bluuebunny/crossref_metadata_2025 huggingface dataset:
Shelf Stability, Sensory Qualities, and Bioavailability of Iron-Fortified Nepalese Curry Powder
Authors: Karn Sanjeev Kumar , Chavasit Visith , Kongkachuichai Ratchanee , Tangsuphoom Nattapol
Published: November 2015

Background

The prevalence of iron-deficiency anemia in Nepal is almost 50% of the whole population. Curry powder is a promising vehicle for fortification due to its use in various meals.

Objective

To evaluate the bioavailability of different iron fortificants in curry powder and their effects on the qualities of curry powder.

Methods

The serving size of curry powder was evaluated in 40 Nepalese households and 10 restaurants. The powders were fortified with iron sources of different bioavailability. Sources with good bioavailability of iron—ferrous sulfate (FS), ferrous fumarate (FF), and sodium ferric ethylenediaminetetraacetic acid (NaFeEDTA)—were added to provide one-third of the recommended daily intake (RDI) of iron per serving. Elemental iron (H-reduced [HRI] and electrolytic [EEI]), which has poor bioavailability, was added to provide two-thirds of the RDI per serving. Both fortified and unfortified products were packed in either commercial packs or low-density polyethylene bags and stored at 40 ± 2°C under fluorescent light for 3 months. The stored products were analyzed for CIE color, peroxide value, thiobarbituric acid reactive substances, moisture, water activity, iron, and sensory qualities. The contents of phenolic compounds and phytate were analyzed, and iron bioavailability was determined by the Caco-2 cell technique.

Results

The serving size of curry powder was 4g. Iron fortificants did not have adverse effects on the physical, chemical, and sensory qualities of curry powder packed in commercial packaging. After 3 months storage, HRI significantly affected darker colors of curry powder and the cooked dishes prepared with curry powder. The relative bioavailabilities of NaFeEDTA and EEI were 1.05 and 1.28 times that of FS, respectively. The cost of fortification with EEI was similar to that with FS and 4.6 times less than that with NaFeEDTA.

Conclusions

It is feasible and economical to fortify Nepalese curry powder packed in commercial packaging with EEI.
The Evolving Food and Nutrition Agenda: Policy and Research Priorities for the Coming Decade
Authors: Kennedy Eileen , Webb Patrick , Walker Peter , Saltzman Edward , Maxwell Dan , Nelson Miriam , Booth Sarah
Published: November 2015

Enormous progress has been made in the past 100 years in improving diet and nutritional status. However, the job is not done. This paper summarizes some of the current challenges and proposes priorities for future research and policy development. The nutrition agenda is more complex than it was 100 years ago. The world now faces undernutrition side-by-side with dietary excess and related chronic diseases. The complexity of modern nutrition necessitates using a systems approach to identifying effective policies and programs. There is a renewed interest in addressing the new nutrition agenda.
Growth and Nutritional Status of Preschool Children in India: A Study of Two Recent Time Periods
Authors: Sen Pronab , Bharati Susmita , Som Suparna , Pal Manoranjan , Bharati Premananda
Published: November 2015

Background

Preschool children call for focused attention in India because India has the highest percentage of undernourished children in the world.

Objective

To compare the growth and nutritional status of Indian preschool children for the periods 1998/99 and 2005/06.

Subjects and methods

Using data on weight and length/height as well as the sociodemographic background of preschool children from the National Family Health Surveys (NFHS) from 1998/99 and 2005/06, we determined the distribution of weight and length/height and their association with sociodemographic variables.

Results

The distributions of weight and length/height around the mean remained remarkably stable over age but were much greater in India than the international norms. The rates of growth of mean weight and length/height were far lower in India than the international norms up to the age of 2 years. The temporal trend indicates declines in the percentages of undernourished (low weight-for-age) and stunted (low height-for-age) children over the 7-year period, although the degree of improvement was far better for stunting than for underweight. Mother's educational status is the only variable that has been found to influence child nutrition.

Conclusion

The level of mothers' education needs urgent attention with top priority to reduce the prevalence of underweight and stunting of children. This also implies that, for future benefit, girls should be given more facilities for better education. Breastfeeding and weaning practices also need special attention.
Professor Rainer Gross, Benefactor to Humanity: A Tribute to His Legacy to Public Nutrition
Authors: Lechtig Aaron
Published: November 2015

In September 2010, Angela Cespedes and Aaron Lechtig were awarded the Rainer Gross Award for “Recent Innovation in Nutrition and Health in Developing Societies” by the Hildegard Grunow Foundation. The award was for the most outstanding innovation which represents the creativity for nutritional health solutions that typified the “Rainer Gross way of doing things.”

In this issue of the Bulletin, we are pleased to be pub- lishing the article,“Social protection programs in Central America and the Dominican Republic: Do they have a nutritional dimension?” by Angela Cespedes, Aaron Lechtig, and Rachel Francischi; the work outlined in this paper was the basis for the Rainer Gross award.

