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Muñoz-Del-Carpio-Toia A, Benites-Meza JK, Herrera-Añazco P, Benites-Zapata VA. Variations in the Prevalence of Childhood Anemia by Ethnicity Before and During the COVID-19 Pandemic in Peru. J Immigr Minor Health 2024; 26:501-516. [PMID: 38280080 DOI: 10.1007/s10903-023-01579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/29/2024]
Abstract
We aimed to determine the variations in the prevalence of childhood anemia according to the ethnic group before and during the COVID-19 pandemic in Peru. Secondary analysis of the Demographic and Family Health Survey during 2016-2021. The outcome variable was anemia, and the exposure variable was maternal ethnicity. Also, we included sociodemographic and clinical confounding variables. We constructed generalized linear models of the Poisson family with a logarithmic link function. We evaluated 85,905 records; 30.34% had anemia, 50.83% were mestizo, 25.98% were Quechua, and 2% were Aymara. Compared with mestizos, Quechua children (PR: 1.11; 95% CI: 1.07-1.15; p < 0.001), Aymara (PR: 1.35; 95% CI: 1.27-1 .44; p < 0.001), natives of the Amazon (PR: 1.20; 95% CI: 1.12-1.28; p < 0.001) and those who belonged to other indigenous peoples (PR: 1.29; 95% CI: 1.05-1.57; p = 0.013) had a higher prevalence of childhood anemia. On the contrary, compared to mestizos, white children had a lower prevalence of anemia (PR: 0.93; 95% CI: 0.89-0.99; p = 0.019). During the COVID-19 pandemic, compared to mestizos, only Quechua (PR: 1.15; 95% CI: 1.08-1.23; p < 0.001) and Aymara (PR: 1.38; 95% CI: 1.23-1.55; p < 0.001) had a higher prevalence of childhood anemia. Except for Afro-descendants, children from 6 to 59 months of age who belong to an ethnic minority had a higher probability of having childhood anemia than mestizos. However, only Quechua and Aymara children had higher odds of anemia during the COVID-19 pandemic than mestizos.
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Affiliation(s)
| | - Jerry K Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Vicente A Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
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Malta DC, Romero-Sandoval N, Cardoso LSDM, Arcos P, Gualán M, Pescarini JM, Brickley EB, Veloso GA, Bernal RTI, Gomes CS, Kerr LRFS, Naghavi M, Cooper PJ, Barreto ML, Leyland AH. Sustainable Development Goals' health-related indicators for Brazil and Ecuador: an analysis for the period of 1990-2019. Public Health 2024; 231:88-98. [PMID: 38653016 DOI: 10.1016/j.puhe.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. STUDY DESIGN Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. METHODS Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. RESULTS Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). CONCLUSIONS Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - N Romero-Sandoval
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.
| | - L S de M Cardoso
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - P Arcos
- Universidad Internacional del Ecuador, Quito, Ecuador.
| | - M Gualán
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.
| | - J M Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Oswaldo Cruz Foundation, Salvador, Brazil.
| | - E B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - G A Veloso
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
| | - R T I Bernal
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - C S Gomes
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - L R F S Kerr
- Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
| | - M Naghavi
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
| | - P J Cooper
- Institute of Infection and Immunity St. George's University of London. School of Medicine, Universidad Internacional del Ecuador, Ecuador.
| | - M L Barreto
- Centre for Data and Knowledge Integration for Health, Fiocruz Bahia, Salvador, Brazil.
| | - A H Leyland
- Social and Public Health Sciences Unit, University of Glasgow, United Kingdom.
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Kanmodi KK, Amzat J, Aminu K. Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review. Health Sci Rep 2024; 7:e2078. [PMID: 38690007 PMCID: PMC11058263 DOI: 10.1002/hsr2.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Aims One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY. Methods/Literature Search Strategy Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review. Results The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY. Conclusion The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.
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Affiliation(s)
- Kehinde Kazeem Kanmodi
- School of DentistryUniversity of RwandaKigaliRwanda
- Child Health and Wellbeing (CHAW) ProgramCephas Health Research Initiative IncIbadanNigeria
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
| | - Jimoh Amzat
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
| | - Kafayat Aminu
- Center for Child and Adolescent Mental HealthUniversity College HospitalIbadanNigeria
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April-Lalonde G, Deaconu A, Cole DC, Batal M. Traditional Food Consumption in Andean Ecuador and Associated Consumer Characteristics, Shopping and Eating Habits. Ecol Food Nutr 2023; 62:308-333. [PMID: 37791736 DOI: 10.1080/03670244.2023.2264197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Traditional foods (TFs) hold increasing global relevance due to their potential to address health and dietary challenges. This study explores TF consumption and patterns in a middle-income country's general population. Using 2017 Ecuadorian highlands survey data, we identified four consumption clusters with distinct TF preferences. Chi-square tests identified variations in independent variables across clusters. Poisson regression models highlighted city, age, education, and food habits as independent predictors of TF-based clusters. Our findings broaden TF importance to nutrition beyond specific populations. Understanding consumption patterns and socioeconomic links supports nuanced public health strategies to tackle contemporary health, social equity, and sustainability issues.
