bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring Anthropometric Indicators through Nutrition Surveillance in Humanitarian Settings: Options, Issues, and Ways Forward
Authors: Bilukha Oleg , Prudhon Claudine , Moloney Grainne , Hailey Peter , Doledec David
Published: November 2015

The technical discourse on nutrition surveillance started decades ago, and the first technical guidelines were proposed in mid-1970s. In spite of this long history, little evidence and consensus exists on the best methods for conducting nutrition surveillance, and on the validity of data produced by these approaches. Multiple nutrition surveillance systems exist in humanitarian settings; however, the validity and usefulness of data produced by these systems are often questionable. In this paper, we outline and define five major methodological approaches to collecting child anthropometric data through surveillance: repeated surveys, community-based sentinel sites, mass screenings, admission data from feeding centers, and data from health clinics. We discuss outstanding methodological and practical challenges with direct implications for quality, validity, and interpretability of collected data and highlight comparative advantages and disadvantages of different methods. We also propose ways forward to building a better evidence base by documenting the strengths and limitations of different approaches, with the eventual goal of achieving consensus on the best ways to collect anthropometric data through surveillance.
Prevalence of Overweight, Obesity, and Thinness among Urban School-Aged Children and Adolescents in Southern Nigeria
Authors: Ene-Obong Henrietta , Ibeanu Vivian , Onuoha Nneola , Ejekwu Ada
Published: November 2015

Background

Overweight and obesity are public health problems all over the world because of their devastating social, economic, and health consequences, and they coexist with undernutrition in developing countries. Yet, there are few data on the magnitude of these problems in Nigeria.

Objective

To assess the prevalence of overweight, obesity, and thinness among urban school-aged children and adolescents.

Methods

A cross-sectional study of 1,599 children and adolescents 5 to 18 years of age was conducted. The subjects were randomly selected from schools in four urban towns (Lagos, Port Harcourt, Nsukka, and Aba) in southern Nigeria. A validated and pretested questionnaire was used to collect information on the background of the children and adolescents and their parents' socioeconomic status. Weight and height measurements were taken, and body mass indexes were calculated. Overweight, obesity, and thinness were defined according to the International Obesity Task Force cutoff points for children and adolescents 2 to 18 years of age. The data were analyzed by descriptive statistics, cross tabulations, and chi-squared tests.

Results

The prevalence rates of overweight, obesity, and thinness were 11.4%, 2.8%, and 13.0%, respectively. More females (3.7%) than males (1.8%) were obese ( p < .05). The prevalence of overweight was higher among adolescents 10 to 18 years of age (13%) than among children 5 to 9 years of age (9.4%) (p < .001) and was highest (23.1%) at age 15 years. Thinness was significantly more prevalent among children (19.0%) than adolescents (8.3%) ( p < .001) and was highest (28.6%) at age 7 years. Age- and sex-related increases and decreases were observed in the prevalence of overweight, obesity, and thinness. The rates of overweight, obesity, and thinness were affected by location and income levels.

Conclusions

The prevalence rates of overweight and obesity are increasing among urban Nigerian children and adolescents and are of equal magnitude to the prevalence of undernutrition.
Nutritional Iodine Status in Gestation and its Relation to Geographic Features in Urmia County of Northwest Iran
Authors: Rostami Rahim , Beiranvend Asghar , Nourooz-Zadeh Jaffar
Published: November 2015

Background

Iodine is an important component for the proper function of the thyroid and fetal development.

Objective

To evaluate the influence of geographic variation on nutritional iodine status during pregnancy.

Methods

Four hundred eighty-nine women in the first trimester of pregnancy were enrolled. Of these, 419 (85.5%) were from the plain districts and 70 (14.5%) from mountainous regions. Data were obtained on demographic characteristics and accessibility of iodized salt, and samples of table salt were collected. In the third trimester, 322 women remained in the study: 281 (87.2%) from the plains and 41 (12.8%) from the mountainous regions. Salt and urine samples were analyzed for iodine content.

Results

All participants stated that they used iodized table salt. The proportion of salt samples with optimal iodine content (30 ppm) from the plains and mountain regions were 68.7% and 88%, respectively. The median urinary iodine content (UIC) in the plains area in the first and third trimesters was 82 and 119 μg/L, respectively. The corresponding values in the mountain region were 34.5 μg/L and 76 μg/L. The prevalence of subjects with an inadequate iodine intake (UIC < 150 μg/L) in first and third trimester in the plains and mountain regions were 84.5% and 66.9% vs 98.6% and 90.2%, respectively.

