Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women)

Transferrin levels are associated with malnutrition markers in hemodialysis patients in KwaZulu-Natal, South Africa

INTRODUCTION

Malnutrition is a global phenomenon and may be contributing to the increasing size of the hemodialysis (HD) population in South Africa and is affecting morbidity and clinical outcomes. Our study assessed whether transferrin could be a possible marker for malnutrition in the HD population.

METHODS

Clinical parameters (including skinfold thickness and mid-upper arm circumference [MUAC]) and laboratory markers (including transferrin and hemoglobin) were measured during a six-month period in a sample of 59 HD patients.

RESULTS

Linear regression analysis showed that MUAC (p = 0.027) as well as skinfold thickness (p = 0.021) had a significant association with transferrin levels within the HD participants. There was no significant association between transferrin levels or MUAC with hemoglobin levels (p = 0.075). Furthermore, the study found that decreased transferrin levels (< 2.15 g/dL to 3.80 g/dL) were closely related to malnutrition in the malnutrition distribution groups within the study, with 97.7% of HD participants being classified in one of the malnutrition groups.

CONCLUSION

Thus, transferrin levels are a valuable marker for malnutrition within the HD patient population and can be included along with clinical assessment parameters such as MUAC and skinfold thickness as primary indicators for malnutrition.

Mid-Upper Arm Circumference Is a Strong Predictor of Mortality Among Ugandan Adults With HIV-Associated Cryptococcal Meningitis: A Prospective Cohort Study

Background

Mortality among adults diagnosed with HIV-associated cryptococcal meningitis remains high (24%-40%). We hypothesized that nutritional state, as measured by mid-upper arm circumference (MUAC), is a potentially modifiable risk factor for mortality.

Methods

Ugandan adults hospitalized with HIV-associated cryptococcal meningitis had MUAC measurements performed at baseline. We compared MUAC measurements with baseline clinical and demographic variables and investigated associations with survival using Cox regression.

Results

Of 433 participants enrolled, 41% were female, the median CD4 T-cell count (interquartile range [IQR]) was 15 (6-41) cells/μL, and 37% were antiretroviral therapy naïve. The median MUAC (IQR) was 24 (22-26) cm, the median weight (IQR) was 53 (50-60) kg, and MUAC correlated with weight (Pearson r = 0.6; P < .001). Overall, 46% (200/433) died during the 18-week follow-up. Participants in the lowest MUAC quartile (≤22 cm) had the highest mortality: 39% (46/118) at 2 weeks and 62% (73/118) at 18 weeks. A baseline MUAC ≤22 cm was associated with an 82% increased risk of 18-week mortality as compared with participants with an MUAC >22 cm (unadjusted hazard ratio, 1.82; 95% CI, 1.36-2.42; P < .001). Following adjustment for antiretroviral therapy status, CD4 count, hemoglobin, amphotericin dose, and tuberculosis status, the adjusted hazard ratio was 1.84 (95% CI, 1.27-2.65; P < .001). As a continuous variable, 18-week mortality was reduced by 10% for every 1-cm increase in MUAC. CSF Th17 immune responses were positively associated with MUAC quartile.

Conclusions

MUAC measurement is a simple bedside tool that can identify adults with HIV-associated cryptococcal meningitis at high risk for mortality for whom an enhanced bundle of care, including nutritional supplementation, should be further investigated.

Accuracy of C-Reactive Protein for Tuberculosis Detection in General-Population Screening and Ambulatory-Care Triage in Uganda

Rationale: C-reactive protein (CRP) has demonstrated utility as a point-of-care triage test for tuberculosis (TB) in clinical settings, particularly among people with human immunodeficiency virus (HIV), but its performance for general-population TB screening is not well characterized. Objective: To assess the accuracy of CRP for detecting pulmonary TB disease among individuals undergoing community-based screening or presenting for evaluation of TB symptoms in Kampala, Uganda. Methods: We pooled data from two case-control studies conducted between May 2018 and December 2022 among adolescents and adults (⩾15 yr) in Kampala, Uganda. We conducted community-based screening for TB, regardless of symptoms. We enrolled people with Xpert MTB/RIF Ultra-positive (including trace) sputum results and a sample of people with Ultra-negative results. We also enrolled symptomatic patients diagnosed with TB and controls with negative TB evaluations from ambulatory care settings. Participants underwent further evaluation, including sputum culture, CRP, and HIV testing. We assessed the accuracy of CRP alone or with symptom screening against a bacteriologic reference standard. Our primary analysis evaluated the sensitivity and specificity of CRP at a cutoff of 5 mg/L. Diagnostic performance was summarized by calculating the area under the receiver operating curve (AUC). Results: In the community setting (n = 544), CRP ⩾ 5 mg/L had a sensitivity of 55.3% (95% confidence interval, 47.0-63.4%) and specificity of 84.7% (79.7-88.8%) for confirmed TB; AUC was 0.75 (0.70-0.79). Screening for CRP ⩾ 5 mg/L or positive symptoms increased sensitivity to 92.0% (86.4-95.8%) at the expense of specificity (57.1% [50.8-63.2%]). In the ambulatory care setting (n = 944), sensitivity of CRP ⩾ 5 mg/L was 86.7% (81.8-90.7%), specificity was 68.6% (64.8-72.2%), and AUC (0.84 [0.81-0.87]) did not differ significantly by HIV status. CRP ⩾ 5 mg/L was >90% sensitive among individuals with a medium or high semiquantitative Xpert result in both settings. Conclusions: Although CRP did not meet World Health Organization (WHO) TB screening benchmarks in the community, it demonstrated high specificity, and sensitivity was high among individuals with high sputum bacillary burden who are likely to be most infectious. In ambulatory care, estimated sensitivity and specificity were each within 4 percentage points of WHO benchmarks, with no meaningful difference in performance by HIV status.

Outcomes of the LEAP feasibility trial-A low-threshold, exercise programme with protein supplementation to target frailty and poor physical functioning in people experiencing homelessness and addiction issues

BACKGROUND

People experiencing homelessness are more likely to experience poor health with physical functioning deficits and frailty commonly reported. It is not well known how strategies to target physical functioning deficits and frailty work in practice in this group. The primary aim of this study was to explore the feasibility of an exercise intervention with protein supplementation to target physical functioning and frailty in people experiencing homelessness evaluated by recruitment and retention rates, adherence to the exercise sessions and protein supplement, adverse effects, programme feedback and characteristics of non-returners, sporadic and frequent attenders. The secondary aim was to evaluate changes in effectiveness outcomes of grip strength, muscle mass, lower extremity physical function, pain, frailty, and risk of malnutrition.

METHOD

This prospective single-arm study evaluated the feasibility of a 16-week rolling, low-threshold, 'drop-in' once weekly exercise programme with protein supplementation. The main recruitment site was a day-service centre for people who are homeless. Feasibility was assessed by the recruitment and retention rates, adherence to the exercise sessions and protein supplement as well as adverse effects, programme feedback and evaluation of characteristics of non-returners, sporadic (≤50% of available sessions) and frequent attenders (≥50% of available sessions). Effectiveness outcomes included pain (Visual Analogue Scale), physical functioning and performance (hand-grip dynamometry, limb circumference, the Short Physical Performance Battery), frailty (SHARE-FI and Clinical Frailty Scale) and nutritional status (Mini Nutritional Assessment).

RESULTS

Thirty-one participants were recruited mean (SD) age 45(16) years. There was a recruitment rate of a median (IQR) of 2(1-3) new participants per week. The retention rate was 45% (n = 14) to the main recruitment site. Adherence to the exercise sessions and nutritional intervention was 90% and 100% respectively. Three adverse events were recorded during 74 interventions over the 16-week programme. The acceptability of the programme was highlighted in participant feedback. Characteristics of frequent returners (≥50%) were older age, female, more stably housed and more stable in addiction. The programme did not induce any changes in effectiveness outcomes.

CONCLUSION

The feasibility of this programme was demonstrated. Overall, the programme was well received with higher retention rates in older participants, females, those more stably housed and those stable in addiction. A higher powered, more intense programme is needed to demonstrate programme effectiveness.

Comparing Mid-Upper Arm Circumference With Body Mass Index for Assessing Nutritional Status in Indian Adults: Evidence From the National Family Health Survey 2015-16 (NFHS-4)

Background The surge in the twin burden of malnutrition - undernutrition and overweight/obesity - poses a severe threat worldwide including India. The adult group, primarily considered as an economic pillar of the society, suffered significant health problems, yet their nutritional issues are often neglected. Screening of nutritional status through anthropometric measurements is widely accepted. Body mass index (BMI) is commonly used but has certain limitations. Mid-upper arm circumference (MUAC), another simpler tool, is universally accepted in children, but its use in adults is debatable. The current research aims to determine the MUAC cutoffs and their predictive accuracies corresponding to BMI cutoffs for adult men and nonpregnant women. Subject and methods A cross-sectional analysis was conducted of the anthropometric data of Indian adult men and nonpregnant women collected in 2015-16 via the National Family Health Survey (NFHS-4). The receiver operating characteristic (ROC) curve analysis was performed to derive the MUAC cutoffs against BMI cutoffs. Results A significant moderate correlation for both men (r=0.56) and women (r=0.68) was observed. In relation to ROC analysis, the MUAC cutoffs against the BMI cutoffs of 18.5, 23, 25, and 30 kg/m2 were approximated to be 25, 26, 28, and 30 cm for men and 23, 25, 27, and 28 cm for women, respectively. These MUAC cutoffs showed good predictive accuracy with a high range of sensitivity and specificity for both men and women. Conclusions The non-invasive MUAC method correlates very well with BMI and offers several advantages, including accuracy, ease of measurement, and minimal logistical support and training, and can assess the nutritional status even in geographically remote areas. Therefore, it can be an important tool in public health, especially in resource-limited settings, for identifying populations at risk of malnutrition.