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Affiliation(s)
- Gabriel April-Lalonde
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Public Health Research, Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal (CReSP), Montréal, Canada
| | - Ana Deaconu
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Public Health Research, Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal (CReSP), Montréal, Canada
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Fair Fields, Neustadt, Canada
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Public Health Research, Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal (CReSP), Montréal, Canada
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Cavagnari BM, Guerrero-Vaca DJ, Carpio-Arias TV, Duran-Aguero S, Vinueza-Veloz AF, Robalino-Valdivieso MP, Morejón-Terán YA, Vinueza-Veloz MF. The double burden of malnutrition and gross motor development in infants: A cross-sectional study. Clin Nutr 2023; 42:1181-1188. [PMID: 37225559 DOI: 10.1016/j.clnu.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of the present work was to study the relationship between the double burden of malnutrition and gross motor development in infants. METHOD ology: Sample included 5900 infants under 24 months of age, participants of the ENSANUT-ECU study. To evaluate nutritional status, we calculated z-scores for body mass index/age (BAZ) and height/age (HAZ). Six gross motor milestones were considered: sitting without-support, crawling, standing and walking with-support, standing and walking without-support. Data was analysed using logistic regression models in R. RESULTS Independently form age, sex and other socio-economic factors, the probability of achieving three gross motor milestones was significantly lower among chronically undernourished infants compared to their peers: sitting without-support, crawling, and walking without-support. Compared to no malnourished infants the probability of sitting without-support at six months was 10% lower for chronically undernourished infants (0.70, 95%CI [0.64-0.75]; 0.60, 95%CI [0.52-0.67]; respectively). The probability of crawling at eight months and walking without-support at 12 months were also significantly lower among chronically undernourished infants (0.62, 95%CI [0.58-0.67]); 0.25, 95%CI [0.20-0.30]; respectively) in comparison to no malnourished infants (0.67, 95%CI [0.63-0.72]); 0.29, 95%CI [0.25-0.34]; respectively). Obesity/overweight was not associated with the achievement of gross motor milestones, except for sitting without-support. Chronically undernourished infants with low or high BMI/age were generally delayed in the achievement of gross motor milestones than their peers. CONCLUSIONS Chronic undernutrition is related to delayed gross motor development. Public health measures are needed to be implemented to prevent the double burden of malnutrition and its detrimental effects on infant development.
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Affiliation(s)
- Brian M Cavagnari
- School of Nutrition, Faculty of Medical Sciences, Pontificia Universidad Católica, Buenos Aires, Argentina
| | - Darío Javier Guerrero-Vaca
- School of Medicine, Faculty of Public Health, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
| | - Tannia Valeria Carpio-Arias
- School of Nutrition and Dietetics, Faculty of Public Health, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
| | - Samuel Duran-Aguero
- Escuela de Nutrición y Dietética, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Santiago, Chile
| | | | | | - Yadira Alejandra Morejón-Terán
- Research Program Social Change, Asthma and Allergy in Latin America - SCAALA, Universidade Federal de Bahía, Salvador, Brazil; Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo (FCSEE). Universidad UTE, Quito, Ecuador
| | - María Fernanda Vinueza-Veloz
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Vélez León EM, Albaladejo Martínez A, Preciado Sarmiento MA, Cordero López MA, Armas ADC, Encalada Verdugo LS, Melo M. Caries Experience in Preschoolers in Three Ecuadorian Communities. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1123. [PMID: 37508620 PMCID: PMC10378548 DOI: 10.3390/children10071123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Dental caries in the preschool population presents a significant challenge in the field of global public health, including Ecuador. Early detection of this disease is crucial for developing effective strategies for prevention and promotion of oral health, which can have a substantial impact on the quality of life of preschool-aged children. This study evaluated 600 children aged 3 to 5 years attending preschool education centers using the ICDAS II diagnostic criteria. The Student's t-test was used to analyze differences between the means of two independent groups. Additionally, an analysis of variance (ANOVA) was conducted to assess differences between the means of three or more groups. The prevalence of caries was 87%, with a dft index of 3.85 in the three provinces studied. A high treatment need was observed in 84.17% of the population. No significant differences in the DFT index were found based on gender, although both groups exhibited elevated values. No significant differences were observed in relation to province and environment. The second molar was the most affected tooth, with a caries prevalence of 58.8%. Despite the lack of significant differences among the evaluated variables, a high prevalence and experience of dental caries were found in the studied population.
