1
|
Erchick DJ, Hazel EA, Katz J, Lee ACC, Diaz M, Wu LSF, Yoshida S, Bahl R, Grandi C, Labrique AB, Rashid M, Ahmed S, Roy AD, Haque R, Shaikh S, Baqui AH, Saha SK, Khanam R, Rahman S, Shapiro R, Zash R, Silveira MF, Buffarini R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zeng L, Zhu Z, He J, Qiu X, Gebreyesus SH, Tesfamariam K, Bekele D, Chan G, Baye E, Workneh F, Asante KP, Kaali EB, Adu-Afarwuah S, Dewey KG, Gyaase S, Wylie BJ, Kirkwood BR, Manu A, Thulasiraj RD, Tielsch J, Chowdhury R, Taneja S, Babu GR, Shriyan P, Ashorn P, Maleta K, Ashorn U, Mangani C, Acevedo-Gallegos S, Rodriguez-Sibaja MJ, Khatry SK, LeClerq SC, Mullany LC, Jehan F, Ilyas M, Rogerson SJ, Unger HW, Ghosh R, Musange S, Ramokolo V, Zembe-Mkabile W, Lazzerini M, Rishard M, Wang D, Fawzi WW, Minja DTR, Schmiegelow C, Masanja H, Smith E, Lusingu JPA, Msemo OA, Kabole FM, Slim SN, Keentupthai P, Mongkolchati A, Kajubi R, Kakuru A, Waiswa P, Walker D, Hamer DH, Semrau KEA, Chaponda EB, Chico RM, Banda B, Musokotwane K, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021. BJOG 2023. [PMID: 37156239 DOI: 10.1111/1471-0528.17510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN Descriptive multi-country secondary data analysis. SETTING Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION Liveborn infants. METHODS Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.
Collapse
Affiliation(s)
- D J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - E A Hazel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Diaz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - L S F Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - R Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - C Grandi
- Argentine Society of Paediatrics, Ciudad Autónoma de Buenos Aires, Argentina
| | - A B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M Rashid
- IntraHealth International, Dhaka, Bangladesh
| | - S Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - A D Roy
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - R Haque
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - S Shaikh
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - A H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - R Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Rahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - R Shapiro
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - R Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - M F Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - R Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - P Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - C Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - L Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - D Roberfroid
- Medicine Department, Faculty of Medicine, University of Namur, Namur, Belgium
| | - L Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Z Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - J He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - X Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - S H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - K Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - D Bekele
- Department of Obstetrics and Gynecology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - G Chan
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - F Workneh
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - K P Asante
- Kintampo Health Research Centre, Research and Development Division, Kintampo, Ghana
| | - E B Kaali
- Kintampo Health Research Centre, Research and Development Division, Kintampo, Ghana
| | - S Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - K G Dewey
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | - S Gyaase
- Department of Statistics, Kintampo Health Research Centre, Kintampo, Ghana
| | - B J Wylie
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - B R Kirkwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A Manu
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- University of Ghana School of Public Health, Accra, Ghana
| | | | - J Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - R Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, Delhi, India
| | - S Taneja
- Centre for Health Research and Development, Society for Applied Studies, Delhi, India
| | - G R Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - P Shriyan
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, India
| | - P Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - K Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - U Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - C Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - S Acevedo-Gallegos
- National Institute of Perinatology, Maternal-Fetal Medicine Department, Mexico City, Mexico
| | - M J Rodriguez-Sibaja
- National Institute of Perinatology, Maternal-Fetal Medicine Department, Mexico City, Mexico
| | - S K Khatry
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - S C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - L C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - F Jehan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - M Ilyas
- The Aga Khan University, Karachi, Pakistan
| | - S J Rogerson
- Department of Infectious Diseases, University of Melbourne, Doherty Institute, Melbourne, Victoria, Australia
| | - H W Unger
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - R Ghosh
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - S Musange
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - V Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - W Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Johannesburg, South Africa
| | - M Lazzerini
- Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - M Rishard
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka
- Department of Obstetrics & Gynaecology, University of Colombo, Colombo, Sri Lanka
| | - D Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - W W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - D T R Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - C Schmiegelow
- Centre for Medical Parasitology, Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Masanja
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - E Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, DC, USA
| | - J P A Lusingu
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - O A Msemo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - F M Kabole
- Ministry of Health Zanzibar, Zanzibar, Tanzania
| | - S N Slim
- Ministry of Health Zanzibar, Zanzibar, Tanzania
| | - P Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - A Mongkolchati
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
| | - R Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - A Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - P Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - D Walker
- Institute for Global Health Sciences and Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - D H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - K E A Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E B Chaponda
- Department of Biological Sciences, School of Natural Sciences, University of Zambia, Lusaka, Zambia
| | - R M Chico
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - B Banda
- Research Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - K Musokotwane
- Health Specialist PMTCT and Pediatric AIDS, UNICEF, Lusaka, Zambia
| | - A Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - B Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - J Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Dailey-Chwalibóg T, Freemark M, Roberfroid D, Kemokai I, Mostak M, Alim M, Khan M, Khan M, Bawo L, Taylor C, Fouillet H, Huneau JF, Kolsteren P, Guesdon B. Signification clinique du diagnostic anthropométrique de la malnutrition aiguë sévère (MAS) de l’enfant : résultats préliminaires de l’étude multicentrique OptiDiag et implications en terme de santé publique. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
3
|
Kamala A, Kimanya M, De Meulenaer B, Kolsteren P, Jacxsens L, Haesaert G, Kilango K, Magoha H, Tiisekwa B, Lachat C. Post-harvest interventions decrease aflatoxin and fumonisin contamination in maize and subsequent dietary exposure in Tanzanian infants: a cluster randomised-controlled trial. WORLD MYCOTOXIN J 2018. [DOI: 10.3920/wmj2017.2234] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A cluster randomised controlled trial was performed in three agro-ecological zones of Tanzania to evaluate the effectiveness of locally available post-harvest mitigation strategies in preventing and reducing aflatoxin and fumonisin contamination in maize. A total of 300 children, each from one household, were randomly selected from 30 villages (intervention: n=15). The mitigation strategies focused on hand sorting (prior to storage and use), drying maize on mat/raised platforms, proper sun drying, application of storage insecticides and de-hulling before milling. Maize sample was collected from each household at harvest (baseline) and six months after harvest. Maize intake by each child, estimated using the 24 h dietary recall technique and its body weight measured using standard procedures were taken at six months after harvest. Aflatoxins and fumonisins in the maize samples were determined using HPLC. Follow-up (six month after harvest) data were available for 261 of the 300 households (intervention: n=136). Mean concentration of aflatoxins, or fumonisins was significantly (P<0.05) lower in the intervention than in the control group: intervention effects: μg/kg (95% confidence interval (CI)) -4.9 (-7.3,-2.5), and -405, (-647,-162), respectively. The difference corresponds to 83 and 70% for aflatoxins, and fumonisins, respectively. At the end of the intervention, aflatoxin and fumonisin estimated mean intakes were lower in the intervention than in the control group by 78 and 65%, respectively. Six months after harvest, prevalence of underweight in the intervention group was 6.7% lower (P=0.014) than in the control group. Mean weight-for-age Z-score difference between the groups was 0.57 (95% CI; 0.16,-0.98; P=0.007). Post-harvest practices are effective in preventing and reducing aflatoxin and fumonisin contamination in maize and subsequent dietary exposure to infants. The interventions may be applied in these and other communities with similar environmental conditions or agricultural practices that favour production of aflatoxin and fumonisins in food crops. The trial was registered at ClinicalTrials.gov identifier: NCT02438774.
