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Hassink SG, Fairbrother G. Obesity and Hunger Threaten the Foundations of Child Health. Acad Pediatr 2021; 21:396-400. [PMID: 32798724 PMCID: PMC7424333 DOI: 10.1016/j.acap.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Gerry Fairbrother
- Fairbrother Policy Studies, LLC, Policy and Health Services, Academic Pediatrics (G Fairbrother), Santa Fe, NM
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Tesema GA, Yeshaw Y, Worku MG, Tessema ZT, Teshale AB. Pooled prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis. PLoS One 2021; 16:e0248637. [PMID: 33765094 PMCID: PMC7993805 DOI: 10.1371/journal.pone.0248637] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Childhood undernutrition is the leading cause of under-five mortality and morbidity in the world particularly in East African countries. Although there are studies on child undernutrition in different East African countries, our search of the literature revealed that there is limited evidence of a pooled analysis of these studies. Therefore, this study aimed to investigate the pooled prevalence and associated factors of chronic undernutrition (i.e. stunting) among under-five children in East Africa. METHODS A pooled analysis of the Demographic and Health Surveys (DHSs) in 12 East African countries was conducted. A total weighted sample of 79744 under-five children was included in the study. Mixed-effect logistic regression analysis was used to identify significant factors associated with chronic undernutrition since the DHS data has a hierarchical structure. The intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), Likelihood Ratio (LR)-test, and deviance was used for model comparison. Variables with p-value <0.2 in the bivariable mixed-effect logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel analysis model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported for significant factors. RESULTS The pooled prevalence of chronic undernutrition among underfive children in East Africa was 33.3% (95% CI: 32.9%, 35.6%) ranging from 21.9% in Kenya to 53% in Burundi. Children whose mothers lived in rural area (AOR = 1.11, 95% CI: 1.06, 1.16), born to mother who had no formal education (AOR = 1.42, 95% CI: 1.34, 1.50) and primary education (AOR = 1.37, 95% CI: 1.31, 1.44), being in poor household (AOR = 1.66, 95% CI: 1.58, 1.74), and middle household (AOR = 1.42, 95% CI: 1.35, 1.49), child aged 36-48 months (AOR = 1.09, 95% CI: 1.04, 1.14), being male (AOR = 1.19, 95% CI: 1.15, 1.23), 2nd - 4th birth order (AOR = 1.08, 95% CI: 1.03, 1.13), and above 4th 1.27 (AOR = 1.27, 95% CI: 1.19, 1.35), home delivery 1.09 (AOR = 1.09, 95% CI: 1.05, 1.13), small size at birth (AOR = 1.35, 95% CI: 1.29, 1.40) and being multiple births (AOR = 1.98, 95% CI: 1.81, 2.17) were associated with increased odds of stunting. While, antenatal care visit (AOR = 0.89, 95% CI: 0.86, 0.93), mothers aged 25-34 (AOR = 0.83, 95% CI: 0.79, 0.86) and ≥ 35 years (AOR = 0.76, 95% CI: 0.72, 0.81), large size at birth (AOR = 0.85, 95% CI: 0.81, 0.88), and family size >8 (AOR = 0.92, 95% CI: 0.87, 0.98) were associated with decreased odds of stunting. CONCLUSION The study revealed that stunting among under-five children remains a major public health problem in East Africa. Therefore, to improve child nutrition status the governmental and non-governmental organizations should design public health interventions targeting rural residents, and the poorest households. Furthermore, enhancing health facility delivery, ANC visit, and maternal health education is vital for reducing child chronic undernutrition.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Balehegn M, Mekuriaw Z, Miller L, Mckune S, Adesogan AT. Animal-sourced foods for improved cognitive development. Anim Front 2019; 9:50-57. [PMID: 32002274 PMCID: PMC6951940 DOI: 10.1093/af/vfz039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mulubrhan Balehegn
- Mekelle University Department of Animal, Rangeland and Wildlife Sciences, Addis Ababa, Ethiopia.,Feed the Future Innovation Lab for Livestock Systems, Addis Ababa, Ethiopia
| | - Zeleke Mekuriaw
- International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Laurie Miller
- School of Medicine, Friedman School of Nutrition Science and Policy, and Eliot-Pearson Department of Child Study and Human Development, Tufts University, Boston, MA
| | - Sarah Mckune
- Feed the Future Innovation Lab for Livestock Systems, Addis Ababa, Ethiopia.,Department for Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Adegbola T Adesogan
