bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Model Newborn Care Practices through a Positive Deviance Inquiry to Guide Behavior-Change Interventions in Haripur, Pakistan
Authors: Marsh David R. , Sternin Monique , Khadduri Rolla , Ihsan Tariq , Nazir Raheel , Bari Abdul , Lapping Karin
Published: November 2015

A positive deviance (PD) inquiry identifies uncommon, model practices that a follow-on program can spread. PD has been used to rehabilitate malnourished children, but not for improving newborn health. Save the Children Federation/US (SC) conducted newborn PD cycles in communities (total population about 5,000 each) in two project areas in Haripur District, Pakistan among Afghan refugees and among local Pakistanis. Each PD cycle included planning, community orientation, situation analysis, PD inquiries, and community feedback with action planning. PD inquiries were in-depth interviews to identify uncommon behaviors among surviving asphyxiated newborns, thriving low birthweight babies, surviving newborns who had danger signs, and normal newborns. The Afghan caregivers showed better use of services and some household practices than their Pakistani counterparts, consistent with duration of SC presence (15 years vs. 18 months, respectively). The practices of both groups for clean delivery, thermal control, immediate and exclusive breastfeeding, and fathers' involvement were weak. But PD individuals, families, and/or birth attendants modeled good maternal care and immediate, routine and special newborn care. Communities enthusiastically committed to change behavior and form neighborhood support groups for better newborn care, including a demand for hygienic delivery. The PD approach for the newborn is more complex than for child nutrition. Yet this pilot-test proposed a conceptual framework for household newborn care, suggested tools and methods for information gathering, identified PDs in two settings of different risk, galvanized SC staff to the potential of the approach, mobilized communities for better newborn health, and drafted a newborn PD training curricula.
Update on Technical issues concerning Complementary Feeding of Young Children in Developing Countries and Implications for Intervention Programs
Authors: Dewey Kathryn G. , Brown Kenneth H.
Published: November 2015

This paper provides an update to the 1998 WHO/UNICEF report on complementary feeding. New research findings are generally consistent with the guidelines in that report, but the adoption of new energy and micronutrient requirements for infants and young children will result in lower recommendations regarding minimum meal frequency and energy density of complementary foods, and will alter the list of “problem nutrients.” Without fortification, the densities of iron, zinc, and vitamin B6 in complementary foods are often inadequate, and the intake of other nutrients may also be low in some populations. Strategies for obtaining the needed amounts of problem nutrients, as well as optimizing breastmilk intake when other foods are added to the diet, are discussed. The impact of complementary feeding interventions on child growth has been variable, which calls attention to the need for more comprehensive programs. A six-step approach to planning, implementing, and evaluating such programs is recommended.
Improving Feeding Practices: Current Patterns, Common Constraints, and the Design of Interventions
Authors: Pelto Gretel H. , Levitt Emily , Thairu Lucy
Published: November 2015

We propose a set of “best-practice complementary feeding behaviors,” which were derived by combining principles of psychosocial care with current knowledge in nutritional sciences. We provide a theoretical rationale for assessing and describing complementary feeding practices in terms of what is fed, how food is prepared and given, who feeds the child, when food is fed (frequency and scheduling), and the feeding environment (where ). We also discuss the significance of selected sociocultural determinants of these practices for the design of interventions. We then review 18 case studies in relation to these practices and their determinants. The exercise, in which we abstracted data from ethnographic reports, revealed areas of congruence and deviations from best-practice behaviors. The data on feeding practices are described with a common framework to facilitate comparison across sites. Key themes emerging from the studies include the significance of the larger family, the effects of competing maternal time demands, and the importance of parental perceptions and cultural constructs in affecting complementary feeding practices. Finally, we discuss the implications of the findings for future interventions.
Combating Iodine and Iron Deficiencies through the Double Fortification of Fish Sauce, Mixed Fish Sauce, and Salt Brine
Authors: Chavasit Visith , Nopburabutr Preeyacha , Kongkachuichai Ratchanee
Published: November 2015

Two iodine and seven iron compounds were tested for use in the fortification of pure fish sauce, mixed fish sauce, and salt brine for cooking as a means to combat iodine and iron deficiencies. Ferrous sulfate, sodium iron ethylenediaminetetraacetic acid, ferric ammonium citrate, and ferrous lactate were combined with potassium iodide with no effect on sensory quality. Product shelf-life testing revealed that no iron or iodine losses occurred during a three-month storage period. Although the color of most products darkened, the color was not significantly different from that of nonfortified products after two to three months. Sensory home-use tests revealed that the fortified products were acceptable to highly acceptable, with only 1.2% to 8.2% of the dishes cooked using the fortified products being reported as discolored. The cost of fortification was minimal, at 0.13 to 2.73 baht per bottle (750 ml)(42 baht = US$1). Consequently, these products show a potential for inclusion in national programs for the prevention of micronutrient deficiencies in Asian countries where fish sauce and its products are routinely consumed.
The Evolving Applications of Spreads as a Foodlet for Improving the Diets of Infants and Young Children
Authors: Briend André , Solomons Noel W.
Published: November 2015