Collapse
Affiliation(s)
- A. Kamala
- Department of Food Technology, Safety and Health, partner in Food2Know, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
- Directorate of Food Safety, Tanzania Food and Drugs Authority, P.O. Box 77150, Dar es Salaam, Tanzania
| | - M. Kimanya
- School of Life Sciences and Bio-Engineering, the Nelson Mandela African Institution of Science and Technology (NM-AIST), P.O. Box 447, Arusha, Tanzania
- Department of Rural Economy and Agriculture, African Union Commission, P.O. Box 3243, Addis Ababa, Ethiopia
| | - B. De Meulenaer
- Department of Food Technology, Safety and Health, partner in Food2Know, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| | - P. Kolsteren
- Department of Food Technology, Safety and Health, partner in Food2Know, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| | - L. Jacxsens
- Department of Food Technology, Safety and Health, partner in Food2Know, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| | - G. Haesaert
- Department of Applied Biosciences, Faculty of Bioscience Engineering, Ghent University, Valentin Vaerwyckweg 1, 9000 Ghent, Belgium
| | - K. Kilango
- Directorate of Food Safety, Tanzania Food and Drugs Authority, P.O. Box 77150, Dar es Salaam, Tanzania
| | - H. Magoha
- Department of Home Economics and Human Nutrition, Open University of Tanzania (OUT), P.O. Box 23409, Dar es Salaam, Tanzania
| | - B. Tiisekwa
- College of Agriculture, Sokoine University of Agriculture, P.O. Box 3005, Morogoro, Tanzania
| | - C. Lachat
- Department of Food Technology, Safety and Health, partner in Food2Know, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| |
Collapse
|
4
|
De Cock N, Van Camp J, Kolsteren P, Lachat C, Huybregts L, Maes L, Deforche B, Verstraeten R, Vangeel J, Beullens K, Eggermont S, Van Lippevelde W. Development and validation of a quantitative snack and beverage food frequency questionnaire for adolescents. J Hum Nutr Diet 2016; 30:141-150. [DOI: 10.1111/jhn.12411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. De Cock
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - J. Van Camp
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - P. Kolsteren
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - C. Lachat
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - L. Huybregts
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
- Poverty; Health and Nutrition Division International Food Policy Research Institute; Washington DC USA
| | - L. Maes
- Department of Public Health; Ghent University; Ghent Belgium
| | - B. Deforche
- Department of Public Health; Ghent University; Ghent Belgium
- Physical Activity; Nutrition and Health Research Unit; Faculty of Physical Education and Physical Therapy; Vrije Universiteit Brussel; Brussels Belgium
| | | | - J. Vangeel
- Leuven School for Mass Communication Research; KU Leuven; Leuven Belgium
| | - K. Beullens
- Leuven School for Mass Communication Research; KU Leuven; Leuven Belgium
- Research Foundation Flanders (FWO); Brussel Belgium
| | - S. Eggermont
- Leuven School for Mass Communication Research; KU Leuven; Leuven Belgium
| | - W. Van Lippevelde
- Physical Activity; Nutrition and Health Research Unit; Faculty of Physical Education and Physical Therapy; Vrije Universiteit Brussel; Brussels Belgium
| |
Collapse
|
5
|
Lachat C, Hawwash D, Ocké MC, Berg C, Forsum E, Hörnell A, Larsson CL, Sonestedt E, Wirfält E, Åkesson A, Kolsteren P, Byrnes G, De Keyzer W, Van Camp J, Cade JE, Slimani N, Cevallos M, Egger M, Huybrechts I. Strengthening the Reporting of Observational Studies in Epidemiology - nutritional epidemiology (STROBE-nut): An extension of the STROBE statement. NUTR BULL 2016; 41:240-251. [PMID: 27587981 PMCID: PMC4988500 DOI: 10.1111/nbu.12217] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Concerns have been raised about the quality of reporting in nutritional epidemiology. Research reporting guidelines such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can improve quality of reporting in observational studies. Herein, we propose recommendations for reporting nutritional epidemiology and dietary assessment research by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology - Nutritional Epidemiology (STROBE-nut). Recommendations for the reporting of nutritional epidemiology and dietary assessment research were developed following a systematic and consultative process, co-ordinated by a multidisciplinary group of 21 experts. Consensus on reporting guidelines was reached through a three-round Delphi consultation process with 53 external experts. In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist. When used appropriately, reporting guidelines for nutritional epidemiology can contribute to improve reporting of observational studies with a focus on diet and health.
Collapse
Affiliation(s)
- C Lachat
- Department of Food Safety and Food Quality Ghent University Ghent Belgium; Unit of Nutrition and Child Health Institute of Tropical Medicine Antwerp Belgium
| | - D Hawwash
- Department of Food Safety and Food Quality Ghent University Ghent Belgium
| | - M C Ocké
- National Institute for Public Health and the Environment Bilthoven The Netherlands
| | - C Berg
- Department of Food and Nutrition, and Sport Science University of Gothenburg Gothenburg Sweden
| | - E Forsum
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - A Hörnell
- Department of Food and Nutrition Umeå University Umeå Sweden
| | - C L Larsson
- Department of Food and Nutrition, and Sport Science University of Gothenburg Gothenburg Sweden
| | - E Sonestedt
- Department of Clinical Sciences Malmö Lund University Malmö Sweden
| | - E Wirfält
- Department of Clinical Sciences Malmö Lund University Malmö Sweden
| | - A Åkesson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - P Kolsteren
- Department of Food Safety and Food Quality Ghent University Ghent Belgium; Unit of Nutrition and Child Health Institute of Tropical Medicine Antwerp Belgium
| | - G Byrnes
- International Agency for Research on Cancer Lyon France
| | - W De Keyzer
- Department of Biosciences and Food Sciences University College Ghent Ghent Belgium
| | - J Van Camp
- Department of Food Safety and Food Quality Ghent University Ghent Belgium
| | - J E Cade
- School of Food Science and Nutrition University of Leeds Leeds UK
| | - N Slimani
- International Agency for Research on Cancer Lyon France
| | - M Cevallos
- Institute of Social and Preventive Medicine University of Bern Bern Switzerland; Department of Clinical Research University of Bern Bern Switzerland
| | - M Egger
- Institute of Social and Preventive Medicine University of Bern Bern Switzerland
| | - I Huybrechts
- International Agency for Research on Cancer Lyon France
| |
Collapse
|
6
|
Magoha H, Kimanya M, De Meulenaer B, Roberfroid D, Lachat C, Kolsteren P. Association between aflatoxin M1 exposure through breast milk and growth impairment in infants from Northern Tanzania. WORLD MYCOTOXIN J 2014. [DOI: 10.3920/wmj2014.1705] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Infants breastfeeding from mothers consuming aflatoxin contaminated foods may be exposed to aflatoxin M1 (AFM1), a metabolite of aflatoxin B1. This study estimated the association between AFM1 exposure levels and growth indicators, for infants under six months of age in the Rombo district in Northern Tanzania. A total of 143 infants and their mothers were involved. Breast-milk samples, infants' anthropometric data and 24 h dietary recall for mothers were taken at the 1st, 3rd and 5th months of children age. AFM1 contaminations in the samples were determined using HPLC. Aflatoxin M1 exposure by an infant was estimated by multiplying contamination in the breast milk consumed by him/her with the breast milk intake recorded by the United States Environmental Protection Agency for infants of his/her age divided by the infant's body weight. All the breast-milk samples were contaminated by AFM1 at levels ranging from 0.01 to 0.55 ng/ml. Above 90% of samples exceeded the EU limit of 0.025 ng/ml for infants' foods while over 76% exceeded the EU limit of 0.05 ng/ml for dairy milk and milk products. Only 1% of the samples exceeded the limit of 0.5 ng/ml set for dairy milk in the United States and several countries in Asia. AFM1 Exposures ranged from 1.13-66.79 ng/kg body weight per day. A small but significant (P<0.05) inverse association was observed between AFM1 exposure levels and weight for age Z-score or height for age Z-score. Appropriate strategies should be applied to minimise aflatoxin B1 exposure in lactating mothers in order to protect infants from AFM1 exposure.
