bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustained Positive Deviant Child Care Practices and Their Effects on Child Growth in Viet Nam
Authors: Mackintosh U. Agnes Trinh , Marsh David R. , Schroeder Dirk G.
Published: November 2015

Save the Children's (SC) successful integrated nutrition program in Viet Nam, the poverty alleviation and nutrition program (PANP), uses the positive deviance (PD) approach to identify key growth promoting behaviors and provides participatory adult education allowing mothers to develop skills related to these behaviors. We investigated whether improvements seen during a PANP intervention (1993–1995) were sustained three and four years after SC's departure. Cross-sectional surveys were administered to 46 randomly selected households in four communes that had previously participated in the PANP and 25 households in a neighboring comparison community in 1998 and 1999. Two children per household, an older child who had participated in the PANP and a younger sibling who had not, were measured (total n = 142 children), and their mothers were interviewed. Older SC children tended to be better nourished than their counterparts. Their younger siblings were significantly better nourished than those in the comparison group, with adjusted mean weight-for-age Z scores of −1.82 versus −2.45 ( p = .007), weight-for-height Z scores of −0.71 versus −1.45 ( p < .001), and height-for-age Z scores of −2.11 and −2.37 (ns, p = .4), respectively. SC mothers reporting feeding the younger siblings more than their counterparts did (2.9 versus 2.2 main meals per day, p < .001, and 96.2% versus 52% offering snacks, p < .01]. SC mothers reported washing their hands “often” more than comparison mothers (100% vs. 76%, p < .001). Growth-promoting behaviors identified through PD studies and practiced through neighborhood-based rehabilitation sessions persisted years after program completion. These sustained behaviors contributed to better growth of younger siblings never exposed to the program.
Design of a Prospective, Randomized Evaluation of an Integrated Nutrition Program in Rural Viet Nam
Authors: Marsh David R. , Pachón Helena , Schroeder Dirk G. , Ha Tran Thu , Dearden Kirk , Lang Tran Thi , Hien Nguyen Dhanh , Tuan Doan Anh , Thach Tran Duc , Claussenius David
Published: November 2015

Few prospective studies of child growth and its determinants take place in programmatic contexts. We evaluated the effect of Save the Children's (SC) community empowerment and nutrition program (CENP) on child growth, care, morbidity, empowerment, and behavioral determinants. This paper describes the research methods of this community-based study. We used a longitudinal, prospective, randomized design. We selected 12 impoverished communes with documented child malnutrition, three comparison, and three intervention communes in each of two districts in Phu Tho Province, west of Hanoi. SC taught district trainers in November 1999 to train local health volunteers to implement the 10-month CENP, including situation analysis, positive deviance (PD) inquiry, growth monitoring and promotion, nutrition education and rehabilitation program (NERP), deworming, and monitoring. PD inquiries aim to discover successful care practices in poor households that likely promote well-nourished children. NERPs are neighborhood-based, facilitated group learning sessions where caregivers of malnourished children learn and practice PD and other healthy behaviors. We dewormed all intervention and comparison children. We weighed all children less than 24 months of age living in the intervention and comparison communes and randomly selected 240 children (120 intervention and 120 comparison). We gathered information on nutritional status, diet, illness, care, behavioral determinants, empowerment, and program quality, monthly for six months with a re-survey at 12 months. We collected most information through maternal interview but also observed hygiene and program quality, and videotaped feedings at home. Some implementation and research limitations will attenuate CENP impact and measurement of its effectiveness.
Weighing Vietnamese Children: How Accurate are Child Weights Adjusted for Estimates of Clothing Weight?
Authors: Tuan T. , Marsh D. R. , Ha T.T. , Schroeder D. G. , Thach T.D. , Dung V. M. , Huong N. T.
Published: November 2015

Children who are weighed for growth monitoring are frequently clothed, especially in the cold weather. Health workers commonly estimate and subtract the weight of these clothes, but the accuracy of these estimates is unknown. We assessed the accuracy of child weights adjusted for estimated clothing typical of hot, cold, and extremely cold ambient temperatures. Trained field workers weighed a sample of 212 children 6 to 42 months old from the ViSION project, adjusted the weights using a job aid describing the weights of common clothing by season and age, and then weighed the clothing to calculate the actual clothing and child weights. Fieldworker estimates of the weight of the clothing that children wore during weighing were remarkably good. In nearly all cases (207 of 212; 97.7%), the difference between the estimated and actual clothing weight was less than the precision of the child scales (± 50 g), and most (181 of 212; 84.5%) were within 25 g. Thus, the calculated child weights were, in fact, equivalent to the actual child weights. Using simulations, we found that improperly accounting for clothing weight can overestimate weight-for-age by 0.1 to 0.4 Z score. Accurate weights are possible, even under adverse conditions. Our training methods, clothing album, and job aid might benefit nutrition research and programming in Viet Nam as well as settings with colder climates.
Effect of an Integrated Child Nutrition Intervention on the Complementary Food Intake of Young Children in Rural North Viet Nam
Authors: Pachón Helena , Schroeder Dirk G. , Marsh David R. , Dearden Kirk A. , Ha Tran Thu , Lang Tran Thi
Published: November 2015

