Background: Vitamin A (VA) intervention programs in developing countries do not generally consider spatial differences in needs or in intervention costs. New data from Cameroon reveal nonuniform spatial distributions of VA deficiency among young children and of costs of some of the programs designed to address them. Methods: We develop a spatially explicit, intertemporal economic optimization tool that makes use of subnational dietary intake data and VA intervention program costs to identify more efficient sets of interventions to improve VA nutrition among young children aged 6 to 59 months in Cameroon. Results: The model suggests substantial changes in the composition and geographic foci of VA intervention programs vis-à-vis a business-as-usual scenario. National VA-fortified edible oil and bouillon cube programs are cost-effective, even when start-up costs are considered. High-dosage VA supplementation delivered via Child Health Days is most cost-effective in the North macro-region, where needs are greatest and the cost per child effectively covered is lowest. Overall, the VA intervention programs suggested by the optimization model are approximately 44% less expensive, with no change in the total number of children effectively covered nationwide. Conclusions: The VA intervention programs should consider spatial and temporal differences in needs and in the expected benefits and costs of alternative VA interventions. Doing so will require spatially disaggregated strategies and the data and political will to support them, longer planning time horizons than are currently used in most developing countries, and long-term funding commitments.

Objective: To examine factors associated with the physical growth of breast-fed Ghanaian infants during the ®rst 18 months of life. Design: A community-based longitudinal study. Setting: The study was carried out in Techiman, a district capital and major food trading center in the Brong Ahafo region of Ghana. Subjects: One-month old infants n 216 with birth weight ! 2X5 kg were recruited from Maternal and Child Health Centers. Method: From 6 to 12 months, infants were provided with one of four types of nutritionally enhanced complementary foods. Anthropometric assessments were completed monthly from 1 to 12 months and every other month from 12 to 18 months. Information was collected on household characteristics, morbidity from common infections and dietary intakes. Blood samples were collected at 6 and 12 months to assess iron, zinc, ribo¯avin and vitamin A status. Multiple regression analysis was used to examine factors associated with growth during the age intervals of 1 ± 6, 4 ± 6, 6 ± 12 and 12 ± 18 months as well as size attained at 12 and 18 months. Results: Prevalence of diarrhea and fever were negatively associated with growth during the ®rst year of life. No signi®cant relationship was found between respiratory illness (de®ned as cough or purulent nasal discharge) and growth. With the exception of dietary zinc intake, dietary variables were generally not signi®cantly associated with growth. Maternal education was positively associated with growth during most of the age intervals. Conclusion: These ®ndings suggest that interventions to reduce morbidity and improve the education of girls may bene®t children's growth in this population.

Objective: To determine the effects of dietary supplements containing bovine serum concentrate (BSC, a source of immunoglobulins) and/or multiple micronutrients (MMN) on children's growth velocity, rates of common infections, and MN status. Design: Randomized, controlled, community-based intervention trial. Setting: Low-income, peri-urban Guatemalan community. Subjects: Children aged 6-7 months initially. Interventions: Children received one of four maize-based dietary supplements daily for 8 months, containing: (1) BSC, (2) whey protein concentrate (WPC, control group), (3) WPC þ MMN, or (4) BSC þ MMN. Results: There were no significant differences in growth or rates of morbidity by treatment group. Children who received MMN had lower rates of anemia and (in the group that received WPC þ MMN) less of a decline in serum ferritin than those who did not, but there were no differences in other biochemical indicators of MN status by treatment group. Conclusions: MMN supplementation reduced anemia and iron deficiency in this population, but the MMN content and source of protein in the supplements did not affect other indicators of MN status, growth or morbidity. Sponsorship: Funding was provided by LG Laboratories (Ames, Iowa), which produces the bovine serum concentrate used in this study. The members of the research team have no financial involvement in this company.

RWJ-800088 is a novel thrombopoietin mimetic peptide for the treatment of thrombocytopenia. The objectives of this study were to evaluate the pharmacokinetics, pharmacodynamics, and safety of ascending doses of RWJ-800088 administered as a single intravenous delivery in a double-blind, placebo-controlled study with five parallel groups of eight healthy human subjects each. Platelet counts and functionality, peripheral stem cells, drug concentrations, and routine laboratory parameters were measured frequently up to day 29, and antibody formation was measured up to days 56-72. At doses > or = 0.75 microg/kg of RWJ-800088, platelet levels showed dose-related elevation as compared to results with placebo. The pharmacokinetic profile was characterized for doses of 2.5 and 3.0 microg/kg, although the dose relationship could not be fully defined. The two highest doses of RWJ-800088 appeared to increase burst-forming units-erythroid and colony-forming unit counts, suggesting some effects on progenitor lineages. RWJ-800088 was well tolerated, with no evidence of antibody formation in this single-dose study. Additional patient studies are warranted to investigate the therapeutic use of this novel peptide.