human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements ( SQ-LNS ) has result ed in improvements in birth outcomes in some low-income setting s. In order to be effective , SQ-LNS must be consumed regularly over sustained periods . Methods The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation . We enrolled women before 20 gestation weeks into r and omized trials in Ghana ( n = 1320 ) and Malawi ( n = 869 ) . In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation . In the control groups participants received multiple micronutrients ( MMN ) during pregnancy and lactation or iron and folic acid ( IFA ) during pregnancy and calcium during lactation . We used question naires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability . Results The mean self-reported adherence during the supplementation period was lower in Ghana ( 79.9 % ) than in Malawi ( 91.7 % ) for all supplements ( difference 11.8 % , P < 0.001 ) . Over time , adherence increased in Malawi but decreased in Ghana . In both countries , adherence in the SQ-LNS group was non-inferior to that in the control groups . Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences , most of the women described incidents of non-adherence . A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy . Especially in Malawi , women reported sharing SQ-LNS with families and friends . Sustained use of  SQ-LNS  was attributed to expected health benefits and favorable sensory attributes . Often women compared their pregnancy to previous ones , and were of the view that SQ-LNS made a positive difference . ConclusionS elf-reported sustained adherence to consume  SQ-LNS  daily was high in both sites but lower in Ghana than in Malawi . In Ghana , adherence decreased over time whereas in Malawi adherence increased . Acceptability and adherence appeared interlinked , complex and context -related . Sustained consumption of SQ-LNS may require tailoring interventions by context .Trial registration The Ghana trial was registered at clinical trials.gov as NCT00970866 , and the Malawi trial as NCT01239693 BACKGROUND Maternal undernutrition and low macro- and micronutrient intake and weight gain during pregnancy have been reported in Bangladesh . OBJECTIVE We aim ed to determine the effects of lipid-based nutrient supplements for pregnant and lactating women ( LNS-PL ) on weight gain and midupper arm circumference ( MUAC ) during pregnancy . METHODS The Rang-Din Nutrition Study , a cluster-r and omized effectiveness trial conducted in Bangladesh , enrolled 4011 pregnant women at ≤20 wk gestation who received either 60 mg Fe + 400 μg folic acid/d or 20 g LNS-PL/d ( 118 kcal ) containing essential fatty acids and vitamins and minerals until delivery . At 36 wk gestation , women were interviewed at home and then attended a follow-up examination at local clinics ( n = 2877 ) , where anthropometric measurements were taken . RESULTS No significant differences between intervention groups in maternal weight gain per week , low weight gain per week , or MUAC at 36 wk gestation were observed in the full sample . However , among multiparous women aged ≥25 y , those in the LNS-PL group gained 34 g/wk more than their counterparts in the iron and folic acid ( IFA ) group ( P = 0.001 ) , whereas no differences were seen in the other parity/age subgroups . Women aged ≥25 y in the LNS-PL group had a 0.4-cm greater MUAC than their counterparts in the IFA group ( P = 0.003 ) ; no significant differences were observed in the other age groups . Among women whose height at baseline was in the lowest quartile of the distribution , those in the LNS-PL group had a 0.1 - 0.3-cm greater MUAC at 36 wk gestation than those in the IFA group ( P = 0.004 - 0.014 ) . CONCLUSIONS Lipid-based nutrient supplements provided during pregnancy did not affect maternal anthropometric indicators in the overall sample but increased MUAC among women aged ≥25 y and those with lower stature and weight gain among multiparous women aged ≥25 y. This trial was registered at clinical trials.gov as NCT01715038 BACKGROUND Results of r and omised controlled trials of newborn ( age 1 - 3 days ) vitamin A supplementation  have been inconclusive . The WHO is coordinating three large r and omised trials in Ghana , India , and Tanzania ( Neovita trials ) . We present the findings of the Neovita trial in Ghana . METHODS This study was a population -based , individually r and omised , double-blind , placebo-controlled trial in the Brong Ahafo region of Ghana . The trial participants