Showing papers in "Food and Nutrition Bulletin in 2010"
TL;DR: To ensure the World Health Organization estimated needs for these minerals from plant-based complementary foods for breastfed infants are met, dephytinization must be combined with enrichment with animal-source foods and/or fortification with appropriate levels and forms of mineral fortificants.
Abstract: Plant-based complementary foods often contain high levels of phytate, a potent inhibitor of iron, zinc, and calcium absorption. This review summarizes the concentrations of phytate (as hexa- and penta-inositol phosphate), iron, zinc, and calcium and the corresponding phytate:mineral molar ratios in 26 indigenous and 27 commercially processed plant-based complementary foods sold in low-income countries. Phytate concentrations were highest in complementary foods based on unrefined cereals and legumes (approximately 600 mg/100 g dry weight), followed by refined cereals (approximately 100 mg/100 g dry weight) and then starchy roots and tubers (< 20 mg/100 g dry weight); mineral concentrations followed the same trend. Sixty-two percent (16/26) of the indigenous and 37% (10/27) of the processed complementary foods had at least two phytate:mineral molar ratios (used to estimate relative mineral bioavailability) that exceeded suggested desirable levels for mineral absorption (i.e., phytate:iron < 1, phytate:zinc < 18, phytate:calcium < 0.17). Desirable molar ratios for phytate:iron, phytate:zinc, and phytate:calcium were achieved for 25%, 70%, and 57%, respectively, of the complementary foods presented, often through enrichment with animal-source foods and/or fortification with minerals. Dephytinization, either in the household or commercially, can potentially enhance mineral absorption in high-phytate complementary foods, although probably not enough to overcome the shortfalls in iron, zinc, and calcium content of plant-based complementary foods used in low-income countries. Instead, to ensure the World Health Organization estimated needs for these minerals from plant-based complementary foods for breastfed infants are met, dephytinization must be combined with enrichment with animal-source foods and/or fortification with appropriate levels and forms of mineral fortificants.
386 citations
TL;DR: The available data indicate that malnutrition is a public health issue in school-aged children in developing countries and countries in transition, however, the available data, especially data on micronutrient status, are limited.
Abstract: BackgroundThe nutritional status of school-aged children impacts their health, cognition, and subsequently their educational achievement. The school is an opportune setting to provide health and nu...
237 citations
TL;DR: Most current iron fortification programs are likely to be ineffective and legislation needs updating in many countries so that flour is fortified with adequate levels of the recommended iron compounds.
Abstract: BackgroundIron fortification of wheat flour is widely used as a strategy to combat iron deficiency.ObjectiveTo review recent efficacy studies and update the guidelines for the iron fortification of...
177 citations
TL;DR: Prenatal DHA supplementation of primigravid women may result in increased birth size in a population where dietary DHA intakes are very low.
Abstract: BackgroundThe need for omega-3 fatty acids, especially docosahexaenoic acid (DHA), during pregnancy has received much attention, but evidence of effects on birth outcomes is limited.ObjectiveTo evaluate whether prenatal DHA supplementation increases gestational age and birth size.MethodsWe conducted a double-blind, randomized, placebo-controlled trial in Cuernavaca, Mexico. We randomly assigned 1,094 pregnant women (18 to 35 years of age; median DHA dietary intake, 55 mg/day) to 400 mg/day of algal DHA or placebo from 18 to 22 weeks of gestation through delivery. Birth outcomes (968 live births and 5 stillbirths) were ascertained from hospital records within 24 hours of delivery.ResultsIntention-to-treat analysis showed no differences between the control and DHA group (all p > .05) in mean gestational age (39.1 + 1.7 and 39.0 ± 1.9 weeks, respectively), weight (3.20 + 0.47 and 3.21 ± 0.45 kg, respectively), length (50.3 ± 2.7 and 50.3 ± 2.3 cm, respectively) and head circumference (34.3 ± 1.8 and 34.3 ± 1...
172 citations
TL;DR: The following policy brief ‘Scaling up Nutrition’ is not directly related to the papers that make up the bulk of this issue covering a history of five decades of research by the Institute of Nutrition of Central America and Panama, although many of its findings are applicable to it.