- Feed the Future Innovation Lab for Livestock Systems, Addis Ababa, Ethiopia.,Department of Animal Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL
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Mezgebo K, Belachew T, Satheesh N. Optimization of red teff flour, malted soybean flour, and papaya fruit powder blending ratios for better nutritional quality and sensory acceptability of porridge. Food Sci Nutr 2018; 6:891-903. [PMID: 29983952 PMCID: PMC6021722 DOI: 10.1002/fsn3.624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/30/2018] [Accepted: 02/11/2018] [Indexed: 11/11/2022] Open
Abstract
This study was carried out to optimize the compositions of red teff flour with malted soybean flour and papaya fruit powders for better nutritional quality and sensory acceptability of porridge. Total eleven formulations of the composite flours were determined using D-optimal mixture design with the help of Minitab Version 16 Statistical Software. The three ingredients were considered in the ranges of 55%-70%, 20%-30%, 5%-15% for red teff flour, malted soybean flour, and Papaya fruit powder, respectively. The prepared porridge samples from formulations were analyzed for nutritional composition, antinutritional factors, and sensory acceptability. Results of the study showed the significant difference (p < .05) in ash, fat, fiber, protein, carbohydrate, energy, iron, calcium, zinc, β-carotene, phytates, tannin, appearance, taste, mouthfeel, and overall acceptability as the composition of ingredients were changed. The overall optimum point was found in a range of red teff flour (60%-70%), malted soybean flour (20%-27.5%), and papaya fruit powder (10%-12.5%). In conclusion, the present approach can help in improve infants dietary quality of complementary foods by developing nutritionally enhanced red teff-based porridge used for intervention of malnutrition.
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Affiliation(s)
- Kiros Mezgebo
- Department of Postharvest ManagementCollege of Agriculture and Veterinary MedicineJimma UniversityJimmaEthiopia
- Department of Food Science and Postharvest TechnologyCollege of Agriculture and Environmental SciencesAdigrat UniversityAdigratEthiopia
| | - Tefera Belachew
- Department of Human NutritionCollege of Health ScienceJimma UniversityJimmaEthiopia
| | - Neela Satheesh
- Department of Postharvest ManagementCollege of Agriculture and Veterinary MedicineJimma UniversityJimmaEthiopia
- School of Chemical and Food EngineeringInstitute of TechnologyBahir Dar UniversityBahir DarEthiopia
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Ng'endo M, Bhagwat S, Keding GB. Contribution of Nutrient Diversity and Food Perceptions to Food and Nutrition Security Among Smallholder Farming Households in Western Kenya: A Case Study. Food Nutr Bull 2017; 39:86-106. [PMID: 28826252 DOI: 10.1177/0379572117723135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sub-Saharan Africa is the only region in the world where hunger is prevalent in over one-third of the population, with smallholder farming households, producers of over 80% of Africa's food, facing both calorie and micronutrient deficiencies. With agricultural systems serving as the main source of all nutrients, little is known about the extent to which agricultural diversity in different seasons can meet macro- and micronutrient needs in rural Africa. OBJECTIVE Linkages between nutrient diversity and food species were investigated. METHODS A case study was conducted in Western Kenya to assess the seasonal nutrient diversity, seasonal nutrient accessibility levels, and food perceptions in 30 smallholder farms, 7 markets, and among 97 focus group discussion participants, respectively. All present food plant and animal species were inventoried and assigned to 1 of the 7 major Food and Agriculture Organization-defined food groups. Based on 2 macronutrients and 5 micronutrients, dendrogram-based nutrient functional diversity metrics were calculated. RESULTS On-farm and market food species offered all 7 macro- and micronutrients under investigation, regardless of seasonal variation in species numbers. Although there were varying seasonal nutrient accessibility levels in markets, farms were especially effective in readily availing 4 of the 7 nutrients. However, the main food shortage months coincided only with maize shortage, but a diversity of local foods, deemed to be of low cultural and culinary preferences, were available. CONCLUSIONS Nutrition education on the importance of a diversity of local foods in meeting dietary needs, thus stimulating the demand side, can contribute to achieving year-round household food security.
