bluuebunny/crossref_metadata_2025 huggingface dataset:
Sugar Fortification in Zambia
Authors: Besa E. M.
Published: November 2015

Food fortification as a strategy for controlling vitamin A deficiency was mooted in Zambia way back when a technical committee was formed following a multisectoral workshop to explore possible food vehicles for vitamin A fortification. The choice of sugar as a vehicle was that it was centrally produced and therefore easy to subject to quality control. Moreover, more than 50% of the households consumed sugar. This initiative was explored with the private firm Zambia Sugar Plc, who saw it as a challenge for them to demonstrate their social responsibility to the public. This marked the beginning of a long-term partnership between the private and public sectors in Zambia. The initiative entailed embracing new technology, securing new equipment, and retraining and orienting staff from both the private and public sectors on the fortification process. Nothing was left to chance. While the orientations were ongoing, the legal framework to govern the standards of the new product was developed. These standards centered on its quality, safety, and labeling. The opinions of the beneficiaries of the fortification program were sought. Most welcomed the idea except for some concern about the added costs, possible toxicity, and accessibility of the new product. The education campaigns addressed these and other concerns.
Enhancing Women's Contributions to Improving Family Food Consumption and Nutrition
Authors: Kurz Kathleen M. , Johnson-Welch Charlotte
Published: November 2015

Despite some recent gains, the prevalence of stunting in many developing countries remains unacceptably high and warrants additional emphasis on sustainable strategies that families can use to promote better nutrition for their members. This review asks: “If women are the primary caregivers in the families, can their ability to carry out their roles be strengthened so they can improve and sustain the nutritional status of their family members?” Women play important roles in promoting and protecting the food intake and nutritional status of their family members through the food they produce and process, and the care- and health-promoting behaviors they practice. It is demonstrated that increasing their resources to carry out these roles—income, production-focused inputs, labor-saving technology, microfinance, social networks, and women's human capital—yields improvements in the nutritional situation of families, particularly children. It is recommended that experts in nutrition and other relevant fields collaborate to design multifaceted interventions focused on increasing women's resources and ability to improve nutritional benefits, thereby enhancing the sustainability of the interventions. More assessments of the process and the outcomes of such interventions need to be made rigorously.
Dietary and Physical Activity Patterns of 8- to 10-year-old Urban Schoolchildren in Manila, Philippines
Authors: Florentino Rodolfo F. , Villavieja Gracia M. , Laña Ruby D.
Published: November 2015

This report is the second part of a study on the nutrition of urban schoolchildren in the city of Manila; the first part was on nutritional status. The primary purpose of the study was to gather data that will assist authorities in planning and implementing nutrition education programs focused on the growing problem of obesity and overweight in children. The study included 1,208 children 8 to 10 years of age, who were randomly selected from all public and private schools in the city of Manila. Data on the children's dietary and physical activity patterns, together with information on nutrition-related knowledge, attitudes, and preferences of the children and their parents, were gathered by interviews and self-administered questionnaires. There were distinct differences in dietary and physical activity patterns between the two groups of children. Children from private schools, who are generally of higher socioeconomic status than those from public schools, tended to consume more total food, more animal foods, fats, and oils, and more beverages, resulting in higher intakes of calories, protein, iron, and vitamin A than public schoolchildren. Moreover, children from private schools were apparently less physically active, were more likely to be driven to school instead of walking, and were more likely to prefer television and computer games over outdoor games. These differences agree with an earlier report on the nutritional status of the children as determined by anthropometry, which showed a higher proportion of overnutrition and a lower proportion of undernutrition among private schoolchildren than among public schoolchildren. Although the emphasis in public schools should be on prevention and control of undernutrition in children, private schools should begin to look at the emerging problem of overnutrition and the role of physical activity programs in the health of children. The information on the knowledge, attitudes, and preferences of the children and their parents showed that parents or guardians, teachers, and television influence the nutritional practices of schoolchildren. These groups should therefore be the major targets for nutrition education programs meant to improve the nutrition and health of schoolchildren.
Combating Iodine Deficiency: Lessons from China, Indonesia, and Madagascar
Authors: Goh Chor-ching
Published: November 2015

