bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Fortification Rapid Assessment Tool (FRAT) Surveys in Sub-Saharan Africa and Suggestions for Future Modifications of the Survey Instrument
Authors: Hess Sonja Y. , Brown Kenneth H. , Sablah Mawuli , Engle-Stone Reina , Aaron Grant J. , Baker Shawn K.
Published: November 2015

Background

Food fortification has been increasingly recognized as a promising approach to prevent micronutrient deficiencies. The Fortification Rapid Assessment Tool (FRAT) was developed to assist public health program managers to acquire the information needed to implement an effective mass food fortification program. Multiple countries have conducted FRAT surveys, but information on results and experiences with the FRAT tool has been available only at the national level.

Objective

To summarize the findings of the FRAT surveys previously conducted in sub-Saharan Africa.

Methods

Surveys from 12 sub-Saharan African countries (Burkina Faso, Cameroon, Congo, Guinea, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Uganda) were identified. Information on consumption patterns for wheat flour, vegetable oil, sugar, and bouillon cubes was reviewed and summarized.

Results

Most surveys found that a moderate to high proportion of women reported consuming wheat flour (48% to 93%), vegetable oil (44% to 98%), sugar (55% to 99%), and bouillon cubes (79% to 99%) in the past 7 days, although consumption was more common and more frequent in urban areas than in rural areas. Similarly, the reported amounts consumed during the previous 24 hours were generally higher in urban settings.

Conclusions

The FRAT instrument has been successfully used in multiple countries, and the results obtained have helped in planning national food fortification programs. However, the recommended sampling scheme may need to be reconsidered, and the guidelines should be revised to clarify important aspects of fieldworker training, implementation, data analysis and interpretation, and reporting of the results.
Sustainability and Scaling-Up Analysis of Community-Based Management of Acute Malnutrition: Lessons Learned from Burkina Faso
Authors: Somassè Yassinmè Elysée , Bahwere Paluku , Laokri Samia , Elmoussaoui Nazia , Donnen Philippe
Published: November 2015

Background

Community-based management of acute malnutrition (CMAM) is an effective strategy frequently implemented by nongovernmental organizations, but handing CMAM over to national health systems and scaling it up remains a great challenge.

Objective

To highlight the challenges to sustainability and scalability of a CMAM program in Burkina Faso.

Methods

We conducted a review of program reports to evaluate program performance and conducted individual interviews with key informants (health system fieldworkers and officials and program staff members) and focus group discussions with beneficiaries (mothers whose children were attending the program, community volunteers, and village leaders) to analyze the required conditions for scaling up using ExpandNet recommendations.

Results

The program coverage rate was 90% among children under 5 years of age in the 180 intervention villages. Between June 2007 and December 2010, 19,009 cases of acute malnutrition (AM) among children under 5 years of age were treated, of which 4,308 (22.7%) were cases of severe acute malnutrition (SAM). The recovery rate was 89.4% for moderate acute malnutrition (MAM) and 86.5% for SAM. The case-fatality rate was 2.8% for MAM and 4.2% for SAM. The default rate was 7% for all cases. The prevalence of SAM decreased between 2008 and 2009 from 5.4% to 1.8%. Barriers to sustainability and scaling up were underlined: management by external personnel from the health system, no financial support for the scaling-up process, insufficient national advocacy, and nonsustainable activities (e.g., free care).

Conclusions

The CMAM program was effective, but the handover conditions and scaling-up requirements were unsatisfactory. We identified poor integration into the health system, lack of resources, and insufficient advocacy.
Vitamin D Insufficiency in a Sunshine-Sufficient Area: Southern Ethiopia
Authors: Gebreegziabher Tafere , Stoecker Barbara J.
Published: November 2015

Background

Although the photosynthesis and bioavailability of vitamin D are influenced by various factors, vitamin D is produced in the skin by ultraviolet B (UVB) radiation from sunlight. However, vitamin D insufficiency is being recognized as a common problem, even in areas with abundant sunshine.

Objective

This study assessed vitamin D status by measuring plasma 25(OH)D concentrations in rural women in southern Ethiopia living in the Rift Valley at 7°3′ N latitude.

Methods

Nonpregnant women ( n = 202) living in three adjacent rural communities volunteered to participate in this cross-sectional study. Demographic, socioeconomic, health, and food frequency data were acquired by questionnaire. Anthropometric measurements and a fasting venipuncture blood sample were obtained by qualified professionals. Body mass index (BMI) was calculated. ELISA kits from ImmunoDiagnostic Systems were used to determine concentrations of 25(OH)D with external quality control standards from UTAK Laboratories.

Results

The self-reported mean ± SD age was 30.8 ± 7.8 years. The mean number of pregnancies was 4.7 ± 2.7, household size was 6.0 ± 2.6, and BMI was 20.0 ± 2.2. None of the participants reported ever consuming vitamin D–rich foods, fortified foods, or dietary supplements. Only 15.8% of the participants had 25(OH) D levels above 50 nmol/L, and 14.8% were below 30 nmol/L, which represents risk of deficiency relative to bone health.