Abstract: The following policy brief ‘Scaling up Nutrition: A Framework for Action’ is not directly related to the papers that make up the bulk of this issue covering a history of five decades of research by the Institute of Nutrition of Central America and Panama (INCAP), although many of its findings are applicable to it. The policy brief includes a call for scaling up high impact interventions that address undernutrtion and build on the kind of knowledge captured in the INCAP studies. “Scaling up Nutrition: A Framework for Action’ is included in this issue because of its urgency and importance to readers of this journal. The policy brief, completed in March 2010, is based on a broad collaborative effort of the World Bank, UNICEF, World Health Organization (WHO), World Food Programme (WFP) and a wide range of developing country partners, civil society organizations and bilateral agencies. The principle objective is to catalyze actions to move undernutrition toward the center stage of international political economy discourse. Intended audiences include policymakers and opinion leaders around the world. The policy brief seeks substantially increased investment for a set of exceptionally cost-effective nutrition interventions that principally target women during pregnancy and children from birth to 24 months of age. The policy brief also calls for making nutrition central to the strategies of other sectors — particularly food security and agriculture, health, and social protection. Enhancing and scaling up support for high impact interventions and a multi-sector approach are imperative both for nutrition objectives and for realization of most of the Millenium Development Goals. This policy brief was prepared with support from the Bill and Melinda Gates Foundation, the Government of Japan, UNICEF and the World Bank. The brief is authored by Keith Bezanson and Paul Isenman, independent consultants. For additional information, please contact Anna Herforth: Aherforth@worldbank.org. Introduction and executive summary
160 citations
TL;DR: Estimates show that in the United States and Canada, the additional intake of about 100 to 150 μg/day of folic acid through food fortification has been effective in reducing the prevalence of NTDs at birth and increasing blood folate concentrations in both countries.
Abstract: BackgroundAfter randomized, controlled trials established that consumption of folic acid before pregnancy and during the early weeks of gestation reduces the risk of a neural tube defect (NTD)-affected pregnancy, the United States Public Health Service recommended in 1992 that all women capable of becoming pregnant consume 400 μg folic acid daily. In 1998, folic acid fortification of all enriched cereal grain product flour was fully implemented in the United States and Canada.ObjectiveTo provide guidance on national fortification of wheat and maize flours to prevent 50 to 70% of the estimated 300,000 NTD-affected pregnancies worldwide.MethodsAn expert workgroup reviewed the latest evidence of effectiveness of folic acid flour fortification and the safety of folic acid.ResultsRecent estimates show that in the United States and Canada, the additional intake of about 100 to 150 μg/day of folic acid through food fortification has been effective in reducing the prevalence of NTDs at birth and increasing blood ...
154 citations
TL;DR: Not just access to food, but an integrated approach that improves the overall socioeconomic well-being of families, maternal education, and knowledge of optimal nutrition practices, together with adequate maternal nutrition, is needed to address malnutrition among young children.
Abstract: BackgroundFood insecurity and malnutrition among children are common in Nepal. However, inadequate data exist on the association between household food insecurity and the nutritional status of chil...
137 citations
TL;DR: Once ART has been established and malnutrition treated, the nutritional quality of the diet remains important, also because of ART's long-term metabolic effects (dyslipidemia, insulin resistance, obesity).
Abstract: BackgroundHIV infection and malnutrition negatively reinforce each other.ObjectiveFor program guidance, to review evidence on the relationship of HIV infection and malnutrition in adults in resourc...
131 citations
TL;DR: Iron–folic acid supplementation is an under-resourced, affordable intervention with substantial potential for contributing to Millennium Development Goal 5 (maternal mortality reduction) in countries where iron intakes among pregnant women are low and anemia prevalence is high.