This study investigated the factors contributing to a successful and sustainable elimination of iodine-deficiency disorders, drawing from salt fortification experiences in China, Indonesia, and Madagascar. Government officials, salt farmers, salt producers, and wholesalers were interviewed to collect data during field visits. Analyses used in the study include simple correlation, and wherever data permit, regression. The study found that measures crucial for combating iodine deficiency include raising public awareness of the disorders, ensuring easy access to iodated salt, promoting compliance in the salt industry, and monitoring and enforcement. Factors that ensure a reliable supply of iodated salt are equally important as those that create the demand for it. Governments must ensure that surveillance and enforcement mechanisms are functioning right from the time that salt iodation is made compulsory. For sustainability during later years, the adequacy of iodine in iodated salt must be monitored, and incentives must be modified as needed to increase compliance rates in the salt industry. Once national coverage of iodated salt reaches over 90%, the government can concentrate on fine-tuning and targeting resources at areas with a low consumption of iodated salt. Elimination of micronutrient deficiencies has a long-term impact on public health; moreover, poorer segments of the population, who are more vulnerable to such deficiencies, have more to gain from fortification programs. Thus, lessons from the successful elimination of iodine-deficiency disorders are valuable for future similar micronutrient activities.
Development and Sensory Acceptability of Crackers made from the Big-eye Fish (Brachydeuterus Auritus)
Authors: King Modupe Abimbola
Published: November 2015

The big-eye (Brachydeuterus auritus ), which is present in a large biomass in the Gulf of Guinea, is generally considered an underutilized fish species. In an attempt to add value, it was used to complement cassava starch (Manihot esculenta Crantz) to produce fish crackers. Three levels of fish (40%, 50%, and 60%) and three levels of starch (60%, 50%, and 40%) were used in the formulations. Proximate analyses and sensory evaluations were carried out. The protein, fat, and ash contents increased with an increase in the proportion of fish. The sensory evaluation tests showed that the most acceptable formulations for the crackers were obtained using 50% fish/50% starch and 40% fish/60% starch combinations. The linear expansion of the fried crackers increased with the increased proportion of fish. Production of fish crackers, apart from its appeal for increasing protein intake, has the potential to support a small regional snack factory in a developing economy.
Standardized Evaluation of Iodine Nutrition in West Africa: The African Phase of the Thyromobil Program
Authors: Delange François M. , Kibambe Théo Ntambwe , Ouedraogo andré , Acakpo Alfred , Salami Machikourou , Jooste Peter L.
Published: November 2015

Extensive programs of iodine supplementation by iodated salt have been implemented in Africa during the last decade. the present work evaluated their effectiveness in Benin, Burkina Faso, Mali, and Togo. A van equipped with a sonographic device visited 39 sites in the four countries. the prevalence of goiter was evaluated on the basis of the determination of thyroid volume by ultrasonography in 4,011 randomly selected 6- to 12-year-old schoolchildren of both sexes in the 39 sites. the concentration of urinary iodine was measured in 1,545 of these children. the iodine content of table salt collected at home by the children was measured by test kits in 3,202 salt samples, 415 of which were also analyzed by titration. Based on the results obtained by the kits, 83.7% to 97.9% of the salt samples contained iodine. However, the test kits had a low sensitivity and specificity in comparison with titration. the median urinary iodine was within an acceptable range (100–300 μg/L) in the four countries, but almost one-third of the values were still below normal. the prevalence of goiter was normal (< 5%) in Benin and Togo, and it was 22.4% and 13.4%, respectively, in Burkina Faso and Mali. These results indicate marked improvement of the status of iodine nutrition in comparison with the situation reported only a few years ago in the same countries, but quality control of the iodine content of salt and monitoring of the iodine status of the populations need to be improved.
Ti Foyer (Hearth) Community-Based Nutrition Activities Informed by the Positive Deviance Approach in Leogane, Haiti: A Programmatic Description
Authors: Bolles Kathryn , Speraw Catherine , Berggren Gretchen , Lafontant Jack Guy
Published: November 2015

This paper details the steps to design and implement a positive deviance-informed, “Hearth” approach for the nutritional rehabilitation of malnourished children in the district of Leogane, Haiti. Groups of four to five children met daily for two weeks at the home of a local volunteer mother for nutritional and health messages and a well-balanced meal. Health messages and meal components were determined using information gathered from interviews with the mothers of positive deviant children in the community who are well nourished despite their family's limited economic resources. Hearth participants were then followed for six months in their own home by the program “monitrices,” women hired from each village and intensively trained to supervise the Hearth program, periodically weigh the children to evaluate their progress, and liaise between the hospital and the community. Monitoring from the first cycle indicated that 100% of children in eight villages and 66% of children in the remaining five villages continued to gain weight as fast or faster than the international standard median six months after participating in a Hearth program. At the conclusion of this cycle, programmers interviewed participant and non-participant families and made six modifications to the model, including the addition of a microcredit option for participating mothers.
An Evaluation of the National Food and Nutrition Policy of Bangladesh
Authors: Mannan M. A.
Published: November 2015