Action is needed to reduce the burden of micronutrient malnutrition in developing countries, and because low-income populations are vulnerable to deficiencies of multiple micronutrients, we need to move beyond approaches that comprise only single nutrients. The normal and evolutionary manner in which to consume nutrients is in the context of foods, both snacks and meals. Spreads are high-viscosity-fat products prepared by mixing dried powdered ingredients with a vegetable fat chosen for its viscosity. Spreads are not traditionally used for feeding infants or young children and were initially proposed as a way to treat children recovering from severe malnutrition. In preparation for the International Research Group on Infant Supplementation (IRIS) III intervention, a sequel to the IRIS I study (which was the focus of a workshop in Lima, Peru, from May 30–June 1, 2001), the feasibility of preparing a FOODlet for feeding infants and young children was explored. Within the spectrum of intervention tools for micronutrient supplementation, tablets are a pharmaceutical form, fortified spreads are a food, and sprinkles are an intermediate approach. The issues still to be discussed and resolved with regard to creating such a spread include its specific micronutrient formulation, the capacity of young children to consume the required amounts (from either the FOODlet alone or the FOODlet mixed with other foods), the iron content and overall antioxidant protection of the spread matrix and its vitamins, potential allergenicity of proteins, and the economic implications of using such a FOODlet in low-income societies.
Effect of Iron-Deficiency Anemia on Cognitive Skills and Neuromaturation in Infancy and Childhood
Authors: Walter Tomas
Published: November 2015

Iron-deficiency anemia in infancy has been consistently shown to negatively influence performance in tests of psychomotor development. In most studies of short-term follow-up, lower scores did not improve with iron therapy, despite complete hematologic replenishment.

The negative impact on psychomotor development of iron-deficiency anemia (IDA) in infancy has been well documented in more than a dozen studies during the last two decades. Two studies will be presented here to further support this assertion. Additionally, we will present some data referring to longer follow-up at 5 and 10 years as well as data concerning recent descriptions of the neurologic derangements that may underlie these behavioral effects.

To evaluate whether these deficits may revert after long-term observation, a cohort of infants was re-evaluated at 5 and 10 years of age. Two studies have examined children aged 5 years who had anemia as infants using comparable tools of cognitive development showing persisting and consistent important disadvantages in those who were formerly anemic. These tests were better predictors of future achievement than psychomotor scores. These children were again examined at 10 years and showed lower school achievement and poorer fine-hand movements. Studies of neurologic maturation in a new cohort of infants aged 6 months included auditory brain stem responses and naptime 18-lead sleep studies. The central conduction time of the auditory brain stem responses was slower at 6, 12, and 18 months and at 4 years, despite iron therapy beginning at 6 months. During the sleep-wake-fulness cycle, heart-rate variability—a developmental expression of the autonomic nervous system—was less mature in anemic infants. The proposed mechanisms are altered auditory-nerve and vagal-nerve myelination, respectively, as iron is required for normal myelin synthesis.
Multiple-Micronutrient Fortification Technology Development and Evaluation: From Lab to Market
Authors: Mehansho Haile , Mellican Renee I. , Hughes Don L. , Compton Don B. , Walter Tomas
Published: November 2015

At the World Summit for Children (New York, 1990), a resolution was passed to eliminate vitamin A and iodine deficiencies and significantly reduce iron-deficiency anemia by the year 2000. In responding to this urgent call, we developed a unique multiple-micronutrient fortification delivery system called “GrowthPlus/CreciPlus®.” Using this technology, a fortified powder fruit drink has been formulated and extensively evaluated. One serving of the product delivers the following US recommended dietary allowances: 20–30% of iron; 10–35% of vitamin A; 25–35% of iodine; 100–120% of vitamin C; 25–35% of zinc; 15–35% of folate; and 10–50% of vitamins E, B2, B6, and B12. This was accomplished through (a) identifying and selecting the right fortificants, and (b) understanding their chemical and physical properties that contribute to multiple problems (product acceptability, stability, and bioavailability). Data from a home-use test showed fortification with the “Multiple-Fortification Technology” has no effect on the appearance and taste of the eventually consumed powder fruit drink. One-year stability studies demonstrated that iodine and the vitamins have adequate stability. Bioavailability evaluation by using double-isotope labeling technique showed that the iron from the fortified powder drink has excellent bioavailability (23.4% ± 6.7). In conclusion, a powder fruit drink has been clinically demonstrated to deliver multiple micronutrients, which include adequate levels of bioavailable iron, vitamin A, iodine, zinc, vitamin C, and B vitamins, without compromising taste, appearance, and bioavailability. The critical limiting step in the micronutrient fortification program is the production and distribution of the multiple-micronutrient-fortified product. The fortified powder drink was marketed in Venezuela under the brand name NutriStar®.
The Challenge of Improving Food and Nutrition in Latin America
Authors: Uauy Ricardo , Monteiro Carlos Augusto
Published: November 2015