were infants aged at least 2 h , identified at home or facilities on the day of birth or in the next 2 days , able to feed orally , and likely to stay in the study area for at least 6 months . They were r and omly assigned ( ratio 1:1 ) to receive either one oral dose of vitamin A ( 50,000 IU ) or placebo immediately after recruitment . The research team and parents of the infants were masked to treatment assignment . Follow-up home visits were undertaken every 4 weeks , when data were recorded for deaths , facility use , and care seeking . The primary outcome was post-supplementation mortality to 6 months of age . Analysis was by intention to treat . Potential adverse events were recorded at 1 and 3 days after supplementation . This trial is registered with the Australian New Zeal and Clinical Trials Registry (ANZCTR)CTRN12610000582055 . FINDINGS We assessed 26,414 livebirths for eligibility between Aug 16 , 2010 , and Nov 7 , 2011 . We recruited 22,955 newborn infants , with 11,474 r and omly assigned to receive vitamin A and 11,481 to receive placebo . Loss to follow-up was low with vital status at 6 months of age reported for 22,698 ( 98·9 % ) infants . We recorded 278 post-supplementation deaths to 6 months of age in the vitamin A group ( mortality risk 24·5 in 1000 supplemented infants ) and 248 deaths in the placebo group ( mortality risk 21·8 per 1000 supplemented infants ) , relative risk ( RR ) 1·12 ( 95 % CI 0·95 - 1·33 ; p=0·183 ) and risk difference ( RD ) 2·66 ( 95 % CI -1·25 to 6·57 ; p=0·18 ) . Adverse events within 3 days of supplementation did not differ by trial group . 122 infants died in the first 3 days after supplementation ; 70 ( 0·6 % ) in the vitamin A and 52 ( 0·5 % ) in the placebo group ( risk ratio [ RR ] 1·35 , 95 % CI 0·94 - 1·93 , p=0·102 ) . 53 infants were reported to have a bulging fontanelle ; 32 ( 0·3 % ) in the vitamin A group and 21 ( 0·2 % ) in the placebo group ( RR 1·53 , 0·88 - 2·62 , p=0·130 ) . INTERPRETATION The results of this trial do not support inclusion of newborn vitamin A supplementation as a child survival strategy in Ghana . FUNDING Bill & Melinda Gates Foundation grant to the WHO BACKGROUND Supplementation of vitamin A in children aged 6 - 59 months improves child survival and is implemented as global policy . Studies of the efficacy of supplementation of infants in the neonatal period have inconsistent results . We aim ed to assess the efficacy of oral supplementation with vitamin A given to infants in the first 3 days of life to reduce mortality between supplementation and 180 days ( 6 months ) . METHODS We did an individually r and omised , double-blind , placebo-controlled trial of infants born in the Morogoro and Dar es Salaam regions of Tanzania . Women were identified during antenatal clinic visits or in the labour wards of public health facilities in Dar es Salaam . In Kilombero , Ulanga , and Kilosa districts , women were seen at home as part of the health and demographic surveillance system . Newborn infants were eligible for r and omisation if they were able to feed orally and if the family intended to stay in the study area for at least 6 months . We r and omly assigned infants to receive one dose of 50,000 IU of vitamin A or placebo in the first 3 days after birth . Infants were r and omly assigned in blocks of 20 , and investigators , participants ' families , and data analysis teams were masked to treatment assignment . We assessed infants on day 1 and day 3 after dosing , as well as at 1 , 3 , 6 , and 12 months after birth . The primary endpoint was mortality at 6 months , assessed by field interviews . The primary analysis included only children who were not lost to follow-up . This trial is registered with the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) , number ACTRN12610000636055 . FINDINGS Between Aug 26 , 2010 , and March 3 , 2013 , 31,999 newborn babies were r and omly assigned to receive vitamin A ( n=15,995 ) or placebo ( n=16,004 ; 15,428 and 15,464 included in analysis of mortality at 6 months , respectively ) . We did not find any evidence for a beneficial effect of vitamin A  supplementation on mortality in infants at 6 months ( 26 deaths per 1000 livebirths in vitamin A vs 24 deaths per 1000 livebirths in placebo group ; risk ratio 1·10 , 95 % CI 0·95 - 1·26 ; p=0·193 ) . There was no evidence of a differential effect for vitamin A supplementation on mortality by sex ; risk ratio for mortality at 6 months for boys was 1·08 ( 0·90 - 1·29 ) and for girls was 1·12 ( 0·91 - 1·39 ) . There was also no evidence of adverse effects of supplementation within 3 days of dosing . INTERPRETATION Neonatal vitamin A supplementation did not result in any immediate adverse events , but had no beneficial effect on survival in infants in Tanzania . These results strengthen the evidence against a global policy recommendation for neonatal vitamin A supplementation . FUNDING Bill & Melinda Gates Foundation to WHO Background : Childhood stunting usually begins in utero and continues after birth ; therefore , its reduction must involve actions across different stages of early life . Objective : We evaluated the efficacy of small-quantity , lipid-based nutrient supplements ( SQ-LNSs ) provided during pregnancy , lactation , and infancy on attained size by 18 mo of age . Design : In this partially double-blind , individually r and omized trial , 1320 women at ≤20 wk of gestation received st and ard iron and folic acid ( IFA group ) , multiple micronutrients ( MMN group ) , or SQ-LNS ( LNS group ) daily until delivery , and then placebo , MMNs , or SQ-LNS , respectively , for 6 mo postpartum ; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age ( endline ) . The primary outcome was child length by 18 mo of age . Results : At endline , data were available for 85 % of 1228 infants enrolled ; overall mean length and length-for-age z score ( LAZ ) were 79.3 cm and −0.83 , respectively , and 12 % of the children were stunted ( LAZ < −2 ) . In analysis based on the intended treatment , mean ± SD length and LAZ for the LNS group ( 79.7 ± 2.9 cm and −0.69 ± 1.01 , respectively ) were significantly greater than for the IFA ( 79.1 ± 2.9 cm and −0.87 ± 0.99 ) and MMN ( 79.1 ± 2.9 cm and −0.91 ± 1.01 ) groups ( P = 0.006 and P = 0.009 , respectively ) . Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference , and the prevalence of stunting in the LNS group was 8.9 % , compared with 13.7 % in the IFA group and 12.9 % in the MMN group ( P = 0.12 ) . In analysis based on actual supplement provided at enrollment 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Supplementing pregnant and lactating mothers with small quantity lipid-based nutrient supplements ( SQ-LNS ) has result ed in improvements in birth outcomes in some low-income setting s. In order to be effective , SQ-LNS must be consumed regularly over sustained periods . Methods The objective was to assess and compare acceptability of and adherence to SQ-LNS consumption among pregnant and lactating women in Ghana and Malawi throughout 12 months of supplementation . We enrolled women before 20 gestation weeks into r and omized trials in Ghana ( n = 1320 ) and Malawi ( n = 869 ) . In the SQ-LNS group participants received a 20 g sachet of supplement per day during pregnancy and the first 6 months of lactation . In the control groups participants received multiple micronutrients ( MMN ) during pregnancy and lactation or iron and folic acid ( IFA ) during pregnancy and calcium during lactation . We used question naires to collect data on self-reported adherence to daily use of supplements and conducted in-depth interviews with women in the SQ-LNS group to examine acceptability . Results The mean self-reported adherence during the supplementation period was lower in Ghana ( 79.9 % ) than in Malawi ( 91.7 % ) for all supplements ( difference 11.8 % , P < 0.001 ) . Over time , adherence increased in Malawi but decreased in Ghana . In both countries , adherence in the SQ-LNS group was non-inferior to that in the control groups . Participants typically reported consuming SQ-LNS as instructed but when interviewers queried about experiences , most of the women described incidents of non-adherence . A usual reason for not consuming SQ-LNS was nausea and vomiting during pregnancy . Especially in Malawi , women reported sharing SQ-LNS with families and friends . Sustained use of  SQ-LNS  was attributed to expected health benefits and favorable sensory attributes . Often women compared their pregnancy to previous ones , and were of the view that SQ-LNS made a positive difference . ConclusionS elf-reported sustained adherence to consume  SQ-LNS  daily was high in both sites but lower in Ghana than in Malawi . In Ghana , adherence decreased over time whereas in Malawi adherence increased . Acceptability and adherence appeared interlinked , complex and context -related . Sustained consumption of SQ-LNS may require tailoring interventions by context .Trial registration The Ghana trial was registered at clinical trials.gov as NCT00970866 , and the Malawi trial as NCT01239693 BACKGROUND Maternal undernutrition and low macro- and micronutrient intake and weight gain during pregnancy have been reported in Bangladesh . OBJECTIVE We aim ed to determine the effects of lipid-based nutrient supplements for pregnant and lactating women ( LNS-PL ) on weight gain and midupper arm circumference ( MUAC ) during pregnancy . METHODS The Rang-Din Nutrition Study , a cluster-r and omized effectiveness trial conducted in Bangladesh , enrolled 4011 pregnant women at ≤20 wk gestation who received either 60 mg Fe + 400 μg folic acid/d or 20 g LNS-PL/d ( 118 kcal ) containing essential fatty acids and vitamins and minerals until delivery . At 36 wk gestation , women were interviewed at home and then attended a follow-up examination at local clinics ( n = 2877 ) , where anthropometric measurements were taken . RESULTS No significant differences between intervention groups in maternal weight gain per week , low weight gain per week , or MUAC at 36 wk gestation were observed in the full sample . However , among multiparous women aged ≥25 y , those in the LNS-PL group gained 34 g/wk more than their counterparts in the iron and folic acid ( IFA ) group ( P = 0.001 ) , whereas no differences were seen in the other parity/age subgroups . Women aged ≥25 y in the LNS-PL group had a 0.4-cm greater MUAC than their counterparts in the IFA group ( P = 0.003 ) ; no significant differences were observed in the other age groups . Among women whose height at baseline was in the lowest quartile of the distribution , those in the LNS-PL group had a 0.1 - 0.3-cm greater MUAC at 36 wk gestation than those in the IFA group ( P = 0.004 - 0.014 ) . CONCLUSIONS Lipid-based nutrient supplements provided during pregnancy did not affect maternal anthropometric indicators in the overall sample but increased MUAC among women aged ≥25 y and those with lower stature and weight gain among multiparous women aged ≥25 y. This trial was registered at clinical trials.gov as NCT01715038 BACKGROUND Results of r and omised controlled trials of newborn ( age 1 - 3 days ) vitamin A supplementation  have been inconclusive . The WHO is coordinating three large r and omised trials in Ghana , India , and Tanzania ( Neovita trials ) . We present the findings of the Neovita trial in Ghana . METHODS This study was a population -based , individually r and omised , double-blind , placebo-controlled trial in the Brong Ahafo region of Ghana . The trial participants were infants aged at least 2 h , identified at home or facilities on the day of birth or in the next 2 days , able to feed orally , and likely to stay in the study area for at least 6 months . They were r and omly assigned ( ratio 1:1 ) to receive either one oral dose of vitamin A ( 50,000 IU ) or placebo immediately after recruitment . The research team and parents of the infants were masked to treatment assignment . Follow-up home visits were undertaken every 4 weeks , when data were recorded for deaths , facility use , and care seeking . The primary outcome was post-supplementation mortality to 6 months of age . Analysis was by intention to treat . Potential adverse events were recorded at 1 and 3 days after supplementation . This trial is registered with the Australian New Zeal and Clinical Trials Registry (ANZCTR)CTRN12610000582055 . FINDINGS We assessed 26,414 livebirths for eligibility between Aug 16 , 2010 , and Nov 7 , 2011 . We recruited 22,955 newborn infants , with 11,474 r and omly assigned to receive vitamin A and 11,481 to receive placebo . Loss to follow-up was low with vital status at 6 months of age reported for 22,698 ( 98·9 % ) infants . We recorded 278 post-supplementation deaths to 6 months of age in the vitamin A group ( mortality risk 24·5 in 1000 supplemented infants ) and 248 deaths in the placebo group ( mortality risk 21·8 per 1000 supplemented infants ) , relative risk ( RR ) 1·12 ( 95 % CI 0·95 - 1·33 ; p=0·183 ) and risk difference ( RD ) 2·66 ( 95 % CI -1·25 to 6·57 ; p=0·18 ) . Adverse events within 3 days of supplementation did not differ by trial group . 122 infants died in the first 3 days after supplementation ; 70 ( 0·6 % ) in the vitamin A and 52 ( 0·5 % ) in the placebo group ( risk ratio [ RR ] 1·35 , 95 % CI 0·94 - 1·93 , p=0·102 ) . 