Conclusions

The prevalence of pregnant women exhibiting UIC < 150 μg/L in the mountain region was substantially higher than those in the plain district. Our findings also show that the current strategy for eradication of iodine deficiency in school-aged children would not fulfill iodine requirements in pregnancy and that additional source(s) of iodine are required to prevent the adverse effects of iodine deficiency in pregnancy. Further studies are needed to address the cause(s) for the rapid depletion of iodine stores in pregnancy.
Repeatability of Food Frequency Assessment Tools in Relation to the Number of Items and Response Categories Included
Authors: Bountziouka Vassiliki , Bathrellou Eirini , Zazpe Itziar , Ezquer Leyre , Martínez-González Miguel-Angel , Panagiotakos Demosthenes B.
Published: November 2015

Background

Accuracy of measurement is a cornerstone of research in order to make robust conclusions about the research hypothesis.

Objective

To examine whether the number of items (questions) and the number of consumption responses (the coding used to measure the frequency of consumption) included in nutritional assessment tools influence their repeatability.

Methods

During 2009, 400 participants (250 from Greece, mean age 37 ± 13 years, 34% males, and 150 from Spain, mean age 39 ± 17 years, 41% males) completed a diet index with 11 items and binary (yes/no) responses, a diet index with 11 items and 6-scale responses, and 36-item and 76-item food frequency questionnaires (FFQs) with 6-scale responses. The participants completed these tools twice, with 15 days between the two administrations of the tools. The Spearman-Brown coefficient ( rsb), Kendall's tau coefficients, and the Bland-Altman method were applied to answer the research hypothesis.

Results

The highest repeatability coefficient was observed for the diet index with 11 items and binary (yes/no) responses ( rsb = 0.948, p < .001), followed by the diet index with 11 items and 6-scale responses ( rsb = 0.943, p < .001), the 36-item FFQ with 6-scale responses ( rsb = 0.936, p < .001), and the 76-item FFQ with 6-scale responses ( rsb = 0.878, p < .001). Statistical comparisons revealed no significant differences between repeatability coefficients of the first three tools ( p > .23), whereas these three tools had significantly higher repeatability coefficients than the 76-item FFQ ( p = .002). Subgroup analyses by sex, education, smoking, and clinical status confirmed these results.

Conclusions

Repeatability was found for all food frequency assessment tools used, irrespective of the number of items or the number of responses included.
Rice Fortification: An Emerging Opportunity to Contribute to the Elimination of Vitamin and Mineral Deficiency Worldwide
Authors: Muthayya Sumithra , Hall Jessica , Bagriansky Jack , Sugimoto Jonathan , Gundry Daniel , Matthias Dipika , Prigge Shane , Hindle Peter , Moench-Pfanner Regina , Maberly Glen
Published: November 2015

Vitamin and mineral deficiencies are ranked among the top causes of poor health and disability in the world. These deficiencies damage developing brains, impair learning ability, increase susceptibility to infections, and reduce the work productivity of nations. Food fortification is a sustainable, cost-effective approach to reducing vitamin and mineral deficiency. As the staple food for an estimated 3 billion people, rice has the potential to fill an obvious gap in current fortification programs. In recent years, new technologies have produced fortified rice kernels that are efficacious in reducing vitamin and mineral deficiency. There are opportunities to fortify a significant share of rice that comes from large mills supplying centralized markets and national welfare programs in major rice-growing countries. The rice export markets, which handle 30 million MT of rice annually, also present a key fortification opportunity. The cost of fortifying rice is only 1.5% to 3% of the current retail price of rice. Countries that mandate rice fortification have the strongest evidence for achieving wide coverage and impact. The Rice Fortification Resource Group (RiFoRG), a global network of public and private partners that offers technical and advocacy support for rice fortification, has a vision of promoting rice fortification worldwide. It has a targeted approach, engaging multisector partners in key countries where the opportunities are greatest and there is receptivity to early adoption of large-scale rice fortification. The challenges are real, the imperative to address them is powerful, and the opportunities to deliver the promise of rice fortification are clear.
Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia
Authors: Saldanha Lisa S. , Buback Laura , White Jessica M. , Mulugeta Afework , Mariam Solomon G. , Roba Alemzewed Challa , Abebe Hiwot , Mason John B.
Published: November 2015

Background

Maternal undernutrition persists as a serious problem in Ethiopia. Although there are maternal nutrition interventions that are efficacious and effective in improving maternal, neonatal, and child health (MNCH) outcomes, implementation has been limited.

Objective

This study explored needs, perceptions, priorities, facilitating factors and barriers to implementation of relevant policies and programs to find opportunities to improve maternal nutrition in Ethiopia

Methods

Background information was compiled and synthesized for a situation analysis. This informed focus group discussions and in-depth interviews with mothers, community leaders, health workers, and district health officials in four woredas (districts) in Tigray and Southern Nations, Nationalities and Peoples Region.

Results

Findings focused on three priority issues: maternal anemia, intrauterine growth retardation (IUGR), and maternal thinness and stunting. Community-level investigations found that women's low status, food insecurity and poverty, and workload were key factors perceived to contribute to women's undernutrition. Awareness of and demand for services to improve women's nutrition were low, except for high demand for supplementary food. On the supply side, barriers included low prioritization of maternal nutrition in health and nutrition service delivery and weak technical capacity to deliver context-sensitive maternal nutrition interventions at all levels.