The Latin American Region has exhibited a marked increase in the consumption of high-energy-density foods (high in fats and sugars) and a decrease in physical activity, with rising trends of sedentary life among the urban population. Social and economic progress led to a decline in infectious diseases, while higher income fostered the consumption of meats, fats and oils, and sugar and reduced the consumption of grains and legumes. The result has been a gradual increase in life expectancy at birth and a greater burden of disease linked to obesity and other nutrition-related chronic diseases (diabetes, cardiovascular disease, certain types of cancer, and osteoporosis). The region is currently facing the challenge of a double disease burden—the unresolved problem of malnutrition caused by nutritional deficits on the one hand, and the steady increase in chronic disease on the other. The need to develop policies and programs that make the healthy choice the easy choice in terms of diet and physical activity is presented. These should encompass not only individual choices, but also environmental factors that condition food and physical activity behavior. Food supply, and hence consumption, is largely driven by the productivity of the food-production chain; demand and consumption are determined by the way food is produced, processed, distributed, marketed, and advertised. These factors are beyond the consumer's control, and they operate to maximize profit, not health. Public health policies should focus not only on the demand side, but also on the supply of more healthful food products. Examples of potential interventions to increase the demand for healthful foods and the supply of healthier choices are presented and discussed.
The who Multicentre Growth Reference Study: Planning, Study Design, and Methodology
Authors: de Onis Mercedes , Garza Cutberto , Victora Cesar G. , Onyango Adelheid W. , Frongillo Edward A. , Martines Jose
Published: November 2015

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development.
Implementation of the who Multicentre Growth Reference Study in Brazil
Authors: Araújo Cora L. , Albernaz Elaine , Tomasi Elaine , Victora Cesar G.
Published: November 2015

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) South American site was Pelotas, Brazil. The sample for the longitudinal component was drawn from three hospitals that account for approximately 90% of the city's deliveries. The cross-sectional sample was drawn from a community survey based on households that participated in the longitudinal sample. One of the criteria for site selection was the availability of a large, community based sample of children whose growth was unconstrained by socioeconomic conditions. Local work done in 1993 demonstrated that children of families with incomes at least six times the minimum wage had a stunting rate of 2.5%. Special public relations and implementation activities were designed to promote the acceptance of the study by the community and its successful completion. Among the major challenges of the site were serving as the MGRS pilot site, low baseline breastfeeding initiation and maintenance rates, and reluctance among pediatricians to acknowledge the relevance of current infant feeding recommendations to higher socioeconomic groups.
Impact of a Homestead Gardening Program on Household Food Security and Empowerment of Women in Bangladesh
Authors: Bushamuka Victor N. , de Pee Saskia , Talukder Aminuzzaman , Kiess Lynnda , Panagides Dora , Taher Abu , Bloem Martin
Published: November 2015

This paper assesses the additional benefits of a homestead gardening program designed to control vitamin A deficiency in Bangladesh. In February and March 2002, data were collected on the food security and social status of women from 2,160 households of active and former participants in the gardening program and from control groups in order to assess the impact and sustainability of the program. The proportions of active and former-participant households that gardened year-round were fivefold and threefold, respectively, higher than that of the control group (78% and 50% vs. 15%). In a three-month period, the households of active participants produced a median of 135 kg and consumed a median of 85 kg of vegetables, while the control households produced a median of 46 kg and consumed a median of 38 kg (p < .001). About 64% of the active-participant households generated a median garden income of 347 taka (US$1 = 51 taka), which was spent mainly on food, and 25% of the control households generated 200 taka in the same period (p < .001). The garden production and income levels of formerly participating households three years after withdrawal of program support were much higher than those of the control households, illustrating the sustainability of the program and its ability to increase household food security. Significantly more women in active- and former-participant households than in control households perceived that they had increased their economic contribution to their households since the time the program was launched in their subdistricts (> 85% vs. 52%). Similar results were found for the level of influence gained by women on household decision-making. These results highlight the multiple benefits that homestead gardening programs can bring and demonstrate that these benefits should be considered when selecting nutritional and development approaches targeting poor households.
Studies on the Effectiveness of Nafeedta-Fortified Soy Sauce in Controlling Iron Deficiency: A Population-Based Intervention Trial
Authors: Chen Junshi , Zhao Xianfeng , Zhang Xin , Yin Shian , Piao Jianhua , Huo Junshen , Yu Bo , Qu Ning , Lu Qiliang , Wang Shisun , Chen Chunming
Published: November 2015