Conclusions

Vitamin D insufficiency is a serious problem in the study population, and living near the Equator does not assure adequate vitamin D status.
Climate Change and Nutrition: Creating a Climate for Nutrition Security
Authors: Tirado M. C. , Crahay P. , Mahy L. , Zanev C. , Neira M. , Msangi S. , Brown R. , Scaramella C. , Coitinho D. Costa , Müller A.
Published: November 2015

Background

Climate change further exacerbates the enormous existing burden of undernutrition. It affects food and nutrition security and undermines current efforts to reduce hunger and promote nutrition. Undernutrition in turn undermines climate resilience and the coping strategies of vulnerable populations.

Objectives

The objectives of this paper are to identify and undertake a cross-sectoral analysis of the impacts of climate change on nutrition security and the existing mechanisms, strategies, and policies to address them.

Methods

A cross-sectoral analysis of the impacts of climate change on nutrition security and the mechanisms and policies to address them was guided by an analytical framework focused on the three ‘underlying causes’ of undernutrition: 1) household food access, 2) maternal and child care and feeding practices, 3) environmental health and health access. The analytical framework includes the interactions of the three underlying causes of undernutrition with climate change, vulnerability, adaptation and mitigation.

Results

Within broad efforts on climate change mitigation and adaptation and climate-resilient development, a combination of nutrition-sensitive adaptation and mitigation measures, climate-resilient and nutrition-sensitive agricultural development, social protection, improved maternal and child care and health, nutrition-sensitive risk reduction and management, community development measures, nutrition-smart investments, increased policy coherence, and institutional and cross-sectoral collaboration are proposed as a means to address the impacts of climate change to food and nutrition security. This paper proposes policy directions to address nutrition in the climate change agenda and recommendations for consideration by the UN Framework Convention on Climate Change (UNFCCC).

Conclusions

Nutrition and health stakeholders need to be engaged in key climate change adaptation and mitigation initiatives, including science-based assessment by the Intergovernmental Panel on Climate Change (IPCC), and policies and actions formulated by the UN Framework Convention on Climate Change (UNFCCC). Improved multi-sectoral coordination and political will is required to integrate nutrition-sensitive actions into climate-resilient sustainable development efforts in the UNFCCC work and in the post 2015 development agenda. Placing human rights at the center of strategies to mitigate and adapt to the impacts of climate change and international solidarity is essential to advance sustainable development and to create a climate for nutrition security.
The Global, Centralized Approach of the GAIN Premix Facility Has Made Oil Fortification in Indonesia More Affordable
Authors: Jallier Vincent , Guyondet Christophe , Provent Adeline , Laillou Arnaud , Soekirman  , Moench-Pfanner Regina
Published: November 2015

Background

Access to high-grade micronutrients is a recurring challenge that often threatens the long-term sustainability of food fortification programs.

Objective

To assess the efficiency of the Global Alliance for Improved Nutrition (GAIN) Premix Facility in procuring quality, affordable vitamin A for fortification of edible oil in Indonesia.

Methods

A global approach to procurement of standard items was used by combining volumes across various demand streams in order to reduce the total cost of acquisition through economies of scale. The GAIN Premix Facility undertook a detailed analysis of vitamin A requirements across its existing customer base, which served as a basis for developing a reliable demand forecast. A consolidated, competitive tender was launched that resulted in the setting up of a long-term commercial agreement with the selected supplier to lock in the most competitive price for a given period of time.

Results

The direct benefit to oil manufacturers of fortifying with vitamin A is that the cost of fortification went down significantly compared with prices they would have been offered had they ordered vitamin A individually. In Indonesia, this consolidated procurement approach has allowed a 14.5% decrease in the unit price of vitamin A.

Conclusions

The GAIN Premix Facility demonstrated its effectiveness in acting as a global procurement platform by aggregating demand across different customers and leveraging improved prices through increased volumes. Building on the success of this effort, the GAIN Premix Facility is replicating this global approach for procurement of other standard items being procured across fortification programs worldwide.
Regulatory Monitoring Systems of Fortified Salt and Wheat Flour in Selected Asean Countries
Authors: van den Wijngaart Annoek , Bégin France , Codling Karen , Randall Philip , Johnson Quentin W.
Published: November 2015

Background

Considerable efforts have been made over the past decade to address vitamin and mineral deficiencies. An increasing number of countries in the Association of Southeast Asian Nations (ASEAN) are adopting mandatory food fortification as one of the primary strategies to overcome these deficiencies. Experience shows that fortified foods can reach large parts of the population, including the poor, if the fortification is done on a mandatory rather than a voluntary basis and if the food vehicle is widely consumed.