Food and nutrition policy activities directed toward improvement of the nutritional status of the people of Bangladesh began in the 1980s. The government formulated a national food and nutrition policy and approved it in 1997. Qualitative methods, including observational techniques, in-depth interviews of the key informants, and focus group discussions, were used to collect information on the strengths, weaknesses, opportunities, and threats (SWOT) of the policy. The information obtained has been transcribed and analyzed using this model. The strengths of the policy are that it is a consensus document that emphasizes human rights, was formulated by a multisectoral approach, complements other government policies, and has broad goals and wide-ranging objectives. The weaknesses include lack of implementation, monitoring, and evaluation guidelines; lack of strong government commitment; inadequate support of policy makers; perhaps an excessively ambitious target; and ignorance of past lessons learned. The opportunities include the scope of social mobilization, the wide scope of the policy, suggested programs and measures to improve nutritional status, a congenial policy environment, and the ability to modify the scope of the policy as needed. The threats to the policy are lack of knowledge of the policy, lack of resources to implement the policy, tension between technical people and bureaucrats, vested business interests, and, possibly, discontinuity of political commitment. The key to reducing the weaknesses of the food and nutrition policy of Bangladesh and minimizing the threats to it is for the stakeholders in the policy to coordinate efforts to use the strengths and opportunities of the policy to effectively implement it.
Adequate Dosing of Micronutrients for Different Age Groups in the Life Cycle
Authors: Bienz Denise , Cori Hector , Hornig Dietrich
Published: November 2015

Many studies of micronutrient supplementation in developing countries have used single-nutrient supplements with either vitamins or minerals. However, people in these countries often suffer from multiple, rather than single, micronutrient deficiencies. The objective of this paper is to discuss the factors that go into determining the adequate dosing of vitamins and/or minerals for people of different ages. To elaborate on the adequacy of micronutrient doses in supplements, a model described by the US FNB was used, which calculates the difference between the mean observed intake for an individual and the estimated average requirement for a life stage and gender group. This model allows estimating the degree of confidence that a certain nutrient intake (from supplements and diet) is adequate. The US/Canadian DRI values have been used as the basis for these calculations, from which it can be concluded that a daily supplement of one RDA of each micronutrient is adequate to cover the personal requirements of all individuals in each respective age and gender group of the population, provided that 20 to 40% of an RDA is supplied by the diet—likely a realistic value for developing countries.

DRI values vary significantly between different age groups, reflecting changing needs over a life cycle. With the objective of a supplement to be adequate and safe, the design of a one-for-all supplement covering all age groups is not realistic. Such a supplement would either underscore or surpass the required intake of some of the age groups. Additionally the dosage of certain micronutrients might exceed the upper level of intake for lower age groups. Therefore, it is suggested that three different supplements following the one RDA concept for all micronutrients be developed for research use in developing countries for the following age groups: 1 to 3 years, 4 to 13 years, and females >14 years (excluding during pregnancy).
Iodine Deficiency: Consequences and Progress toward Elimination
Authors: Maberly Glen F. , Haxton David P. , van der Haar Frits
Published: November 2015

While traditionally associated with cretinism and goiter, iodine deficiency has broad effects on central nervous system development that can occur in the absence of either condition. Any maternal iodine deficiency results in a range of intellectual, motor, and hearing deficits in offspring. This loss in intellectual capacity limits educational achievement of populations and the economic prowess of nations. Progress made since the historic World Summit for Children in 1990 has been outstanding. Approximately 70% of households in the world used iodized salt by 2000, compared with less than 20% in 1990. It is estimated that at least 85 million newborns out of 130 million annual births are protected from a loss in learning ability that would otherwise have occurred. The elimination of iodine deficiency, by expedient production, marketing, and universal consumption of iodized salt, represents a significant development effort in public nutrition. Although globally iodine nutrition has greatly improved, 20% to 30% of pregnancies and thus newborns still do not fully benefit from the use of iodized salt. Countries where success is in evidence could rapidly revert back to deficiency if vigilance is not maintained. Just as success came through concerted public-private-civic actions, making sure that this is expanded and will steadily go on requires continuous collaboration.
Efficacy Trials of a Micronutrient Dietary Supplement in Schoolchildren and Pregnant Women in Tanzania
Authors: Latham Michael C. , Ash Deborah M. , Makola Diklar , Tatala Simon R. , Ndossi Godwin D. , Mehansho Haile
Published: November 2015

