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Yan T, Mullany LC, Subedi S, Hazel EA, Khatry SK, Mohan D, Zeger S, Tielsch JM, LeClerq SC, Katz J. Risk factors for neonatal mortality: an observational cohort study in Sarlahi district of rural southern Nepal. BMJ Open 2023; 13:e066931. [PMID: 37709319 PMCID: PMC10503364 DOI: 10.1136/bmjopen-2022-066931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES To assess the association between maternal characteristics, adverse birth outcomes (small-for-gestational-age (SGA) and/or preterm) and neonatal mortality in rural Nepal. DESIGN This is a secondary observational analysis to identify risk factors for neonatal mortality, using data from a randomised trial to assess the impact of newborn massage with different oils on neonatal mortality in Sarlahi district, Nepal. SETTING Rural Sarlahi district, Nepal. PARTICIPANTS 40 119 pregnant women enrolled from 9 September 2010 to 16 January 2017. MAIN OUTCOME The outcome variable is neonatal death. Cox regression was used to estimate adjusted Hazard Ratios (aHRs) to assess the association between adverse birth outcomes and neonatal mortality. RESULTS There were 32 004 live births and 998 neonatal deaths. SGA and/or preterm birth was strongly associated with increased neonatal mortality: SGA and preterm (aHR: 7.09, 95% CI: (4.44 to 11.31)), SGA and term/post-term (aHR: 2.12, 95% CI: (1.58 to 2.86)), appropriate-for-gestational-age/large-for-gestational-age and preterm (aHR: 3.23, 95% CI: (2.30 to 4.54)). Neonatal mortality was increased with a history of prior child deaths (aHR: 1.53, 95% CI: (1.24 to 1.87)), being a twin or triplet (aHR: 5.64, 95% CI: (4.25 to 7.48)), births at health posts/clinics or in hospital (aHR: 1.34, 95% CI: (1.13 to 1.58)) and on the way to facilities or outdoors (aHR: 2.26, 95% CI: (1.57 to 3.26)). Risk was lower with increasing maternal height from <145 cm to 145-150 cm (aHR: 0.78, 95% CI: (0.65 to 0.94)) to ≥150 cm (aHR: 0.57, 95% CI: (0.47 to 0.68)), four or more antenatal care (ANC) visits (aHR: 0.67, 95% CI: (0.53 to 0.86)) and education >5 years (aHR: 0.75, 95% CI: (0.62 to 0.92)). CONCLUSION SGA and/or preterm birth are strongly associated with increased neonatal mortality. To reduce neonatal mortality, interventions that prevent SGA and preterm births by promoting ANC and facility delivery, and care of high-risk infants after birth should be tested. TRIAL REGISTRATION NUMBER NCT01177111.
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Affiliation(s)
- Tingting Yan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seema Subedi
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth A Hazel
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, Tripureshwor, Kathmandu, Nepal
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James M Tielsch
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Nepal Eye Hospital Complex, Tripureshwor, Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Imdad A, Rogner J, Sherwani RN, Sidhu J, Regan A, Haykal MR, Tsistinas O, Smith A, Chan XHS, Mayo-Wilson E, Bhutta ZA. Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years. Cochrane Database Syst Rev 2023; 3:CD009384. [PMID: 36994923 PMCID: PMC10061962 DOI: 10.1002/14651858.cd009384.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Zinc deficiency is prevalent in low- and middle-income countries, and is considered a significant risk factor for morbidity, mortality, and linear growth failure. The effectiveness of preventive zinc supplementation in reducing prevalence of zinc deficiency needs to be assessed. OBJECTIVES To assess the effects of zinc supplementation for preventing mortality and morbidity, and for promoting growth, in children aged 6 months to 12 years. SEARCH METHODS A previous version of this review was published in 2014. In this update, we searched CENTRAL, MEDLINE, Embase, five other databases, and one trials register up to February 2022, together with reference checking and contact with study authors to identify additional studies. SELECTION CRITERIA Randomized controlled trials (RCTs) of preventive zinc supplementation in children aged 6 months to 12 years compared with no intervention, a placebo, or a waiting list control. We excluded hospitalized children and children with chronic diseases or conditions. We excluded food fortification or intake, sprinkles, and therapeutic interventions. DATA COLLECTION AND ANALYSIS Two review authors screened studies, extracted data, and assessed the risk of bias. We contacted study authors for missing information and used GRADE to assess the certainty of evidence. The primary outcomes of this review were all-cause mortality; and cause-specific mortality, due to all-cause diarrhea, lower respiratory tract infection (LRTI, including pneumonia), and malaria. We also collected information on a number of secondary outcomes, such as those related to diarrhea and LRTI morbidity, growth outcomes and serum levels of micronutrients, and adverse events. MAIN RESULTS We included 16 new studies in this review, resulting in a total of 96 RCTs with 219,584 eligible participants. The included studies were conducted in 34 countries; 87 of them in low- or middle-income countries. Most of the children included in this review were under five years of age. The intervention was delivered most commonly in the form of syrup as zinc sulfate, and the most common dose was between 10 mg and 15 mg daily. The median duration of follow-up was 26 weeks. We did not consider that the evidence for the key analyses of morbidity and mortality outcomes was affected by risk of bias. High-certainty evidence showed little to no difference in all-cause mortality with preventive zinc supplementation compared to no zinc (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.84 to 1.03; 16 studies, 17 comparisons, 143,474 participants). Moderate-certainty evidence showed that preventive zinc supplementation compared to no zinc likely results in little to no difference in mortality due to all-cause diarrhea (RR 0.95, 95% CI 0.69 to 1.31; 4 studies, 132,321 participants); but probably reduces mortality due to LRTI (RR 0.86, 95% CI 0.64 to 1.15; 3 studies, 132,063 participants) and mortality due to malaria (RR 0.90, 95% CI 0.77 to 1.06; 2 studies, 42,818 participants); however, the confidence intervals around the summary estimates for these outcomes were wide, and we could not rule out a possibility of increased risk of mortality. Preventive zinc supplementation likely reduces the incidence of all-cause diarrhea (RR 0.91, 95% CI 0.90 to 0.93; 39 studies, 19,468 participants; moderate-certainty evidence) but results in little to no difference in morbidity due to LRTI (RR 1.01, 95% CI 0.95 to 1.08; 19 studies, 10,555 participants; high-certainty evidence) compared to no zinc. There was moderate-certainty evidence that preventive zinc supplementation likely leads to a slight increase in height (standardized mean difference (SMD) 0.12, 95% CI 0.09 to 0.14; 74 studies, 20,720 participants). Zinc supplementation was associated with an increase in the number of participants with at least one vomiting episode (RR 1.29, 95% CI 1.14 to 1.46; 5 studies, 35,192 participants; high-certainty evidence). We report a number of other outcomes, including the effect of zinc supplementation on weight and serum markers such as zinc, hemoglobin, iron, copper, etc. We also performed a number of subgroup analyses and there was a consistent finding for a number of outcomes that co-supplementation of zinc with iron decreased the beneficial effect of zinc. AUTHORS' CONCLUSIONS Even though we included 16 new studies in this update, the overall conclusions of the review remain unchanged. Zinc supplementation might help prevent episodes of diarrhea and improve growth slightly, particularly in children aged 6 months to 12 years of age. The benefits of preventive zinc supplementation may outweigh the harms in regions where the risk of zinc deficiency is relatively high.
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Affiliation(s)
- Aamer Imdad
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jaimie Rogner
- Departments of Medicine and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Rida N Sherwani
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jasleen Sidhu
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Allison Regan
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Maya R Haykal
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Olivia Tsistinas
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Abigail Smith
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Xin Hui S Chan
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Evan Mayo-Wilson
- Department of Epidemiology, UNC Gillings School of Global Public HealthMcGavran-Greenberg Hall, Chapel Hill, NC, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for SickKids, Toronto, Canada
- Center of Excellence for Women and Child Health, Aga Khan University, Karachi, Pakistan
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Nathem Rashed R. Effect biological life factors on pregnant woman. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.02.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Define anemia is the low concentration in the amount of hemoglobin according to age, sex and trimester pregnancy. The pregnant has three trimesters and has an exceptional hemoglobin range in every trimester. The pregnant has 124-135 g/dl in the 1st trimester, 110-117 g/dl in the 2nd trimester and 106-109 g/dl in the 3rd trimester. Many pregnant females had been found with anemia because of a low level of Iron. This leads to megaloblastic anemia because of iron deficiency anemia and B12 Vitamin, diet, gastrectomy, malabsorption, blood loss and physiological demand (pregnancy infancy and adolescence). The blood consists of Hemoglobin (Heam + globin) Heam and Iron protoporphyrin ring. Globin is the type of protein with a specific length of amino acid and a specific type of A, maybe 2 Alpha 2 Beta called A1 or 2 Alpha and 2 Bata called A2 or 2Alpha and Gamma called F Fetal. The production of hemoglobin depends on the previously mentioned factors. In this study, we focused on some factors associated with the amount of blood and how these factors affected anemia, which is the most important in Iron treatments, with considering other factors such as food, diversity, Economic situation, social status, number of the fetus, and number of pregnancies. Statistical analysis was used to detect the effect factors of anemia in pregnant. This study refers to 23.2% of anemia because of Iron deficiency during pregnancy. So, treatment of Iron deficiency reduces anemia during pregnancy time.
Keywords. Anemia; Hemoglobin; Pregnant Woman
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Affiliation(s)
- Rawya Nathem Rashed
- Umm Al-rabeein High School for Outstanding Students _Directorate General of Education Nineveh. Mosul - Iraq
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Chitekwe S, Parajuli KR, Paudyal N, Haag KC, Renzaho A, Issaka A, Agho K. Individual, household and national factors associated with iron, vitamin A and zinc deficiencies among children aged 6-59 months in Nepal. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 1:e13305. [PMID: 34897980 PMCID: PMC8770653 DOI: 10.1111/mcn.13305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022]
Abstract
Iron, vitamin A and zinc deficiencies are the top three micronutrients contributing to disability-adjusted life years globally. The study assessed the factors associated with iron, vitamin A, and Zinc deficiencies among Nepalese children (n = 1709) aged 6-59 months using data from the 2016 Nepal National Micronutrient Status Survey. The following cut-off points were applied: iron deficiency [ferritin < 12 μg/L or soluble transferrin receptor (sTfR) > 8.3 mg/L], vitamin A deficiency (retinol-binding protein < 0.69 μmol/L) and zinc deficiency (serum zinc < 65 μg/dl for morning sample and <57 μg/dl for afternoon sample). We used multiple logistic regression adjusted for sampling weights and clustering to examine the predictors of micronutrient deficiencies. The prevalence of iron depletion (ferritin), tissue iron (sTfR), vitamin A and zinc deficiencies were 36.7%, 27.6%, 8.5% and 20.4%, respectively. Children were more likely to be iron deficient (ferritin) if aged 6-23 months, stunted, and in a middle-wealth quintile household. Vitamin A deficiency was associated with development region and was higher among children living in severe food-insecure households and those who did not consume fruits. Zinc deficiency was higher among children in rural areas and the poorest wealth quintile. The Government of Nepal should focus on addressing micronutrient deficiencies in the early years, with emphasis on improving food systems, promote healthy diets, among younger and stunted children and provide social cash transfer targeting high-risk development regions, poorest and food insecure households.