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Affiliation(s)
- Eleonor María Vélez León
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
- School of Dentistry, Catholic University of Cuenca, Cuenca 010107, Ecuador
| | | | | | | | | | | | - María Melo
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
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Carrington SJ, Romero-Alvarez D, Coral-Almeida M, Vela A, Henríquez-Trujillo AR, Mascialino G. Ethnodemographic characterization of stroke incidence and burden of disease in hospital discharge records in Ecuador. Front Neurol 2023; 14:1059169. [PMID: 36846135 PMCID: PMC9945224 DOI: 10.3389/fneur.2023.1059169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Stroke is the second most common cause of death and disability-adjusted life years (DALYs) globally. However, the incidence and impact of stroke by ethnicity and gender is frequently distinct. This is particularly the case in Ecuador where geographic and economic marginalization are often correlated with ethnic marginalization and the extent to which females lack the same opportunities as their male counterparts. The aim of this paper is to investigate the differential impacts in terms of stroke diagnosis and burden of disease by ethnicity and gender, using hospital discharge records over the years 2015-2020. Methods This paper calculates stroke incidence, and fatality rates using hospital discharge and death records over the years 2015-2020. The DALY package in R was employed to calculate the Disability Adjusted Life Years lost due to stroke in Ecuador. Results The results show that while the incidence rate of stroke in males (64.96 per 100,000 persons-year) is higher than that for females on average (57.84 per 100,000 persons-year), males accounted for 52.41% of all stroke cases and 53% of all surviving cases. Thus, hospital data suggests that females had a higher death rate when compared to males. Case fatality rates also differed significantly by ethnicity. The highest fatality rate corresponded to the Montubio ethnic group (87.65%), followed by Afrodescendants (67.21%). The estimated burden of disease of stroke calculated using Ecuadorian hospital records (2015-2020) varied from 1,468 to 2,991 DALY per 1,000 population on average. Discussion Differences in the burden of disease by ethnic group are likely to reflect differential access to care by region and socio-economic group, both of which are frequently correlated with ethnic composition in Ecuador. Equitable access to health services remains an important challenge in the country. The gender discrepancy in fatality rates suggests that there is a need for targeted educational campaigns to identify stroke signs early, especially in the female population.
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Affiliation(s)
- Sarah J. Carrington
- Department of Economics, Universidad de Las Américas, Quito, Ecuador,*Correspondence: Sarah J. Carrington ✉
| | - Daniel Romero-Alvarez
- Biodiversity Institute and Department of Ecology and Evolutionary Biology, The University of Kansas, Lawrence, KS, United States,One Health Research Group, Faculty of Medicine, Universidad de Las Américas, Quito, Ecuador
| | - Marco Coral-Almeida
- Grupo de bioquimioinformática GBQ, Universidad de Las Américas, Quito, Ecuador
| | - Andrea Vela
- Facultad de Ciencias Pecuarias, Carrera de Medicina Veterinaria, Escuela Superior Politécnica de Chimborazo, Chimborazo, Ecuador
| | | | - Guido Mascialino
- Escuela de Psicología, Universidad de Las Américas, Quito, Ecuador,Guido Mascialino ✉
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de Juras AR, Hu SC. A Review on Dietary Patterns and Double Burden of Malnutrition: Knowledge Gaps for Future Research. Asia Pac J Public Health 2023; 35:7-13. [PMID: 35906812 DOI: 10.1177/10105395221115221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Nutrition transition is characterized by shifts in dietary patterns (DPs) and is one of the factors associated with the double burden of malnutrition (DBM). Evidence indicates correlations between DPs and obesity, diabetes, and cardiovascular diseases. However, little is known on how DP influences DBM. This mini-review examined DP-DBM relationship among adults along with different DP approaches and DBM definitions. A structured search of peer-reviewed articles was performed from Web of Science. Keywords related to "dietary patterns," "double burden of malnutrition," and "adults" were used. A total of 133 studies were included. Results showed that factor analysis was the predominant DP analysis method. DBM was frequently assessed at the national level and defined as the coexistence of overweight/obesity and underweight. From the 133 studies, only four articles investigated DP-DBM association and suggested that healthier DPs positively improved DBM. Significant knowledge gaps remain, including (1) application of a combination of DP approaches, (2) evaluation of individual-level and household-level DBM, and (3) inconsistency of micronutrient deficiencies and non-communicable disease indicators in DBM definition. This review revealed paucity of studies on the nexus of DPs and DBM. Future research is imperative to establish evidence on the link between food patterns and multiple burdens of malnutrition.
