bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of an Improved Local-Ingredient-Based Complementary Food and Technology Transfer to Rural Housewives
Authors: Ouédraogo Hermann Z. , Traoré Tahirou , Zèba Augustin , Tiemtoré Saïdou , Dramaix-Wilmet Michèle , Hennart Philippe , Donnen Philippe
Published: November 2015

Background

Food technology transfer to rural households, based on local ingredients, is a relevant and sustainable strategy to ensure better nutrition of young children.

Objective

To develop an improved mush based on local ingredients and evaluate the potential for transferring its technology to rural housewives.

Methods

We developed a flour-based food using Alicom software and performed laboratory trials to evaluate its actual nutritional quality. Then we recruited housewives from each of the 27 project villages and trained them in flour production and mush preparation twice daily, 6 days a week, for 26 weeks. Mush was sampled during the training session and at weeks 4, 12, and 22 and evaluated for actual flow distance and dry matter content, which served to estimate energy density and iron and zinc contents.

Results

The laboratory trials reported average energy densities of 103 kcal/100 g, iron contents of 2.6 mg/100 kcal, and zinc contents of 1.2 mg/100 kcal. The average ( ± SD) energy densities of the mush samples obtained during the training session and at weeks 4, 12, and 22 were 103.0 ± 5.6,103.3 ± 5.2,107.9 ± 11.5, and 101.3 ± 8.7 kcal/100 g, respectively. The average iron contents were 2.3 ± 0.5,2.3 ± 0.5,2.6 ± 0.3, and 1.8± 0.8 mg/ 100 kcal, respectively, and the average zinc contents were 1.6± 0.1, 1.6± 0.1,1.7 ± 0.1, and 1.6± 0.2 mg/100 kcal.

Conclusions

Developing a suitable complementary food from local ingredients and educating households in nutrition and use of local products are feasible. Such education should come with measures aimed at improving the accessibility of some ingredients to ensure feasibility and sustainability.
Iron in Vitro Bioavailability and Iodine Storage Stability in Double-Fortified Salt
Authors: Li Yao Olive , Diosady Levente L. , Wesley Annie S.
Published: November 2015

Background

Ferrous fumarate is useful in iron fortification because of its high bioavailability, mild taste, and relatively low cost. A ferrous fumarate premix for incorporation into salt has been developed by agglomerating ferrous fumarate with appropriate binder materials into salt-size particles followed by microencapsulation.

Objective

The bioavailability of iron is critical for the usefulness of double-fortified salt. This study examined the in vitro bioavailability of various iron forms in double-fortified salt and microencapsulated ferrous fumarate premixes prepared by various techniques in an effort to identify key processing factors affecting iron bioavailability.

Methods

Iron in vitro bioavailability was approximated through the rate of dissolution of iron in 0.1 N HCl, which closely approximates the acid in gastric juice. Iron in vivo bioavailability was tested using the hemoglobin repletion assay in rats.

Results

The materials and techniques used in microencapsulating ferrous fumarate had little effect on iron in vivo bioavailability: more than 90% of iron in the premixes was released during 2 hours of digestion in the simulated gastric fluid. By incorporating titanium dioxide in the coating materials, the dark reddish-brown color of ferrous fumarate was effectively masked, resulting in acceptable sensory qualities, while maintaining the stability of iodine in the salt. Iron in vivo tests in rats have confirmed that the ferrous fumarate microencapsulated in a lipid is highly bioavailable, with a bioavailability of 95% relative to ferrous sulfate.

Conclusions

These findings were corroborated by field tests in southern India which demonstrated that double-fortified salt containing microencapsulated ferrous fumarate was effective in reducing the prevalence of iron-deficiency anemia and iodine-deficiency disorders.
Relationship between Food Aid and Acute Malnutrition following an Earthquake
Authors: Hossain S. M. Moazzem , Maggio David M. , Sullivan Kevin M.
Published: November 2015

Background

The relationship between food aid and acute malnutrition among children under 5 years of age was assessed in northern Pakistan following the 2005 earthquake.

Methods

Separate cross-sectional household-based surveys were performed in Mansehra and Muzaffarabad districts. Probability proportional to size (PPS) was used to select clusters in each district, and households were randomly selected within each cluster. Information collected included receipt of food aid, child health, level of household damage, water sources, and excreta disposal.

