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Al-Biltagi M, Faysal W, Alabdulrazzaq F, Alsabea H, Bassil Z, Chamseddine F, Chokr I, El-Beleidy A, Ezzat M, Farrah A, Mizyed M, Sayed AOS, Talib HA, Wali Y. Middle East consensus recommendations on the use of young child formula (YCF) in toddlers. J Nutr Sci 2022; 11:e53. [PMID: 35836695 PMCID: PMC9274381 DOI: 10.1017/jns.2022.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023] Open
Abstract
The transition of foods during toddlerhood and the suboptimal diets consumed in the Middle East make children susceptible to malnutrition and micronutrient deficiencies. Based on international recommendations, coupled with the merits of clinical studies on the application of young child formula (YCF), a group of fourteen experts from the Middle East reached a consensus on improving the nutritional status of toddlers. The recommendations put forth by the expert panel comprised twelve statements related to the relevance of YCF in young children; the impact of YCF on their nutritional parameters and functional outcomes; characteristics of the currently available YCF and its ideal composition; strategies to supply adequate nutrition in young children and educational needs of parents and healthcare professionals (HCPs). This consensus aims to serve as a guide to HCPs and parents, focusing on improving the nutritional balance in toddlers in the Middle Eastern region. The panellists considere YCF to be one of the potential solutions to improve the nutritional status of young children in the region. Other strategies to improve the nutritional status of young children include fortified cow's milk and cereals, vitamin and mineral supplements, early introduction of meat and fish, and the inclusion of diverse foods in children's diets.
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Affiliation(s)
- Mohammed Al-Biltagi
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- University Medical Center, Arabian Gulf University, King Abdulla Medical City, Manama, Bahrain
- Correspondening author: Mohammed Al-Biltagi,
| | - Wafaa Faysal
- Department of Pediatrics, Dr. Sulaiman Al Habib Hospital, Dubai, United Arab Emirates
| | | | - Hassan Alsabea
- Pediatric Department, Medical Park Consultants, Abu Dhabi, United Arab Emirates
| | - Ziad Bassil
- Pediatric Department, Saint Joseph Hospital, Beirut, Lebanon
| | - Fadi Chamseddine
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Chokr
- Pediatric Department, Al-Zahraa Hospital, Beirut, Lebanon
| | - Ahmed El-Beleidy
- Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Ezzat
- Pediatric Department, Dr. Hala Essa Bin Laden Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Antoine Farrah
- Department of Pediatrics, Saint George Hospital Ajaltoun, Beirut, Lebanon
| | - Mohammad Mizyed
- Department of Pediatrics, Dr. Sulaiman Al Habib Medical Group, Riyadh, Kingdom of Saudi Arabia
| | - Ashraf Othman Saleh Sayed
- Department of Pediatrics, Dar Al-Shifa Hospital, Hawally, Kuwait
- Faculty of Medicine, Minia University, Minya, Egypt
| | - Hussam Abu Talib
- Pediatric Department, Primary Health Care Corporation, Doha, Qatar
| | - Yasser Wali
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Maciel BLL, Costa PN, Filho JQ, Ribeiro SA, Rodrigues FAP, Soares AM, Júnior FS, Ambikapathi R, McQuade ETR, Kosek M, Ahmed T, Bessong P, Kang G, Shresthra S, Mduma E, Bayo E, Guerrant RL, Caulfield LE, Lima AAM. Higher Energy and Zinc Intakes from Complementary Feeding Are Associated with Decreased Risk of Undernutrition in Children from South America, Africa, and Asia. J Nutr 2021; 151:170-178. [PMID: 32939530 PMCID: PMC7779220 DOI: 10.1093/jn/nxaa271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/15/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Few studies have focused on quantitatively analyzing nutrients from infant diets, compromising complementary feeding evaluation and health promotion worldwide. OBJECTIVES This study aimed to describe dietary intake in infants from 9 to 24 mo of age, determining nutrient intakes associated with the risk of underweight, wasting, and stunting. METHODS Usual nutrient intakes from complementary feeding were determined by 24-h recalls collected when infants were 9-24 mo of age in communities from 7 low- and middle-income countries: Brazil (n = 169), Peru (n = 199), South Africa (n = 221), Tanzania (n = 210), Bangladesh (n = 208), India (n = 227), and Nepal (n = 229), totaling 1463 children and 22,282 food recalls. Intakes were corrected for within- and between-person variance and energy intake. Multivariable regression models were constructed to determine nutrient intakes associated with the development of underweight, wasting, and stunting at 12, 18, and 24 mo of age. RESULTS Children with malnutrition presented significantly lower intakes of energy and zinc at 12, 18, and 24 mo of age, ranging from -16.4% to -25.9% for energy and -2.3% to -48.8% for zinc. Higher energy intakes decreased the risk of underweight at 12 [adjusted odds ratio (AOR): 0.90; 95% CI: 0.84, 0.96] and 24 mo (AOR: 0.91; 95% CI: 0.86, 0.96), and wasting at 18 (AOR: 0.91; 95% CI: 0.83, 0.99) and 24 mo (AOR: 0.83; 95% CI: 0.74, 0.92). Higher zinc intakes decreased the risk of underweight (AOR: 0.12; 95% CI: 0.03, 0.55) and wasting (AOR: 0.19; 95% CI: 0.04, 0.92) at 12 mo, and wasting (AOR: 0.05; 95% CI: 0.00, 0.76) at 24 mo. CONCLUSIONS Higher intakes of energy and zinc in complementary feeding were associated with decreased risk of undernutrition in the studied children. Data suggest these are characteristics to be improved in children's complementary feeding across countries.
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Affiliation(s)
- Bruna L L Maciel
- Nutrition Postgraduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Priscila N Costa
- Nutrition Postgraduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - José Q Filho
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Samilly A Ribeiro
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Francisco A P Rodrigues
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Alberto M Soares
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Francisco S Júnior
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | - Elizabeth T R McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Margaret Kosek
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tahmeed Ahmed
- Division of Nutrition and Clinical Services, icddr,b, Dhaka, Bangladesh
| | | | - Gangadeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sanjaya Shresthra
- Walter Reed/Armed Forces Research Institute of Medical Sciences (AFRIMS) Research Unit, Nepal (WARUN), Kathmandu, Nepal
| | - Estomih Mduma
- Haydom Global Health Research Centre, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Eliwaza Bayo
- Haydom Global Health Research Centre, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Richard L Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Laura E Caulfield
- Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aldo A M Lima
- INCT—Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Khan GN, Kureishy S, Ariff S, Rizvi A, Sajid M, Garzon C, Khan AA, de Pee S, Soofi SB, Bhutta ZA. Effect of lipid-based nutrient supplement-Medium quantity on reduction of stunting in children 6-23 months of age in Sindh, Pakistan: A cluster randomized controlled trial. PLoS One 2020; 15:e0237210. [PMID: 32790725 PMCID: PMC7425934 DOI: 10.1371/journal.pone.0237210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Chronic childhood malnutrition, or stunting, remains a persistent barrier to achieve optimal cognitive development, child growth and ability to reach full potential. Almost half of children under-five years of age are stunted in the province of Sindh, Pakistan. Objective The primary objective of this study was to test the hypothesis that the provision of lipid-based nutrient supplement—medium-quantity (LNS-MQ) known as Wawamum will result in a 10% reduction in risk of being stunted at the age of 24 months in the intervention group compared with the control group. Design A cluster randomized controlled trial was conducted in Thatta and Sujawal districts of Sindh province, Pakistan. A total of 870 (419 in intervention; 451 in control) children between 6–18 months old were enrolled in the study. The unit of randomization was union council and considered as a cluster. A total of 12 clusters, 6 in each study group were randomly assigned to intervention and control group. All children received standard government health services, while children in the intervention group also received 50 grams/day of Wawamum. Results Children who received Wawamum were found to have a significantly reduced risk of stunting (RR = 0.91, 95% CI; 0.88–0.94, p<0.001) and wasting (RR = 0.78, 95% CI; 0.67–0.92, p = 0.004) as compared to children who received the standard government health services. There was no evidence of a reduction in the risk of underweight (RR = 0.94, 95% CI; 0.85–1.04, p = 0.235) in the intervention group compared to the control group. Statistically significant reduction in anaemia in the intervention group was also found as compared to the control group (RR = 0.97, 95% CI; 0.94–0.99, p = 0.042). The subgroup analysis by age, showed intervention effect is significant in reduction of risk of stunting in younger children of aged 6–12 month (RR = 0.83, 95% CI; 0.81–0.86, p = <0.001) and their older peers aged 13–18 month- (RR = 0.90, 95% CI; 0.83–0.97, p = 0.008). The mean compliance of Wawamum was 60% among children. Conclusions The study confirmed that the provision of Wawamum to children 6–23 months of age is effective in reducing the risk of stunting, wasting and anaemia. This approach should be scaled up among the most food insecure areas/households with a high prevalence of stunting to achieve positive outcomes for nutrition and health. This study was registered at clinicaltrials.gov as NCT02422953. Clinical Trial Registration Number: NCT02422953
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Affiliation(s)
- Gul Nawaz Khan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Sajid
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Saskia de Pee
- World Food Programme, Rome, Italy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- * E-mail:
| | - Zulfiqar A. Bhutta
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Abstract
BACKGROUND Education of family members about infant weaning practices could affect nutrition, growth, and development of children in different settings across the world. OBJECTIVES To compare effects of family nutrition educational interventions for infant weaning with conventional management on growth and neurodevelopment in childhood. SEARCH METHODS We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5), MEDLINE via PubMed (1966 to 26 June 2018), Embase (1980 to 26 June 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 June 2018). We searched clinical trials databases, conference proceedings, and references of retrieved articles. We ran an updated search from 1 January 2018 to 12 December 2019 in the following databases: CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA We included randomised controlled trials that examined effects of nutrition education for weaning practices delivered to families of infants born at term compared to conventional management (standard care in the population) up to one year of age. DATA COLLECTION AND ANALYSIS Two review authors independently identified eligible trial reports from the literature search and performed data extraction and quality assessments for each included trial. We synthesised effect estimates using risk ratios (RRs), risk differences (RDs), and mean differences (MDs), with 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 21 trials, recruiting 14,241 infants. Five of the trials were conducted in high-income countries and the remaining 16 were conducted in middle- and low-income countries. Meta-analysis showed that nutrition education targeted at improving weaning-related feeding practices probably increases both weight-for-age z scores (WAZ) (MD 0.15 standard deviations, 95% CI 0.07 to 0.22; 6 studies; 2551 infants; I² = 32%; moderate-certainty evidence) and height-for-age z scores (0.12 standard deviations, 95% CI 0.05 to 0.19; 7 studies; 3620 infants; I² = 49%; moderate-certainty evidence) by 12 months of age. Meta-analysis of outcomes at 18 months of age was heterogeneous and inconsistent in the magnitude of effects of nutrition education on WAZ and weight-for-height z score across studies. One trial that assessed effects of nutrition education on growth at six years reported an uncertain effect on change in height and body mass index z score. Two studies investigated effects of nutrition education on neurodevelopment at 12 to 24 months of age with conflicting results. No trials assessed effects of nutrition education on long-term neurodevelopmental outcomes. AUTHORS' CONCLUSIONS Nutrition education for families of infants may reduce the risk of undernutrition in term-born infants (evidence of low to moderate certainty due to limitations in study design and substantial heterogeneity of included studies). Modest effects on growth during infancy may not be of clinical significance. However, it is unclear whether these small improvements in growth parameters in the first two years of life affect long-term childhood growth and development. Further studies are needed to resolve this question.