Forty-two percent of Vietnamese children are stunted by two years of age. Since 1990, Save the Children Federation/US (SC) has implemented integrated nutrition programs targeting young children. We evaluated the effect of SC's nutrition program on the complementary food intake of young rural Vietnamese children. Using a longitudinal, prospective, randomized design, we followed 238 children (119 each from intervention and comparison communes) age 5 to 25 months old for six months with a re-survey at 12 months. We gathered 24-hour recall data at baseline and at months 2, 4, 6, and 12. Dietary energy intake was calculated using the 1972 Vietnamese food composition table. Key outcomes were daily frequency of consuming intervention-promoted food and non-breastmilk liquids and food, daily quantity of non-breastmilk liquids and food consumed, daily energy intake, and proportion of children meeting daily median energy requirements. Young rural children exposed to SC's program consumed intervention-promoted and any foods more frequently, ate a greater quantity of any food, consumed more energy, and were more likely to meet their daily energy requirements than comparison children. Some effects were only observed during the intensive intervention period; others persisted into or were evident only at the 12-month follow-up, approximately four months after program completion. Based on the mothers' reports, the intervention did not apparently compromise breastfeeding prevalence or frequency. The intervention improved children's food and energy intake and protected them from declining as rapidly as comparison children in meeting their energy requirements.
Empowerment in Rural Viet Nam: Exploring Changes in Mothers and Health Volunteers in the Context of an Integrated Nutrition Project
Authors: Hendrickson Julia L. , Dearden Kirk , Pachón Helena , An Ngyuyen Hoi , Schroeder Dirk G. , Marsh David R.
Published: November 2015

Empowerment is often cited as a fundamental component of health promotion strategies. Anecdotes suggest that Save the Children's integrated nutrition project empowers local women and health volunteers. The aim of this research was to document the degree to which this is being accomplished. Using qualitative methodologies, we conducted a cross-sectional assessment to compare self-reported changes in identified empowerment domains among 17 program health volunteers and 20 mothers involved in a child nutrition intervention and among five Women's Union leaders and five mothers in a non-intervention comparison commune. Intervention mothers reported increased knowledge, confidence, and information sharing about child-care and feeding, while non-intervention mothers reported minimal changes in these domains. Both intervention health volunteers and non-intervention Women's Union leaders expressed improvements in knowledge, confidence, and relationships with community members. In this study we found that the relative increases in empowerment were greater for mothers than for health volunteers. Intervention mothers reported more sharing of information on child relationships with community members than Women's Union leaders. The increased information sharing has positive implications for spread of key messages to families that did not directly participate in intensive feeding and the sustainability of the intervention's impact. Future research should focus on developing culturally specific concepts of empowerment to better understand the effects of empowerment efforts. This study's identification of empowerment domains will inform future empowerment studies in Vietnam.
An Epidemic of Scurvy in Afghanistan: Assessment and Response
Authors: Cheung Edith , Mutahar Roya , Assefa Fitsum , Ververs Mija-Tesse , Nasiri Shah Mahmood , Borrel Annalies , Salama Peter
Published: November 2015

In March 2002, there were reports of a hemorrhagic fever outbreak in western Afghanistan. It was later confirmed that the hemorrhagic symptoms and increased mortality were actually due to scurvy. Most aid workers did not include scurvy in the initial differential diagnosis because it is uncommon throughout the world and has mainly been reported in refugee populations in recent times. A rapid assessment confirmed the cases clinically, estimated a prevalence rate of 6.3% (a severe public health problem), and determined that the attack rates peaked each year in January and February (the end of the winter). Many Afghans have limited dietary diversity due to isolated locations, lengthy winters, the continuing drought of the last four years, asset depletion, and loss of livelihood. After numerous food and fortification options to prevent future outbreaks had been considered, vitamin C tablet supplementation was selected because of the relatively rapid response time as compared with other prevention methods. A three-month course of vitamin C tablets was distributed to 827 villages in at-risk areas. The tablets were acceptable and compliance was good. No cases of scurvy were reported for the winter of 2002–03. The case study from Afghanistan demonstrates that scurvy can occur in nonrefugee or nondisplaced populations; vitamin C supplementation can be an effective prevention strategy; there is an urgent need to develop field-friendly techniques to diagnose micronutrient-deficiency diseases; food-security tools should be used to assess and predict risks of nutritional deficiencies; and the humanitarian community should address prevention of scurvy in outbreak-prone areas.
Vitamin A Deficiency Disorders in Children and Women
Authors: West Keith P.
Published: November 2015