Results

Children in households receiving food aid had a lower prevalence of acute malnutrition in Mansehra (adjusted OR, controlled for confounders, 0.40; 95% CI, 0.13 to 1.22) and Muzaffarabad (adjusted OR, 0.72; 95% CI, 0.36 to 1.44). Communities with higher levels of complete household destruction were more likely to receive food aid.

Conclusions

Children in households receiving food aid had a lower prevalence of acute malnutrition than those in households not receiving food aid, even after accounting for various confounding variables, although this difference was not statistically significant.
Total Daily Water Intake in Guatemalan Children
Authors: Montenegro-Bethancourt Gabriela , Vossenaar Marieke , Doak Colleen M. , Solomons Noel W.
Published: November 2015

Background

Water is an essential nutrient, but recommendations for total water requirements only emerged in 2005, in the context of estimated average population targets in the Dietary Reference Intakes (DRIs) for US and Canadian societies.

Objective

To assess total daily water acquisition, and the contribution of water acquired from all possible sources, among Guatemalan children.

Methods

A total of 449 urban Guatemalan schoolchildren, aged 8 to 11 years, evenly divided between two socioeconomic strata, completed a 1-day pictorial registry of all foods and beverages consumed. Estimated energy intake, total water intake, and the contributions of water from drinking water, beverages, intrinsic and extrinsic water in foods, and the oxidation of macronutrients were assessed.

Results

The contribution of water from the examined water sources was 8% for drinking water, 49% for beverages, 29% for all foods, and 14% for metabolism of macronutrients, with only slight variance across sexes and social class. The average total daily water acquisition was 1,841 ± 572 mL for boys and 1,834 ± 484 mL for girls, which fall short of the North American DRI recommendations of 2.4 and 2.1 L, respectively. There was correspondingly lower average consumption of dietary liquids.

Conclusions

Foods play an important role in the acquisition of water from their hydration and metabolic oxidation, contributing 43.8% of the daily supply to these children. There is still a calculated shortfall of daily water acquisition, as compared with the DRI recommendations, which could be overcome by greater intake of plain water and low-energy fresh produce.
The Potential to Improve Zinc Status through Biofortification of Staple Food Crops with Zinc
Authors: Hotz Christine
Published: November 2015

Biofortification is an agricultural strategy that aims to increase the content of select micronutrients, including zinc, in staple food crops such as rice, wheat, maize, pearl millet, and others. When consumed among zinc-deficient populations, zinc-biofortified staple foods should improve the adequacy of zinc intakes and hence reduce the risk of dietary zinc deficiency. Several conditioning factors will contribute to the potential for this strategy to meet its goal, including the additional amount of zinc that can be bred into the staple crop food, the amount of zinc that remains in the staple crop food following usual processing methods, and the bioavailability of zinc from the staple crop food in the context of the usual diet. Reduction of the phytate content of cereals with the use of agricultural techniques is a potential complementary strategy for improving the bioavailability of zinc. The feasibility of biofortification to result in a meaningful increase in the adequacy of population zinc intakes and to reduce the consequences of zinc deficiencies still needs to be determined through efficacy trials. At the program level, the ability to widely disseminate biofortified crop varieties and the willingness of farmers to adopt them will also affect the magnitude of the impact of this strategy.
Trends in low Birthweight among the Bhutanese Refugee Population in Nepal
Authors: Shrimpton Roger , Thorne-Lyman Andrew , Tripp Katie , Tomkins Andrew
Published: November 2015

Background

Although much is known about risk factors for low birthweight, an important cause of neonatal death, little is known about how to reduce or prevent low birthweight.

Objective

This study aimed to verify a low rate in the incidence of low birthweight reported in the Bhutanese refugee camps in Nepal and, if true, to try to understand how this came about.

Methods

Medical records from 1994 to 2001 were recovered for half of the refugee population, and birthweight and other maternal factors were analyzed. The adequacy of the food ration provided to the general population was assessed by comparing it with the nutrient requirements of pregnant women.

Results

The rates of low birthweight were indeed low in the refugee camps, averaging 11% in the years reviewed. Between 1996 and 1998, the mean rate of low birthweight fell from 16% to 8% and mean birthweight increased from 2.84 kg (SE, 2.80–2.87) to 3.0 kg (SE, 2.97–3.03). The increase in birthweight occurred following improvements in the micronutrient-to-energy ratios of the general ration.