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Affiliation(s)
- Mary Ng'endo
- 1 World Agroforestry Centre (ICRAF), Nairobi, Kenya
| | - Shonil Bhagwat
- 2 Department of Geography, The Open University, Milton Keynes, United Kingdom.,3 School of Geography and the Environment, University of Oxford, Oxford, United Kingdom
| | - Gudrun B Keding
- 4 Center for Development Research (ZEF), Department of Ecology and Natural Resources Management, University of Bonn, Bonn, Germany.,5 Bioversity International, Nairobi, Kenya
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Schmeer KK, Piperata BA. Household food insecurity and child health. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27126348 DOI: 10.1111/mcn.12301] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 11/29/2022]
Abstract
Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low-income settings. We use data from a population-based sample of households with children ages 3-11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height-for-age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7-8 years). We discuss the potential implications of these results for future child health research and policies in low-income countries. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- Kammi K Schmeer
- Department of Sociology, The Ohio State University, Columbus, USA
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Kshatriya GK, Acharya SK. Triple Burden of Obesity, Undernutrition, and Cardiovascular Disease Risk among Indian Tribes. PLoS One 2016; 11:e0147934. [PMID: 26808418 PMCID: PMC4726542 DOI: 10.1371/journal.pone.0147934] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socio-cultural transitions among individuals from vulnerable groups introduce epidemiological transition, with a concomitant increase in the prevalence of undernutrition, obesity, and cardiovascular disease risks. An accepted conventional wisdom exists for Indian tribes that they are undernourished and away from lifestyle-related diseases. However, the extent of this triple burden affecting them is unknown. In this study, we assessed this triple burden among the 9 major tribes of India. METHODS AND FINDINGS During January 2011 to December 2013, we conducted a cross-sectional study among 1066 men and 1090 women constituting a total of 2156 adults belonging to the 9 major tribal groups: Santals, Oraons, and Koras (West Bengal); Santals, Bhumijs, and Bathudis (Odisha); and Dhodias, Kuknas, and Chaudharis (Gujarat) to estimate the prevalence of the triple burden (undernutrition, overweight or obesity, and hypertension). A high prevalence of undernutrition and hypertension was observed among the Koras (51.9%and 10.6%, respectively), Bathudis (51.3% and 12.1%, respectively), and Oraons (49.6% and 16.5%, respectively). However, the prevalence of overweight and hypertension among the Bhumijs (17.7% and 14.7%, respectively), Dhodias (23.8% and 12.9%, respectively), Kuknas (15.8% and 11.3%, respectively), and Santals of West Bengal (12.2% and 11.8%, respectively) and Odisha (15% and 9.6%, respectively) was most alarming. The prevalence of overweight or obesity among the women was 10.9% and 1.5%, respectively, with 14.0% hypertensive women. The prevalence of overweight and obesity among the men was 14.8% and 1.7%, respectively, with 9.2% hypertensive men. Undernutrition was highly prevalent among men and women. However, data from the past 30 years on systolic blood pressure (SBP) and body mass index (BMI) revealed that the studied tribes were at a higher risk than the general Indian population. In addition, a vast gender disparity with relation to the disease and risk prevalence was observed. CONCLUSION The alarming trend of an increasing prevalence of overweight/obesity, undernutrition, and hypertension is observed among indigenous populations of India, emphasizing the incorporation of a specific health management policy.