The objective of this research was to study the effectiveness of NaFeEDTA-fortified soy sauce for controlling iron deficiency in a high-risk population. This was an 18-month, randomized, placebo-controlled intervention trial in 14,000 residents aged three years or older in Bijie City, Guizhou Province, China, using sodium-iron ethylene diamine tetraacetate (NaFeEDTA)-fortified soy sauce (29.6 mg Fe/100 ml). The study data included measurements of food consumption, hemoglobin, serum ferritin, and serum retinol. The results showed that the diet consisted primarily of cereals, fruits, and vegetables, with very little meat. Food consumption remained unchanged during the study period and was similar in the fortified and control groups. The average daily soy sauce consumption of the group consuming the fortified product was 16.4 ml per person, which provided 4.9 mg of iron from NaFeEDTA. At the end of the trial, all age and sex subgroups receiving NaFeEDTA had significantly higher hemoglobin levels, a lower prevalence of anemia, and higher plasma ferritin levels than the controls. The effects became statistically significant after six months of intervention and were maintained throughout the study period. We conclude that NaFeEDTA-fortified soy sauce was highly effective in controlling iron deficiency and reducing the prevalence of iron-deficiency anemia in men, women, and children. NaFeEDTA-fortified soy sauce is affordable and was well accepted by the study population.
Thirty years of a Ban on the Sale of Noniodized Salt: Impact on Iodine Nutrition in Children in Himachal Pradesh, India
Authors: Kapil Umesh , Dutt Sharma Thakur , Singh Preeti , Dwivedi Sada Nand , Kaur Supreet
Published: November 2015

Background

A survey conducted by the central iodine-deficiency disorders team in Himachal Pradesh, a state in the goiter-endemic belt of India, revealed that 10 of its 12 districts have an endemic prevalence of goiter. The survey was conducted to provide health program managers data to determine whether it would be necessary to initiate intervention measures.

Objective

To assess the status of urinary iodine excretion and household salt iodization levels after three decades of a complete ban on the sale of noniodized salt in this goiter-endemic state in India as measured by assessment of urinary iodine excretion levels and iodine content of salt at the household level.

Methods

The guidelines recommended by WHO/UNICEF/ICCIDD for a rapid assessment of salt iodization were adopted. In each of the 12 studied districts, all senior secondary schools were enlisted and one school was selected by using a random sampling procedure. Two hundred fifty children 11 to 18 years of age were included in the study. Urine samples were collected from a minimum of 170 children and analyzed using the wet digestion method. Salt samples were also collected from a minimum of 170 children and analyzed using the spot testing kit.

Results

All districts had a median urinary iodine excretion level > 200 μg/L and 82% of the families were consuming salt with an iodine content of 15 ppm or higher.

Conclusions

The results of the present study highlight the successful implementation of the salt iodization program in the state of Himachal Pradesh. This positive impact may be due to the comprehensive strategy adopted by the state government to improve the quality of salt, development of an effective monitoring information system and effective information, education, and communication activities.
Effect of Prenatal Multiple Micronutrient Supplements on Maternal Weight and Skinfold Changes: A Randomized Double-Blind Clinical Trial in Mexico
Authors: Ramakrishnan Usha , González-Cossío Teresa , Neufeld Lynnette Marie , Rivera Juan , Martorell Reynaldo
Published: November 2015

Background

Recent trials of prenatal multivitamin-mineral supplements have yielded mixed findings for outcomes such as birth size, but the benefits of prenatal multivitamin-mineral supplements for maternal outcomes are unknown.

Objective

The main objective of this study was to examine the effect of prenatal multiple micronutrient supplements (MM) compared to iron only (FE) supplements on changes in maternal weight and body composition during pregnancy and the early postpartum period.

Methods

A randomized double-blind clinical trial was conducted in semi-rural Mexico. Women received either MM or FE supplements, 6 days per week from early pregnancy to delivery. Anthropometric measurements were obtained at recruitment, 26 and 37 weeks pregnancy, and 1 month postpartum. Women in both groups were similar at recruitment except that body-mass index (BMI) was greater in the FE group.

Results

Mean weight gain during pregnancy was significantly greater (∼0.6 kg) in the MM group ( n = 283) compared to the FE group ( n = 287), but not after adjusting for maternal BMI at recruitment. Overweight women in the MM group gained 0.53 kg between recruitment and 1 month postpartum, whereas those in the FE group lost 0.63 kg; there were no differences between experimental groups among non-overweight women ( p = .06 for interaction).