Traditionally, the main strategies used to control micronutrient deficiencies have been food diversification, consumption of medicinal supplements, and food fortification. In Tanzania, we conducted efficacy trials using a dietary supplement as a fourth approach. These were randomized, double-blind, placebo-controlled efficacy trials conducted separately first in children and later in pregnant women. The dietary supplement was a powder used to prepare an orange-flavored beverage. In the school trial, children consumed 25 g per school day attended. In the pregnancy trial, women consumed the contents of two 25-g sachets per day with meals. This dietary supplement, unlike most medicinal supplements, provided 11 micronutrients, including iron and vitamin A, in physiologic amounts. In both trials we compared changes in subjects consuming either the fortified or the nonfortified supplement. Measures of iron and vitamin A status were similar in the groups at the baseline examination, but significantly different at follow-up, always in favor of the fortified groups. Children receiving the fortified supplement had significantly improved anthropometric measures when compared with controls. At four weeks postpartum, the breast milk of a supplemented group of women had significantly higher mean retinol content than did the milk of mothers consuming the nonfortified supplement. The advantages of using a fortified dietary supplement, compared with other approaches, include its ability to control several micronutrient deficiencies simultaneously; the use of physiologic amounts of nutrients, rather than megadoses that require medical supervision; and the likelihood of better compliance than with the use of pills because subjects liked the beverage used in these trials.
Children Aged 6 to 60 Months in Nepal May Require a Vitamin A Supplement Regardless of Dietary Intake from Plant and Animal Food Sources
Authors: Grubesic Ruth B.
Published: November 2015

The purpose of this survey was to explore the relationship between the prevalence of the health indicators of malnutrition, diarrhea, and acute respiratory infection and the consumption of vitamin A–rich food and the supplementation status of three groups of children in Nepal (supplemented, supplemented only once, and never supplemented). A trained female community health worker interviewed mothers about vitamin A–rich food feeding practices to children aged 6 to 60 months using a standardized questionnaire and then estimated the nutritional status of the children using mid-upper-arm circumference measurements and recording the incidence of diarrhea and acute respiratory infection from mothers’ interviews. Regardless of the amount of vitamin A–rich foods consumed, children who were regularly supplemented with high doses of vitamin A were protected against malnutrition, diarrhea, and acute respiratory infection at a higher rate than children who were supplemented only once or were never supplemented. Regularly providing a high-dose (200,000 IU) capsule of vitamin A to children aged 6 to 60 months, including those who eat vitamin A–rich foods, may be effective in decreasing the prevalence of morbidity from malnutrition, diarrhea, and acute respiratory infection.
Stability of Salt Double-Fortified with Ferrous Fumarate and Potassium Iodate Or Iodide under Storage and Distribution Conditions in Kenya
Authors: Oshinowo Toks , Diosady Levente , Yusufali Rizwan , Laleye Louis
Published: November 2015

The stability of table salt double-fortified with iron as ferrous fumarate, and with iodine as potassium iodide or potassium iodate, has been investigated under actual field conditions of storage and distribution in the coastal and highland regions of Kenya. Seven 200-g sample packets of double-fortified salt in sealed polyethylene bags and a similar packet containing a datalogger for monitoring temperature and humidity were packaged with 21 sample bags of salt from another study into a bundle, which then entered the distribution network from a salt manufacturer's facility to the consumer. Iodine retention values of up to 90% or more were obtained during the three-month study. Double-fortified salt was prepared using ferrous fumarate microencapsulated with a combination of binders and coloring agents and coated with soy stearine, in combination with either iodated salt or salt iodized with potassium iodide microencapsulated with dextrin and coated with soy stearine. Most of the ferrous iron was retained, with less than 17% being oxidized to the ferric state. The polyethylene film overwrap of salt packs in the bundles provided significant protection from ambient humidity. Salt double-fortified with iodine and microencapsulated iron ferrous fumarate premix was generally quite stable, because both iodine and ferrous iron were protected during distribution and retail in typical tropical conditions in Kenya's highlands and humid lowlands.
The Effect of Family Structure on a Sample of Malnourished Urban Nigerian Children
Authors: Adekunle Lola
Published: November 2015

This study focused on the role of family structure in 458 malnourished children under five years of age clinically diagnosed with protein-energy malnutrition (PEM), kwashiorkor, and marasmus. The majority of these children were of higher birth order (3rd child and higher): 63.2% based on the mother's parity and 56.4% based on the father's parity. More than half (54.8%) of the malnourished children's mothers were the first wives of their respective husbands. About 43.9% of the children's fathers were urban danfo (public minibus transport) drivers. Half (51.5%) of the mothers who claimed to be single opted into single status and were mostly from polygamous households, but 87.6% of the children were from polygamous families, of which 18.6% of the mothers had divorced. Only 27.7% of the children lived with both parents; 40.4% lived with their grandparents, and 37.8% were the financial responsibility of their grandparents. We observed an association between children treated for malnutrition and father's occupation, parents’ marital status, mothers’ seniority among other wives, and source of financial responsibility for the children.
Women's Access to Food-Processing Technology at the Household Level is Associated with Improved Diets at the Pre-Harvest Lean Season in the Gambia
Authors: Silva-Barbeau Irma , Hull Stephen G. , Prehm Marilyn S. , Barbeau William E.
Published: November 2015

Background

Women's access to food processing technology at the household level may have positive dietary benefits during the pre-harvest lean season when households are most stressed from food shortages and higher energy expenditures from agricultural work.

