Helen Nabwera

Aga Khan University

Apnoea of prematurity (AOP) is a common complication among preterm infants (< 37 weeks gestation), globally. However, access to caffeine citrate (CC) that is a proven safe and effective treatment in high-income countries is largely unavailable in low- and-middle income countries, where most preterm infants are born. Therefore, the overall aim of th...

[This corrects the article DOI: 10.1371/journal.pone.0244109.].

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is...

Background Preterm (born < 37 weeks’ gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of fe...

Longitudinal, community-based sampling is important for understanding prevalence and transmission of respiratory pathogens. Using a minimally invasive sampling method, the FAMILY Micro study monitored the oral, nasal and hand microbiota of families for 6 months. Here, we explore participant experiences and opinions. A mixed methods approach was uti...

Monitoring the presence of commensal and pathogenic respiratory microorganisms is of critical global importance. However, community-based surveillance is difficult because nasopharyngeal swabs are uncomfortable and painful for a wide age range of participants. We designed a methodology for minimally invasive self-sampling at home and assessed its u...

Background Undernutrition in the critical first 1000 days of life is the most common form of childhood malnutrition, and a significant problem in low‐ and middle‐income countries (LMICs). The effects of undernutrition in children aged under five years are wide‐ranging and include increased susceptibility to and severity of infections; impaired phys...

Background: Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality. Objectives: To explore how PND influences neonatal f...

Background Globally, low birthweight (LBW) infants (<2,500 g) have the highest risk of mortality during the first year of life. Those who survive often have adverse health outcomes. Post-discharge outcomes of LBW infants in impoverished communities in Africa are largely unknown. This paper describes the design and implementation of a mother-to-moth...

Background: The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. Methods: The records of women who delivered in hospitals and...

Background: Low birth weight (LBW) is associated with neonatal mortality and sequelae of lifelong health problems; prioritizing the most promising antenatal interventions may guide resource allocation and improve health outcomes. Objective: We sought to identify the most promising interventions that are not yet included in the policy recommendat...

Longitudinal, community-based sampling is important for understanding prevalence and transmission of respiratory pathogens. Using a minimally invasive sampling method, the FAMILY Micro study monitored the oral, nasal and hand microbiota of families for 6 months. Here, we explore participant experiences and opinions. A mixed methods approach was uti...

Background: Monitoring the presence of commensal and pathogenic microorganisms in the human oral, nasal and hand niches as determinants for respiratory tract infections is of critical global relevance as was evident during the COVID-19 pandemic. However, community-based surveillance is difficult because current sampling methods are not optimal for...

Background Stunting-length for age more than 2 standard deviations below the median for the World Health Organisation (WHO) growth reference standards, is the most common form of childhood malnutrition. As of 2020, there were approximately 149 million stunted children under the age of five worldwide, which threatens to derail global efforts to achi...

Objectives Neonatal sepsis, a major cause of death amongst infants in sub-Saharan Africa, is often gut derived. Gut colonisation by Enterobacteriaceae producing extended spectrum beta-lactamase (ESBL) or carbapenemase enzymes can lead to antimicrobial-resistant (AMR) or untreatable infections. We sought to explore the rates of colonisation by ESBL...

Although access to effective medical care for acutely sick children has improved globally, the number of children surviving but who may not be thriving due to disability, is increasing. This study aimed to understand the views of health professionals, educators and caregivers of pre-school children with disabilities in Malawi, Pakistan and Uganda r...

The majority of the 2.4 million neonates (infants<28 days) who died in 2020 were born weighing <2500g i.e. low birth weight (LBW). In Africa, approximately 1 in 10 neonates are LBW. The majority of those who survive beyond the neonatal period are undernourished, have neuro-developmental impairment, or die before their second birthday. Unaddressed f...

Objectives Accurate and timely diagnosis of common neonatal conditions is crucial for reducing neonatal deaths. In low/middle-income countries with limited resources, there is sparse information on how neonatal diagnoses are made. The aim of this study was to describe the diagnostic criteria used for common conditions in neonatal units (NNUs) in Ni...

Background Previous Kenyan studies suggest postnatal depression (PND) may negatively impact infant growth. However these studies are limited to Nairobi and no research has explored the effects of PND in the neonatal period. Aim To explore the impact of PND on neonatal feeding practices, weight gain, illness episodes and identify key maternal careg...

Aims To assess the feasibility and acceptability of using trained peer mothers to deliver breastfeeding support to mothers of low-birth-weight (LBW, <2500g) infants in healthcare facilities in rural, western Kenya. Methods The study was conducted in Homa Bay County. Seventeen peer mothers attended a 4-day training programme that focussed on commun...

Background Optimizing nutrition in very preterm (28–32 weeks gestation) and very low birth weight (VLBW; 1,000 g to <1,500 g) infants has potential to improve their survival, growth, and long-term health outcomes. Aim To assess feeding practices in Nigeria and Kenya for very preterm and VLBW newborn infants. Methods This was a cross-sectional stu...

Poor knowledge and management of menstruation impacts girls’ school attendance and academic performance. This paper aims to explore how menstrual hygiene management practices and related factors influence school absenteeism and drop-out among primary and secondary school girls in rural Gambia. Mixed-method studies were conducted among students and...

Objectives Neonatal sepsis, a major cause of death amongst infants in sub-Saharan Africa, is often gut derived. Impairments in immunity and the gut barrier in sick neonates allow colonisation by opportunistic pathogens such as Enterobacteriaceae to progress to blood stream infection. Colonisation by Enterobacteriaceae producing extended spectrum be...