Collapse
Affiliation(s)
- H. Magoha
- Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Research group Food Chemistry and Human Nutrition - nutriFOODchem, Ghent University, Coupure links 653, 9000 Ghent, Belgium
- Department of Home economics and Human nutrition, Open University of Tanzania (OUT), P.O. Box 23409, Dar es Salaam, Tanzania
| | - M. Kimanya
- Nelson Mandela African Institute of Science and Technology, P.O. Box 447, Arusha, Tanzania
| | - B. De Meulenaer
- Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Research group Food Chemistry and Human Nutrition - nutriFOODchem, Ghent University, Coupure links 653, 9000 Ghent, Belgium
| | - D. Roberfroid
- Department of Public Health, Nutrition and Child Health Unit, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - C. Lachat
- Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Research group Food Chemistry and Human Nutrition - nutriFOODchem, Ghent University, Coupure links 653, 9000 Ghent, Belgium
- Department of Public Health, Nutrition and Child Health Unit, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - P. Kolsteren
- Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Research group Food Chemistry and Human Nutrition - nutriFOODchem, Ghent University, Coupure links 653, 9000 Ghent, Belgium
- Department of Public Health, Nutrition and Child Health Unit, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| |
Collapse
|
7
|
Ochoa-Avilés A, Andrade S, Huynh T, Verstraeten R, Lachat C, Rojas R, Donoso S, Manuel-y-Keenoy B, Kolsteren P. Prevalence and socioeconomic differences of risk factors of cardiovascular disease in Ecuadorian adolescents. Pediatr Obes 2012; 7:274-83. [PMID: 22715112 DOI: 10.1111/j.2047-6310.2012.00061.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/11/2012] [Accepted: 03/07/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this paper is to report the prevalence of cardiovascular risk factors and socioeconomic differences in school-going Ecuadorian adolescents. METHODS A cross-sectional study was performed from January 2008 until April 2009 in 770 adolescents aged 10 to 16 years old, who attend secondary schools in an urban (Cuenca), and rural area (Nabón) in Ecuador. Data collected for the overall sample included anthropometric variables (weight, height and waist circumference), blood pressure and socio-demographic characteristics. Fasting blood glucose and lipid profile determinations were collected in a subsample of 334 adolescents. RESULTS The most prevalent cardiovascular risk factors were dyslipidemia (34.2%), abdominal obesity (19.7%) and overweight (18.0%). The prevalence of the remaining cardiovascular risk factors were high levels of blood pressure (6.2%) and obesity (2.1%). Boys were 3.3 times (P < 0.001) more likely to have risk levels of blood pressure. Compared to their peers from lower socioeconomic groups, children from better off socioeconomic strata were 1.5 times (P = 0.048) more likely to be overweight/obese and 1.5 times (P = 0.046) more likely to have abdominal obesity. Overweight and obese children were 4.4 times more likely to have dyslipidemia (P < 0.001). Children living in the rural area were 2.8 times (P = 0.002) more likely to have dyslipidemia than those from the urban area. CONCLUSIONS Our results demonstrate the advanced levels of the nutrition transition in this Ecuadorian adolescent population. Primary health care should monitor and take actions to address this public health problem in adolescents.
Collapse
Affiliation(s)
- A Ochoa-Avilés
- Food Nutrition and Health Program, Universidad de Cuenca, Cuenca, Ecuador.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Lachat C, Nago E, Verstraeten R, Roberfroid D, Van Camp J, Kolsteren P. Eating out of home and its association with dietary intake: a systematic review of the evidence. Obes Rev 2012; 13:329-46. [PMID: 22106948 DOI: 10.1111/j.1467-789x.2011.00953.x] [Citation(s) in RCA: 447] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
During the last decades, eating out of home (OH) has gained importance in the diets worldwide. We document the nutritional characteristics of eating OH and its associations with energy intake, dietary quality and socioeconomic status. We carried out a systematic review of peer-reviewed studies in eight databases up to 10 March 2011. Of the 7,319 studies retrieved, 29 met the inclusion criteria and were analysed in this review. The quality of the data was assessed and a sensitivity analysis was conducted by isolating nationally representative or large cohort data from 6 and 11 countries, respectively. OH foods were important sources of energy in all age groups and their energy contribution increased in adolescents and young adults. Eating OH was associated with a higher total energy intake, energy contribution from fat in the daily diet and higher socioeconomic status. Two large studies showed how eating OH was also associated with a lower intake of micronutrients, particularly vitamin C, Ca and Fe. Although the studies were cross-sectional and heterogeneous in the way they classified eating OH, we conclude that eating OH is a risk factor for higher energy and fat intake and lower micronutrient intake.
Collapse
Affiliation(s)
- C Lachat
- Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | |
Collapse
|
9
|
Diasolua Ngudi D, Banea-Mayambu JP, Lambein F, Kolsteren P. Konzo and dietary pattern in cassava-consuming populations of Popokabaka, Democratic Republic of Congo. Food Chem Toxicol 2011; 49:613-9. [DOI: 10.1016/j.fct.2010.06.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 05/10/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
|
10
|
Kimanya ME, De Meulenaer B, Tiisekwa B, Ndomondo-Sigonda M, Devlieghere F, Van Camp J, Kolsteren P. Co-occurrence of fumonisins with aflatoxins in home-stored maize for human consumption in rural villages of Tanzania. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2010; 25:1353-64. [PMID: 19680843 DOI: 10.1080/02652030802112601] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study determined maize-user practices that influence the presence of fumonisin and aflatoxin contamination of maize in food consumed in the rural areas of Tanzania. Samples of the 2005 maize harvest in Tanzania were collected from 120 households and examined for fumonisins and aflatoxins. Information on whether the maize was sorted to remove defective (visibly damaged or mouldy) maize before storage and whether the damaged and mouldy maize or the non-dehulled maize was used as food was also collected. In addition, the percentage of defective kernels in the samples was determined. Ninety per cent of the households sorted out defective maize, 45% consumed the defective maize and 30% consumed non-dehulled maize. In 52% of the samples fumonisins were determined at levels up to 11,048 microg kg(-1) (median = 363 microg kg(-1)) and in 15% exceeded 1000 microg kg(-1); the maximum tolerable limit (MTL) for fumonisins in maize for human consumption in other countries. Aflatoxins were detected in 18% of the samples at levels up to 158 microg kg(-1) (median = 24 microg kg(-1)). Twelve per cent of the samples exceeded the Tanzanian limit for total aflatoxins (10 microg kg(-1)). Aflatoxins co-occurred with fumonisins in 10% of the samples. The percentage defective kernels (mean = 22%) correlated positively (r = 0.39) with the fumonisin levels. Tanzanians are at a risk of exposure to fumonisins and aflatoxins in maize. There is a need for further research on fumonisin and aflatoxin exposure in Tanzania to develop appropriate control strategies.