The following is an excerpt of the remarks made by Aaron Lechtig at the II World Congress on Public Health Nutrition in Porto, Portugal on September 25, 2010 on his acceptance of the Rainer Gross Award.
Comparison of Median Urinary Iodine Concentration as an Indicator of Iodine Status among Pregnant Women, School-Age Children, and Nonpregnant Women
Authors: Wong Esther M. , Sullivan Kevin M. , Perrine Cria G. , Rogers Lisa M. , Peña-Rosas Juan Pablo
Published: November 2015

Background

Most surveys that assess the iodine status of populations target school-age children, whereas others may target nonpregnant women with the assumption that the iodine status of these groups is representative of other groups in the same population.

Objective

To assess whether the median urinary iodine concentration (UIC) of school-age children or nonpregnant women can be used to accurately represent the iodine status of pregnant women.

Methods

Using the World Health Organization Vitamin and Mineral Nutrition Information System and a literature review, we identified urinary iodine surveys that included pregnant women and school-age children and/or nonpregnant women in the same location and year using estimates from the smallest geographic level to increase the number of data points. Linear regression was used to assess the relationships between the median UIC for the comparisons.

Results

There were 48 survey pairs with pregnant women and school-age children (total sample sizes of 8,622 and 16,844, respectively), and 26 pairs with pregnant and nonpregnant women (sample sizes of 3,222 and 5,520, respectively). The country contributing the most data points was China. When the median UIC in school-age children or nonpregnant women indicated iodine intake was adequate or above requirements, approximately half the time pregnant women had inadequate iodine intake.

Conclusions

Adequate iodine nutrition status of school-age children or nonpregnant women may not indicate adequate iodine nutrition status among pregnant women. In order to assess the iodine status of pregnant women, the iodine status would need to be assessed in this group.
Beyond Food Insecurity: How Context Can Improve Complementary Feeding Interventions
Authors: Paul Keriann H. , Muti Monica , Khalfan Sabra S. , Humphrey Jean H. , Caffarella Rosemary , Stoltzfus Rebecca J.
Published: November 2015

Background

The role of context has not been elaborated with respect to current recommendations for complementary feeding interventions, apart from a gross distinction based on food security.

Objective

Our objective was to compare two food-insecure settings in sub-Saharan Africa to determine how context (i.e., the set of local social, cultural, and physical circumstances) influences complementary feeding practices and nutrient intakes and how the results can help in the design of a suitable intervention strategy.

Methods

We conducted formative research using 24-hour dietary recalls, household interviews, and focus group discussions with mothers of 6- to 12-month-old infants in rural Zimbabwe ( n = 32) and Pemba Island, Zanzibar, Tanzania (n = 44).

Results

In both settings, many infants had suboptimal nutrient intakes, poor dietary diversity, and poor hygiene. Breastfeeding practices were poor in Pemba, and the infants' diet had low energy density in Zimbabwe. Beyond food insecurity, contextual determinants of practices included inaccurate indigenous knowledge, time-consuming maternal livelihoods, family eating behaviors, local agriculture, and the local ecosystem. Both settings would require nutrition education, but it should target the broader indigenous ways of learning and family eating behaviors in order to achieve the necessary behavior change. A home-based fortificant would probably be enough for Pemban children, because the ecosystem of the island provides sufficient sources of macronutrients. However, Zimbabwean children appear to need a fortified food-based supplement to overcome the poor agricultural and economic context.

Conclusions

Assessing context was essential to intervention design. A framework to guide future formative research is proposed.
Effectiveness of Fortification of Drinking Water with Iron and Vitamin C in the Reduction of Anemia and Improvement of Nutritional Status in Children Attending Day-Care Centers in Belo Horizonte, Brazil
Authors: da Silva Rocha Daniela , Capanema Flávio Diniz , Netto Michele Pereira , de Almeida Carlos Alberto Nogueira , Franceschini Sylvia do Carmo Castro , Lamounier Joel Alves
Published: November 2015

Background

Because of the high prevalence of iron-deficiency anemia in Brazil, individual control measures tend to be ineffective, and fortification of foods with iron is considered the most effective method to fight anemia.

Objective

To evaluate the effectiveness of fortification of drinking water with iron and vitamin C in the reduction of anemia in children in day-care centers in Belo Horizonte, Brazil.

Methods

This before-and-after study evaluated 318 children aged 6 to 74 months. Identification data and data on socioeconomic variables were collected; anthropometric and biochemical measurements were performed before and after 5 months of fortification of water with 5 mg of elemental iron and 50 mg of ascorbic acid per liter. The fortified water was used for drinking and cooking at the day-care center. Wilcoxon's nonparametric test was used to evaluate the differences in continuous variables, and McNemar's test was used to compare the prevalence rates of anemia.