Conclusions

Community-based health and nutrition services were promising platforms for expanding access to interventions such as micronutrient supplements and social and behavior change communication. Investments are needed to support these community-based programs, including training, supplies, supervision and monitoring. To address IUGR at scale, increased access to cash or food transfers could be explored.
Household Consumption and Expenditures Surveys (HCES): A Primer for Food and Nutrition Analysts in Low- and Middle-Income Countries
Authors: Fiedler John L. , Lividini Keith , Bermudez Odilia I. , Smitz Marc-Francois
Published: November 2015

Background

The dearth of 24-hour recall and observed-weighed food record data—what most nutritionists regard as the gold standard source of food consumption data—has long been an obstacle to evidence-based food and nutrition policy. There have been a steadily growing number of studies using household food acquisition and consumption data from a variety of multipurpose, nationally representative household surveys as a proxy measure to overcome this fundamental information gap.

Objective

To describe the key characteristics of these increasingly available Household Consumption and Expenditures Surveys (HCES) in order to help familiarize food and nutrition analysts with the strengths and shortcomings of these data and thus encourage their use in low- and middle-income countries; and to identify common shortcomings that can be readily addressed in the near term in a country-by-country approach, as new HCES are fielded, thereby beginning a process of improving the potential of these surveys as sources of useful data for better understanding food- and nutrition-related issues.

Methods

Common characteristics of key food and nutrition information that is available in HCES and some basic common steps in processing HCES data for food and nutrition analyses are described.

Results

The common characteristics of these surveys are documented, and their usefulness in addressing major food and nutrition issues, as well as their short-comings, is demonstrated.

Conclusions

Despite their limitations, the use of HCES data constitutes a generally unexploited opportunity to address the food consumption information gap by using survey data that most countries are already routinely collecting.
Validation of Dietary Applications of Household Consumption and Expenditures Surveys (HCES) against a 24-Hour Recall Method in Uganda
Authors: Dary Omar , Jariseta Zo Rambeloson
Published: November 2015

Background

The benefits of food fortification depend on the proportion of the population that uses the fortified food (coverage), the amount of the food being consumed, and the additional content of micronutrients in the food. Coverage and amounts consumed can be determined by 24-hour recall or Food Frequency Questionnaires (FFQs). However, these methods are rarely applied. Secondary analysis of data from Household Consumption and Expenditures Surveys (HCES) can be used for these purposes; however, such data analysis has not been validated.

Objective

To compare the results of HCES and 24-hour recall for estimating the consumption profile of potential fortification vehicles in Uganda.

Methods

Food intake estimates for 24- to 59-month-old children and 15- to 49-year-old women derived from a one-day 24-hour recall carried out in Uganda (Kampala, North, and Southwest) were compared with data from two HCES (2006, nationwide, and 2008, coupled with the 24-hour recall). The analyzed foods were vegetable oil, sugar, wheat flour, maize flour, and rice.

Results

Food consumptiòn estimates calculated from HCES may be less accurate than estimates derived by 24-hour recall. Nevertheless, the HCES results are sensitive enough to differentiate consumption patterns among population strata. In Uganda, HCES predicted proportion of the population that consumes the foods, and approximated intakes of main food vehicles by the “observed” consumers (those who reported using the foods), although estimates for the latter were lower for wheat flour and rice.

Conclusions

HCES data offer the basic information needed to provide a rationale for, and help design, food fortification programs. Individual intake surveys are still needed, however, to assess intrahousehold use of foods.
Validation of a User-Friendly and Rapid Method for Quantifying Iodine Content of Salt
Authors: Rohner Fabian , Garrett Greg S. , Laillou Arnaud , Frey Simone K. , Mothes Ralf , Schweigert Florian J. , Locatelli-Rossi Lorenzo
Published: November 2015

Background

Despite considerable progress made in the past decade through salt iodization programs, over 2 billion people worldwide still have inadequate iodine intake, with devastating consequences for brain development and intellectual capacity. To optimize these programs with regard to salt iodine content, careful monitoring of salt iodine content is essential, but few methods are available to quantitatively measure iodine concentration in a simple, fast, and safe way.

Objective

We have validated a newly developed device that quantitatively measures the content of potassium iodate in salt in a simple, safe, and rapid way.

Methods

The linearity, determination and detection limit, and inter- and intra-assay variability of this colorimetric method were assessed and the method was compared with iodometric titration, using salt samples from several countries.

Results

Linearity of analysis ranged from 5 to 75 mg/kg iodine, with 1 mg/kg being the determination limit; the intra- and interassay imprecision was 0.9%, 0.5%, and 0.7% and 1.5%, 1.7%, and 2.5% for salt samples with iodine contents of 17, 30, and 55 mg/kg, respectively; the interoperator imprecision for the same samples was 1.2%, 4.9%, and 4.7%, respectively. Comparison with the iodometric method showed high agreement between the methods ( R2 = 0.978; limits of agreement, −10.5 to 10.0 mg/kg).