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Affiliation(s)
- Aileen R de Juras
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines Los Baños, Los Baños, Philippines
| | - Susan C Hu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Rosas-Jiménez C, Tercan E, Horstick O, Igboegwu E, Dambach P, Louis VR, Winkler V, Deckert A. Prevalence of anemia among Indigenous children in Latin America: a systematic review. Rev Saude Publica 2022; 56:99. [PMID: 36515311 PMCID: PMC9749659 DOI: 10.11606/s1518-8787.2022056004360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe the prevalence pattern of anemia among Indigenous children in Latin America. METHODS PRISMA guidelines were followed. Records were identified from the databases PubMed, Google Scholar, and Lilacs by two independent researchers between May and June 2021. Studies were included if the following criteria were met: a) studied Indigenous people b) was about children (from 0 to 12 years old); c) reported a prevalence estimate of anemia; d) had been conducted in any of the countries of Latin America; e) was published either in English, Portuguese, or Spanish; f) is a peer-reviewed article; and g) was published at any date. RESULTS Out of 2,401 unique records retrieved, 42 articles met the inclusion criteria. A total of 39 different Indigenous communities were analyzed in the articles, and in 21 of them (54.0%) child anemia was a severe public health problem (prevalence ≥ 40%). Those communities were the Aymara (Bolivia); Aruak, Guaraní, Kamaiurá, Karapotó, Karibe, Kaxinanuá, Ma-cro-Jê, Suruí, Terena, Xavante (Brazil); Cabécar (Costa Rica), Achuar, Aguaruna, Awajún, Urarina, Yomybato (Peru); Piaroa and Yucpa (Venezuela); and Quechua (Peru and Bolivia). Children below two years had the highest prevalence of anemia (between 16.2% and 86.1%). Among Indigenous people, risk factors for anemia include nutrition, poor living conditions, access to health services, racism, and discrimination. Bolivia and Guatemala are scarcely studied, despite having the highest proportion of Indigenous communities in Latin America. CONCLUSIONS Anemia constitutes a poorly documented public health problem among Indigenous children in 21 Indigenous communities in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, and Peru. In all Indigenous communities included in this study child anemia was an issue, especially in younger children.
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Affiliation(s)
- Carlos Rosas-Jiménez
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Engin Tercan
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Olaf Horstick
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Ekeoma Igboegwu
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Peter Dambach
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Valérie R. Louis
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Volker Winkler
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
| | - Andreas Deckert
- Heidelberg UniversityHeidelberg Institute for Global HealthHeidelbergBaden-WürttembergGermanyHeidelberg University. Heidelberg Institute for Global Health. Heidelberg, Baden-Württemberg, Germany
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Costa JC, Mujica OJ, Gatica-Domínguez G, del Pino S, Carvajal L, Sanhueza A, Caffe S, Victora CG, Barros AJ. Inequalities in the health, nutrition, and wellbeing of Afrodescendant women and children: A cross-sectional analysis of ten Latin American and Caribbean countries. LANCET REGIONAL HEALTH. AMERICAS 2022; 15:100345. [PMID: 36405302 PMCID: PMC9669334 DOI: 10.1016/j.lana.2022.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Afrodescendants are systematically affected by discrimination in the Americas and few multi-country studies addressed ethnic inequalities in health and wellbeing in the region. We aimed to investigate gaps in coverage of key health outcomes and socioeconomic inequalities between Afrodescendants and non-Afrodescendants populations in Latin American and Caribbean countries. METHODS Using national household surveys (2011-2019) from ten countries, we analyzed absolute inequalities between Afrodescendants and a comparison group that includes non-Afrodescendants and non-Indigenous individuals (henceforth non-Afrodescendants) across 17 indicators in the continuum of reproductive, maternal, newborn, child, and adolescent health. These include indicators of family planning, antenatal care, delivery assistance, child nutrition, immunization coverage, child protection, access to improved water, sanitation and hygiene, adolescent fertility, and early childhood mortality. Inequalities between country-specific subgroups of Afrodescendants were also explored. The slope index of inequality was used to assess wealth-based inequalities within each ethnic group. FINDINGS Afrodescendants represented from 2·8% (Honduras) to 59·1% (Brazil) of the national samples. Of the 128 combinations of country and indicators with data, Afrodescendants fared worse in 78 (of which 33 were significant) and performed better in 50 (15 significant). More