Results

The prevalence of anemia decreased signifi- cantly from 29.3% before fortification to 7.9% at the end of the study, with a significant increase in hemoglobin levels. Reductions in the prevalence rates of stunting and underweight were observed.

Conclusions

Fortification of water with iron and vitamin C significantly reduced the prevalence of anemia and improved nutritional status among children attending day-care centers.
Nutritional Enhancement of US Title II Food Aid Products
Authors: Rosenberg Irwin , Tilahun Jessica , Schlossman Nina , Bagriansky Jack , Johnson Quentin , Webb Patrick , Rogers Beatrice , Masterson Amelia Reese
Published: November 2015

Background

Food aid provided by the United States has saved the lives of the vulnerable for many years. Recognizing the need for a thorough review of product formulations and specifications, the US Agency for International Development (USAID) commissioned a 2-year assessment of quality issues relating to Title II food aid products. This article presents findings and recommendations of that review relating to product enhancements.

Objective

The core question addressed was: Are current commodity specifications for enriched FBFs appropriate in light of evolving nutritional science and food fortification technology, or do they need to be updated?

Methods

Empirical data were derived from a number of sources, including a survey of Title II implementing partners focusing on procurement and logistics, and uses of FBFs and other foods. Input of implementing partners, civil society, and donor organizations was obtained through individual consultations, international and small group meetings. More than 400 individuals accessed the project's website. The project convened a panel of experts in food technology and science, food policy, law, industry, medicine, development and humanitarian work, and the maritime industry, and held regular joint meetings with USDA and USAID. The draft report was widely disseminated and posted on the website.

Results and conclusions

The findings of this research led to the following broad areas of improvement in US Title II food aid products: 1) Improve the formulation of existing FBF products used in Title II programming. This includes the addition of a dairy source of protein to products targeted to children 6 to 24 months of age, pregnant and lactating women, wasted children, and wasted individuals undergoing HIV/AIDS treatment. 2) Upgrade the vitamin and mineral mixes used and diversify approaches to addressing micronutrient needs. Enhance the composition of premixes used to fortify blended foods as well as milled grains and vegetable oil; facilitate shipping of fortificant premix with bulk cereals for in-country fortification; and develop micronutrient powders (sachets) and other point-of-use fortification options. 3) Develop or adopt non-cereal-based (e.g., lipid-based) products for the management of nutritional deficiencies. This is an argument for more choice among appropriate tools, not for discarding products that have already shown their value over many years. It also does not reduce the need to maintain a focus on supplying high volumes of quality grains as the main staple in food aid baskets.
Universal Salt Iodization in the Central and Eastern Europe, Commonwealth of Independent States (CEE/CIS) Region during the Decade 2000–09: Experiences, Achievements, and Lessons Learned
Authors: van der Haar Frits , Gerasimov Gregory , Tyler Vilma Qahoush , Timmer Arnold
Published: November 2015

Background

By 2000, the global track record on universal salt iodization (USI) indicated 26% access to adequately iodized salt in the Central and Eastern Europe, Commonwealth of Independent States (CEE/ CIS) Region.

Objective

Aimed at extracting lessons learned, this study examined experiences, achievements, and outcomes of USI strategies in CEE/CIS countries during the subsequent decade.

Methods

Information from the design, timing, execution, outputs, multi-sector management and results of actions by national stakeholders yielded 20 country summaries. Analysis across countries used a LogFrame Analysis typical for public nutrition development.

Results

By 2009, USI strategies had reached the target and population iodine nutrition shown adequate levels in 9 countries, while in 6 others, USI was close and/or population iodine status showed only minor imperfection. True USI, i.e., iodization of salt destined both for the food industry and the household, had been made mandatory in 13 of these 15 countries. In the Balkan area, USI and iodine nutrition advanced more than in CIS. Of the 20 sample countries, 17 (85%) had exceeded the mark of 50% adequate access, while the overall regional score reached 55% by 2010.

Conclusions

Experience from this region suggests that strong partnership collaboration, a new concept in post-Soviet societies, was a major success factor. Voluntary iodization or focusing on household salt alone was less likely conducive for success. Achieving optimum iodine nutrition required the setting of proper iodine standards. Weak political leadership insistence in the Russian Federation and Ukraine to embrace USI is the main factor why the region remains behind in the global progress.
Agriculture and Malnutrition in India
Authors: Gulati Ashok , Kumar A. Ganesh , Shreedhar Ganga , Nandakumar T.
Published: November 2015

Background

Despite the high and relatively stable overall growth of the economy, India's agriculture sector is underperforming and a vast section of the population remains undernourished.

Objective

To explore the possible interplay between agricultural performance and malnutrition indicators to see whether states that perform better in agriculture record better nutritional outcomes.

Methods

Correlation analysis and a simple linear regression model were used to study the relationship between agricultural performance and malnutrition among children under 5 years of age and adults from 15 to 49 years of age at 20 major states using data from the National Family Health Survey-3 for the year 2005/06 and the national accounts.

