamblia which was found in 14.8% of the samples. The highest prevalence of cryptosporidium was found in children aged 6-11 months, whereas the prevalence of other enteric parasites increased with age. Cryptosporidiosis showed a marked seasonal variation, with peak prevalences found consistently at the beginning of or just before the rainy seasons, May through July. By contrast, no seasonality was found for the enteric parasites Giardia lamblia or Entamoeba histolytica. We conclude that Cryptosporidium parvum is an important pathogen in children with diarrhoea.
International Journal of Occupational and Environmental Health, 2010
Due to the infectious nature of some clinical waste, poor disposal practices have sparked concern... more Due to the infectious nature of some clinical waste, poor disposal practices have sparked concern regarding the impact on public health and the environment. Lack of sufficient knowledge of the associated risks may be a strong factor contributing to inadequate disposal practices. We conducted a survey to evaluate hospital workers' awareness of health and environmental impacts of poor clinical waste disposal in Cameroon. We randomly distributed 500 questionnaires to hospital workers in three hospitals in the Northwest Region of Cameroon in April 2008. In addition, we observed collection, segregation, transportation, and disposal of clinical waste at the three hospitals. Of 475 total respondents, most lacked sufficient awareness of any environmental or public health impacts of poor clinical waste disposal and had never heard of any policy--national or international--on safe clinical waste management. Methods of collecting, segregating, transporting and disposing clinical waste at the three hospitals was poor. The development of a comprehensive policy on efficient clinical waste management in Cameroon is imperative.
Twin research and human genetics : the official journal of the International Society for Twin Studies, 2016
We analyzed birth order differences in means and variances of height and body mass index (BMI) in... more We analyzed birth order differences in means and variances of height and body mass index (BMI) in monozygotic (MZ) and dizygotic (DZ) twins from infancy to old age. The data were derived from the international CODATwins database. The total number of height and BMI measures from 0.5 to 79.5 years of age was 397,466. As expected, first-born twins had greater birth weight than second-born twins. With respect to height, first-born twins were slightly taller than second-born twins in childhood. After adjusting the results for birth weight, the birth order differences decreased and were no longer statistically significant. First-born twins had greater BMI than the second-born twins over childhood and adolescence. After adjusting the results for birth weight, birth order was still associated with BMI until 12 years of age. No interaction effect between birth order and zygosity was found. Only limited evidence was found that birth order influenced variances of height or BMI. The results wer...
The American Journal of Tropical Medicine and Hygiene, Aug 1, 1999
To examine the association between diarrhea in early childhood and malaria parasitemia, we conduc... more To examine the association between diarrhea in early childhood and malaria parasitemia, we conducted a nested case-control study in Guinea-Bissau of 297 children with diarrhea and a similar number of children without diarrhea matched for age, season, and residential area. There were no associations between diarrhea and parasite rate, parasite density, or clinical malaria. However, anti-malarials were easily available and frequently used, which was reflected by a 0.7% prevalence of children with a parasite density Ͼ 100/200 leukocytes. Thus, the findings do not preclude that diarrhea may be a sign of clinical malaria or high-parasite density in endemic areas with lower use of antimalarials.
Trans Roy Soc Trop Med Hyg, 1999
The aim of the present study, carried out in Guinea-Bissau, West Africa, was to identify episode-... more The aim of the present study, carried out in Guinea-Bissau, West Africa, was to identify episode-specific risk factors for persistent diarrhoea (I'D) related to clinical observations and management efforts. We followed 3 19 episodes of childhood diarrhoea by repeated household interviews until the episode stopped or after 14 days with diarrhoea. Children who still had diarrhoea after 14 days (n=40,125% of episodes) were regarded as suffering from PD. Clinical signs, perceived by the mother, were recorded together with care-seeking behaviour and management actions. Tired and rapid breathing prior (OR=652 (95% CI 1.69-25-l)), mother had to force breast feeding (OR=801 (2.99-215)) and current infection with Cryptosporidium (OR335.53 (2.10-14.6)) were the most important independent risk factors for the development of PD. Late consultation (>48 h) was associated with PD, reflecting that these episodes initially were less acute. Use of oral rehydration salts did not have an impact on development of I'D, whereas home medication tended to increase the risk of PD. Our study confirms the close association between systemic illness and I'D as well as the importance of cryptosporidiosis as a cause of PD. We were unable to identify management factors with a significant influence on the risk of developing PD.
Http Dx Doi Org 10 2989 16085906 2013 815405, Mar 1, 2013
Adherence is a decisive factor in achieving a successful response to antiretroviral therapy (ART)... more Adherence is a decisive factor in achieving a successful response to antiretroviral therapy (ART) for HIV infection. No previous studies have been conducted regarding HIV treatment adherence in Guinea-Bissau. In this study we assessed barriers and facilitators to patient ART adherence. Semi-structured interviews were conducted with 20 adult, HIV infected individuals receiving ART at a HIV treatment centre in Bissau, Guinea-Bissau. The grounded theory method was used to gather and analyse data. Results indicated that HIV-related knowledge was a determining factor for optimal adherence. The facilitators were experienced treatment benefits and complementing social networks. The barriers were treatment-related costs and competing livelihood needs; poor clinic infrastructure; perceived stigma; and traditional practices. Our findings indicate that good ART adherence, especially in resource-limited settings, requires that patients achieve adequate HIV-related knowledge. More studies on HIV-related knowledge and adherence among HIV infected individuals are currently needed.