systematic disadvantages for Afrodescendants were found for demand for family planning satisfied, early marriage, and household handwashing and sanitation facilities. In contrast, Afrodescendants tended to present lower c-section rates and lower stunting prevalence. Honduras was the only country where Afrodescendants performed better than non-Afrodescendants in several indicators. Wealth gaps among Afrodescendants were wider than those observed for non-Afrodescendants for most indicators and across all countries. INTERPRETATION Gaps in health outcomes between Afrodescendants and non-Afrodescendants were observed in most countries, with more frequent disadvantages for the former although, in many cases, the gaps were reversed. Wealth inequalities within Afrodescendants tended to be wider than for non-Afrodescendants. FUNDING Pan American Health Organization, Bill and Melinda Gates Foundation, and the Wellcome Trust.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Brazil
| | | | | | | | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sonja Caffe
- Pan American Health Organization, Washington D.C., USA
| | - Cesar G. Victora
- International Center for Equity in Health, Federal University of Pelotas, Brazil
| | - Aluísio J.D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Brazil
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Antioxidant Potential of the Sweet Whey-Based Beverage Colada after the Digestive Process and Relationships with the Lipid and Protein Fractions. Antioxidants (Basel) 2022; 11:antiox11091827. [PMID: 36139901 PMCID: PMC9495724 DOI: 10.3390/antiox11091827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Whey-based beverages could be an effective way of reusing a by-product of th cheese industry, mitigating environmental hazards and, at the same time, profiting a useful food with high nutritional and antioxidant properties. In this study, a traditional Ecuadorian beverage (Colada) was prepared combining sweet whey, Maracuyá and barley. Antioxidant properties before and after an in vitro digestion using the INFOGEST method were determined, and relationships with intestinal transformations of the lipid and protein fractions were analyzed. The digestive process had a positive effect on antioxidant properties based on increased values of ABTS and FRAP located in the bioaccessible fraction (BF), together with strong increments of total polyphenols. Moreover, pretreatment of Caco-2 cells with the BF of Colada significantly reduced ROS generation (p < 0.001) measured by the dichlorofluorescein assay. Substantial changes of the fatty acid profile occurred during digestion, such as a fall of saturated fatty acids and a rise of polyunsaturated. The protein profile, examined by SDS-PAGE and exclusion molecular chromatography in the BF, showed that the major part of the proteins were digested in the intestinal phase. Analysis of NanoLC-MS/MS revealed 18 antioxidant peptides originated from whey proteins, but also 16 peptides from barley with potential antioxidant properties. In conclusion, combining sweet whey with Maracuyá and barley constitutes an excellent nutritional beverage with a strong antioxidant potential.
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12
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Evaluation of School Children Nutritional Status in Ecuador Using Nutrimetry: A Proposal of an Education Protocol to Address the Determinants of Malnutrition. Nutrients 2022; 14:nu14183686. [PMID: 36145057 PMCID: PMC9502477 DOI: 10.3390/nu14183686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
The education sector is a cornerstone in the battle against malnutrition in children. However, there are still no consolidated protocols that outline strategies for how nutrition programs in low- and middle-income countries can be delivered through the education sector. Establishing the correct community diagnosis is essential prior to the elaboration of an intervention plan for a school population that takes into account more than just traditional variables related to the nutritional status. A total of 574 boys and girls aged 3–11 years from three educational institutions in different municipalities in Ecuador participated in the study. Sociodemographic, anthropometric (weight and height) and coproparasitological data were obtained. Nutrimetry, which is a combination of two classical anthropometrics indicators, was used for the analysis of the nutritional status, and the indicators’ frequencies varied among the schools. In order to improve the nutritional status of children, we proposed a framework mainly focusing on establishing alliances with the education sector and taking into account gender equality; respect for the environment; and the customs, beliefs and traditions of each population. The results obtained from the analyses of other variables demonstrated the importance of an adequate diagnosis prior to any type of intervention at the nutritional level, since characteristics could vary by local area and have an impact on the successfulness of the intervention.