Conclusions

Rates of low birthweight comparable to those in developed countries were achieved in an ethnic Nepali population within 5 years of settlement in refugee camps. These low rates were probably achieved because basic needs of mothers were met, including both the quantity and the micronutrient content of food, water and sanitation, antenatal care, and education. The improvement from 1996 to 1998 coincided with increased availability of micronutrients in the food ration. We hypothesize that increased periconceptional micronutrient intake may be responsible for the increase in birthweight.
Dietary Counseling in the Management of Moderate Malnourishment in Children
Authors: Ashworth Ann , Ferguson Elaine
Published: November 2015

Background

Dietary counseling is an integral part of treating malnutrition. A first step toward improving the management of moderate malnutrition is to evaluate dietary messages in current programs and assess their adequacy and effectiveness.

Objectives

To ascertain current recommendations regarding family foods for the treatment of moderate malnutrition and assess whether these are likely to meet nutritional requirements for rehabilitation; to review the effectiveness of dietary counseling in the management of moderate malnutrition.

Methods

Information was requested from 10 United Nations agencies or donors, 20 international non-governmental organizations, 3 pediatric associations, and 6 national programs about the dietary advice they give to caregivers of moderately malnourished children. Adequacy was assessed by comparing dietary recommendations with nutritional requirements. Linear programming was used to identify problem nutrients. A literature search was conducted of studies using family foods for rehabilitating malnourished children.

Results

There was a greater emphasis on providing food supplements for rehabilitation than on utilizing family foods. Dietary recommendations were mostly vague and unlikely to be effective. Those developed by the World Health Organization and the Food and Agriculture Organization for well-nourished children may meet nutritional requirements in moderate malnutrition if the recommendations are made more prescriptive. Zinc and vitamin E emerged as possible problem nutrients. Intervention studies in wasted children suggest that counseling caregivers about family foods can achieve good rates of weight gain.

Conclusions

Dietary counseling can be effective in managing malnutrition, but it is often weak or absent and should be strengthened. More attention will need to be given to formulating the messages and improving counseling skills.
Preventing low Birthweight through Maternal Multiple Micronutrient Supplementation: A Cluster-Randomized, Controlled Trial in Indramayu, West Java
Authors: Sunawang  , Utomo Budi , Hidayat Adi , Kusharisupeni  , Subarkah
Published: November 2015

Background

Micronutrient deficiencies may contribute to a higher incidence of low birthweight (LBW). UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micronutrient supplement for pregnant women, and several effectiveness trials were conducted to assess its impact.

Objective

To evaluate the efficacy of prenatal multiple micronutrient supplementation for improving birth size, pregnancy outcome, and maternal micronutrient status in comparison with iron–folic acid supplementation.

Methods

We carried out a cluster-randomized, controlled trial in Indramayu, Indonesia, involving 843 pregnant women. Of these, 432 received multiple micronutrients and 411 received iron–folic acid. Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality.

Results

The mean number of supplements consumed during pregnancy and 30 days postpartum was high (136 in the group receiving multiple micronutrients and 140 in the iron–folic acid group). The women consumed the supplements on average 5 days per week. Although there were no significant differences between the groups in the percentage of infants with LBW, there was a trend toward a lower incidence of LBW in the group receiving multiple micronutrients (6.3% vs. 7.3%), and the mean birthweight was 40 g higher in the group receiving multiple micronutrients than in the iron–folic acid group, although the difference was not significant. Among those who consumed 90 or more supplements during pregnancy, women taking multiple micronutrients had a 3.3% combined rate of miscarriage, stillbirth, or neonatal death, as compared with 6.9% for those taking iron–folic acid only (p < .049). The anemia rates in the two groups were similar after supplementation, even though the amount of iron in the multiple micronutrient supplement was half that in the iron–folic acid supplement. Serum retinol was higher in the group receiving multiple micronutrients.

Conclusions

Multivitamin supplementation use among pregnant women is as effective as iron–folic acid in improving anemia status and appears to have other benefits for maternal and child nutritional status.
INCAP Studies of Endemic Goiter and its Prevention
Authors: Scrimshaw Nevin S.
Published: November 2015

The high prevalence of goiter among adults in its member countries of Central America and Panama was observed as soon as INCAP began field studies. This led to systematic studies of goiter in schoolchildren in all of the countries as described, beginning with Guatemala where the rate was 38% nationally.