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Affiliation(s)
- Shalini Ojha
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
- Children's Hospital, University Hospitals of Derby and Burton, Derby, UK
| | - Zenab Elfzzani
- Academic Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | | | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Choudhury N, Raihan MJ, Ahmed SMT, Islam KE, Self V, Rahman S, Schofield L, Hall A, Ahmed T. The evaluation of Suchana, a large-scale development program to prevent chronic undernutrition in north-eastern Bangladesh. BMC Public Health 2020; 20:744. [PMID: 32443977 PMCID: PMC7245033 DOI: 10.1186/s12889-020-08769-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/23/2020] [Indexed: 11/27/2022] Open
Abstract
Evidence of the impact of community-based nutrition programs is uncommon for two main reasons: the lack of untreated controls, and implementation does not account for the evaluation design. Suchana is a large-scale program to prevent malnutrition in children in Sylhet division, Bangladesh by improving the livelihoods and nutrition knowledge of poor and very poor households. Suchana is being implemented in 157 unions, the smallest administrative unit of government, in two districts of Sylhet. Suchana will deliver a package of interventions to poor people in about 40 randomly selected new unions annually over 4 years, until all are covered. All beneficiaries will receive the normal government nutrition services. For evaluation purposes the last 40 unions will act as a control for the first 40 intervention unions. The remaining unions will receive the program but will not take part in the evaluation. A baseline survey was conducted in both intervention and control unions; it will be repeated after 3 years to estimate the impact on the prevalence of stunted children and other indicators. This stepped wedge design has several advantages for both the implementation and evaluation of services, as well as some disadvantages. The units of delivery are randomized, which controls for other influences on outcomes; the program supports government service delivery systems, so it is replicable and scalable; and the program can be improved over time as lessons are learned. The main disadvantages are the difficulty of estimating the impact of each component of the program, and the geographical distribution of unions, which increases program delivery costs. Stepped implementation allows a cluster randomized trial to be achieved within a large-scale poverty alleviation program and phased-in and scaled-up over a period of time. This paper may encourage evaluators to consider how to estimate attributable impact by using stepped implementation, which allows the counterfactual group eventually to be treated.
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Affiliation(s)
- Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddrb, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
- Department of Anthropology, Durham University, Durham, UK.
| | - Mohammad Jyoti Raihan
- Nutrition and Clinical Services Division, icddrb, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - S M Tanvir Ahmed
- Save the Children Bangladesh, House CWN (A) 35, Road 43, Gulshan, Dhaka, Bangladesh
| | - Kazi Eliza Islam
- Save the Children Bangladesh, House CWN (A) 35, Road 43, Gulshan, Dhaka, Bangladesh
| | - Vanessa Self
- Save the Children U.K., 1 St John's Lane, London, EC1M 4AR, UK
| | - Shahed Rahman
- Save the Children Bangladesh, House CWN (A) 35, Road 43, Gulshan, Dhaka, Bangladesh
| | - Lilly Schofield
- Save the Children U.K., 1 St John's Lane, London, EC1M 4AR, UK
| | - Andrew Hall
- Save the Children U.K., 1 St John's Lane, London, EC1M 4AR, UK
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddrb, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Foreword. Nestle Nutr Inst Workshop Ser 2020; 93:IX-X. [PMID: 31991440 DOI: 10.1159/000504231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
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Preface. Nestle Nutr Inst Workshop Ser 2020; 93:VII-VIII. [PMID: 31991441 DOI: 10.1159/000504447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
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Worku T, Gonete KA, Muhammad EA, Atnafu A. Sustainable under nutrition reduction program and dietary diversity among children's aged 6-23 months, Northwest Ethiopia: Comparative cross-sectional study. Int J Equity Health 2020; 19:14. [PMID: 31992299 PMCID: PMC6986108 DOI: 10.1186/s12939-019-1120-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Adequate dietary diversity is vital for the survival, growth and development of infants and children. Inadequate dietary diversity is the major cause of micronutrient deficiency in Sub-saharan Africa, including Ethiopia, where only less than one-fourth of the children aged 6-23 months obtain adequate diversified diet. Thus country implemented a strategy known as the Sustainable Undernutrtion Reduction (SUR) programs to alleviate the problem. However, empirical evidences are scarce on the impact of the program on children aged 6-23 months. Therefore, this study aimed to compare the level of dietary diversity among children aged 6-23 months in districts covered and not covered by SURE program in West Gojjam zone. METHODS A community based comparative cross-sectional study was conducted in three districts of West Gojjam zone, Ethiopia, from February 29 to April 20, 2019. A total of 832 mother and child pairs were selected by the simple random sampling technique. A pretested and structured interviewer-administered questionnaire was used to collect data. A binary logistic regression model was fitted to identify factors associated with dietary diversity. Crude odds and adjusted odds ratios with 95% confidence intervals (CI) were calculated to assess the strength of associations and significance of the identified factors for dietary diversity score. RESULT The overall proportion of adequate dietary diversity among children aged 6-23 months was 29.9% (95% CI: 27.0-33.0), whereas in SURE covered and uncovered districts it was 33.4% (95%CI: 29.0-38.and 26.4%(95% CI: 22.0, 31.0), respectively. ANC (Antenatal care) (AOR = 1.7; 95% CI: 1.16, 2.55) and postnatal care services (AOR = 2.1; 95% CI: 1.38, 3.28), participating in food preparation programs (AOR = 1.9; 95% CI: 1.19, 2.96), GMP (AOR = 2.74,95%CI:1.80, 4.18), vitamin A supplementation (AOR = 2.10,95%CI:1.22, 3.61) and household visits by health extension workers (AOR = 2.0; 95% CI: 1.25, 3.21) were significantly associated with dietary diversity. CONCLUSION The proportion of adequate dietary diversity was higher among children in the program than those out of the program. ANC visits, PNC follow-ups, women's participating in food preparation programs and household visits by health extension workers were significantly associated with dietary diversity. Therefore, and strengthening and scaling up the program to non covered districts and providing health and nutrition counseling on Infant and Young Child Feeding (IYCF) during ANC and PNC services are recommended for achieving the recommended dietary diversity.
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Affiliation(s)
| | - Kedir Abdela Gonete
- Department of Human Nutrition, Institute of Public Health, University of Gondar, College of Medicine and Health Sciences, P.O. Box 196, Gondar, Ethiopia
| | - Esmael Ali Muhammad
- Department of Human Nutrition, Institute of Public Health, University of Gondar, College of Medicine and Health Sciences, P.O. Box 196, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Borg B, Sok D, Mihrshahi S, Griffin M, Chamnan C, Berger J, Laillou A, Roos N, Wieringa FT. Effectiveness of a locally produced ready-to-use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial. Matern Child Nutr 2020; 16:e12896. [PMID: 31885221 PMCID: PMC7038903 DOI: 10.1111/mcn.12896] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/01/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
This cluster randomised controlled trial tested the effectiveness of a locally produced, fish-based, ready-to-use supplementary food (RUSF) to prevent growth faltering (decline in z-scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn-Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight-for-age z-scores (WAZ; -0.02, 95%CI = -0.03 - -0.01, P= 0.001) and height-for-age z-scores (HAZ; -0.07, 95%CI = -0.09 - -0.05, P < 0.001), and increased mid-upper arm-circumference (MUAC; 0.02cm, 95%CI = 0.01 - 0.04, P = 0.010), but no statistically significant change in weight-for-height z-scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 - 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01-0.06, P = 0.006; 0.04, 95%CI = 0.01-0.08, P = 0.026; and 0.05cm, 95%CI = 0.02-0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.
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Affiliation(s)
- Bindi Borg
- School of Public Health, Faculty of MedicineUniversity of SydneySydneyAustralia
| | - Daream Sok
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenCopenhagenDenmark
- Department of Fisheries Post‐Harvest Technologies and Quality Control, Fisheries AdministrationMinistry of Agriculture, Forestry and FisheriesPhnom PenhCambodia
| | - Seema Mihrshahi
- School of Public Health, Faculty of MedicineUniversity of SydneySydneyAustralia
| | - Mark Griffin
- School of Public Health, Faculty of MedicineUniversity of SydneySydneyAustralia
- School of Public HealthUniversity of QueenslandBrisbaneAustralia
| | - Chhoun Chamnan
- Department of Fisheries Post‐Harvest Technologies and Quality Control, Fisheries AdministrationMinistry of Agriculture, Forestry and FisheriesPhnom PenhCambodia
| | - Jacques Berger
- UMR‐204 NutripassInstitut de Recherche pour le Développement, IRD/UM/SupAgroMontpellierFrance
| | - Arnaud Laillou
- Child Survival and Development SectionUNICEFPhnom PenhCambodia
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Frank T. Wieringa
- UMR‐204 NutripassInstitut de Recherche pour le Développement, IRD/UM/SupAgroMontpellierFrance
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Becquey E, Huybregts L, Zongrone A, Le Port A, Leroy JL, Rawat R, Touré M, Ruel MT. Impact on child acute malnutrition of integrating a preventive nutrition package into facility-based screening for acute malnutrition during well-baby consultation: A cluster-randomized controlled trial in Burkina Faso. PLoS Med 2019; 16:e1002877. [PMID: 31454347 PMCID: PMC6711504 DOI: 10.1371/journal.pmed.1002877] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community management of acute malnutrition (CMAM) is a highly efficacious approach for treating acute malnutrition (AM) in children who would otherwise be at significantly increased risk of mortality. In program settings, however, CMAM's effectiveness is limited because of low screening coverage of AM, in part because of the lack of perceived benefits for caregivers. In Burkina Faso, monthly screening for AM of children <2 years of age is conducted during well-baby consultations (consultation du nourrisson sain [CNS]) at health centers. We hypothesized that the integration of a preventive package including age-appropriate behavior change communication (BCC) on nutrition, health, and hygiene practices and a monthly supply of small-quantity lipid-based nutrient supplements (SQ-LNSs) to the monthly screening would increase AM screening and treatment coverage and decrease the incidence and prevalence of AM. METHODS AND FINDINGS We used a cluster-randomized controlled trial and allocated 16 health centers to the intervention group and 16 to a comparison group. Both groups had access to standard CMAM and CNS services; caregivers in the intervention group also received age-appropriate monthly BCC and SQ-LNS for children >6 months of age. We used two study designs: (1) a repeated cross-sectional study of children 0-17 months old (n = 2,318 and 2,317 at baseline and endline 2 years later) to assess impacts on AM screening coverage, treatment coverage, and prevalence; (2) a longitudinal study of 2,113 children enrolled soon after birth and followed up monthly for 18 months to assess impacts on AM screening coverage, treatment coverage, and incidence. Data were analyzed as intent to treat. Level of significance for primary outcomes was α = 0.016 after adjustment for multiple testing. Children's average age was 8.8 ± 4.9 months in the intervention group and 8.9 ± 5.0 months in the comparison group at baseline and, respectively, 0.66 ± 0.32 and 0.67 ± 0.33 months at enrollment in the longitudinal study. Relative to the comparison group, the intervention group had significantly higher monthly AM screening coverage (cross-sectional study: +18 percentage points [pp], 95% CI 10-26, P < 0.001; longitudinal study: +23 pp, 95% CI 17-29, P < 0.001). There were no impacts on either AM treatment coverage (cross-sectional study: +8.0 pp, 95% CI 0.09-16, P = 0.047; longitudinal study: +7.7 pp, 95% CI -1.2 to 17, P = 0.090), AM incidence (longitudinal study: incidence rate ratio = 0.98, 95% CI 0.75-1.3, P = 0.88), or AM prevalence (cross-sectional study: -0.46 pp, 95% CI -4.4 to 3.5, P = 0.82). A study limitation is the referral of AM cases (for ethical reasons) by study enumerators as part of the monthly measurement in the longitudinal study that may have attenuated the detectable impact on AM treatment coverage. CONCLUSIONS Adding a preventive package to CMAM delivered at health facilities in Burkina Faso increased participation in monthly AM screening, thus overcoming a major impediment to CMAM effectiveness. The lack of impact on AM treatment coverage and on AM prevalence and incidence calls for research to address the remaining barriers to uptake of preventive and treatment services at the health center and to identify and test complementary approaches to bring integrated preventive and CMAM services closer to the community while ensuring high-quality implementation and service delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT02245152.