Objective

This study in rural Gambia was conducted to determine if women's access to small manually operated oil presses (ram) for sesame oil extraction had any significant effects on seasonal fluctuations of household oil supply and on dietary intakes of women and children.

Methods

Participants were 40 women and children with access to community-based motorized oil press expellers (Expeller-control), 37 women and children with access to village-based ram presses (Press-experiment), and 43 women and children with access to both ram press and motorized expeller (Combination). Dietary data were collected at baseline, at peak oil-pressing, at pre-harvest lean, and at the post-harvest seasons.

Results

Households in the Press-experiment and Combination groups consumed 37 and 51 percent more oil, respectively, than those in the Expeller-control group during the pre-harvest lean season. Women from the Press-experiment and Combination groups consumed more energy at the lean season than those in the Expeller-control group. Similarly, children from the Press-experiment and Combination groups consumed more protein at peak oil-processing season than those from the Expeller-control group. At the pre-harvest season children from these two groups also consumed more protein, however, only the consumption of the Combination children was statistically significant compared with that of the Expeller-control group ( p < .05). Press-experiment children consumed more nutrient-dense weaning foods during the pre-harvest lean season than Expeller-control children.

Conclusions

Women's access to appropriate technology can provide the means to “add value” to their agriculture product, which may serve as an economic stabilizer with potential to increase dietary intakes and incomes, especially during the pre-harvest lean season.
Nutrient Content of Complementary Foods Based on Processed and Fermented Sorghum, Groundnut, Spinach, and Mango
Authors: Oumarou Habiba , Ejoh Richard , Ndjouenkeu Robert , Tanya Agatha
Published: November 2015

Background

Many African mothers use gruels made of maize and sorghum as complementary foods for their infants because they cannot afford the cost of nutritionally superior commercial weaning foods.

Objective

To improve the nutritional quality of traditional sorghum gruels used as complementary foods for children between six months and five years in the northern part of Cameroon.

Methods

Sorghum grains were processed by dehulling, sprouting, dehulling and cooking, and sprouting and cooking, then fermented using Saccharomyces cerevisae and tested for nutritional quality. The processed samples were analyzed for their nutrient composition and the digestibility of proteins and carbohydrates.

Results

The resulting products showed a significant reduction in antinutritional factors (e.g., phenolic compounds and phytates). In addition, germination improved the in vitro digestibility of proteins and carbohydrates. These effects were enhanced by fermentation of the resulting sorghum flour, regardless of how grains were pretreated, although the protein and mineral content remained low. Use of a composite flour made from pretreated sorghum, groundnut, spinach, and mango improved the protein, mineral, and vitamin A and C content of the gruels. Fermentation of composite flours resulted in an improvement in the protein content.

Conclusions

This study, conducted under local conditions and using local technology, describes an opportunity for improving the quality of complementary foods using local ingredients.
Rationale for a Follow-up Study Focusing on Economic Productivity
Authors: Martorell Reynaldo , Behrman Jere R. , Flores Rafael , Stein Aryeh D.
Published: November 2015

Past studies of nutrition, human capital formation, and economic productivity have been limited by the fact that biomedical researchers and economists work largely in isolation, with loss of complementarity. Biomedical researchers are faulted for not adequately addressing bias and measurement issues and for naïve analyses and interpretation of results, whereas economists are criticized for using simplistic nutrition and physiological measures and for relying on statistical methods rather than experimental designs. To avoid these problems, a multidisciplinary team of biomedical investigators and economists undertook a follow-up study in 2002–04 of a cohort of young men and women, who participated as young children in a randomized community trial of nutrition supplementation carried out from 1969–77. Previous studies, particularly the original trial and a 1988–89 follow-up, are described to provide an overview of the data available for linkage with the 2002–04 follow-up. Key results from these earlier studies are reviewed but judged inconclusive because the data used were collected when many subjects were still growing and developing physically, in school, unmarried, and/or not yet settled into occupations. The subjects were 26 to 41 years of age in 2003, permitting a more complete assessment of human capital and economic productivity. The experimental design of the 1969–77 original study, 35 years of follow-up, use of robust methods of data collection, and the participation of a multidisciplinary team will likely lead to the most comprehensive assessment to date of the importance of nutrition for economic productivity.
Household Expenditures and Wealth among Young Guatemalan Adults
Authors: Maluccio John A. , Martorell Reynaldo , Ramírez Luis Fernando
Published: November 2015