Results

Indicators of the level of agricultural performance or income have a strong and significant negative relationship with indices of undernutrition among adults and children, a result suggesting that improvement of agricultural productivity can be a powerful tool to reduce undernutrition across the vast majority of the population. In addition to agriculture, access to sanitation facilities and women's literacy were also found to be strong factors affecting malnutrition. Access to healthcare for women and child-care practices, in particular breast-feeding within 1 hour after birth, are other important determinants of malnutrition among adults and children.

Conclusions

Malnutrition is a multidimensional problem that requires multisectoral interventions. The findings show that improving agricultural performance can have a positive impact on nutritional outcomes. However, improvements in agriculture alone cannot be effective in combating malnutrition if several other mediating factors are not in place. Interventions to improve education, health, sanitation and household infrastructure, and care and feeding practices are critical. Innovative strategies that integrate agriculture and nutrition programs stand a better chance of combating the malnutrition problem.
Performance of Iron Spot Test with Arabic Bread Made from Fortified White Wheat Flour
Authors: Nichols Erin , Aburto Nancy , Masa'd Hanan , Wirth James , Sullivan Kevin , Serdula Mary
Published: November 2015

Background

The iron spot test (IST) is a simple qualitative technique for determining the presence of added iron in fortified flour. IST performance in bread has never been investigated. If found to perform well, the IST has the potential to provide a field-friendly method for testing bread and thus support the monitoring and evaluation of flour fortification programs.

Objective

To assess the performance of the IST in Arabic bread made from white wheat flour.

Methods

Bread samples were collected from 1,737 households during a national micronutrient survey in Jordan. A subsample of Arabic bread ( n = 44) was systematically selected for testing by both the IST and spectrophotometry (criterion reference). Performance measures (sensitivity, specificity, and positive and negative predictive values) were calculated using five cutoffs to define the presence of added iron, including ≥ 15.0 ppm (approximate level of natural iron in Arabic bread) and four additional cutoffs based on test performance.

Results

The iron contents of samples testing negative by IST ranged from 10.4 to 18.4 ppm, with one outlier at 41.0 ppm, which was excluded from subsequent analyses. The iron contents of samples testing positive by IST ranged from 16.1 to 38.4 ppm. With the exception of negative predictive values for the two lowest cutoffs (≥ 15.0 and ≥ 16.1 ppm), all performance measures exceeded 83.3%.

Conclusions

These results show promise for the IST as an inexpensive, field-friendly method for testing bread that could have a useful role in the monitoring and evaluation process for flour fortification programs.
Effect on School Attendance and Performance of Iron and Multiple Micronutrients as Adjunct to Drug Treatment of Schistosoma-Infected Anemic Schoolchildren
Authors: Ayoya Mohamed Ag , Spiekermann-Brouwer Gerburg Maria , Traoré Abdel Kader , Garza Cutberto
Published: November 2015

Background

Relationships among Schistosoma haematobium, anemia, and iron deficiency have been documented, and all have been found to be associated with a decline in school attendance and lower performance.

Objective

To assess the effect of single or combined iron and multiple micronutrients and/or praziquantel on school attendance and achievement in randomly selected 7- to 12-year-old anemic children with documented S. haematobium infection ( n = 406) in Mali over a 3-month period.

Methods

Schistosomiasis infection was diagnosed by the presence of schistosome eggs in the urine. Venous blood samples (5 mL) were drawn from an antecubital vein for hemoglobin assessment. Children were randomly assigned to one of four treatment groups: praziquantel alone, praziquantel + iron, praziquantel + multiple micronutrients, and praziquantel + multiple micronutrients + iron. School attendance was defined by the number of days the child was absent from class. Achievement was defined by the child's overall school grades.

Results

Changes within treatment groups from baseline to the end of study were found for attendance ( p < .001) but not for achievement ( p > .05). Significant supplement treatments by age group interactions were found in 7- to 9-year-old children for attendance. Further exploration of treatment effects in this age group showed that only iron treatment's main effect was significant on attendance ( p = .049) and was of borderline significance on school grades ( p = .08).

Conclusions

Combined praziquantel and iron treatment improved children's school attendance and performance better than praziquantel alone, particularly among younger children.
Community-Based Management of Severe and Moderate Acute Malnutrition during Emergencies in Sri Lanka: Challenges of Implementation
Authors: Jayatissa Renuka , Bekele Aberra , Kethiswaran A. , de Silva A. H.
Published: November 2015

Background

With the documentation of high rates of acute malnutrition in children under 5 years of age, the Ministry of Health of Sri Lanka established a Nutrition Rehabilitation Program in Jaffna District of the Northern Province.

Objective

To assess the impact of community-based management of acute malnutrition among children under 5 years of age and its operational challenges.