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Affiliation(s)
- Stanley Chitekwe
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | | | - Naveen Paudyal
- Nutrition SectionUnited Nations Children's Fund (UNICEF)KathmanduNepal
| | | | - Andre Renzaho
- School of Social Sciences and PsychologyWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Abukari Issaka
- School of ScienceWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Kingsley Agho
- School of Health SciencesWestern Sydney UniversityPenrithNew South WalesAustralia
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Hanley‐Cook G, Argaw A, Dahal P, Chitekwe S, Kolsteren P. Infant and young child feeding practices and child linear growth in Nepal: Regression-decomposition analysis of national survey data, 1996-2016. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 1:e12911. [PMID: 31922348 PMCID: PMC8770650 DOI: 10.1111/mcn.12911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
Suboptimal infant and young child feeding (IYCF) practices have profound implications on child survival, health, growth, and development. First, our study analysed trends in 18 IYCF indicators and height-for-age z-score (HAZ) and stunting prevalence across Nepal's Family Health Survey 1996 and four rounds of Nepal Demographic and Health Surveys from 2001-2016. Second, we constructed multivariable regression models and decomposed the contribution of optimal IYCF practices on HAZ and stunting prevalence over the 1996-2016 period. Our findings indicate that most age-appropriate IYCF practices and child linear growth outcomes improved over the past two decades. At present, according to the World Health Organization's tool for national assessment of IYCF practices, duration of breastfeeding is rated very good, early initiation of breastfeeding and exclusive breastfeeding (EBF) are rated good, whereas minimal bottle-feeding and introduction of solid, semi-solid or soft foods are rated fair. Our study also reports that a paucity of age-appropriate IYCF practices-in particular complementary feeding-are significantly associated with increased HAZ and decreased probability of stunting (p < .05). Moreover, age-appropriate IYCF practices-in isolation-made modest statistical contributions to the rapid and sustained reduction in age-specific child linear growth faltering from 1996-2016. Nevertheless, our findings indicate that comprehensive multisectoral nutrition strategies-integrating and advocating optimal IYCF-are critical to further accelerate the progress against child linear growth faltering. Furthermore, specific focus is needed to improve IYCF practices that have shown no significant development over the past two decades in Nepal: EBF, minimum acceptable diet, and minimal bottle-feeding.
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Affiliation(s)
- Giles Hanley‐Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
- Department of Population and Family Health, Institute of HealthJimma UniversityJimmaEthiopia
| | - Pradiumna Dahal
- Nutrition Section, United Nations Children's Fund (UNICEF)KathmanduNepal
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF)KathmanduNepal
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
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Chowdhury MRK, Khan MMH, Khan HTA, Rahman MS, Islam MR, Islam MM, Billah B. Prevalence and risk factors of childhood anemia in Nepal: A multilevel analysis. PLoS One 2020; 15:e0239409. [PMID: 33021981 PMCID: PMC7537867 DOI: 10.1371/journal.pone.0239409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/05/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Anemia is a common problem in children particularly in developing countries and taking steps to tackle it is one of the major public health challenges for Nepal. The objective of this study is to investigate the prevalence of individual, household and community level determinants of childhood anemia in Nepal. METHODS Data was taken from a nationally representative sample of 1,942 Nepalese children aged from 6-59 months. The Chi-square test was used to determine the bivariate relationship between the selected variables and childhood anemia and a multilevel logistic regression model with a random intercept at household and community level was used to identify important determinants of this kind of anemia. RESULTS The results showed that 52.6% (95% CI: 49.8%-55.4%) of the children were anemic while 26.6% (95% CI: 24.0%-29.3%) of them were moderate to severe. The prevalence of overall anemia was higher among children aged less than 11 months as well as in underweight children, children of underweight, anemic and uneducated mothers and those in the terrain ecological regions. Multivariable analysis showed that children aged less than 11 months, who were underweight and had anemic mothers were more likely to have moderate or severe anemia. Children in the hilly ecological region were less likely to have it compared to mountain and terrain ecological regions. Children in middle-class families and children of mothers who completed secondary education were more likely to have anemia. CONCLUSION Nepal is facing a serious public health problem due to the high prevalence of childhood anemia. This adverse situation occurs due to socio-demographic and geographical factors such as age, malnutrition status, mother's anemia status, socio-economic status and regional variations. Prevention of childhood anemia should be given top priority in Nepal and should be considered as a major public health intervention.
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Affiliation(s)
| | | | - Hafiz T. A. Khan
- College of Nursing, Midwifery and Healthcare, University of West London, London, United Kingdom
| | - Md. Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
| | - Md Rashedul Islam
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Md Moinul Islam
- School of Business, Middlesex University, London, United Kingdom
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Shimanda PP, Amukugo HJ, Norström F. Socioeconomic factors associated with anemia among children aged 6-59 months in Namibia. J Public Health Afr 2020; 11:1131. [PMID: 33209233 PMCID: PMC7649727 DOI: 10.4081/jphia.2020.1131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022] Open
Abstract
Anemia remains a public health concern, and its prevalence varies between countries as well as between age, sex and levels of poverty. This study aims at examining the association between socio-demographic factors and anemia among children aged 6–59 months in Namibia. Data was extracted from the 2013 Namibian Demographic Health Survey. The association between anemia and other factors was examined with logistic regression. Results are reported in odds ratio (OR), with 95% confidence intervals (CI). In total, 1,383 children aged 6–59 months had complete data and included in the analyses. Our study shows that there is a statistically significantly increased risk of anemia among children from poorer households compared with the richest quintile. Also, there was a statistically significance supporting anemia being more common among boys than girls. There was also a statistically significant negative effect related to age. Our study shows that young children, boys and children in poorer households have an increased risk of anemia. Considering the adverse impact of anemia on child development, policies must prioritize factors exacerbating anemia risk.
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Affiliation(s)
- Panduleni Penipawa Shimanda
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia
| | - Hans Justus Amukugo
- School of Nursing Science, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Ford ND, Bichha RP, Parajuli KR, Paudyal N, Joshi N, Whitehead RD, Chitekwe S, Mei Z, Flores-Ayala R, Adhikari DP, Rijal S, Jefferds ME. Age, Ethnicity, Glucose-6-Phosphate Dehydrogenase Deficiency, Micronutrient Powder Intake, and Biomarkers of Micronutrient Status, Infection, and Inflammation Are Associated with Anemia Among Children 6-59 Months in Nepal. J Nutr 2020; 150:929-937. [PMID: 31883009 PMCID: PMC7350881 DOI: 10.1093/jn/nxz307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/23/2019] [Accepted: 11/22/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Anemia is a major concern for children in Nepal; however, little is known about context-specific causes of anemia. OBJECTIVE We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anemia in a nationally representative, population-based sample of children 6-59 mo (n = 1367). METHODS Hemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood samples. Soil-transmitted helminth (STH) and Helicobacter pylori infections were assessed from stool. Anthropometry was measured with standard procedures. Sociodemographic and household characteristics, diet, micronutrient powder (MNP) intake, pica, and morbidity recall were ascertained by caregiver interview. Multivariable logistic regression that accounted for complex sampling design, determined predictors of anemia (hemoglobin <11.0 g/dL, altitude adjusted); candidate predictors were variables with P < 0.05 in bivariate models. RESULTS Anemia prevalence was 18.6% (95% CI: 15.8, 21.4). MNP intake [adjusted OR (AOR): 0.25, 95% CI: 0.07, 0.86], log (ln) ferritin (μg/L) (AOR: 0.49, 95% CI: 0.38, 0.64), and ln RBP (μmol/L) (AOR: 0.42, 95% CI: 0.18, 0.95) were associated with reduced odds of anemia. Younger age (6-23 mo compared with 24-59 mo; AOR: 2.29, 95% CI: 1.52, 3.46), other Terai ethnicities (AOR: 2.59, 95% CI: 1.25, 5.35) and Muslim ethnicities (AOR: 3.15, 95% CI: 1.30, 7.65) relative to Brahmin/Chhetri ethnicities, recent fever (AOR: 1.68, 95% CI: 1.08, 2.59), ln C-reactive protein (mg/L) (AOR: 1.23, 95% CI: 1.03, 1.45), and glucose-6-phosphate dehydrogenase deficiency (AOR: 2.84, 95% CI: 1.88, 4.30) were associated with increased odds of anemia. CONCLUSION Both nonmodifiable and potentially modifiable factors were associated with anemia. Thus some but not all anemia might be addressed through effective public health policy, programs, and delivery of nutrition and infection prevention and control.
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Affiliation(s)
- Nicole D Ford
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, 4770 Buford Hwy NW, Atlanta, GA, 30341, USA
| | - RP Bichha
- Nepal Ministry of Health and Population, Kathmandu 44600, Nepal
| | | | - Naveen Paudyal
- Nutrition Section, United Nations Children’s Fund (UNICEF), Leknath Marg, Kathmandu 44600, Nepal
| | - Nira Joshi
- New ERA, Rudramati Marg, Kalopul, Kathmandu 44600, Nepal
| | - Ralph D Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, 4770 Buford Hwy NW, Atlanta, GA, 30341, USA
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children’s Fund (UNICEF), Leknath Marg, Kathmandu 44600, Nepal
| | - Zuguo Mei
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, 4770 Buford Hwy NW, Atlanta, GA, 30341, USA
| | - Rafael Flores-Ayala
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, 4770 Buford Hwy NW, Atlanta, GA, 30341, USA
| | - Debendra P Adhikari
- United States Agency for International Development (USAID), Maharajgunj, Kathmandu 44600, Nepal
| | - Sanjay Rijal
- Nutrition Section, United Nations Children’s Fund (UNICEF), Leknath Marg, Kathmandu 44600, Nepal
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, 4770 Buford Hwy NW, Atlanta, GA, 30341, USA
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Bliznashka L, Arsenault JE, Becquey E, Ruel MT, Olney DK. Using structural equation modelling to understand the contributors to anaemia among young Burkinabe children. MATERNAL & CHILD NUTRITION 2020; 16:e12881. [PMID: 31351027 PMCID: PMC7038887 DOI: 10.1111/mcn.12881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
Anaemia is a persistent problem among young Burkinabe children, yet population-specific information on its determinants is scant. We used baseline data from an evaluation of Helen Keller International's Enhanced Homestead Food Production Program (n=1210 children) to quantify household-, mother-, and child-level factors associated with anaemia in Burkinabe children aged 6-12 months. We used structural equation modelling to assess a theoretical model, which tested four categories of factors: (a) household food security and dietary diversity, (b) household sanitation and hygiene (latrine and poultry access and bednet ownership), (c) maternal factors (anaemia, stress, cleanliness, and health, hygiene and feeding knowledge and practices), and (d) child nutrition and health (iron deficiency (ID), retinol binding protein (RBP), malaria, and inflammation). The model also included household socio-economic status, size, and polygamy; maternal age and education; and child age and sex. Results showed that ID, malaria, and inflammation were the primary direct determinants of anaemia, contributing 15%, 10%, and 10%, respectively. Maternal knowledge directly explained improved child feeding practices and household bednet ownership. Household dietary diversity directly explained 18% of child feeding practices. Additionally, RBP, child age and sex, and maternal anaemia directly predicted child haemoglobin. Our findings suggest that program effectiveness could be increased by addressing the multiple, context-specific contributors of child anaemia. For young Burkinabe children, anaemia control programs that include interventions to reduce ID, malaria, and inflammation should be tested. Other potential intervention entry points suggested by our model include improving maternal knowledge of optimal health, hygiene, and nutrition practices and household dietary diversity.