Objective

To review the importance of regulatory monitoring as an essential component of food fortification efforts in selected ASEAN countries, with special focus on the available information on regulatory monitoring systems for iodized salt and fortified wheat flour.

Methods

The role of regulatory monitoring in strengthening food fortification programs was discussed during a joint regional meeting of the World Health Organization, UNICEF, the Flour Fortification Initiative, the Global Alliance for Improved Nutrition, the Micronutrient Initiative, and the World Bank on regulatory monitoring of salt and wheat flour fortification programs in Asia, which took place in Manila, Philippines, on 27–29 September 2011. This paper reviews the regulatory monitoring systems of selected ASEAN countries that participated in this meeting.

Results

Problems and challenges in regulatory monitoring systems for iodized salt and fortified wheat flour in selected ASEAN countries are identified, and a description of the role of regulatory monitoring in strengthening food fortification initiatives, particularly of salt and flour, and highlights of areas for improvement are presented.

Conclusions

Regulatory monitoring consists of monitoring activities conducted at the production level, at customs warehouses, and at retail stores by concerned regulatory authorities, and at the production level by producers themselves, as part of quality control and assurance efforts. Unless there are appropriate enforcement and quality assurance mechanisms in place to stimulate compliance by food producers, i.e., regulatory monitoring, having national legislation will not necessarily lead to increased coverage of fortified products and associated outcomes.
Legal Framework for Food Fortification: Examples from Vietnam and Indonesia
Authors: Dijkhuizen Marjoleine Amma , Wieringa Frank Tammo , Soekarjo Damayanti , Van Khan Tran , Laillou Arnaud
Published: November 2015

Background

Food fortification is a cost-effective, powerful, and sustainable strategy to combat micronutrient deficiency, with the potential to reach large sections of the population with minimal cost and effort. However, the implementation of food fortification on a systematic and large scale, for instance in national programs, has often been challenging.

Objective

This paper takes a closer look at food fortification efforts and legislation mechanisms in Vietnam and Indonesia in order to determine specific factors and components in the legal framework that are crucial to the success of fortification programs.

Methods

Fortification efforts in Indonesia and Vietnam are evaluated using published data as well as unpublished data from detailed evaluation reports, and compared with respect to the specific circumstances, constraints, objectives and results in each country.

Results

The legal framework is a crucial factor for the success of food fortification programs, as it shapes to a large extent the implementation of food fortification. The legal framework is instrumental to ensure the quality, safety, availability, cost-effectiveness, and sustainability of food fortification. In the first place, the legal framework should specify the fortificants and fortification levels, as well as the food vehicles and the fortification procedures. In addition, it should ensure the commitment of policy makers and producers to fortification, regulate the costing, describe and ensure information and communication such as product labeling, integrate social marketing into the implementation, and provide the means to monitor and enforce fortification. A clear public health objective, together with careful consideration of the choices and restrictions dictated by the specific national environments, will help to develop legal frameworks that optimize the potential success of food fortification strategies.

Conclusions

The lessons from these experiences show that a mandatory approach to fortification, with costing, monitoring and enforcement, and social marketing clearly defined and well embedded in the legal framework and in the implementation structures, is the best foundation for an effective, sustainable, and feasible food fortification program.
An Analysis of the Costs of Uganda's Child Days Plus: Do Low Costs Reveal an Efficient Program or an Underfinanced One?
Authors: Fiedler John L. , Semakula Richard
Published: November 2015

Background

Twice annually, Uganda implements Child Days Plus (CDP), a month-long outreach activity that distributes vitamin A capsules to preschool children and deworms children 6 months to 14 years old. Introduced initially as a temporary, interim strategy, CDP is now a decade old.

Objective

To assess how well CDP is implemented using an activity-based cost analysis.

Methods

In the absence of a cost-accounting system for CDP, we defined the six major CDP activities as cost centers and identified five important subactivities required to implement a round of CDP. Based on a purposive sample, we conducted a structured interview survey of 59 Ministry of Health facilities, 9 district offices, and national-level CDP staff.

Results

Only one-third of the facilities implemented all 11 CDP core activities. The survey revealed that Ministry of Health staff and volunteers are frequently paid substantially less in allowances than they are entitled to for their CDP outreach activities. Viewing these two practices—nonimplementation and less-than-full-reimbursement—as indicators of CDP's underfinancing, we estimate the program is underfinanced by the equivalent of 37% of its “full implementation” costs. Two-thirds of underfinancing is manifested in nonimplementation and one-third as less-than full-reimbursement. CDP exploits economies of scale and scope and has an average cost per child served of US$0.22. We estimate that it annually saves 367,000 disability-adjusted life-years (DALYs) at an average cost of US$12.5, making it—despite its underfinancing—highly cost-effective.