Targeting strategies of antenatal balanced energy and protein supplementation in Addis Ababa, Ethiopia: study protocol for a randomized effectiveness study

BACKGROUND

Antenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries.

METHODS

A randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies.

DISCUSSION

This study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women.

TRIAL REGISTRATION

ClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.

Determinants of continued breastfeeding in children aged 12-23 months in three regions of Haiti

Objectives

To identify the prevalence and determinants of continued breastfeeding in Haitian children aged 12-23 months.

Methods

Three cross-sectional surveys were conducted yearly during the summers of 2017 to 2019 as part of a 4-year (2016-2020) multisectoral maternal and infant health initiative in the regions of Les Cayes, Jérémie, and Anse d'Hainault in Haiti. A total of 455 children 12-23 months of age and their mothers participated in the study. A child was considered to be continuing breastfeeding if the mother reported giving breast milk in the 24-hour dietary recall. Unadjusted and adjusted prevalence ratios were estimated, and associations were assessed between continued breastfeeding and explanatory factors related to sociodemographic characteristics, household food security, maternal nutrition, and breastfeeding knowledge and practices.

Results

The prevalence of continued breastfeeding was 45.8%. Continued breastfeeding was significantly more prevalent among younger children, children who did not have a younger sibling, children whose mother was not pregnant, those living in the Jérémie region, children who had been exclusively breastfed for less than 1 month, and children whose mother knew the World Health Organization's recommendation for continued breastfeeding up to 2 years or beyond.

Conclusions

The study results highlight the need for geographically equitable access to tailored and adequate health services and education that support breastfeeding in a way that is compatible with the local context.

The effectiveness of malaria camps as part of the malaria control program in Odisha, India

Durgama Anchalare Malaria Nirakaran (DAMaN) is a multi-component malaria intervention for hard-to-reach villages in Odisha, India. The main component, malaria camps (MCs), consists of mass screening, treatment, education, and intensified vector control. We evaluated MC effectiveness using a quasi-experimental cluster-assigned stepped-wedge study with a pretest-posttest control group in 15 villages: six immediate (Arm A), six delayed (Arm B), and three previous interventions (Arm C). The primary outcome was PCR + Plasmodium infection prevalence. The time (i.e., baseline vs. follow-up 3) x study arm interaction term shows that there were statistically significant lower odds of PCR + Plasmodium infection in Arm A (AOR = 0.36, 95% CI = 0.17, 0.74) but not Arm C as compared to Arm B at the third follow-up. The cost per person ranged between US$3-8, the cost per tested US$4-9, and the cost per treated US$82-1,614, per camp round. These results suggest that the DAMaN intervention is a promising and financially feasible approach for malaria control.

The L-shaped association of mid-upper arm circumference with all-cause and cause-specific mortality in US adults: a population-based prospective cohort study

BACKGROUND

The arm circumference is a feasible and reliable indicator in evaluating the nutritional status of children. However, its application in general adults has yet to be thoroughly investigated.

OBJECTIVE

This study aimed to evaluate the association between mid-upper arm circumferences (MUACs) and mortality in general adults.

METHODS

The nationally representative cohort from the National Health and Nutrition Examination Survey (1999-2018) was analyzed with mortality information obtained through linkage to the National Death Index. The baseline MUACs were collected as exposure. Survey-weighted Cox proportional hazard regressions were performed to estimate the hazard ratios (HRs) and 95% confidential intervals (CIs) of mortality risk for individuals with different MUACs. Restricted cubic spline analyses were performed to examine the nonlinear association of MUAC with all-cause and cause-specific mortality.

RESULTS

A total of 52,159 participants were included in this study. During a median follow-up time of 117 months, 7157 deaths were documented, with leading causes of cardiovascular disease (CVD), cancer, and respiratory disease. Individuals in the first quartile (Q1) of MUAC tended to have higher all-cause mortality risk than the rest after full adjustment. Similarly, CVD mortality risk in Q1 was higher than that in the second quartile (Q2) and the third quartile (Q3); respiratory mortality risk in Q1 was higher than in Q2. MUAC was non-linearly associated with all-cause mortality and CVD mortality. Individuals in Q1 MUAC (≤ 29.3) tended to have higher all-cause mortality risk, with HRs (95% CIs) estimated to be 0.76 (0.67-0.87) for Q2 (29.4, 32.5), 0.69 (0.59-0.81) for Q3 (32.6, 36.0), and 0.59 (0.46-0.75) for Q4 (≥ 36.1) after adjustment of demographic, lifestyle, and comorbidity covariates. Similarly, compared with Q1, HRs (95% CIs) for CVD mortality were estimated to be 0.73 (0.58-0.93) for Q2 and 0.57 (0.43-0.47) for Q3; HRs (95% CIs) for respiratory mortality was estimated to be 0.57 (95% CI, 0.37-0.87) for Q2 with other differences not significant.

CONCLUSION

The MUAC was inversely associated with long-term mortality in general adults in the United States and may serve as a valuable measurement in adult health evaluations.

Validating a linear regression equation using mid-upper arm circumference to predict body mass index

BACKGROUND

Estimating body mass index (BMI) in hospitalised patients for nutritional assessment is challenging when measurement of weight and height is not feasible. The study aimed to validate a previously published regression equation to predict BMI using mid-upper arm circumference (MUAC). We also evaluated the proposed global MUAC cut-off of ≤24 cm to detect undernutrition.

METHODS

We measured standing height, weight, and MUAC prospectively in a sample of stable patients. Agreement between calculated and predicted BMI was evaluated using Bland-Altman analysis.

RESULTS

We studied 201 patients; 102 (51%) were male. Median (IQR age was 42 (29-50) years. 95% limits of agreement between predicted and calculated BMI were +0.6767 to +1.712 and the bias was +1.076. MUAC ≤24 cm was 97% sensitive and 83% specific to detect undernutrition.

CONCLUSION

BMI derived from MUAC had poor calibration for estimating actual BMI. However, low MUAC has good discriminative accuracy to detect undernutrition.

Maternal mid-upper arm circumference to predict small for gestational age: Findings in a Zambian cohort

OBJECTIVE

To compare the performance of mid upper arm circumference (MUAC) and body mass index (BMI) for prediction of small for gestational age (SGA) in Zambia.

METHODS

This is a secondary analysis of an ongoing clinical cohort that included women with a single gestation and MUAC measured before 24 weeks of pregnancy. We assessed relationships between maternal MUAC and birth weight centile using regression. The performance of MUAC and BMI to predict SGA was compared using receiver operating characteristic curves and the effect of maternal HIV was investigated in sub-group analyses.

RESULTS

Of 1117 participants, 847 (75%) were HIV-negative (HIV-) and 270 (24%) were HIV-positive (HIV+). Seventy-four (7%) delivered severe SGA infants (<3rd centile), of whom 56 (76%) were HIV- and 18 (24%) were HIV+ (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.58-1.75). MUAC was associated with higher birth weight centile (+1.2 centile points, 95% CI 0.7-1.6; P < 0.001); this relationship was stronger among HIV+ women (+1.7 centile points, 95% CI 0.8-2.6; P < 0.001) than HIV- women (+0.9 centile points, 95% CI 0.4-1.4; P = 0.001). The discriminatory power was similar, albeit poor (area under the curve [AUC] < 0.7), between MUAC and BMI for the prediction of SGA. In stratified analysis, MUAC and BMI showed excellent discrimination predicting severe SGA among HIV+ (AUC 0.83 and 0.81, respectively) but not among HIV- women (AUC 0.64 and 0.63, respectively).

CONCLUSION

Maternal HIV infection increased the discrimination of both early pregnancy MUAC and BMI for prediction of severe SGA in Zambia.

CLINICAL TRIAL NUMBER

ClinicalTrials.gov (NCT02738892).

Dietary Diversity and Haemoglobin Level Associated With Under Nutrition Among Pregnant Women at Sidama Hawassa, Ethiopia: Facility Based Cross-Sectional Study

Background

Under nutrition among pregnant women is common public health problem in developing countries including Ethiopia. It leads to poor maternal and neonatal outcomes. Despite its consequences there is shortage of research evidence to support intervention in this regard in the southern part of the country. Therefore, the aim of the study was to assess the determinates of under nutrition among pregnant women visiting antenatal care clinics at selected health facilities in Hawassa town.

Methods

Health facility based cross-sectional study was employed among 454 systematically selected study participants. Data were collected by using structured and pre-tested questionnaires with face to face interview. Data were entered into Epi info and then exported to SPSS version 26 statistical software for analysis. Data were analyzed with descriptive statistics; bivariate and multivariate binary logistic regression.