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13
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Ramírez-Luzuriaga MJ, Kobes S, Sinha M, Knowler WC, Hanson RL. Increased Adiposity and Low Height-for-Age in Early Childhood Are Associated With Later Metabolic Risks in American Indian Children and Adolescents. J Nutr 2022; 152:1872-1885. [PMID: 35147199 PMCID: PMC9554900 DOI: 10.1093/jn/nxac031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growth abnormalities in childhood have been related to later cardiometabolic risks, but little is known about these associations in populations at high risk of type 2 diabetes. OBJECTIVES We examined the associations of patterns of growth, including weight and height at ages 1-59 months, with cardiometabolic risk factors at ages 5-16 years. METHODS We linked anthropometric data collected at ages 1-59 months to cardiometabolic data obtained from a longitudinal study in a southwestern American Indian population at high risk of diabetes. Analyses included 701 children with ≥1 follow-up examination at ages 5-16 years. We derived age- and sex-specific weight-for-height z-scores (WHZ) and height-for-age z-scores (HAZ) at ages 1-59 months. We selected the highest observed WHZ and the lowest observed HAZ at ages 1-59 months and analyzed associations of z-scores and categories of WHZ and HAZ with cardiometabolic outcomes at ages 5-16 years. We used linear mixed-effects models to account for repeated measures. RESULTS Overweight/obesity (WHZ >2) at ages 1-59 months was significantly associated with increased BMI, fasting and 2-hour postload plasma glucose, fasting and 2-hour insulin, triglycerides, systolic blood pressure, diastolic blood pressure, and decreased HDL cholesterol at ages 5-16 years relative to normal weight (WHZ ≤1). For example, at ages 5-9 years, 2-hour glucose was 10.4 mg/dL higher (95% CI: 5.6-15.3 mg/dL) and fasting insulin was 4.29 μU/mL higher (95% CI: 2.96-5.71 μU/mL) in those with overweight/obesity in early childhood. Associations were attenuated and no longer significant when adjusted for concurrent BMI. A low height-for-age (HAZ < -2) at ages 1-59 months was associated with 5.37 mg/dL lower HDL (95% CI: 2.57-8.17 mg/dL) and 27.5 μU/mL higher 2-hour insulin (95% CI: 3.41-57.6 μU/mL) at ages 10-16 years relative to an HAZ ≥0. CONCLUSIONS In this American Indian population, findings suggest a strong contribution of overweight/obesity in early childhood to cardiometabolic risks in later childhood and adolescence, mediated through persistent overweight/obesity into later ages. Findings also suggest potential adverse effects of low height-for-age, which require confirmation.
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Affiliation(s)
- María J Ramírez-Luzuriaga
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Sayuko Kobes
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Robert L Hanson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
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Hernández-Ruiz Á, Madrigal C, Soto-Méndez MJ, Gil Á. Challenges and perspectives of the double burden of malnutrition in Latin America. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34 Suppl 1:S3-S16. [PMID: 35153111 DOI: 10.1016/j.arteri.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
Nutrition is a key factor in the development of non-communicable chronic diseases (NCCDs), especially cardiovascular diseases (CVD) and their risk factors. The "double burden of malnutrition" (DBM) is the coexistence of undernutrition and overnutrition in the same population across the life-course. In Latin America, the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world. Undernutrition and the micronutrient deficiencies particularly iron, zinc, and vitamins A and D, present high heterogeneity in Latin American countries, and are currently considered important public health problems. In this region, NCCDs account for 50% of the disability-adjusted life-years, led by CVD. The most prevalent cardiovascular risk factors are overweight, obesity, hypertension, dyslipidemia and type 2 diabetes mellitus. Because of the cost of treatment and the potential years of life lost due to premature death, CVD is known to affect the poorest segments of the population, affecting communities, and governments. More than 80% of CVD deaths occur in low- and middle-income countries. The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD. These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development. Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system. The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority, considering country-specific inequalities and socio-demographic differences in the Latin American region, using diverse and multidisciplinary strategies.
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Affiliation(s)
- Ángela Hernández-Ruiz
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain
| | - Casandra Madrigal
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain; Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - María José Soto-Méndez
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3.ª pta., Armilla 18016, Granada, Spain; Department of Biochemistry and Molecular Biology II University of Granada, University of Granada, Granada, Spain; Institute of Nutrition and Food Technology "José Mataix," Biomedical Research Center, University of Granada, Granada, Spain; Biosanitary Research Institute IBS.GRANADA, Granada University Hospital Complex, Granada, Spain; CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain.