Vitamin A deficiency is an endemic nutrition problem throughout much of the developing world, especially affecting the health and survival of infants, young children, and pregnant and lactating women. These age and life-stage groups represent periods when both nutrition stress is high and diet likely to be chronically deficient in vitamin A. Approximately 127 million preschool-aged children and 7 million pregnant women are vitamin A deficient. Health consequences of vitamin A deficiency include mild to severe systemic effects on innate and acquired mechanisms of host resistance to infection and growth, increased burden of infectious morbidity, mild to severe (blinding) stages of xerophthalmia, and increased risk of mortality. These consequences are defined as vitamin A deficiency disorders (VADD). Globally, 4.4 million preschool children have xerophthalmia and 6 million mothers suffer night blindness during pregnancy. Both conditions are associated with increased risk of morbidity and mortality. While reductions of child mortality of 19–54% following vitamin A treatment have been widely reported, more recent work suggests that dosing newborns with vitamin A may, in some settings, lower infant mortality. Among women, one large trial has so far reported a ≥ 40% reduction in mortality related to pregnancy with weekly, low-dose vitamin A supplementation. Epidemiologic data on vitamin A deficiency disorders can be useful in planning, designing, and targeting interventions.
Iron Deficiency: Global Prevalence and Consequences
Authors: Stoltzfus Rebecca J.
Published: November 2015

Iron deficiency is considered to be one of most prevalent forms of malnutrition, yet there has been a lack of consensus about the nature and magnitude of the health consequences of iron deficiency in populations. This paper presents new estimates of the public health importance of iron-deficiency anemia (IDA), which were made as part of the Global Burden of Disease (GBD) 2000 project. Iron deficiency is considered to contribute to death and disability as a risk factor for maternal and perinatal mortality, and also through its direct contributions to cognitive impairment, decreased work productivity, and death from severe anemia. Based on meta-analysis of observational studies, mortality risk estimates for maternal and perinatal mortality are calculated as the decreased risk in mortality for each 1 g/dl increase in mean pregnancy hemoglobin concentration. On average, globally, 50% of the anemia is assumed to be attributable to iron deficiency. Globally, iron deficiency ranks number 9 among 26 risk factors included in the GBD 2000, and accounts for 841,000 deaths and 35,057,000 disability-adjusted life years lost. Africa and parts of Asia bear 71% of the global mortality burden and 65% of the disability-adjusted life years lost, whereas North America bears 1.4% of the global burden. There is an urgent need to develop effective and sustainable interventions to control iron-deficiency anemia. This will likely not be achieved without substantial involvement of the private sector.
Consumption of Vitamin A by Breastfeeding Children in Rural Kenya
Authors: Ettyang Grace , Oloo Aggrey , van Marken Lichtenbelt Wauter , Saris Wim
Published: November 2015

Vitamin A deficiency remains a significant health risk in developing countries, affecting infants and children in particular. To counter child malnutrition, mothers are encouraged to breastfeed to ensure that their children receive adequate macro- and micronutrients, including vitamin A. However, this assumes that the mother has sufficient vitamin A intake to provide enough vitamin A to her child. This study investigates maternal and infant intakes of locally available foods of high vitamin A content in a rural agricultural community in Kenya. The study aims to establish the community risk for vitamin A deficiency and to assess whether breast milk is adequate to maintain and build retinol reserves of the breastfed infant. The study assesses 62 mother-child pairs and employs several methods to support its objectives, including the Helen Keller International food-frequency survey, maternal and infant anthropometric measurements, and maternal breast-milk and blood samples to determine breast-milk and serum retinol levels. We found that mothers with marginal (< 0.700 μmol/l) serum retinol and breast-milk deficient (< 1.05 μmol/l) in retinol accounted for 45.2% and 77.4%, of our sample, respectively. A significant (p < 0.05) proportion (40.3%) of mothers had breast milk deficient in retinol and marginal levels of serum retinol. The risk of vitamin A deficiency in breastfed infants older than six months was high, because 89.5% of them did not consume foods high in vitamin A content three times weekly. The primary source of vitamin A for infants younger than six months was breast-milk deficient in retinol vitamin A. This study suggests that in this rural community, breastfed infants may not receive appropriate foods with high vitamin A content and that although exclusive breastfeeding is advocated, most breast milk is deficient in retinol, further heightening the risk of vitamin A deficiency.
Rethinking Food Aid to Fight Aids
Authors: Kadiyala Suneetha , Gillespie Stuart
Published: November 2015

While the realization that AIDS is far more than a health problem has dawned only recently, many development organizations have yet to undertake thorough analyses of what this means for what they do, and how they do it. Even fewer have actually changed their policies and procedures to adjust to these new realities. We know that food and nutrition are fundamentally intertwined with HIV transmission and the impacts of AIDS. Food and nutrition security is fundamentally relevant to all four of the conventional pillars of HIV/AIDS response—prevention, care, treatment, and mitigation—and food aid can be an important weapon in the arsenal. This paper, based on a detailed review of the relevant literature and the findings of a mission to eastern and southern Africa, highlights the implications of the HIV/AIDS pandemic for food aid strategy and programming. By viewing food aid programs through an “HIV/AIDS lens” and in the context of a livelihoods approach, the authors argue that organizations can effectively design interventions that reduce both susceptibility to HIV and vulnerability to AIDS impacts. Though there is little empirical evidence regarding the effectiveness of food aid in responding to HIV/AIDS, the authors argue that this should not constrain action. Using past experience as a guide, organizations can learn by doing, documenting, and continually reassessing their programs using the evolving lens, so as to ensure maximal relevance and impact.
School-Based Iron and Folic Acid Supplementation for Adolescent Girls: Findings from Manica Province, Mozambique
Authors: Horjus Peter , Aguayo Victor M. , Roley Julie A. , Pene Maurício C. , Meershoek Stephan P.
Published: November 2015

