Traditional food consumption and nutritional status of Dalit mothers in rural Andhra Pradesh, South India

Small Area Variations in Dietary Diversity Among Children in India: A Multilevel Analysis of 6–23-Month-Old Children

Dietary diversity is an important indicator of child malnutrition. However, little is known about the geographic variation of diet indicators across India, particularly within districts and across states. As such, the purpose of this paper was to elucidate the small area variations in diet indicators between clusters within districts of India. Overall, we found that clusters were the largest source of variation for children not eating grains, roots, and tubers, legumes and nuts, dairy, vitamin A-rich vegetables and fruits, and other vegetables and fruits. We also found positive correlations between the district percent and cluster standard deviations of children not breastfeeding or eating grains, roots, and tubers, but negative correlations between the district percent and cluster standard deviation for the remaining seven outcomes. These findings underscore the importance of targeting clusters to improve child dietary diversity.

Social identity as a driver of adult chronic energy deficiency: analysis of rural Indian households

This study investigates the effect of social identity (caste, religion, gender, and asset) on adult chronic energy deficiency (CED) using the Indian Human Development Survey (IHDS) data from 2005 and 2011. From 2005 to 2011, out of 63,323 adult individuals, four-fifths (85.7%) of men and two-fifths (44.7%) of women improved their health status from CED to non-CED. The lowest improvement was observed among Dalit (Scheduled Casts, Scheduled Tribes) women: 41.9% moved from CED to non-CED status. We also find significant differences in prevalence of CED between Dalit and non-Dalit individuals and households. To achieve a significant improvement in CED, programs targeting malnourishment must be prioritized the Dalit households.

Food insecurity among women of reproductive age in Nepal: prevalence and correlates

BACKGROUND

Food insecurity is widely prevalent in certain sections of society in low and middle-income countries. The United Nations has challenged all member countries to eliminate hunger for all people by 2030. This study examines the prevalence and correlates of household food insecurity among women, especially Dalit women of reproductive age in Nepal.

METHODS

Data came from 2016 Nepal Demographic Health Survey, a cross-sectional, nationally representative survey that included 12,862 women between 15 and 49 years of age of which 12% were Dalit. Descriptive analysis was used to assess the prevalence of household food insecurity while logistic regression examined the relationship between women's ethnicity and the risk of food insecurity after accounting for demographic, economic, cultural, and geo-ecological characteristics.

RESULTS

About 56% of all women and 76% of Dalit women had experienced food insecurity. Ethnicity is strongly related to food insecurity. Dalit women were most likely to be food insecure, even after accounting for factors such as education and wealth. They were 82, 85, 89 and 92% more vulnerable to food insecurity than Muslims, Brahmin/Chhetri, Terai Indigenous, and Hill Indigenous populations, respectively. Education was a protective factor-women with secondary education (6th to 10th grade) were 39% less likely to be food insecure compared to their counterparts without education. With a more than 10th grade education, women were 2.27 times more likely to be food secure compared to their counterparts without education. Marriage was also protective. Economically, household wealth is inversely correlated with food insecurity. Finally, residence in the Mid-Western, Far-Western and Central Development regions was correlated with food insecurity.

CONCLUSION

To reduce food insecurity in Nepal, interventions should focus on improving women's education and wealth, especially among Dalit and those residing in the Far- and Mid-Western regions.

How Do Fruit and Vegetable Markets Operate in Rural India? A Qualitative Study of the Impact of Supply and Demand on Nutrition Security

BACKGROUND

Diets in rural India are cereal based with low intakes of micronutrient-rich foods. The value chains for nutrition approach aims to study supply and demand of such foods. This may aid in development of interventions to improve diets and livelihoods.

OBJECTIVES

(1) To identify how fruit and vegetables are accessed, (2) to describe and map the structure of value chains for exemplar foods, (3) to understand how foods are priced, and (4) to explore factors that affect decisions about which crops are grown, marketed, and sold.

METHODS

After stakeholder consultation, we identified 2 fruits (mango and guava) and 2 vegetables (shepu and spinach) as exemplar foods. Criteria for these exemplar foods were that they should be known to participants and there should be variability in intakes. We held 24 interviews with value chain actors including farmers, wholesalers, and vendors of the exemplar foods. Data collection was stopped when no new information emerged. We used inductive thematic coding for our analysis.

RESULTS

The value chains for each of the exemplar foods were relatively simple and involved farmers, middlemen, and vendors at either city or village level. The main themes identified as being factors considered when making decisions about which foods to grow and sell were (1) farming resources and assets, (2) quality of produce, (3) environmental conditions, (4) financial factors, (5) transport availability, and (6) consumer demand.