Methods

The Nutrition Rehabilitation Program was introduced and implemented in phases covering the entire district and was integrated into the routine healthcare system from the beginning. Children were categorized into severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) groups according to World Health Organization weight-for-height growth standards. Children with SAM were given ready-to-use-therapeutic food (RUTF), and children with MAM were given 100 g (450 kcal) of high-energy biscuits (HEBs) provided by UNICEF. All children received daily supplementary food consisting of locally produced Thriposha or 50 g of corn—soya blend provided by the World Food Programme that provides approximately 200 kcal in addition to the general food ration. The children were followed up according to the guidelines stipulated in the Nutrition Rehabilitation Program manual.

Results

An endline representative survey conducted 2 years after implementation of the Nutrition Rehabilitation Program revealed that the prevalence of global acute malnutrition (GAM) among children under five dropped from 18% to 9.6%, a reduction of 47%, while the prevalence of SAM dropped from 3.5% to 0.7%, a reduction of 80%. However, the prevalence of anemia remained at 34%, which is higher than the national prevalence of 25%, in spite of supplementation with 200% of the Recommended Nutrient Intake of iron and vitamin A.

Conclusions

Proper targeting of feeding programs with good coverage can reduce the rates of acute malnutrition in emergencies. It is important also to consider the control of anemia in emergencies.
Does Greater Workload Lead to Reduced Quality of Preventive and Curative Care among Community Health Workers in Bangladesh?
Authors: Puett Chloe , Coates Jennifer , Alderman Harold , Sadruddin Salim , Sadler Kate
Published: November 2015

Background

Community health workers (CHWs) perform a range of important tasks; however, limited evidence is available regarding the association between their workload and the quality of care they provide.

Objective

To analyze the quality of preventive and curative care provided by two groups of CHWs with different workloads in southern Bangladesh.

Methods

One group of CHWs provided preventive care in addition to implementing community case management (CCM) of acute respiratory infection and diarrhea, and another group additionally treated severe acute malnutrition (SAM). Preventive care was measured by case management observation at a routine household visit. Curative care was measured by case scenarios. Qualitative methods were used to contextualize CHWs' performance by examining their perceptions of challenges related to their workload. A total of 338 CHWs were assessed.

Results

CHWs managing cases of SAM worked significantly more hours than the other group (16.7 ± 6.9 hours compared with 13.3 ± 4.6 hours weekly, p < .001) but maintained quality of care on curative and preventive work tasks. Effectively treating cases of SAM appeared to motivate CHWs.

Conclusions

This was one of the first trials adding the treatment of SAM to a CHW workload and suggests that adding SAM to a well-trained and supervised CHW's workload, including preventive and curative tasks, does not necessarily yield lower quality of care. However, increased workloads had consequences for CHWs' domestic life, and further increases in workload may not be possible without additional incentives.
Improving the Comparability of National Estimates of Fruit and Vegetable Consumption for Cross-National Studies of Dietary Patterns
Authors: Moore Spencer , Lloyd Beate
Published: November 2015

Background

Developing global approaches to the problem of low fruit and vegetable consumption requires cross-nationally comparable estimates of fruit and vegetable consumption. National differences in the definitions of fruits and vegetables and serving size amounts limit the comparability of estimates.

Objectives

To describe national differences in fruit and vegetable definitions, serving size amounts, and how these factors can influence the comparability of fruit and vegetable consumption estimates; and to provide a series of reporting recommendations that could facilitate cross-national studies of fruit and vegetable consumption.

Methods

A comprehensive review of national dietary guidelines, fruit and vegetable definitions, and fruit and vegetable consumption recommendations was undertaken for Canada, the United States, and the United Kingdom.

Results

To improve cross-national comparability, the findings suggest that researchers could report fruit and vegetable consumption separately, provide separate average fruit and vegetable intake amounts, report potato and legume or pulse consumption separately from vegetable consumption, and report consumption of 100% fruit juice separately from fruit consumption.

Conclusions

These four low-cost, high-value additions to conventional research reporting standards will aid in the development of cross-national research on global fruit and vegetable consumption and the design of global policies that can target low fruit and vegetable consumption in populations.
A Program Needs-Driven Approach to Selecting Dietary Assessment Methods for Decision-Making in Food Fortification Programs
Authors: Coates Jennifer , Colaiezzi Brooke , Fiedler John L. , Wirth James , Lividini Keith , Rogers Beatrice
Published: November 2015

Background

Dietary assessment data are essential for designing, monitoring, and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness, and cost tradeoffs of employing alternative dietary assessment methods, but little guidance exists.

Objective

To identify and apply criteria to assess the tradeoffs of using alternative dietary methods for meeting fortification programming needs.

Methods

Twenty-five semistructured expert interviews were conducted and literature was reviewed for information on the validity, usefulness, and cost of using 24-hour recalls, Food Frequency Questionnaires/ Fortification Rapid Assessment Tool (FFQ/FRAT), Food Balance Sheets (FBS), and Household Consumption and Expenditures Surveys (HCES) for program stage-specific information needs. Criteria were developed and applied to construct relative rankings of the four methods.