Conclusions

Compare./d to iron supplements, MM supplements did not increase weight gain during pregnancy after adjusting for baseline differences in BMI but may lead to greater postpartum weight retention among overweight women.
Development of Fortified Dried Broken Rice as a Complementary Food
Authors: Chitpan Monthana , Chavasit Visith , Kongkachuichai Ratchanee
Published: November 2015

Background

Commercially produced dried broken rice is widely used to prepare complementary foods for Thai infants, and it is both convenient and acceptable to persons from all socioeconomic classes. However, inadequate levels of calcium, iron, thiamine, and folate are common in complementary foods for breastfed infants.

Objective

We developed dried broken rice fortified with these nutrients at levels recommended by the 2001 guidelines of the World Health Organization.

Methods

The fortification process involved predrying broken rice at 90°C for 1 hour, soaking in a nutrient solution (2:1 ratio of rice to solution), and drying at 70°C for 1 hour and 50 minutes. Calcium lactate or calcium lactate gluconate was the calcium source, and ferrous sulfate, ferrous lactate, or ferric sodium ethylenediaminetetraacetic acid (NaFeEDTA) was the iron source. The vitamin sources were thiamine hydrochloride and folic acid. The product contained 40 mg of calcium, 5.3 mg of iron, 0.08 mg of thiamine, and 11 μg of folate per 20-g serving.

Results

Approximately 5% and 10% of calcium and iron, respectively, were lost during processing, with a thiamine loss of approximately 13%, and a folate loss ranging from 17% to 23%. The thiamine loss during accelerated storage (42°C for three months) was not significant ( p > .05).

Conclusions

NaFeEDTA was the most appropriate iron fortificant because it provided prolonged product stability and high in vitro dialyzability.
Nutrition Education in Chilean Primary Schools
Authors: Olivares Sonia , Zacarías Isabel , Andrade Margarita , Kain Juliana , Lera Lydia , Vio Fernando , Morón Cecilio
Published: November 2015

The purpose of this study was to incorporate nutrition education in Chilean primary schools. The baseline information included nutritional status, food consumption and physical activity of 1,701 children from 3rd to 7th grade in ten urban and rural schools. Main results showed a high prevalence of obesity (15.4%) and overweight (19.6%), low consumption of vegetables, fruits, and dairy products, high intake of snacks and a low level of physical activity, especially in girls. Because the Ministry of Education does not allow the incorporation of new programs into the curriculum, the educational strategy was based on the development of a text book, a teacher's guide, five practical guides for students from third to eighth grade and a CD-Rom. These materials were validated by 36 teachers in six schools through an educational intervention. Teachers and students considered the educational materials useful, motivational and easy to understand. This program is being implemented in 57 schools.
School Health and Nutrition: Policy and Programs
Authors: Bundy Donald
Published: November 2015

This paper argues that there is now reliable evidence that ill health and malnutrition affect education access, participation, completion, and achievement, and that school-based health and nutrition programs can provide a cost-effective and low-cost solution. International coordination around this issue has been helped by a consensus framework to “Focus Resources on Effective School Health (FRESH),” developed jointly by UNESCO, WHO, UNICEF, Education International, and the World Bank, and launched at the World Education Forum in Dakar in April 2000 as part of the global effort to achieve the goal of Education for All (EFA). The need for school health and nutrition programs as part of EFA actions is now recognized by both countries and development partners, and examples of successful practical sector programs that have gone to scale are presented for both low- and middle-income countries. This paper argues that, despite this progress, there are two key unresolved issues related to the targeting of nutrition interventions toward school-age children. The first concerns the role of food as an incentive for participation in education, and the second concerns the appropriate target age group for nutrition interventions. It is suggested that finding clear answers to these key policy questions in nutrition could profoundly influence the impact of future school health and nutrition programs.
Diet Quality Affects the Playground Activities of Kenyan Children
Authors: Sigman Marian , Whaley Shannon E. , Neumann Charlotte G. , Bwibo Nimrod , Guthrie Donald , Weiss Robert E. , Liang Li-Jung , Murphy Suzanne P.
Published: November 2015

The present study examined the effects of a school breakfast program on the activity level, emotional state, and social interactions of a group of Kenyan schoolchildren on the playground. Five hundred forty children in rural Kenya participated in the study. The first standard (grade) classes were randomly assigned to groups provided for 21 months with school breakfasts of equivalent caloric value while families with children in the control group were given a goat at the end of the study. The study aimed to determine whether enhanced caloric intake or diet quality influenced the children's behavior on the school playground. The results indicate that supplemented children were more active and showed more leadership behavior and initiative than did non-supplemented children. In addition, children given meat showed fewer periods of low activity and more leadership behaviors and initiative than did children provided entirely with vegetable source foods. These results support our previous findings from naturalistic studies in the same community that both diet quantity and quality are important for children's development.
Schoolteachers' Awareness about Scholastic Performance and Nutritional Status of Egyptian Schoolchildren
Authors: Galal Osman M. , Ismail Ibrahim , Gohar Azza S. , Foster Zoë
Published: November 2015