Collapse
Affiliation(s)
- M E Kimanya
- Tanzania Food and Drugs Authority, Dar es Salaam, Tanzania
| | | | | | | | | | | | | |
Collapse
|
11
|
Elmadfa I, Meyer A, Nowak V, Hasenegger V, Putz P, Verstraeten R, Remaut-DeWinter AM, Kolsteren P, Dostálová J, Dlouhý P, Trolle E, Fagt S, Biltoft-Jensen A, Mathiessen J, Velsing Groth M, Kambek L, Gluskova N, Voutilainen S, Erkkilä A, Vernay M, Krems C, Strassburg A, Vasquez-Caicedo AL, Urban C, Naska A, Efstathopoulou E, Oikonomou E, Tsiotas K, Bountziouka V, Benetou V, Trichopoulou A, Zajkás G, Kovács V, Martos E, Heavey P, Kelleher C, Kennedy J, Turrini A, Selga G, Sauka M, Petkeviciene J, Klumbiene J, Holm Totland T, Andersen LF, Halicka E, Rejman K, Kowrygo B, Rodrigues S, Pinhão S, Ferreira LS, Lopes C, Ramos E, Vaz Almeida MD, Vlad M, Simcic M, Podgrajsek K, Serra Majem L, Román Viñas B, Ngo J, Ribas Barba L, Becker W, Fransen H, Van Rossum B, Ocké M, Margetts B, Rütten A, Abu-Omar K, Gelius P, Cattaneo A. European Nutrition and Health Report 2009. Ann Nutr Metab 2009; 55 Suppl 2:1-40. [PMID: 20104000 DOI: 10.1159/000244607] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- I Elmadfa
- Institute of Nutritional Sciences, University of Vienna, Althanstrasse 14/2F, AT-1090 Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Elmadfa I, Meyer A, Nowak V, Hasenegger V, Putz P, Verstraeten R, Remaut-DeWinter AM, Kolsteren P, Dostálová J, Dlouhý P, Trolle E, Fagt S, Biltoft-Jensen A, Mathiessen J, Velsing Groth M, Kambek L, Gluskova N, Voutilainen N, Erkkilä A, Vernay M, Krems C, Strassburg A, Vasquez-Caicedo AL, Urban C, Naska A, Efstathopoulou E, Oikonomou E, Tsiotas K, Bountziouka V, Benetou V, Trichopoulou A, Zajkás G, Kovács V, Martos E, Heavey P, Kelleher C, Kennedy J, Turrini A, Selga G, Sauka M, Petkeviciene J, Klumbiene J, Holm Totland T, Andersen LF, Halicka E, Rejman K, Kowrygo B, Rodrigues S, Pinhão S, Ferreira LS, Lopes C, Ramos E, Vaz Almeida MD, Vlad M, Simcic M, Podgrajsek K, Serra Majem L, Román Viñas B, Ngo J, Ribas Barba L, Becker V, Fransen H, Van Rossum C, Ocké M, Margetts B. European Nutrition and Health Report 2009. ACTA ACUST UNITED AC 2009; 62:1-405. [PMID: 20081327 DOI: 10.1159/000242367] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- I Elmadfa
- Institute of Nutritional Sciences, University of Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kimanya M, De Meulenaer B, Tiisekwa B, Ugullum C, Devlieghere F, Van Camp J, Samapundo S, Kolsteren P. Fumonisins exposure from freshly harvested and stored maize and its relationship with traditional agronomic practices in Rombo district, Tanzania. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2009. [DOI: 10.1080/02652030902922784] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Abstract
Fumonisins contaminate maize worldwide resulting in unacceptable fumonisin exposures in people relying on maize as staple food. This study determined fumonisins B1 (FB1) and B2 (FB2) in maize from 120 rural households: 30 from each of four main maize producing regions of Tabora, Ruvuma, Iringa and Kilimanjaro in Tanzania in order to estimate total fumonisin (FB1 + FB2) exposures to adult individuals in the households. The average daily per capita maize consumption of 771 g, recommended by the Tanzania Food and Nutrition Centre (TFNC) for an adult relying on it as a main meal, and also average daily per capita maize consumptions of 129, 308 and 356 g documented for Tanzania, were used in the exposure estimation. The fumonisins were determined by HPLC using fluorescence detection. Total fumonisins exposure (µg/kg body weight (bw)/day) was determined by multiplying average daily per capita maize consumption (kg) by fumonisin level in maize (µg/kg) from a given household and then dividing by an average bw of an adult of 60 kg. Of the 120 samples, 52% were contaminated with fumonisins at levels of up to 11,048 µg/kg (median; 363 µg/kg). Based on the recommended maize consumption of 771 g/person/day, fumonisin exposures to adult individuals in 38% of the households would exceed the provisional maximum tolerable daily intake (PMTDI) of 2 µg/kg bw, recommended by the Joint FAO/WHO Expert Committee on Food Additives. At the least documented maize consumption of 129 g/person/day, fumonisin exposures in 16% of the households were still above the PMTDI. Reduction of the maize consumption level to 40 g/person/day is an impractical, and reduction of the maximum contamination level to 155 µg/kg is a possibly practical, option for effective minimisation of fumonisin exposures in these communities. A relatively larger study is needed in order to generate comprehensive data for the formulation of appropriate strategies to minimise fumonisin exposures in Tanzania.