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Affiliation(s)
- Lilia Bliznashka
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Joanne E. Arsenault
- Program in International and Community NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Elodie Becquey
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
| | - Marie T. Ruel
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
| | - Deanna K. Olney
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
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Wei J, Bhurtyal A, Dhungana RR, Bhattarai B, Zheng J, Wang L, Sun X, Maskey M, Wang Y. Changes in patterns of the double burden of undernutrition and overnutrition in Nepal over time. Obes Rev 2019; 20:1321-1334. [PMID: 31322314 DOI: 10.1111/obr.12883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/20/2022]
Abstract
Knowledge regarding nutrition transition in Nepal remains limited. This systematic review examined the shifts in undernutrition and overnutrition in Nepal during the past two decades. We searched PubMed for studies and reports published between January 1, 2000, and June 30, 2018. Publications with a sample size greater than or equal to 500 that reported prevalence of nutritional status were included. Six large national reports and 36 studies met study inclusion criteria and were included. Overall, available nationally representative data remained limited. The Nepal Demographic and Health Survey 2001 to 2016 showed that underweight prevalence decreased from 26.7% to 17.2% and prevalence of overweight/obesity increased from 6.5% to 22.1% among women of reproductive age (15-49 years). In preschool children, prevalence of stunting, wasting, and underweight decreased from 57.2% to 35.8%, 11.2% to 9.7%, and 42.7% to 27.0%, respectively. Prevalence of overweight/obesity was low among children and was higher in higher socio-economic status (SES) groups. The overweight-obesity/underweight ratios indicate a shift from undernutrition to overnutrition problem; it was more evident in urban areas and higher SES groups. In conclusion, Nepal is experiencing a nutrition transition. More research is warranted to address this shift, and well-tailored public health efforts need to combat the double burden of overweight/obesity and undernutrition.
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Affiliation(s)
- Junxiang Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Global Health Institute, Xi'an Jiaotong University, Xi'an, China
| | - Ashok Bhurtyal
- Global Health Institute, Xi'an Jiaotong University, Xi'an, China.,Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Raja Ram Dhungana
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Basudev Bhattarai
- Nepal Public Health Foundation (NPHF), Maharajgunj, Kathmandu, Nepal
| | - Jinge Zheng
- Global Health Institute, Xi'an Jiaotong University, Xi'an, China
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Xiaomin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Global Health Institute, Xi'an Jiaotong University, Xi'an, China
| | - Mahesh Maskey
- Nepal Public Health Foundation (NPHF), Maharajgunj, Kathmandu, Nepal
| | - Youfa Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Global Health Institute, Xi'an Jiaotong University, Xi'an, China
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Parental Perception of Childhood Anaemia and Efficiency of Instrument Assisted Pallor Detection among Mothers in Southeast Nigeria: A Field Validation Study. Int J Pediatr 2019; 2019:7242607. [PMID: 31531028 PMCID: PMC6719268 DOI: 10.1155/2019/7242607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background Control of anemia can be achieved with early detection of pallor by parents at home. However, most parents lack the capacity to recognize pallor; thus most cases of anaemia are detected during hospital visit due to other symptoms. This study aimed to evaluate parental ability to detect pallor when aided with the anaemia screening tool. Methods In the study information on the symptoms of illness and parental knowledge on anaemia. Their ability to detect anaemia aided with the Home-Base anaemia-screen tool (HB-Anae) was compared to the healthcare providers' assessment of pallor. The haemoglobin estimation with the Hb-301 haemoglobinometer was used as the gold standard. Results None of the children in their previous illnesses had paleness as a complaint. Few (20.8%) parents knew what anaemia meant. Only 18.3% knew sites on the body where pallor can be detected. Many (55.1%; 304/552) surveyed children were anaemic (Hb<11g/dl) based on HB 301. Majority (88.8%; 270/304) of the parents aided with the HB-Anae were able to detect pallor on the children who were anaemic compared to 95.1% (289/304) detected by healthcare workers unaided, and the difference was not statistically significant (p=0.25). Conclusion There was poor knowledge on anaemia among parents. The ability of parents to detect anaemia could be improved with the simple HB-Anae screen tool.
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Karkuki Osguei N, Mascie-Taylor CN. Association of nutritional status with socio-economic and demographic variables of under five year old Nepalese children. Med J Islam Repub Iran 2019; 33:28. [PMID: 31380318 PMCID: PMC6662538 DOI: 10.34171/mjiri.33.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background: To see which socioeconomic and demographic variables associate with the nutritional status of under five-year old Nepalese children. This nationwide study provides a comprehensive analysis on of risk factors for childhood acute and chronic undernutrion.
Methods: The Nepal Demographic and Health Survey 2006 was used as a cross sectional data source. A total of 3630 children were analysed. Standard Z-score were used for children. Anaemia was also defined using international norms. The statistical analysis used was binary logistic regression, which was performed using SPSS software package for Windows. The cut-off for a significant result was <0.05.
Results: The results showed that 1680 (46.3%) of children were stunted, 1384 (38.1%) were underweight, 513 (14.1%) were wasted and 1631 (44.9%) were anaemic. Underweight and stunting showed significant association with mother’s education and ethnicity. All nutritional factors were associated with ecological zone and standard of living. Also, underweight and wasting showed a significant relationship with religion.
Conclusion: Maternal education, ecological zone, ethnicity and standard of living were the main predictors of child nutritional status.
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Affiliation(s)
- Nushin Karkuki Osguei
- Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Cg Nicholas Mascie-Taylor
- Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK
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Evaluation of the Performance of Haemoglobin Colour Scale and Comparison with HemoCue Haemoglobin Assay in Diagnosing Childhood Anaemia: A Field Validation Study. Int J Pediatr 2019; 2019:3863070. [PMID: 31354845 PMCID: PMC6633866 DOI: 10.1155/2019/3863070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anaemia in children has high mortality. We present the results of assessment of the accuracy of Haemoglobin Colour Scale in identifying anaemia compared with HemoCue assay. METHODS The presence of anaemia in 524 children from four communities was screened using the Haemoglobin Colour Scale (HCS) and HemoCue assay. Independent healthcare providers that estimated the haemoglobin level using Hb-301 haemoglobinometer were different from those that read the colour scale. The sensitivity, specificity, positive predictive value, and negative predictive value were estimated. RESULTS Of the 524 children surveyed, 44.5% (233/524), 50% (262/524), and 32.2% (168/524) were found to be anaemic using the HemoCue, HCS (p= 0.25), and clinical pallor (p=0.03) respectively. Using the HemoCue as standard, the sensitivity of the HCS and clinical pallor was 89.1% and 72.1%, respectively, and specificity 90.2% and 84.6%, respectively. 74.7 % of the colour scale result was within the 1.0g/dl of the HemoCue reading and 23 % was within 2.0g/dl. CONCLUSION The HCS can improve the ability to detect anaemia especially where the use of the HemoCue is not feasible as in the resource poor countries. However, every case of anaemia requires further investigation to determine the underlying causes.
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Kao J, Mutuku F, Martin S, Lee J, Mwandi J, Mukoko D, Malhotra I, King CH, LaBeaud AD. Early Childhood Anemia in a Birth Cohort in Coastal Kenya: Links to Infection and Nutrition. Am J Trop Med Hyg 2019; 101:242-252. [PMID: 31074407 PMCID: PMC6609201 DOI: 10.4269/ajtmh.17-0688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/11/2019] [Indexed: 11/07/2022] Open
Abstract
Anemia is known to impact a child's growth and development, but not all anemias are caused by iron deficiency, and the CDC and WHO have emphasized investigating other contributors to anemia. This cross-sectional sub-study of a 2012-2016 maternal-child cohort in coastal Kenya evaluated 244 children and found 185 (76%) to have been anemic on at least one time point since birth. At the time of assessment in 2016, evaluation included a complete blood count, nutritional assessment, and testing for parasitic infections, focusing on the primary outcome of anemia, defined as hemoglobin (Hb) < 11 g/dL. The average age at assessment was 20.5 ± 7 months. Ninety-five percent had a lifetime average Hb in the anemic range. Adjusting for age and gender, prior or current malaria infection (prior: Hb β = -0.99, 95% CI: -1.49 to -0.49, P = 0.01), or having any current infection with hookworm, Trichuris, Strongyloides, Ascaris, and/or malaria (β = -0.84, 95% CI: -1.36 to -0.33, P = 0.01) was associated with decreased current Hb. Nutritional evaluation revealed that children with a declining Hb ate fewer vitamin-A-rich vegetables per week (P = 0.01) or eggs (P = 0.01), drank more milk (P = 0.07), and ate more bread (P = 0.01), and were more likely to live in a household that experienced food shortage (P = 0.05). The high prevalence of anemia, polyparasitism, and dietary insufficiency among children in rural coastal Kenya suggests that remedial interventions will need to address both diet and parasitic infections to effectively combat this significant health threat.
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Affiliation(s)
- Julia Kao
- Stanford University School of Medicine, Stanford, California
| | | | - Shanique Martin
- Stanford University School of Medicine, Stanford, California
| | - Justin Lee
- Stanford University School of Medicine, Stanford, California
| | - Jackson Mwandi
- Vector Borne Disease Control Unit, Msambweni Field Laboratory, Kwale County, Kenya
| | - Dunstan Mukoko
- Vector-Borne Diseases Control Unit, Ministry of Health, Nairobi, Kenya
| | - Indu Malhotra
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
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Morseth MS, Torheim LE, Chandyo RK, Ulak M, Shrestha SK, Shrestha B, Pripp AH, Henjum S. Severely inadequate micronutrient intake among children 9-24 months in Nepal-The MAL-ED birth cohort study. MATERNAL & CHILD NUTRITION 2018; 14:e12552. [PMID: 29094796 PMCID: PMC6866178 DOI: 10.1111/mcn.12552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/22/2017] [Accepted: 09/27/2017] [Indexed: 12/26/2022]
Abstract
Prevalence of micronutrient deficiencies is high among infants and children in low- and middle income countries, but knowledge about nutrient adequacy across the complementary feeding period is limited. We investigated probability of adequacy (PA) of breast milk and complementary food combined and nutrient density adequacy (NDA) of complementary food and tracking of NDA over time among 229 children from 9-24 months of age in Bhaktapur, Nepal. Monthly, 24 h dietary recalls (16 in total) were performed and subgrouped into four 4-month time periods. Ten micronutrients (thiamin, riboflavin, niacin, vitamin B6 , folate, vitamin C, vitamin A, calcium, iron, and zinc) were assessed. Nutrient density was defined as the amount of a nutrient in a child's complementary food per 100 kcal, whereas NDA was the nutrient density as percentage of the context specific desired nutrient density. Tracking of NDA was investigated using generalized estimating equations models. PA for B vitamins (except riboflavin), vitamin A, calcium, iron, and zinc (low absorption group) was very low (0% to 8%) at all time slots. Median (IQR) mean PA (of all 10 micronutrients) increased from 11% (9, 15) in the second to 21% (10, 35) in the last time slot. Median value for mean nutrient density adequacy of all micronutrients varied between 42% and 52%. Finally, tracking of NDA was low (correlation <0.30) or moderate (0.30-0.60) indicating poor association between the first and subsequent measurements of NDA. These findings raise grave concerns about micronutrient adequacy among young children in Nepal. Urgent interventions are needed.
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Affiliation(s)
| | | | - Ram K. Chandyo
- Kathmandu Medical CollegeKathmanduNepal
- University of BergenBergenNorway
- Institute of MedicineKathmanduNepal
| | | | - Sanjaya K. Shrestha
- University of BergenBergenNorway
- Institute of MedicineKathmanduNepal
- Walter Reed/Armed Forces Research Institute of Medical Sciences Research UnitKathmanduNepal
| | - Binob Shrestha
- Walter Reed/Armed Forces Research Institute of Medical Sciences Research UnitKathmanduNepal
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Tracking of infant and young child feeding practices among 9- to 24-month-old children in Nepal: the MAL-ED Birth Cohort Study. Public Health Nutr 2017; 21:355-364. [PMID: 29037267 DOI: 10.1017/s1368980017002294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The present study aimed to assess infant and young child feeding (IYCF) practices and the tracking of dietary diversity score (DDS), intakes of Fe- and vitamin A-rich foods and meal frequency in a peri-urban area in Nepal. Furthermore, to explore whether sociodemographic factors were associated with tracking patterns of these IYCF practices. DESIGN Longitudinal study. Monthly food intake was measured by 24 h recall. Four time slots were used (9-12, 13-16, 17-20 and 21-24 months). Tracking of IYCF practices was investigated using generalized estimating equations (GEE) models and Cohen's weighted kappa. Multinominal logistic regression was used to identify determinants for tracking of the IYCF practices. SETTING Bhaktapur municipality, Nepal. SUBJECTS Children (n 229) aged 9-24 months, randomly selected. RESULTS Prevalence of minimum meal frequency was higher than for minimum dietary diversity at all time slots. Tracking based on absolute measures (GEE models) was moderate for DDS (0·48) and meal frequency (0·53), and low for intakes of Fe- (0·23) and vitamin A-rich (0·35) foods. Tracking based on rank measured was moderate for DDS and meal frequency, and fair for Fe- and vitamin A-rich foods. Low socio-economic status significantly increased the odds (OR; 95 % CI) of tracking of low v. high DDS (3·31; 1·44, 7·60) and meal frequency (3·46; 1·54, 7·76). CONCLUSIONS Low tracking for intakes of Fe- and vitamin A-rich foods implies that interventions to improve these IYCF practices must address underlying causes for irregular intake to have sustainable effects.