Result

The over all of prevalence of under nutrition among pregnant women was 27.6% [95% CI (22.6, 30.8)]. In multivariate logistic regression model, lowest wealth quintile [AOR = 3.3, 95% CI (1.7, 7.0)], women with dietary diversity [AOR = 2.0, 95% CI (1.3, 4.0)], presence of anemia [AOR = 10.7, 95% CI (5.8,19.8)], lower pregnant women education level [AOR = 3.3, 95% CI (1.4, 7.9)], lower partner education level [AOR = 3.1, 95% CI (1.1, 8.5)], not ate flush/meat food [AOR = 2.8, 95% CI (1.7, 4.8)], and not ate other fruits [AOR = 1.8, 95% CI (1.1, 2.8)] had significant association with under nutrition.

Conclusion

In this health facility based study, the burden of under nutrition was high. Lowest wealth quintiles, low dietary diversity scores, being anemic and low education of the pregnant women and her partner were associated with under nutrition. Therefore, counseling for dietary diversity during antenatal care, health promotion and education for pregnant women and empowering women on income generation activities are a key intervention to tackle under nutrition.

It Cost Us All of Our Savings to Deliver Our Baby: A Qualitative Study to Explore Barriers and Facilitators of Maternal and Child Health Service Access and Utilization in a Remote Rural Region in India During the COVID-19 Pandemic

INTRODUCTION

During the coronavirus disease 2019 (COVID-19) pandemic, rural and geographically isolated regions in lower-middle-income countries (LMICs) encountered major deficits in maternal and child health (MCH) care that were accentuated by pre-existing weak public health infrastructure and diversion of existing health resources for pandemic management purposes. This explorative qualitative study was conducted to assess the barriers, challenges, and facilitators in the access and utilization of essential MCH services among pregnant women during the COVID-19 pandemic in a geographically remote and rural area in India, having nearly 70% rural population.

METHOD

The study was conducted using an ethnographic approach. Three villages were selected purposively from the Purba Medinipur district of the Eastern state of West Bengal, geographically isolated by a local river. Information on challenges of utilization was collected by in-depth interviews (IDI) with a universal sample of 25 mothers who underwent pregnancy after March 2020 and focus group discussions (FGD) with their husbands and mothers-in-laws. Thematic analysis was used to analyze the qualitative data.

RESULTS

The median (IQR) age of the mothers that delivered during pregnancy were 23 (18, 28) years and ranging from 18 to 28 years (N=25). All the mothers were married, housewives, literate, and Hindu by religion, while in the accompanying husband cohort, a majority (56 %) had completed high school. Half (52%) were primigravida with at least one living child (60 %). All the mothers had a successful birth outcome and only one had current evidence of mild depression. Low utilization of MCH services during the pandemic in the study area was recognized as an outcome of individual-level, interpersonal-level, and community-level barriers. Diversion of routine health staff for COVID-19 related services occasionally compelled pregnant women and children to seek care from unlicensed healthcare providers who remained accessible even during periods of stringent lockdown. Furthermore, the irregular functioning of the local primary health care system translated into missed home visits and disruption of nutritional assistance services. A dual burden of economic loss was reported in most households from loss of livelihood and wages and additional expenditure incurred in underdoing deliveries at private health facilities, thereby potentially translating into catastrophic out-of-pocket costs. The designation of a separate government health facility for delivery due to the unavailability of the local hospital did not mitigate the circumstances due to its lack of utilization by the villagers who encountered difficult access and a lack of trust in an unfamiliar environment. The functioning of a popular conditional cash transfer scheme for promoting safe motherhood was also possibly compromised during the pandemic.

CONCLUSIONS

Accessibility to MCH services was severely affected during the COVID-19 pandemic, especially during the stringent lockdown periods in remote and rural areas in India. Future pandemic preparedness must have enhanced health policy and administrative focus on preventing significant disruption of MCH services by maintaining improved accessibility to alternative health facilities, monitoring regular home visits by frontline health workers, rendering effective distribution of benefits from existing social protection schemes, and universal promotion of respectful maternity care.

The effectiveness of malaria camps as part of the malaria control program in Odisha, India

Durgama Anchalare Malaria Nirakaran (DAMaN) is a multi-component malaria intervention for hard-to-reach villages in Odisha, India. The main component, Malaria Camps (MCs), consists of mass screening, treatment, education, and intensified vector control. We evaluated MC effectiveness using a quasi-experimental cluster-assigned stepped-wedge study with a pretest-posttest control group in 15 villages: six immediate (Arm A), six delayed (Arm B), and three previous interventions (Arm C). The primary outcome was PCR+ Plasmodium infection prevalence. Across all arms, the odds of PCR+ malaria were 54% lower at the third follow-up compared to baseline. A time (i.e., visit) x study arm interaction revealed significantly lower odds of PCR+ malaria in Arm A versus B at the third follow-up. The cost per person ranged between US$3-8, the cost per tested US$4-7, and the cost per treated US$82-1,614, per camp round. These results suggest that the DAMaN intervention is a promising, financially feasible approach for malaria control.

The prevalence of under nutrition and associated factors among pregnant women attending antenatal care service in public hospitals of western Ethiopia

BACKGROUND

Pregnancy is a time when the body is under a lot of stress, which increases your dietary needs. Under nutrition is a worldwide health issue, especially among pregnant women. Malnutrition during pregnancy can result in miscarriages, fetal deaths during pregnancy, pre-term delivery, and maternal mortality for both the mother and her fetus. Therefore, this research aimed to assess the prevalence of under nutrition and associated factors among pregnant woman attending antenatal care services at public hospitals in west Ethiopia.

OBJECTIVE

To assess the prevalence of under nutrition and associated factors among pregnant women attending Antenatal Care service in Public Hospitals of western Ethiopia.

METHODS

Facility based cross-sectional study was conducted from April 10 to May 10, 2020 among 780 pregnant mothers. The study participants were selected by systematic random sampling methods from antenatal care clinics of the hospitals. Interviewer administered structured questionnaire was used to collect the data and Mid-upper arm circumference, height and weight were measured to determine the magnitude of under nutrition among the study participants. The data were entered to Epi Info version 7.2.3, and then exported to SPSS version 24 for analysis. Multivariable logistic regression was used to identify independent predictors considering adjusted odd ratio (AOR) at p-value ≤ 0.05 to measure the strength of association between dependent and independent variables.

RESULT

The prevalence of under nutrition among pregnant women was found to be 39.2% (95%CI: 35.7%, 42.6%). Rural residence [(AOR = 1.97, 95% CI: (1.24, 3.14)], substance use [(AOR: 3.33, 95% CI: (1.63, 6.81)], low dietary diversity of women [(AOR = 7.56, 95% CI: (4.96, 11.51)], mildly food insecure household [(AOR = 4.36, 95% CI: (2.36, 8.79)], moderately food insecure household [(AOR = 3.71, 95%CI: (1.54, 8.79), and severely food insecure household [(AOR = 6.96, 95% CI: (3.15, 15.42)] were factors significantly associated with under nutrition.

CONCLUSION

The study showed that the prevalence of under nutrition is very high among pregnant women. Factors associated with under nutrition of pregnant women were rural residency, household food insecurity, dietary diversity and substance use. All concerned bodies should made efforts to reduce the risk of under nutrition by reducing substance use and improving household food security there by to increase women's dietary diversity.

Factors associated with undernutrition among pregnant women in Haramaya district, Eastern Ethiopia: A community-based study

INTRODUCTION

Although undernutrition in pregnancy has continued to get global attention as pregnancy is considered a critical period in the life cycle owed to increase the metabolic and physiological demands, evidence is scarce on undernutrition and associated factors among pregnant women in eastern Ethiopia. Therefore, this study assessed the undernutrition and associated factors among pregnant women in Haramaya district, Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among randomly selected pregnant women in Haramaya district, eastern Ethiopia. Data were collected through face-to-face interviews, anthropometric measurement, and hemoglobin analysis by trained research assistants. An adjusted Prevalence ratio (aPR), and a 95% confidence interval (CI), were used to report associations. Poisson regression analysis model with a robust variance estimate identified variables associated with undernutrition. Data were double entered using Epi-data 3.1 and cleaned, coded, checked for missing and outliers, and analyzed using Stata 14 (College Station, Texas 77845 USA. Finally, the p-value <0.05 was the cut-off point for the significant association.

RESULTS

A total of 448 pregnant women with a mean age of 25.68 (± 5.16) were included in the study. The prevalence of undernutrition among pregnant women was 47.9% (95% CI: 43%-53%). From the analysis, the undernutrition was more likely higher among respondents who had five or more family members (APR = 1.19; 95% CI = 1.02-1.40), lower dietary diversity (APR = 1.58; 95% CI = 1.13-2.21) and those who were anemic (APR = 4.27; 95% CI = 3.17-5.76).

CONCLUSION

Nearly half of the pregnant women in study area were undernourished. High prevalence was found among women who had large family sizes, low dietary diversity and anemia during pregnancy. Improving dietary diversity, strengthening family planning services and giving special attention to pregnant women, supplementation of iron and folic acid, and early detection and treatment of anemia is essential to improve the high burden of undernutrition and the adverse effect on pregnant women and the fetus.

Determinants of nutritional status among pregnant women in East Shoa zone, Central Ethiopia

Background

Undernutrition is an insufficient intake of energy and nutrients to meet an individual's needs to maintain good health. Undernutrition during pregnancy severely affects the health of mothers and her baby. Globally it contributes directly or indirectly to 3.5 million maternal deaths annually. This study aimed to determine the level of undernutrition and identify factors associated with undernutrition among pregnant women attending public health facilities in the East Shoa Zone, Central Ethiopia.