However, efforts to eliminate the consequences of iodine with iodized salt using the water soluble potassium iodate and a process that had proved successful in Switzerland and the United States could not be used with the crude moist salt of the region. INCAP identified potassium iodate that is insoluble in water, and in four schools (two each in El Salvador and Guatemala) proved that the iodine in this compound was as available as that in potassium iodate. It remained evenly distributed in moist salt.

When added to salt in Guatemala, goiter rate dropped to 15% in four years and less than 5% in eight years. Compulsory iodation of salt in other developing countries followed with comparable results. This method is now used in worldwide campaigns against iodine deficiency in developing countries.
Five Decades of Vitamin A Studies in the Region of Central America and Panama
Authors: Arroyave Guillermo , Mejía Luis A.
Published: November 2015

Vitamin A deficiency in Central America was first identified as a public health problem in the 1950s. It affected primarily children. The main underlying cause was a deficient intake of pre-formed vitamin A, but infection and intestinal parasitism also played important roles. INCAP focused its efforts on overcoming this problem and developed, as a short-term solution, the technology to fortify sugar with vitamin A. Fortification programs were implemented in several Central American countries. Evaluation of these programs revealed a significant impact—not only on vitamin A status, but also on iron nutrition and hematological condition. Longer-term solutions, like increasing the availability and consumption of vitamin A-rich foods, were later suggested and operational tools were developed to assist the countries in the region in the implementation, evaluation and monitoring of their own fortification programs.
Diet and Chronic Diseases: INCAP Studies of Atherosclerosis and Coronary Heart Disease
Authors: Guzmán Miguel A. , Scrimshaw Nevin S.
Published: November 2015

This paper describes early INCAP studies showing that cholesterol and lipoprotein levels were much lower in the low-income populations of Central America than values that were just beginning to emerge from industrialized countries. These led to the collection of aortas and coronary vessels from 14,610 males and 7,906 females from serial autopsies from 12 public general hospitals in developing countries, mostly in Latin America and in New Orleans and Oslo. The severity of atherosclerotic lesions in the samples was evaluated independently by four pathologists after the samples were randomized, who determined that the severity of atherosclerosis progressed so slowly in the developing country samples that it rarely became clinically significant. The strongest correlation with the severity of lesions was the fat content of the diet.
Reflections on the Legacy of INCAP
Authors: Béhar Moisés
Published: November 2015

The second Director of the Institute of Nutrition of Central America and Panama (INCAP) reminisces about the productive program of valuable and practical research at the highest level developed with local personnel in a small and poor developing region. The same was true for the world-class advanced training program that contributed many hundreds of professionals, not only to the region, but to all of Latin America and to other countries. The major contributions of INCAP in its first 25 years are cited along with reasons for its success.
Iodine Status and Availability of Iodized Salt: An Across-Country Analysis
Authors: Horton Sue , Miloff Alexander
Published: November 2015

Background

Iodine deficiency has serious consequences, and the Universal Salt Iodization initiative has attempted to reduce the extent of deficiency.

Objective

We aim to see how far across-country variations in urinary iodine in school-age children can be explained by environmental factors, particularly soil iodine and the availability of iodized salt.

Methods

We use simple multivariate regression for two separate datasets, one for 30 developing countries, and one for 13 developed countries, using data on availability of iodized salt and soil iodine levels.

Results

Median urinary iodine excretion is significantly and positively related to household availability of iodized salt (elasticity, 0.73) for developing countries, but the soil coefficient is not significant, probably because the dummy variable is not well measured. For the developed countries, there is a positive and significant effect of salt penetration rates (elasticity, 0.83) and a positive and significant effect of soil iodine (elasticity, 0.77). There is also a suggestion that countries with more serious soil deficits are more likely to iodize salt, so that univariate regressions of urinary iodine excretion on salt availability or penetration rates underestimate the beneficial effects of iodized salt availability on iodine nutrition.

Conclusions

There are limitations to cross-sectional (ecologic) studies such as this, and the data are not perfect. Nevertheless, the results provide support for policies to iodize salt, given the widespread deficiency of iodine in diets worldwide.
Determinants of Infant and Young Child Feeding Practices in Nepal: Secondary Data Analysis of Demographic and Health Survey 2006
Authors: Pandey Sharada , Tiwari Kalpana , Senarath Upul , Agho Kingsley E. , Dibley Michael J. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background

Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority.