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Anemia and Its Relationship with Academic Performance among Adolescent School Girls in Kebena District, Southwest Ethiopia. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/bhs.13431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Humphrey JH, Jones AD, Manges A, Mangwadu G, Maluccio JA, Mbuya MNN, Moulton LH, Ntozini R, Prendergast AJ, Stoltzfus RJ, Tielsch JM. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Rationale, Design, and Methods. Clin Infect Dis 2016; 61 Suppl 7:S685-702. [PMID: 26602296 PMCID: PMC4657589 DOI: 10.1093/cid/civ844] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Child stunting and anemia are intractable public health problems in developing countries and have profound short- and long-term consequences. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is motivated by the premise that environmental enteric dysfunction (EED) is a major underlying cause of both stunting and anemia, that chronic inflammation is the central characteristic of EED mediating these adverse effects, and that EED is primarily caused by high fecal ingestion due to living in conditions of poor water, sanitation, and hygiene (WASH). SHINE is a proof-of-concept, 2 × 2 factorial, cluster-randomized, community-based trial in 2 rural districts of Zimbabwe that will test the independent and combined effects of protecting babies from fecal ingestion (factor 1, operationalized through a WASH intervention) and optimizing nutritional adequacy of infant diet (factor 2, operationalized through an infant and young child feeding [IYCF] intervention) on length and hemoglobin at 18 months of age. Within SHINE we will measure 2 causal pathways. The program impact pathway comprises the series of processes and behaviors linking implementation of the interventions with the 2 child health primary outcomes; it will be modeled using measures of fidelity of intervention delivery and household uptake of promoted behaviors and practices. We will also measure a range of household and individual characteristics, social interactions, and maternal capabilities for childcare, which we hypothesize will explain heterogeneity along these pathways. The biomedical pathway comprises the infant biologic responses to the WASH and IYCF interventions that ultimately result in attained stature and hemoglobin concentration at 18 months of age; it will be elucidated by measuring biomarkers of intestinal structure and function (inflammation, regeneration, absorption, and permeability); microbial translocation; systemic inflammation; and hormonal determinants of growth and anemia among a subgroup of infants enrolled in an EED substudy. This article describes the rationale, design, and methods underlying the SHINE trial. CLINICAL TRIALS REGISTRATION NCT01824940.
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Abstract
Children, especially infants, are highly vulnerable to iron-deficiency anemia because of their rapid growth of the brain and the rest of the body. The objectives of this study were to compare the prevalence of iron-deficiency anemia in infants born from HIV-positive mothers and HIV-negative mothers and to identify the determinants of iron-deficiency anemia in infants.A comparative cross-sectional study was conducted in Bahir Dar city. Simple random sampling technique was used to select the study participants. Mothers were interviewed; blood samples were collected from mothers and infants to measure the hemoglobin level and anthropometric indicators were obtained from the infants using world health organization standards. Descriptive statistics were used to estimate the prevalence of infantile anemia. Binary logistic regression and multiple linear regressions were used to identify the determinants of infant anemia.A total of 1459 infants born from HIV-positive and HIV-negative mothers were included. The prevalence of iron-deficiency anemia in infants born from HIV-positive and HIV-negative mothers was 41.9% (95% CI: 39-44). Infantile iron-deficiency anemia was associated with maternal HIV infection (adjusted odds ratio [AOR] 2.54 [95% CI: 1.65-3.9]), stunting (AOR 3.46 [95% CI: 2.41-4.97]), low income (AOR 2.72 [95% CI: 2-3.73]), maternal malaria during pregnancy (AOR 1.81 [95% CI: 1.33-2.47]), use of cow milk before 6 month (AOR 1.82 [95% CI: 1.35-2.45]), residence (AOR 0.09 [95% CI: 0.06-0.13]), history of cough or fever 7 days preceding the survey (AOR 2.71 [95% CI: 1.99-3.69]), maternal hemoglobin (B 0.65 [95% CI: 0.61-0.68]), educational status of mother (B 0.22 [95% CI: 0.2-0.23]), age of the mother (B -0.03 [95% CI: -0.03, -0.02]), and family size (B -0.14 [95% CI: -0.18,-0.11]).
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Affiliation(s)
- Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
- Correspondence: Berhan Elfu Feleke, Bahir Dar University, Bahir Dar, Ethiopia (e-mail: ;)
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Khatiwada S, Lamsal M, Gelal B, Gautam S, Nepal AK, Brodie D, Baral N. Anemia, Iron Deficiency and Iodine Deficiency among Nepalese School Children. Indian J Pediatr 2016; 83:617-21. [PMID: 26558919 DOI: 10.1007/s12098-015-1924-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess iodine and iron nutritional status among Nepalese school children. METHODS A cross-sectional, community based study was conducted in the two districts, Ilam (hilly region) and Udayapur (plain region) of eastern Nepal. A total of 759 school children aged 6-13 y from different schools within the study areas were randomly enrolled. A total of 759 urine samples and 316 blood samples were collected. Blood hemoglobin level, serum iron, total iron binding capacity and urinary iodine concentration was measured. Percentage of transferrin saturation was calculated using serum iron and total iron binding capacity values. RESULTS The mean level of hemoglobin, serum iron, total iron binding capacity, transferrin saturation and median urinary iodine excretion were 12.29 ± 1.85 g/dl, 70.45 ± 34.46 μg/dl, 386.48 ± 62.48 μg/dl, 19.94 ± 12.07 % and 274.67 μg/L respectively. Anemia, iron deficiency and iodine deficiency (urinary iodine excretion <100 μg/L) were present in 34.5 %, 43.4 % and 12.6 % children respectively. Insufficient urinary iodine excretion (urinary iodine excretion <100 μg/L) was common in anemic and iron deficient children. CONCLUSIONS Iron deficiency and anemia are common in Nepalese children, whereas, iodine nutrition is more than adequate. Low urinary iodine excretion was common in iron deficiency and anemia.
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Affiliation(s)
- Saroj Khatiwada
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, 44600, Nepal.
| | - Madhab Lamsal
- Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Basanta Gelal
- Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Sharad Gautam
- Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Ashwini Kumar Nepal
- Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - David Brodie
- Faculty of Society and Health, Buckinghamshire University, Buckinghamshire, UK
| | - Nirmal Baral
- Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
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Wirth JP, Rohner F, Petry N, Onyango AW, Matji J, Bailes A, de Onis M, Woodruff BA. Assessment of the WHO Stunting Framework using Ethiopia as a case study. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27126511 DOI: 10.1111/mcn.12310] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 01/21/2023]
Abstract
Poor linear growth in children <5 years old, or stunting, is a serious public health problem particularly in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) released a conceptual framework on the Context, Causes and Consequences of Childhood Stunting (the 'WHO framework') that identifies specific and general factors associated with stunting. The framework is based upon a global review of data, and we have applied it to a country-level analysis where health and nutrition policies are made and public health and nutrition data are collected. We reviewed the literature related to sub-optimal linear growth, stunting and birth outcomes in Ethiopia as a case study. We found consistent associations between poor linear growth and indicators of birth size, recent illness (e.g. diarrhoea and fever), maternal height and education. Other factors listed as causes in the framework such as inflammation, exposure to mycotoxins and inadequate feeding during and after illness have not been examined in Ethiopia, and the existing literature suggests that these are clear data gaps. Some factors associated with poor linear growth in Ethiopia are missing in the framework, such as household characteristics (e.g. exposure to indoor smoke). Examination of the factors included in the WHO framework in a country setting helps identifying data gaps helping to target further data collection and research efforts. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- James P Wirth
- GroundWork, Crans-près-Céligny, Switzerland.,Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier, France
| | | | | | | | - Joan Matji
- UNICEF Ethiopia, Nutrition and Food Security Section, Addis Ababa, Ethiopia
| | - Adam Bailes
- UNICEF Ethiopia, Nutrition and Food Security Section, Addis Ababa, Ethiopia
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Vitamin Status among Breastfed Infants in Bhaktapur, Nepal. Nutrients 2016; 8:149. [PMID: 27005657 PMCID: PMC4808878 DOI: 10.3390/nu8030149] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/17/2016] [Accepted: 03/03/2016] [Indexed: 12/16/2022] Open
Abstract
Vitamin deficiencies are known to be common among infants residing in low- and middle-income countries but relatively few studies have assessed several biochemical parameters simultaneously. The objective of the study was to describe the status of vitamins (A, D, E, B6, B12 and folate) in breastfed infants. We measured the plasma concentrations of trans retinol, 25 hydroxy vitamin D, α-tocopherol, pyridoxal 5′-phosphate, cobalamin, folate, methylmalonic acid, homocysteine, hemoglobin and C-reactive protein from 467 randomly selected infants. One in five (22%) was deficient in at least one vitamin. Mean (SD) plasma folate concentration was 73 (35) nmol/L, and no infant in the sample was folate deficient. Vitamin B6 deficiency and vitamin B12 deficiency was found in 22% and 17% of the infants, respectively. Elevated plasma methylmalonic acid or total homocysteine concentration was found in 82% and 62% of infants, respectively. Fifteen percent of infants were vitamin A deficient and 65% were marginally deficient in vitamin A. Fewer than 5% of infants had low plasma vitamin D concentration or vitamin E concentration (α-tocopherol <9.3 µmol/L). Our results illustrate the importance of continued supplementation campaigns and support the expansion of food fortification and dietary diversification programs that target children and women in Nepal.
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Achouri I, Aboussaleh Y, Sbaibi R, Ahami A, El Hioui M. Prevalence of Iron Deficiency Anaemia Among School Children in Kenitra, Northwest of Morocco. Pak J Biol Sci 2015; 18:191-5. [PMID: 26506650 DOI: 10.3923/pjbs.2015.191.195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Iron deficiency anaemia is an important health problem in Morocco. This study was conducted to estimate the prevalence of anaemia among school children in Kenitra. The sample represents school children of all educational levels and age ranged between 6-15 years. The level of hemoglobin, haematocrit, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration was measured in a group of 271 school children. The seric iron was assessed and anaemia was defined when hemoglobin < 11.5 g dL(-1). A questionnaire was developed to obtain information about the daily food consumption and socio-economic conditions. The prevalence of anaemia was 16.2%. The mean hemoglobin concentration was 12.53 g dL(-1) in boys and 12.52 g dL(-1) in girls. The results suggest that iron deficiency is an important determinant of anaemia in this population. There was a significant relationship between education of the mother and anaemia in children (p = 0.004) but not with the family income. It is concluded that improving the economic status of the family, women education and health education about balanced animal and plant food consumption are recommended strategies to reduce the burden of anaemia.