Abstract: BackgroundAccording to a World Health Organization (WHO) review of nationally representative surveys from 1993 to 2005, 42% of pregnant women have anemia worldwide. Almost 90% of anemic women reside in Africa or Asia. Most countries have policies and programs for prenatal iron–folic acid supplementation, but coverage remains low and little emphasis is placed on this intervention within efforts to strengthen antenatal care services. The evidence of the public health impact of iron–folic acid supplementation and documentation of the potential for scaling up have not been reviewed recently.ObjectiveThe purpose of this review is to examine the evidence regarding the impact on maternal mortality of iron–folic acid supplementation and the evidence for the effectiveness of this intervention in supplementation trials and large-scale programs.MethodsThe impact on mortality is reviewed from observational studies that were analyzed for the Global Burden of Disease Analysis in 2004. Reviews of iron–folic acid supplem...
130 citations
TL;DR: Most breastfeeding indicators in Bangladesh were below acceptable levels, and nationwide application of breastfeeding promotion programs in Bangladesh need nationwide application because of the low rates of appropriate infant feeding indicators.
Abstract: BackgroundIn Bangladesh, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition.ObjectiveTo estimate the determinants of selected feeding practices and key indicators of breastfeeding and complementary feeding in Bangladesh.MethodsThe sample included 2,482 children aged 0 to 23 months from the Bangladesh Demographic and Health Survey of 2004. The World Health Organization (WHO)-recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses.ResultsOnly 27.5% of mothers initiated breastfeeding within the first hour after birth, 99.9% had ever breastfed their infants, 97.3% were currently breastfeeding, and 22.4% were currently bottle-feeding. Among infants under 6 months of age, 42.5% were exclusively breastfed, and among those aged 6 to 9 months, 62.3% received complementary foods...
129 citations
TL;DR: Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households to reduce the burden of malnutrition and infant and child mortality.
Abstract: BackgroundIn India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality.ObjectiveTo estimate infant and young child feeding indicators ...
TL;DR: Zinc fortification of cereal flour is a safe and appropriate strategy for enhancing the zinc status of population subgroups who consume adequate amounts of fortified cereal flour, although additional information is needed to confirm the efficacy and effectiveness of large-scale zinc fortification programs to control zinc deficiency.
Abstract: BackgroundZinc fortification is recommended as an appropriate strategy to enhance population zinc status, but guidelines are needed on the appropriate types and levels of zinc fortification of cere...
TL;DR: The scientific evidence about the interactions among tuberculosis, nutrition, and HIV coinfection is reviewed to review the many risk factors for the development of tuberculosis and food insecurity and undernutrition.
Abstract: BackgroundTuberculosis is the second leading cause of infectious disease mortality (1.8 million/year), after HIV/AIDS. There are more than 9 million new cases each year. One-third of the world's po...
TL;DR: Child stunting in Bogotá is associated with poor socioeconomic and maternal nutritional status and predicts symptoms of respiratory infection.
Abstract: BackgroundThere are few recent reports on the prevalence and risk factors of stunting and thinness among schoolchildren in Latin America.ObjectiveTo determine the prevalence and sociodemographic co...
TL;DR: It is indicated that in major maize-producing and -consuming areas of Africa, home cultivation and use of QPM in children's diets could reduce or prevent growth faltering and may in some cases support catch-up growth in weight.
Abstract: BackgroundUndernutrition is a persistent problem in Africa, especially in rural areas where the poor largely depend on staples and have limited access to a diverse diet. Quality protein maize (QPM)...
TL;DR: Growth impairment and micronutrient deficiencies are prevalent among schoolchildren in Himalayan villages of India and living at higher altitude was associated with low serum levels of ferritin, retinol, and vitamin B12.
Abstract: BackgroundAnemia and micronutrient deficiencies are common among Indian schoolchildren. However, past studies have narrowly focused on only a few micronutrients and have not carefully evaluated the...
TL;DR: Infant and young child feeding practices in the South Asia region have not reached the expected levels that are required to achieve a substantial reduction in child mortality and the countries with lower rates of exclusive breastfeeding have a great potential to improve the rates by preventing infants from receiving water and water-based or other nonmilk liquids during the first 6 months of life.