In this article, we describe expenditure and wealth patterns, indicators of long-run economic well-being, for a sample of young Guatemalan adults interviewed for the Human Capital Study 2002–04, finding a number of differences across subgroups of the sample. The main difference across birth-year cohorts is that younger subjects tend to live in smaller households, with lower total annual household expenditures (and fewer durable goods), though per capita measures are similar across cohorts. This appears to be related to life-cycle fertility patterns. There is a clear positive association between parental socioeconomic status (SES) and current levels of expenditure and durable goods ownership. This association does not hold for all households, however, as there is both upward and downward “mobility” in the sample. Those living in the capital have the highest overall wealth levels, consistent with typical rural-urban patterns. Where there are expenditure differences across groups, they tend to be driven by differences in nonfood rather than food expenditures. Lastly, the study sample is relatively well off compared with their compatriots, with a poverty rate of 35% and an extreme poverty rate of only 3%, against national averages of 56% and 15%, respectively.
Using the School Feeding System as a Vehicle for Micronutrient Fortification: Experience from South Africa
Authors: van Stuijvenberg Martha E.
Published: November 2015

School-age children are often a neglected group in terms of micronutrient interventions because they are not reached by the intervention strategies aimed at preschool children or pregnant women. School feeding, however, offers an excellent opportunity for targeted intervention in this age group, especially with regard to fortification. This paper first gives a brief overview of the school-feeding program in South Africa, and second reports on a number of trials conducted in South African schools by the South Africa Medical Research Council that examined the feasibility of using school feeding as a vehicle for micronutrient fortification. Various food items, such as biscuits, bread spread, and soup, are evaluated as potential carriers for micronutrients with positive effects on outcomes such as micronutrient status, growth, morbidity and cognitive function. For schoolchildren to realize their full mental and physical potential and to perform optimally at school, both short-term hunger and hidden hunger (micronutrient deficiencies) need to be addressed. School feeding has the potential to contribute toward alleviating both of these conditions and should therefore be fully utilized.
Improved Effect of School Meals with Micronutrient Supplementation and Deworming
Authors: Gopaldas Tara
Published: November 2015

A mid-day meal or school lunch program commenced in Gujarat, India from the sixties. In 1994, it was serving approximately 3 million schoolchildren. In 1994, the program was improved with the addition of a “package” of health inputs, including anthelmintics and micronutrient supplementation of iron and vitamin A, and iodine fortified salt. Tara Consultancy Services (TCS), India, a member of the Partnership of Child Development, Oxford University, evaluated Gujarat's improved midday meal program from 1993 to 1996. The program was implemented by the Commissionerate of the mid-day meal program, part of the government of Gujarat. The cost of the 'health package' in 1994, per child per year was 35 US cents (1 US $ = Rs.30). The study to evaluate the improved program included the following components:

Focus group discussions

Government officials, teachers, students, parents, and community members participated in focus groups to elicit opinions on the proposed program which were predominantly positive.

Process evaluation

Logistical delivery defined as the adequacy, timeliness and cost of procurement of the anthelmintic drugs and micronutrients and the cost of this 'health package' per schooler per school year by the pharmaceutical companies was 100%. Efficiency of logistics to the schools, defined as the efficiency and cost of logistical delivery of the 'Health Package', from the State Head Quarters to the District to the Taluka to the School was 100%. Coverage defined as consumption of the 'Health Package' by schooler at least once in the 6–9 months of the school year, as stated by the implementing agency was 94%–100% (urban) and 42%–94% (rural); coverage as stated by the schoolchildren was 71%–79% (urban) and 50%–67% (rural).

Impact evaluation

On average, students who received supplements were 1.1 kg heavier and 1.1 cm taller than those who did not; hemoglobin (Hb) levels were > 12 g/dL intestinal parasite prevalence rates dropped from 71% to 39%; prevalence of night blindness and vitamin A deficiency were reduced from 67% to 34%.

Lesson learned

Since 2003, 4 states in India, namely, Gujarat, Andhra Pradesh, Karnataka, and Tamil Nadu covering approximately 30 million schoolers have adopted the “Gujarat Model.”
Seed-Specific Expression of the Lysine-Rich Protein Gene sb401 Significantly Increases Both Lysine and Total Protein Content in Maize Seeds
Authors: Yu Jingjuan , Peng Peng , Zhang Xiujun , Zhao Qian , Zhu Dengyun , Sun Xuehui , Liu Junqi , Ao Guangming
Published: November 2015

The sb401 gene from potato ( Solanum berthaultii) encoding a pollen-specific protein with high lysine content was successfully integrated into the genome of maize plants, and its expression was correlated with increased levels of lysine and total protein content in maize seeds. A plasmid vector containing the sb401 gene under the control of a maize seed-specific expression storage protein promoter (P19z) was constructed and introduced into maize calli by microprojectile bombardment. The integration of the sb401 gene into the maize genome was confirmed by Southern blot analysis, and its expression was confirmed by Western blot analysis. Quantification of the lysine and protein contents in R1 maize seeds showed that, compared with the nontransgenic maize control, the lysine content increased by 16.1% to 54.8% and the total protein content increased by 11.6% to 39.0%. There were no visible morphological changes in the vegetative parts and seeds of the transgenic maize plants. Lysine and protein analysis of the transgenic maize grains showed that the levels of lysine and total protein remained high for six continuous generations, indicating that the elevated lysine and total protein levels were heritable. These results indicate that the sb401 gene could be successfully employed in breeding programs aimed at improving the nutritional value of maize.
Quantifiable Impact on Poverty in Trinidad and Tobago of the Uruguay Round Agreement on Agriculture
Authors: Pemberton Carlisle , Ramnarine Deokie
Published: November 2015