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Decline in the prevalence of anaemia among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan. Public Health Nutr 2015; 19:1486-97. [DOI: 10.1017/s1368980015002785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo examine changes in the prevalence of anaemia and its correlates among children of pre-school age after implementation of wheat flour fortification with multiple micronutrients in Jordan.DesignRetrospective analysis of the data from two repeated national cross-sectional panels of pre-school children.SettingThe two surveys were conducted in 2007 and 2009, 16–20 months and 34–36 months, respectively, after implementation of wheat flour fortification with multiple micronutrients in Jordan. Anaemia was considered if Hb level was <11 g/dl. An anaemia prevalence of ≥40 % was considered a severe public health problem, while that of 20–39·9 % was considered a moderate public health problem.SubjectsA total of 3789 and 3447 children aged 6–59 months tested in 2007 and 2009, respectively.ResultsThe prevalence of anaemia in pre-school children declined from 40·4 % in 2007 to 33·9 % in 2009 (adjusted OR=0·74; P<0·001). The decline in the prevalence in 2009 as compared with 2007 was more pronounced among children aged >24 months (−13·7 points), children living in urban areas (−8·0 points), children from rich households (−9·0 points), children who had never been breast-fed (−17·0 points) and well-nourished children (−6·8 points). In both surveys, presence of childhood anaemia was strongly associated with child age ≤24 months, living in poor households, breast-feeding for ≥6 months, malnourishment, poor maternal education and maternal anaemia.ConclusionsThe public health problem of childhood anaemia declined from severe in 2007 to moderate in 2009, after the implementation of wheat flour fortification with multiple micronutrients in Jordan.
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Affiliation(s)
- Jon A Vanderhoof
- Boston Children's Hospital, Harvard Medical School, Boston, MA; Mead Johnson Nutrition, Glenview, IL
| | - Ronald E Kleinman
- MassGeneral Hospital for Children and Harvard Medical School, Boston, MA.
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Locks LM, Pandey PR, Osei AK, Spiro DS, Adhikari DP, Haselow NJ, Quinn VJ, Nielsen JN. Using formative research to design a context-specific behaviour change strategy to improve infant and young child feeding practices and nutrition in Nepal. MATERNAL & CHILD NUTRITION 2015; 11:882-96. [PMID: 23557321 PMCID: PMC6860308 DOI: 10.1111/mcn.12032] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Global recommendations on strategies to improve infant feeding, care and nutrition are clear; however, there is limited literature that explains methods for tailoring these recommendations to the local context where programmes are implemented. This paper aims to: (1) highlight the individual, cultural and environmental factors revealed by formative research to affect infant and young child feeding and care practices in Baitadi district of Far Western Nepal; and (2) outline how both quantitative and qualitative research methods were used to design a context-specific behaviour change strategy to improve child nutrition. Quantitative data on 750 children aged 12-23 months and their families were collected via surveys administered to mothers. The participants were selected using a multistage cluster sampling technique. The survey asked about knowledge, attitude and behaviours relating to infant and young child feeding. Qualitative data on breastfeeding and complementary feeding beliefs and practices were also collected from a separate sample via focus group discussions with mothers, and key informant interviews with mothers-in-law and husbands. Key findings revealed gaps in knowledge among many informants resulting in suboptimal infant and young child feeding practices - particularly with relation to duration of exclusive breastfeeding and dietary diversity of complementary foods. The findings from this research were then incorporated into a context-specific nutrition behaviour change communication strategy.
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Affiliation(s)
| | | | - Akoto K. Osei
- Helen Keller InternationalAsia Pacific Regional OfficePhnom PenhCambodia
| | | | | | - Nancy J. Haselow
- Helen Keller InternationalAsia Pacific Regional OfficePhnom PenhCambodia
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Chandyo RK, Ulak M, Adhikari RK, Sommerfelt H, Strand TA. Prevalence of Iron Deficiency and Anemia among Young Children with Acute Diarrhea in Bhaktapur, Nepal. Healthcare (Basel) 2015; 3:593-606. [PMID: 27417782 PMCID: PMC4939584 DOI: 10.3390/healthcare3030593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 06/26/2015] [Accepted: 07/14/2015] [Indexed: 11/21/2022] Open
Abstract
Iron deficiency anemia is still common in children under five years of age and may impair their growth and cognitive development. Diarrhea is the second most common reason for seeking medical care for young children in Nepal. However, neither screening programs nor effective preventive measures for anemia and iron deficiencies are in place among children with diarrhea in many developing countries. The aims of this study were to determine the prevalence of anemia and iron deficiency and explore their associations with clinical, socioeconomic, and anthropometric parameters in Nepalese children. This was a cross-sectional study based on 1232 children, six to 35 months old, with acute diarrhea participating in a zinc supplementation trial. The mean (SD) hemoglobin was 11.2 g/dL (1.2). Anemia was found in 493 children (40%); this estimate increased to 641 (52%) when we adjusted for the altitude of the study area (hemoglobin <11.3 g/dL). One in every three children had depleted iron stores and 198 (16%) of the children had both depleted iron stores and anemia, indicating iron deficiency anemia. The prevalence of anemia among children presenting with acute diarrhea was high but the degree of severity was mainly mild or moderate. Iron deficiency explained less than half of the total anemia, indicating other nutritional deficiencies inducing anemia might be common in this population.
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Affiliation(s)
- Ram K Chandyo
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
- Community Medicine Department, Kathmandu Medical College, Kathmandu University, Kathmandu P.O. Box 21266, Nepal.
| | - Manjeswori Ulak
- Department of Child Health, Institute of Medicine, Kathmandu P.O. Box 1524, Nepal.
| | - Ramesh K Adhikari
- Department of Pediatrics, Kathmandu Medical College, Kathmandu University, Kathmandu P.O. Box 21266, Nepal.
| | - Halvor Sommerfelt
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
| | - Tor A Strand
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
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Khatiwada S, Gelal B, Gautam S, Tamang MK, Shakya PR, Lamsal M, Baral N. Anemia among school children in eastern Nepal. J Trop Pediatr 2015; 61:231-3. [PMID: 25828831 DOI: 10.1093/tropej/fmv016] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anemia is one of the most common public health problems in developing countries like Nepal. This study was done to find the prevalence of anemia among the children aged 4-13 years in eastern Nepal. A cross-sectional study was conducted in 2012 in four districts (Morang, Udayapur, Bhojpur and Ilam) of eastern Nepal to find the prevalence of anemia among the school children of eastern Nepal. Children aged 4-13 years were selected randomly from different schools of above districts and 618 venous blood samples were collected. Hemoglobin level was estimated by using cyanmethemoglobin method. The mean hemoglobin level was 12.2 ± 1.82 gm/dl. About 37.9% (n = 234) children were found anemic. Anemia prevalence was 42.4% (n = 78), 31.6% (n = 60), 45.3% (n = 48) and 34.8% (n = 48) among school children of Morang, Udayapur, Bhojpur and Ilam district, respectively. The study finds anemia as a significant health problem among the school children of eastern Nepal.
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Affiliation(s)
- Saroj Khatiwada
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal, Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal, Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, Dharan, Nepal and Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Basanta Gelal
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal, Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal, Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, Dharan, Nepal and Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Sharad Gautam
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal, Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal, Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, Dharan, Nepal and Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Man Kumar Tamang
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal, Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal, Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, Dharan, Nepal and Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Prem Raj Shakya
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal, Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal, Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, Dharan, Nepal and Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Madhab Lamsal
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal, Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal, Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, Dharan, Nepal and Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Nirmal Baral
- Department of Pharmacy, Central Institute of Science and Technology (CIST) College, Pokhara University, Kathmandu, Nepal, Department of Biochemistry, B P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal, Department of Nutrition and Dietetics, Central Campus of Technology, Tribhuvan University, Dharan, Nepal and Department of Biochemistry, School of Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
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El Kishawi RR, Soo KL, Abed YA, Wan Muda WAM. Anemia among children aged 2-5 years in the Gaza Strip- Palestinian: a cross sectional study. BMC Public Health 2015; 15:319. [PMID: 25879619 PMCID: PMC4391478 DOI: 10.1186/s12889-015-1652-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 03/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anemia is a major public health problem worldwide, with adverse consequences on child growth, development, and survival. This deficiency has affected approximately a quarter of the world population. This study aimed to determine the prevalence of anemia and the associated factors among preschool children in the Gaza Strip. METHODS A cross-sectional study was conducted between May and September 2012. A total of 357 preschool children were selected using multistage sampling method from Jabalya refugee camp, El Remal urban area, and Al Qarara rural area. Hemoglobin level was measured, and anemia diagnosis was confirmed at a level <11.0 g/dL. In this study, we utilized a pretested questionnaire for face to face interview with mothers. Anthropometric indicators for children were measured using the WHO guideline. Descriptive and multivariate analyses were conducted to determine the prevalence and associated factors of anemia. RESULTS The overall prevalence of anemia was 59.7% among preschool children in the Gaza Strip, 46.5% and 13.5% of which are mild and moderate, respectively. The mean hemoglobin level was 10.83 ± 0.86 g/dl. Children living in Jabalya refugee camp have a high risk of anemia [adjusted b= -0.55; 95% confidence interval (CI;-0.72,-0.39); p < 0.001]. Boys were more susceptible to this deficiency than girls [adjusted b = 0.17; 95% CI (0.0.01, 0.33); p = 0.031]. Hemoglobin level increased with age [adjusted b = 0.02; 95% CI (0.01, 0.03); p < 0.001]. Hemoglobin level decreased in children living in poor households [adjusted b = -0.24; 95%CI (-0.41,-0.06); p = 0.006]. Underweight children were more susceptible to anemia than normal weight children [adjusted b = - 0.22; 95% CI (-0.41, -0.03); p = 0.025]. CONCLUSIONS The prevalence of anemia among preschool children in the Gaza Strip was higher than those reported in previous local studies, indicating that anemia is a major public health problem. In this study, we also observed mild and moderate cases among children, whereas severe anemia was not observed. Independent predictors of anemia were geographic location, sex, age, monthly income, and malnutrition. Results provided the baseline information on anemia, therefore, especial attention should be given on intervention of anemia.
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Affiliation(s)
| | - Kah Leng Soo
- Department of Nutrition, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia.
| | - Yehia Awad Abed
- School of Public Health, Al Quds University, Gaza City, Gaza Strip, Palestine.
| | - Wan Abdul Manan Wan Muda
- Department of Nutrition, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia.
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Surkan PJ, Charles MK, Katz J, Siegel EH, Khatry SK, LeClerq SC, Stoltzfus RJ, Tielsch JM. The role of zinc and iron-folic acid supplementation on early child temperament and eating behaviors in rural Nepal: a randomized controlled trial. PLoS One 2015; 10:e0114266. [PMID: 25821959 PMCID: PMC4379028 DOI: 10.1371/journal.pone.0114266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 10/31/2014] [Indexed: 11/18/2022] Open
Abstract
Child eating behaviors play an important role in nutrient intake, ultimately affecting child growth and later outcomes in adulthood. The study assessed the effects of iron-folic acid and zinc supplementation on child temperament and child eating behaviors in rural Nepal. Children (N = 569) aged 4–17 months in Sarlahi district, southern Nepal were randomized to receive daily supplements of placebo, iron-folic acid, zinc, or zinc plus iron-folic acid and followed for approximately 1 year. At baseline and four follow-up visits mothers completed questionnaires including information on demographic characteristics and child temperament and eating behaviors. The main effects of zinc and iron-folic acid supplementation on temperament and eating behaviors were assessed through crude and adjusted differences in mean cumulative score changes between visits 1 and 5. The adjusted rate-of-change for these outcomes was modeled using generalized estimating equations. Mean changes in temperament scores and in eating behavior scores between visits 1 and 5 were not significant in either the zinc or non-zinc group. Children in the iron-folic acid group increased temperament scores by 0.37 points over 5 visits (95% CI 0.02, 0.7), which was not significant after adjustment. Neither the adjusted rate-of-change in temperament scores between zinc and non-zinc (β = −0.03, 95% CI −0.3, 0.2) or iron-folic acid and non-iron-folic acid (β = 0.08, 95% CI −0.2, 0.3) were significantly different. Adjusted rate of change analysis showed no significant difference between zinc and non-zinc (β = −0.14, 95% CI −0.3, 0.04) or between iron and non-iron eating behavior scores (β = −0.11, 95% CI −0.3, 0.1). Only among children with iron-deficiency anemia at baseline was there a significant decrease in eating behavior score, indicating better eating behaviors, when supplemented with zinc (β = −0.3, 95% CI −0.6, −0.01), Ultimately, this effect of zinc on eating behaviors was the only effect we observed after approximately one year of micronutrient supplementation.