Results

Needs assessment: HCES offers the greatest suitability at the lowest cost for estimating the risk of inadequate intakes, but relative to 24-hour recall compromises validity. Design: HCES should be used to identify vehicles and to estimate coverage and likely impact due to its low cost and moderate-to-high validity. Baseline assessment: 24-hour recall should be applied using a representative sample. Monitoring: A simple, low-cost FFQ can be used to monitor coverage. Impact evaluation: 24-hour recall should be used to assess changes in nutrient intakes. FBS have low validity relative to other methods for all programmatic purposes.

Conclusions

Each dietary assessment method has strengths and weaknesses that vary by context and purpose. Method selection must be driven by the program's data needs, the suitability of the methods for the purpose, and a clear understanding of the tradeoffs involved.
Using Household Consumption and Expenditures Survey (HCES) Data to Assess Dietary Intake in Relation to the Nutrition Transition: A Case Study from Cape Verde
Authors: Dop Marie Claude , Pereira Clodomir , Mistura Lorenza , Martinez Claudio , Cardoso Edith
Published: November 2015

Background

Few surveys of food and nutrient intakes are conducted at the individual level in low- and middle- income countries, whereas Household Consumption and Expenditures Surveys (HCES) are regularly carried out to monitor economic conditions. Because of the paucity of individual-level data, there is interest in using HCES to aid in the design of food and nutrition policies.

Objective

Data from the 2001/02 HCES from Cape Verde were used to assess household dietary intakes in the context of the country's nutrition transition.

Methods

The survey included weighed measure- ments of household food intake and measurements of the weight and height of all household members. Households were classified as “underweight” if they had at least one underweight member, “overweight” if they had at least one overweight member, and “dual burden” if they had at least one underweight and one overweight member.

Results

The proportion of households classified as underweight, overweight, and dual burden was 18%, 41%, and 14%, respectively. Household food and nutri- ent intakes were higher in the overweight households (particularly protein, vitamin A, and calcium) and lower in the underweight households, while there was no clear pattern of intakes in the dual burden group. Overweight households consumed more animal food groups than other households. Intakes of fruits and vegetables were low in all groups.

Conclusions

The HCES data for Cape Verde were useful for assessing the extent of the nutrition transition and characterizing dietary intakes by anthropometric classification. Analysis of nutrient and food intakes showed that ensuring sufficient energy availability is no longer the most important issue for Cape Verde, but that ensuring dietary quality is equally crucial, in particular increasing access to fruits and vegetables.
What Linear Programming Contributes: World Food Programme Experience with the “Cost of the Diet” Tool
Authors: Frega Romeo , Lanfranco Jose Guerra , De Greve Sam , Bernardini Sara , Geniez Perrine , Grede Nils , Bloem Martin , de Pee Saskia
Published: November 2015

Background

Linear programming has been used for analyzing children's complementary feeding diets, for optimizing nutrient adequacy of dietary recommenda- tions for a population, and for estimating the economic value of fortified foods.

Objective

To describe and apply a linear pro- gramming tool (“Cost of the Diet”) with data from Mozambique to determine what could be cost-effective fortification strategies.

Methods

Based on locally assessed average household dietary needs, seasonal market prices of available food products, and food composition data, the tool estimates the lowest-cost diet that meets almost all nutrient needs. The results were compared with expenditure data from Mozambique to establish the affordability of this diet by quintiles of the population.

Results

Three different applications were illustrated: identifying likely “limiting nutrients,” comparing cost effectiveness of different fortification interventions at the household level, and assessing economic access to nutritious foods. The analysis identified iron, vitamin B2, and pantothenic acid as “limiting nutrients.” Under the Mozambique conditions, vegetable oil was estimated as a more cost-efficient vehicle for vitamin A fortification than sugar; maize flour may also be an effective vehicle to provide other constraining micronutrients. Multiple micronutrient fortification of maize flour could reduce the cost of the “lowest-cost nutritious diet” by 18%, but even this diet can be afforded by only 20% of the Mozam- bican population.

Conclusions

Within the context of fortification, linear programming can be a useful tool for identifying likely nutrient inadequacies, for comparing fortification options in terms of cost effectiveness, and for illustrating the potential benefit of fortification for improving household access to a nutritious diet.
Processed Foods as an Integral Part of Universal Salt Iodization Programs: A Review of Global Experience and Analyses of Bangladesh and Pakistan
Authors: Spohrer Rebecca , Garrett Greg S. , Timmer Arnold , Sankar Rajan , Kar Basanta , Rasool Faiz , Locatelli-Rossi Lorenzo
Published: November 2015

Background

Despite the reference to salt for food processing in the original definition of universal salt iodization (USI), national USI programs often do not explicitly address food industry salt. This may affect program impact and sustainability, given the increasing consumption of processed foods in developing countries.

Objective

To review experience of the use of iodized salt in the food industry globally, and analyze the market context in Bangladesh and Pakistan to test whether this experience may be applicable to inform improved national USI programming in developing countries.