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Affiliation(s)
- Elodie Becquey
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
- * E-mail:
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Amanda Zongrone
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Agnes Le Port
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Jef L. Leroy
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Rahul Rawat
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Mariama Touré
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Marie T. Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
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11
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Adhisivam B, Thanigainathan S. Commercializing Donor Human Milk - Nip it in the Bud. Indian Pediatr 2019; 56:608. [PMID: 31333221] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- B Adhisivam
- Department of Neonatology, JIPMER, Puducherry, India.
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Samuel A, Osendarp SJM, Ferguson E, Borgonjen K, Alvarado BM, Neufeld LM, Adish A, Kebede A, Brouwer ID. Identifying Dietary Strategies to Improve Nutrient Adequacy among Ethiopian Infants and Young Children Using Linear Modelling. Nutrients 2019; 11:E1416. [PMID: 31238506 PMCID: PMC6627485 DOI: 10.3390/nu11061416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
Nutrient adequacy of young children's diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6-8, 9-11 and 12-23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6-12 months of age and every other day for 12-23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.
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Affiliation(s)
- Aregash Samuel
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
- Nutrition International (NI), Ottawa, ON K2P2K3, Canada.
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK.
| | - Karin Borgonjen
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Brenda M Alvarado
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Lynnette M Neufeld
- Global Alliance for Improved Nutrition (GAIN), 1202 Geneva, Switzerland.
| | - Abdulaziz Adish
- Nutrition International (NI), Nifas Silk Lafto Sub City, Kebele 04, Addis Ababa, Ethiopia.
| | - Amha Kebede
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
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Khan NUZ, Rasheed S, Sharmin T, Siddique AK, Dibley M, Alam A. How can mobile phones be used to improve nutrition service delivery in rural Bangladesh? BMC Health Serv Res 2018; 18:530. [PMID: 29986733 PMCID: PMC6038298 DOI: 10.1186/s12913-018-3351-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/03/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nutrition has been integrated within the health services in Bangladesh as it is an important issue for health and development. High penetration of mobile phones in the community and favourable policy and political commitment of the Government of Bangladesh has created possibilities of using Information Communication Technology such as mobile phones for nutrition programs. In this paper the implementation of nutrition services with a specific focus on infant and young child feeding was explored and the potential for using mobile phones to improve the quality and coverage of nutrition services was assessed. METHODS A qualitative study was conducted in Mirzapur and Chakaria sub-districts, Bangladesh from February-April 2014. We conducted 24 in-depth interviews (mothers of young children), 8 focus group discussions (fathers and grandmothers); and 13 key informant interviews (community health workers or CHWs). We also observed 4 facilities and followed 2 CHWs during their work day. The data was analyzed manually using pre-existing themes. RESULTS In this community, mothers demonstrated gaps in knowledge about IYCF. They depended on their social network and media for IYCF information. Although CHWs were trusted in the community, mothers and their family members did not consider them a good source of nutrition information as they did not talk about nutrition. In terms of ICTs, mobile phones were the most available and used by both CHWs and mothers. CHWs showed willingness to incorporate nutrition counselling through mobile phone as this can enhance their productivity, reduce travel time and improve service quality. Mothers were willing to receive voice calls from CHWs as long as the decision makers in the households were informed. CONCLUSIONS Our study indicated that there are gaps in IYCF related service delivery and there is a potential for using mobile phones to both strengthen the quality of service delivery as well as reaching out to the mothers in the community. It is important however, to consider the community readiness to accept the technology during the design and delivery of the intervention.
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Affiliation(s)
- Nazib Uz Zaman Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sabrina Rasheed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Tamanna Sharmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - A. K. Siddique
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Micheal Dibley
- International Public Health, Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Ashraful Alam
- International Public Health, Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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Scott M, Malde B, King C, Phiri T, Chapota H, Kainja E, Banda F, Vera-Hernandez M. Family networks and infant health promotion: a mixed-methods evaluation from a cluster randomised controlled trial in rural Malawi. BMJ Open 2018; 8:e019380. [PMID: 29880562 PMCID: PMC6009513 DOI: 10.1136/bmjopen-2017-019380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Parents may rely on information provided by extended family members when making decisions concerning the health of their children. We evaluate whether extended family members affected the success of an information intervention promoting infant health. METHODS This is a secondary, sequential mixed-methods study based on a cluster randomised controlled trial of a peer-led home-education intervention conducted in Mchinji District, Malawi. We used linear multivariate regression to test whether the intervention impact on child height-for-age z-scores (HAZ) was influenced by extended family members. 12 of 24 clusters were assigned to the intervention, in which all pregnant women and new mothers were eligible to receive 5 home visits from a trained peer counsellor to discuss infant care and nutrition. We conducted focus group discussions with mothers, grandmothers and peer counsellors, and key-informant interviews with husbands, chiefs and community health workers to better understand the roles of extended family members in infant feeding. RESULTS Exposure to the intervention increased child HAZ scores by 0.296 SD (95% CI 0.116 to 0.484). However, this effect is smaller in the presence of paternal grandmothers. Compared with an effect size of 0.441 to 0.467 SD (95% CI -0.344 to 1.050) if neither grandmother is alive, the effect size was 0.235 (95% CI -0.493 to 0.039) to 0.253 (95% CI -0.529 to 0.029) SD lower if the paternal grandmother was alive. There was no evidence of an effect of parents' siblings. Maternal grandmothers did not affect intervention impact, but were associated with a lower HAZ score in the control group. Qualitative analysis suggested that grandmothers, who act as secondary caregivers and provide resources for infants, were slower to dismiss traditionally held practices and adopt intervention messages. CONCLUSION The results indicate that the intervention impacts are diminished by paternal grandmothers. Intervention success could be increased by integrating senior women.
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Affiliation(s)
| | - Bansi Malde
- Centre for Evaluation of Development Policies, Institute for Fiscal Studies, London, UK
- School of Economics, University of Kent, London, UK
| | - Carina King
- Institute for Global Health, University College London, London, UK
| | | | | | | | | | - Marcos Vera-Hernandez
- Centre for Evaluation of Development Policies, Institute for Fiscal Studies, London, UK
- Department of Economics, University College London, London, UK
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Chanani S, Waingankar A, Shah More N, Pantvaidya S, Fernandez A, Jayaraman A. Participation of pregnant women in a community-based nutrition program in Mumbai's informal settlements: Effect on exclusive breastfeeding practices. PLoS One 2018; 13:e0195619. [PMID: 29621355 PMCID: PMC5886586 DOI: 10.1371/journal.pone.0195619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background In urban Maharashtra, India, approximately half of mothers exclusively breastfeed. For children residing in informal settlements of Mumbai, this study examines factors associated with exclusive breastfeeding, and whether exclusive breastfeeding, in a community-based nutrition program to prevent and treat wasting among children under age three, is associated with enrolment during the mother’s pregnancy. Methods The nutrition program conducted a cross-sectional endline survey (October-December 2015) of caregivers in intervention areas. Factors associated with exclusive breastfeeding for infants under six months of age were explored using multi-level logistic regressions. Additionally, program surveillance data collected during home-based counselling visits documented breastfeeding practices for children under six months of age. Using the surveillance data (January 2014-March 2016), exclusive breastfeeding status was regressed adjusting for child, maternal and socioeconomic characteristics, and whether the child was enrolled in the program in utero or after birth. Results The community-based endline survey included 888 mothers of infants. Mothers who received the nutrition program home visits or attended group counselling sessions were more likely to exclusively breastfeed (adjusted odds ratio 1.67, 95% CI 1.16, 2.41). Having a normal weight-for-height z-score (adjusted odds ratio 1.57, 95% CI 1.00, 2.45) was associated positively with exclusive breastfeeding. As expected, being an older infant aged three to five months (adjusted odds ratio 0.34, 95% CI 0.25, 0.48) and receiving a prelacteal feed after birth (adjusted odds ratio 0.57, 95% CI 0.41, 0.80) were associated with lower odds of exclusively breastfeeding. Surveillance data (N = 3420) indicate that infants enrolled in utero have significantly higher odds of being exclusively breastfed (adjusted odds ratio 1.55, 95% CI 1.30, 1.84) than infants enrolled after birth. Conclusions Prenatal enrolment in community-based programs working on child nutrition in urban informal settlements of India can improve exclusive breastfeeding practices.