Conclusions

The device offers a field- and user-friendly solution to quantifying potassium iodate salt content reliably. For countries that use potassium iodide in salt iodization programs, further validation is required.
Fortification of Wheat Flour and Maize Meal with Different Iron Compounds: Results of a Series of Baking Trials
Authors: Randall Philip , Johnson Quentin , Verster Anna
Published: November 2015

Background

Wheat and maize flour fortification is a preventive food-based approach to improve the micronutrient status of populations. In 2009, the World Health Organization (WHO) released recommendations for such fortification, with guidelines on the addition levels for iron, folic acid, vitamin B12, vitamin A, and zinc at various levels of average daily consumption. Iron is the micronutrient of greatest concern to the food industry, as some believe there may be some adverse interaction(s) in some or all of the finished products produced from wheat flour and maize meal.

Objective

To determine if there were any adverse interactions due to selection of iron compounds and, if differences were noted, to quantify those differences.

Methods

Wheat flour and maize meal were sourced in Kenya, South Africa, and Tanzania, and the iron compound (sodium iron ethylenediaminetetraacetate [NaFeEDTA], ferrous fumarate, or ferrous sulfate) was varied and dosed at rates according to the WHO guidelines for consumption of 75 to 149 g/day of wheat flour and > 300 g/day of maize meal and tested again for 150 to 300 g/day for both. Bread, chapatti, ugali (thick porridge), and uji (thin porridge) were prepared locally and assessed on whether the products were acceptable under industry-approved criteria and whether industry could discern any differences, knowing that differences existed, by academic sensory analysis using a combination of trained and untrained panelists and in direct side-by-side comparison.

Results

Industry (the wheat and maize milling sector) scored the samples as well above the minimal standard, and under academic scrutiny no differences were reported. Side-by-side comparison by the milling industry did indicate some slight differences, mainly with respect to color, although these differences did not correlate with any particular iron compound.

Conclusions

The levels of iron compounds used, in accordance with the WHO guidelines, do not lead to changes in the baking and cooking properties of the wheat flour and maize meal. Respondents trained to measure against a set benchmark and/or discern differences could not consistently replicate perceived difference observations.
Validity of Food Consumption Indicators in the Lao Context: Moving toward Cross-Cultural Standardization
Authors: Baumann Soo Mee , Webb Patrick , Zeller Manfred
Published: November 2015

Background

Cross-cultural validity of food security indicators is commonly presumed without questioning the suitability of generic indicators in different geographic settings. However, ethnic differences in the perception of, and reporting on, food insecurity, as well as variations in consumption patterns, may limit the comparability of results. Although research on correction factors for standardization of food security indicators is in process, so far no universal indicator has been identified.

Objective

The current paper considers the ability of the Food Consumption Score (FCS) developed by the World Food Programme in southern Africa in 1996 to meet the requirement of local cultural validity in a Laotian context. The analysis is based on research that seeks to identify options for correcting possible biases linked to cultural disparities.

Methods

Based on the results of a household survey conducted in different agroecological zones of Laos in 2009, the FCS was validated against a benchmark of calorie consumption. Changing the thresholds and excluding small amounts of food items consumed were tested as options to correct for biases caused by cultural disparities.

Results

The FCS in its original form underestimates the food insecurity level in the surveyed villages. However, the closeness of fit of the FCS to the benchmark classification improves when small amounts of food items are excluded from the assessment.

Conclusions

Further research in different cultural settings is required to generate more insight into the extent to which universal thresholds can be applied to dietary diversity indicators with or without locally determined correction factors such as the exclusion of small amounts of food items.
Associations among Dietary Zinc Intakes and Biomarkers of Zinc Status before and after a Zinc Supplementation Program in Guatemalan Schoolchildren
Authors: Bui Vinh Q. , Marcinkevage Jessica , Ramakrishnan Usha , Flores-Ayala Rafael C. , Ramirez-Zea Manuel , Villalpando Salvador , Martorell Reynaldo , Digirolamo Ann M. , Stein Aryeh D.
Published: November 2015

Background

The associations among dietary zinc intakes and biomarkers of zinc status are unknown in apparently healthy children at high risk for zinc deficiency.

Objective

To assess associations among zinc-related parameters in a sample of Guatemalan school-aged children.

Methods

We assessed total dietary intakes and biomarkers of zinc status before and after receiving 6 months of zinc supplementation or placebo in 691 Guatemalan schoolchildren aged 6 to 11 years. Most of the children also received zinc-fortified milk from a government program that started shortly after the trial began. We assessed associations between zinc intakes and serum zinc, alkaline phosphatase (ALP), and albumin.