Conclusions and recommendations

Increased CDP funding would enable its vitamin A coverage rate of 58% and its deworming coverage rate of 62% to be increased, thereby increasing its effectiveness and efficiency. CDP should be “relaunched,” as part of an effort to improve the structure of the program, set expectations about it, and earmark a minimum of resources for CDP. The Ministry of Health should demonstrate its new, greater commitment to CDP by introducing a program-specific budget line item, increasing CDP's budget allocation, and developing and implementing a training program that identifies the minimum uniform activities required to implement CDP.
Changing Dietary Patterns in the Canadian Arctic: Frequency of Consumption of Foods and Beverages by Inuit in Three Nunavut Communities
Authors: Sheehy Tony , Kolahdooz Fariba , Roache Cindy , Sharma Sangita
Published: November 2015

Background

Inuit in Arctic regions are experiencing a rapid diet and lifestyle transition. There are limited data on food consumption patterns among this unique population, raising concerns about assessing the risk for the development of diet-related chronic diseases.

Objective

To assess the current frequency of consumption of foods and beverages among Inuit in Nunavut, Arctic Canada.

Methods

A cross-sectional dietary study was con- ducted among randomly selected Inuit adults from three communities in Nunavut using a validated quantitative food frequency questionnaire. The participants were 175 women and 36 men with median (IQR) ages of 41.0 (32.5–48.5) and 40.1 (30.0–50.0) years, respectively. The mean and median frequencies of consumption over a 30-day period were computed for 147 individual food items and grouped as foods or beverages.

Results

The 30 most frequently consumed foods were identified. Non-nutrient-dense foods (i.e., high-fat and high-sugar foods) were the most frequently consumed food group (median intake, 3.4 times/day), followed by grains (2.0 times/day) and traditional meats (1.7 times/ day). The frequency of consumption of fruits (0.7 times/ day) and vegetables (0.4 times/day) was low. The median values for the three most frequently consumed food items were sugar or honey (once/day), butter (0.71 times/day), and Coffee-mate (0.71 times/day). Apart from water, coffee, and tea, the most frequently consumed beverages were sweetened juices (0.71 times/day) and regular pop (soft drinks) (0.36 times/day). This study showed that non-nutrient-dense foods are consumed most frequently in these Inuit communities.

Conclusions

The results have implications for dietary quality and provide useful information on current die- tary practices to guide nutritional intervention programs.
Mid-Upper-Arm and Calf Circumferences are Useful Predictors of Underweight in Women of Reproductive Age in Northern Vietnam
Authors: Nguyen Phuong , Ramakrishnan Usha , Katz Benjamin , Gonzalez-Casanova Ines , Lowe Alyssa E. , Nguyen Hieu , Pham Hoa , Truong Truong , Nguyen Son , Martorell Reynaldo
Published: November 2015

Background

Mid-upper-arm circumference (MUAC) and calf circumference (CC) are correlated with body mass index (BMI) in adults and may be useful for screening women with underweight (BMI < 18.5 kg/m2). However, there is no consensus on appropriate MUAC and CC cutoff points in diverse populations, especially in women of reproductive age.

Objective

To assess the accuracy of different MUAC and CC cutoff points to screen for underweight and to identify the most appropriate cutoff points in a sample of women of reproductive age from rural northern Vietnam.

Methods

Anthropometric measurements (weight, height, MUAC, CC, and triceps and subscapular skinfold thicknesses) were obtained for 4,981 women of reproductive age who participated in a micronutrient intervention trial (PRECONCEPT) in Thái Nguyên Province, Viet- nam. Receiver operating characteristic (ROC) analysis was used to evaluate different cutoff values of MUAC and CC and identify the most appropriate cutoff values to predict underweight.

Results

The overall prevalence of underweight was 32%. The MUAC value of 23.5 cm and the CC value of 31 cm were identified as the best cutoffs based on low misclassification (16% for MUAC and 21% for CC) and good balance of sensitivity (89% and 85%, respectively) and specificity (71% and 67%, respectively. The ROC curves were similar across different ethnic groups, with the area under the curve (AUC) values reaching 0.89 to 0.93 for MUAC and 0.83 to 0.89 for CC.

Conclusions

MUAC and CC perform adequately in screening for underweight in women. The utility of these measurements in predicting functional outcomes should be examined.
Challenges in the Elaboration of a Field Interview Instrument to Capture Information for the Evaluation of Adherence to the WHO/PAHO Guiding Principles for Complementary Feeding of the Breastfed Child
Authors: Vossenaar Marieke , Doak Colleen M. , Solomons Noel W.
Published: November 2015

Background

In 2003, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) published “Guiding principles for complementary feeding of the breastfed child,” which includes a series of 10 recommendations.

Objective

To illustrate the challenges in creating operative criteria for the evaluation of concordance with the tenets of the WHO/PAHO Guiding Principles recommendations.

Methods

We set out to define operative criteria for the evaluation of adherence to the tenets of the WHO/ PAHO Guiding Principles. The 10 Guiding Principles were divided into subcomponents and examined carefully. Our indicators were based on evaluation variables collected by means of our prospectively designed data collection tool. The 2008 WHO-validated infant and young child feeding (IYCF) indicators were taken as a reference for evaluation.