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Affiliation(s)
- Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Mary Katherine Charles
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Emily H. Siegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Subarna K. Khatry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Nepal Nutrition Intervention Project—Sarlahi (NNIP-S), Hariaun, Nepal
| | - Steven C. LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Nepal Nutrition Intervention Project—Sarlahi (NNIP-S), Hariaun, Nepal
| | - Rebecca J. Stoltzfus
- Nepal Nutrition Intervention Project—Sarlahi (NNIP-S), Hariaun, Nepal
- Division of Nutritional Sciences, Program in International Nutrition, Cornell University, Ithaca, New York, United States of America
| | - James M. Tielsch
- George Washington University, School of Public Health, Washington, District of Columbia, United States of America
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McDonald CM, McLean J, Kroeun H, Talukder A, Lynd LD, Green TJ. Household food insecurity and dietary diversity as correlates of maternal and child undernutrition in rural Cambodia. Eur J Clin Nutr 2014; 69:242-6. [PMID: 25117993 DOI: 10.1038/ejcn.2014.161] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/16/2014] [Accepted: 07/09/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess household food insecurity and dietary diversity as correlates of maternal and child anthropometric status and anemia in rural Cambodia. METHODS Trained interviewers administered a survey to 900 households in four rural districts of Prey Veng, Cambodia. The Household Food Insecurity Access Scale (HFIAS) and Household Dietary Diversity Score (HDDS) were used to assess household food insecurity and dietary diversity. The height, weight and hemoglobin concentration of the mother and youngest child under 5 years in each household were measured. Multivariate logistic regression models were constructed to assess the association between household food insecurity and dietary diversity, and child stunting and wasting, maternal thinness, maternal and child anemia. RESULTS The mean (s.d.) HFIAS and HDDS scores were 5.3 (3.9) and 4.7 (1.6), respectively. The respective prevalences of mild, moderate and severe food insecurity were 33, 37 and 12%. Maternal thinness, child stunting and child wasting were present in 14.6, 25.4 and 8.1% of respondents, respectively. The risk of maternal thinness, but not child stunting or wasting, increased as the severity of household food insecurity increased. Household food insecurity was also positively associated with maternal, but not child, anemia. Household dietary diversity status was not significantly associated with any of the outcomes we assessed. CONCLUSIONS Efforts to improve household food security are important as a means of promoting maternal nutritional status; however, additional research is needed to better understand the role of other factors that are driving the burden of child undernutrition in Cambodia.
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Affiliation(s)
- C M McDonald
- Famine Early Warning Systems Network, Washington, DC, USA
| | - J McLean
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
| | - H Kroeun
- Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia
| | - A Talukder
- Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia
| | - L D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - T J Green
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
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Mayo-Wilson E, Junior JA, Imdad A, Dean S, Chan XHS, Chan ES, Jaswal A, Bhutta ZA. Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years of age. Cochrane Database Syst Rev 2014:CD009384. [PMID: 24826920 DOI: 10.1002/14651858.cd009384.pub2] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Zinc deficiency is prevalent in low- and middle-income countries, and contributes to significant diarrhoea-, pneumonia-, and malaria-related morbidity and mortality among young children. Zinc deficiency also impairs growth. OBJECTIVES To assess the effects of zinc supplementation for preventing mortality and morbidity, and for promoting growth, in children aged six months to 12 years of age. SEARCH METHODS Between December 2012 and January 2013, we searched CENTRAL, MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, African Index Medicus, Conference Proceedings Citation Index, Dissertation Abstracts, Global Health, IndMED, LILACS, WHOLIS, metaRegister of Controlled Trials, and WHO ICTRP. SELECTION CRITERIA Randomised controlled trials of preventive zinc supplementation in children aged six months to 12 years compared with no intervention, a placebo, or a waiting list control. We excluded hospitalised children and children with chronic diseases or conditions. We excluded food fortification or intake, sprinkles, and therapeutic interventions. DATA COLLECTION AND ANALYSIS Two authors screened studies, extracted data, and assessed risk of bias. We contacted trial authors for missing information. MAIN RESULTS We included 80 randomised controlled trials with 205,401 eligible participants. We did not consider that the evidence for the key analyses of morbidity and mortality outcomes were affected by risk of bias. The risk ratio (RR) for all-cause mortality was compatible with a reduction and a small increased risk of death with zinc supplementation (RR 0.95, 95% confidence interval (CI) 0.86 to 1.05, 14 studies, high-quality evidence), and also for cause-specific mortality due to diarrhoea (RR 0.95, 95% CI 0.69 to 1.31, four studies, moderate-quality evidence), lower respiratory tract infection (LRTI) (RR 0.86, 95% CI 0.64 to 1.15, three studies, moderate-quality evidence), or malaria (RR 0.90, 95% CI 0.77 to 1.06, two studies, moderate-quality evidence).Supplementation reduced diarrhoea morbidity, including the incidence of all-cause diarrhoea (RR 0.87, 95% CI 0.85 to 0.89, 26 studies, moderate-quality evidence), but the results for LRTI and malaria were imprecise: LRTI (RR 1, 95% CI 0.94 to 1.07, 12 studies, moderate-quality evidence); malaria (RR 1.05, 95% 0.95 to 1.15, four studies, moderate-quality evidence).There was moderate-quality evidence of a very small improvement in height with supplementation (standardised mean difference (SMD) -0.09, 95% CI -0.13 to -0.06; 50 studies), but the size of this effect might not be clinically important. There was a medium to large positive effect on zinc status.Supplementation was associated with an increase in the number of participants with at least one vomiting episode (RR 1.29, 95% CI 1.14 to 1.46, five studies, high-quality evidence). We found no clear evidence of benefit or harm of supplementation with regard to haemoglobin or iron status. Supplementation had a negative effect on copper status. AUTHORS' CONCLUSIONS In our opinion, the benefits of preventive zinc supplementation outweigh the harms in areas where the risk of zinc deficiency is relatively high. Further research should determine optimal intervention characteristics such as supplement dose.
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Affiliation(s)
- Evan Mayo-Wilson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore MD, MD, USA, 21205
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Shill KB, Karmakar P, Kibria MG, Das A, Rahman MA, Hossain MS, Sattar MM. Prevalence of iron-deficiency anaemia among university students in Noakhali region, Bangladesh. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2014; 32:103-110. [PMID: 24847599 PMCID: PMC4089078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Iron-deficiency anaemia (IDA) is a common health problem in rural women and young children of Bangladesh. The university students usually take food from residential halls, and the food value of their diets is not always balanced. This cross-sectional study was conducted to estimate the prevalence of iron-deficiency anaemia among the university students of Noakhali region, Bangladesh. Haemoglobin level of 300 randomly-selected students was measured calorimetrically, using Sahli's haemoglobinometer during October to December 2011. Statistical analysis was done by using SPSS software for Windows (version 16) (SPSS Inc., Chicago, IL, USA). In the study, 55.3% students were found anaemic, of whom 36.7% were male, and 63.3% were female. Students aged 20-22 years were more anaemic (43.4%) than other age-groups. Majority (51.3%) of male students showed their haemoglobin level in the range of 13-15 g/dL, followed by 26.0% and 21.3% with 10-12 g/dL and 16-18 g/dL respectively. Although 50.5% anaemic and 51.1% non-anaemic female students showed normal BMI--lower percentage than anaemic (60.7%) and non-anaemic (71.9%) male students, the underweight students were found more anaemic than the overweight and obese subjects. Regular breakfast-taking habit showed significant (p = 0.035, 95% CI 0.5-1.0) influence on IDA compared to non-regular breakfast takers. Consumption of meat, fish, poultry, eggs, or peanut butter regularly; junk food; multivitamins; and iron/iron-rich food showed insignificant (p = 0.097, 95% CI 0.5-1.1; p = 0.053, 95% CI 1.1-2.3; p = 0.148, 95% CI 0.6-1.2; and p = 0.487, 95% CI 0.7-1.4 respectively) role in provoking IDA. In the case of non-anaemic subjects, all of the above parameters were significant, except the junk food consumption (p = 0.342, 95% CI 0.5-1.2). Our study revealed that majority of university students, especially female, were anaemic that might be aggravated by food habit and lack of awareness. The results suggest that anaemia can be prevented by providing proper knowledge on the healthful diet, improved lifestyle, and harmful effect of anaemia to the students.
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Affiliation(s)
- Kumar B. Shill
- Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Palash Karmakar
- Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Md. G. Kibria
- Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Abhijit Das
- Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Mohammad A. Rahman
- Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | | | - Mohammad M. Sattar
- Professor, Department of Pharmacy, Jahangirnagar University, Savar, Dhaka, Bangladesh
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Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, Regan M, Weatherall D, Chou DP, Eisele TP, Flaxman SR, Pullan RL, Brooker SJ, Murray CJL. A systematic analysis of global anemia burden from 1990 to 2010. Blood 2014; 123:615-24. [PMID: 24297872 PMCID: PMC3907750 DOI: 10.1182/blood-2013-06-508325] [Citation(s) in RCA: 1151] [Impact Index Per Article: 115.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/08/2013] [Indexed: 12/14/2022] Open
Abstract
Previous studies of anemia epidemiology have been geographically limited with little detail about severity or etiology. Using publicly available data, we estimated mild, moderate, and severe anemia from 1990 to 2010 for 187 countries, both sexes, and 20 age groups. We then performed cause-specific attribution to 17 conditions using data from the Global Burden of Diseases, Injuries and Risk Factors (GBD) 2010 Study. Global anemia prevalence in 2010 was 32.9%, causing 68.36 (95% uncertainty interval [UI], 40.98 to 107.54) million years lived with disability (8.8% of total for all conditions [95% UI, 6.3% to 11.7%]). Prevalence dropped for both sexes from 1990 to 2010, although more for males. Prevalence in females was higher in most regions and age groups. South Asia and Central, West, and East sub-Saharan Africa had the highest burden, while East, Southeast, and South Asia saw the greatest reductions. Iron-deficiency anemia was the top cause globally, although 10 different conditions were among the top 3 in regional rankings. Malaria, schistosomiasis, and chronic kidney disease-related anemia were the only conditions to increase in prevalence. Hemoglobinopathies made significant contributions in most populations. Burden was highest in children under age 5, the only age groups with negative trends from 1990 to 2010.
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Affiliation(s)
- Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
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Anaemia in infancy in rural Bangladesh: contribution of iron deficiency, infections and poor feeding practices. Br J Nutr 2013; 111:172-81. [PMID: 23768445 DOI: 10.1017/s0007114513001852] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Few data exist on the aetiology of anaemia and Fe deficiency (ID) during early infancy in South Asia. The present study aimed to determine the contribution of ID, infections and feeding practices to anaemia in Bangladeshi infants aged 6-11 months. Baseline data from 1600 infants recruited into a cluster-randomised trial testing the effectiveness of micronutrient powder sales by frontline health workers on the prevalence of anaemia were used. Multivariate logistic regression was used to identify risk factors for anaemia and ID, and population attributable fractions (PAF) were computed to estimate the proportion of anaemia that might be prevented by the elimination of individual risk factors. It was found that 68 % of the infants were anaemic, 56 % were Fe deficient, and one-third had evidence of subclinical infections. The prevalence of anaemia and ID increased rapidly, until 8-9 months of age, while that of subclinical infections was constant. ID (adjusted OR (AOR) 2·6-5·0; P< 0·001) and subclinical infections (AOR 1·4-1·5; P< 0·01) were major risk factors for anaemia, in addition to age and male sex. Similarly, subclinical infections, age and male sex were significant risk factors for ID. Previous-day consumption of Fe-rich foods was very low and not associated with anaemia or ID. The PAF of anaemia attributable to ID was 67 % (95 % CI 62, 71) and that of subclinical infections was 16 % (95 % CI 11, 20). These results suggest that a multipronged strategy that combines improvements in dietary Fe intake alongside infection control strategies is needed to prevent anaemia during infancy in Bangladesh.