CONCLUSIONS

There are opportunities to intervene within fruit and vegetable value chains to increase availability, affordability, and access to produce in rural India. Future research is required to determine which interventions will be feasible, effective, and acceptable to the community and other stakeholders.

Selection of complementary foods based on optimal nutritional values

Human milk is beneficial for growth and development of infants. Several factors result in mothers ceasing breastfeeding which leads to introduction of breast-milk substitutes (BMS). In some communities traditional foods are given as BMS, in others they are given as complementary foods during weaning. Improper food selection at this stage is associated with a high prevalence of malnutrition in children under 5 years. Here we listed the traditional foods from four continents and compared them with human milk based on their dietary contents. Vitamins such as thiamine (~[2-10] folds), riboflavin (~[4-10] folds) and ascorbic acid (<2 folds) contents of Asian and African foods were markedly lower. In order to extend the search for foods that includes similar dietary constituents as human milk, we designed a strategy of screening 8654 foods. 12 foods were identified and these foods were evaluated for their ability to meet the daily nutritional requirement of breastfed and non-breastfed infants during their first year of life. Genome-scale models of infant's hepatocytes, adipocytes and myocytes were then used to simulate in vitro growth of tissues when subjected to these foods. Key findings were that pork ham cured, fish pudding, and egg lean white induced better tissue growth, and quark with fruit, cheese quarg 45% and cheese cream 60% had similar lactose content as human milk.

Coverage of Adequately Iodized Salt Is Suboptimal and Rice Fortification Using Public Distribution Channels Could Reach Low-Income Households: Findings from a Cross-Sectional Survey of Anganwadi Center Catchment Areas in Telangana, India

Food fortification is a cost-effective approach to prevent and control of micronutrient deficiencies in India. A cross-sectional survey of children 0-35 months of age residing in the catchment areas of anganwadi centers in the state of Telangana was conducted to assess the coverage of adequately iodized salt and the potential for rice fortification. Salt samples were collected and tested for iodine concentration using iodometric titration. Information on demographics, household rice consumption, and Telangana's rice sector was collected and interpreted. In households of selected children, 79% of salt samples were found to be adequately iodized. Salt brand and district were significant predictors of inadequately iodized salt. Daily rice consumption among children and women averaged 122 grams and 321 grams per day, respectively. Approximately 28% of households reported consuming rice produced themselves or purchased from a local farmer, 65% purchased rice from a market or shop, 6% got rice from a public distribution system site, and 2% obtained it from a rice mill. In the catchment areas of Telangana's anganwadi centers, there is significant variation in the coverage of adequately iodized salt by district. Future surveys in Telangana should measure the coverage of salt iodization in the general population using quantitative methods. Nonetheless, increasing the adequacy of iodization of smaller salt manufacturers would help achieve universal salt iodization in Telangana. Despite high consumption of rice, our findings suggest that large-scale market-based rice fortification is not feasible in Telangana due to a large proportion of households producing their own rice and highly fragmented rice distribution. Distributing fortified rice via Telangana's public distribution system may be a viable approach to target low-income households, but would only reach a small proportion of the population in Telangana.

Prevalence and causes of monocular childhood blindness in a rural population in southern India

PURPOSE

To determine the prevalence and etiology of childhood monocular blindness in a rural population in southern India.

METHODS

A total of 14,423 children younger than 15 years in randomly selected villages (8,222 households) with a total population of 40,336 were screened. Screening was performed in two stages. In the first stage, all children with visual acuity worse than 6/18 in at least one eye were screened. Subsequently, children with visual acuity worse than 3/60 in one eye were referred to a tertiary care hospital for further examination for determination of the cause of visual impairment.

RESULTS

The age range of affected children was 1 to 15 years (median age: 12 years). Fifteen children had monocular visual impairment, yielding a prevalence rate of 1.13 in 1,000 children. Refractive error leading to amblyopia was the most common cause of monocular visual impairment, followed by trauma, congenital disorders, and vitamin A deficiency. One case had toxoplasmosis. Approximately one-third of the children were born of a consanguineous marriage (30.06%). The proportion of first-degree consanguinity (46.4%) was higher than that of second-degree (37.5%) or third-degree (16.1%) consanguinity.

CONCLUSION

The prevalence of childhood monocular blindness was high in the current study, but most causes were preventable or treatable. Improved screening methods (especially for refractive errors), genetic counseling, and therapeutic interventions can reduce the burden of childhood blindness.