Results

After careful examination of the 10 WHO/ PAHO Guiding Principles, we were able to identify 28 specific subcomponents for evaluation. With our prospectively designed data collection tool, we were able to set evaluations for 17 of these 28 subcomponents.

Conclusions

The considerations for devising the criteria involved in evaluation instruments must be transparently available to clarify the interpretations and conclusions derived from their application. Evaluation criteria can be set for most, but not all, IYCF practices of the WHO/PAHO Guiding Principles. Indicators that focus on selected, food-related dimensions of child feeding can be measured in large surveys, whereas other dimensions of optimal feeding, such as hygienic food handling and adequate texture of food, are likely to require more complex measurement and evaluation approaches.
Organizational Factors, Planning Capacity, and Integration Challenges Constrain Provincial Planning Processes for Nutrition in Decentralizing Vietnam
Authors: Lapping Karin , Frongillo Edward A. , Nguyen Phuong H. , Coates Jennifer , Webb Patrick , Menon Purnima
Published: November 2015

Background

Translating national policies and guidelines into effective action at the subnational level (e.g., province or region) is a prerequisite for ensuring an impact on nutrition. In several countries, including Vietnam, the focus of this paper, this process is affected by the quality of the decentralized process of planning and action.

Objective

This study examined how provincial planning processes for nutrition occurred in Vietnam during 2009 and 2010. Key goals were to understand variability in processes across provinces, identify factors that influenced the process, and assess the usefulness of the process for individuals involved in planning and action.

Methods

A qualitative case-study methodology was used. Data were drawn from interviews with 51 government officials in eight provinces.

Results

The study found little variability in the planning process among these eight provinces, probably due to a planning process that was predominantly a fiscal exercise within the confines of a largely centralized structure. Respondents were almost unanimous about the main barriers: a top-down approach to planning, limited human capacity for effective planning at subnational levels, and difficulty in integrating actions from multiple sectors. Provincial-level actors were deeply dissatisfied with the nature of their role in the process.

Conclusions

Despite the rhetoric to the contrary, too much power is probably still retained at the central level. A strategic multiyear approach is needed to strengthen the provincial planning process and address many of the key barriers identified in this study.
Prevalence and Determinants of Vitamin A Deficiency among Brazilian Children under 2 Years of Age from the 2006 National Demographic Health Survey
Authors: Konstantyner Tulio , Warkentin Sarah , de Aguiar Carrazedo Taddei José Augusto
Published: November 2015

Background

Vitamin A deficiency is prevalent among infants, primarily in undeveloped communities, compromising immune system competence and raising morbidity and mortality rates. Understanding the risk factors associated with vitamin A deficiency is essential to create informed health policies.

Objective

To identify and quantify risk factors for vitamin A deficiency in a probabilistic sample of children under 2 years of age participating in a national survey in Brazil and to provide a comprehensive risk factor model to inform health strategies and policies.

Methods

We analyzed data from a cross-sectional study of 1,436 children from the 2006 Brazilian National Survey on Demography and the Health of Women and Children. Vitamin A deficiency was defined as retinol levels below 0.70 μg/dL.

Results

The prevalence of vitamin A deficiency was estimated at 16.1% (95% CI, 12.7 to 20.2). The Poisson regression model identified three risk factors for vitamin A deficiency: urban residence (prevalence ratio [PR] = 1.47, p = .023), no consumption of animal meat within the past week (PR = 1.41, p = .031), and a mother older than 25 years (PR = 1.31, p = .048).

Conclusions

Strategies to control infant vitamin A deficiency should include health promotion and nutrition education for families from all socioeconomic levels. Improvements in lifestyle quality, based on adequate food consumption by all infants, must be achieved by communities, especially in urban areas and for older mothers.
Assessment of a Portable Device to Quantify Vitamin A in Fortified Foods (Flour, Sugar, and Milk) for Quality Control
Authors: Laillou Arnaud , Renaud Cécile , Berger Jacques , Moench-Pfanner Regina , Fontan Laura , Avallone Sylvie
Published: November 2015

Background

Simple-to-use quantitative methods are needed to check the adequacy of vitamin A fortification levels.

Objective

To assess the capacity of a portable fluorometer (iCheck FLUORO) and its test kit vials (iEx Mila) to quantify retinyl palmitate in fortified milks, flours (wheat, maize), and sugar.

Methods

The portable fluorometer was assessed in a three-step procedure to determine its working range and linearity, intra-assay precision, and interperson precision. Measurements were compared with the results obtained by high-performance liquid chromatography (HPLC), commonly regarded as the standard method for vitamin A analysis.