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Leite MS, Cardoso AM, Coimbra CEA, Welch JR, Gugelmin SA, Lira PCI, Horta BL, Santos RV, Escobar AL. Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition. Nutr J 2013; 12:69. [PMID: 23714275 PMCID: PMC3681561 DOI: 10.1186/1475-2891-12-69] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the country. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first survey based on a nationwide representative sample to study the prevalence of anemia and associated factors among indigenous children in Brazil. METHODS The survey assessed the health and nutritional status of indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations. RESULTS Evaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North. CONCLUSIONS The prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.
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Affiliation(s)
- Maurício S Leite
- Departamento de Nutrição, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC 88040-900, Brazil
| | - Andrey M Cardoso
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brazil
| | - Carlos EA Coimbra
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brazil
| | - James R Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brazil
| | - Silvia A Gugelmin
- Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso, Av. Fernando Correa da Costa 2367, Cuiabá, MT 78060-900, Brazil
| | - Pedro Cabral I Lira
- Departamento de Nutrição, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego 1235, Recife, PE 50670-901, Brazil
| | - Bernardo L Horta
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS 96020-220, Brazil
| | - Ricardo Ventura Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brazil
- Departamento de Antropologia, Museu Nacional, Universidade Federal do Rio de Janeiro, Quinta da Boa Vista s/n, Rio de Janeiro, RJ 20940-040, Brazil
| | - Ana Lúcia Escobar
- Departamento de Ciências Biomédicas, Universidade Federal de Rondônia, Rodovia BR-364 Km 9.5, Porto Velho, RO 76801-059, Brasil
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Anaemia and iron deficiency between 2003 and 2007 in Amazonian children under 2 years of age: trends and associated factors. Public Health Nutr 2013; 16:1751-9. [PMID: 23369207 DOI: 10.1017/s1368980012005617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe trends in the prevalence of anaemia and Fe deficiency in children under 2 years of age living in a town in western Brazilian Amazonia. DESIGN Temporal analysis of two cross-sectional population-based surveys. Information on socio-economic status, morbidity and breast-feeding was obtained using a structured questionnaire. Child weight and length were measured for anthropometric evaluation. Concentrations of blood Hb, plasma ferritin and soluble transferrin receptor were measured. SETTING The town of Acrelândia, state of Acre, north-west Brazil. SUBJECTS A total of 170 and 224 participants of the 2003 and 2007 surveys, respectively. RESULTS Comparison between the 2003 and 2007 surveys revealed no statistically significant differences in the prevalence of anaemia (48 (95% CI 39, 56)% to 40 (95% CI 33, 47)%) or Fe-deficiency anaemia (39 (95% CI 30, 48)% to 37 (95% CI 30, 45)%), respectively. However, an increase in the overall prevalence of Fe deficiency from 62 (95% CI 51, 68)% to 81 (95% CI 75, 86)% was observed (χ2 test, P≤0.001). In age- and sex-adjusted analyses for risk of Fe deficiency, only early introduction of cow's milk (<90 d) was associated with Fe deficiency in 2003 (prevalence ratio (PR)=0.76; 95% CI 0.57, 1.01), while caesarean section (PR=1.18; 95% CI 1.03, 1.35) and birth weight <3500 g (PR=1.15; 95% CI 1.00, 1.34) were associated with Fe deficiency in 2007. CONCLUSIONS No improvements were observed in the prevalence of anaemia, exposing a worrying scenario for public health, while a significant increase was found in the prevalence of Fe deficiency in the studied infants and toddlers.
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Effects of zinc and iron supplementation fail to improve motor and language milestone scores of infants and toddlers. Nutrition 2013; 29:542-8. [PMID: 23298972 DOI: 10.1016/j.nut.2012.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the effects of zinc and iron-folic acid supplementation on motor and language milestones in Nepali children. METHODS Five hundred forty-four children 4 to 17 mo old residing in Ishwarpur, Nepal were randomized to receive placebo, iron-folic acid, zinc, or zinc plus iron-folic acid daily. Data were collected at baseline and at 3-mo intervals for 1 y. The main effects of zinc and iron folic-acid supplementation were estimated for motor and language milestones. Crude and adjusted mean cumulative changes in scores from visits 1 to 5 and adjusted rates of change were modeled. RESULTS Adjusted differences in motor milestone scores from visits 1 to 5 and rates of change were not significantly different for the zinc and non-zinc groups (adjusted β = -0.7, 95% confidence interval [CI] -1.4 to 0.01; adjusted β = -0.1, 95% CI -0.5 to 0.3, respectively). Motor milestones in children receiving and not receiving iron supplements were not significantly different (adjusted β = 0.1, 95% CI -0.7 to 0.8, from visits 1 to 5; adjusted β = 0.1, 95% CI -0.3 to 0.5, for rate of change). Children receiving zinc had a 0.8 lower mean crude change in language score from visits 1 to 5 compared with children not receiving zinc (95% CI -1.3 to -0.3), but the significance was lost after adjustment (adjusted β = -0.2, 95% CI -0.6 to 0.2, for visits 1 to 5; β = -0.1, 95% CI -0.3 to 0.2, for rate of change). No significant difference in motor or language milestone scores from iron supplementation was observed. CONCLUSION After 1 y, neither zinc nor iron-folic acid supplementation in Nepali children improved the attainment of motor or language milestones.
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Beneficial effects of zinc supplementation on head circumference of Nepalese infants and toddlers: a randomized controlled trial. Eur J Clin Nutr 2012; 66:836-42. [DOI: 10.1038/ejcn.2012.42] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Joshi N, Agho KE, Dibley MJ, Senarath U, Tiwari K. Determinants of inappropriate complementary feeding practices in young children in Nepal: secondary data analysis of Demographic and Health Survey 2006. MATERNAL AND CHILD NUTRITION 2012; 8 Suppl 1:45-59. [PMID: 22168518 DOI: 10.1111/j.1740-8709.2011.00384.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Inappropriate complementary feeding increases the risk of undernutrition, illness and mortality in infants and children. This study uses a subsample of 1428 children of 6-23 months from Nepal Demographic and Health Survey (NDHS), 2006. The 2006 NDHS was a multistage cluster sample survey. The complementary feeding indicators were estimated according to the 2008 World Health Organization recommendations. The rate of introduction of solid, semi-solid or soft foods to infants aged 6-8 months was 70%. Minimum meal frequency and minimum dietary diversity rates were 82% and 34%, respectively, and minimum acceptable diet for breastfed infants was 32%. Multivariate analysis indicated that working mothers and mothers with primary or no education were significantly less likely to give complementary foods, to meet dietary diversity, minimum meal frequency and minimum acceptable diet. Children living in poor households were significantly less likely to meet minimum dietary diversity and minimum acceptable diet. Mothers who had adequate exposure to media, i.e. who watch television and who listen to radio almost every day, were significantly more likely to meet minimum dietary diversity and meal frequency. Infants aged 6-11 months were significantly less likely to meet minimum acceptable diet [adjusted odds ratio (OR)=3.13, confidence interval (CI)=2.16-4.53] and to meet minimum meal frequency (adjusted OR=4.46, CI=2.67-7.46). In conclusion, complementary feeding rates in Nepal are inadequate except for minimum meal frequency. Planning and promotion activities to improve appropriate complementary feeding practices should focus on illiterate mothers, those living in poor households, and those not exposed to media.
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Affiliation(s)
- Nira Joshi
- NewERA: Development Research and Training for Change, Kathmandu, Nepal.
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Siegel EH, Kordas K, Stoltzfus RJ, Katz J, Khatry SK, LeClerq SC, Tielsch JM. Inconsistent effects of iron-folic acid and/or zinc supplementation on the cognitive development of infants. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2011; 29:593-604. [PMID: 22283033 PMCID: PMC3259722 DOI: 10.3329/jhpn.v29i6.9896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Despite concerns over the neurocognitive effects of micronutrient deficiencies in infancy, few studies have examined the effects of micronutrient supplementation on specific cognitive indicators. This study investigated, in 2002, the effects of iron-folic acid and/or zinc supplementation on the results of Fagan Test of Infant Intelligence (FTII) and the A-not-B Task of executive functioning among 367 Nepali infants living in Sarlahi district. Infants were enrolled in a cluster-randomized, placebo-controlled clinical trial of daily supplementation with 5 mg of zinc, 6.25 mg of iron with 25 microg of folic acid, or zinc-iron-folic acid, or placebo. These were tested on both the tasks using five indicators of information processing: preference for novelty (FTII), fixation duration (FTII), accelerated performance (> or = 85% correct; A-not-B), deteriorated performance (< 75% correct and > 1 error on repeat-following-correct trails; A-not-B), and the A-not-B error (A-not-B). At 39 and 52 weeks, 247 and 333 infants respectively attempted the cognitive tests; 213 made an attempt to solve both the tests. The likelihood of females completing the A-not-B Task was lower compared to males when cluster randomization was controlled [odds ratio = 0.67; 95% confidence interval 0.46-0.97; p < 0.05]. All of the five cognitive outcomes were modelled in linear and logistic regression. The results were not consistent across either the testing sessions or the information-processing indicators. Neither the combined nor the individual micronutrient supplements improved the performance on the FTII or the A-not-B Task (p > 0.05). These findings suggest that broader interventions (both in terms of scope and duration) are needed for infants who face many biological and social stressors.
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Affiliation(s)
- Emily H Siegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Anaemia in Ugandan preschool-aged children: the relative contribution of intestinal parasites and malaria. Parasitology 2011; 138:1534-45. [PMID: 21819635 DOI: 10.1017/s0031182011001016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anaemia is a severe public health issue among African preschool-aged children, yet little effective progress has been made towards its amelioration, in part due to difficulties in unravelling its complex, multifactorial aetiology. To determine the current anaemia situation and assess the relative contribution of malaria, intestinal schistosomiasis and infection with soil-transmitted helminths, two separate cross-sectional epidemiological surveys were carried out in Uganda including 573 and 455 preschool-aged children (≤6 years) living along the shores of Lake Albert and on the islands in Lake Victoria, respectively. Anaemia was found to be a severe public health problem in Lake Albert, affecting 68·9% of children (ninety-five percent confidence intervals (95% CI) 64·9-72·7%), a statistically significant higher prevalence relative to the 27·3% detected in Lake Victoria (95% CI: 23·3-31·7%). After multivariate analysis (controlling for sex and age of the child), the only factor found to be significantly associated with increased odds of anaemia in both lake systems was malaria (Lake Albert, odds ratio (OR)=2·1, 95% CI: 1·4-3·2; Lake Victoria, OR=1·9, 95% CI: 1·2-2·9). Thus intervention strategies primarily focusing on very young children and combating malaria appear to represent the most appropriate use of human and financial resources for the prevention of anaemia in this age group and area. Looking to the future, these activities could be further emphasised within the National Child Health Days(PLUS) agenda.