Background

The 1997 Demographic and Health Survey in Mozambique shows that 47% of girls 15 to 19 years old living in Manica province (west-central Mozambique) are pregnant or have already had a child. A recent survey also shows that 45% of girls 10 to 18 years old attending school are anemic. Strategies are needed to build iron stores before pregnancy and to control seasonal and chronic iron deficiency and anemia in school-aged girls.

Objective

To assess the program effectiveness of two school-based weekly iron and folic acid (IFA) supplementation regimes (5-month supplementation vs. 8-month supplementation) in girls 10 to 18 years old attending school in Manica province.

Methods

Twelve schools were included in the study. Schools were ordered by descending mean hemoglobin concentration, and assigned alternately to study group 5 (six schools; 5-month supplementation) or study group 8 (six schools; 8-month supplementation). In both study groups, the weekly supplement contained 60 mg of elemental iron and 400 μg of folic acid. All girls received a single dose of mebendazol (500 mg) twice—once at the beginning of the study (T0) and once six months later (T6). Supplementation was implemented and supervised by the teachers of the schools included in the study. Between T0 and T3, girls in study group 8 received IFA supplements weekly whereas girls in study group 5 did not. Between T3 and T8, all girls in both groups received weekly IFA supplements.

Results

At T0, mean hemoglobin concentration and anemia prevalence were comparable in study groups 8 and 5 (125.3 ± 12.6 g/L vs. 123.8 ± 12.8 g/L; 28% vs. 29%, respectively). At T3, the mean hemoglobin concentration in study group 8 was significantly higher (126.3 ± 14.3 g/L vs. 121.5 g/dL ± 11.9 g/L p < .001) and the prevalence of anemia was lower (28% vs. 35%, p = .076) than in study group 5. At T8, after an additional 5-month supplementation period in both study groups, mean hemoglobin concentration and anemia prevalence in study groups 8 and 5 were not significantly different (126.5 ± 12.6 g/L vs. 124.9 ± 12.3 g/L; 23% vs. 27%, respectively).

Conclusion

In Manica Province, school-based weekly IFA supplementation is a feasible and effective intervention to prevent seasonal drops in hemoglobin concentration and increases in anemia prevalence. Short supplementation periods can have an important impact on girls' hematological status. However, the size of girls' hematological response in this study was significantly lower that that observed in studies with similar population groups, initial anemia prevalence, supplement dosing, and/or supplementation regime.
The Long-Term Impact of Preschool Health and Nutrition on Education
Authors: Jukes Matthew
Published: November 2015

Malnutrition and infectious diseases in infancy and early childhood have an impact on the cognitive development of children in developing countries. The long-term effects of these diseases are less well understood. A number of studies relate early malnutrition, iron deficiency, and malaria infection to poor cognitive abilities in the school-age years. The long-term effect of randomized interventions in early childhood has been evaluated for nutrition supplementation and psychosocial stimulation of malnourished children and for malaria prevention in a community cohort. The evidence suggests that improving the health and nutrition of young children can improve their subsequent chances of attending school, the gender equity of education access, and performance of children once at school.
Development of Weaning Food from Sorghum Supplemented with Legumes and Oil Seeds
Authors: Asma M. Ali , El Fadil E. Babiker , El Tinay Abdullahi H.
Published: November 2015

Background

The development of low-cost, high-protein food supplements for weaning infants from local and readily available raw materials is a constant challenge for developing countries.

Objective

To formulate, develop, and assess the nutritive value, acceptability, and keeping quality of sorghum-based staple dried flakes as instant weaning foods.

Methods

Weaning blends composed of 42% sorghum supplemented with 20% legumes, 10% oil seeds, and 28% additives (sugar, oil, skim milk powder, and vanillin) were prepared according to FAO/WHO/UNU recommendations and processed in a twin-roller drum dryer. The effects of fermentation and of the addition of malt on the nutritive value and functional properties of the blends were investigated.

Results

The blends were found to contain 16.6% to 19.3% protein, 68.7% to 72.7% carbohydrate, 0.9% to 1.3% fiber, and 405.8 to 413.2 kcal of energy per 100 g. The iron content of the blends ranged from 5.3 to 9.1 mg/100 g, and the calcium content ranged from 150 to 220 mg/100 g. All blends reconstituted well and formed a soft paste when stirred with hot or cold water. The water-holding capacity, wettability, and bulk density were within the ranges of corresponding values of commercial weaning foods. Sensory attributes, viscosity values, and in vitro digestibility varied among the blends, whereas lysing content improved considerably ( p ≤ .05) for all blends. All blends had similar keeping quality, with no signs of spoilage or development of off-flavors or colors after 10 months of storage. Most blends remained free of aflatoxins.