Results

The portable fluorometer (iCheck FLUORO) and its test kit vials (iEx Mila) precisely determined the vitamin A contents in fortified flours, sugar, and milks. Its working range was 1 to 10, 0.5 to 3.0, and 5 to 15 mg retinol equivalents (RE) kg−1 for flours (wheat and corn), milks, and sugar, respectively; these values are in accordance with the World Health Organization recommendations for food fortification in least developed countries. The limits of detection are higher than those of HPLC but are all satisfactory (< 1.46 mg RE kg−1). The coefficients of variation within and between observers were satisfactory, especially for sugar and milk.

Conclusions

The linear relationship between the data from the portable fluorometer and the HPLC data confirms that the portable fluorometer provides a good determination of the vitamin A content of the fortified products in the tested range.
Food Crop Production, Nutrient Availability, and Nutrient Intakes in Bangladesh: Exploring the Agriculture—Nutrition Nexus with the 2010 Household Income and Expenditure Survey
Authors: Fiedler John L.
Published: November 2015

Background

Systematic collection of national agricultural data has been neglected in many low- and middle-income countries for the past 20 years. Commonly conducted nationally representative household surveys collect substantial quantities of highly underutilized food crop production data.

Objective

To demonstrate the potential usefulness of commonly available household survey databases for analyzing the agriculture—nutrition nexus.

Methods

Using household data from the 2010 Bangladesh Household Income and Expenditure Survey, the role and significance of crop selection, area planted, yield, nutrient production, and the disposition of 34 food crops in affecting the adequacy of farming households' nutrient availability and nutrient intake status are explored. The adequacy of each farming household's available energy, vitamin A, calcium, iron, and zinc and households' apparent intakes and intake adequacies are estimated. Each household's total apparent nutrient intake adequacies are estimated, taking into account the amount of each crop that households consume from their own production, together with food purchased or obtained from other sources.

Results

Even though rice contains relatively small amounts of micronutrients, has relatively low nutrient density, and is a relatively poor source of nutrients compared with what other crops can produce on a given tract of land, because so much rice is produced in Bangladesh, it is the source of 90% of the total available energy, 85% of the zinc, 67% of the calcium, and 55% of the iron produced by the agricultural sector. The domination of agriculture and diet by rice is a major constraint to improving nutrition in Bangladesh. Simple examples of how minor changes in the five most common cropping patterns could improve farming households' nutritional status are provided.

Conclusions

Household surveys' agricultural modules can provide a useful tool for better understanding national nutrient production realities and possibilities.
Community-Based Management of Acute Malnutrition (CMAM) in Sub-Saharan Africa: Case Studies from Ghana, Malawi, and Zambia
Authors: Maleta Kenneth , Amadi Beatrice
Published: November 2015

Background

Recent success with community-based management of acute malnutrition (CMAM) has spurred interest on how to improve coverage while maintaining treatment outcomes.

Objective

To document, as case studies, the experi- ence of three African countries, Malawi, Ghana, and Zambia, in scaling up CMAM.

Methods

Desk review using published and unpub- lished data and country programmatic data and key informant interviews.

Results

All three countries, with different motivations for startup, have successfully integrated CMAM into their essential health packages for children under 5 years of age, at least in their policy and strategic documents. Strong leadership by the ministries of health has been instrumental, complemented by key stakeholders and donor partners. Implementation is at variable stages, depending on when the program rolled out, with Malawi having achieved the most integration, followed by Ghana and Zambia. Using CMAM, the three countries have significantly extended service coverage and improved treatment outcomes, with cure rates ranging from 73% in Ghana to 90% in Malawi, while maintaining very low death rates: 1.7% in Malawi, 2% in Ghana, and 5% in Zambia.

Conclusions

CMAM is a viable option to improve service coverage and outcomes in health systems where inpatient therapeutic care alone cannot suffice.
Development and Implementation of a Locally Produced Ready-to-Use Therapeutic Food (RUTF) in Vietnam
Authors: Phuong Huynh , Nga Tran Thuy , Mathisen Roger , Nguyen Marie , Hop Le Thi , Hoa Do Thi Bao , Minh Hong Nguyen , Tuyen Le Danh , Berger Jacques , Wieringa Frank Tammo
Published: November 2015

Background

In Vietnam, malnutrition remains a public health problem, even though much progress has been made in the last decades. The number of cases of severe acute malnutrition (SAM) is more than 200,000 per year. To accelerate the treatment of SAM, community-based treatment with ready-to-use-therapeutic foods (RUTFs) is preferred. However, a locally available and acceptable RUTF for the treatment of SAM was lacking.

Objective

In a joint effort by the National Institute of Nutrition, UNICEF, and the Institut de Recherche pour le Développement, a local RUTF was developed and tested.

Methods

The product was optimalized for impact and acceptability. At the same time, capacity for the Integrated Management of Acute Malnutrition (IMAM) was developed.

Results

The local product was found to be highly acceptable and effective. After training of health staff, the product could be introduced in the IMAM program.