Abstract: Background: Information on infant and young child feeding is widely available in Demographic and Health Surveys and National Family Health Surveys for countries in South Asia; however, infant and young child feeding indicators from these surveys have not been compared between countries in the region. Objective. To compare the key indicators of breastfeeding and complementary feeding and their determinants in children under 24 months of age between four South Asian countries. Methods: We selected data sets from the Bangladesh Demographic and Health Survey 2004, the India National Family Health Survey (NFHS-03) 2005–06, the Nepal Demographic and Health Survey 2006, and the Sri Lanka 2000 Demographic and Health Survey. Infant feeding indicators were estimated according to the key World Health Organization indicators. Results: Exclusive breastfeeding rates were 42.5% in Bangladesh, 46.4% in India, and 53.1% in Nepal. The rate of full breastfeeding ranged between 60.6% and 73.9%. There were no factors consistently associated with the rate of no exclusive breastfeeding across countries. Utilization of health services (more antenatal clinic visits) was associated with higher rates of exclusive breastfeeding in India but lower rates in Nepal. Delivery at a health facility was a negative determinant of exclusive breastfeeding in India. Postnatal contacts by Public Health Midwives were a positive factor in Sri Lanka. A considerable proportion of infants under 6 months of age had been given plain water, juices, or other nonmilk liquids. The rate of timely first suckling ranged from 23.5% in India to 56.3% in Sri Lanka. Delivery by cesarean section was found to be a consistent negative factor that delayed initiation of breastfeeding. Nepal reported the lowest bottle-feeding rate of 3.5%. Socioeconomically privileged mothers were found to have higher bottlefeeding rates in most countries. Conclusions: Infant and young child feeding practices in the South Asia region have not reached the expected levels that are required to achieve a substantial reduction in child mortality. The countries with lower rates of exclusive breastfeeding have a great potential to improve the rates by preventing infants from receiving water and water-based or other nonmilk liquids during the first 6 months of life.
TL;DR: Evidence that nutrition interventions are effective in preventing growth failure and its consequences, if targeted to needy women and young children and demonstration that growth failure predicts functional impairment in the child as well as in the adult are reviewed.
Abstract: This paper reviews the main findings and policy implications of 50 years (1949-1999) of research conducted by INCAP on growth and development. Topical areas reviewed include a) maternal size and birthweight and the causes of intrauterine growth retardation (IUGR), b) patterns and causes of postnatal growth retardation, c) the relative importance of genetics and the environment in explaining differences in growth among populations, d) the implications of being small, for both children and adults, e) bone growth and maturation and dental development, f) menarche, and g) methodological contributions such as anthropometric reference data, quality control of data collection, development of risk indicators and use of anthropometry in nutrition surveillance systems. Key contributions to knowledge by INCAP include a) characterization of growth failure and maturational delays as mainly occurring during the intrauterine period and the first 3 years of life b) clarification of the role of small maternal size and of inadequate dietary intakes during pregnancy as major causes of intrauterine growth failure, c) evidence that diarrheal diseases and poor dietary intakes are the principal causes of growth failure in early childhood, d) demonstration that environmental factors related to poverty, and not genetic or racial ancestry, account for most of the differences in growth between populations, e) evidence that growth failure predicts functional impairment in the child as well as in the adult andf) demonstration that nutrition interventions are effective in preventing growth failure and its consequences, if targeted to needy women and young children. INCAP's work has contributed knowledge that has informed and improved policies and programs aimed at overcoming maternal and child undernutrition and promoting optimal growth and development.
TL;DR: Sprinkles program monitoring in Kenya was critically important for understanding sales and distribution trends and vendor perceptions, and understanding these trends led to strategic changes to the intervention over time.
Abstract: BackgroundIn 2007, the US Centers for Disease Control and Prevention partnered with local Kenyan institutions to implement the Nyando Integrated Child Health and Education Project, an effectiveness study that used social marketing and a community-based distribution program to promote the sale of Sprinkles and other health products.ObjectiveTo describe monitoring of wholesale sales, household demand, promotional strategies, and perceived factors influencing Sprinkles sales among vendors.MethodsOngoing quantitative and qualitative monitoring of Sprinkles sales began in May 2007 in 30 intervention villages. Data sources included baseline and follow-up cross-sectional surveys; office records of Sprinkles sales to vendors; biweekly household monitoring of Sprinkles use; and qualitative data collection, including vendor focus groups and key informant interviews.ResultsA total of 550 children aged 6 to 35 months were enrolled at baseline, and 451 were available at 12-month follow-up. During this period, nearly 1...