Malnutrition disorders affect more than 30% of schoolchildren in Egypt. This problem appears to be largely attributable to poor dietary quality and micronutrient deficiencies, such as iron and vitamin A. Inadequate nutrition intake has important implications because malnutrition has been shown to negatively affect the cognitive development of primary schoolchildren. This study assesses the awareness of schoolteachers about the impact of malnutrition on the scholastic performance of primary schoolchildren living in Egypt. Two focus group discussions were conducted with Egyptian schoolteachers from the Quena and Kharbia Governorates. The study indicates that schoolteachers consider low body weight and thinness as the primary signs of malnutrition. They do not prioritize malnutrition as a factor for poor scholastic performance. They also suggest that unhealthful eating habits, especially a lack of breakfast, negatively affect children's interaction with schoolteachers and their ability to excel in their studies. Schoolteachers endorse a more reliable and nutritionally valuable school-feeding program as a way to increase the scholastic performance of their students. The teachers advocate developing integrated programs between the Ministry of Education, the Ministry of Health and Population, teachers, children, and parents that provide nutrition education. A lack of awareness among teachers about the relationship of nutrition and cognitive function can lead to the misdiagnosis or delayed management of malnourished and scholastically challenged schoolchildren. This paper suggests that proper school-feeding programs and nutrition education programs, which integrate government ministries, teachers, children and parents, should be developed to improve the physical and cognitive health status of Egyptian schoolchildren.
Biotechnology, Biofortification, and Global Health
Authors: Welch Ross M.
Published: November 2015

Deficiencies of micronutrients such as iron, zinc, and vitamin A afflict over three billion people (more than 50% of the world's population), most of them women, infants, and children in resource-poor families in the developing world. This global crisis in nutritional health is the result of dysfunctional food systems that do not consistently supply enough of these essential nutrients to meet the nutritional requirements of high-risk groups. Deficiencies of micronutrients result in increased morbidity and mortality rates, lost worker productivity, stagnated national development, permanent impairment of cognitive development in infants and children, and large economic costs and suffering to those societies affected. Because agricultural systems are the primary source of all micronutrients for all people, changes in agricultural policies and systems must be made that will ensure consistent and adequate supplies of all essential nutrients to all people. Additionally, the nutrition and health sectors must turn to agricultural interventions as a primary tool in their efforts to eliminate malnutrition from the world if they want to ensure sustainability. Biotechnological advances show great promise for improving the output of bioavailable micronutrients from agricultural systems that feed the poor. This paper reviews some of these opportunities and discusses the questions and concerns that should be raised when these technologies are used to improve the micronutrient status of vast numbers of people who are dependent on staple food crops for their sustenance. Further, important issues surrounding micronutrient bioavailability and plant food factors that affect it are discussed.
Update on the Development of Virus-Resistant Papaya: Virus-Resistant Transgenic Papaya for People in Rural Communities of Thailand
Authors: Sakuanrungsirikul S. , Sarindu N. , Prasartsee V. , Chaikiatiyos S. , Siriyan R. , Sriwatanakul M. , Lekananon P. , Kitprasert C. , Boonsong P. , Kosiyachinda P. , Fermin G. , Gonsalves D.
Published: November 2015

Papaya ( Carica papaya L.) is one of the most important and preferred crops in rural communities in Thailand. Papaya ringspot virus (PRSV) is a serious disease of papaya throughout Thailand. Efforts to control the virus by various methods either have not been successful or have not resulted in sustainable control. In 1995, collaborative research by the Department of Agriculture of Thailand and Cornell University to develop transgenic papaya resistant to PRSV was initiated. Two local Thai cultivars were transformed by microprojectile bombardment with the use of a nontranslatable coat protein gene of PRSV from Khon Kaen. Numerous kanamycin-resistant plants were regenerated and were inoculated with the PRSV Khon Kaen isolate for selection of resistant lines.

Since 1997, promising R0 transgenic lines have been transferred to the research station at Thapra for subsequent screenhouse tests and selection of the most PRSV-resistant lines. In selection set 1, three R3 lines initially derived from Khaknuan papaya showed excellent resistance to PRSV (97% to 100%) and had a yield of fruit 70 times higher than nontransgenic Khaknuan papaya. In selection set 2, one R3 line initially derived from Khakdam papaya showed 100% resistance.

Safety assessments of these transgenic papayas have so far found no impact on the surrounding ecology. No natural crossing between transgenic and nonmodified papaya was observed beyond a distance of 10 m from the test plots. Analysis of the nutritional composition found no differences in nutrient levels in comparison with the nonmodified counterparts. Molecular characterization by Southern blotting revealed three copies of the transgene presented; however, no coat protein product was expressed. Data on additional topics, such as the effects of feeding the transgenic papaya to rats and the stability of the gene inserts, are currently being gathered.
Determinants of Anemia among Pregnant Women in Mali
Authors: Ayoya Mohamed Ag , Spiekermann-Brouwer Gerburg Maria , Traoré Abdel Kader , Stoltzfus Rebecca Joyce , Garza Cutberto
Published: November 2015

Background

Anemia in pregnancy remains a major problem in nearly all developing and many industrialized countries. In Mali, the subpopulation prevalence and etiology of anemia during pregnancy are largely unknown.