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Humphries DL, Behrman JR, Crookston BT, Dearden KA, Schott W, Penny ME. Households across all income quintiles, especially the poorest, increased animal source food expenditures substantially during recent Peruvian economic growth. PLoS One 2014; 9:e110961. [PMID: 25372596 PMCID: PMC4220962 DOI: 10.1371/journal.pone.0110961] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 09/26/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. OBJECTIVE To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. METHODS The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. RESULTS Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. CONCLUSIONS Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of households were proportionately greater than increases in total food expenditures, and proportionately less than overall expenditures.
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Affiliation(s)
- Debbie L. Humphries
- Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Jere R. Behrman
- Department of Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Benjamin T. Crookston
- Department of Health Science, Brigham Young University, Provo, Utah, United States of America
| | - Kirk A. Dearden
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Whitney Schott
- Department of Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Strengthening the engagement of food and health systems to improve nutrition security: Synthesis and overview of approaches to address malnutrition. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2014. [DOI: 10.1016/j.gfs.2014.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Wondimagegn ZT. Magnitude and Determinants of Stunting Among Children in Africa: A Systematic Review. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE JOURNAL 2014. [DOI: 10.12944/crnfsj.2.2.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Globally it is estimated that 162 million under-five year old children are stunted. Africa is known with one of the highest prevalence of stunting in the world. Even though studies suggested various determinants for stunting in Africa; there is lack of agreement about the relative importance of factors affecting the nutritional status of children. We reviewed all literatures, including: observational studies, and prospective randomized controlled trials (RCTs) evaluating the prevalence and determinants of stunting in children under the age of five years in Africa to identify systematically, appraise and synthesize the best available evidence on the magnitude and epidemiological factors for stunting among children under the age of five years in Africa by conducting electronic search of Medline, Pub Med, Health Inter-network access to Research Initiative (HINARI), and Google Scholar databases. After exclusion of irrelevant ones, 21 out of 55 articles were considered for the final analysis. On the basis of this review, majority of the articles reported highest prevalence of stunting in Africa and its progress is found unsatisfactory. Inappropriate complementary feeding practice, maternal under nutrition, household food insecurity, economic growth and maternal education, are identified as the principal determinants of stunting. Some studies confer the determinants of stunting is multidimensional and intertwined. The remaining articles reviewed, noted the synergistic interaction between inadequate dietary intake and disease as the main determinant of stunting. The magnitude of stunting in Africa is found as one of the highest in the world and the trend shows stagnating rather than progress. It is confirmed that the determinants of stunting in the continent are varied and intertwined; showing variations from region to region. It is recommended that; African countries should give more emphasis to fight stunting; further research on target implementation sites is needed before creating health policies. They should also consider the cultural beliefs and socio cultural realities of their population. We therefore encourage policy makers to use facts from this review on creating policies to reverse the situation.