TL;DR: A language test for children aged 12 to 18 months based on mothers' report, suitable for use in large-scale surveys, and examine its concurrent and predictive validity was developed and was sensitive to environmental and child characteristics.
Abstract: BackgroundIn developing countries, it is often important to have measures of development in children under 3 years of age in large-scale surveys or evaluations of nutrition and stimulation programs. However, there is a lack of suitable instruments with established validity.ObjectiveTo develop a language test for children aged 12 to 18 months based on mothers' report, suitable for use in large-scale surveys, and examine its concurrent and predictive validity. To determine whether the test is sensitive to home stimulation and nutritional status and compare the test with the Bayley Scales of Infant Development (BSID).MethodsA subsample of participants in a large, prospective cohort study in rural Bangladesh (MINIMat) was selected for a study of child development (n = 2,852). A total of 2,418 participants were interviewed concerning their children's expressive and receptive vocabulary, and children were tested using the BSID.ResultsThe language test had reasonable short- and long-term reliability between 12 a...
TL;DR: Although the evidence is limited, it shows that fortified flour, consumed as bread, can improve vitamin B12 status, and further research should evaluate the bioavailability of the vitamin from fortified flour by elderly people with food cobalamin malabsorption and gastric atrophy.
Abstract: Reasons to fortify flour with vitamin B12 are considered, including the high prevalence of depletion and deficiency of this vitamin that occurs in persons of all ages in resource-poor countries and in the elderly in wealthier countries, and the adverse functional consequences of poor vitamin B12 status. From a global perspective, the main cause of inadequate intake and status is a low intake of animal-source foods; even lacto-ovo vegetarians have lower serum vitamin B12 concentrations than omnivores, and for various reasons many populations have limited consumption of animal-source foods. Infants are vitamin B12-depleted from early infancy if their mothers' vitamin B12 status and intake are poor during pregnancy and lactation. Even in the United States, more than 20% of the elderly have serum vitamin B12 concentrations that indicate depletion, and an additional 6% have deficiency, primarily due to gastric atrophy, which impairs the absorption of the vitamin from food but usually not from supplements or fortified foods. Although the evidence is limited, it shows that fortified flour, consumed as bread, can improve vitamin B12 status. Where vitamin B12 fortification is implemented, the recommendation is to add 20 microg/kg flour, assuming consumption of 75 to 100 g flour per day, to provide 75% to 100% of the Estimated Average Requirement; the amount of the vitamin that can be added is limited by its cost. The effectiveness of this level of addition for improving vitamin B12 status in programs needs to be determined and monitored. In addition, further research should evaluate the bioavailability of the vitamin from fortified flour by elderly people with food cobalamin malabsorption and gastric atrophy.
TL;DR: Intervention training sessions and promotions were tailored to answer frequently asked questions, increase knowledge of Sprinkles, and provide tangible evidence of health benefits, as well as addressing potential barriers.
Abstract: BackgroundThere is a lack of peer-reviewed literature describing in detail the formative research to develop Sprinkles interventions.ObjectiveTo describe community members' reactions to and experiences using Sprinkles, with an emphasis on acceptability, utilization, and promotion.MethodsFourteen initial focus group discussions on Sprinkles and a 25-family home study were conducted. For the home study, each child 6 to 59 months of age in the household received 30 sachets (1 per day). The initial 14 focus group discussions included mothers, grandmothers, vendors, women who purchased from vendors, and adults in the general population. Home study families were recruited from participants in the initial 14 focus group discussions who had at least one child 6 to 59 months of age.ResultsSprinkles were highly acceptable to adults and most children; some children thought Sprinkles were sugar. Most home study families prepared and used Sprinkles correctly. All families reported positive effects, particularly increa...
TL;DR: Mill-rolled wheat flour is a technically fortifiable, centrally processed food vehicle that, where routinely and adequately consumed by target groups, should be considered a candidate for fortification.