Objective

To examine the prevalence and likely etiologies of anemia in pregnancy in a poor urban population in Bamako, Mali.

Methods

Pregnant women ( n = 190) were selected randomly. Hemoglobin, serum iron, and total iron-binding capacity were measured; blood smears were examined for Plasmodium falciparum malaria; and single stool and urine samples were examined for Schistosoma haematobium and hookworm. Gynecologic examinations were performed and interviews conducted to qualitatively assess food consumption and other socioeconomic characteristics. Associations among mild, moderate, and severe anemia; iron and parasite status; erythrocyte sedimentation rates; and the presence of abnormal vaginal discharge were evaluated. Differences in hemoglobin and serum iron concentrations, total iron-binding capacity, and anemia were compared according to trimester of pregnancy and between infected and noninfected women. The relative and attributable risks of anemia were calculated, and adjusted odds ratios for anemia and low serum iron were estimated by multivariate logistic regression.

Results

Of the 131 women for whom complete data were available, 47% had hemoglobin concentrations below 110 g/L; 13% had serum iron concentrations below 12 μmol/L; none had transferrin saturation values below 16%; 11%, 23%, and 8% harbored P. falciparum, S. haematobium, and hookworm, respectively; and 82% had an abnormal vaginal discharge. Food restrictions were reported by 45% of the women. Abnormal vaginal discharge correlated significantly with anemia (Pearson χ2 = 62.4; p < .01). Univariate and multivariate analyses found that infections were strongly associated with and predictive of anemia.

Conclusions

Our data suggest that infections and food accessibility contribute to the high rates of anemia during pregnancy in Mali.
Prevalence of Anemia among Pregnant Women and Adolescent Girls in 16 Districts of India
Authors: Toteja G. S. , Singh Padam , Dhillon B. S. , Saxena B. N. , Ahmed F. U. , Singh R. P. , Prakash Balendu , Vijayaraghavan K. , Singh Y. , Rauf A. , Sarma U. C. , Gandhi Sanjay , Behl Lalita , Mukherjee Krishna , Swami S. S. , Meru Viu , Chandra Prakash , Chandrawati  , Mohan Uday
Published: November 2015

Background

Nutritional anemia is one of India's major public health problems. The prevalence of anemia ranges from 33% to 89% among pregnant women and is more than 60% among adolescent girls. Under the anemia prevention and control program of the Government of India, iron and folic acid tablets are distributed to pregnant women, but no such program exists for adolescent girls.

Objective

To assess the status of anemia among pregnant women and adolescent girls from 16 districts of 11 states of India.

Methods

A two-stage random sampling method was used to select 30 clusters on the basis of probability proportional to size. Anemia was diagnosed by estimating the hemoglobin concentration in the blood with the use of the indirect cyanmethemoglobin method.

Results

The survey data showed that 84.9% of pregnant women ( n = 6,923) were anemic (hemoglobin < 110 g/L); 13.1% had severe anemia (hemoglobin < 70 g/L), and 60.1% had moderate anemia (hemoglobin ≥ 70 to 100 g/L). Among adolescent girls ( n = 4,337) from 16 districts, the overall prevalence of anemia (defined as hemoglobin < 120 g/L) was 90.1%, with 7.1% having severe anemia (hemoglobin < 70 g/L).

Conclusions

Any intervention strategy for this population must address not only the problem of iron deficiency, but also deficiencies of other micronutrients, such as B12 and folic acid and other possible causal factors.
A Review of Methods to Detect Cases of Severely Malnourished Children in the Community for Their Admission into Community-Based Therapeutic Care Programs
Authors: Myatt Mark , Khara Tanya , Collins Steve
Published: November 2015

Background

The complexity and cost of measuring weight-for-height make it unsuitable for use by community-based volunteers. This has led community therapeutic care programs to adopt a two-stage screening and admission procedure in which mid-upper-arm circumference (MUAC) is used for referral and weight-for-height is used for admission. Such a procedure results in many individuals being referred for care on the basis of MUAC but subsequently being refused treatment because they do not meet the weight-for-height admission criterion. This “problem of rejected referrals” has proved to be a major barrier to program uptake.

Objective

To systematically review methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs.

Methods

Clinical and anthropometric methods for case detection of severely malnourished children in the community were reviewed with regard to their ability to reflect both mortality risk and nutritional status.