Conclusions

Legumes and oil seeds can be effectively used in sorghum-based weaning foods as an acceptable protein and mineral supplement.
Contribution of a Novel High-Density Micronutrient Condiment (HDMC) to Nutrient Adequacy of Home-Prepared Guatemalan Dishes
Authors: Orozco Mónica , Solomons Noel W. , Briend André
Published: November 2015

Background

The diet of low-income Guatemalan populations is mostly plant-based, deficient in some vitamins and minerals, and rich in antinutritional compounds that reduce the bioavailability of several micronutrients.

Objective

To describe the manner in which low-income Guatemalan women in rural and urban settings would prepare dishes for main meals using a high-density multimicronutrient condiment (HDMC) and to compare the nutrient density and contribution to the recommended dietary allowance (RDA) of the dishes with and without added HDMC.

Methods

A sample of 30 women, 15 each from rural and urban households, were enrolled. The women were given 20 g of the HDMC and asked to prepare a dish at home, serve it to their families at a time of their own choosing, record the recipe and the amount of condiment added, and report these facts to an interviewer on the following day. The nutrient content of each dish was calculated from food-composition table values for raw, whole ingredients and the package label values for the HDMC.

Results

For all dishes combined, the HDMC provided on average 78% of the total vitamins. The proportion of the total vitamins provided by the HDMC varied greatly among different dishes. Typically a single serving of a dish without added HDMC provided less than half of the RDA (vitamin B12 and folate) for children and adult women. The midday meal is the most important meal of the day and should provide at least half of the RDA of all essential nutrients. With the HDMC added, the dishes on average provided 2 to 10 times the RDA for nutrients such as vitamins B6 and C and niacin in the reference children, and just satisfied the RDA intake for corresponding nutrients in adult women.

Conclusions

The proportion of the RDAs of micronutrients provided by this novel, micronutrient-rich condiment varies over a wide range, depending on idiosyncrasies of recipe ingredients, amounts of condiment added, individuals served, and age- and physiology-dependent requirements. HDMCs could provide an efficient way to deliver essential micronutrients to vulnerable populations.
Efficacy and Effectiveness of Community-Based Treatment of Severe Malnutrition
Authors: Ashworth Ann
Published: November 2015

Background

There is a long tradition of community-based rehabilitation for treatment of severe malnutrition: the question is whether it is effective and whether it should be advised for routine health systems.

Objective

To examine the effectiveness of rehabilitating severely malnourished children in the community in nonemergency situations.

Methods

A literature search was conducted of community-based rehabilitation programs delivered by day-care nutrition centers, residential nutrition centers, primary health clinics, and domiciliary care with or without provision of food, for the period 1980–2005. Effectiveness was defined as mortality of less than 5% and an average weight gain of at least 5 g/kg/day.

Results

Thirty-three studies of community-based rehabilitation were examined and summarized. Eleven (33%) programs were considered effective. Of the sub-sample of programs reported since 1995, 8 of 13 (62%) were effective. None of the programs operating within routine health systems without external assistance was effective.

Conclusions

With careful planning and resources, all four delivery systems can be effective. It is unlikely that a single delivery system would suit all situations worldwide. The choice of a system depends on local factors. High energy intakes (> 150 kcal/kg/day), high protein intakes (4–6 g/kg/day), and provision of micronutrients are essential for success. When done well, rehabilitation at home with family foods is more cost-effective than inpatient care, but the cost effectiveness of ready-to-use therapeutic foods (RUTF) versus family foods has not been studied. Where children have access to a functioning primary health-care system and can be monitored, the rehabilitation phase of treatment of severe malnutrition should take place in the community rather than in the hospital but only if caregivers can make energy- and protein-dense food mixtures or are given RUTF. For routine health services, the cost of RUTF, logistics of procurement and distribution, and sustainability need to be carefully considered.
Improvement of the Nutritional Quality of a Traditional Complementary Porridge Made of Fermented Yellow Maize (Zea Mays): Effect of Maize–Legume Combinations and Traditional Processing Methods
Authors: Ejigui Jeanne , Savoie Laurent , Marin Johanne , Desrosiers Thérèse
Published: November 2015

Background

Blends with a cereal–legume ratio of 70:30 have been introduced in many communities for use in the preparation of complementary foods with augmented protein quality. These foods should meet World Health Organization estimated energy and nutrient needs from complementary foods.

Objective

To increase energy and nutrient densities and nutrient availability in a traditional complementary porridge.

Methods

Yellow maize was processed by lactic acid fermentation. Peanuts (Arachis hypogea) and beans (Phaseolus vulgaris) were processed by germination, roasting, dehulling, and a combination of germination and roasting. Blends were prepared from processed peanuts and beans and cooked into porridges with viscosities less than 3,000 cp. Traditional porridge was the control and consisted of fermented yellow maize only. The porridges were analyzed for their physicochemical and nutritional properties.