Abstract: Background: Vitamin A deficiency is a major public health nutrition problem, affecting an estimated 190 million preschool-aged children and 19 million pregnant and lactating women globally, and 83 million adolescents in Southeast Asia alone Its consequences (disorders) include xerophthalmia (the leading cause of early childhood blindness), increased severity of infection, anemia, and death Because vitamin A deficiency is largely due to chronic dietary insufficiency of preformed vitamin A and proactive carotenoids, food fortification can offer an effective approach to prevention Objective : To provide guidance on fortifying wheat and maize flour milled in industrial rollers for national fortification programs in countries where vitamin A deficiency is considered a public health problem Methods: Critical review of the literature on the dietary gap in vitamin A intake and levels of wheat flour intake among risk groups as a basis for determining vitamin A fortificant levels Additional review of efficacy evidence, safety and cost considerations, and country experiences related to wheat-flour fortification with vitamin A Results: Mill-rolled wheat flour is a technically fortifiable, centrally processed food vehicle that, where routinely and adequately consumed by target groups, should be considered a candidate for fortification Vitamin A can be stable in flour under typical, ambient conditions, with processing losses estimated at approximately 30%, depending on source and premix conditions Conclusions : Factors to guide a decision to fortify flour with vitamin A include the extent of deficiency, availability of other food vehicle options, the centrality of milling, market reach and population intake distributions of the flour products, the dietary vitamin A intake required, and associated costs Large gaps persist in knowledge of these factors, which are needed to enable evidence-based fortification in most countries, leaving most decisions to fortify guided by assumptions Where flour can and should be fortified, guidelines are given for providing nearly 25% of the Recommended Dietary Allowance for vitamin A to vulnerable groups consuming varying ranges of flour products The costs will vary according to the level of fortification
TL;DR: A framework to understand the linkages between HIV/AIDS and food insecurity is proposed, distinguishing four types of interventions to address them and intending to widen the lens to regard food not just as a means to provide calories or an income transfer but also as a carrier of adequate nutrition in the context of HIV.
Abstract: Background Food insecurity can be both a consequence and a driver of HIV/AIDS. It is often difficult to disentangle these two roles of food insecurity, since the HIV epidemic has different drivers in different settings. The advent of antiretroviral treatment in resource-limited settings adds an additional layer of complexity. This paper seeks to organize current thinking by reviewing the existing literature on food insecurity and HIV/AIDS and describing the complex interactions between them. Objective Based on literature review, the paper proposes a framework to understand the linkages, distinguishing four types of interventions to address them. It is hoped that the model, albeit simplified as is any framework, will help to structure research, policy, and programming in the field of HIV/AIDS and food insecurity. Finally, the paper intends to widen the lens to regard food not just as a means to provide calories or an income transfer but also as a carrier of adequate nutrition in the context of HIV. Results and conclusions An adequate response to HIV/AIDS and food insecurity must be tailored to specific settings. Interventions distinguished in this paper are aimed at both promoting food security and providing antiretroviral treatment and nutrition support. The four types of interventions are containing HIV and preventing AIDS through comprehensive treatment regimes that include nutritional support; mitigating the effects of AIDS through support; providing HIV-sensitive, but not HIV-exclusive, safety nets at the individual, household, and community levels; and limiting the exposure to risk through HIV prevention activities.
TL;DR: Survey estimates of wasting, when seen in the context of historical values and viewed as specific to different livelihood groups, can provide useful timely warning of the need for intervention to mitigate developing nutritional crises.
