Figure 1
CONAMAD Study Site and Enrollment Locations, Madre de Dios, Peru.
Dotted lines represent estimated catchment area; large “+” symbols represent enrollment sites (health centers). ASGM is currently concentrated in the Colorado, Puquiri, Inambari and Malinowski rivers. Sample size obtained in each zone at enrollment and followed at birth: Zone 1, 43 enrolled, 37 births; Zone 2, 67 enrolled, 50 births; Zone 3, 147 enrolled, 121 births; Zone 4, 13 enrolled, 7 births.
Figure 2
CONAMAD Study Design Overview and timing of data collection.
The SARS-COV-2 has delayed the 24-month follow-up by at least 12 months; thus, we will initiate follow-up in January 2022.
Table 1
CONAMAD Enrollment characteristics.
| VARIABLE | ZONE | P-VALUE, DIFFERENCE ACROSS ZONE | ||||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | ALL ZONES | ||
| NUMBER OF MOTHER-CHILD PAIRS (%) | 43 (16%) | 67 (25%) | 147 (54%) | 13 (5%) | 270 | |
| Median Age, years (mean) | 27 (26.9) | 28 (27.6) | 28 (27.4) | 25.5 (25.3) | 28 (27.3) | 0.2532 |
| Weeks pregnant at enrollment (SD) | 20.1 (8.12) | 20.7 (7.09) | 20.5 (6.53) | 16.4 (7.05) | 20.3 (6.98) | 0.2288 |
| Enrolled in … 1st Trimester (<14 weeks) | 27.9% | 19.4% | 19.1% | 38.5% | 21.5% | 0.1995 |
| … 2nd Trimester (14–26 weeks) | 39.5% | 50.8% | 57.8% | 53.9% | 53.0% | |
| … 3rd Trimester (>26 weeks) | 32.6% | 30.0% | 23.1% | 7.7% | 25.6% | |
| % Short Stature, ht ≤ 1.45 m | 23.30% | 20.90% | 12.90% | 15.40% | 16.60% | 0.2953 |
| Median age of male partner, years (mean) | 31.5 (31.4) | 31 (32.2) | 30 (30.7) | 28 (29.0) | 30 (31.1) | 0.1859 |
| Mother lives near1 | ||||||
| … gold shops | 25.6% | 20.3% | 7.9% | 8.3% | 13.6% | 0.0098 |
| … mining | 53.9% | 20.3% | 7.9% | 0.0% | 17.7% | <0.0001 |
| … gas station | 56.4% | 20.3% | 37.9% | 8.3% | 35.2% | 0.0050 |
| … road near vehicle traffic | 74.4% | 25.4% | 58.6% | 16.7% | 51.2% | <0.0001 |
| … trash burning | 71.8% | 35.6% | 37.9% | 8.3% | 41.2% | 0.0007 |
| … farms that burn before planting | 51.3% | 23.7% | 18.0% | 50.0% | 26.1% | <0.0001 |
| Mother takes the following supplements1 | ||||||
| … Folic Acid | 84.2% | 96.7% | 77.7% | 80.0% | 83.7% | 0.0111 |
| … Iron | 41.7% | 93.6% | 35.5% | 57.1% | 51.6% | <0.0001 |
| … Ferrous Sulfate | 79.3% | 83.9% | 76.0% | 62.5% | 77.4% | 0.5889 |
| … Any above supplements | 90.5% | 96.9% | 86.7% | 91.7% | 90.1% | 0.1537 |
[i] Health posts by zone: Zone 1-Mazuko, Primavera Baja, Santa Rosa; Zone 2-Laberinto, Alto Libertad; Zone 3-El Triunfo, Nuevo Milenio, Jorge Chavez, La Joya, Pueblo Viejo; Hospital Santa Rosa; Zone 4-Hospital San Martin de Porres (Iberia).
1 Maternal residence and nutritional supplements have the following sample sizes in each zone: 39, 59, 140, and 12 for zones 1–4, respectively.