Collapse
Affiliation(s)
- M. Kimanya
- Tanzania Food and Drugs Authority, P.O. Box 77150, Dar es Salaam, Tanzania
- Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000 Ghent, Belgium
| | - B. De Meulenaer
- Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000 Ghent, Belgium
| | - B. Tiisekwa
- Department of Food Science and Technology, Sokoine University of Agriculture, P.O. Box 3006, Morogoro, Tanzania
| | | | - P. Kolsteren
- Faculty of Bioscience Engineering, Department of Food Safety and Food Quality, Ghent University, Coupure links 653, 9000 Ghent, Belgium
- Department of Public Health, Nutrition and Child Health Unit, Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium
| |
Collapse
|
15
|
Huybregts L, Roberfroid D, Lachat C, Van Camp J, Kolsteren P. Validity of photographs for food portion estimation in a rural West African setting. Public Health Nutr 2008; 11:581-7. [PMID: 17686204 DOI: 10.1017/s1368980007000870] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractObjectiveTo validate food photographs for food portion size estimation of frequently consumed dishes, to be used in a 24-hour recall food consumption study of pregnant women in a rural environment in Burkina Faso. This food intake study is part of an intervention evaluating the efficacy of prenatal micronutrient supplementation on birth outcomes.SubjectsWomen of childbearing age (15–45 years).DesignA food photograph album containing four photographs of food portions per food item was compiled for eight selected food items. Subjects were presented two food items each in the morning and two in the afternoon. These foods were weighed to the exact weight of a food depicted in one of the photographs and were in the same receptacles. The next day another fieldworker presented the food photographs to the subjects to test their ability to choose the correct photograph.ResultsThe correct photograph out of the four proposed was chosen in 55% of 1028 estimations. For each food, proportions of underestimating and overestimating participants were balanced, except for rice and couscous. On a group level, mean differences between served and estimated portion sizes were between −8.4% and 6.3%. Subjects who attended school were almost twice as likely to choose the correct photograph. The portion size served (small vs. largest sizes) had a significant influence on the portion estimation ability.ConclusionsThe results from this study indicate that in a West African rural setting, food photographs can be a valuable tool for the quantification of food portion size on group level.
Collapse
Affiliation(s)
- L Huybregts
- Department of Food Safety and Food Quality, Coupure Links 653, Ghent University, B-9000 Ghent, Belgium
| | | | | | | | | |
Collapse
|
16
|
Sejas E, Kolsteren P, Hoeree T, Roberfroid D. Iron supplementation in previously anemic Bolivian children normalized hematologic parameters, but not immunologic parameters. J Trop Pediatr 2008; 54:164-8. [PMID: 18211949 DOI: 10.1093/tropej/fmm106] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Iron deficiency anemia (IDA) is considered to be the most prevalent micronutrient deficiency in the world. Estimates indicate that 1.2 billion people suffer mild to severe forms of anemia and that up to 46% of schoolchildren in developing countries are affected. In 2003, ENDSA, the national demographic and health survey of Bolivia showed that 60% of children under five and 72% of children under 2 years old were anemic. Micronutrient deficiency has been suggested to impair cell-mediated immunity. In particular, iron, zinc and vitamin A deficiencies have an impact on the immune system. In vitro and in vivo laboratory studies indicate a link between iron deficiency and impaired T-lymphocyte proliferation. The exact effects or mechanisms of iron deficiency on maturation and proliferation of T-lymphocytes in vivo are, however, not yet known. This study investigated the effects of iron on the maturation of T-lymphocytes in anemic but otherwise healthy schoolchildren (no apparent protein-energy deficiency or other morbidity). Anemic children of a poor peri-urban school of Cochabamba city, Bolivia, were given iron treatment for three consecutive months. We chose to look at CD1a+ lymphocytes, which are immature thymocytes. The proportions of CD1a+ lymphocytes in the peripheral circulation measured at baseline and after treatment were compared with a reference group of age-matched non-anemic children controls from the same school. The immunologic parameters, although improved, did not reach the proportions of the control group. Overall, the proportion of circulating immature T-lymphocytes decreased from 18.3% to 9.2% in the treated following iron supplementation in anemic children, compared with 3.4% in non-anemic children.
Collapse
Affiliation(s)
- E Sejas
- Urbanización FUD No 17, Puntiti Norte, Cochabamba-Bolivia
| | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVE To evaluate maternal comprehension of growth charts used in growth monitoring and promotion (GMP), a worldwide programme with important budgets but contrasting results. METHODS Systematic literature review through MEDLINE, POPLINE, Global Health, ERIC and the Cochrane Library with the keywords 'growth monitoring' or 'growth chart' limited to the title/abstract field and to the 0-5 years age range. RESULTS Twenty studies from Asia (8), Africa (8) and Latin America/Caribbean (3) were included in the review. The results of the 14 non-intervention, cross-sectional studies provide convincing evidence that a third to three-fourths of carers in developing countries do not understand the growth charts. Literacy had a strong effect on women's ability to interpret the cards. Appropriate training and educational activities also increased substantially maternal comprehension as demonstrated in five of the six intervention trials. CONCLUSIONS Many carers have poor comprehension of growth charts, but their comprehension increases not only with literacy, but also with training. Activities aimed at improving communication skills of health staff and at empowering parents to practice responsive parenting could greatly improve GMP outcomes.
Collapse
Affiliation(s)
- D Roberfroid
- Nutrition and Child Health Unit, Department of Public Health, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | |
Collapse
|
18
|
Al Sabbah H, Vereecken C, Kolsteren P, Abdeen Z, Maes L. Food habits and physical activity patterns among Palestinian adolescents: findings from the national study of Palestinian schoolchildren (HBSC-WBG2004). Public Health Nutr 2007; 10:739-46. [PMID: 17381946 DOI: 10.1017/s1368980007665501] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the food habits and physical (in)activity patterns and to investigate the relationship with sociodemographic factors among Palestinian adolescents. DESIGN AND SUBJECTS The Palestinian Health Behaviour in School-aged Children (HBSC) is a cross-sectional survey of grades 6, 8, 10 and 12. Students completed a modified version of the international HBSC questionnaire. A total of 8885 students were included in this analysis; 53% were from the West Bank and 47% from the Gaza Strip. RESULTS Adolescents in the West Bank consume more fruit, meat, chicken, sweets and soft drinks, but less vegetables than adolescents in Gaza (P<0.01). Girls reported more daily consumption of fruit, vegetables and sweets than boys (P<0.001), and less consumption of soft drinks, milk, meat and chicken (P<0.01). Boys were physically more active than girls (P<0.01), whereas girls reported doing more homework (P<0.001). Both boys and girls reported less physical activity with increasing age (P<0.001). Consumption of fruit and milk was positively associated with both parents' education, while consumption of meat, chicken and soft drinks was positively associated with mother's education only. Having breakfast on schooldays was positively associated with the father's education. Physical activity and television viewing were associated with the mother's education (P<0.01). The parents' level of education had no effect on vegetable consumption and dieting status. CONCLUSION This study indicated that there are problems with Palestinian adolescents' eating, dieting and physical activity. Regional, gender and parental socio-economic status differences should be taken into account in developing interventions. More detailed studies are needed with more elaborate instruments about food habits and physical activity of adolescents.