Conclusions

The IMAM program was highly successful in treating children with SAM, with more than 90% of the children recovering. Production capacity of the factory is currently being increased to enable up-scaling of the IMAM program and potential export of the product to countries in the region.
Fluid Management of Shock in Severe Malnutrition: What is the Evidence for Current Guidelines and What Lessons Have Been Learned from Clinical Studies and Trials in other Pediatric Populations?
Authors: Obonyo Nchafatso , Maitland Kathryn
Published: November 2015

Management of shock in children with severe malnutrition remains controversial. To date, the evidence supporting either benefit or harm of fluid resuscitation or rehydration is weak. This issue, however, is not unique to children with severe malnutrition; pediatric guidelines worldwide have a weak level of evidence and remain unsupported by appropriate clinical studies. In this review we give an overview of the current recommendations in other pediatric populations and appraise the strength of evidence supporting these. We summarize results from the only controlled trial ever undertaken, FEAST (Fluid Expansion As Supportive Therapy), which was conducted in resource-poor hospitals involving 3,141 African children with severe febrile illnesses and shock, including large subgroups with sepsis and malaria but excluding children with severe malnutrition. This high-quality trial provided robust evidence that fluid resuscitation increased the risk of death, leading to an excess mortality of 3 in every 100 children receiving fluid boluses, compared with controls receiving no boluses. These findings may have particular relevance to management of septic shock in children with severe malnutrition. However, they cannot be extrapolated to children with gastroenteritis, since this condition was not included in the trial. Current observational studies under way in East Africa may provide insights into myocardial and hemodynamic function in severe malnutrition, including responses to fluid challenge in those complicated by gastroenteritis. Such studies are an essential step for setting the research agenda regarding fluid management of shock in severe malnutrition.
Yearly Household Record of Food from the Forest for Home Consumption by Rural Villagers in North-East Thailand
Authors: Kunarattanapruk Kiatirat , Chokkanapitak Juruwan , Uttamavatin Pissanu , Muktabhant Benja , Lowirakorn Suwalee , Saowakontha Sastri
Published: November 2015

Forests provide food and resources that are used in the daily life of the rural villagers who live nearby. This study explored the contribution of forest food to household nutrition and food security of these people. The study focused on the frequency, varieties, and amounts of forest food gathered for consumption in the household, and the reduction in food expenditure resulting from using forest food. Seven households in a village near a forest in north-east Thailand were selected for a one-year study of forest food consumption using household food records. The data were collected from May 1988 to April 1989. Forest food was gathered for consumption an average of three days a week. One hundred twenty-six kinds of forest food were gathered. The amount gathered for consumption was highest in May and lowest in December, with an average of 126.6 kg per household per year. The use of forest food could reduce food expenditure for the rural villagers.
Food Aversions and Cravings during Pregnancy: Prevalence and Significance for Maternal Nutrition in Ethiopia
Authors: Demissie Tsegaye , Muroki N. M. , Kogi-Makau Wambui
Published: November 2015

A cross-sectional study of the nutritional significance of food aversions and cravings during pregnancy was conducted on 295 women in southern Ethiopia between February and May 1995. A questionnaire was used to collect data on dietary practices. Mid-upper-arm circumference (MUAC), triceps skinfold thickness (TSFT), and weight measurements were used to assess nutritional status. Slightly fewer than three-quarters (71%) of the women craved one or more foods, whereas about two-thirds (65%) avoided at least one food. Cereal foods, despite being staple foods in the area, were avoided by more women (41%) than any other foods. Livestock products, which were scarce at the time of the study, were craved by more women (55%) than any other foods. Comparisons using various anthropometric indicators revealed that women who avoided foods had significantly higher MUAC and TSFT than those who did not ( p < .05), whereas there was no difference in nutritional status between women who craved foods and those who did not. However, those craving women who managed to get the desired foods had significantly higher weight gain ( p < .05), but not significantly higher MUAC or TSFT, than those who did not. Aversion and craving were positively associated (χ2 = 10.66, p < .001; odds ratio, 2.36). Thus, women who avoided foods were 2.4 times more likely to crave foods than those who did not avoid foods. This implies that aversion and craving are complementary processes geared towards ensuring optimal nutrition during pregnancy. Aversion results in the avoidance of monotonous diets, whereas craving calls for varied and nutritious foods. More research, however, is needed before such a conclusion is warranted.
Determinants of the Nutritional Status of Children in a Rural African Setting: The Case of Chobe District, Botswana
Authors: Gobotswang Kesitegile
Published: November 2015

Variations in interdistrict nutritional status have puzzled both social policy makers and health workers in Botswana. A total of 643 households and 898 pre-school children were surveyed to determine factors that are associated with the nutritional status of children below the age of five years in the north-western District of Chobe. Except for those in remote and difficult-to-reach places, all households with a pre-school child were selected for the study. The results showed that the nutritioneal status of the pre-school children had a strong positive correlation with access to a latrine ( r = 0.52) and ownership of cattle ( r = 0.27). Age was negatively correlated with the child's nutritional status ( r = −0.02).
Technical Aspects of Food Fortification
Authors: Wirakartakusumah Moehammad Aman , Hariyadi Purwiyatno
Published: November 2015