Table 2
Characteristics of Mothers Followed at Birth.
| VARIABLE | ZONE OF ENROLLMENT | ALL ZONES | P-VALUE, DIFFERENCE BY ZONE | |||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | |||
| N (%) | 37 (17%) | 50 (23%) | 121 (56%) | 7 (3%) | 215 | |
| Median Age, years (mean) | 27 (27.2) | 27.5 (27.8) | 28 (27.7) | 23 (23.9) | 28 (27.6) | 0.1033 |
| Hemoglobin (Hb) Level2 | ||||||
| … Moderate Anemia (Hb 7.0–9.9) | 5.4% | 4.2% | 9.2% | 0.0% | 7.1% | 0.9041 |
| … Anemia (Hb 10.0-11.9) | 62.2% | 66.7% | 61.7% | 66.7% | 63.0% | |
| … Normal (Hb ≥ 12) | 32.4% | 29.2% | 29.2% | 33.3% | 29.9% | |
| Short Stature, % ht ≤ 1.45m3 | 11.1% | 22.0% | 6.7% | 20.0% | 11.4% | 0.0350 |
| Total Prenatal Visits | 7.5 (2.1) | 7.9 (1.8) | 6.9 (2.2) | 7.4 (2.4) | 7.2 (2.10) | 0.0253 |
| Hypertension during pregnancy, percent4 | 8.3% | 8.2% | 5.2% | 0.0% | 6.3% | 0.7428 |
| Emergency Cesarean5 | 19.4% | 8.0% | 11.6% | 0.0% | 11.7% | 0.2973 |
| Birth attendant ….. Physician | 18.9% | 20.0% | 17.4% | 28.6% | 18.6% | 0.7858 |
| …. Obstetrician | 78.4% | 78.0% | 77.7% | 57.2% | 77.2% | |
[i] Health posts by zone: Zone 1-Mazuko, Primavera Baja, Santa Rosa; Zone 2-Laberinto, Alto Libertad; Zone 3-El Triunfo, Nuevo Milenio, Jorge Chavez, La Joya, Pueblo Viejo; Hospital Santa Rosa; Zone 4-Hospital San Martin de Porres (Iberia).
2 No women were classified as having severe anemia (Hb < 7.0). Hb level reported is from the last prenatal visit, sample sizes by zone are: 37, 48, 120, 6.
3 Short Stature sample sizes by zone are: 36, 50, 120, and 5.
4 Hypertension during pregnancy sample sizes by zone are: 36, 49, 115, 7.
5 Emergency cesarean has a sample size in zone 1 of 36.
Table 3
Characteristics of Newborns.
| VARIABLE | ZONE OF ENROLLMENT | ALL ZONES | P-VALUE, DIFFERENCE BY ZONE | |||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | |||
| N (%) | 37 (17%) | 51 (24%) | 121 (56%) | 7 (3%) | 216 | |
| Male, % | 51.1% | 68.3% | 51.2% | 57.1% | 55.6% | 0.194 |
| Gestational age at birth, weeks (SD)1 | 39.1 (2.13) | 39.3 (1.41) | 38.8 (3.40) | 39.0 (1.87) | 39.0 (2.82) | 0.7613 |
| Gestation: % born before 37 weeks1 | 2.8% | 8.5% | 4.1% | 11.1% | 5.3% | 0.4575 |
| Size for gestational age (clinical) | 0.4072 | |||||
| …. Small | 2.7% | 3.9% | 5.8% | 0.0% | 4.6% | |
| …. Large | 32.40% | 35.30% | 38.00% | 0 | 35.20% | |
| Birth weight2 | 0.1677 | |||||
| …. <2500 g | 0.0% | 2.0% | 2.5% | 0.0% | 1.9% | |
| …. 2500–3000 | 13.9% | 5.9% | 9.1% | 9.0% | 8.8% | |
| …. 3000–3500 | 36.1% | 27.5% | 31.4% | 85.7% | 33.0% | |
| …. >3500 | 50.0% | 64.7% | 67.0% | 14.3% | 56.3% | |
| APGAR < 7, 1 minute2 | 0.0% | 3.9% | 2.5% | 0.0% | 2.3% | 0.6575 |
| APGAR < 7, 5 minutes | 0.0% | 2.0% | 1.0% | 0.0% | 1.0% | 0.8000 |
[i] Health posts by zone: Zone 1-Mazuko, Primavera Baja, Santa Rosa; Zone 2-Laberinto, Alto Libertad; Zone 3-El Triunfo, Nuevo Milenio, Jorge Chavez, La Joya, Pueblo Viejo; Hospital Santa Rosa; Zone 4-Hospital San Martin de Porres (Iberia).
1 Gestational age at birth has the following sample sizes, respectively by zone: 36, 46, 120, 7.
2 Birthweight and APGAR score sample sizes by zone: 36, 47, 120, 7.