Results

At baseline, the prevalence of serum zinc < 65 μg/dL and dietary zinc intake below Estimated Average Requirements (EAR) (< 4 and < 7 mg/day for children < 9 and ≥ 9 years, respectively) were 21.6% and 39.4%, respectively. Pearson correlations between serum zinc concentration and dietary zinc intake, serum ALP, and serum albumin were r = 0.07, 0.15, and 0.07, respectively. At the 6-month follow-up, low serum zinc and low total (diet plus fortified milk) zinc intakes were observed in 1.2% and 0.0% of children in the zinc-supplemented group and 4.0% and 34.1% in the placebo group, respectively. Pearson correlations between serum zinc concentration and total zinc intake, serum ALP, and serum albumin were 0.10, 0.06, and −0.11 in the zinc-supplemented group and −0.04, 0.05, and 0.01 in the placebo group, respectively.

Conclusions

Zinc intake was inconsistently associated with markers of serum zinc concentration. Zinc fortification or supplementation attenuated the associations.
Using Program Impact Pathways to Understand and Improve Program Delivery, Utilization, and Potential for Impact of Helen Keller International's Homestead Food Production Program in Cambodia
Authors: Olney Deanna K. , Vicheka Sao , Kro Meng , Chakriya Chhom , Kroeun Hou , Hoing Ly Sok , Talukder Aminzzaman , Quinn Victoria , Iannotti Lora , Becker Elisabeth , Roopnaraine Terry
Published: November 2015

Background

Evidence of the impact of homestead food production programs on nutrition outcomes such as anemia and growth is scant. In the absence of information on program impact pathways, it is difficult to understand why these programs, which have been successful in increasing intake of micronutrient-rich foods, have had such limited documented impact on nutrition outcomes.

Objective

To conduct a process evaluation of Helen Keller International's (HKI's) homestead food production program in Cambodia to assess whether the program was operating as planned (in terms of design, delivery, and utilization) and to identify ways in which the program might need to be strengthened in order to increase its potential for impact.

Methods

A program theory framework, which laid out the primary components along the hypothesized program impact pathways, was developed in collaboration with HKI and used to design the research. Semistructured interviews and focus group discussions with program beneficiaries ( n = 36 and 12, respectively), nonbeneficiaries ( n = 12), and program implementers ( n = 17 and 2, respectively) and observations of key program delivery points, including health and nutrition training sessions ( n = 6), village model farms ( n = 6), and household gardens of beneficiaries ( n = 36) and nonbeneficiaries ( n = 12), were conducted to assess the delivery and utilization of the primary program components along the impact pathways.

Results

The majority of program components were being delivered and utilized as planned. However, challenges with some of the key components posited to improve outcomes such as anemia and growth were noted. Among these were a gap in the expected pathway from poultry production to increased intake of eggs and poultry meat, and some weaknesses in the delivery of the health and nutrition training sessions and related improvements in knowledge among the village health volunteers and beneficiaries.

Conclusions

Although the program has been successful in delivering the majority of the program components as planned and has documented achievements in improving household production and intake of micronutrient-rich foods, it is likely that strengthening delivery and increasing utilization of some program components would increase its potential for nutritional impacts. This research has highlighted the importance of designing a program theory framework and assessing the components that lie along the primary program impact pathways to optimize program service delivery and utilization and, in turn, potential for impact.
Are School Feeding Programs in Low-Income Settings Sustainable? Insights on the Costs of School Feeding Compared with Investments in Primary Education
Authors: Gelli Aulo , Daryanani Roshan
Published: November 2015

Background

School feeding programs are ubiquitous. Benchmarking expenditures for school feeding is an important component of program accountability and sustainability.

Objective

To analyze the costs of school feeding and the cost relative to education expenditure and other measures of economic growth.

Methods

Data on the costs of school feeding were collected from multiple sources, including United Nations databases, gray literature, and published reviews. Relationships between costs of school feeding, costs of education, and GDP per capita were analyzed through standard linear regression.

Results

Data on costs of school feeding were obtained for 74 countries, including 12 high-income, 40 middle-income, and 22 in low-income countries. School feeding programs were found to cost US$173 per child per year, ranging from US$54 in low-income countries to US$693 in high-income countries. In high-income countries, school feeding costs per capita were on average equivalent to 11% of the per capita investments in primary education, compared with 19% in middle-income countries and 68% in low-income countries. In middle- and low-income countries, school feeding programs covered on average 18% and 13% of the children enrolled in primary school, respectively. The total budget for school feeding in low-income countries was found to be on average 11% of the estimated total primary school education budget, compared to 4% in middle-income countries.

Conclusions

School feeding investments are targeted in low- and middle-income settings, reaching only a portion of primary schoolchildren, with total costs only a fraction of the overall investment in education. As countries get richer, school feeding costs become a much smaller proportion of education costs. The findings of this study provide an updated framework for benchmarking school feeding programs.
Relative Costs of 24-Hour Recall and Household Consumption and Expenditures Surveys for Nutrition Analysis
Authors: Fiedler John L. , Martin-Prével Yves , Moursi Mourad
Published: November 2015

Background

The technical and resource demands of the most precise dietary assessment methods, 24-hour recall and observed-weighed food records, have proven impractical for most low- and middle-income countries, leaving nutrition policymakers with a woefully inadequate evidence base and compromising nutrition program effectiveness.