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Affiliation(s)
- Sheila Chanani
- Society for Nutrition, Education and Health Action, Mumbai, India
- * E-mail:
| | | | - Neena Shah More
- Society for Nutrition, Education and Health Action, Mumbai, India
| | | | - Armida Fernandez
- Society for Nutrition, Education and Health Action, Mumbai, India
| | - Anuja Jayaraman
- Society for Nutrition, Education and Health Action, Mumbai, India
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Kadiyala S, Prost A, Harris-Fry H, O’Hearn M, Pradhan R, Pradhan S, Mishra NK, Rath S, Nair N, Rath S, Tripathy P, Krishnan S, Koniz-Booher P, Danton H, Elbourne D, Sturgess J, Beaumont E, Haghparast-Bidgoli H, Skordis-Worrall J, Mohanty S, Upadhay A, Allen E. Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child nutritional outcomes in rural Odisha, India: study protocol for a cluster randomised controlled trial. Trials 2018; 19:176. [PMID: 29523173 PMCID: PMC5845188 DOI: 10.1186/s13063-018-2521-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Maternal and child undernutrition have adverse consequences for pregnancy outcomes and child morbidity and mortality, and they are associated with low educational attainment, economic productivity as an adult, and human wellbeing. 'Nutrition-sensitive' agriculture programs could tackle the underlying causes of undernutrition. METHODS/DESIGN This study is a four-arm cluster randomised controlled trial in Odisha, India. Interventions are as follows: (1) an agricultural extension platform of women's groups viewing and discussing videos on nutrition-sensitive agriculture (NSA) practices, and follow-up visits to women at home to encourage the adoption of new practices shown in the videos; (2) women's groups viewing and discussing videos on NSA and nutrition-specific practices, with follow-up visits; and (3) women's groups viewing and discussing videos on NSA and nutrition-specific practices combined with a cycle of Participatory Learning and Action meetings, with follow-up visits. All arms, including the control, receive basic nutrition training from government community frontline workers. Primary outcomes, assessed at baseline and 32 months after the start of the interventions, are (1) percentage of children aged 6-23 months consuming ≥ 4 out of 7 food groups per day and (2) mean body mass index (BMI) (kg/m2) of non-pregnant, non-postpartum (gave birth > 42 days ago) mothers or female primary caregivers of children aged 0-23 months. Secondary outcomes are percentage of mothers consuming ≥ 5 out of 10 food groups per day and percentage of children's weight-for-height z-score < -2 standard deviations (SD). The unit of randomisation is a cluster, defined as one or more villages with a combined minimum population of 800 residents. There are 37 clusters per arm, and outcomes will be assessed in an average of 32 eligible households per cluster. For randomisation, clusters are stratified by distance to nearest town (< 10 km or ≥ 10 km), and low (< 30%), medium (30-70%), or high (> 70%) proportion of Scheduled Tribe or Scheduled Caste (disadvantaged) households. A process evaluation will assess the quality of implementation and mechanisms behind the intervention effects. A cost-consequence analysis will compare incremental costs and outcomes of the interventions. DISCUSSION This trial will contribute evidence on the impacts of NSA extension through participatory, low-cost, video-based approaches on maternal and child nutrition and on whether integration with nutrition-specific goals and enhanced participatory approaches can increase these impacts. TRIAL REGISTRATION ISRCTN , ISRCTN65922679 . Registered on 21 December 2016.
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Affiliation(s)
- Suneetha Kadiyala
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Audrey Prost
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Helen Harris-Fry
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Meghan O’Hearn
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Ronali Pradhan
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Shibananth Pradhan
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Keonjhar, 754224 Odisha India
| | - Naba Kishore Mishra
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Keonjhar, 754224 Odisha India
| | - Suchitra Rath
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | - Nirmala Nair
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | - Shibanand Rath
- Ekjut, 556 B, Ward No. 17, Potka, Chakradharpur, 833102 Jharkhand India
| | | | - Sneha Krishnan
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Peggy Koniz-Booher
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th Floor, Arlington, 22209 VA USA
| | - Heather Danton
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research & Training Institute, Inc., 1616 Fort Myer Drive, 16th Floor, Arlington, 22209 VA USA
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Joanna Sturgess
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Emma Beaumont
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Jolene Skordis-Worrall
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Satyanarayan Mohanty
- Development Corner Consulting Pvt. Ltd. (DCOR), 131(P), Punjabi Chhak, Satyanagar, Near Hotel Sungreen, Bhubaneshwar, 751007 India
| | - Avinash Upadhay
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016 India
| | - Elizabeth Allen
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Wang X, Luo R, Liu C, Zhang L, Yue A, Medina A, Rozelle S. Using daily text messages to improve adherence to infant micronutrient powder (MNP) packets in rural western China: A cluster-randomized controlled trial. PLoS One 2018; 13:e0191549. [PMID: 29352304 PMCID: PMC5774801 DOI: 10.1371/journal.pone.0191549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 01/04/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the effectiveness of daily text messages as a means to improve caregivers’ adherence to infant micronutrient powder (MNP) in rural Shaanxi Province of China. Methodology 638 infants aged 6–11 months in 234 villages were involved in a cluster-randomized controlled trial (RCT). All caregivers were given free infant MNP packets at baseline in April 2013 and the follow-up survey was in July 2013. We randomly assigned 318 infants in 117 villages to treatment group (receiving daily text message) and 320 infants in the other 117 villages as control group. Results On average, daily text messages increased the number of MNP packets fed (marginal effect = 4.63; 95% confidence interval (CI) = 0.16, 9.10). The text message is more likely to increase the consumption of MNP packets if the primary caregiver was the mother (marginal effect = 12.19; 95% CI = 0.69, 23.68). Receiving the text message appears to significantly increase the likelihood of full adherence when the primary caregiver can either check (odds ratio = 2.93; 95% CI = 1.34, 6.40) or knows how to send (odds ratio = 3.26; 95% CI = 1.53, 6.97) text messages. Conclusion Daily text messages improved the consumption of infant MNP packets. However, the impact was not large enough to increase the probability of caregivers being fully adherent to the feeding instruction, which is to feed 5–7 packets per week as recommended. In addition, when the mother is the caregiver and when the caregiver can check or knows how to send text messages there is greater adherence by the primary caregivers. Trial registration http://www.isrctn.com/ISRCTN44149146
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Affiliation(s)
- Xu Wang
- Education Global Practices (East and South Africa), the World Bank Group, NW, Washington DC, United States of America
| | - Renfu Luo
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Haidian District, Beijing, China
- * E-mail:
| | - Chengfang Liu
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Haidian District, Beijing, China
| | - Linxiu Zhang
- Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Chaoyang District, Beijing, China
| | - Ai Yue
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi’an, Shaanxi, China
| | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, United States of America
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, United States of America
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Chadare FJ, Madode YE, Fanou-Fogny N, Kindossi JM, Ayosso JO, Honfo SH, Kayodé AP, Linnemann AR, Hounhouigan DJ. Indigenous food ingredients for complementary food formulations to combat infant malnutrition in Benin: a review. J Sci Food Agric 2018; 98:439-455. [PMID: 28731216 DOI: 10.1002/jsfa.8568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
This paper reviews indigenous Beninese food resources as potential ingredients for complementary infant foods with the aim to develop affordable formulations for low-income households in each agro-ecological zone of the country. Potential ingredients were selected on their documented nutritional value. The selected foods encompass 347 food resources, namely 297 plant products from home gardens or collected from natural vegetation and 50 animals, either domesticated or from the wild. The compiled data reveal that the distribution of the available food resources was unbalanced between agro-ecological zones. Only a few animal ingredients are obtainable in northern Benin. Most resources are seasonal, but their availability may be extended. A high variation was observed in energy and nutrient contents. Antinutritional factors were identified in some resources, but processing techniques were reported to reduce their presence in meals. In general, ingredients from local tree foods (Adansonia digitata, Parkia biglobosa) were adequate as sources of nutrients for complementary infant foods. Based on this review, local foods for the development of complementary food formulas for Beninese infants and children may be selected for each agro-ecological zone. The approach used is exemplary for other sub-Saharan African countries in need of complementary infant foods. © 2017 Society of Chemical Industry.
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Affiliation(s)
- Flora J Chadare
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
- Ecole des Sciences et Techniques de Conservation et de Transformation des produits Agricoles, Université Nationale d'Agriculture (ESTCTPA/UNA), Sakété, Bénin
| | - Yann E Madode
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
| | - Nadia Fanou-Fogny
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
| | - Janvier M Kindossi
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
| | - Juvencio Og Ayosso
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
| | - S Hermann Honfo
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
- Laboratoire de Biomathématiques et d'Estimations Forestières, Université d'Abomey-Calavi (Labef/UAC), Abomey-Calavi, Benin
| | - Ap Polycarpe Kayodé
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
| | - Anita R Linnemann
- Food Quality and Design, Wageningen University (FQD/WU), Wageningen, The Netherlands
| | - D Joseph Hounhouigan
- Laboratoire de Sciences des Aliments, Faculté des Sciences Agronomiques, Université d'Abomey-Calavi (LSA/FSA/UAC), Abomey-Calavi, Benin
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Prahl C, Kuijpers-Jagtman AM, Van 't Hof MA, Prahl-Andersen B. Infant Orthopedics in UCLP: Effect on Feeding, Weight, and Length: A Randomized Clinical Trial (Dutchcleft). Cleft Palate Craniofac J 2017; 42:171-7. [PMID: 15748108 DOI: 10.1597/03-111.1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 11/22/2022] Open
Abstract
Objective To study the effects of infant orthopedics (IO) on feeding, weight, and length. Design Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. Setting Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients Infants with complete unilateral cleft lip and palate (UCLP), no other malformations. Interventions One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO−) did not. All other interventions were the same for both groups. Main Outcome Measures Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands’ third nationwide survey on growth. Results Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO− group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure. Conclusion Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned.
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Affiliation(s)
- Charlotte Prahl
- Department of Orthodontics and Oral Biology, University Medical Center Nijmegen, Nijmegen, Netherlands
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20
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Iqbal R, Tahir S, Ghulamhussain N. The need for dietary guidelines in Pakistan. J PAK MED ASSOC 2017; 67:1258-1261. [PMID: 28839315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Diet is one of the most important contributors to health and disease. Developing countries such as Pakistan are facing a growing epidemic of under nutrition resulting in stunting, wasting and micronutrient deficiencies in the population. This severe situation of under nutrition in the country is coupled with rising tide of non-communicable diseases (NCD) posing the double burden of disease on the country. These burden of NCD, along with over and under nutrition poses a huge burden on the already over-utilized multi-tiered health care system in Pakistan. In this alarming situation, nutrition education in the form of food based dietary guidelines (FBDGs) naturally becomes the most essential tool for promoting a health culture within the country and eventually changing behaviour.
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Edward RR, Innes JK, Marino LV, Calder PC. Influence of different intravenous lipid emulsions on growth, development and laboratory and clinical outcomes in hospitalised paediatric patients: A systematic review. Clin Nutr 2017; 37:765-783. [PMID: 28712532 DOI: 10.1016/j.clnu.2017.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Fats in the form of lipid emulsions (LEs) are an integral part of intravenous nutrition. The fatty acid composition of different LEs varies. The exact composition of a LE may influence cell and tissue function and clinical outcome. Currently, it is not clear which LE might be best for paediatric patients. We conducted a systematic review of the effects of different intravenous LEs in hospitalised paediatric patients. METHODS Randomised controlled trials published in a peer reviewed journal, written in the English language, and comparing two or more different intravenous LEs in hospitalised paediatric patients were included. Data on outcomes of relevance (growth, development, laboratory and clinical outcomes) were extracted, collated and interpreted. RESULTS Thirty-one articles involving 1522 infants or children were included. Most outcomes were not affected by the nature of the LE used. LEs containing fish oil, a source of omega-3 fatty acids, improved outcome of retinopathy of prematurity, decreased liver cholestasis and increased blood omega-3 fatty acid levels. LEs containing olive oil increased blood oleic acid level and had a cholesterol lowering effect. CONCLUSION Blood fatty acids are influenced by the nature of the intravenous LE used in hospitalised paediatric patients. Most studies suggest limited differences in relevant laboratory or clinical outcomes or in growth in paediatric patients receiving different LEs, although several studies do find benefits from including fish oil or olive oil. There is a need for larger trials to fully evaluate the effects of the available LE types in hospitalised paediatric patients.
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Affiliation(s)
- Roy-Rosshan Edward
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Jacqueline K Innes
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Luise V Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton SO16 6YD, United Kingdom.