Vitamin A fortification of wheat flour: considerations and current recommendations

BACKGROUND

Vitamin A deficiency is a major public health nutrition problem, affecting an estimated 190 million preschool-aged children and 19 million pregnant and lactating women globally, and 83 million adolescents in Southeast Asia alone. Its consequences (disorders) include xerophthalmia (the leading cause of early childhood blindness), increased severity of infection, anemia, and death. Because vitamin A deficiency is largely due to chronic dietary insufficiency of preformed vitamin A and proactive carotenoids, food fortification can offer an effective approach to prevention.

OBJECTIVE

To provide guidance on fortifying wheat and maize flour milled in industrial rollers for national fortification programs in countries where vitamin A deficiency is considered a public health problem.

METHODS

Critical review of the literature on the dietary gap in vitamin A intake and levels of wheat flour intake among risk groups as a basis for determining vitamin A fortificant levels. Additional review of efficacy evidence, safety and cost considerations, and country experiences related to wheat-flour fortification with vitamin A.

RESULTS

Mill-rolled wheat flour is a technically fortifiable, centrally processed food vehicle that, where routinely and adequately consumed by target groups, should be considered a candidate for fortification. Vitamin A can be stable in flour under typical, ambient conditions, with processing losses estimated at approximately 30%, depending on source and premix conditions.

CONCLUSIONS

Factors to guide a decision to fortify flour with vitamin A include the extent of deficiency, availability of other food vehicle options, the centrality of milling, market reach and population intake distributions of the flour products, the dietary vitamin A intake required, and associated costs. Large gaps persist in knowledge of these factors, which are needed to enable evidence-based fortification in most countries, leaving most decisions to fortify guided by assumptions. Where flour can and should be fortified, guidelines are given for providing nearly 25% of the Recommended Dietary Allowance for vitamin A to vulnerable groups consuming varying ranges of flour products. The costs will vary according to the level of fortification.

Potential roles of high salt intake and maternal malnutrition in the development of hypertension in disadvantaged populations

1. It has been argued that all major risk factors for cardiovascular disease have been identified. Yet, epidemiological studies undertaken to identify risk factors have largely focused on populations in developed nations or on the urban or relatively affluent rural populations of developing countries. Poor rural populations are seldom studied. 2. Somewhat different risk factors may operate in poor rural populations. Evidence for this is provided by the finding that, in disadvantaged rural India, the prevalence of hypertension is greater than would be expected based on established risk factors in these populations. One risk factor to be considered is a poor intrauterine environment. 3. In animals, maternal macro- and micronutrient malnutrition can lead to reduced nephron endowment. Nephron deficiency, in turn, can render blood pressure salt sensitive. The combination of nephron deficiency and excessive salt intake will predispose to hypertension. 4. Human malnutrition may have similar effects, particularly in regions of the world where malnutrition is endemic and where women are disadvantaged by existing social practices. 5. Moreover, high salt intake is endemic in many parts of Asia, including India. Therefore, we propose that maternal malnutrition (leading to reduced nephron endowment), when combined with excessive salt intake postnatally, will account, at least in part, for the unexpectedly high prevalence of hypertension in disadvantaged rural communities in India and elsewhere.

Assessing diet in longitudinal birth cohort studies

Diet is an important component of a person's environment. It is important for adults and particularly for mothers during pregnancy and while breast feeding, and for children in utero and during later growth and development. Measurement of the type and amount of foods consumed is complex. Here we describe the different methods that can be used, when and when not to use each one, and the importance of validation studies.

Pediatric ophthalmology in the developing world

PURPOSE OF REVIEW

It is estimated that of the 45 million people who are blind worldwide in 2000, 1.4 million are children from middle-income and low-income countries, the majority of whom live in the poorest regions of Africa and Asia. The focus of this paper is to discuss the status of pediatric ophthalmology in developing countries and the progress that has been made in the areas of avoidable childhood blindness and visual impairment, particularly corneal scarring as a result of vitamin A deficiency, congenital cataract and retinopathy of prematurity. In addition, we will review the prevalence of uncorrected refractive error and discuss the access to pediatric ophthalmologists in developing countries.

RECENT FINDINGS

Some developing countries have begun incorporating vitamin A supplementation and measles immunizations and have seen a decrease in xerophthtalmia. With improvement in vitamin A status, cataract is becoming a more apparent cause of treatable childhood blindness. Amblyopia and uncorrected refractive errors are important and inexpensively treatable causes of visual impairment, with myopia being most common. As neonatal intensive care services in middle-income developing countries improve the survival of premature infants, retinopathy of prematurity is emerging as a significant cause of childhood blindness.

SUMMARY

Childhood blindness and visual impairment in developing countries remains a significant public health issue, but recent initiatives have shown promise of future improvements.