Abstract: BACKGROUND: Malnutrition in preschool children usually measured as wasting is widely used to assess possible needs for emergency humanitarian interventions in areas vulnerable to drought displacement and related causes of food insecurity. The extent of fluctuations in wasting by season year-to-year and differential effects by livelihood group need to be better established as a basis for interpretation together with ways of presenting large numbers of survey results to facilitate interpretation. OBJECTIVE: To estimate levels of and fluctuations in wasting prevalences in children from surveys conducted in arid and semiarid areas of the Greater Horn of Africa according to livelihood (pastoral agricultural mixed migrant) season or month and year from 2000 to 2006. METHODS: Results from around 900 area-level nutrition surveys (typical sample size about 900 children) were compiled and analyzed. These surveys were carried out largely by nongovernmental organizations coordinated by UNICEF in vulnerable areas of Eritrea Ethiopia Kenya Somalia Southern Sudan and Uganda. Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data were used for comparison. Data were taken from measurements of children 0 to 5 years of age (or less than 110 cm in height). RESULTS: Among pastoral child populations the average prevalence of wasting (< -2 SD weight-for-height) was about 17% 6-7 percentage points higher than the rates among agricultural populations or populations with mixed livelihoods. Fluctuations in wasting were greater among pastoralists during years of drought with prevalences rising to 25% or higher; prevalences among agricultural populations seldom exceeded 15%. This difference may be related to very different growth patterns (assessed from DHS and UNICEF/MICS surveys) whereby pastoral children typically grow up thinner but taller than children of agriculturalists. Wasting peaks are seen in the first half of the year usually during the dry or hunger season. In average years the seasonal increase is about 5 percentage points. Internally displaced people and urban migrants have somewhat higher prevalence rates of wasting. Year-to-year differences are the largest loosely correlated with drought at the national level but subject to local variations. CONCLUSIONS: Tracking changes in wasting prevalence over time at the area level--e.g. with time-series graphical presentations--facilitates interpretation of survey results obtained at any given time. Roughly wasting prevalences exceeding 25% in pastoralists and 15% in agriculturalists (taking account of timing) indicate unusual malnutrition levels. Different populations should be judged by population-specific criteria and invariant prevalence cutoff points avoided; interpretation rules are suggested. Survey estimates of wasting when seen in the context of historical values and viewed as specific to different livelihood groups can provide useful timely warning of the need for intervention to mitigate developing nutritional crises.
TL;DR: Intensification of the ongoing vitamin A supplementation program, postpartum vitamin A supplements for mothers, intensifying efforts to improve the health status of preschool age children, and promotion of production and consumption of fruits and vegetables are recommended.
Abstract: BackgroundSeveral surveys conducted over a period of 40 years have shown that vitamin A deficiency is a serious public health problem in Ethiopia. To address the problem effectively, up-to-date, comprehensive information on the magnitude and distribution of vitamin A deficiency is needed.ObjectiveA national vitamin A survey was conducted to assess the national and regional prevalence rates of vitamin A deficiency in Ethiopia.MethodsThe survey employed a multistage, cluster-sampling approach and a cross-sectional study design. A total of 23,148 children aged 6 to 71 months and their respective mothers were examined for clinical signs and symptoms, and blood samples were collected from 1,200 systematically selected children for serum retinol analysis.ResultsThe findings indicated national prevalence rates of 1.7% for Bitot's spots among children. 0.8% for night-blindness among children, and 1.8% for night-blindness among mothers. Nationally, 37.7% of children (95% CI, 35.6% to 39.9%) had deficient serum ret...
TL;DR: Although the lack of information on the vitamin A deficiency status of consumers of oil and sugar precludes making definitive conclusions, the increased coverage and cost per DALY averted due to sugar fortification suggests—based on World Health Organization guidelines—that the Government of Uganda should pursue sugar fortify.
Abstract: Background. Twenty-eight percent of Ugandan preschool children suffer from vitamin A deficiency. With vitamin A supplementation covering only a third of children under 5 years of age, fortification is essential to reduce their vitamin A deficiency–related disease burden. At present, the only widely consumed food in Uganda that is fortified with vitamin A is vegetable oil. Objective. To compare the feasibility, coverage, costs, and cost-effectiveness of fortifying vegetable oil and sugar with vitamin A in order to assess, from a public health policy perspective, whether sugar should also be fortified. Methods. The 2005/6 Uganda Household Budget Survey was used to analyze households’ apparent consumption levels of sugar and vegetable oil and to model the additional intake of vitamin A, assuming the sugar and oil fortification levels are those set by the Uganda Bureau of Standards. Results. The annual incremental private sector cost of vitamin fortification is US$555,668 for oil and US$2,644,765 for sugar. Assuming that oil and sugar fortification are both effective in reducing vitamin A deficiency by 30% among those who consume these foods, the estimated cost per disability-adjusted life year (DALY) averted is US$82 for sugar and US$18 for oil. Vitamin A fortification of vegetable oil is 4.6 times more cost-effective than vitamin A fortification of sugar. If sugar were to be fortified, the 17% of Ugandans who purchase sugar but do not purchase oil would become new beneficiaries of vitamin A fortification. This would increase the coverage of vitamin A–fortified foods by 31% and reduce the percentage of Ugandans without any coverage to 25%. Those most at risk for vitamin A deficiency—members of rural, poor households—would benefit disproportionately from the introduction of sugar fortification. Conclusions. Although the lack of information on the vitamin A deficiency status of consumers of oil and sugar precludes making definitive conclusions, the increased coverage and cost per DALY averted due to sugar fortification suggests—based on World Health Organization guidelines—that the Government of Uganda should pursue sugar fortification.