Methods

Institution-based cross-sectional study was conducted among 472 randomly selected pregnant women from June to August 2021. Sociodemographic, obstetrics, and knowledge related data were collected using a structured interviewer-administered questionnaire, and maternal nutritional status was measured using the Mid Upper Arm Circumference (MUAC). The collected data were entered to EPI-info version 3.5.4 and then exported to SPSS for windows version 26.0 software for analysis. Multivariable regression analysis was fitted to identify determinants of undernutrition. An adjusted odds ratio with 95% confidence intervals and a p-value < 0.05 was considered a statistically significant.

Results

The prevalence of undernutrition among pregnant women was 13.9% [95% CI: 11.0-17.4]. On multivariable logistic regression model after adjusting background variables, wealth (AOR: 4.9, 95% CI 1.34-18.20), women's decision making power (AOR: 3.31, 95% CI 1.18-7.79), and nutritional counseling (AOR: 3.53, 95% CI 1.29-9.60) were independently associated with nutritional status of pregnant women.

Conclusion

Findings indicated that significant number of pregnant women in the study were undernourished. Higher wealth index, nutritional counseling, and women's decision-making power were inversely associated with undernutrition. The findings imply the need for economic empowerment of women, enhancing decision-making ability of women and routine and consistent nutritional counseling to decrease undernutrition among pregnant women.

Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan

Background

Body mass index (BMI) remains the most used indicator of nutritional status despite the presence of a potentially credible alternative. Mid-upper arm circumference (MUAC) is an anthropometric measure that requires simple equipment and minimal training. The aim of this study was to compare MUAC with BMI and propose a MUAC cut-off point corresponding to a BMI of < 18.5 kg/m² (underweight) and ≥ 30.0 kg/m² (obesity) among Sudanese adults.

Methods

A cross-sectional study using multistage cluster sampling was conducted in New-Halfa, eastern Sudan. Participants’ age and sex were recorded and their MUAC, weight and height were measured using the standard procedures. The MUAC (cm) cut-offs corresponding to < 18.5 kg/m² and ≥ 30.0 kg/m² were calculated and determined using receiver operating characteristic (ROC) curve analysis

Results

Five hundreds and fifty-two adults were enrolled in the study. The median (interquartile range, IQR) of the participants age was 31.0 (24.0 – 40.0) years and 331 (60.0%) of them were females. The medians (IQR) of BMI and MUAC were 22.4 (19.1 – 26.3) kg/m² and 25.0 (23.0 – 28.0) cm, respectively.

There was a significant positive correlation between MUAC and BMI (r = 0.673, p < 0.001).

Of the 552 enrolled participants, 104 (18.8%), 282 (51.1%), 89 (16.1%) and 77 (13.9%) were normal weight, underweight, overweight and obese, respectively. Best statistically derived MUAC cut-off corresponding to a BMI < 18.5 kg/m² (underweight) was ≤ 25.5 cm in both males and females (Youden’s Index, YI = 0.51; sensitivity = 96.0%; specificity = 54.0%), with a good predictive value (AUROCC = 0.82). Best statistically derived MUAC cut-off corresponding to a BMI ≥ 30.0 kg/m² (obesity) was ≥ 29.5 cm in both males and females (YI = 0.62, sensitivity = 70.3%, specificity = 92.0%), with a good predictive value (AUROCC = 0.86, 95.0% CI = 0.76 – 0.95).

Conclusion

The results suggest that the cut-offs based on MUAC can be used for community-based screening of underweight and obesity

High prevalence, low identification and screening tools of hospital malnutrition in critically- ill patients in Malawi

BACKGROUND/OBJECTIVES

In Africa, approximately two-thirds of patients are at risk of malnutrition on admission and the nutritional status of patients deteriorates during hospitalization, with associated increased morbidity, mortality, and hospital-related cost. This cross-sectional study aimed at estimating rates of malnutrition in critical care units and determining the extent to which malnutrition diagnoses are documented in medical records by physicians, at two public tertiary hospitals in Malawi.

METHODS

A total of 315 adult (n = 112) and paediatric (n = 203) participants from Queen Elizabeth Central Hospital and Kamuzu Central Hospital, were included in the analysis. Nutrition status was measured by Subjective Global Assessment (SGA) and Mid-Upper Arm circumference (MUAC) and medical notes were reviewed, in both adults and paediatrics.

RESULTS

In adults, more than half were malnourished, with a higher proportion considered moderately-to-severely malnourished using SGA compared to MUAC (84.8%; 57.3%, respectively). Likewise, in paediatrics, a higher proportion was considered moderately-to-severely malnourished using SGA compared to MUAC (84.7%; 23.4%, respectively). Both adult and paediatric patients with cancer had the highest rates of malnutrition. Only 12.9% and 9.6% had documentation of malnutrition diagnosis in the medical record, for paediatrics and adult patients, respectively.

CONCLUSION

The high rates of hospital malnutrition in critically ill patients in Malawi call for comprehensive screening practices and methods; complemented by documentation of the malnutrition diagnosis and use of nutrition interventions by dietitians. This includes enteral, parenteral and supplemental nutrition as a prerequisite for patient recovery in hospitals.

Determinants of exclusive breastfeeding among Haitian children under 6 months of age

Objective.

To identify the determinants of exclusive breastfeeding (EBF) among children under 6 months of age from three regions in the South and Grand’Anse Departments of Haiti.

Methods.

Data were pooled from three cross-sectional surveys conducted yearly from 2017 to 2019 with the guardians of 638 children under 6 months of age. A non-quantitative 24-hour dietary recall was used to assess EBF the day before the survey. Using unadjusted and adjusted prevalence ratios, associations were assessed between EBF and several explanatory factors: infant’s age and sex; maternal age, educational attainment, mid-upper arm circumference (MUAC), dietary diversity, number of children under 5 years of age, responsibility for the main or secondary source of income of the household, initiation of breastfeeding within one hour, knowledge of EBF duration; household severe food insecurity, socioeconomic status, dependency ratio, region, and residential zone (urban/rural).

Results.

Prevalence of EBF was 68% in the study sample. From the fully adjusted model, prevalence of EBF was statistically significantly higher among younger infants, mothers with larger MUAC, who met or exceeded Minimum Dietary Diversity for Women (MDD-W), who initiated breastfeeding within one hour, who were knowledgeable of the recommendations for EBF duration, and living in the Jérémie region.

Conclusions.

The main determinants of EBF identified in this study attest to the importance of breastfeeding mothers’ access to nutritious food for the practice and maintenance of EBF and the need for geographically equitable access to health services and education that support breastfeeding.

The Effect of Pumpkin Seed Biscuits on Nutritional and Zinc Status: A Randomized Controlled Trial in Pregnant Women

BACKGROUND: In several studies in Indonesia, low birth weight (LBW) is shown as the most dominant risk factor for stunting. Some of the causes of LBW are chronic energy deficiency during pregnancy, anemia during pregnancy, lack of nutrient supply during pregnancy, pregnancy complications, maternal parity, and birth spacing. In this case, women commonly suffer from micronutrient deficiencies including iodine, iron, Vitamin A, zinc, and folate. Related to this, about 80% of pregnant women in the world fulfill normative pregnancy needs due to inadequate zinc intake. One source of micronutrients rich in zinc is pumpkin seeds. The nutritional potential of pumpkin seeds is realized in the form of food products for pregnant women, including amino acids. One example of pumpkin seed fortification has been assessed in biscuit products by trained panelists and consumers, obtaining results that 20% additional pumpkin seed flour to biscuits becomes the best treatment. Meanwhile, in the case of this study, we expect that the pumpkin seed biscuits provided can increase the energy intake in pregnant women because when pumpkin seeds are added, the nutrition contained in the biscuits is also increased, in this case, the nutrition includes the zinc and Fe. AIM: The purpose this research is to figure out how pumpkin seed biscuits affect pregnant women concerning their nutrition status and serum zinc levels. METHODS: The method employed was a double-blind and randomized experimental research involving pre- and post-test control groups. The inclusion criteria of the participants involved were pregnant women aged 20–35 years old who were at their first and second trimesters of pregnancy and parity one to three and singleton pregnancy. Meanwhile, the exclusion criteria of the participants were pregnant women suffering from severe complications. There were 89 pregnant women further gathered in this study, but only 66 of them met the criteria and idled into two groups. In this case, one group received the pumpkin seed biscuit intervention, while the other received placebo biscuits. The intervention was conducted for 90 days where the pregnant women were provided with four biscuits for daily consumption. RESULTS: The nutritional status parameter of pregnant women involved in the current research was assessed, including body weight, mid-upper arm circumference (MUAC), and serum zinc levels. In this case, the average serum zinc level obtained was 48.75 g/dL from 60 pregnant women. Furthermore, a significant increase occurred in nutritional status for each group, marked by body weight gain, and increased MUAC. However, no significant difference emerged between the pumpkin seed biscuit group and the placebo biscuit group with p = 0.914 and p = 0.916, respectively. A significant increase in zinc levels was observed in both groups. In this case, changes in zinc levels between the two groups were significantly different (13.72 ± 1.84 vs. 9.81 ± 11.81, p = 0.007). CONCLUSION: Giving pumpkin seed biscuits contribute to weight gain and increase the MUAC the pregnant women which, in turn, improves their nutritional status and serum zinc.