Results

Blends increased energy and nutrient densities in porridges compared with the control (p < .05). The maize–peanuts combination yielded porridges with higher energy densities and improved nutritional quality compared with the maize–beans combinations. In vitro availability of iron did not change (p > .05) with formulation of the blends except for porridges made from maize and germinated peanuts, but there was a significant increase in zinc in vitro availability, whereas a decrease was observed for calcium in vitro availability. The energy densities of maize–peanuts porridges were sufficient to cover energy required from complementary foods for infants aged 6 to 11 months receiving four meals of complementary foods per day and an average amount of energy from breastmilk.

Conclusions

Maize-legume blends can efficiently improve the nutritional quality of traditional porridge. Peanuts are the best legume complements.
Iron-Deficiency Anemia among Children in Southwest Iran
Authors: Keikhaei Bijan , Zandian Khodamorad , Ghasemi Ali , Tabibi Ramin
Published: November 2015

Background

Iron deficiency is a major health problem worldwide and especially in developing countries. Iron-deficiency anemia has adverse effects on the development of children.

Objective

The purpose of this study was to determine the prevalence of iron-deficiency anemia in children under 5 years of age in southwest Iran. The study also sought to investigate the association between socioeconomic, demographic, cultural, and nutritional factors and iron-deficiency anemia in the selected area.

Methods

A randomized, cross-sectional study was performed of children 6 to 59 months of age living in urban and rural areas of Ahwaz District in Khuzestan Province. At eight randomly selected health centers, the children's height (or length) and weight were measured, and information on length and weight at birth was obtained from growth charts. Blood samples were taken from 337 randomly selected children.

Results

The results showed that 43.9% of the children had anemia and 29.1% iron-deficiency anemia. The highest prevalence of iron-deficiency anemia was in the 12- to 24-month age group. In the urban areas, infants 6 to 11 months of age had the highest prevalence of iron-deficiency anemia.

Conclusions

The high prevalence of iron-deficiency anemia among children in southwest Iran indicates a major nutrition and health problem.
Weeds or Useful Medicinal Plants in the Rural Home Garden?
Authors: Geldenhuys Coert J.
Published: November 2015

Background

Traditional medicines remain an important health-care service among African indigenous cultures. In South Africa, medicinal plant use (bark, roots, bulbs, and herbs) threatens biodiversity and the sustainability of this informal industry. Several realities have stimulated experimental and adaptive management research into cultivation of key high-demand medicinal plant species in and around the home gardens of poor rural communities for domestic use and for trade: declining supplies, localized extinctions, increasing market prices, and economic opportunities for commercializing traditional medicinal products.

Objective and methods

This paper reviews three recent South African studies aiming to create alternative medicinal plant resources to reduce dependency on the dwindling wild resources: commercial production of medicinal crop plants; chemistry of wild versus cultivated plants, and of bark versus leaves; and growing of forest tree seedlings in rural home gardens.

Results

Cultivation trials and chemical testing indicated that different agricultural treatments suit each species differently in terms of either rapid growth rates, strong chemical concentrations, or both. Wild-harvested plants of some species have stronger chemical concentrations than cultivated plants. For several tree species, the bark and leaves contain the same active components associated with healing.

Conclusions

Successful propagation is not dependent on elaborate and expensive equipment and technologies, but rather on some basic principles of plant growth and methods of manipulating these under controlled conditions. An alternative cultivation method for tree species is the production of leaves as opposed to bark. Cultivation could be done successfully at the school, in home gardens, and in production systems in the village.
Functional Indicators for Assessing Zinc Deficiency
Authors: Walker Christa L. Fischer , Black Robert E.
Published: November 2015

Zinc is an essential micronutrient for growth and proper immune function. There is currently no simple recommendation for the assessment of population-level zinc deficiency. Trials of zinc supplementation have shown positive effects of supplementation on clinical outcomes and growth. We reviewed the results of randomized trials of zinc supplementation and correlation studies that assessed infectious diseases, growth, and development outcomes among children under 5 years of age. The results indicate that zinc supplementation decreases the incidence and prevalence of diarrhea and pneumonia, but the use of trial data to make population-level estimates of zinc deficiency is not practical and is difficult to quantify. The data also indicate that zinc supplementation increases growth, especially among children who are stunted. Stunting rates are commonly estimated and can be used to estimate zinc deficiency. Previous recommendations suggest that stunting rates at or above 20% should be indicative of zinc deficiency among children under 5 years of age. This review provides additional data and analysis to support the current recommendation.
Mechanism of Iron Toxicity
Authors: Hershko Chaim
Published: November 2015

The subtle balance between proinflammatory and antiinflammatory cytokines plays an important role in determining the severity of the inflammatory reaction and in the anomalous iron handling associated with infection. Conversely, iron deficiency per se appears to limit the severity of the inflammatory response. All of these considerations are at present highly speculative and in need of further experimental and epidemiologic support. If confirmed, the beneficial biological effects of iron depletion may have a defensive role in inflammation and may be perturbed by the nonselective administration of iron to iron-replete patients who would not benefit from such treatment in the first place. In view of the importance of non-transferrin-bound plasma iron (NTBI) in iron toxicity and its rapid cellular uptake, it may play an important role in the harmful effects of iron in infection, and this is illustrated by the infectious complications of parenteral iron therapy in tropical countries.
Iron Metabolism and Malaria
Authors: Prentice Andrew M. , Ghattas Hala , Doherty Conor , Cox Sharon E.
Published: November 2015