Collapse
Affiliation(s)
- H Al Sabbah
- Department of Public Health, Faculty of Medicine, Ghent University, Belgium
| | | | | | | | | |
Collapse
|
19
|
Kimanya M, De Meulenaer B, Tiisekwa B, Ndomondo-Sigonda M, Devlieghere F, Van Camp J, Lachat C, Baert K, Kolsteren P. Assessment of fumonisin exposure to infants consuming maize based complementary foods in Rombo District of Tanzania. Commun Agric Appl Biol Sci 2007; 72:13-17. [PMID: 18018852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- M Kimanya
- Tanzania Food and Drugs Authority, Dar es Salaam, Tanzania
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Lachat C, Dehenauw S, van Camp J, Matthys C, Larondelle Y, Kolsteren P. [A review of the nutritional management plans in the member states of the European Union]. Verh K Acad Geneeskd Belg 2006; 68:55-76. [PMID: 16610423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Obesity has reached epidemiological proportions in Europe and the burden of diseases attributable to nutrition is substantial. Under the impetus of the World Health Organisation (WHO), member states have been urged to develop national action plans for nutrition and physical activity. This study describes what has been done in terms of nutrition policy at national level in the member states of the European Union right before its enlargement in 2004. It is a critical review of publicly available policy documents on nutrition and physical activity. The background idea was to assist the initiative of the Belgian food industry to play a proactive role in the development of a Belgian nutrition action plan. At the time of writing, in total six out of the fifteen EU member states namely Sweden, Finland, Denmark, France, the Netherlands and the United Kingdom, reported to have an operational national nutrition plan. By the end of the year 2004, another four countries are expected to have their plan finalised. In line with WHO guidelines, all nutrition plans in this study acknowledge the importance of a multidisciplinary approach and promote stakeholder involvement at some point. Most of the plans however, do not elaborate on their specific role and strategies that will be used to do so. It seems that stakeholder mobilisation is largely restricted to the implementation phases. All operational nutrition plans envisage reducing social disparities. Long-established vulnerable groups in society such as pregnant women, children and elderly are targeted. Considerable variability was observed for nutritional objectives and dietary recommendations between the different countries. Nutrition surveillance and monitoring activities seem to vary considerably between the different action plans. None of the countries except Denmark documents the theoretical foundations and development process of their nutritional surveillance system. National nutrition policy in Europe is clearly in a state of flux and the centre of gravity seems to move away from Scandinavia. Although the importance of nutritional surveillance, comprehensive approach to nutritional problems and stakeholder involvement is recognised by the action plans, the rationale, justification and mechanisms for it is vaguely described. Our findings call for increased efforts to strengthen the evidence base of public health nutrition policy. To achieve this however, systematic evaluations and proper reporting of which health and nutrition promotion strategies work in the different countries in the EU are urgently needed.
Collapse
Affiliation(s)
- C Lachat
- Vakgroep Voedselveiligheid en Voedselkwaliteit, Faculteit Bio-ingenieurswetenschappen, Universiteit Gent
| | | | | | | | | | | |
Collapse
|
21
|
Roberfroid D, Kolsteren P, Hoerée T, Maire B. Do growth monitoring and promotion programs answer the performance criteria of a screening program? A critical analysis based on a systematic review. Trop Med Int Health 2005; 10:1121-33. [PMID: 16262737 DOI: 10.1111/j.1365-3156.2005.01498.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Growth Monitoring and Promotion programs (GMP) have been intensively promoted to improve children's health in developing countries. It has been hoped that regularly weighing children would result in the early detection of growth falterers, and that the growth chart would serve as an educational tool to make that state apparent to both health workers and caretakers in order to trigger improved caring practices. Our objective was to review whether GMP answers the theoretical grounds of a screening and intervention program. METHOD A systematic literature review was performed. The WHO framework developed by Wilson and Jungner for planning and evaluating screening programs guided the analysis. RESULTS Sixty-nine studies were retrieved. Overall, evidence is weak on the performance of GMP as a screening program for malnutrition through early detection of growth falterers. The main results are: (1) malnutrition remains a public health problem, but its importance is context specific; (2) the value of a low weight velocity to predict malnutrition is unknown and likely to vary in different contexts; (3) the performance of GMP for improving nutrition status of children and in reducing mortality and morbidity is unknown; (4) the performance of the screening is affected by the unreliability of weight measurements; (5) the promotional and educational effectiveness of GMP is low, in particular the growth chart is poorly understood by mothers; (6) the acceptability seems low in regards of low attendance rates; (7) evidence is lacking regarding cost-effectiveness. CONCLUSIONS We conclude that there is too little scientific evidence to indiscriminately support international promotion of GMP. However GMP could constitute a valid strategy of public nutrition in specific situations. We indicate paths for further research and how prevention programs could be developed.
Collapse
Affiliation(s)
- D Roberfroid
- Department of Public Health, Nutrition Unit, Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | |
Collapse
|
22
|
De Baets AJ, Edidi BS, Kasali MJ, Beelaert G, Schrooten W, Litzroth A, Kolsteren P, Denolf D, Fransen K. Pediatric human immunodeficiency virus screening in an African district hospital. Clin Diagn Lab Immunol 2005; 12:86-92. [PMID: 15642990 PMCID: PMC540202 DOI: 10.1128/cdli.12.1.86-92.2005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 09/20/2004] [Accepted: 09/24/2004] [Indexed: 11/20/2022]
Abstract
In order to evaluate alternative tests and strategies to simplify pediatric human immunodeficiency virus (HIV) screening at the district hospital level, a cross-sectional exploratory study was organized in the Democratic Republic of the Congo. Venous and capillary phlebotomies were performed on 941 Congolese children, aged 1 month to 12 years (153 children under 18 months and 788 children more than 18 months old). The HIV prevalence rate was 4.7%. An algorithm for children more than 18 months old, using serial rapid tests (Determine, InstantScreen, and Uni-Gold) performed on capillary blood stored in EDTA tubes, had a sensitivity of 100.0% (95% confidence interval [CI], 88.9 to 100.0%) and a specificity of 100.0% (95% CI, 99.5 to 100.0%). The results of this study suggest that the ultrasensitive p24 antigen assay may be performed on capillary plasma stored on filter paper (sensitivity and specificity, 100.0%; n=87) instead of venous plasma (sensitivity, 92.3%; specificity, 100.0%; n=150). The use of glucolets (instruments used to perform capillary phlebotomies), instead of syringes and needles, may reduce procedural pain and the risk of needle stick injuries at a comparable cost. Compared to the reference, HIV could have been correctly excluded based on one rapid test for at least 90% of these children. The results of this study point towards underutilized opportunities to simplify phlebotomy and pediatric HIV screening.
Collapse
Affiliation(s)
- A J De Baets
- Nutrition and Child Health Unit, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Colebunders R, Kolsteren P, Ryder R. Editorial: giving antiretrovirals in the peripartum period to prevent mother-to-child HIV transmission in low-income countries: only a short-term stopgap measure. Trop Med Int Health 2003; 8:375-7. [PMID: 12753629 DOI: 10.1046/j.1365-3156.2003.01041.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Varandas L, Julien M, Gomes A, Rodrigues P, Van Lerberghe W, Malveiro F, Aguiar P, Kolsteren P, Van Der Stuyft P, Hilderbrand K, Labadarios D, Ferrinho P. A randomised, double-blind, placebo-controlled clinical trial of vitamin A in severe malaria in hospitalised Mozambican children. Ann Trop Paediatr 2001; 21:211-22. [PMID: 11579859 DOI: 10.1080/02724930120077781] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper reports a randomised, double-blind, placebo-controlled clinical trial of the effect of routine vitamin A supplementation given on admission to children with severe malaria with regard to survival, recovery during hospitalisation and outcome 6 weeks after discharge. Children aged between 6 and 72 months admitted to the paediatric wards of the Central Hospital of Maputo (CHM), Mozambique with a diagnosis of severe malaria were randomly assigned either to a control group (placebo) or an experimental group (vitamin A) and were followed up 6 weeks after discharge. There were 280 children in the experimental and 290 in the placebo group. Seven (2.5%) and 13 (4.5%) children died in the experimental and the placebo groups, respectively, a relative risk of death of 0.56 (95% CI 0.23-1.38, p = 0.201). During the 1st 5 hours of admission, the relative risk of death in the vitamin A-supplemented group was 2.54 (0.50-12.96); after 5 hours of admission it was 0.19 (95% CI 0.04-0.85; p = 0.015). In the supplemented group, 4/82 (4.9%) of the children developed neurological sequelae vs 2/78 (2.6%) in the placebo group (RR = 1.90; 95% CI 0.36-10.09; p = 0.682). Although the overall reduction in the risk of death observed for all children receiving vitamin A is not statistically significant, it might be clinically important. This finding cannot, however, be accepted as a firm conclusion and requires validation by future trials.