Clinical Relevance of Liver Involvement in the Clinical Course of Systemic Sclerosis

Liver involvement in systemic sclerosis (SSc) is rare. We evaluated the prevalence of liver fibrosis and hepatic autoimmunity in SSc patients in a retrospective observational cohort (97 SSc or mixed connective tissue disease with sclerodermic manifestations patients undergoing transient elastography, evaluating liver stiffness (LS) and controlled attenuation parameter (CAP), due to clinical indications along with biochemistry assessments and major antibodies associated to liver autoimmunity). Among them, 11 had LS ≥ 7.5 kPa and 5 showed an LS compatible with cirrhosis (LS ≥ 12.5 kPa). Predictors of LS ≥ 7.5 fibrosis were alcohol consumption (>14 or >7 alcoholic units/week for men and women, respectively), waist circumference (>102 or >88 cm for men and women, respectively), elevated alkaline phosphatase, and anti-La and anti-mitochondrial antibody (AMA) positivity. Six patients had CAP values compatible with severe steatosis (≥280 dB/m). Waist circumference, body mass index and diabetes mellitus were significant predictors of steatosis. Out of 97 patients, 19 were positive for AMA, 4 for anti-Sp100, 1 for anti-Gp210 and 7 were diagnosed with primary biliary cholangitis. Among SSc patients, hepatic fibrosis biomarkers and AMA prevalence are relatively high, suggesting the opportunity of performing a transient elastography and a screening for hepatic autoimmunity at diagnosis and/or during disease progression.

Nutritional screening and assessment in inflammatory bowel disease

Inflammatory bowel disease (IBD) is associated with increased risk of malnutrition and sarcopenia. Both malnutrition and sarcopenia negatively impact the clinical course, quality of life, response to therapy, and surgical outcomes in patients with IBD. This review article highlights the importance of nutritional assessment in patients with IBD and also discusses the different nutritional screening and assessment tools, and measures to detect sarcopenia in relation to IBD. Identification of malnutrition and sarcopenia will allow prioritization of the corrective actions, such as nutritional rehabilitation, to improve clinical outcomes. An approach to the evaluation of nutritional status in patients with IBD is also suggested.

Prevalence of Mycobacterium tuberculosis in sputum and reported symptoms among clinic attendees compared to a community survey in rural South Africa

BACKGROUND

Tuberculosis (TB) case finding efforts typically target symptomatic people attending health facilities. We compared the prevalence of Mycobacterium tuberculosis (Mtb) sputum culture-positivity among adult clinic attendees in rural South Africa with a concurrent, community-based estimate from the surrounding demographic surveillance area (DSA).

METHODS

Clinic: Randomly-selected adults (≥18 years) attending two primary healthcare clinics were interviewed and requested to give sputum for mycobacterial culture. HIV and antiretroviral therapy (ART) status were based on self-report and record review. Community: All adult (≥15 years) DSA residents were invited to a mobile clinic for health screening, including serological HIV testing; those with ≥1 TB symptom (cough, weight loss, night sweats, fever) or abnormal chest radiograph were asked for sputum.

RESULTS

Clinic: 2,055 patients were enrolled (76.9% female, median age 36 years); 1,479 (72.0%) were classified HIV-positive (98.9% on ART) and 131 (6.4%) reported ≥1 TB symptom. Of 20/2,055 (1.0% [95% CI 0.6-1.5]) with Mtb culture-positive sputum, 14 (70%) reported no symptoms. Community: 10,320 residents were enrolled (68.3% female, median age 38 years); 3,105 (30.3%) tested HIV-positive (87.4% on ART) and 1,091 (10.6%) reported ≥1 TB symptom. Of 58/10,320 (0.6% [95% CI 0.4-0.7]) with Mtb culture-positive sputum, 45 (77.6%) reported no symptoms.In both surveys, sputum culture positivity was associated with male sex and reporting >1 TB symptom.

CONCLUSIONS

In both clinic and community settings, most participants with Mtb culture-positive sputum were asymptomatic. TB screening based only on symptoms will miss many people with active disease in both settings.

Mid-upper arm circumference for identifying adult overweight in large-scale population-based surveys: empirical evaluation using data of the EAT Addis study, Ethiopia

OBJECTIVES

The present study evaluates body circumferences as a nutrition screening tool for women of reproductive age with children less than 5 years of age to improve the detection of overweight and obesity in a community setting.

DESIGN

This study draws data from a community-based cross-sectional study conducted between July-August 2017 and January-February 2018 to account for seasonality in Addis Ababa, Ethiopia.

SETTING

One hundred and sixteen districts were included in Addis Ababa, Ethiopia.

PARTICIPANTS

A total of 4914 women of reproductive age with children less than 5 years of age were participated in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures included anthropometric indices. There were no secondary outcomes.

RESULTS

The optimal cut-off points to identify overweight women of reproductive age were >87.5 cm for waist circumference (WC), >31.7 cm for neck circumference (NC) and >28.0 cm for mid-upper arm circumference (MUAC) based on the highest corresponding Youden index. The area under the receiver operating characteristics curve was 0.92 (95% CI: 0.91 to 0.93) for WC, 0.83 (95% CI: 0.82 to 0.84) for NC and 0.91 (95% CI: 0.89 to 0.92) for MUAC.

CONCLUSIONS

Our result shows that WC and MUAC are alternative tools to body mass index. Both WC and MUAC are effective in identifying overweight women. We recommend using MUAC in large-scale population-based assessments to identify overweight and obesity in low-income settings as it is logistically simpler and operationally feasible.

Child nutritional status as screening tool for identifying undernourished mothers: an observational study of mother–child dyads in Mogadishu, Somalia, from November 2019 to March 2020

Background

Active screening of only pregnant and lactating mothers (PLMs) excludes other mothers of reproductive age susceptible to undernutrition. Our analysis evaluated if mothers presenting with wasted children were more likely to be undernourished themselves.

Methods

The observational study enrolled mother and child dyads presenting to an outpatient facility in Mogadishu, Somalia, between November 2019 and March 2020. Trained nurses recorded lower extremity oedema for children aged 6–59 months, parity and gestational status for women aged 19–50 years and age, access to care, height/length, mid-upper arm circumference (MUAC) and weight for both. Weight-for-height z-score (WHZ) for children and body mass index (BMI) for mothers were calculated using standard procedures. Wasting was defined as WHZ <−2, MUAC <12.5 cm and/or presence of oedema for children. Undernutrition was defined as MUAC <23 cm for PLMs and BMI <18.5 kg/m² for neither pregnant nor lactating mothers (non-PLMs). Four multivariable linear regression models were fit to evaluate maternal anthropometric indicators (BMI or MUAC) given child anthropometric indicators (MUAC or WHZ), adjusting for maternal age, parity and gestational status.

Results

A total of 93.6% (2142/2288) of enrolled dyads met inclusion criteria. Wasting was observed among 57.5% of children; 20.2% of pregnant mothers, 20.0% of lactating mothers and 7.95% of non-PLMs were undernourished. Models suggest significant, positive associations between child and maternal anthropometrics; a one-unit increase in WHZ and a 1 cm increase in child MUAC were associated with 0.22 kg/m² (95% CI 0.22 to 0.24) and 0.19 kg/m² (95% CI 0.16 to 0.21) increases in maternal BMI, respectively, and 0.20 cm (95% CI 0.18 to 0.22) and 0.24 cm (95% CI 0.23 to 0.25) increases in maternal MUAC, respectively. Adjusted R² values were low (range 0.06–0.10).

Conclusions

Undernutrition among non-PLMs illustrates the importance of expanding screening. However, while significant, the strength of association between mother and child anthropometrics does not support child nutritional status as a screening tool for identifying at-risk mothers.

Evaluation of the Relationships between Simple Anthropometric Measures and Bioelectrical Impedance Assessment Variables with Multivariate Linear Regression Models to Estimate Body Composition and Fat Distribution in Adults: Preliminary Results

BACKGROUND

Overweight and obesity are conditions associated with sedentary lifestyle and accumulation of abdominal fat, determining increased mortality, favoring chronic diseases, and increasing cardiovascular risk. Although the evaluation of body composition and fat distribution are highly relevant, the high cost of the gold standard techniques limits their wide utilization. Therefore, the aim of this work was to explore the relationships between simple anthropometric measures and BIA variables using multivariate linear regression models to estimate body composition and fat distribution in adults.

METHODS

In this cross-sectional study, sixty-eight adult individuals (20 males and 48 females) were subjected to bioelectrical impedance analysis (BIA), anthropometric measurements (waist circumference (WC), neck circumference (NC), mid-arm circumference (MAC)), allowing the calculation of conicity index (C-index), fat mass/fat-free mass (FM/FFM) ratios, body mass index (BMI) and body shape index (ABSI). Statistical analyzes were performed with the R program. Nonparametric Statistical tests were applied to compare the characteristics of participants of the groups (normal weight, overweight and obese). For qualitative variables, the Fisher's exact test was applied, and for quantitative variables, the paired Wilcoxon signed-rank test. To evaluate the linear association between each pair of variables, the Pearson correlation coefficient was calculated, and Multivariate linear regression models were adjusted using the stepwise variable selection method, with Akaike Information Criterion (p ≤ 0.05).

RESULTS

BIA variables with the highest correlations with anthropometric measures were total body water (TBW), body fat percentage (BFP), FM, FFM and FM/FFM. The multiple linear regression analysis showed, in general, that the same variables can be estimated through simple anthropometric measures.