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Barbas KH, Sussman-Karten K, Kamin D, Huh SY. Unpasteurized Shared Human Milk Use in Pediatric Inpatients: Health and Ethical Implications. Hosp Pediatr 2017; 7:352-356. [PMID: 28473474 DOI: 10.1542/hpeds.2016-0178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 06/07/2023]
Abstract
Growing evidence supporting the health benefits of human milk, particularly in the preterm population, has led to rising demand for donor human milk in NICUs and pediatric hospitals. There are no previous reports describing the use of unpasteurized shared human milk (USHM) in the hospital setting, but the use of USHM solicited from community donors through social networks appears to be common. Many pediatric hospitals permit inpatients to receive breast milk that has been screened and pasteurized by a human milk banking organization and will provide pasteurized donor human milk (PDHM) only to infants who are preterm or have specific medical conditions. These policies are designed to minimize potential adverse effects from improperly handled or screened donor milk and to target patients who would experience the greatest benefit in health outcomes with donor milk use. We explore the ethical and health implications of 2 cases of medically complex infants who did not meet criteria in our tertiary care hospital for the use of PDHM from a regulated human milk bank and were incidentally found to be using USHM. These cases raise questions about how best to balance the ethical principles of beneficence, nonmaleficence, justice, and patient autonomy in the provision of PDHM, a limited resource. Health care staff should ask about USHM use to provide adequate counseling about the risks and benefits of various feeding options in the context of an infant's medical condition.
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Affiliation(s)
| | | | - Daniel Kamin
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Susanna Y Huh
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts
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Wang J, Chang S, Zhao L, Yu W, Zhang J, Man Q, He L, Duan Y, Wang H, Scherpbier R, Yin SA. Effectiveness of community-based complementary food supplement (Yingyangbao) distribution in children aged 6-23 months in poor areas in China. PLoS One 2017; 12:e0174302. [PMID: 28319154 PMCID: PMC5358851 DOI: 10.1371/journal.pone.0174302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/28/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation. METHODS Baseline and follow-up cross-sectional surveys were conducted before and after a nutrition intervention program in 3 national poverty counties in China. Soybean-based complementary food supplements called Yingyangbao (YYB) in Chinese and training materials on child feeding were distributed to households with children aged 6-23 months for 18 months. Representative children were selected by probability proportional to size sampling methods to assess compliance of YYB and the intervention efficacy. A questionnaire was designed to collect data on basic characteristics of children, breastfeeding, 24-hour dietary intake, and consumption and appetite of YYB. Anthropometrics and hemoglobin were measured in the field, and anemia prevalence was evaluated. Venous blood was drawn from children aged 12-35 months to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia. RESULTS Of the children involved in the follow-up survey (n = 693), the P50 (P25, P75) intake of YYB was 6.7 (3.5, 7.0) sachets weekly, and 54.7% of the children liked the taste of YYB. Compared with the baseline situation (n = 823), the proportion of children fed a diverse diet and foods rich in iron or vitamin A increased (P < 0.01) in the follow-up study. The prevalence of stunting and underweight decreased (P < 0.05), the prevalence of anemia decreased from 28.0% to 19.9% (P < 0.01), and the prevalence of vitamin B12 deficiency decreased from 26.8% to 15.4% (P < 0.01). For children aged 12-23 months, those who liked YYB and consumed 6 or more sachets of YYB weekly were at lower risk for anemia (OR = 0.34, 95% CI 0.13-0.90, P < 0.05), but the risk of stunting was associated with a non-diverse diet (OR = 1.48, 95% CI 1.06-2.07, P < 0.05). CONCLUSION The quality of diet and nutritional status of children aged 6-23 months are significantly improved by the intervention of YYB and nutrition education, and good compliance to YYB contributes to a low risk for anemia. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-OOC-16008846.
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Affiliation(s)
- Jie Wang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Suying Chang
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Liyun Zhao
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wentao Yu
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Zhang
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingqing Man
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li He
- Department of Science and Technology, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yifan Duan
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Wang
- Department of Population Research, China Population and Development Research Center, Beijing, China
| | - Robert Scherpbier
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Shi-an Yin
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Smuts CM, Benadé AJS, Berger J, Hop LT, López de Romaña G, Untoro J, Karyadi E, Erhardt J, Gross R. Iris I: A Foodlet-Based Multiple-Micronutrient Intervention in 6- to 12-Month-Old Infants at High Risk of Micronutrient Malnutrition in Four Contrasting Populations: Description of a Multicenter Field Trial. Food Nutr Bull 2016; 24:S27-33. [PMID: 14564941 DOI: 10.1177/15648265030243s105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/15/2022]
Abstract
Infants in developing countries are at risk of concurrent micronutrient deficiencies, because the same causative factors may lead to deficiencies of different micronutrients. Inadequate dietary intake is considered one of the major causes of micronutrient deficiencies, especially among poor and underprivileged children in developing countries. Operational strategies and distribution systems are often duplicated when supplementation programs for single micronutrients are implemented at the same time. The International Research on Infant Supplementation (IRIS) trial was conducted in four distinct populations on three continents: Africa, Latin America, and Asia. The participating countries were South Africa, Peru, Vietnam, and Indonesia. The study had a randomized, doubleblind, placebo-controlled design. Each country aimed to enroll at least 70 infants per intervention group (65 + 5 anticipated dropouts). The micronutrient vehicle was in the form of a “foodlet” (food-like tablet) manufactured as chewable tablets, which were easy to break and dissolve, and which had the same taste, color, and flavor for all countries. Children were randomly assigned to one of four 6-month intervention groups: group 1 received a daily foodlet containing multiple micronutrients; group 2 received a daily placebo foodlet containing no micronutrients; group 3 received a weekly foodlet that contained multiple micronutrients (twice the dose of the daily foodlet) and placebo foodlets on the other days of the week; group 4 received a daily foodlet containing only 10 mg of elemental iron. The IRIS Trial aimed to examine the prevalence of multi-micronutrient deficiencies in 6- to 12-month-old infants from rural populations, and to examine the efficacy of multi-micronutrient supplementation in infants from the different countries included in the study. This paper describes the general methodology of the IRIS trial and the operational differences among the country sites.
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Affiliation(s)
- C Marius Smuts
- Nutritional Intervention Research Unit, MRC, Parow, South Africa.
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25
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McGuire E, Kam R. The roles of zinc in lactation. Breastfeed Rev 2016; 24:41-48. [PMID: 29211421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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26
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Zhang Y, Wu Q, Wang W, van Velthoven MH, Chang S, Han H, Xing M, Chen L, Scherpbier RW. Effectiveness of complementary food supplements and dietary counselling on anaemia and stunting in children aged 6-23 months in poor areas of Qinghai Province, China: a controlled interventional study. BMJ Open 2016; 6:e011234. [PMID: 27799239 PMCID: PMC5093399 DOI: 10.1136/bmjopen-2016-011234] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of dietary counselling and complementary food supplements on anaemia and stunting prevalence in children aged 6-23 months. DESIGN A controlled intervention study with measurements of height and haemoglobin levels, and cross-sectional surveys in August 2012 (baseline), 2013 (mid-term) and 2014 (end-line). SETTING One intervention county and one control county in rural Qinghai Province, China. INTERVENTION Complementary food supplements (containing protein, fat, carbohydrate, vitamin A, B1, B2, B12, D3, folic acid, iron, zinc and calcium) and complementary feeding counselling were given in the intervention county. PARTICIPANTS Caregivers and their children aged 6-23 months. PRIMARY AND SECONDARY OUTCOME MEASURES Effect of the interventions on the prevalence of anaemia (haemoglobin <110 g/L) and stunting (z-score of height-for-age <-2.0) (controlled for differences between the counties), and on infant feeding practices. RESULTS The surveys were conducted on 1804, 2187 and 2186 children aged 6-23 months in the intervention county in August 2012, 2013 and 2014, respectively, and 804, 680 and 790 children in the control county, respectively. Between the baseline and end-line surveys, anaemia prevalence decreased more in the intervention county than in the control county (71.1% to 47.8% vs 86.3% to 75.3%, respectively; p<0.0001). There was no difference in the decrease in stunting prevalence between the counties (9.7% to 7.1% vs 17.0% to 15.0%; p=0.7954). The proportions of children given iron-rich or iron-fortified food, introduced to (semi-) solid food at 6-8 months, and given food with minimum dietary diversity increased from 43.2% to 88.8% (p<0.0001), 81.4% to 96% (p=0.0470) and 53.0% to 59.8% (p<0.0001), respectively in the intervention county. CONCLUSIONS We found much higher anaemia prevalence in poor rural areas of Qinghai Province compared with the national data. Community-based complementary food supplements combined with dietary counselling can improve feeding practices and reduce anaemia prevalence. Future studies should use longer follow-up to assess the effects on stunting. STRENGTHS AND LIMITATIONS We included a large number of participants and assessed a combined complementary food supplements and dietary counselling intervention in a poor rural area in China with high anaemia prevalence. Although the study took place in only one intervention county and one control county, we conducted an analysis that controlled for differences between the two counties. Also, although we made significant efforts to train village doctors, their education was not systematically assessed after training and thus their delivery of the interventions may have been variable. TRIAL REGISTRATION NUMBER ChiCTRPRC12002444; Pre-results.
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Affiliation(s)
- Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Qiong Wu
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Wei Wang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | | | - Suying Chang
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Huijun Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Min Xing
- Department of Health Education in Framing and Pastoral Areas, Qinghai Health Education Center, Qinghai, China
| | - Li Chen
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Robert W. Scherpbier
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
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Sjarif DR, Yuliarti K, Wahyuni LK, Wiguna T, Prawitasari T, Devaera Y, Triyuniati HW, Afriansyah A. Effectiveness of a comprehensive integrated module using interactive lectures and workshops in understanding and knowledge retention about infant feeding practice in fifth year medical students: a quasi-experimental study. BMC Med Educ 2016; 16:210. [PMID: 27538528 PMCID: PMC4991091 DOI: 10.1186/s12909-016-0705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/01/2016] [Indexed: 05/13/2023]
Abstract
BACKGROUND Sixty percent of the 10.9 million under-5 deaths every year are related to malnutrition. More than two thirds of malnutrition is caused by inappropriate infant feeding practice. Only 35 % of mothers worldwide provide 4 months of exclusive breast-feeding, while complementary feeding is often untimely, nutritionally inadequate, hygienically poor, and improperly delivered. The existing pediatric nutrition module in our institution does not include proper delivery of food that involves oral-motor skills and feeding behavior. To scale up the knowledge and skill of medical students regarding evidence-based infant feeding practice, we designed a new module composed of comprehensive and integrated lectures with additional multidisciplinary lectures on oral-motor skill development and feeding behavior. METHODS A quasi-experimental study was conducted to evaluate the efficacy of the new module compared to the previous module. Fifth year medical students of Universitas Indonesia were divided into intervention and control groups. The control group received lectures and a paper-based workshop. The intervention group received comprehensive and integrated interactive lectures with additional multidisciplinary lectures on oral-motor skill development and behavioral approaches to feeding problems. A hands-on workshop using real cases shown on recorded video and role-play sessions was also presented to the intervention group. A pre-/post-test, 3-month retention test, and Observed Structured Clinical Examination (OSCE) were performed to evaluate understanding, knowledge retention, and counseling skills. RESULTS A linear mixed effect model with a random intercept analysis for pre-test, post-test, and retention test scores showed significant higher result for intervention group compared to control group (p < 0.001). Comprehensive knowledge and counselling skills were better in the intervention group than in the control group as shown by the OSCE score (68.6 vs 59.3, p < 0.001). CONCLUSIONS Our comprehensive integrated infant feeding practice module, which incorporates multidisciplinary learning processes and an interactive hands-on workshop with a role-play session yields better knowledge understanding and counseling skills compared with the existing module. Comprehensive knowledge and good counseling skills of medical students as future doctors are a pre-requisite to provide effective education to parents to support successful infant feeding practices.