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15
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Quizhpe E, Teran E, Pulkki-Brännström AM, San Sebastián M. Social inequalities in healthcare utilization during Ecuadorian healthcare reform (2007-2017): a before-and-after cross-sectional study. BMC Public Health 2022; 22:499. [PMID: 35287629 PMCID: PMC8922889 DOI: 10.1186/s12889-022-12884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited research is available about the impact of healthcare reforms on healthcare utilization according to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gap between the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007-2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization. METHODS We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difficulties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes in inequalities over time. Sample weights were applied to all analyses, and 95% confidence intervals were calculated to assess statistical significance in the regression analysis. RESULTS In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically significant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women. CONCLUSIONS Our results showed remarkable and significant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specific indicators. Further studies are also needed to identify the main barriers that contribute to UHCN among socially disadvantaged groups.
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Affiliation(s)
- Edy Quizhpe
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden. .,Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Quito, Ecuador.
| | - Enrique Teran
- Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Quito, Ecuador
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Carpio-Arias TV, Verdezoto N, Guijarro-Garvi M, Abril-Ulloa V, Mackintosh N, Eslambolchilar P, Ruíz-Cantero MT. Healthcare professionals' experiences and perceptions regarding health care of indigenous pregnant women in Ecuador. BMC Pregnancy Childbirth 2022; 22:101. [PMID: 35120490 PMCID: PMC8815715 DOI: 10.1186/s12884-022-04432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is an important life experience that requires uniquely tailored approach to health care. The socio-cultural care practices of indigenous pregnant women (IPW) are passed along the maternal line with respect to identity, worldview and nature. The cultural differences between non-indigenous healthcare professionals (HPs) and IPW could present a great challenge in women's health care. This article presents an analysis from a human rights and gender perspective of this potential cultural divide that could affect the health of the IPW in an Andean region of Ecuador with the objective of describing the health challenges of IPWs as rights holders through the experiences and perceptions of HP as guarantors of rights. METHODS We conducted 15 in-depth interviews with HPs who care for IPW in Chimborazo, Pichincha provinces of Ecuador. We utilized a semi-structured interview guide including questions about the experiences and perceptions of HPs in delivering health care to IPW. The interviews were recorded, transcribed and subjected to thematic analysis in Spanish and translated for reporting. RESULTS We found disagreements and discrepancies in the Ecuadorian health service that led to the ignorance of indigenous cultural values. Common characteristics among the indigenous population such as illiteracy, low income and the age of pregnancy are important challenges for the health system. The gender approach highlights the enormous challenges: machismo, gender stereotypes and communication problems that IPWs face in accessing quality healthcare. CONCLUSIONS Understanding the diverse perspectives of IPW, acknowledging their human rights particularly those related to gender, has the potential to lead to more comprehensive and respectful health care delivery in Ecuador. Further, recognizing there is a gender and power differential between the provider and the IPW can lead to improvements in the quality of health care delivery and reproductive, maternal and child health outcomes.
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Affiliation(s)
- Tannia Valeria Carpio-Arias
- Research Group on Food and Human Nutrition (GIANH), Faculty of Public Health, Higher Polytechnic School of Chimborazo, Pan-American Sur Km 1 1/2, Riobamba, Ecuador
| | - Nervo Verdezoto
- School of Computer Science and Informatics, Human-centered Computing Group, Cardiff University, Cardiff, UK
| | - Marta Guijarro-Garvi
- Department of Economics, University of Cantabria, Cantabria, Spain
- Public Health Research Group, University of Alicante, Alicante, Spain
| | - Victoria Abril-Ulloa
- Research Group on Public Health, Nutrition and Physical Activity in the Life Cycle, University of Cuenca, Cuenca, Ecuador
| | - Nicola Mackintosh
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Parisa Eslambolchilar
- School of Computer Science and Informatics, Human-centered Computing Group, Cardiff University, Cardiff, UK
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Hadi H, Fatimatasari F, Irwanti W, Kusuma C, Alfiana RD, Asshiddiqi MIN, Nugroho S, Lewis EC, Gittelsohn J. Exclusive Breastfeeding Protects Young Children from Stunting in a Low-Income Population: A Study from Eastern Indonesia. Nutrients 2021; 13:4264. [PMID: 34959815 PMCID: PMC8706015 DOI: 10.3390/nu13124264] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022] Open
Abstract
The prevalence of stunting in young Indonesian children is the highest among countries belonging to the Association of Southeast Asian Nations (ASEAN). Breastfed children are reported to grow better than non-breastfed. The present study examined the protective effect of exclusive breastfeeding against stunting in children under two years old (CU2) and its interaction with monthly household expenditure. Secondary analyses were conducted based on a 2012 cross-sectional study including 408 children aged 6-24 months and their caregivers from 14 villages in rural Eastern Indonesia. Data on breastfeeding history, childcare, and household expenditures were collected using structured questionnaires. Focus Group Discussions (FGDs) were conducted in each village (n = 14). Nearly two-thirds (61%) of caregivers who identified as the biological mother exclusively breastfed their child at 6 months. Exclusively-breastfed CU2 from poorer households were 20% less likely to be stunted than their non-exclusively-breastfed peers. Further, exclusively-breastfed CU2 from wealthier households were 50% less likely to be stunted than non-exclusively-breastfed CU2 from poorer households. FGDs revealed that some mothers were unaware of the importance of recommended breastfeeding practices. Exclusive breastfeeding may protect low-income children against stunting. Health promotion to improve caregiver motivation to exclusively breastfeed is critical in the present setting and beyond.