53 infants were reported to have a bulging fontanelle ; 32 ( 0·3 % ) in the vitamin A group and 21 ( 0·2 % ) in the placebo group ( RR 1·53 , 0·88 - 2·62 , p=0·130 ) . INTERPRETATION The results of this trial do not support inclusion of newborn vitamin A supplementation as a child survival strategy in Ghana . FUNDING Bill & Melinda Gates Foundation grant to the WHO BACKGROUND Supplementation of vitamin A in children aged 6 - 59 months improves child survival and is implemented as global policy . Studies of the efficacy of supplementation of infants in the neonatal period have inconsistent results . We aim ed to assess the efficacy of oral supplementation with vitamin A given to infants in the first 3 days of life to reduce mortality between supplementation and 180 days ( 6 months ) . METHODS We did an individually r and omised , double-blind , placebo-controlled trial of infants born in the Morogoro and Dar es Salaam regions of Tanzania . Women were identified during antenatal clinic visits or in the labour wards of public health facilities in Dar es Salaam . In Kilombero , Ulanga , and Kilosa districts , women were seen at home as part of the health and demographic surveillance system . Newborn infants were eligible for r and omisation if they were able to feed orally and if the family intended to stay in the study area for at least 6 months . We r and omly assigned infants to receive one dose of 50,000 IU of vitamin A or placebo in the first 3 days after birth . Infants were r and omly assigned in blocks of 20 , and investigators , participants ' families , and data analysis teams were masked to treatment assignment . We assessed infants on day 1 and day 3 after dosing , as well as at 1 , 3 , 6 , and 12 months after birth . The primary endpoint was mortality at 6 months , assessed by field interviews . The primary analysis included only children who were not lost to follow-up . This trial is registered with the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) , number ACTRN12610000636055 . FINDINGS Between Aug 26 , 2010 , and March 3 , 2013 , 31,999 newborn babies were r and omly assigned to receive vitamin A ( n=15,995 ) or placebo ( n=16,004 ; 15,428 and 15,464 included in analysis of mortality at 6 months , respectively ) . We did not find any evidence for a beneficial effect of vitamin A  supplementation on mortality in infants at 6 months ( 26 deaths per 1000 livebirths in vitamin A vs 24 deaths per 1000 livebirths in placebo group ; risk ratio 1·10 , 95 % CI 0·95 - 1·26 ; p=0·193 ) . There was no evidence of a differential effect for vitamin A supplementation on mortality by sex ; risk ratio for mortality at 6 months for boys was 1·08 ( 0·90 - 1·29 ) and for girls was 1·12 ( 0·91 - 1·39 ) . There was also no evidence of adverse effects of supplementation within 3 days of dosing . INTERPRETATION Neonatal vitamin A supplementation did not result in any immediate adverse events , but had no beneficial effect on survival in infants in Tanzania . These results strengthen the evidence against a global policy recommendation for neonatal vitamin A supplementation . FUNDING Bill & Melinda Gates Foundation to WHO Background : Childhood stunting usually begins in utero and continues after birth ; therefore , its reduction must involve actions across different stages of early life . Objective : We evaluated the efficacy of small-quantity , lipid-based nutrient supplements ( SQ-LNSs ) provided during pregnancy , lactation , and infancy on attained size by 18 mo of age . Design : In this partially double-blind , individually r and omized trial , 1320 women at ≤20 wk of gestation received st and ard iron and folic acid ( IFA group ) , multiple micronutrients ( MMN group ) , or SQ-LNS ( LNS group ) daily until delivery , and then placebo , MMNs , or SQ-LNS , respectively , for 6 mo postpartum ; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age ( endline ) . The primary outcome was child length by 18 mo of age . Results : At endline , data were available for 85 % of 1228 infants enrolled ; overall mean length and length-for-age z score ( LAZ ) were 79.3 cm and −0.83 , respectively , and 12 % of the children were stunted ( LAZ < −2 ) . In analysis based on the intended treatment , mean ± SD length and LAZ for the LNS group ( 79.7 ± 2.9 cm and −0.69 ± 1.01 , respectively ) were significantly greater than for the IFA ( 79.1 ± 2.9 cm and −0.87 ± 0.99 ) and MMN ( 79.1 ± 2.9 cm and −0.91 ± 1.01 ) groups ( P = 0.006 and P = 0.009 , respectively ) . Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference , and the prevalence of stunting in the LNS group was 8.9 % , compared with 13.7 % in the IFA group and 12.9 % in the MMN group ( P = 0.12 ) . In analysis based on actual supplement provided at enrollment 
    Output:
    