Background

The agreement on agriculture and the World Trade Organization were major outcomes of the 1986–1994 Uruguay Round (UR) negotiations within the General Agreement on Tariffs and Trade (GATT). The measures under the UR were predicted to increase poverty in developing countries, a serious cause for concern since poverty alleviation is a major goal of developing countries. Thus this paper simulated the impact on poverty of the UR for a net food importing country, Trinidad and Tobago.

Objective

The objectives of the study were to determine the changes in poverty levels in Trinidad and Tobago that we expected would result from changes in the price levels of food commodities after the removal of trade protection following the UR, and to examine recent trends in poverty in Trinidad and Tobago and the prices of major agricultural exports from the United States, its principal trading partner.

Methods

A regression model (poverty model) was used to determine the relationship between poverty levels and the prices of sensitive imported food commodities (SIFCs) and other key economic variables. Impact models were used to project changes in world market prices of the SIFCs due to the UR, and these price changes were used to predict changes in poverty in Trinidad and Tobago.

Results

The results showed a positive elasticity between poverty and the prices of SIFCs. The study also predicted that the average projected increase in price levels of the SIFCs of less than 9% by the year 2000 would cause an increase in poverty in Trinidad and Tobago of less than 4%.

Conclusions

There has been, in fact, a small decline in poverty in Trinidad and Tobago since 1996. The prices of major agricultural exports from the United States have also been falling since 1995. Thus, so far the UR has had no perceptible effects in increasing the prices of food exports from the United States. Also, so far the UR has had no perceptible effect on the poverty level in Trinidad and Tobago.
Protective Effect of Multimicronutrient Supplementation against Anemia among Children, Women, and Adolescent Girls in Lower-Income Areas of Chiclayo, Peru
Authors: de Romaña Daniel López , Verona Sara , Vivanco Oscar Aquino , Gross Rainer
Published: November 2015

Background

The Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) implemented a campaign to promote weekly multimicronutrient supplementation among women and adolescent girls of childbearing age and children under 5 years of age.

Objectives

To assess the impact of the campaign on the growth of children and on anemia among children and among women and adolescent girls of childbearing age.

Methods

Weekly multimicronutrient supplementation was provided for 8 weeks. Weights, heights, and hemoglobin concentrations were assessed at the beginning and end of the campaign.

Results and conclusions

Although supplementation did not significantly increase the hemoglobin concentrations of children (p = .80) or women and adolescent girls (p = .65) in the intervention group, the hemoglobin concentrations of the comparison groups were significantly lower after 8 weeks (p = .001 for children and p = .03 for women and adolescent girls). Furthermore, the percentage of anemic children in the comparison group increased significantly (p < .001), and the final value was significantly higher than that for the intervention group (p = .004). There were no significant effects of weekly multimicronutrient supplementation on the growth of children, but the study was too short to reliably determine any effects on growth.
Economic Inequality and Undernutrition in Women: Multilevel Analysis of Individual, Household, and Community Levels in Cambodia
Authors: Hong Rathavuth , Hong Rathmony
Published: November 2015

Background

Many people in developing countries are still struggling to emerge from the realm of extreme poverty, where economic improvements tend to benefit a small, affluent group of the population and cause growing inequality in health and nutrition that affects the most vulnerable groups of the population, including women and children.

Objective

To examine how household and community economic inequality affects nutritional status in women using information on 6,922 nonpregnant women aged 15 to 49 years included in the 2000 Cambodia Demographic and Health Survey.

Methods

Nutritional status is defined with the use of the body-mass index (BMI). BMI less than 18.5 kg/m 2 is defined as undernourishment. The household wealth index was calculated from household ownership of durable assets and household characteristics. Community wealth is an average household wealth index at the community level. Household and community economic inequalities were measured by dividing the wealth index into quintiles. The effects of household and community economic inequality were estimated by multilevel analysis.

Results

Independently of community economic status and other risk factors, women in the poorest 20% of households are more likely to be undernourished than women in the richest 20% of households (RR = 1.63; p = .008). The results also show variation among communities in the nutritional status of women. Age, occupation, and access to safe sources of drinking water are significantly associated with women's nutritional status.