CONCLUSIONS

The assessment of fat distribution in the body is desirable for the diagnosis and definition of obesity severity. However, the high cost of the instruments (dual energy X-ray absorptiometry, hydrostatic weighing, air displacement plethysmography, computed tomography, magnetic resonance) to assess it, favors the use of BMI in the clinical practice. Nevertheless, BMI does not represent a real fat distribution and body fat percentage. This highlights the relevance of the findings of the current study, since simple anthropometric variables can be used to estimate important BIA variables that are related to fat distribution and body composition.

Profile of Double of Undernutrition Problem, Coexistence with Anemia among Pregnant Women Indonesia 2018: A Cross Sectional Survey

BACKGROUND: Anemia is the most common type of malnutrition in pregnant women, and when combined with another nutritional problem, it would increase the risk of adverse pregnancy outcomes. AIM: This study aims to analyze the risk of double undernutrition in pregnant women with anemia. MATERIALS AND METHODS: We used secondary data from the 2018 National Basic Health Survey as well as biomedical anemia samples. Anthropometric measurements were maternal body height, middle–upper circumference (MUAC) for chronic energy malnutrition (CEM); anemia was predicted using hemoglobin levels. The number of samples is 484, considering the minimum sample size for each undernutrition proportion. RESULTS: Anemia in pregnant women is not a single malnutrition issue. Almost one–third of pregnant women with anemia also had another form of undenutrition. In this study, the prevalence of anemia among pregnant women (%) is 35.7; stunted is 35.9, and CEM is 16.7. The malnutrition was identified as double nutritional problems coexistence to anemia, such as prevalence stunted–anemia (%) 12.5; anemia–CEM 9.2; and anemia–stunted–CEM 4.4. Overall, CEM is associated with anemia with p < 0.05 and AOR 2.25 (CI; 1.38–3.66), adjusted to height and type of residence, education, and occupation. Urban areas have a similar risk to rural areas with AOR for CEM to anemia, 2.29 (CI; 1.12–4.69); rural areas 2.23 (CI; 1.14–4.33), respectively. Moreover, women with double of undernutrition stunted–CEM in rural areas have a risk of anemia with AOR 2.75 (1.14–6.65). CONCLUSION: The risk of anemia in pregnant women with chronic energy malnutrition has increased more than twice in rural and urban areas.

Validation of New Interactive Nutrition Assistant - Diet in India Study of Health (NINA-DISH) FFQ with multiple 24-h dietary recalls among pregnant women in Pune, India

Adequate dietary intake is critical to prevent adverse pregnancy outcomes. India has a high burden of maternal and child morbidity and mortality, but there is a lack of adequate tools to assess dietary intake. We validate an FFQ, New Interactive Nutrition Assistant - Diet in India Study of Health (NINA-DISH), among pregnant women living with and without HIV in Pune, India. Women were selected from a cohort study investigating immune responses to HIV and latent tuberculosis during pregnancy. The FFQ was administered during the third trimester and validated against multiple 24-h dietary recalls (24-HDR) collected in second and third trimesters. Data for analysis were available from fifty-eight women out of seventy enrolled into this sub-study, after excluding those with incomplete data or implausible energy intake. The median (Q1, Q3) age of study participants was 23 (20, 25) years. Median (Q1, Q3) daily energy intakes were 10 552 (8000, 11 958) and 10 673 (8510, 13 962) kJ by 24-HDR and FFQ, respectively, with FFQ overestimating nutrient intake. Pearson correlations between log-transformed estimates from FFQ and 24-HDR for energy, protein, carbohydrate, fat, Fe and Zn were 0·47, 0·48, 0·45, 0·33, 0·4 and 0·54, respectively. Energy-adjusted and de-attenuated correlations ranged from 0·41 (saturated fat) to 0·73 (Na). The highest misclassification into extreme tertiles was observed for fat (22 %), saturated fat (21 %) and Na (21 %). Bias existed at higher intake levels as observed by Bland-Altman plots. In conclusion, NINA-DISH is a valid and feasible tool for estimating dietary intakes among urban pregnant women in Western India.

The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults

BACKGROUND

Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising.

OBJECTIVES

To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults.

METHODS

We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models.

RESULTS

In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia.

CONCLUSIONS

The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS' performance in capturing NCD outcomes in sub-Saharan Africa.

Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS)

BACKGROUND

Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups.

OBJECTIVES

We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings.

METHODS

Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics.

RESULTS

We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes).

CONCLUSIONS

The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.

The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries

BACKGROUND

Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden.

OBJECTIVES

We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults.

METHODS

We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models.

RESULTS

Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive.

CONCLUSIONS

The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.

Validating mid-upper arm circumference (MUAC) cut off points as an indicator of nutritional status among nine tribal populations of India

Mid-upper arm circumference (MUAC) is an alternative anthropometric measurement to assess undernutrition but a universally accepted cut-off is yet to be established. The objectives of the present study are to determine whether the proposed sex-specific global cut-offs are suitable across several tribes in India. This cross-sectional study was conducted among nine tribal populations in India (1046 males, 1087 females). Weight, height and MUAC values were obtained, and body mass index (BMI) was calculated. The BMI cut-off (<18.5 kg/m2) was used to determine chronic energy deficiency (CED). The ROC Curve analyses of binomial logistic regression for MUAC versus CED revealed optimal cut-off point of MUAC as 23.8 cm (in males) and 21.8 cm (in females). MUAC cut-offs were similar in females, relative to males, in all tribes. Males with MUAC<24cm and females with MUAC<22 encompassed significantly higher numbers of CED than those with MUAC≥24 and ≥22 cm, respectively (χ2-value males: 254.9, p<0.001; females: 493.60, p<0.01). A single cut off point of MUAC may not be universally applicable for diverse populations and both sexes as well. It seemed that there is no alternative than to undertake further validation studies in various populations before using the MUAC cut off to identify undernourished or CED condition.

Use of mid-upper arm circumference to screen for thinness among sub-Saharan African male detainees

OBJECTIVE

BMI is a time-intensive measurement to assess nutritional status. Mid-upper arm circumference (MUAC) has been studied as a proxy for BMI in adults, but there is no consensus on its optimal use.

DESIGN

We calculated sensitivity, specificity and area under receiver operating characteristic curve (AUROCC) of MUAC for BMI < 18·5, <17 and <16 kg/m2. We designed a system using two MUAC cut-offs, with a healthy (non-thin) 'green' group, a 'yellow' group requiring BMI measurement and a 'red' group who could proceed directly to treatment for thinness.

SETTING

We retrospectively analysed monitoring data collected by the International Committee of the Red Cross in places of detention.

PARTICIPANTS

11 917 male detainees in eight African countries.

RESULTS

MUAC had excellent discriminatory ability with AUROCC: 0·87, 0·90 and 0·92 for BMI < 18·5, BMI < 17 and BMI < 16 kg/m2, respectively. An upper cut-off of MUAC 25·5 cm to exclude healthy detainees would result in 64 % fewer detainees requiring BMI screening and had sensitivity 77 % (95 % CI 69·4, 84·7) and specificity 79·6 % (95 % CI 72·6, 86·5) for BMI < 18·5 kg/m2. A lower cut-off of MUAC < 21·0 cm had sensitivity 25·4 % (95 % CI 11·7, 39·1) and specificity 99·0 % (95 % CI 97·9, 100·0) for BMI < 16 kg/m2. An additional 50 kg weight requirement improved specificity to 99·6 % (95 % CI 99·0, 100·0) with similar sensitivity.

CONCLUSIONS

A MUAC cut-off of 25·5 cm, above which detainees are classified as healthy and below receive further screening, would result in significant time savings. A cut-off of <21·0 cm and weight <50 kg can identify some detainees with BMI < 16 kg/m2 who require immediate treatment.

High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique

The increasing prevalence of overweight/obesity may already have reached the farmers in Tanzania and Mozambique. Here, the measurement of the mid-upper-arm-circumference (MUAC) could become a simple and sensitive tool for early detection of at-risk groups of overweight as well as underweight. Body Mass Index (BMI) and MUAC of female and male farmers (n = 2106) from different regions of Tanzania and the Zambézia province, Mozambique, were analyzed by region, sex, age, and correlates. MUAC cut-offs, calculated via BMI cut-offs (<18.5, ≥25, and ≥30 kg/m²), and multiple linear regression (MLR), compared to those selected by highest Youden’s index (YI) value, were assessed. The study showed an overall higher prevalence of overweight (19%) than underweight (10%) due to the high number of overweight female farmers (up to 35%) in southern Tanzania. BMI, which was mainly and positively predicted by MUAC, was higher in Tanzania and among female farmers, and decreased significantly from the age of ≥65 years. MUAC cut-offs of <24 cm and ≥30.5 cm, calculated by MLR, detected 55% of farmers being underweight and 74% being overweight, with a specificity of 96%; the higher cut-off <25 cm and lower cut-off ≥29 cm, each selected according to YI, consequently detected more underweight (80%) and overweight farmers (91%), but on the basis of a lower specificity (87–88%). Overweight was evident among female farmers in East Africa. MUAC cut-offs, whether defined via linear regression or Youden’s Index, could prove to be easy-to-use tools for large-scale screenings of both underweight and overweight.