Objective

To estimate infant and young child feeding indicators and the determinants of selected feeding practices.

Methods

The sample consisted of 1,906 children aged 0 to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses.

Results

Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel.

Conclusions

Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued.
Prevalence of Prehypertension and Hypertension among Adolescent High School Girls in Tabriz, Iran
Authors: Rafraf Maryam , Gargari Bahram Pourghassem , Safaiyan Abdolrasol
Published: November 2015

Background

There are few studies of the prevalence of elevated blood pressure that include Iranian adolescent girls.

Objective

The aim of this cross-sectional study was to determine the blood pressure status and its relationship with body mass index (BMI) in adolescent girls attending high school in Tabriz, Iran.

Methods

A sample of 985 girls was selected by stepwise random sampling from five districts of Tabriz. Blood pressure, weight, and height of the subjects were measured and BMI was calculated. Blood pressure measurements were categorized as normal, prehypertension, or hypertension using the 2004 Fourth Report blood pressure screening recommendations. Overweight and obesity were defined according to International BMI Cut Off Points for adolescents.

Results

The prevalence rates of of prehypertension and hypertension were 13.9% and 19.4%, respectively. Obesity and overweight were seen in 2.8% and 16.4% of subjects, respectively. The prevalence rates of hypertension and prehypertension increased with increasing BMI.

Conclusions

Hypertension and prehypertension were highly prevalent in the studied adolescent girls. Obesity was associated with an increased risk of elevated blood pressure. Further studies are needed to identify other risk factors for high blood pressure in our studied population. Routine blood pressure measurements in adolescent girls of our community are suggested to prevent high blood pressure in adolescence and its complications in later life.
Household Food Insecurity and Nutritional Status of Children Aged 6 to 23 Months in Kailali District of Nepal
Authors: Osei Akoto , Pandey Pooja , Spiro David , Nielson Jennifer , Shrestha Ram , Talukder Zaman , Quinn Victoria , Haselow Nancy
Published: November 2015

Background

Food insecurity and malnutrition among children are common in Nepal. However, inadequate data exist on the association between household food insecurity and the nutritional status of children.

Objective

To assess the relationship between household food insecurity and malnutrition among children aged 6 to 23 months in Kailali District of Nepal.

Methods

We analyzed data from families of 368 children 6 to 23 months of age who completed a cross-sectional survey in January 2009. The data contained information on sociodemographic characteristics, food insecurity, child feeding practices, use of preventive health services, and height, weight, and hemoglobin levels of children and mothers.

Results

More than two-thirds (69%) of households were classified as food insecure (had insufficient access to adequate food). The prevalence rates of stunting, underweight, and wasting among children were 41%, 24%, and 9%, respectively. The prevalence of anemia was 58%. There were no significant associations between household food insecurity and stunting, underweight, or anemia. Stunting and underweight were associated with maternal height and household wealth ( p < .05). Underweight was also associated with maternal education ( p < .05). Anemia was associated with low maternal hemoglobin concentration ( p < .05).

Conclusions

Food insecurity was common in households with children 6 to 23 months of age in Kailali District of Nepal. The rates of stunting, underweight, wasting, and anemia were also high. However, there was no significant association between household food insecurity and malnutrition among children. Therefore, not just access to food, but an integrated approach that improves the overall socioeconomic well-being of families, maternal education, and knowledge of optimal nutrition practices, together with adequate maternal nutrition, is needed to address malnutrition among young children.
Correspondence of Hemoglobin Values Obtained by a Noninvasive, Cutaneous-Contact Method with Values Obtained by Conventional Methods from Whole Blood Samples in a Guatemalan Field Setting
Authors: Crowley Caitlin , Montenegro-Bethancourt Gabriela , Arriaga Claudia , Solomons Noel W. , Schümann Klaus
Published: November 2015

Background

Anemia is a widespread public health issue, conventionally diagnosed by analyzing the hemoglobin concentration in whole blood samples. Aspects of safety, comfort, and cultural acceptability would be obviated if reliable, noninvasive anemia screening were available.

Objective

To determine day-to-day variations within subjects in hemoglobin measurements and the correspondence of hemoglobin values obtained by a noninvasive, photometric, cutaneous-contact method with values obtained by conventional methods from blood samples.