Ugeskrift For Laeger, Jan 11, 2010
The present paper reviews studies carried out by the Bandim Health Project during the armed confl... more The present paper reviews studies carried out by the Bandim Health Project during the armed conflict in Guinea-Bissau, 1998-1999. Common health interventions like vaccination and breastfeeding, as well as focused interventions such as nutrition interventions aimed at malnourished children are effective measures. Population-based studies of health status gives important information about health conditions for groups at special risk, and provides information about which interventions are the most effective in an emergency.
To evaluate the impact of promotion of exclusive breastfeeding on infant health in Guinea-Bissau,... more To evaluate the impact of promotion of exclusive breastfeeding on infant health in Guinea-Bissau, West Africa, where mortality rates are high, breastfeeding is widely practiced but exclusive breastfeeding is rare. At the Bandim Health Project in Guinea Bissau, West Africa, a birth cohort of 1721 infants were randomized to receive health education: promotion of exclusive breastfeeding for the first 4-6 months of life according to WHO recommendations at the time of the study. All children were followed from birth to 6 months of age. Introduction of both water and weaning food was significantly delayed in the intervention group. However we found no beneficial health effects of the intervention; there was no reduction in mortality in the intervention group compared with the control group (mortality rate ratio: 1.86 (0.79-4.39)), weight at 4-6 months of age was significantly lower in the intervention group (7.10 kg vs. 7.25 kg; Wilcoxon two-sample test: p=0.03). There was no difference in diarrhoea morbidity and hospitalization rates. Although mothers were sensitive to follow new breastfeeding recommendations, it had no beneficial impact on infant health in this society with traditional, intensive breastfeeding. There seems to be little reason to discourage local practices as long as there are no strong data justifying such a change.
Ugeskrift For Laeger, 2013
Methods Two cohorts (A and B) were used to describe the mortality pattern for children with and w... more Methods Two cohorts (A and B) were used to describe the mortality pattern for children with and without BCG scar and to determine specific causes of death. In cohort A (n = 1813), BCG scar was assessed at 6 months of age and as previously described children with a BCG scar had lower mortality over the next 12 months than
Twin research and human genetics : the official journal of the International Society for Twin Studies, Jan 4, 2015
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been sugges... more A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than ...
Twin research and human genetics : the official journal of the International Society for Twin Studies, Jan 27, 2015
For over 100 years, the genetics of human anthropometric traits has attracted scientific interest... more For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We a...
Journal of Public Health in Africa, 2011
Clinical waste is ineffectively treated and disposed in Cameroon. Disposal sites have unrestricte... more Clinical waste is ineffectively treated and disposed in Cameroon. Disposal sites have unrestricted access and are located within communities. We hypothesize that vector proliferation and exposure to chronic low-level emissions will increase morbidity in children living around such sites. Self-reported disease frequency questionnaires were used to estimate the frequency of new episodes of intestinal, respiratory and skin infections among exposed children less than 10 years. Data was simultaneously collected for unexposed children of the same age, using the same questionnaire. Data reporting by the parents was done in the first week in each of the 6 months study period. The risk ratios were 3.54 (95% CI, 2.19-5.73), 3.20 (95% CI, 1.34-7.60) and 1.35 (95% CI, 0.75-2.44) for respiratory, intestinal and skin infections respectively. Their respective risk differences were 0.47 (47%), 0.18 (18%) and 0.08 (8%). The study revealed that poor treatment and disposal of clinical waste sites enhance morbidity in children living close to such areas. Simple health promotion and intervention programs such as relocating such sites can significantly reduce morbidity.
Scandinavian journal of public health, Jan 9, 2015
Background: Knowledge regarding the human papillomavirus (HPV) and HPV vaccine uptake among ethni... more Background: Knowledge regarding the human papillomavirus (HPV) and HPV vaccine uptake among ethnic minorities is poorly explored in Denmark. The objective of this study was to explore attitudes and knowledge towards HPV vaccination among Arab mothers and their daughters. Methods: Five Arabic-speaking focus groups with mothers of vaccine-eligible girls and three focus groups with daughters were conducted. The participants were recruited through different social clubs. A phenomenological approach was used to investigate attitudes and knowledge of HPV vaccination. Meaning condensation inspired by Amedeo Giorgi was used to analyse the transcribed material. Results: A total of 23 women and 13 daughters were included in this study. The mothers' knowledge regarding HPV was limited to the fact that HPV can cause cervical cancer. Two focus groups mentioned that HPV is a sexually transmitted disease and none of the mothers knew that HPV also causes genital warts. Both mothers and daughter...
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Papers by Morten Sodemann