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Affiliation(s)
- Damayanti Rusli Sjarif
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Klara Yuliarti
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Luh Karunia Wahyuni
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Indonesia, Cipto Mangukusumo Hospital, Jakarta, 10430 Indonesia
| | - Tjhin Wiguna
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, 10430 Indonesia
| | - Titis Prawitasari
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Yoga Devaera
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Henni Wahyu Triyuniati
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
| | - Andika Afriansyah
- Division of Nutrition and Metabolic Disease, Department of Pediatrics, Cipto Mangukusumo Hospital / Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro 71, Jakarta, 10430 Indonesia
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Abstract
BACKGROUND Malnutrition is a major cause of child morbidity and mortality. There are several interventions to prevent the condition but it is unclear how well they are taken up by both malnourished and well nourished children and their mothers and the extent to which this is influenced by socio-economic factors. We examined socio-economic factors, health outcomes and the uptake of interventions to prevent malnutrition by mothers of malnourished and well-nourished in under-fives attending Princess Marie Louise Children's Hospital (PML). METHODS An unmatched case control study of malnourished and well-nourished children and their mothers was conducted at PML, the largest facility for managing malnutrition in Ghanaian children. Malnourished children with moderate and severe acute malnutrition were recruited and compared with a group of well-nourished children attending the hospital. Weight-for-height was used to classify nutritional status. Record forms and a semi-structured questionnaire were used for data collection, which was analysed with Stata 11.0 software. RESULTS In all, 182 malnourished and 189 well-nourished children and their mothers/carers participated in the study. Children aged 6-12 months old formed more than half of the malnourished children. The socio-demographic factors associated with malnutrition in the multivariate analysis were age ≤24 months and a monthly family income of ≤200 GH Cedis. Whereas among the health outcomes, low birth weight, an episode of diarrhoea and the presence of developmental delay were associated with malnutrition. Among the interventions, inadequate antenatal visits, faltering growth and not de-worming one's child were associated with malnutrition in the multivariate analysis. Immunisation and Vitamin A supplementation were not associated with malnutrition. Missed opportunities for intervention were encountered. CONCLUSION Poverty remains an important underlying cause of malnutrition in children attending Princess Marie Louise Children's Hospital. Specific and targeted interventions are needed to address this and must include efforts to prevent low birthweight and diarrhoea, and reduce health inequalities. Regular antenatal clinic attendance, de-worming of children and growth monitoring should also be encouraged. However, further studies are needed on the timing and use of information on growth faltering to prevent severe forms of malnutrition.
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Affiliation(s)
- Edem M A Tette
- Department of Community Health, School of Public Health, University of Ghana, P.O. Box 4236, Accra, Ghana.
- Princess Marie Louis Children's Hospital (PML), P.O. Box GP 122, Accra, Ghana.
| | - Eric K Sifah
- Princess Marie Louis Children's Hospital (PML), P.O. Box GP 122, Accra, Ghana.
| | - Edmund T Nartey
- World Health Organisation Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology & Therapeutics, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana.
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Eidelman AI. Breastfeeding: The Basis for Normal Infant Development and Societal Well-Being. Breastfeed Med 2015; 10:405-6. [PMID: 26501891 DOI: 10.1089/bfm.2015.29014.eid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Possner M. [The first 1,000 days - an important period for our lifelong health]. Kinderkrankenschwester 2015; 34:382-387. [PMID: 27349070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Kimani-Murage EW, Kimiywe J, Kabue M, Wekesah F, Matiri E, Muhia N, Wanjohi M, Muriuki P, Samburu B, Kanyuira JN, Young SL, Griffiths PL, Madise NJ, McGarvey ST. Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial. Trials 2015; 16:431. [PMID: 26416177 PMCID: PMC4587817 DOI: 10.1186/s13063-015-0935-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 08/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya. METHODS The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government's Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health. DISCUSSION Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community-based intervention aimed at promoting optimal breastfeeding and other infant feeding practices. The intervention, if proved feasible and effective, will inform policy and practice in Kenya and similar settings, particularly regarding implementation of the baby friendly community initiative. TRIAL REGISTRATION ISRCTN03467700 ; Date of Registration: 24 September 2014.
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Affiliation(s)
- Elizabeth W Kimani-Murage
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Judith Kimiywe
- Department of Food, Nutrition and Dietetics, Kenyatta University, School of Applied Human Sciences Complex, Conference Road, Room HE7, P.O. Box 43844, 00100, Nairobi, Kenya.
| | - Mark Kabue
- Jhpiego, Off Riverside Drive, 14 Riverside, Arlington Block-2nd Floor, Nairobi, Kenya.
| | - Frederick Wekesah
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Evelyn Matiri
- PATH, ACS Plaza, 4th floor, Lenana Road, P.O. Box 76634-00508, Nairobi, Kenya.
| | - Nelson Muhia
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Milka Wanjohi
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Peterrock Muriuki
- African Population and Health Research Centre (APHRC), APHRC Campus, Kirawa Road, Off PeponiRoad, P.O. Box 10787, 00100, Nairobi, Kenya.
| | - Betty Samburu
- Human Nutrition and Dietetics Unit, Ministry of Health, P.O. Box 43319-00100, Nairobi, Kenya.
| | - James N Kanyuira
- Action Against Hunger (ACF), 4th Floor, Suite 17, Green House, Ngong Road, P.O. Box 39900-00623, Nairobi, Kenya.
| | - Sera L Young
- Department of Population Medicine and Diagnostics, Program in International Nutrition, Cornell University, Ithaca, NY, USA.
| | - Paula L Griffiths
- Centre for Global Health and Human Development, Loughborough University, Loughborough, UK.
| | - Nyovani J Madise
- Centre for Global Health, Population, Poverty and Policy, ESRC Centre for Population Change, Faculty of Social and Human Science, University of Southampton, Building 58, Room 2001, Southampton, SO17 1BJ, UK.
| | - Stephen T McGarvey
- International Health Institute, Brown University, Providence, RI 02903, USA.
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Cowbrough K. Part one: Portion control during infancy and toddler years. J Fam Health 2015; 25:16-19. [PMID: 26387245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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McGuire E. Vitamin D and breastfeeding: an update. Breastfeed Rev 2015; 23:26-32. [PMID: 26287042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Mofid LS, Casapía M, Montresor A, Rahme E, Fraser WD, Marquis GS, Vercruysse J, Allen LH, Gyorkos TW. Maternal Deworming Research Study (MADRES) protocol: a double-blind, placebo-controlled randomised trial to determine the effectiveness of deworming in the immediate postpartum period. BMJ Open 2015; 5:e008560. [PMID: 26084556 PMCID: PMC4480032 DOI: 10.1136/bmjopen-2015-008560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/12/2015] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Soil-transmitted helminth infections are endemic in 114 countries worldwide, and cause the highest burden of disease among all neglected tropical diseases. The WHO includes women of reproductive age as a high-risk group for infection. The primary consequence of infection in this population is anaemia. During lactation, anaemia may contribute to reduced quality and quantity of milk, decreasing the duration of exclusive breastfeeding and lowering the age at weaning. To date, no study has investigated the effects of maternal postpartum deworming on infant or maternal health outcomes. METHODS AND ANALYSIS A single-centre, parallel, double-blind, randomised, placebo-controlled trial will be carried out in Iquitos, Peru, to assess the effectiveness of integrating single-dose 400 mg albendazole into routine maternal postpartum care. A total of 1010 mother-infant pairs will be randomised to either the intervention or control arm, following inhospital delivery and prior to discharge. Participants will be visited in their homes at 1, 6, 12 and 24 months following delivery for outcome ascertainment. The primary outcome is infant mean weight gain between birth and 6 months of age. Secondary outcomes include other infant growth indicators and morbidity, maternal soil-transmitted helminth infection and intensity, anaemia, fatigue, and breastfeeding practices. All statistical analyses will be performed on an intention-to-treat basis. ETHICS AND DISSEMINATION Research ethics board approval has been obtained from the McGill University Health Centre (Canada), the Asociación Civil Impacta Salud y Educación (Peru) and the Instituto Nacional de Salud (Peru). A data safety and monitoring committee is in place to oversee study progression and evaluate adverse events. The results of the analyses will be published in peer-reviewed journals, and presented at national and international conferences. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT01748929.
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Affiliation(s)
- Layla S Mofid
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | | | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Elham Rahme
- Research Institute of the McGill University Health Centre, Division of Clinical Epidemiology, Montréal, Québec, Canada
| | - William D Fraser
- Département d'obstétrique et de gynécologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Grace S Marquis
- School of Dietetics and Human Nutrition, McGill University, Ste. Anne-de-Bellevue, Québec, Canada
| | - Jozef Vercruysse
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California, Davis, California, USA
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Research Institute of the McGill University Health Centre, Division of Clinical Epidemiology, Montréal, Québec, Canada
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Farebrother J, Naude CE, Nicol L, Sang Z, Yang Z, Andersson M, Jooste PL, Zimmermann MB. Systematic review of the effects of iodised salt and iodine supplements on prenatal and postnatal growth: study protocol. BMJ Open 2015; 5:e007238. [PMID: 25908676 PMCID: PMC4410124 DOI: 10.1136/bmjopen-2014-007238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Iodine is an essential micronutrient and component of the thyroid hormones. Sufficient ingestion of iodine is necessary for normal growth and development. If iodine requirements are not met, growth can be impaired. Salt iodisation and supplementation with iodine can prevent iodine deficiency disorders and stunted growth. No systematic review has yet collated the evidence linking iodine to growth. With an increased emphasis on stunting within the WHO Global Nutrition Targets for 2025, we propose a systematic review to address this question. METHODS AND ANALYSIS We will undertake a systematic review, and if appropriate, meta-analyses, evaluating the effects of iodised salt or iodine supplements on prenatal and postnatal somatic growth, until age 18. We will search a number of databases, including MEDLINE, EMBASE, Web of Science, CINAHL, PsychINFO, the Cochrane Library, including the CENTRAL register of Controlled Trials and also the WHO library and ICTRP (International Clinical Trials Registry Platform), which includes the Clinicaltrials.gov repository. We will also search Wanfang Data and the China Knowledge Resource Integrated Database. Included studies must have compared exposure to iodised salt, iodine supplements or iodised oil, to placebo, non-iodised salt or no intervention. Primary outcomes will be continuous and categorical markers of prenatal and postnatal somatic growth. Secondary outcomes will cover further measures of growth, including growth rates and indirect markers of growth such as insulin-like growth factor-1 (IGF-1). ETHICS AND DISSEMINATION The systematic review will be published in a peer-reviewed journal, and will be sent directly to the WHO, United Nations Children's Fund, International Council for the Control of Iodine Deficiency Disorders and other stakeholders. The results generated from this systematic review will provide evidence to support future programme recommendations regarding iodine fortification or supplementation and child growth. TRIAL REGISTRATION NUMBER PROSPERO CRD42014012940.