Methods

A review of relevant international experience was undertaken. In Bangladesh and Pakistan, local rural market surveys were carried out. In Bangladesh, structured face-to-face interviews with bakers and indepth interviews with processed food wholesalers and retailers were conducted. In Pakistan, face-to-face structured interviews were conducted with food retailers and food labels were checked.

Results

Experience from industrialized countries reveals impact resulting from the use of iodized salt in the food industry. In Bangladesh and Pakistan, bread, biscuits, and snacks containing salt are increasingly available in rural areas. In Bangladesh, the majority of bakers surveyed claimed to use iodized salt. In Pakistan, 6 of 362 unique product labels listed iodized salt.

Conclusions

Successful experience from developed countries needs to be adapted to the developing country context. The increasing availability of processed foods in rural Bangladesh and Pakistan provides an opportunity to increase iodine intake. However, the impact of this intervention remains to be quantified. To develop better national USI programs, further data are required on processed food consumption across population groups, iodine contents of food products, and the contribution of processed foods to iodine nutrition.
Fortification of Staple Cereal Flours with Iron and other Micronutrients: Cost Implications of following World Health Organization—Endorsed Recommendations
Authors: Grant J. Aaron , Laillou Arnaud , Wolfson Julian , Moench-Pfanner Regina
Published: November 2015

Background

Wheat and maize flours are widely used delivery vehicles for mass fortification. In lower-income countries, most, if not all, national-level cereal flour fortification programs routinely fortify with iron; however, cofortification with other micronutrients is common. Little information is available on the cost implications programs face when considering current fortification practices versus what the World Health Organization (WHO) interim consensus statement recommends.

Objective

The objectives of the present paper are to provide information on the costs of adding different chemical forms of iron and/or other micronutrients to premix formulations, and to discuss some of the issues that should be considered regarding which micronutrients to include in the premix.

Methods

Nine countries in Latin America, Africa, and Asia (three countries per region) that currently cofortify with multiple micronutrients including iron were selected based on low (< 75 g/day), medium (75 to 149 g/day), and high (≥ 150 g/day) mean population flour consumption levels. Premix costs per metric ton of flour produced were estimated for improving iron formulations and for following WHO recommendations for other micronutrients.

Results

For the selected programs to maintain current premix formulations and improve iron compounds, premix costs would increase by between 155% and 343% when the iron compound was switched from electrolytic iron to sodium iron ethylenediaminetetraacetate (NaFeEDTA), by 6% to 50% when it was switched from electrolytic iron to ferrous sulfate, and by 4% to 13 when iron addition rates were adjusted without switching the compound. To meet WHO recommendations for other micronutrients, premix costs would increase the most when the amounts of vitamins B12 and A were increased.

Conclusions

For programs that currently cofortify with iron and additional micronutrients, the quality of the iron fortificant should not be overlooked simply to be able to afford to add more micronutrients to the premix. Micronutrients should be selected according to population needs, costs, and potential beneficial synergistic reactions the added micronutrients may have.
Rice Fortification: Its Potential for Improving Micronutrient Intake and Steps Required for Implementation at Scale
Authors: Piccoli Nina Beretta , Grede Nils , de Pee Saskia , Singhkumarwong Anusara , Roks Eveline , Moench-Pfanner Regina , Martin W. Bloem
Published: November 2015

Background

Micronutrient deficiencies affect over 2 billion people worldwide, with profound implications for health, cognitive development, education, economic development, and productivity. Fortification of staple foods is a cost-effective strategy to increase vitamin and mineral intake among the general population. Rice is consumed by billions of people (> 440 million MT/year) but is as yet rarely fortified.

Objective

To discuss the untapped opportunity of rice fortification.

Methods

Review literature and experience with rice fortification and compare to fortification of other staple foods.

Results

Most technologies used to fortify rice first produce the fortified kernels and then blend them with regular, polished rice. Technologies differ with regard to how nutrients are added to the rice kernels, required investment, production cost, and degree of resemblance to unfortified rice. There are, so far, limited success stories for rice fortification. Some of the main roadblocks appear to be high initial investment and associated cost; lack of government leadership; and consumer hesitation to accept variations in the characteristics of rice, or a higher price, without good understanding of the benefits.

Conclusions

In countries with a large centralized rice milling industry, starting rice fortification is easier than in countries with many small mills. Countries with large safety nets that supply rice to the poorest, for free or subsidized, have a good channel to reach those most in need. Furthermore, key players from the public and private sectors should establish a coalition to support the use of fortified rice and address some of the barriers to its implementation.
GAIN Premix Facility: An Innovative Approach for Improving Access to Quality Vitamin and Mineral Premix in Fortification Initiatives
Authors: Guinot Philippe , Jallier Vincent , Blasi Alessandro , Guyondet Christophe , Van Ameringen Marc
Published: November 2015

Background

Vitamin and mineral premix is one of the most significant recurring input costs for large-scale food fortification programs. A number of barriers exist to procuring adequate quality premix, including accessing suppliers, volatile prices for premix, lack of quality assurance and monitoring of delivered products, and lack of funds to purchase premix.