The nutritional status of the population is one of the important factors determining the quality and productivity of the population, which in turn affects national productivity. In the long term, good nutritional status contributes to the intelligence and health of the population. Consequently, programmes directed at improving the nutritional status of the population will undoubtedly be a high priority in the national development scheme of any country, developed or developing. Food fortification, i.e., the addition of nutrients to specific foods based on the dietary habits and nutritional status of the target population, is one of the most popular nutritional interventions for improving the population's nutritional status. For food-fortification programmes to be successful, their technical aspects need to be carefully assessed. These include the nutritional justification for food fortification, the acceptability of the fortified food product to consumers (both cost and taste), and any technical or analytical limitation to compliance with food regulations and labeling requirements. Important technical aspects of developing effective food-fortification programmes are the choice of food carrier, nutrient interactions, bioavailability of nutrients, stability of nutrients added under anticipated conditions of storage and processing (food preparation at the household level), and safety. A good fortified product should not cause nutrition imbalance, and excessive intake of nutrients should not have adverse effects. To provide better information for the consumer, the concept of overage should be introduced. Overage is the use of kinetic data on nutrient stability to calculate the amount of added nutrient so that the anticipated level of the nutrient at the end of the product's shelf life is in accordance with the level indicated on the label.
Update on Rice Fortification in the Philippines
Authors: Florentino Rodolfo F. , Pedro Ma. Regina A.
Published: November 2015

Rice, the staple in all regions in the Philippines, is an excellent vehicle for fortification. The Food and Nutrition Research Institute developed the technology for the fortification of rice with iron, using ferrous sulphate as the fortificant. A prototype machine was manufactured for the production of iron-fortified premix with a capacity of 200 kg per batch. A study on iron bioavailability showed a significant increase in the amount of iron absorbed with iron-fortified rice. A clinical trial conducted with 173 schoolchildren for six months showed a greater increase in haemoglobin in subjects who received iron-fortified rice than in those who did not. The problems and constraints that arise with rice fortification include the added cost of fortification (estimated at 2.5% of the cost of rice), which would probably be passed on to the consumer, and the presence of numerous rice mills throughout the country, which may pose difficulties in enforcement. Nevertheless, when carried out in large rice mills, fortification of rice with iron could reach a significant portion of the population.
Iron and Micronutrients: Complementary Food Fortification
Authors: Yeung David L.
Published: November 2015

Iron deficiency, one of the most prevalent problems of micronutrient malnutrition, occurs in both developing and industrialized countries. The impact of iron deficiency and iron-deficiency anaemia on the individual can result in lifelong disadvantages. The causes of the problem are many, but the principal cause is lack of iron-rich food. The International Conference of Nutrition sponsored by the World Health Organization (WHO) in Rome in 1992 estimated that over 2,000 million people worldwide suffer from anaemia, most of which is related to iron deficiency. Infants and young children are decidedly vulnerable groups, for a number of reasons. Their food choices are limited. The amount of food they consume is relatively low, but the demand for nutrients is high. Experience from industrialized countries indicates that one of the best strategies to eliminate or markedly reduce micronutrient malnutrition globally is through food fortification, with the goal of increasing the level of consumption of added nutrients to improve the nutritional status of the target population.

The current recommendation for infant feeding to ensure good iron status is breastfeeding for at least four to six months. The range of iron bioavailability in breastmilk is 50% to 80%, probably because of the presence of lactoferrin, which enhances iron absorption. Thus, it is not surprising that the prevalence of iron-deficiency anaemia in early infancy is inversely correlated with the incidence of breastfeeding. If breastfeeding is not possible, iron-fortified formula should be substituted. By about four to six months, an exogenous source of iron is required. The limited food choices and the few iron-rich foods generally available make fortification of complementary food mandatory. Iron-fortified cereal has been demonstrated to be one of the most effective food vehicles in combating iron deficiency. It is usually the first solid introduced to infants to supplement breastmilk. Clinical research in China, Chile, and Canada has shown that the iron is bioavailable and the iron-fortified infant cereals are effective in the prevention and treatment of iron deficiency. In the United States the use of iron-fortified infant formula and cereal has significantly reduced iron deficiency among infants and pre-schoolers. Many other examples illustrate the importance of the food industry and food fortification in combating micronutrient malnutrition. The Global Plan of Action advocated collaboration among governments, non-governmental organizations, the private sector, local communities, etc. in the elimination of the problem. It is clear that without the food industry, iron-rich foods will not be available. Support and recognition of public health organizations must be given to the food industry to encourage the development of affordable and culturally appropriate iron-fortified foods.