Undernutrition, food insecurity, and leprosy in North Gondar Zone, Ethiopia: A case-control study to identify infection risk factors associated with poverty

BACKGROUND

Ethiopia has over 3,200 new cases of leprosy diagnosed every year. Prevention remains a challenge as transmission pathways are poorly understood. Susceptibility and disease manifestations are highly dependent on individual host-immune response. Nutritional deficiencies, such as protein-energy malnutrition, have been linked to reduced cell-mediated immunity, which in the case of leprosy, could lead to a higher chance of active leprosy and thus an increased reservoir of transmissible infection.

METHODOLOGY/PRINCIPAL FINDINGS

Between June and August 2018, recently diagnosed patients with leprosy and individuals without known contact with cases were enrolled as controls in North Gondar regional health centers. Participants answered survey questions on biometric data, demographics, socioeconomic situation, and dietary habits. Descriptive statistics, univariate, and multivariate logisitic regression examined associations between undernutrition, specifically body mass index (BMI), middle upper arm circumference (MUAC), and leprosy. Eighty-one participants (40 cases of leprosy, 41 controls) were enrolled (75% male) with an average age of 38.6 years (SD 18.3). The majority of cases were multibacillary (MB) (90%). There was a high prevalence of undernutrition with 24 (29.6%) participants underweight (BMI <18.5) and 17 (21%) having a low MUAC. On multivariate analysis, underweight was significantly associated with leprosy (aOR = 9.25, 95% CI 2.77, 30.81). Also found to be associated with leprosy was cutting the size of meals/skipping meals (OR = 2.9, 95% CI 1.0, 8.32) or not having enough money for food (OR = 10, 95% CI 3.44 29.06).

CONCLUSIONS/SIGNIFICANCE

The results suggest a strong association between leprosy and undernutrition, while also supporting the framework that food insecurity may lead to undernutrition that then could increase susceptibility to leprosy. In conclusion, this study highlights the need to study the interplay of undernutrition, food insecurity, and the manifestations of leprosy.

Proposal of MUAC as a fast tool to monitor pregnancy nutritional status: results from a cohort study in Brazil

OBJECTIVE

In Brazil, although the assessment of maternal nutritional status is recommended using body mass index (BMI), this is only possible in settings adequately prepared. Midupper arm circumference (MUAC) is another biological variable identified as a tool for rapid assessment of nutritional status that is correlated with BMI. Therefore, we aim to surrogate BMI by MUAC cut-offs for rapid screening of maternal nutritional status starting at midpregnancy.

DESIGN

Analysis of the multicentre cohort study entitled 'Preterm SAMBA' using an approach of validation of diagnostic test.

SETTING

Outpatient prenatal care clinics from five tertiary maternity hospitals from three different Brazilian regions.

PARTICIPANTS

1165 pregnant women attending prenatal care services from 2015 to 2018 and with diverse ethnic characteristics who were enrolled at midpregnancy and followed in three visits at different gestational weeks.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sensitivity, specificity, positive and negative predictive values, likelihood ratio and accuracy of MUAC being used instead of BMI for the assessment of nutritional status of women during pregnancy.

RESULTS

We found a strong correlation between MUAC and BMI, in the three set points analysed (r=0.872, 0.870 and 0.831, respectively). Based on BMI categories of nutritional status, we estimated the best MUAC cut-off points, finding measures according to each category: underweight <25.75 cm (19-39 weeks); overweight 28.11-30.15 cm (19-21 weeks), 28.71-30.60 cm (27-29 weeks) and 29.46-30.25 cm (37-39 weeks); and obese >30.15 cm (19-21 weeks), >30.60 cm (27-29 weeks) and >30.25 cm (37-39 weeks) per gestational week. Therefore, we defined as adequate between 25.75-28.10 cm (19-21 weeks), 25.75-28.70 cm (27-29 weeks) and 25.75-29.45 cm (37-39 weeks) of MUAC.

CONCLUSION

We conclude that MUAC can be useful as a surrogate for BMI as a faster screening of nutritional status in pregnant women.

Sex Differences in the Physiological Network of Healthy Young Subjects

Within human physiology, systemic interactions couple physiological variables to maintain homeostasis. These interactions change according to health status and are modified by factors such as age and sex. For several physiological processes, sex-based distinctions in normal physiology are present and defined in isolation. However, new methodologies are indispensable to analyze system-wide properties and interactions with the objective of exploring differences between sexes. Here we propose a new method to construct complex inferential networks from a normalization using the clinical criteria for health of physiological variables, and the correlations between anthropometric and blood tests biomarkers of 198 healthy young participants (117 women, 81 men, from 18 to 27 years old). Physiological networks of men have less correlations, displayed higher modularity, higher small-world index, but were more vulnerable to directed attacks, whereas networks of women were more resilient. The networks of both men and women displayed sex-specific connections that are consistent with the literature. Additionally, we carried out a time-series study on heart rate variability (HRV) using Physionet's Fantasia database. Autocorrelation of HRV, variance, and Poincare's plots, as a measure of variability, are statistically significant higher in young men and statistically significant different from young women. These differences are attenuated in older men and women, that have similar HRV distributions. The network approach revealed differences in the association of variables related to glucose homeostasis, nitrogen balance, kidney function, and fat depots. The clusters of physiological variables and their roles within the network remained similar regardless of sex. Both methodologies show a higher number of associations between variables in the physiological system of women, implying redundant mechanisms of control and simultaneously showing that these systems display less variability in time than those of men, constituting a more resilient system.

Prevalence of Undernutrition and Associated Factors among Lactating Mothers of Angecha District, Kembata Tembaro Zone, Southern Ethiopia

Background

Major reasons for malnutrition, particularly among those who live in low- and middle-income countries, are physiological vulnerability and inadequate intake. The objective of the study was to assess the prevalence of undernutrition and associated factors among lactating mothers of Angecha District, Southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among randomly selected lactating mothers in Angecha District from March to April 2017. A pretested structured questionnaire was used to assess the prevalence of undernutrition and associated factors among lactating mothers. Undernutrition was defined as the body mass index of less than 18.5 kg/m². A multivariable logistic regression model was fitted, and the adjusted odds ratio (AOR) at a p value less than 0.05 was used to determine a statistically significant association between predictors and outcome variables.

Result

The prevalence of undernutrition among lactating mothers was 21.2% (95% CI: 17.52, 25.46). The odds of undernutrition were higher among lactating mothers in the younger age group (AOR 4.12 (95% CI: 1.25–13.63), compared to 36–49 years group), dietary diversity less than five food groups (AOR 2.4, 95% CI: 1.35–4.36), and not attending antenatal care (ANC) (AOR 2.90 (95% CI: 1.43–5.86), compared to those who attended ANC for 4 or more times). The odds of undernutrition among lactating women from 3^rd quantile wealth index households reduced by nearly half (AOR 0.47, 95% CI: 0.23–0.98) compared to lactating mothers from 1^st quantile wealth index households.

Conclusion

Nearly one in every five lactating mothers was undernourished. Age, dietary diversity score, ANC visit, and wealth index were found to be the associated factors of undernutrition. Therefore, due attention should have to be given to increase the use of ANC.

Nutrition Screening, Reported Dietary Intake, Hospital Foods, and Malnutrition in Critical Care Patients in Malawi

In low-income countries there are few data on hospital malnutrition. Reduced food intake combined with nutrient-poor foods served in hospitals contribute to nutritional risk. This study investigated whether reported dietary intake and disease state of hospitalized adults in critical care units was related to malnutrition determined by mid-upper arm circumference (MUAC). Adult in-patients (n = 126) in tuberculosis, burn, oncology, and intensive care units in two public tertiary hospitals in Malawi were screened for nutritional status using MUAC and a question on current dietary intake. The hospital menu was reviewed; portion sizes were weighed. The prevalence of moderate and severe malnutrition was 62%. Patients with organ-related diseases and infectious diseases had the highest rates of reduced reported dietary intake, 71.4% and 57.9%, respectively; however, there was no association between reported dietary intake and MUAC. In those unable to eat, however, the rate of severe malnutrition was 50%. The menu consisted of porridge and thickened corn-based starch with fried cabbage; protein foods were provided twice weekly. There was a nutrient gap of 250 calories and 13 gm protein daily. The findings support the need for increasing dietetic/nutrition services to prevent and treat malnutrition in hospitals using simple screening tools.

Effect of balanced energy-protein supplementation during pregnancy and lactation on birth outcomes and infant growth in rural Burkina Faso: study protocol for a randomised controlled trial

INTRODUCTION

Adequate nutrition during pregnancy is crucial to both mother and child. Maternal malnutrition can be the cause of stillbirth or lead to poor birth outcomes such as preterm delivery and small-for-gestational-age newborns. There is a probable positive effect of providing pregnant women a balanced energy-protein (BEP) food supplement, but more evidence is needed. The MIcronutriments pour la SAnté de la Mère et de l'Enfant (MISAME) III project aims to improve birth outcomes and infant growth by testing a BEP supplement during pregnancy and lactation in rural Burkina Faso. This paper describes the study protocol.