Objective

To develop and test a model to procure premix through a transparent and efficient process in which an adequate level of quality is guaranteed and a financial mechanism is in place to support countries or specific target groups when there are insufficient resources to cover the cost of premix.

Methods

Efforts focused on premixes used to fortify flour, such as wheat or maize (iron, zinc, B vitamins, and vitamin A), edible oils (vitamins A and D), and other food vehicles, such as fortified complementary foods, complementary food supplements, and condiments. A premix procurement model was set up with three distinct components: a certification process that establishes industry-wide standards and guidelines for premix, a procurement facility that makes premix more accessible to countries and private industry engaged in fortification, and a credit facility mechanism that helps projects finance premix purchases.

Results

After three years of operation, 15 premix suppliers and 29 micronutrient manufacturers have been certified, and more than US$23 million worth of premix that met quality standards has been supplied in 34 countries in Africa, Central and Southern Asia, and Eastern Europe, reaching an estimated 242 million consumers.

Conclusions

The Premix Facility demonstrated its effectiveness in ensuring access to high-quality premixes, therefore enabling the success of various fortification programs.
Household Economic and Food Security after the 2010 Pakistan Floods
Authors: Doocy Shannon , Leidman Eva , Aung Tricia , Kirsch Thomas
Published: November 2015

Background

The 2010 floods inundated one-fifth of Pakistan and affected more than 20 million people.

Objective

To characterize the impact of the floods and subsequent humanitarian response on household economy and food security.

Methods

A cross-sectional 80 × 20 cluster survey ( n = 1,569 households) was conducted using probability proportional to size sampling in the four most flood-affected provinces 6 months after the floods. Analysis included both descriptive statistics and regression models, with receipt of food aid (in the first month), dietary quality, and household income at 6 months postflood as outcomes.

Results

Need for food aid was nearly ubiquitous (98.9%); however, only half of the study population ever received food aid. Displacement was not a significant predictor of food aid receipt (OR, 1.28; 95% CI, 0.83 to 1.98); however urban location (OR, 2.78; 95% CI, 2.00 to 3.86) and damage to the home (OR, 2.73; 95% CI, 1.34 to 5.60) were significantly associated. Some of the hardest-hit groups, including both farmers and day laborers, were significantly less likely to receive food aid ( p < .05). Additionally, receipt of food aid was not necessarily associated with improved household economy or food security; although households in internally displaced people (IDP) camps were more likely to receive food aid (OR, 2.78; 95% CI, 2.00 to 3.86), they were less likely to report same or improved dietary quality (OR, 0.63; 95% CI, 0.46 to 0.88) or income status (OR, 0.55; 95% CI, 0.35 to 0.86).

Conclusions

Food aid coverage following the 2010 floods was relatively low, and many of the most affected populations were less likely to receive aid, suggesting that targeting should be improved in future responses.
Differences in Circulating Non-Transferrin-Bound Iron after Oral Administration of Ferrous Sulfate, Sodium Iron EDTA, or Iron Polymaltose in Women with Marginal Iron Stores
Authors: Schümann Klaus , Solomons Noel W. , Orozco Monica , Romero-Abal Maria Eugenia , Weiss Guenter
Published: November 2015

Background

The adverse interactions between iron supplements and malaria have driven the assessment of new therapeutic options for anemia prophylaxis in areas holoendemic for falciparum malaria.

Objective

To determine the responses of circulating non-transferrin-bound iron (NTBI) and plasma iron to three different oral iron compounds—ferrous sulfate, sodium iron ethylenediaminetetraacetate (NaFeEDTA), and iron polymaltose (IPM)—in women with marginal iron stores.

Methods

Serum samples from 10 Guatemalan women with marginal iron stores were collected every 90 minutes over a period of 270 minutes, after the individually randomized administration of 100 mg of iron from each of the three studied iron compounds or water alone. Serum iron concentration was quantified by the ferrozine method, and circulating NTBI concentration was determined with a fluorometric competitive binding assay. Kinetic responses and maximal cumulative changes in serum concentrations of iron and NTBI were compared between the four treatments. Comparison was made with data from the same protocol in iron-adequate men.

Results

The serum iron and NTBI responses to ferrous sulfate were significantly greater than those to water and the other two iron compounds. Serum iron responses to IPM did not differ from those to water alone.

Conclusions

The administration of the two “slow-release” iron compounds, NaFeEDTA and IPM, resulted in a highly significant suppression of the appearance of NTBI in the circulation in the postsupplement period. These two bioavailable forms of iron supplement could represent a safe option for supplementation in malarial areas. The slope of the iron—NTBI relationship is steeper in men than in women.