Results

MUAC, with the addition of the presence of bipedal edema, was found to be the indicator best suited to screening and case detection of malnutrition in the community. The case definition “MUAC < 110 mm OR the presence of bipedal edema,” with MUAC measured by a color-banded strap, is suitable for screening and case detection of malnutrition in the community for children aged between 6 and 59 months. Monitoring and discharge criteria were also reviewed.

Conclusions

There is no compelling evidence to support a move away from using weight in combination with clinical criteria for monitoring and discharge.
We Know Much about What to Do but Little about How to Do it: Experiences with a Weekly Multimicronutrient Supplementation Campaign
Authors: Gross Rainer , Gross Ursula , Lechtig Aarón , De Romaña Daniel López
Published: November 2015

Background

Global population growth is concentrated in urban areas, but there is little understanding of how to implement the necessary interventions to control food and nutrition insecurity. In the urban area of Peru, food insecurity is characterized mainly by micronutrient deficiencies and not by energy deficiency.

Objective

To increase the effectiveness and cost-effectiveness of weekly multimicronutrient supplementation programs in poor urban communities.

Methods

A series of operational studies were conducted of preventive weekly multimicronutrient supplementation to reduce micronutrient-deficiency anemia in a population consisting of 8,081 children under 5 years of age and 20,082 women and adolescent girls of reproductive age (12 through 44 years).

Results

This is one of a series of papers that describe in as much detail as possible the experiences of a multimicronutrient intervention program for poor urban mothers and their young children and summarizes the lessons learned for consideration of future programming.

Conclusions

This paper shows that such programs can achieve a high compliance with good training of program staff, involvement of the community, education and motivation of beneficiaries, adequate supplies, and careful monitoring.
Theoretical Considerations Related to Cutoff Points
Authors: Pelletier David
Published: November 2015

The cutoff points for creating anthropometric indicators of size and growth can be established by three distinct methods: statistical, risk-based, and prescriptive. The theoretical, philosophical, and technical bases for these are quite distinct, but the implications of each method for applications at population and individual levels can be explored by using a common conceptual model. This model posits that any observed anthropometric distribution is a mixed distribution of two (or more) subpopulations, representing some individuals who are or will remain healthy (the specificity distribution) and those who are or will become unhealthy (the sensitivity distribution). The performance and appropriateness of cutoff points based on statistical, risk-based, and prescriptive criteria depend upon the relative sizes of these two subpopulations in a given context, the distance between their means, and the strength and shape of the relationship between the anthropometric indicator and the health outcomes that define these two subpopulations. The risk-based and prescriptive methods both require substantial epidemiologic evidence if they are to fulfill their theoretical and public health expectations, and both face normative (ethical) trade-offs in establishing cutoff points. The prescriptive method faces even stronger normative challenges, especially in relation to overweight and obesity, because its explicit claim regarding the desirable size and growth of children and adolescents may understate the importance of individuality and overstate the strength of the relationship (and the evidence for the relationship) between size, growth, and future health. These concerns are most pronounced for applications at the individual level and for mild-to-moderate elevations of body-mass index and other indicators.
The International Growth Standard for Children and Adolescents Project: Environmental Influences on Preadolescent and Adolescent Growth in Weight and Height
Authors: Ulijaszek Stanley J.
Published: November 2015

This review has two aims. The first is to identify important environmental influences on the growth of children aged 1 to 9 years and of adolescents, defined as those aged 10 to 19 years. The second is to identify possible environmentally based criteria for the selection of individuals and populations for data collection in the development of an international growth reference for these age ranges. There are many common environmental influences on the growth of children between the ages of 1 and 19 years; the examination and description of these forms the main body of this review. Subsequently, environmental factors influencing adolescent growth only are considered. In both cases, possible selection criteria are put forward. The most important inclusion criteria for both preadolescence and adolescence are good nutrition, lack of infection, and socioeconomic status that does not constrain growth. Additionally, low birthweight, catch-up growth, breastfeeding, and early adiposity rebound have impacts on growth and/or body composition into puberty. Exclusion of children born at low birth and/or experiencing catch-up growth could be most realistically operationalized if populations in which secular trends in growth were either completed or minimal were selected. Although an effect of hypoxia on child and adolescent growth, independent of nutrition, is small at most, many high-altitude populations have high prevalances of low birthweight and should be excluded on this basis. Since all populations are exposed to pollutants, contaminants, and toxicants in varying degrees, they cannot be realistically excluded from the sample frame. However, it may be desirable to exclude populations that are habitually exposed to extremely high levels of environmental pollution, including air pollution, and those living in close proximity to toxic waste. It is impossible to exclude populations and individuals on the basis of their exposure to aflatoxin contamination of food. However, exclusion on the basis of low socioeconomic status or poverty may well act as a proxy for this. There are a small number of populations that show extreme patterns of growth in body size and proportion in preadolescence and adolescence, and these should be excluded from the sample frame.