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Affiliation(s)
- Jessica Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Celeste E Naude
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Liesl Nicol
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Zhongna Sang
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhenyu Yang
- Key Laboratory of Trace Element Nutrition of the Ministry of Health, National Institute of Nutrition and Food Safety, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Pieter L Jooste
- Faculty of Health Sciences, Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
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Laterra A, Ayoya MA, Beaulière JM, Bienfait M, Pachón H. Infant and young child feeding in four departments in Haiti: mixed-method study on prevalence of recommended practices and related attitudes, beliefs, and other determinants. Rev Panam Salud Publica 2014; 36:306-313. [PMID: 25604100] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/24/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To determine and describe the prevalence and patterns of three recommended practices for infant and young child feeding-exclusive breastfeeding (EB), continued breastfeeding (CB), and achievement of minimum dietary diversity-in four regions in Haiti, and to identify the attitudes and beliefs that inform these practices and any other factors that may facilitate or impede their implementation. METHODS This study utilized a mixed-methods approach consisting of 1) a cross-sectional survey (n = 310) and 2) 12 focus group discussions among women ≥18 years old with children ≤ 2 years old. Multivariable logistic regression analyses were conducted to identify factors associated with 1) EB during the first six months of life, 2) CB for children ≥ 2 years old, and 3) receipt of a diverse variety of complementary foods. Qualitative data were recorded, transcribed verbatim, and analyzed for common themes. Data were collected in June and July 2013 in four departments in Haiti: Artibonite, Nippes, Ouest, and Sud-Est. RESULTS Prevalence of EB, CB, and achievement of minimum dietary diversity was 57.0%, 11.9%, and 21.2% respectively. EB was statistically significantly associated with infant's age when controlling for annual household income, location of most recent birth, or receipt of CB counseling (odds ratio (OR) = 0.67 (95% CI: 0.47-0.97)). CB was not statistically significantly associated with rural place of residence, receipt of CB counseling, parity, or infant's age. Meeting minimum dietary diversity was not significantly associated with parity, receipt of postnatal care, rural place of residence, location of most recent birth, receipt of infant and young child feeding counseling, or level of schooling. Beliefs surrounding the relationship between the mother's health and her diet on the quality of breast milk may prohibit EB and CB. Qualitative data revealed that dietary diversity may be low because 1) mothers often struggle to introduce complementary foods and 2) those that are traditionally introduced are not varied and primarily consist of grains and starches. CONCLUSIONS Prevalence of the three recommended infant and young child feeding practices examined in this study is suboptimal, particularly CB and achievement of minimum dietary diversity. Future communication and programming efforts should address the misunderstandings and concerns identified through the qualitative methods used in this research.
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Affiliation(s)
- Anne Laterra
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America,
| | - Mohamed A Ayoya
- Nutrition Section, UNICEF Country Office, Port-au-Prince, Haiti
| | | | | | - Helena Pachón
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America,
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Lee G, Paredes Olortegui M, Rengifo Pinedo S, Ambikapathi R, Peñataro Yori P, Kosek M, Caulfield LE. Infant feeding practices in the Peruvian Amazon: implications for programs to improve feeding. Rev Panam Salud Publica 2014; 36:150-157. [PMID: 25418764] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/11/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To characterize feeding practices in a community in the Peruvian Amazon and to consider how this information could be used to strengthen programs and policies designed to improve nutrition and reduce child malnutrition in vulnerable communities. METHODS Data from three structured questionnaires were combined to produce a comprehensive depiction of feeding in a sample of 246 infants from birth through 8 months of life in the community of Santa Clara de Nanay near Iquitos, Peru. Breastfeeding initiation practices, exclusive breastfeeding in the first 180 days of life, the introduction of solids, and complementary feeding practices from 6-8 months, were described and related to maternal, infant, and household characteristics, including food insecurity. RESULTS The median duration of exclusive breastfeeding was 19 days. However, over the first 180 days of life, children were exclusively breastfed on 46.1% of days. Overall, 68.3% of infants received some semi-solid or solid food between 0-6 months and all had received semi-solids by the end of 8 months of age. The proportion of infants consuming a minimally acceptable (frequent and diverse) complementary diet was 2.9%, 7.9%, and 16.1% at 6, 7, and 8 months respectively. CONCLUSIONS Although breastfeeding is nearly universal, promotion programs are needed in Santa Clara to 1) delay the introduction of plain water, other non-breast milk liquids, and semi-solid foods; 2) extend the period of exclusive breastfeeding; and 3) increase food diversity and the frequency of feeding during the period of complementary feeding. These results can be used to guide programs and policies to improve nutrition and reduce child malnutrition.
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Affiliation(s)
- Gwenyth Lee
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America,
| | | | | | - Ramya Ambikapathi
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America,
| | - Pablo Peñataro Yori
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America,
| | - Margaret Kosek
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America,
| | - Laura E Caulfield
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America,
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Lemale J. [Feeding and nutritionnal requirements of infants and children]. Rev Prat 2014; 64:995-1000. [PMID: 25362793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ojha S, Szatkowski L, Sinha R, Yaron G, Fogarty A, Allen S, Choudhary S, Smyth AR. Feasibility and pilot study of the effects of microfinance on mortality and nutrition in children under five amongst the very poor in India: study protocol for a cluster randomized controlled trial. Trials 2014; 15:298. [PMID: 25052420 PMCID: PMC4119203 DOI: 10.1186/1745-6215-15-298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/08/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The United Nations Millennium Development Goals include targets for the health of children under five years old. Poor health is linked to poverty and microfinance initiatives are economic interventions that may improve health by breaking the cycle of poverty. However, there is a lack of reliable evidence to support this. In addition, microfinance schemes may have adverse effects on health, for example due to increased indebtedness. Rojiroti UK and the Centre for Promoting Sustainable Livelihood run an innovative microfinance scheme that provides microcredit via women's self-help groups (SHGs). This pilot study, conducted in rural Bihar (India), will establish whether it is feasible to collect anthropometric and mortality data on children under five years old and to conduct a limited cluster randomized trial of the Rojiroti intervention. METHODS/DESIGN We have designed a cluster randomized trial in which participating tolas (small communities within villages) will be randomized to either receive early (SHGs and microfinance at baseline) or late intervention (SHGs and microfinance after 18 months). Using predesigned questionnaires, demographic, and mortality data for the last year and information about participating mothers and their children will be collected and the weight, height, and mid upper arm circumference (MUAC) of children will be measured at baseline and at 18 months. The late intervention group will establish SHGs and microfinance support at this point and data collection will be repeated at 36 months.The primary outcome measure will be the mean weight for height z-score of children under five years old in the early and late intervention tolas at 18 months. Secondary outcome measures will be the mortality rate, mean weight for age, height for age, prevalence of underweight, stunting, and wasting among children under five years of age. DISCUSSION Despite economic progress, marked inequalities in child health persist in India and Bihar is one of the worst affected states. There is a need to evaluate programs that may alleviate poverty and improve health. This study will help to inform the design of a definitive trial to determine if the Rojiroti scheme can improve the nutrition and survival of children under five years of age in deprived rural communities. TRIAL REGISTRATION Clinicaltrials.gov (study ID: NCT01845545). Registered on 24 April 2013.
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Affiliation(s)
- Shalini Ojha
- />Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Queen’s Medical Center, Derby Road, NG7 2UH Nottingham, UK
| | - Lisa Szatkowski
- />Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences, City Hospital, NG5 1 PB Nottingham, UK
| | - Ranjeet Sinha
- />Department of Community Medicine, Patna Medical College & Hospital, 800004 Patna, India
| | - Gil Yaron
- />Chair of the Board of Trustees, Rojiroti UK, 32 Amenbury Lane, AL5 2DF Harpenden, UK
| | - Andrew Fogarty
- />Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences, City Hospital, NG5 1 PB Nottingham, UK
| | - Stephen Allen
- />Pediatrics and International Health, College of Medicine, The College of Medicine, Swansea University, Room 314, SA2 8PP Swansea, UK
| | - Sunil Choudhary
- />Secretary, CPSL, House No-22, R.L. Enclave, Duplex Colony, Near at Sonali Auto, Bye Pass Road, Vishnupuri, Anishabad, Patna, 800002 Bihar India
| | - Alan R Smyth
- />Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Queen’s Medical Center, Derby Road, NG7 2UH Nottingham, UK
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Sazawal S, Dhingra P, Dhingra U, Gupta S, Iyengar V, Menon VP, Sarkar A, Black RE. Compliance with home-based fortification strategies for delivery of iron and zinc: its effect on haematological and growth markers among 6-24 months old children in north India. J Health Popul Nutr 2014; 32:217-226. [PMID: 25076659 PMCID: PMC4216958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Compliance is a key component in successful implementation of the delivery of micronutrients among children. The present study evaluates the compliance with two home-based food fortification strategies (fortified complementary food or sprinkle) for providing iron and zinc among children aged 6-24 months. A total of 292 children were randomly allocated to receive either rice-based fortified complementary food and nutrition education (Cf = 101), sprinkle and nutrition education (Mp = 97), or nutrition education alone as control (Ed = 94). All the enrolled children were breastfed at the beginning of the study and were advised to continue breastfeeding. Biweekly information on compliance and anthropometry was collected. Complete haemogram estimation was conducted at baseline and end of the study. Compliance with the fortified complementary food was higher compared to sprinkle (Cf = 81%, Mp = 64% child-days). Consumption of the fortified complementary food for 6 months resulted in a significant increase in mean haemoglobin in the intervention group compared to control group (Cf 1.29 +/- 1.6 g/dL; Ed 0.23 +/- 1.3 g/dL; p < 0.001). Our results showed that fortified complementary food had higher compliance than sprinkle and is a suitable delivery mechanism for iron and zinc in preschool children.