Recent evidence from a large, randomized, controlled trial has suggested that the universal administration of iron to children in malaria-endemic areas is associated with an increase in adverse health outcomes. The purpose of this paper is to summarize the available ecologic and intervention trials related to iron and malaria in children, and to set these against current knowledge of the biology of host–pathogen interactions involving iron metabolism. We conclude that, although not fully consistent, the balance of evidence confirms that administration of iron (usually in combination with folic acid) increases the incidence of malaria when given without prophylaxis and in the absence of universal access to treatment. The mechanisms by which additional iron can benefit the parasite are far from clear. There is evidence to suggest that the apparent detrimental effect of iron supplementation may vary according to levels of antecedent iron status, the presence of hemoglobinopathies and glucose-6-phosphate dehydrogenase (G6PD) deficiency, and other host genetic variants, such as variants in haptoglobin. The effects of malaria on host iron metabolism are also reviewed and reveal that the key cause of malaria-induced anemia is a maldistribution of iron and suppression of erythropoiesis rather than an exacerbation of gross iron deficiency. We tentatively conclude that, if it is to be recommended, universal iron supplementation in malarious areas should only be considered in conjunction with some form of prophylaxis (e.g., intermittent preventive therapy [IPT]) or in the context of good health services with ready access to facilities for malaria diagnosis and treatment. An alternative approach would be to screen for anemia and target supplementation only to anemic children. With regard to treatment, there is good evidence that iron supplementation should be withheld until the treatment schedule is complete, both because iron may inhibit treatment and because the absorption of oral iron is blocked by the inflammatory response.
Food-Coping Strategy Index Applied to a Community of Farm-Worker Households in South Africa
Authors: Kruger Rozanne , Schönfeldt Hettie Carina , Owen Johanna Hendriena
Published: November 2015

Background

In South Africa, households living in informal urban settlements, in rural areas, and on commercial farms experience various levels of dietary variety, food intake, and household hunger. Low incomes, poor food production and availability, and low spending power characterize these households. Households employ various food-coping strategies to alleviate food stress or poor food availability.

Objective

To apply an existing food-coping strategy (FCS) index to assess household hunger and its usefulness in identifying the level of food stress and the patterns of food coping in farm-worker households.

Methods

A cross-sectional survey was conducted. Data were gathered from women (18 to 57 years of age) responsible for food provision in a small farm-worker community in Fouriesburg, South Africa. A structured food-coping questionnaire and a standardized FCS index were used to gather data.

Results

The two most common FCS used were relying on cheaper food (chicken feet, diluted soya-mince soup) or less preferred food (meat bones) and employing food-seeking strategies (gathering wild foods), followed by consumption of seed stock (maize) and reduced portion sizes (protein foods and side dishes), resulting in starch-based diets of poor variety. Seasonal strategies varied according to the level of food stress experienced. Patterns of food coping were identified.

Conclusions

Negative FCS (limiting food choices, only consuming starchy staples) may cause poor health status. The FCS index was effectively used to assess farm-worker household food-coping behavior (early, clear signals of the level of food distress). These results could be used to allocate appropriate food aid (type of food) and to design nutrition education programs focused on positive FCS (food gathering or bartering) in a particular community to prevent suboptimal nutritional status.
Relationship between Paternal Involvement and Child Malnutrition in a Rural Area of Vietnam
Authors: Tran Bich Huu
Published: November 2015

Background

Malnutrition is a public health problem in Vietnam. Child health and the status of women have been targets for various health programs in the country. In general, reports in the literature suggest that care is positively correlated with positive nutritional status of children. In the household, the father is considered a resource for care. However, the role of paternal care in health programs has not received the attention it deserves.

Objective

To identify associations between the involvement of fathers in child care and housework and the nutritional status of children under 3 years of age.

Methods

This cross-sectional study was based on a random sample of 547 children under 3 years of age from intact families and their biological parents. The main outcome variable was child nutrition. Predictor variables represented two domains of father's involvement. Multivariable general linear modeling and multivariable logistic regression modeling were performed with the use of a combination of stepwise and hierarchical approaches in data analysis.

Results

The overall prevalence of underweight among children was 19.1%, and the prevalence of stunting was 14.4%. Children whose fathers did not bring them to a medical facility for immunization were about 1.7 times more likely to be underweight and stunted than those whose fathers did bring them for immunization after child's age, household economic status, and mother's education were controlled for. Father's involvement in housework was not found to be related to the prevalence of malnutrition.

Conclusions

Paternal involvement in child immunization should be encouraged by health-care providers who manage immunization programs.
A Global Nutritional Index
Authors: Rosenbloom Joshua I. , Kaluski Dorit Nitzan , Berry Elliot M.
Published: November 2015

Background

A standardized global nutritional index (GNI) would provide a single statistic for each country according to its overall level of nutrition, which could then guide national policies.