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Affiliation(s)
- Hamam Hadi
- Alma Ata Graduate School of Public Health, the University of Alma Ata, Yogyakarta 55183, Indonesia; (C.K.); (S.N.)
- Alma Ata Center for Healthy Life and Foods (ACHEAF), the University of Alma Ata, Yogyakarta 55183, Indonesia
| | - Fatimatasari Fatimatasari
- Department of Midwifery, Faculty of Health Sciences, the University of Alma Ata, Yogyakarta 55183, Indonesia; (F.F.); (R.D.A.)
| | - Winda Irwanti
- Department of Nutrition, Faculty of Health Sciences, The University of Alma Ata, Yogyakarta 55183, Indonesia;
| | - Chahya Kusuma
- Alma Ata Graduate School of Public Health, the University of Alma Ata, Yogyakarta 55183, Indonesia; (C.K.); (S.N.)
| | - Ratih Devi Alfiana
- Department of Midwifery, Faculty of Health Sciences, the University of Alma Ata, Yogyakarta 55183, Indonesia; (F.F.); (R.D.A.)
| | - M. Ischaq Nabil Asshiddiqi
- Department of Nursing, Faculty of Health Sciences, the University of Alma Ata, Yogyakarta 55183, Indonesia;
| | - Sigit Nugroho
- Alma Ata Graduate School of Public Health, the University of Alma Ata, Yogyakarta 55183, Indonesia; (C.K.); (S.N.)
| | - Emma Clare Lewis
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (E.C.L.); (J.G.)
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (E.C.L.); (J.G.)
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Shimabuku RL, Delgado CA, Nakachi G, Teruya AA, Velasquez PM. Double Burden of Excess Weight and Anemia in Latin American Children up to 2019. TOHOKU J EXP MED 2020; 252:159-168. [PMID: 33041315 DOI: 10.1620/tjem.252.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The double burden of malnutrition is the coexistence of two different conditions, mainly reflected as excess or deficit in weight. Anemia is a specific nutritional deficit not always included in the double burden assessment. We reviewed overweight and/or obesity (OW/OB) and anemia studies from Latin-American Children over the last ten years up to 2019. Two authors evaluated the MEDLINE, SCOPUS, and LILACS databases. A scale of ten questions was used to assess the risk of bias in prevalence studies. Fourteen studies were selected. The population studies' size ranged from 147 to 20,342 children with different socio-economic backgrounds, such as urban, peri-urban and rural settings, socio-economic status, schooling, population (ethnic minorities and indigenous), and environmental differences (sea level or high altitude). The prevalence of OW/OB ranged from 4.9% to 42%. The prevalence of anemia was from 3.4% to 67%. The double burden, including OW/OB and anemia, ranged from 0.7% to 67%. A higher prevalence of excess weight and anemia was found in rural and high altitude above sea level environments, extreme poverty, low education level, and indigenous communities. These heterogeneous data, before the 2020 (COVID-19 pandemic), reflect the vast inequities between countries and within each country. Food insecurity linked to poverty and the induced change in eating habits and lifestyles threaten optimal child nutrition in ongoing and future scenarios. The existence of OW/OB and anemia and their simultaneous coexistence in the community, home, and individual levels, indicates that interventions should be comprehensive to face the double burden of malnutrition.
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Affiliation(s)
- Roberto L Shimabuku
- Department of Pediatrics, Faculty of Medicine, Universidad Nacional Mayor de San Marcos
| | - Carlos A Delgado
- Department of Pediatrics, Faculty of Medicine, Universidad Nacional Mayor de San Marcos
- Neonatal Unit, Instituto Nacional de Salud del Niño
| | | | - Alberto A Teruya
- Department of Endocrinology, Hospital Edgardo Rebagliati Martins
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