METHODS AND ANALYSIS

MISAME-III is a four-arm individually randomised efficacy trial implemented in six rural health centre catchments areas in the district of Houndé. Eligible pregnant women, aged between 15 and 40 years old and living in the study areas, will be enrolled. Women will be randomly assigned to one of the four study groups: (1) prenatal intervention only, (2) postnatal intervention only, (3) prenatal and postnatal intervention or (4) no prenatal or postnatal intervention. The intervention group will receive the BEP supplement and iron/folic acid (IFA) tablets, while the control group will only receive the IFA tablets following the national health protocol. Consumption will be supervised by trained village women on a daily basis by means of home visits. The primary outcomes are small-for-gestational age at birth and length-for-age z-score at 6 months of age. Secondary outcomes will be measured at birth and during the first 6 months of the infants' life. Women will be enrolled from October 2019 until the total sample size is reached.

ETHICS AND DISSEMINATION

MISAME-III has been reviewed and approved by the University Hospital of Ghent and the ethics committee of Centre Muraz, Burkina Faso. Informed consent will be obtained. Results will be published in relevant journals and shared with other researchers and public health institutions.

TRIAL REGISTRATION NUMBER

NCT03533712.

Determinants of dietary diversity and its relationship with the nutritional status of pregnant women

There is little information regarding factors that determine dietary diversity among pregnant women in Ghana. The present study, therefore, sought to assess the independent predictors of dietary diversity and its relationship with nutritional status of pregnant women in the Northern Region of Ghana. The present study was an analytical cross-sectional survey involving 423 pregnant women in different stages of gestation. The 24-h dietary recall method was used to assess minimum dietary diversity for women (MDD-W), and nutritional status was assessed using mid-upper arm circumference (MUAC) measurements. Binary logistic regression was performed to assess the association between maternal dietary diversity and maternal thinness and a P value of <0⋅05 was considered statistically significant. Of the 423 women, 79⋅9 % (95 % CI 76⋅1, 83⋅7) met the MDD-W and the prevalence of undernutrition among the pregnant women was 26⋅0 %. The analysis showed that women of low household wealth index were 48 % less likely (AOR 0⋅52, CI 0⋅31, 0⋅88) of meeting the MDD-W, whereas women from households of poor food insecurity were 88 % less likely (AOR 0⋅12, CI 0⋅05, 0⋅27) of achieving the MDD-W. Women of low household size were three times more likely of meeting the MDD-W (AOR 3⋅07, CI 1⋅13, 8⋅39). MDD-W was not associated with maternal underweight during pregnancy. In conclusion, the results of the present study showed that food insecurity and not low MDD-W, associated with mothers' thinness (underweight) during pregnancy in peri-urban setting of Northern Ghana.

Prevalence and associated factors of undernutrition among pregnant women visiting ANC clinics in Silte zone, Southern Ethiopia

BACKGROUND

Maternal undernutrition is highly prevalent in underdeveloped countries. Hence, this study was intended to determine the prevalence and associated factors of undernutrition among pregnant women visiting ANC clinics in Silte Zone.

METHOD

Facility-based cross-sectional study was conducted from July to January 2019. Systematic random sampling technique was used to select 422 study participants from 11 randomly selected health facilities. Data was collected by using a structured-interviewer administered questionnaire. Mid upper arm circumference (MUAC) was measured by standard non stretchable MUAC tape. Data was entered into a computer using Epi data 3.1 and edited, cleaned, and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses were employed to identify factors associated with maternal undernutrition.

RESULT

In this study, the overall prevalence of undernutrition among study subjects was 21.8%. Age greater than 31 years of women (AOR = 0.15; 95% CI: 0.03, 0.93), Birth intervals > 2 years (AOR = 0.18; 95% CI: 0.04, 0.76), good nutritional knowledge (AOR = 0.34; 95% CI: 0.17, 0.67), and having no dietary change as a result of current pregnancy AOR = 6.02; 95% CI: 2.99, 12.14) were significantly associated with undernutrition.

CONCLUSIONS

The prevalence of undernutrition among pregnant women was 21.8%. Current estimate is lower than previously reported in the study area but higher than reported in developed country. Age of women, Birth intervals, and Dietary change as a result of current pregnancy and Nutrition knowledge were important risk factors/ predictors of undernutrition (MUAC < 23 cm). Interventions targeting maternal nutrition education and child spacing with giving special emphasis to adolescent pregnant women are recommended.

Association between micronutrients and maternal leukocyte telomere length in early pregnancy in Rwanda

BACKGROUND

Exposure to environmental stressors can lead to shorter leukocyte telomere length and increase the risk of chronic diseases. Preservation of leukocyte telomere length by reducing oxidative stress exposure and reinforcing immunity may be a mechanism by which nutritional factors delay or prevent chronic disease development.

METHODS

Healthy pregnant women (aged 18-45 years) at 9-15 weeks of gestation living in Gasabo District, Kigali, Rwanda, were recruited from 10 health centers for a prospective, longitudinal study from September to October 2017 to determine possible associations between nutrition health, infectious disease and leukocyte telomere length. Anthropometric and laboratory measurements were performed using standard procedures; sociodemographic parameters and health histories were assessed via surveys, and leukocyte telomere length was assessed using quantitative PCR expressed as the ratio of a telomeric product to a single-copy gene product (T/S).

RESULTS

Mean gestational age of participants (n = 297) at enrollment was 13.04 ± 3.50 weeks, age was 28.16 ± 6.10 years and leukocyte telomere length was 1.16 ± 0.22 (T/S). Younger age; no schooling vs. primary schooling; and lower levels of ferritin, soluble transferrin receptors and retinol-binding protein were independent predictors of longer telomere length in multivariable models.

CONCLUSIONS

Leukocyte telomere length is an indicator of biological aging in pregnant Rwandan women. Maternal micronutrient status, specifically lower ferritin, soluble transferrin receptor levels, and retinol-binding protein levels were associated with longer maternal telomere length in contrast with some studies from North America and Europe. There were no associations between inflammation and infectious disease status and maternal leukocyte telomere length. Further studies are needed to enhance our understanding of the interplay between maternal nutritional status and infectious disease in relation to leukocyte telomere length in developing countries.

Magnitude of Anemia and Its Associated Factors Among Pregnant Women Attending Antenatal Care in Southern Ethiopia: A Cross-Sectional Study

PURPOSE

The aim of this study was to assess the magnitude of anemia and its associated factors among pregnant women attending antenatal care (ANC) at Dilla University referral Hospital, South Ethiopia.

PATIENTS AND METHODS

An institution-based cross-sectional study was conducted from January to February 2019, among 373 pregnant women who attended antenatal care at Dilla University referral hospital. Socio-demographic factors, nutritional, medical and obstetric information of the study participants were collected using a structured questionnaire. Hemoglobin was measured using a hemacue machine, and fecal specimens were examined to detect intestinal parasites. Bivariate and multiple variable binary logistic regressions were used to identify predictors of anemia. A p-value less than 0.05 was used to declare statistical significance.

RESULTS

Overall prevalence of anemia was 28.7%, of which 19.6% had mild anemia. Decreased odds of anemia were found in women with good nutritional status (MUAC ≥24 cm) (AOR= 0.07 95% CI: 0.03-0.1), iron supplementation (AOR=0.06 95% CI: 0.02-0.15) and birth spacing ≥2 yrs (AOR=0.03 95% CI: 0.009-0.45). However, increased odds of anemia were seen in pregnant women with intestinal parasites (AOR=6.11 95% CI 7.70-37.0).

CONCLUSION

The magnitude of anemia among pregnant women was found to be a moderate public health problem. Iron supplementation, good nutritional status (MUAC> 24 cm), and birth spacing reduce the odds of anemia. But having intestinal parasites was found to increase the likelihood of anemia during pregnancy. Counseling on birth spacing, strengthening iron supplementation, and intestinal parasite management during pregnancy should be given due emphasis.

Equity implications of rice fortification: a modelling study from Nepal

Objective:

To model the potential impact and equity impact of fortifying rice on nutritional adequacy of different subpopulations in Nepal.

Design:

Using 24-h dietary recall data and a household consumption survey, we estimated: rice intakes; probability of adequacy (PA) of eight micronutrients commonly fortified in rice (vitamin A, niacin (B₃), pyridoxine (B₆), cobalamin (B₁₂), thiamin (B₁), folate (B₉), Fe and Zn) plus riboflavin (B₂), vitamin C and Ca and mean probability of adequacy (MPA) of these micronutrients. We modelled: no fortification; fortification of purchased rice, averaged across all households and in rice-buying households only. We compared adequacy increases between population subgroups.

Setting:

(i) Dhanusha and Mahottari districts of Nepal (24-h recall) and (ii) all agro-ecological zones of Nepal (consumption data).

Participants:

(i) Pregnant women (n 128), mothers-in-law and male household heads; (ii) households (n 4360).

Results:

Unfortified diets were especially inadequate in vitamins B₁₂, A, B_9, Zn and Fe. Fortification of purchased rice in rice-purchasing households increased PA > 0·9 for thiamin, niacin, B₆, folate and Zn, but B₁₂ and Fe remained inadequate even after fortification (PA range 0·3–0·9). Pregnant women’s increases exceeded men’s for thiamin, niacin, B₆, folate and MPA; men had larger gains in vitamin A, B₁₂ and Zn. Adequacy improved more in the hills (coefficient 0·08 (95 % CI 0·05, 0·10)) and mountains (coefficient 0·07 (95 % CI 0·01, 0·14)) but less in rural areas (coefficient −0·05 (95 % CI −0·09, −0·01)).

Conclusions:

Consumption of purchased fortified rice improves adequacy and gender equity of nutrient intake, especially in non-rice-growing areas.