Objective

To better understand the relative costs of informing food and nutrition policy-making using two different data sources: 24-hour recall survey data and Household Consumption and Expenditures Survey (HCES) data.

Methods

A comparative analysis of the costs of designing, implementing, and analyzing a 24-hour recall survey and the cost of secondary analysis of HCES data.

Results

The cost of conducting a 24-hour recall survey with a sample of the size typical of HCES would be roughly 75 times higher than the cost of analyzing the HCES data.

Conclusions

Although the 24-hour recall method is undoubtedly more precise, it has become self-evident that the practical choice for most countries is not between these two surveys, but between having data from less precise, but much more readily available and affordable HCES or having no nationally representative data. In the light of growing concerns about inappropriate fortification policies developed without data, there is an urgent need to begin working to strengthen HCES to provide more precise food and nutrition data. The best way forward is not likely to rest with one data source or another, but with the development of an eclectic approach that exploits the strengths and weaknesses of alternative surveys and uses them to complement one another.
Strengthening Systems to Support Mothers in Infant and Young Child Feeding at Scale
Authors: Sanghvi Tina , Martin Luann , Hajeebhoy Nemat , Abrha Teweldebrhan Hailu , Abebe Yewelsew , Haque Raisul , Tran Ha Thi Thu , Roy Sumitro
Published: November 2015

Background

Systems strengthening is essential for implementation of large-scale nutrition interventions, including infant and young child feeding (IYCF), since rapid geographic expansion places additional burdens on service delivery systems.

Objective

To document approaches for building capacity and supporting programs to scale up IYCF counseling in three different country contexts.

Methods

Situational assessments, stakeholder consultations, formative research, household and frontline health worker surveys, other related studies, and program monitoring in three countries identified gaps and opportunities for strengthening IYCF service delivery.

Results

Variations in program platforms, level and roles of service providers, places of service delivery, community factors, and the needs of managers and frontline workers influenced the intervention mix used for strengthening IYCF services. The programs ranged from a highly structured and standardized package of IYCF counseling services in Vietnam delivered through government health facilities to counseling delivered at the doorstep by incentivized nongovernmental organization volunteers in Bangladesh. In Ethiopia, government health extension workers based at health posts conducted outreach visits with support from volunteers.

Conclusions

Guidelines and standards of care, training, job aids, supportive supervision, incentives, and monitoring data can enhance performance and strengthen systems for delivering IYCF counseling services in the community or at health facilities. Leadership, financing, partnerships, and logistics support are essential to support large-scale implementation of the IYCF counseling package in diverse service delivery environments.
Learning How Programs Achieve their Impact: Embedding Theory-Driven Process Evaluation and Other Program Learning Mechanisms in Alive & Thrive
Authors: Rawat Rahul , Nguyen Phuong H. , Ali Disha , Saha Kuntal , Alayon Silvia , Kim Sunny S. , Ruel Marie , Menon Purnima
Published: November 2015

Background

Traditionally, impact evaluations have focused primarily on answering what impact programs or interventions have, with less attention to how or why impacts are achieved, or not achieved. The Alive & Thrive initiative, a 6-year program that aims to improve infant and young child feeding (IYCF) practices and reduce stunting in Bangladesh, Ethiopia, and Vietnam, has a specific objective to generate learning on how to achieve and replicate Alive & Thrive's impact.

Objective

In Alive & Thrive, theory-driven process evaluation methods are the primary mechanism through which data are generated to address this objective. This paper focuses on the different methodological approaches that are being utilized, to answer the critical “how”; questions, and to generate information on the many processes and pathways to program impact.

Methods

We identify four key principles in our methodological approach that guides all process evaluation activities: 1) developing detailed program impact pathway (PIP) models, 2) linking data collection to PIPs utilizing mixed methods and multiple data sources, 3) linking evaluation activities with program implementation timelines, and 4) engaging with the program implementation and management teams.

Results

Beginning with the launch of the program, we outline the steps that have been taken in the design and implementation of the process evaluations of Alive & Thrive, and provide examples of how these steps have been operationalized in different country contexts.