Conclusions

Improving household income and creating employment opportunities for women, in particular poor women, may be a key to improving the nutritional status of women in Cambodia.
Mediterranean Diet, Traditional Foods, and Health: Evidence from the Greek EPIC Cohort
Authors: Trichopoulou Antonia
Published: November 2015

Background

For more than 50 years, the traditional Mediterranean diet has been considered health- promoting, but it was not until the mid-1990s that the topic began to receive increased scrutiny and prominence.

Objective

To highlight the health benefits of the Mediterranean diet as documented by studies undertaken mostly within a large countrywide general population cohort in Greece.

Methods

The Greek EPIC (European Prospective Investigation into Cancer) cohort, a prospective study based on volunteers from the general population of Greece, and other investigations with converging objectives. In the Greek EPIC cohort of more than 28,000 volunteers being followed for more than 10 years, several findings on the association of diet with chronic diseases have been published in the international scientific literature.

Results

The traditional Mediterranean diet of Greece is associated with reduced total mortality as well as reduced mortality from coronary heart disease and cancer. It is applicable in other Western populations, where it has also been shown to be inversely related to total mortality. Moreover, the traditional Mediterranean diet may be optimal for patients who have suffered a coronary infarct, and it does not promote obesity. Tra- ditional foods are integral components of the Mediter- ranean diet and may contribute to its health-promoting attributes.

Conclusions

The traditional Mediterranean diet may be an optimal diet both for healthy people and for patients with coronary heart disease and other chronic conditions.
Utilization of Positive Deviance Analysis in Evaluating Community-Based Nutrition Programs: An Application to the Dular Program in Bihar, India
Authors: Levinson F. James , Barney Jessica , Bassett Lucy , Schultink Werner
Published: November 2015

Background

Positive deviance is increasingly employed in international development activities to permit the utilization of proven local solutions. Including positive deviance methods in evaluation analysis, particularly in places like Bihar, India, where the rates of child underweight hover at 55%, can help identify project activities and household characteristics that affect key outcomes. These can, in turn, inform decision-making regarding the intensification of particularly promising activities.

Objectives

To apply positive deviance analysis to the Dular program in Bihar, a community-based nutrition program that seeks to improve the impact of India's Integrated Child Development Services on young children.

Methods

In order to assure that desired program outcomes were not dependent on higher economic status, the analysis isolated a subset of program beneficiaries—the poorest children with the best nutritional outcomes—and examined the behavioral and project factors that may have brought about positive results in this subgroup. The data for this analysis were drawn from a 2005 program evaluation with a sample of 1,560 children.

Results

The analysis found that positive deviant children with normal nutritional status in the poorest 50% of Dular households were introduced to complementary food almost 2 months earlier (7.18 vs. 9.02 months of age) than severely malnourished children, were more than twice as likely to use soap for handwashing after defecation (25.0% vs. 11.8%), and were more than seven times as likely to have literate mothers (25.0% vs. 3.5%).

Conclusions

The analysis suggests that programmatic efforts relating to these activities have been particularly effective and may well deserve increased investment.
Prevalence of Goiter in Children 6 to 12 Years of Age in Ethiopia
Authors: Abuye Cherinet , Berhane Yemane , Akalu Girma , Getahun Zewditu , Ersumo Tesema
Published: November 2015

Background

Iodine-deficiency disorders are a major public health problem in Ethiopia. In conjunction with implementing control programs, baseline information needs to be established.

Objective

To investigate the distribution and degree of severity of iodine-deficiency disorders in terms of goiter prevalence, urinary iodine excretion (UIE) levels, and proportion of households with iodated salt in Ethiopia.

Methods

A nationwide, community-based, cross-sectional study was conducted from February to May 2005 among 10,965 children aged 6 to 12 years. A multistage, proportional-to-population-size sampling method was used. Goiters were classified by the method recommended by the World Health Organization/UNICEF/International Council for the Control of Iodine Deficiency Disorders (WHO/UNICEF/ICCIDD), in which the thyroid gland is graded as 0 (normal), 1 (palpable goiter), or 2 (visible goiter); urinary iodine was determined by the wet digestion method; and salt samples were analyzed by a rapid test kit.

Results

The national total goiter weighted prevalence rate among children aged 6 to 12 years was 39.9% (95% confidence interval, 38.6% to 41.2%), representing more than 4 million children. The median UIE was 2.45 μg/dL; 45.8% of children had UIE values of 2 μg/dL or less, and 22.8% had UIE values of 2.01 to 5.0 μg/dL. Only 4.2% of the households had iodated salt.

Conclusions

According to the WHO/UNICEF/ICCIDD classification, both goiter prevalence and UIE levels indicate that the whole country appears to be severely affected by iodine deficiency. Furthermore, the virtual absence of iodated salt in the households shows that currently there is no salt iodization program in the country. Dietary sources of iodine in Ethiopia are not dependable, and hence a sustainable universal salt iodization program needs to be implemented without delay.