Objectives and methods

We have developed a GNI modeled on the human development index (HDI), based on three indicators of nutritional status: deficits, excess, and food security. Calculations were made within four groups of countries (GNI) (32 developed countries, 26 countries in transition, 64 low-mortality developing countries, and 70 high-mortality developing countries) as well as between them—the Global Nutrition Index World wide (GNIg).

Results

Complete data were available for 192 countries. The ranking of the highest and lowest countries in the four groups (with their GNIg values) is as follows: developed countries—Japan 1 (0.989), United States 99 (0.806); countries in transition—Estonia 10 (0.943), Tajikistan 173 (0.629); low-mortality developing countries—Republic of Korea 12 (0.939), Nauru 185 (0.565); high-mortality developing countries— Algeria 47 (0.876), Sierra Leone 192 (0.420). A “double burden,” in which nutrient deficits and excesses coexist in the same country, was seen in Mauritania (rank 139), South Africa (rank 146), Samoa (rank 157), Lesotho (rank 160), and Fiji (rank 169). The correlation between GNIg and HDI was intermediate (0.74, 55% of variance explained), demonstrating that good nutrition and development are not necessarily synonymous. Countries may be developed yet have a low GNIg (e. g., Australia, Canada, and the United States) and vice versa (e. g., Indonesia and China).

Conclusions

Since nutrition is fundamental to a nation's health and productivity, the GNI and GNIg should be used alongside the HDI to obtain an optimal index of a country's overall well-being.
Development of Field Test Kits for Determination of Microencapsulated Iron in Double-Fortified Salt
Authors: Yuan Jessica S. , Li Yao O. , Ue Judy W. , Wesley Annie S. , Diosady Levente L.
Published: November 2015

Background

Efficacy studies have shown that salt double-fortified with iodine and iron can significantly reduce the incidence rates of iron-deficiency anemia and iodine-deficiency disorders. Double-fortified salt can be prepared by mixing microencapsulated iron compounds into conventionally iodated salt. Effective implementation of a double fortification program requires field-based analytical methods to ensure iron levels in double-fortified salt.

Objective

To develop semiquantitative and qualitative field test kits by adopting standard analytical methods for iron determination to the analysis of iron in double-fortified salt.

Methods

Thermal, mechanical, and chemical strategies were assessed to enable contact between analytical reagents and the encapsulated iron compounds during the analysis. A chemical approach using nonpolar solvents was adopted in semiquantitative and qualitative field tests. The fat coating of the iron premix was removed by solvents, releasing the iron for subsequent colorimetric determination.

Results

Both semiquantitative and qualitative field tests were based on initial removal of the microencapsulant, followed by iron quantitation. Solvent dissolution of the coating layer was most useful for rapid release of iron. A semiquantitative field test kit was developed using a mixture of 5% heptane and 95% tetrachloroethylene to free the iron, which was then determined by the 1,10-phenanthroline method. The field test had a useful detection range of 0 to 2,000 ppm of iron. Statistical analyses revealed that the results obtained with the kit correlated well with those obtained by standard laboratory methods ( p < .001). A qualitative field test kit was developed to identify the presence of iron. Microencapsulated iron was freed with the use of tetrachloroethylene and then reacted with phenanthroline to form a visually observable coloration on the salt sample.

Conclusion

Semiquantitative and qualitative field test kits for iron determination in double-fortified salt have been developed and tested. These kits could be useful in quality control of double fortification of salt in small salt-production facilities and in the field, particularly in developing countries.
Kpejigaou: An Indigenous, High-Protein, Low-Fat, Cowpea-Based Griddled Food Proposed for Coastal West Africa
Authors: Amonsou Eric Oscar , Sakyi-Dawson Esther , Saalia Firibu Kwesi , Houssou Paul
Published: November 2015

Background

Griddled cowpea paste foods have high nutritional potential because they are low in fat but high in protein. A good understanding of process and product characteristics of kpejigaou is necessary to improve its quality and enhance acceptability.

Objective

To describe the product, evaluate critical variables in traditional processing, and determine consumer quality criteria and preferences for kpejigaou.

Methods

A survey of kpejigaou processing was carried out among processors and regular consumers of kpejigaou.

Results

Kpejigaou is flat and circular in shape, with uniform thickness and porous structure. The production process of kpejigaou was found to be simple and rapid, but the quality of the finished product varied among processors and among batches. Critical processing variables affecting quality were dehulling of the cowpeas, type of griddling equipment, and griddling temperature. Texture (sponginess) is the most important quality index that determines the preference and acceptability of kpejigaou by consumers.

Conclusions

Traditionally processed kpejigaou does not meet current standards for high-quality foods. This study provides the basis for efforts to standardize the kpejigaou process to ensure consistent product quality and enhance the acceptability of kpejigaou among consumers. Kpejigaou has a potential for success if marketed as a low-fat, nutritious fast food.