Conclusions

This theory-driven and country- and component-specific approach, centered on careful analysis of PIPs, is intended to generate information on implementation and utilization pathways of Alive & Thrive's interventions, thereby answering the questions of how impacts are achieved, or why not. This evaluation approach is not without challenges, and we highlight some of these key challenges.
Effectiveness of Wetting Method for Control of Konzo and Reduction of Cyanide Poisoning by Removal of Cyanogens from Cassava Flour
Authors: Banea Jean Pierre , Bradbury J. Howard , Mandombi Chretienne , Nahimana Damien , Denton Ian C. , Kuwa N'landa , Katumbay D. Tshala
Published: November 2015

Background

Konzo is an irreversible paralysis of the legs that occurs mainly among children and young women in remote villages in tropical Africa and is associated with a monotonous diet of bitter cassava. Konzo was discovered in 1938 by Dr. G. Trolli in the Democratic Republic of Congo (DRC). It also occurs in Mozambique, Tanzania, Cameroon, Central African Republic, and Angola. It was first controlled in Kay Kalenge village, DRC, in 2011 with the use of a wetting method to remove cyanogens from cassava flour. Fourteen months later, another visit was made to Kay Kalenge.

Objective

To determine whether Kay Kalenge women were still using the wetting method, whether there were new cases of konzo, and whether the wetting method had spread to other villages.

Methods

Meetings were held with chiefs, leaders, and heads of mothers' groups, women from 30 households were interviewed, and three nearby villages were visited. Total cyanide and thiocyanate were analyzed in cassava flour and urine samples, respectively.

Results

The women in Kay Kalenge village still used the wetting method. There were no new cases of konzo. The mean cyanide content of the flour samples was 9 ppm, and no child had a mean urinary thiocyanate content greater than 350 μmol/L. The use of the wetting method had spread naturally to three adjacent villages.

Conclusions

The wetting method has been readily accepted by rural women as a simple and useful method to control konzo by removing cyanide from cassava flour, and its use has spread to nearby villages. The wetting method should be promoted by health authorities to control konzo and reduce cyanide poisoning from high-cyanide cassava flour.
Impacts of Agriculture on Nutrition: Nature of the Evidence and Research Gaps
Authors: Webb Patrick , Kennedy Eileen
Published: November 2015

Background

In the past decade, numerous exercises have been undertaken to document knowledge of the effects of agricultural development projects on human nutrition.

Objective

The present paper reviews 10 papers published since 2000 to synthesize current evidence of agriculture-to-nutrition linkages.

Results

Although there are differences in focus, methods used, and standards of evidence across the set of papers considered, three common findings emerge. First, the empirical evidence for plausible and significant impacts of agricultural interventions on defined nutrition outcomes remains disappointingly scarce. Second, absence of evidence should not be equated with evidence of no impact. Weaknesses in study design and survey methods are all too common, leading to weak results and limited generalizability. Third, the broad domains of “agriculture' on the one hand, and “nutritional status' on the other, must be unpackaged in future analyses if statistically significant findings and relevant policy or program conclusions are to be drawn.

Conclusions

Expectations of the potential for nutrition impact of different kinds of investment in agriculture must be set rationally, based on well-defined mechanisms and pathways. Planned and ongoing initiatives aimed at generating such evidence must hold themselves to high standards of both research and communication of findings to appropriate policy audiences globally.
Which Aid Spending Categories Have the Greatest Untapped Potential to Support the Reduction of Undernutrition? Some Ideas on Moving Forward
Authors: Haddad Lawrence , Isenman Paul
Published: November 2015

The financial resource needs for the reduction of under-nutrition are significant, while the returns from reducing undernutrition are large. Yet the share of public resources allocated to the reduction of undernutrition remains disproportionately small. For overseas development assistance, the investment in nutrition-specific and nutrition-sensitive categories amounts to less than 3% of the total. What is the potential for other categories of public resource investments to reduce undernutrition, and in which sectors are these investments to be found? This paper proposes a framework for addressing this question and ventures some suggestions as to which of the categories of overseas development assistance beyond the well-known “nutrition-specific” and “nutrition-sensitive” categories are most likely to yield improvements in nutrition status if they could be redesigned with this in mind. We conclude that policy makers should look widely within the underlying and basic determinant intervention space for investments that, when changed at the margins, could result in significant improvements in nutrition.
Differences in Relative Iron Bioavailability in Traditional Bangladeshi Meal Plans
Authors: DellaValle Diane M. , Glahn Raymond P.
Published: November 2015

Background

Iron deficiency is the most common nutrient deficiency worldwide. Large intakes of micronutrient-poor staple crops, coupled with low intakes of highly bioavailable dietary iron, are a major cause of this deficiency.

Objective

To examine the concentration and relative bioavailability of iron in several models ( n = 23) of traditional Bangladeshi meals (rice, lentils/dal, vegetable, and fish), as well as the effect of removal of the lentil seed coat on the nutritional quality of iron.

Methods

The relative bioavailability of iron was assessed by the in vitro/Caco-2 cell culture method, iron concentration by an inductively coupled argon-plasma emission spectrometer (ICAP-ES), and phytic acid concentration by colorimetric assay. The recipes contained 75% to 85% rice, 0% to 15% dal (containing whole or dehulled lentils), 0% to 15% vegetable curry, and 0% to 8% fish.