Background: The specific roles that gut microbiota, known pathogens, and host energy-regulating hormones play in the pathogenesis of non-edematous severe acute malnutrition (marasmus SAM) and moderate acute malnutrition (MAM) during outpatient nutritional rehabilitation are yet to be explored. Methods: We applied an ensemble of sample-specific (...

Background Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. Objective The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and...

We assessed the effect of COVID-19 lockdown on deliveries and neonatal admissions according to gestation in Lagos, Nigeria. During lockdown (April-June 2020), there was a marked fall of about 50% in in-hospital deliveries and admissions to the neonatal wards for both in and outborn infants compared with prelockdown (January-March 2020) and a compar...

Background Accurate and timely diagnosis and management of common neonatal conditions is crucial for reducing preventable neonatal deaths. In low- and middle-income countries, there is sparse information on how neonatal diagnoses are made including use of clinical guidelines and access to appropriate laboratory and radiology services. An improved u...

Background Alder Hey Children’s Hospital has a tertiary acute general paediatric service with a very high number of admissions. In the context of reduced community-based support for mothers with young infants to establish and sustain breastfeeding or other appropriate infant feeding strategies, we were concerned that some of our neonatal admissions...

Background: Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes. Aim: To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Ke...

Inadequate menstrual hygiene management (MHM) practices have been associated with adverse health outcomes. This study aimed to describe MHM practices among schoolgirls from rural Gambia and assess risk factors associated with urogenital infections and depressive symptoms. A cross-sectional study was conducted among adolescent schoolgirls in thirtee...

Objective To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria. Study design In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period. Resu...

Background Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to COVID-19 infection, progression to symptoms, likelihood of severe disease and survival. The pandemic has fostered many nutrition-related theories, sometimes backed by a biased interpretation of evidence. Objectives To provide a systematic...

Background There is a scarcity of information around the most important outcomes for research in neonatal units in low-resource settings. Identification of important outcomes, which reflect shared clinical decisions between healthcare workers and parents, would inform the development of a core outcome set (COS) for use in research. Objective To id...

Aims To explore the experiences of accessing care for low birth weight (LBW) infants in rural Kenya, in order to identify the barriers and facilitators to support the development of interventions to improve outcomes of these infants in rural Kenya and other similar settings. Methods Qualitative research using in-depth interviews. Purposive samplin...

Objective To explore the experiences of using continuous positive airway pressure (CPAP) in newborn care among healthcare workers in Kenya, and to identify factors that would promote successful scale-up. Design and setting A qualitative study using key informant interviews and focus group discussions, based at secondary and tertiary level hospital...

Background There is a scarcity of information regarding the most important outcomes for research in neonatal units in low-resource settings. Identification of important outcomes by different stakeholder groups would inform the development of a core outcome set (COS) for use in neonatal research. Objective To determine the perceptions and opinions...

OBJECTIVE: To develop a shared anonymized database of key clinical variables across the Neonatal Nutrition Network and to characterize the population and burden of disease in all 7 neonatal unit admissions. It also set out to identify research priorities and basis for quality improvement. STUDY DESIGN: Multi-centre cross-sectional study involving 7...

Background Appropriate menstrual hygiene management (MHM) is impeded by taboos and secrecy surrounding menstruation. Unhygienic menstrual practices and unpreparedness for managing menstruation has been associated with adverse health and social outcomes among adolescent girls. In The Gambia, there is limited data on menstrual practices among girls a...

Abstract Background Childhood malnutrition remains highly prevalent in low-income countries, and a 40% reduction in under-5 year stunting is WHO’s top Global Target 2025. Disappointingly, meta-analyses of intensive nutrition interventions reveal that they generally have low efficacy at improving growth. Unhygienic environments also contribute to gr...

Aim To describe the operational aspects of continuous positive airway pressure (CPAP) use in newborn care in Kenya. Methods An ongoing nationwide survey of all health facilities in Kenya that use CPAP in newborn care. The mixed method approach used includes a standard questionnaire to describe CPAP use; key informant interviews and focus group dis...

Background: Severe wasting affects 16 million under 5's and carries an immediate risk of death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a high-risk period. We aimed to explore risk factors for severe wasting in rural Gambian infants. Methods: We undertook a case-control study from November 2014 to June 201...

Growth faltering associated with undernutrition in early childhood is endemic in sub- Saharan Africa. Worldwide, over 3 million child deaths annually are attributed to foetal growth restriction, underweight, stunting, wasting, suboptimal breastfeeding and micronutrient deficiencies. Survivors suffer adverse health and socio-economic outcomes. Altho...

Background: Malnourished children show variable growth responses to nutritional rehabilitation. We aimed to investigate whether these differences could be explained by variations in growth and energy-regulating hormones. Methods: Quasi-experimental study: Children aged 6-24 months in rural Gambia were recruited to controls if weight-for-height z...

Background Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. We aimed to describe the decision-making processes around infant feeding at a rural HIV clinic in Kenya. Methods We used a qualit...

Background: Severe acute malnutrition (SAM) is a major public health problem. Mid-upper arm circumference (MUAC) is widely used to admit children to treatment programmes. However, insufficient data supporting MUAC discharge criterion limits its use as a stand-alone tool. Our aim was to evaluate MUAC for monitoring nutritional recovery and discharg...

Background: Growth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality. Due to a very slow decline in the prevalence of stunting, the total number of children with stunting continues to rise in sub-Saharan Africa. Identification of effective interventions remains a challenge. Methods...

Table S1. Clinical data extracted from case note review