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Ramzi M, Haghpanah S, Malekmakan L, Cohan N, Baseri A, Alamdari A, Zare N. Anemia and iron deficiency in adolescent school girls in kavar urban area, southern iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:128-33. [PMID: 22737447 PMCID: PMC3371916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/02/2010] [Accepted: 08/09/2010] [Indexed: 11/01/2022]
Abstract
BACKGROUND Anemia is one of the most common public health problems especially in developing countries. We investigated the prevalence of anemia, iron deficiency anemia and related risk factors in adolescent school girls in Kavar urban area in southern Iran. METHODS A total of 363 adolescent school girls were evaluated by a cross sectional study. Socioeconomic, demographic and related risk factors were obtained by a questionnaire. Hematological parameters and serum iron indices were measured. RESULTS There were 21 cases of anemia (5.8%), 31 (8.5%) iron deficiency and 6 (1.7%) iron deficiency anemia. Most of anemic girls (85.7%) had mild anemia. MCV, TIBC, age, and BMI had statistically significant relationship with hemoglobin. Only parasites infestation in the last three months had a 6.83 times more risk of anemia than those without this history (95% CI, 1.66-28.11). CONCLUSION The prevalence of anemia and iron deficiency anemia in this study were substantially less than what reported in many other regions of Iran as well as other developing countries. It seems that related implemented strategies in the recent years have been successful. More especial attention to prevention of parasite infestation should be considered in this area.
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Affiliation(s)
- M Ramzi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - L Malekmakan
- Nephrourology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N Cohan
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Baseri
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Alamdari
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N Zare
- Statistical Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Osei A, Pandey P, Spiro D, Nielson J, Shrestha R, Talukder Z, Quinn V, Haselow N. Household Food Insecurity and Nutritional Status of Children Aged 6 to 23 Months in Kailali District of Nepal. Food Nutr Bull 2010. [DOI: 10.1177/156482651003100402] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Food insecurity and malnutrition among children are common in Nepal. However, inadequate data exist on the association between household food insecurity and the nutritional status of children. Objective To assess the relationship between household food insecurity and malnutrition among children aged 6 to 23 months in Kailali District of Nepal. Methods We analyzed data from families of 368 children 6 to 23 months of age who completed a cross-sectional survey in January 2009. The data contained information on sociodemographic characteristics, food insecurity, child feeding practices, use of preventive health services, and height, weight, and hemoglobin levels of children and mothers. Results More than two-thirds (69%) of households were classified as food insecure (had insufficient access to adequate food). The prevalence rates of stunting, underweight, and wasting among children were 41%, 24%, and 9%, respectively. The prevalence of anemia was 58%. There were no significant associations between household food insecurity and stunting, underweight, or anemia. Stunting and underweight were associated with maternal height and household wealth ( p < .05). Underweight was also associated with maternal education ( p < .05). Anemia was associated with low maternal hemoglobin concentration ( p < .05). Conclusions Food insecurity was common in households with children 6 to 23 months of age in Kailali District of Nepal. The rates of stunting, underweight, wasting, and anemia were also high. However, there was no significant association between household food insecurity and malnutrition among children. Therefore, not just access to food, but an integrated approach that improves the overall socioeconomic well-being of families, maternal education, and knowledge of optimal nutrition practices, together with adequate maternal nutrition, is needed to address malnutrition among young children.
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Wu L, Katz J, Mullany LC, Haytmanek E, Khatry SK, Darmstadt GL, West KP, LeClerq SC, Tielsch JM. Association between nutritional status and positive childhood disability screening using the ten questions plus tool in Sarlahi, Nepal. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2010; 28:585-594. [PMID: 21261204 PMCID: PMC2995027 DOI: 10.3329/jhpn.v28i6.6607] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The study was conducted to examine the association between the indicators of malnutrition and disability of children as reported by caregivers. The Ten Questions Plus questionnaire was administered to caregivers of 1,902 children aged 1-9 years, during August 2007-March 2008, in rural Nepal. Height and weight of children were also measured. The main outcome was a positive response to one or more questions. In total, 514 (27%) children had a positive response to at least one question. Moderate stunting [odds ratio (OR)=1.47, 95% confidence interval (CI) 1.02-2.12) and severe (OR=2.39, 95% CI 1.60-3.57) stunting were independently associated with reported delay in sitting, standing, or walking. Severe stunting was also associated with report of delayed learning compared to other children of similar age (OR=2.01, 95% CI 1.27-3.20). Parental report of disability was quite prevalent in this setting, with over a quarter of the sample screening positive. Chronic malnutrition may be associated with delayed motor and mental development.
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Affiliation(s)
- L Wu
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2103, USA
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Katz J, Khatry SK, LeClerq SC, Mullany LC, Yanik EL, Stoltzfus RJ, Siegel EH, Tielsch JM. Daily supplementation with iron plus folic acid, zinc, and their combination is not associated with younger age at first walking unassisted in malnourished preschool children from a deficient population in rural Nepal. J Nutr 2010; 140:1317-21. [PMID: 20484548 PMCID: PMC2884332 DOI: 10.3945/jn.109.119925] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A community-based, cluster-randomized, placebo-controlled trial of daily zinc and/or iron+folic acid supplementation was conducted in rural southern Nepal to examine motor milestone attainment among 3264 children 1-36 mo of age between 2001 and 2006. Treatment groups included placebo, zinc (10 mg), iron+folic acid (12.5 mg iron + 50 microg folic acid), and zinc+iron+folic acid (10 mg zinc + 12.5 mg iron + 50 microg folic acid). Infants received half of these doses. The iron arms were stopped November 2003 by recommendation of the Data Safety and Monitoring Board; zinc and placebo continued until January 2006. A total of 2457 children had not walked at the time of entry into the trial and 1775 were followed through 36 mo. Mean age at first walking unassisted did not differ among groups and was 444 +/- 81 d (mean +/- SD) in the placebo group, 444 +/- 81 d in the zinc group, 464 +/- 85 d in the iron+folic acid group, and 446 +/- 87 d in the iron+folic acid+zinc group. Results were similar after adjustment for age at enrollment, asset ownership, maternal literacy, and prior child deaths in the household and in children who consumed at least 60 tablets. Compared with placebo, iron+folic acid was associated with an adjusted mean delay of 28.0 d (95% CI: 11.3, 44.7) in time to walking among infants and the delay was more pronounced with mid-upper arm circumference (MUAC) < 9.5 cm [60.6 d, (95% CI: 28.5, 92.6)]. Risks and benefits of universal iron+folic acid supplementation of infants beyond improved hematologic status deserve further consideration.
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Affiliation(s)
- Joanne Katz
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850,To whom correspondence should be addressed. E-mail:
| | - Subarna K. Khatry
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850
| | - Steven C. LeClerq
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850
| | - Luke C. Mullany
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850
| | - Elizabeth L. Yanik
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850
| | - Rebecca J. Stoltzfus
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850
| | - Emily H. Siegel
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850
| | - James M. Tielsch
- Department of International Health and; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205; Nepal Nutrition Intervention Project–Sarlahi, Kathmandu, Nepal; and Department of Nutrition Science, Cornell University, Ithaca, NY 14850
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The effects of iron and/or zinc supplementation on maternal reports of sleep in infants from Nepal and Zanzibar. J Dev Behav Pediatr 2009; 30:131-9. [PMID: 19322104 PMCID: PMC2771202 DOI: 10.1097/dbp.0b013e31819e6a48] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is some evidence that sleep patterns may be affected by iron deficiency anemia but the role of iron in sleep has not been tested in a randomized iron supplementation trial. OBJECTIVE We investigated the effect of iron supplementation on maternal reports of sleep in infants in 2 randomized, placebo-controlled trials from Pemba Island, Zanzibar, and Nepal. DESIGN In both studies, which had parallel designs and were carried out in years 2002 to 2003, infants received iron-folic acid with or without zinc daily for 12 months, and assessments of development were made every 3 months for the duration of the study. Eight hundred seventy-seven Pemban (12.5 +/- 4.0 months old) and 567 Nepali (10.8 +/- 4.0 months) infants participated. Maternal reports of sleep patterns (napping frequency and duration, nighttime sleep duration, frequency of night waking) were collected. RESULTS Mean Hb concentration was 9.2 +/- 1.1 for Pemban and 10.1 +/- 1.2 g/dL for Nepali infants. Approximately, one-third of the children were stunted. Supplemental iron was consistently associated with longer night and total sleep duration. The effects of zinc supplementation also included longer sleep duration. CONCLUSIONS Micronutrient supplementation in infants at high risk for iron deficiency and iron deficiency anemia was related to increased night sleep duration and less night waking.
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Dietary practices and nutritional status of 0–24-month-old children from Brazilian Amazonia. Public Health Nutr 2009; 12:2335-42. [DOI: 10.1017/s1368980009004923] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo assess the nutritional status and dietary practices of 0–24-month-old children living in Brazilian Amazonia.DesignCross-sectional study. Information on children’s dietary intakes was obtained from diet history data. Weight and length were measured for anthropometric evaluation. Fe status was assessed using fasting venous blood samples; Hb, serum ferritin and soluble transferrin receptor concentrations were measured.SettingThe towns of Assis Brasil and Acrelândia in the state of Acre, north-west Brazil.SubjectsA total of sixty-nine randomly selected 0–24-month-old children.ResultsOf these children, 40·3 % were anaemic, 63·1 % were Fe-deficient, 28·1 % had Fe-deficiency anaemia and 11·6 % were stunted. Breast-feeding was initiated by 97·1 % of mothers, followed by early feeding with complementary foods. The dietary pattern reflected a high intake of carbohydrate-rich foods and cow’s milk, with irregular intakes of fruit, vegetables and meat. All infants and 92·3 % of toddlers were at risk of inadequate Fe intakes. Fe from animal foods contributed on average 0·5 % and 14·3 % to total dietary Fe intake among infants and toddlers, respectively.ConclusionsPoor nutritional status and inadequate feeding practices in this study population reinforce the importance of exclusive breast-feeding during the first 6 months of life. Greater emphasis is required to improve the bioavailability of dietary Fe during complementary feeding practices.
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Maternal reports of sleep in 6-18 month-old infants from Nepal and Zanzibar: association with iron deficiency anemia and stunting. Early Hum Dev 2008; 84:389-98. [PMID: 18022771 DOI: 10.1016/j.earlhumdev.2007.10.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 10/09/2007] [Accepted: 10/15/2007] [Indexed: 01/01/2023]
Abstract
BACKGROUND Infants with iron deficiency anemia (IDA) and stunting explore and interact less with their environment. They may also be fatigued more often, suggesting their sleep may be affected. It is unclear whether fatigue in these infants is due to poor nighttime sleep or if it is compensated for with frequent naps or longer sleep. AIMS In 2 studies from Pemba Island, Zanzibar and 1 from Nepal we investigated the relationship between IDA, stunting, and maternal reports of sleep in 6-18 mo old infants. METHODS Parents reported on the number and duration of naps, hours of nighttime sleep, and frequency of night waking. Anemia was defined as Hb<10 g/dL, iron deficiency as zinc protoporphyrin (ZPP > or = 90 micromol/mol heme), stunting as HAZ<-2 SD, and IDA as Hb<10 g/dL and ZPP > or = 90 micromol/mol heme. RESULTS The prevalence of IDA and stunting was 34-84% and 22-37%, respectively. Most infants napped during the day and took approximately 1.5 naps (mean nap duration 1.4-1.7 h). Mean nighttime sleep duration was 8.3-9.7 h and infants awoke 2.1-2.5 times per night. Both IDA and stunting were associated with differences in reported sleep characterized by shorter night sleep duration and higher frequency of night waking; stunting was also related to shorter nap duration. CONCLUSIONS We found reduced sleep duration and increased night waking among infants with IDA and stunting. Because sleep plays an essential role in infant development, our findings indicate a clear need for further research into these relationships.
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Sanou D, Turgeon-O’Brien H, Desrosiers T. Prévalence et déterminants non alimentaires de l’anémie et de la carence en fer chez des orphelins et enfants vulnérables d’âge préscolaire du Burkina-Faso. NUTR CLIN METAB 2008. [DOI: 10.1016/j.nupar.2008.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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