Collapse
Affiliation(s)
- L Varandas
- Health Systems Unit and Centre for Malaria and other Tropical Diseases, Institute of Hygiene and Tropical Medicine, New University of Lisbon, Portugal.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Mamiro PR, Van Camp J, Roberfroid D, Kolsteren P, Huyghebaert A. Prevalence of malnutrition and anaemia among infants aged 4 - 12 months in Kilosa district-rural Tanzania. Meded Rijksuniv Gent Fak Landbouwkd Toegep Biol Wet 2001; 66:69-73. [PMID: 15954266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- P R Mamiro
- Department of Food Technology and Nutrition, Faculty of Agriculture and Applied Biological Sciences, Ghent University, Coupure links 653, B-9000 Ghent-Belgium
| | | | | | | | | |
Collapse
|
26
|
Mamiro PR, Van Camp J, Roberfroid D, Kolsteren P, Huyghebaert A. Nutritional problems of infants in Kilosa district, rural Tanzania, and appropriate interventions. Meded Rijksuniv Gent Fak Landbouwkd Toegep Biol Wet 2001; 66:291-4. [PMID: 15954306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- P R Mamiro
- Department of Food Technology and Nutrition, Faculty of Agriculture and Applied Biological Sciences, Ghent University, Coupure links 653, B-9000 Ghent-Belgium
| | | | | | | | | |
Collapse
|
27
|
Sevilla R, Sejas E, Zalles L, Belmonte G, Chevalier P, Parent G, Katherine H, Kolsteren P. ["CLAPSEN", a global approach to the rehabilitation of severe childhood malnutrition in Bolivia]. Sante 2000; 10:97-102. [PMID: 10960806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The "CLAPSEN" approach was developed at the Hospital Materno Infantil German Urquidi in Cochabamba, to provide a global response for the study and treatment of childhood malnutrition. "CLAPSEN" is short for Clinical, Laboratory, Anthropometry, Psychology, Sociology, Nursing (Enfermera in Spanish) and Nutritional care. Most of the malnourished children admitted to Cochabamba Hospital are from poor families, more than three quarters of whom have only recently arrived in the city. Acute malnutrition is just one of the manifestations of a generally unfavorable environment. Malnutrition should not be considered as a simple deficiency in energy, protein or micronutrients, but rather as a multi-deficiency syndrome, also involving a lack of basic health and social care. This study demonstrates that malnourished children display a considerable degree of psychological retardation and of immune system depression. After five weeks of rehabilitation, the children were considered to have recuperated physically, as assessed by anthropometry, but not psychologically, as assessed by the adapted Dewer Score, or immunologically, as shown by the size of the thymus or the extent of maturation of lymphocytes. This strategy was not designed as a long-term approach for treating malnutrition, but rather as a research project to characterize the children arriving at the hospital, to determine the reasons for their malnutrition and to identify strategies that could be implemented earlier by health centers of social services, to prevent deterioration in the condition of these children to severe malnutrition requiring hospital admission. We believe that, in this Latin American context, in which the rate of acute malnutrition is low, the hospital should continue to be involved in the treatment of severely malnourished children with associated diseases. The child's stay in hospital should be short and once the child has recovered clinically, he should be sent home. In light of the observed levels of social deprivation, psychosocial and immune deficits, there appears to be a need for continued support for the family, to ensure the full recovery of the child and to prevent relapses.
Collapse
Affiliation(s)
- R Sevilla
- Faculdad de Medicina, UMSS, CP 3119, Cochabamba, Bolivia
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Julien MR, Gomes A, Varandas L, Rodrigues P, Malveiro F, Aguiar P, Kolsteren P, Stuyft P, Hildebrand K, Labadarios D, Ferrinho P. A randomized, double-blind, placebo-controlled clinical trial of vitamin A in Mozambican children hospitalized with nonmeasles acute lower respiratory tract infections. Trop Med Int Health 1999; 4:794-800. [PMID: 10632986 DOI: 10.1046/j.1365-3156.1999.00493.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to test the potential of routine vitamin A supplementation at admission to speed up recovery during hospitalization for acute lower respiratory tract infections (ALRI) and to decrease the levels of morbidity at 6 weeks after discharge. The study was conducted in the Central Hospital of Maputo (CHM), Mozambique, from 1995 to 1997. METHODS Children aged 6-72 months with ALRI admitted to the paediatric wards of the CHM were assigned to a supplementation group (n = 71, receiving 200000 IU of vitamin A) or a control group (n = 93, receiving a placebo). RESULTS The prevalence of vitamin A deficiency was very high and similar between the two groups. The median number of inpatient days for the supplementation group was 3, for the placebo group 4 days. On day 5 the rate of clinical discharge was 88.4% (n = 61/69) in the experimental intervention group and 73.9% (n = 65/88) in the placebo group (P = 0.023). CONCLUSION We found a statistically significant reduction in duration of admission among vitamin A-supplemented children with ALRI. This effect is in line with what is known about the role of vitamin A in human defence and immune mechanisms and with the serological evidence of the extent of vitamin A deficiency among the children in this trial.
Collapse
Affiliation(s)
- M R Julien
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
The health and nutritional status of many urban slum dwellers in the developing world is said to be deteriorating. The nutritional profile of 328 adult, non-pregnant women from the slums of Dinajpur, Bangladesh, confirms this. Results of a cross-sectional survey showed that approximately half the women were acutely malnourished and all but six were anaemic. This, despite the fact that the slums of Dinajpur are considered relatively 'better-off' than many in the developing world; most families having permanent land tenureship, and access to basic education and health services.