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Affiliation(s)
- Sunil Sazawal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Center for Micronutrient Research, Annamalai University, Chidambaram, India
- Center for Public Health Kinetics, New Delhi, India
| | - Pratibha Dhingra
- Center for Micronutrient Research, Annamalai University, Chidambaram, India
- Center for Public Health Kinetics, New Delhi, India
| | - Usha Dhingra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Center for Public Health Kinetics, New Delhi, India
| | - Shilpi Gupta
- Center for Public Health Kinetics, New Delhi, India
| | | | - Venugopal P. Menon
- Center for Micronutrient Research, Annamalai University, Chidambaram, India
| | - Archana Sarkar
- Center for Micronutrient Research, Annamalai University, Chidambaram, India
| | - Robert E. Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Chomtho S. Breastfeeding to prevent double burden of malnutrition. Southeast Asian J Trop Med Public Health 2014; 45 Suppl 1:132-136. [PMID: 25423804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Nair M, Ariana P, Ohuma EO, Gray R, De Stavola B, Webster P. Effect of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) on malnutrition of infants in Rajasthan, India: a mixed methods study. PLoS One 2013; 8:e75089. [PMID: 24086447 PMCID: PMC3783470 DOI: 10.1371/journal.pone.0075089] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/11/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives Analyse the effect of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a wage-for-employment policy of the Indian Government, on infant malnutrition and delineate the pathways through which MGNREGA affects infant malnutrition. Hypothesis: MGNREGA could reduce infant malnutrition through positive effects on household food security and infant feeding. Method Mixed methods using cross-sectional study and focus group discussions conducted in Dungarpur district, Rajasthan, India. Participants: Infants aged 1 to <12 months and their mothers/caregivers. Final sample 528 households with 1056 participants, response rate 89.6%. Selected households were divided into MGNREGA-households and non-MGNREGA-households based on participation in MGNREGA between August-2010 and September-2011. Outcomes: Infant malnutrition measured using anthropometric indicators - underweight, stunting, and wasting (WHO criteria). Results We included 528 households with 1,056 participants. Out of 528, 281 households took part in MGNREGA between August’10, and September’11. Prevalence of wasting was 39%, stunting 24%, and underweight 50%. Households participating in MGNREGA were less likely to have wasted infants (OR 0·57, 95% CI 0·37–0·89, p = 0·014) and less likely to have underweight infants (OR 0·48, 95% CI 0·30–0·76, p = 0·002) than non-participating households. Stunting did not differ significantly between groups. We did 11 focus group discussions with 62 mothers. Although MGNREGA reduced starvation, it did not provide the desired benefits because of lower than standard wages and delayed payments. Results from path analysis did not support existence of an effect through household food security and infant feeding, but suggested a pathway of effect through low birth-weight. Conclusion Participation in MGNREGA was associated with reduced infant malnutrition possibly mediated indirectly via improved birth-weight rather than by improved infant feeding. Addressing factors such as lack of mothers’ knowledge and inappropriate feeding practices, over and above the social and economic policies, is key in efforts to reduce infant malnutrition.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Proochista Ariana
- Nuffield Department of Population Health, & Department of International Development, University of Oxford, Oxford, United Kingdom
| | - Eric O. Ohuma
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom
| | - Ron Gray
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Bianca De Stavola
- Department of Medical Statistics & Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Premila Webster
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Abstract
Diarrhea is still responsible for high rates of morbidity and mortality in children under 5 years of age. The prolongation of the acute episode may cause digestive and absorptive malfunction and, consequently, malnutrition, raising the risk of death. The objective of this review is to supply the most recent knowledge in the field of persistent diarrhea and to contribute to the decrease of its incidence. Some possible etiologic agents may be involved, including viruses, bacteria, and parasites. Treatment must be addressed to avoid malabsorption of the nutrients of the diet, associated with replacement of the hydroelectrolytic losses, to prevent its prolongation. In the great majority of the episodes, antibiotics are not indicated. Breastfeeding, introduction of safe dietary strategies to prevent protein-energy malnutrition, and improvement of sanitary conditions and hygiene are measures to be promoted with the objective of decreasing the morbidity/mortality of the diarrheic disease in children less than 5 years of age.
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Affiliation(s)
- Ulysses Fagundes-Neto
- Division of Pediatric Gastroenterology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
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44
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Sweet L, Jerling J, Van Graan A. Field-testing of guidance on the appropriate labelling of processed complementary foods for infants and young children in South Africa. Matern Child Nutr 2013; 9 Suppl 1:12-34. [PMID: 23167582 PMCID: PMC6860532 DOI: 10.1111/mcn.12019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is a lack of formal guidance from international normative bodies on the appropriate marketing of processed complementary foods. Such guidance is necessary to protect and promote optimal infant and young child feeding practices. The aim of this study was to field-test, in South Africa, the interim guidance provided by the Maternal, Infant and Young Child Nutrition Working Group's Draft Guide for Marketing Complementary Foods as a potential tool for use by manufacturers and national governments for guiding the appropriate labelling (as a subset of appropriate marketing practices) of complementary foods. This guidance was used to develop a checklist of questions and criteria for each possible answer, which was tested using a comprehensive database of labels from products purchased in South Africa from June to August 2011. One hundred and sixty product labels of 35 manufacturers were analysed, none of which complied with all checklist criteria. Fifty-six (35%) labels did not provide an appropriate age of introduction while 37 (23%) used images of infants appearing younger than 6 months. Nineteen (12%) labels suggested a daily ration too large for a breastfed child, and 32 (20%) potentially promote the manufacturer's infant formula. Only 58 (36%) labels were easy to read. The majority (69% and 92%) of labels provided instructions for safe and appropriate preparation/use and storage, respectively. The Draft Guide for Marketing Complementary Foods was found to be a useful tool for guiding the appropriate labelling of complementary foods, although some changes and additions are recommended to improve understanding, ease of use and to minimise the subjective interpretation of the guidance.
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Affiliation(s)
- Lara Sweet
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.
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45
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46
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Abstract
Essential fatty acids (EFAs), linoleic acid (LA) and α-linolenic acid (ALA), play a critical role in the growth and development of infants and young children. However, national guidelines for recommended intakes of EFAs are lacking in most developing countries. The objective of this study was to convert international EFA recommendations based on % of daily energy intake to recommended daily amounts for children aged 6-23 months in developing countries. The Food and Agriculture Organization (FAO) reports adequate intakes (AIs) for ALA as 0.4-0.6% of energy intake for children 6-23 months of age and as 3.0-4.5% of energy intake for LA. In order to estimate energy intakes, FAO daily energy requirements based on body weight were used. The daily AI amounts for these EFAs were calculated using the median body weight of the World Health Organization (WHO) Growth Standard population and median body weights with varying levels of malnutrition. The AI for ALA is equivalent to 0.3-0.4, 0.3-0.5 and 0.4-0.6 g day(-1), and the AI for LA is equivalent to 2.1-3.1, 2.4-3.5 and 2.8-4.3 g day(-1) for children aged 6-8, 9-11 and 12-23 months, respectively. While the lower median body weights of children in developing countries and associated reduced energy intake recommendations give lower estimated EFA requirements, recommendations based on median body weights in the WHO Reference Growth Standard is suggested. The upper levels of these calculated AIs are lower than or equal to those in North America (ALA: 0.5 and 0.7 g day(-1); LA: 4.6 and 7 g day(-1) for children aged 6-12 months and 1-3 years, respectively). The FAO AIs (g day(-1)) calculated here for ALA and LA can serve as a guideline for developing countries for setting national standards.
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Affiliation(s)
- Zhenyu Yang
- National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China.
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47
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Carroll K, Herrmann K. Introducing donor human milk to the NICU: lessons for Australia. Breastfeed Rev 2012; 20:19-26. [PMID: 23330447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There is an increased use of pasteurised donor human milk (PDHM) in North American neonatal intensive care units (NICU) in order to achieve exclusive human milk (EHM) feeding for preterm infants. Australia, on the other hand, is relatively new to reintroducing PDHM to NICUs. Very little is known about the perception of multidisciplinary NICU teams toward PDHM. This article reports on a survey of 89 NICU clinicians that was implemented during the first weeks of PDHM use in an American NICU, and was repeated 6 months later. Their knowledge and opinions of PDHM in addition to their inclination to recommend its use were evaluated using thematic coding and descriptive statistics. We found that after a 6-month trial, preparedness to recommend PDHM increased to 93%. We found that NICU clinicians' support for PDHM exceeded their knowledge about its risks and benefits and clinicians requested education about various aspects of PDHM. This research in this article aims to assist clinical staff educators as they go about introducing PDHM in NICUs.
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48
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Schmitt F, Caldari D, Corradini N, Gicquel P, Lutz P, Leclair MD, Podevin G. Tolerance and efficacy of preventive gastrostomy feeding in pediatric oncology. Pediatr Blood Cancer 2012; 59:874-80. [PMID: 22492612 DOI: 10.1002/pbc.24161] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/12/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malnutrition in pediatric oncology remains underestimated, although having a negative impact on outcome. Enteral nutrition (EN) using percutaneous endoscopic gastrostomy (PEG) may prevent or reverse malnutrition consequences. We aimed to evaluate both efficacy and safety of early EN during tumors treatment in children. PROCEDURES Medical records of pediatric patients having a PEG tube inserted between 1995 and 2009 were retrospectively reviewed. We compared type and incidence of complications in Group 1, including 74 patients suffering from cancer, and control Group 2, including 57 patients with neurological impairment. Efficacy of EN was evaluated through nutritional parameters [Z-scores weight for height (W/H) and height for age (H/A)], post-operative complications and relapse rates. Statistical significance was set for P < 0.05. RESULTS PEG tolerance was similar in both groups, as shown by comparable complication rates (62% vs. 76%, NS). EN allowed improvement or stabilization of Z-score W/H in 76% of oncologic patients. The final height loss was lower (-0.5 vs. -1.2 SD of Z-scores H/A) when EN was started at the beginning of the oncologic treatment. In bone tumors, EN prevented weight loss during chemotherapy, and tended to lessen surgical complications, relapses and deaths. CONCLUSIONS Early gastrostomy feeding represents a relatively safe way to prevent malnutrition in children with cancer, and might play a role in bone tumors oncological outcome. Further prospective studies are needed to confirm these results and assess the impact of EN and PEG on quality of life.
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Affiliation(s)
- Françoise Schmitt
- Department of Pediatric Surgery, Mother and Child Hospital, Nantes University Hospital, Nantes, France.
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49
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Abstract
Obesity and its serious comorbidities, type 2 diabetes, coronary heart disease, hypertension, and dyslipidemia, have reached epidemic proportions in adults and children. Female obesity is more prevalent and, thus, has greater epidemiological importance: mothers transmit the disease epigenetically and genetically. Maternal obesity affects maternal health, pregnancy outcome, and fetal, neonatal, childhood, and ultimately adult morbidity and mortality. Obesity is easy to diagnose, as are most of its risk factors, yet very little progress has been made in preventing the disease. During a brief period of rapid early growth, there is imprinting of antecedents of adult obesity and obesity-related disease. Because of the rapidity of this early growth and the relative brevity of the critical period, early recognition and prompt intervention are necessary and possibly sufficient to prevent the development of obesity. Identification of inappropriate rapid weight gain through frequent weighing should trigger immediate adjustment of energy intake, a simple intervention in bottle-fed infants, the ones at greatest risk for becoming obese. This review presents a step-care strategy with fail-safe action levels starting with maternal education and diet, exercise, and behavior modification for mother and child and progressing to drug treatment and, in selected cases, laparoscopic surgery for young women of childbearing age in whom other measures have failed. This approach is predicated on the assumption that careful monitoring and responsive supplementation of potential deficiencies is easier to achieve, more cost-effective, and safer than effectively treating manifest obesity and its comorbidities in adults.
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Affiliation(s)
- John G Kral
- Department of Surgery, Box 40, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
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50
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Murielle C, Megnier-Mbo E. [The promotion of breastfeeding in Gabon]. Soins Pediatr Pueric 2012:28-30. [PMID: 23016216] [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: 06/01/2023]
Abstract
Breastfeeding is beneficial for all newborns, but even more so in Gabon where the neonatal mortality rate is still high. The neonatal intensive care and neonatology department of Libreville hospital has set up a support scheme for mothers in order to promote the breastfeeding of hospitalised newborns.
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