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Food insecurity among Iraqi refugees living in Lebanon, 10 years after the invasion of Iraq: data from a household survey. Br J Nutr 2014; 112:70-9. [PMID: 24739803 DOI: 10.1017/s0007114514000282] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Iraqi refugees in Lebanon are vulnerable to food insecurity because of their limited rights and fragile livelihoods. The objective of the present study was to assess household food insecurity among Iraqi refugees living in Lebanon, almost 10 years after the invasion of Iraq. A representative survey of 800 UN High Commissioner for Refugees-registered refugee households in Lebanon was conducted using multi-stage cluster random sampling. We measured food insecurity using a modified US Department of Agriculture household food security module. We collected data on household demographic, socio-economic, health, housing and dietary diversity status and analysed these factors by food security status. Hb level was measured in a subset of children below 5 years of age (n 85). Weighted data were used in univariate and multivariate analyses. Among the Iraqi refugee households surveyed (n 630), 20·1% (95% CI 17·3, 23·2) were found to be food secure, 35·5% (95% CI 32·0, 39·2) moderately food insecure and 44·4% (95% CI 40·8, 48·1) severely food insecure. Severe food insecurity was associated with the respondent's good self-reported health (OR 0·3, 95% CI 0·2, 0·5), length of stay as a refugee (OR 1·1, 95% CI 1·0, 1·2), very poor housing quality (OR 3·3, 95% CI 1·6, 6·5) and the number of children in the household (OR 1·2, 95% CI 1·0, 1·4), and resulted in poor dietary diversity (P< 0·0001). Anaemia was found in 41% (95% CI 30·6, 51·9) of children below 5 years of age, but was not associated with food insecurity. High food insecurity, low diet quality and high prevalence of anaemia in Iraqi refugees living in Lebanon call for urgent programmes to address the food and health situation of this population with restricted rights.
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Grijalva-Eternod CS, Wells JCK, Cortina-Borja M, Salse-Ubach N, Tondeur MC, Dolan C, Meziani C, Wilkinson C, Spiegel P, Seal AJ. The double burden of obesity and malnutrition in a protracted emergency setting: a cross-sectional study of Western Sahara refugees. PLoS Med 2012; 9:e1001320. [PMID: 23055833 PMCID: PMC3462761 DOI: 10.1371/journal.pmed.1001320] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 08/21/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency. METHODS AND FINDINGS We implemented a stratified nutrition survey in October-November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6-59 mo) and 1,781 women (15-49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively. The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden-affected (24.7%). CONCLUSIONS The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention and management with interventions to tackle under-nutrition. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Carlos S. Grijalva-Eternod
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
- Emergency Nutrition Network, Oxford, United Kingdom
| | - Jonathan C. K. Wells
- Medical Research Council Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom
| | - Mario Cortina-Borja
- Medical Research Council Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom
| | | | | | - Carmen Dolan
- Emergency Nutrition Network, Oxford, United Kingdom
| | - Chafik Meziani
- Tindouf Sub-Office, United Nations High Commissioner for Refugees, Tindouf, Algeria
| | - Caroline Wilkinson
- Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Paul Spiegel
- Public Health and HIV Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Andrew J. Seal
- Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom
- Emergency Nutrition Network, Oxford, United Kingdom
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Ndemwa P, Klotz CL, Mwaniki D, Sun K, Muniu E, Andango P, Owigar J, Rah JH, Kraemer K, Spiegel PB, Bloem MW, de Pee S, Semba RD. Relationship of the availability of micronutrient powder with iron status and hemoglobin among women and children in the Kakuma Refugee Camp, Kenya. Food Nutr Bull 2011; 32:286-91. [PMID: 22073802 DOI: 10.1177/156482651103200314] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Micronutrient powder is a potential strategy to improve iron status and reduce anemia in refugee populations. OBJECTIVE To evaluate the effect of the availability of home fortification with a micronutrient powder containing 2.5 mg of sodium iron ethylenediaminetetraacetate (NaFeEDTA) on iron status and hemoglobin in women and children in the Kakuma Refugee Camp in northwest Kenya. METHODS Hemoglobin and soluble transferrin receptor were measured in 410 children 6 to 59 months of age and 458 women of childbearing age at baseline (just before micronutrient powder was distributed, along with the regular food ration) and at midline (6 months) and endline (13 months)follow-up visits. RESULTS At the baseline, midline, and endline visits, respectively, the mean (+/- SE) hemoglobin concentration in women was 121.4 +/- 0.8, 120.8 +/- 0.9, and 120.6 +/- 1.0 g/L (p = .42); the prevalence of anemia (hemoglobin < 120 g/L) was 42.6%, 41.3%, and 41.7% (p = .92); and the mean soluble transferrin receptor concentration was 24.1 +/- 0.5, 20.7 +/- 0.7, and 20.8 +/- 0.7 nmol/L (p = .0006). In children, the mean hemoglobin concentration was 105.7 +/- 0.6, 109.0 30322 1.5, and 105.5 +/- 0.3 g/L (p = .95), respectively; the prevalence of anemia (hemoglobin < 110 g/L) was 55.5%, 52.3%, and 59.8% (p = .26); and the mean soluble transferrin receptor concentration was 36.1 +/- 0.7, 29.5 +/- 1.9, and 28.4 +/- 3.2 nmol/L (p = .02), in models that were adjusted for age using least squares means regression. CONCLUSIONS In children and in women of childbearing age, the availability of micronutrient powder was associated with a small improvement in iron status but no significant change in hemoglobin in this refugee camp setting.