Collapse
Affiliation(s)
- S Rahman
- Dinajpur Medical College, Bangladesh
| | | | | | | |
Collapse
|
30
|
Kolsteren P, Rahman SR, Hilderbrand K, Diniz A. Treatment for iron deficiency anaemia with a combined supplementation of iron, vitamin A and zinc in women of Dinajpur, Bangladesh. Eur J Clin Nutr 1999; 53:102-6. [PMID: 10099942 DOI: 10.1038/sj.ejcn.1600684] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The study was set up to determine to what extent the addition of a supplement of vitamin A alone or in combination with zinc would improve standard iron treatment and correction of iron deficiency anaemia. DESIGN 216 non-pregnant anaemic women of 15-45 years of age with haemoglobin levels < or = 100 g/l were randomly assigned to three treatment groups. One group (A) received iron alone, a second group (B) received iron and vitamin A, and a third group (C) received iron, vitamin A and zinc. Every woman was given one iron capsule per day for 60 days as FeSO4 containing 60 mg of elemental iron. In addition, groups B and C received 200,000 i.u. of vitamin A, given as a supervised dose, on the first day of the treatment after collection of the blood sample. Group C received one zinc tablet per day for 60 days as zinc gluconate containing 15 mg of elemental zinc. SETTING The north-western part of Bangladesh in the urban slums of Dinajpur district between February and August 1995. SUBJECTS To select women with a haemoglobin level of < or = 100 g/l, all the women of four randomly selected municipal slums of the district in the targeted age group (328) were invited to take part in the study. Blood samples were analysed for haemoglobin, serum iron, total iron binding capacity (TIBC), ferritin, retinol and zinc. RESULTS Out of the 328 women screened, 254 (77.5%) had a haemoglobin level < or = 100 g/l and 322 (98%) < or = 120 g/l. The three treatment schedules significantly increased haemoglobin levels and improved iron parameters, except for serum iron in the group who received iron alone. The group who received iron, vitamin A and zinc responded best with an increase in haemoglobin of 17.9 g/l as compared to the group receiving iron alone (13.4 g/l). Iron and vitamin A treatment gave an intermediate response of 15.9 g/l. However, these differences are only statistically significant only for the group who received iron, vitamin A and zinc and only for the increase in haemoglobin, P = 0.03. CONCLUSION The results are suggestive that the addition of vitamin A and zinc to the treatment for anaemia can increase haemoglobin levels more than with iron alone.
Collapse
Affiliation(s)
- P Kolsteren
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | |
Collapse
|
31
|
Kolsteren P, Lefèvre P, Lerude PM. Nutrition rehabilitation and the importance of the perception of malnutrition in the follow-up of rehabilitated children. Asia Pac J Clin Nutr 1997; 6:106-110. [PMID: 24394711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Nutrition rehabilitation of malnourished children remains a challenge for health services. This paper reports the results of an evaluation of the nutrition component of a mother and child health program in Nepal. The treatment of severely malnourished children was very satisfactory: case fatality rate varied from 4 to 9 % between projects. Follow-up, however, was found to be very poor: only one percent of the discharged children came for a follow-up visit after the first two weeks. The perception of malnutrition within the communities was identified as one of the possible determinants for a successful follow-up and small scale qualitative investigations were organized to gain insight in the topic. Results are quite revealing regarding the perception of nutrition problems. If for severe cases (kwashiorkor and marasmus) awareness of malnutrition did exist in the community, chronic malnutrition seems to be considered as a normal state of being. When a problem is perceived (in severe cases) people will seldom think of it as a nutrition related disease. Results show that the aetiology used by the people differs significantly from the western paradigm, and that traditional convictions put the causes at natural, supra-natural or social levels. The striking point is that no relation is established in the traditional framework between malnutrition (either severe or mild) and food intake of the children. Perception of malnutrition and of its causes influences health seeking behaviour in terms of prevention and treatment. Traditional healers play an important curative role and will often be the first to be contacted. The absence of perception of the links between the shape of the body and nutrients is put forward as one of the possible explaining mechanisms for low follow-up rates observed. An implication of this study would be to revise the health messages delivered to the communities in order to make them culturally more appropriate and relevant.
Collapse
|
32
|
Kolsteren P. The determinants of stunting: Can we regard the linear growth performance as a continuum of fetal development? Asia Pac J Clin Nutr 1996; 5:59-69. [PMID: 24394512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The relationship between early post-natal growth and the possible links with intra-uterine development is emphasised in this review. In some Asian populations linear growth faltering starts very early after birth and the deficit is most marked in the first six months of life. Catch-up growth, later in life, is possible. Children in developing countries, however, will most often become short adults. The environment is not permissive for a catch-up growth. A conceptual model has been constructed and divided in two parts: intra-uterine factors and factors in the first year of life. Only those determinants which the author considered important for the link between fetal life and early post-natal linear growth are analysed.
Collapse
Affiliation(s)
- P Kolsteren
- Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
33
|
Kolsteren P, Atkinson S, Maskall K. [A nutritional survey in Tibet]. Sante 1995; 5:247-52. [PMID: 7582646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We present the most striking results of a nutritional assessment held in Tibet from May to July 1990, performed at the request of the Health Authorities of the Tibet Autonomous Region. Using a cut-off value which adjusts for the haemoglobin increase with increasing altitude, 40% of the women of reproductive age were considered anaemic. However, the distribution of their haemoglobin values was gaussian with a mean value of 13.6%. Apparently, the Tibetans respond differently to high altitude, compared to other populations living at high altitudes. Goitre remains a problem despite the goitre control program. Rickets, investigated by clinical signs, was prevalent in 9.2% of the children 0 to 6 years old. Rural children were shorter and lighter than urban ones and started to accumulate their deficit earlier.
Collapse
Affiliation(s)
- P Kolsteren
- Unité de nutrition, Institut de médecine tropicale, Anvers, Belgique
| | | | | |
Collapse
|
34
|
Kolsteren P, van der Stuyft P. [Diagnosis of anemia at high altitude: problems encountered in Tibet]. Ann Soc Belg Med Trop 1994; 74:317-22. [PMID: 7726665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To test the hypothesis that Tibetans do not increase their haemoglobin concentration with increasing altitude, haemoglobin concentrations of children aged 6 to 72 months were analyzed. The mean haemoglobin concentrations in the different age groups are significantly lower than the mean concentrations expected at this altitude. Histograms and tests for normality show that the haemoglobin distributions are Gaussian. The probability plots confirm the coefficients of skewness, which indicate a superimposed subpopulation towards the lower range of haemoglobin values. A mixed distribution analysis identifies that the curvilinear deviation found in the probability plot encompasses 10 to 12% of the studied population. Together with the normality of the haemoglobin distributions, we are led to suppose that this is the anaemic population. These figures are considerably lower than those found using recommended cut-off values for this altitude; 40 and 46%. Two possible explanations are put forward: 1) the whole population is submitted to the same factor and hence the whole population should be considered anaemic, 2) Tibetans react differently to altitude than other mountain people and have adapted themselves without increase in haemoglobin.
Collapse
Affiliation(s)
- P Kolsteren
- Unité de Nutrition, Institut de Médecine Tropicale, Antwerpen, Belgique
| | | |
Collapse
|
35
|
Kolsteren P. Kashin-Beck disease. Ann Soc Belg Med Trop 1992; 72:81-91. [PMID: 1417163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The article describes the history, clinical picture and anatomopathological changes of Kashin-Beck disease with reference to the stages of the disease which are at present agreed upon. Specific reference is made to the occurrence of the disease in Tibet. An overview is given of the different proposed etiologies.
Collapse
Affiliation(s)
- P Kolsteren
- Department of Community Health, Institute of Tropical Medicine, Antwerpen, Belgium
| |
Collapse
|