Results

While the iron concentrations of recipes containing dehulled dal were significantly lower than those of recipes containing whole dal ( p = .005), seed coat removal doubled relative iron bioavailability and increased phytic acid concentration ( p < .001). The addition of fish to the meals had no significant effect on relative iron bioavailability. Iron concentration and relative iron bioavailability were correlated in the recipes containing dehulled dal ( r = 0.48, p = .03), but not whole dal ( r = −0.047, p = .84).

Conclusions

The total amount of iron absorbed from traditional Bangladeshi meals is dependent upon iron concentration, and dehulling lentils removes inhibitory factors increasing iron uptake but also increases the density of phytic acid in the lentil sample. Thus, along with breeding for high iron concentration and bioavailability (i.e., biofortification), seed coat removal plus measures to lower phytic acid concentrations may be an important strategy to improve the bioavailability of iron in lentils and other pulse crops.
Nutrition Education and Introduction of Broad Bean—Based Complementary Food Improves Knowledge and Dietary Practices of Caregivers and Nutritional Status of Their Young Children in Hula, Ethiopia
Authors: Negash Canaan , Belachew Tefera , Henry Carol J. , Kebebu Afework , Abegaz Kebede , Whiting Susan J.
Published: November 2015

Background

Nutritious complementary foods are needed in countries where undernutrition and stunting are major problems, but mothers may be reluctant to change from traditional gruels.

Objective

To test whether a recipe-based complementary feeding education intervention would improve knowledge and practice of mothers with young children in Hula, Ethiopia.

Methods

A baseline survey of 200 eligible, randomly selected mother—child pairs gathered data on sociodemographic characteristics, food security status, knowledge and practices concerning complementary feeding, food group intakes of children aged 6 to 23 months by 24-hour recalls, and children's anthropometric measurements. Twice a month for 6 months, women in the intervention group received an education session consisting of eight specific messages using Alive and Thrive posters and a demonstration and tasting of a local barley and maize porridge recipe containing 30% broad beans. The control group lived in a different area and had no intervention.

Results

At 6 months, knowledge and practice scores regarding complementary feeding were significantly improved ( p < .001) in the intervention group but not in the control group. The intervention resulted in improvement of children's dietary diversity, as well as mean intake of energy and selected nutrients, compared with children in the control group. Changes in height and weight did not differ between the two groups.

Conclusions

Community-based nutrition education over 6 months that included demonstration of a local porridge recipe with broad beans added improved the complementary feeding practices of caregivers and the nutritional status of their young children.
Treatment and Prevention of Malnutrition in Latin America: Focus on Chile and Bolivia
Authors: Weisstaub Gerardo , Aguilar Ana Maria , Uauy Ricardo
Published: November 2015

Seven million children under 5 years of age died worldwide in 2011, and one-third had malnutrition. Latin America and Caribbean countries stand out for the notable improvement of their health and nutrition situation, particularly in pregnant women and young children. Nutrition-sensitive interventions such as promoting food security, women's empowerment, social safety nets, clean water, and sanitation, among others, are critical for success. In Bolivia, the program Desnutrición Cero (Malnutrition Zero) was able to reduce mortality from severe malnutrition after 5 years from 25% to less than 5%, based on widespread implementation of the World Health Organization 10-steps protocol for hospitalized care and the application of community management. The Economic Commission for Latin America estimated the cost of malnutrition for Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic as US$6,658 million. Approximately 1 million children have dropped out of school because of malnutrition, and as a result, malnourished children have 2 years less schooling, which brings social and economic losses not only to those affected but to society at large. National and international nutrition and food programs developed over the past 50 years have been implemented as integral components of broader strategies of primary healthcare and education, oriented toward preventing deaths and improving the quality of life of low-socioeconomic-status groups. Treating hundreds or thousands of affected children will not solve the global public health problem of malnutrition. Access to adequate amounts of quality foods represents a basic human right and is a necessary precondition for health. In turn, good nutrition and health are prerequisites for human, social, and economic development.
Severe Acute Malnutrition during Emergencies: Burden, Management, and Gaps
Authors: Bahwere Paluku
Published: November 2015

Natural and man-made disasters, including floods, droughts, earthquakes, and armed conflicts, create nutrition crises. Unfortunately, the frequency and severity of such disasters have been increasing since the beginning of the 20th century, and their contribution to the burden of acute malnutrition is increasing every year. However, their contribution to the burden of acute malnutrition is underrecognized due to the ways in which global statistics are built and causes of death are reported. Fortunately, the success of the current protocol for treatment of severe acute malnutrition (SAM) and the integrated approach to treatment has created a momentum allowing expanded coverage of treatment of SAM, especially in humanitarian emergency contexts. For this progress to be maintained and accelerated, changes in nutrition information systems at the national and global levels are needed, and the persisting barriers to the expansion and integration of treatment of SAM into routine health systems need to be removed. Emergency funding approaches and objectives have to include sustaining and amplifying the achievements of the short-term palliative interventions. Nutrition programs implemented in emergency contexts have the capacity to contribute to answering priority research questions, and this capacity should be more optimally utilized.