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Kounnavong S, Sunahara T, Mascie-Taylor CGN, Hashizume M, Okumura J, Moji K, Boupha B, Yamamoto T. Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial. Nutr J 2011; 10:129. [PMID: 22111770 PMCID: PMC3266642 DOI: 10.1186/1475-2891-10-129] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 11/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple micronutrient deficiencies, in particular iron deficiency anaemia (IDA) is a severe public health problem in Lao People's Democratic Republic (Lao PDR). Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children, recently, home-fortification with multivitamins and minerals sprinkles was recommended. This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder (MMP) on anaemia prevalence, haemoglobin concentration, and growth in infants and young children in a rural community in Lao PDR. METHODS A randomized trial was conducted in six rural communities. Children aged 6 to 52 months (n = 336) were randomly assigned to a control group (n = 110) or to one of two intervention groups receiving either two sachets per week (n = 115) or a daily sachet (n = 111) of MMP for 24 weeks; 331 children completed the study. A finger prick of blood was taken at baseline, at week 12, and again at week 24 to determine haemoglobin concentration. Anthropometric measurements were taken every 4 weeks. The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups. RESULTS MMP supplementation resulted in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group (p <0.001). The severely to moderately anaemic children (Hb <100 g/L) on daily supplementation recovered faster than those on twice weekly supplementation. MMP was well accepted and compliance was high in both treatment groups. Overall, the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups. CONCLUSIONS MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration. For severely to moderately anaemic children, daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence. A longer intervention period is probably needed to have a positive effect on growth.
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Affiliation(s)
- Sengchanh Kounnavong
- National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic.
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Dror DK, Allen LH. The Importance of Milk and other Animal-Source Foods for Children in Low-Income Countries. Food Nutr Bull 2011; 32:227-43. [DOI: 10.1177/156482651103200307] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Milk and other animal-source foods are concentrated dietary sources of macro- and micronutrients. Despite a global increase in milk production and consumption over the past decades, milk and other animal-source foods are often lacking in the diets of children in developing countries. Objective To evaluate the importance of milk and other animal-source food intake in promoting the growth, development, and health of children in low-income countries. Methods Original research articles describing observational and intervention studies with unfortified milk, fortified milk, and other animal-source foods in children were identified by searching the PubMed database. Results Consumption of milk and other animal-source foods by undernourished children improves anthropometric indices and cognitive function and reduces the prevalence of biochemical and functional nutritional deficiencies, reducing morbidity and mortality. Unfortified and fortified milk used in supplementation trials has been well tolerated and widely accepted by parents and children. Conclusions To improve the dietary quality of children in low-income countries and further the effort to eradicate extreme poverty and hunger in accordance with the United Nations Millennium Development Goals, additional research is necessary to identify and implement programs and policy supporting increased intake of milk and other animal-source foods.
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Abstract
Pediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.
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Affiliation(s)
- Midge Kirby
- Clinical Nutrition, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 53201, USA.
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