TL;DR: A course of 60 Sprinkles micronutrient powder sachets taken daily for 2 months is effective in improving hemoglobin levels and reducing the prevalence of anemia among young children in the Kyrgyz Republic.
Abstract: BackgroundIron-deficiency anemia is widespread among young children in the Kyrgyz Republic, and there is an urgent need to identify an effective intervention to address this significant public health problem.ObjectiveTo test the effectiveness of a 2-month intervention with daily home fortification of complementary food using micronutrient powder (Sprinkles) in reducing anemia among children 6 to 36 months of age in the Kyrgyz Republic.MethodsIn this cluster-randomized, community-based effectiveness trial conducted in three regions of the Kyrgyz Republic, 24 clusters of children aged 6 to 36 months were randomly assigned to two groups. The intervention group (12 clusters, n = 1,103) received 60 sachets of micronutrient powder (12.5 mg elemental iron), which were taken as one sachet daily for 2 months. The control group (12 clusters, n = 1,090) did not receive micronutrient powder until after the study period. Blood hemoglobin concentration was assessed at the start and end of the intervention.ResultsFrom b...
TL;DR: The Nutridev experience in Vietnam, Madagascar, and Burkina Faso demonstrates that it is possible to produce affordable, high-quality complementary foods and supplements locally in developing countries, and the optimal approach appears to be strengthening the existing food distribution network to sell complementary food products.
Abstract: BackgroundSustainable approaches to improving infant and young child feeding are needed. The Nutridev program worked in Vietnam, Madagascar, and Burkina Faso to test different strategies to improve complementary feeding using fortified products sold to families.ObjectiveTo review the experiences of programs producing and marketing fortified complementary foods and to report on the feasibility of local production and marketing of fortified complementary foods to increase usage of high-quality foods among children of low-income families in a self-sustaining manner.MethodsProject documents, surveys of mothers, and production and sales reports were reviewed.ResultsNutridev experience in Vietnam, Madagascar, and Burkina Faso demonstrates that it is possible to produce affordable, high-quality complementary foods and supplements locally in developing countries. Strategies to make products readily available to the targeted population and to convince this population to consume them yielded mixed results, varying ...
TL;DR: Hypertension and prehypertension were highly prevalent in the studied adolescent girls and Obesity was associated with an increased risk of elevated blood pressure.
Abstract: BackgroundThere are few studies of the prevalence of elevated blood pressure that include Iranian adolescent girls.ObjectiveThe aim of this cross-sectional study was to determine the blood pressure status and its relationship with body mass index (BMI) in adolescent girls attending high school in Tabriz, Iran.MethodsA sample of 985 girls was selected by stepwise random sampling from five districts of Tabriz. Blood pressure, weight, and height of the subjects were measured and BMI was calculated. Blood pressure measurements were categorized as normal, prehypertension, or hypertension using the 2004 Fourth Report blood pressure screening recommendations. Overweight and obesity were defined according to International BMI Cut Off Points for adolescents.ResultsThe prevalence rates of of prehypertension and hypertension were 13.9% and 19.4%, respectively. Obesity and overweight were seen in 2.8% and 16.4% of subjects, respectively. The prevalence rates of hypertension and prehypertension increased with increasi...