Methods

The hemoglobin level was determined in 40 pregnant women from the Guatemalan coastal plain (low values) and 40 men from the highlands (high values). Hemoglobin concentrations (g/dl) were measured in an automated cell counter and, in parallel, estimated with the use of the Rad-87™ Rainbow pulse CO-Oximeter placed over the nail bed of the ring finger.

Results

The mean value for invasively determined hemoglobin was 13.5 g/dl, as compared with 12.2 and 12.1 g/dl for the noninvasive nail-bed estimate at 10 and 5 minutes, respectively. Measurements using the noninvasive technology were highly stable within days and from day to day. The noninvasive screening method showed satisfactory sensitivity and specificity at hemoglobin concentrations of < 12.0 g/dl (cutoff value for nonpregnant women) and < 13.0 g/dl (cutoff value for adult men). Diagnostic discrimination was poorer for the lower cutoff criteria; the anemia cutoff values were < 11.5 g/dl for school-age children and < 11.0 g/dl for pregnant women and children under 5 years of age.

Conclusions

Noninvasive hemoglobin screening shows considerable promise, although improvement of sensitivity and specificity in the anemic range and determination periods of less than 10 minutes are desirable.
Validity and Reliability of Mothers' Reports of Language Development in 1-Year-Old Children in a Large-Scale Survey in Bangladesh
Authors: Hamadani Jena D. , Baker-Henningham Helen , Tofail Fahmida , Mehrin Fardina , Huda Syed N. , Grantham-McGregor Sally M.
Published: November 2015

Background

In developing countries, it is often important to have measures of development in children under 3 years of age in large-scale surveys or evaluations of nutrition and stimulation programs. However, there is a lack of suitable instruments with established validity.

Objective

To develop a language test for children aged 12 to 18 months based on mothers' report, suitable for use in large-scale surveys, and examine its concurrent and predictive validity. To determine whether the test is sensitive to home stimulation and nutritional status and compare the test with the Bayley Scales of Infant Development (BSID).

Methods

A subsample of participants in a large, prospective cohort study in rural Bangladesh (MINIMat) was selected for a study of child development ( n = 2,852). A total of 2,418 participants were interviewed concerning their children's expressive and receptive vocabulary, and children were tested using the BSID.

Results

The language test had reasonable short- and long-term reliability between 12 and 18 months ( r = 0.50) and concurrent validity with the Bayley Mental Development Index (MDI) ( r = 0.32 language comprehension to 0.41 language expression). Its predictive validity with IQ at age 5 years was similar to that of the Bayley MDI ( r = 0.37 to 0.41 for language and r = 0.37 for MDI). Child language was independently associated with postnatal growth, stimulation in the home, gestational age, and socioeconomic status, and a similar set of variables predicted the Bayley MDI.

Conclusions

The language test was reliable, had acceptable concurrent and predictive validity, and was sensitive to environmental and child characteristics. Mothers' reports of language could be useful in large-scale programs.
The Impact of Orphanhood on Food Security in the High-HIV Context of Blantyre, Malawi
Authors: Rivers Jonathan , Mason John B. , Rose Donald Diego , Eisele Thomas P. , Gillespie Stuart , Mahy Mary , Monasch Roeland
Published: November 2015

Background

A 2004 UNICEF/UNAIDS/USAID survey in Blantyre, Malawi, examined methods to improve monitoring and evaluation of interventions aimed at orphans and vulnerable children.

Objective

A derivative of this larger study, the present study utilized the household data collected to assess differences in food security status among orphan households with the aim of helping food security programmers focus resources on the households most affected.

Methods

Orphan households were classified by number and type of orphans supported. Descriptive analyses and logistic regressions were performed to assess differential vulnerability to food insecurity according to these classifications.

Results

Multiple-orphan households and multiple-orphan households that cared for at least one foster child were 2.42 and 6.87 times more likely to be food insecure, respectively, than nonorphan households. No other category of orphan household was at elevated risk.

Conclusions

The food security impact of caring for orphans varied significantly among orphan households, requiring food security planners to focus resources on the households most heavily impacted by HIV/AIDS, including multiple-orphan households, rather than focusing on conventional designations of vulnerability, such as orphans and vulnerable children.
Social Protection Networks in Central America and the Dominican Republic: Do They Have a Nutritional Dimension?
Authors: Cespedes Angela , Lechtig Aaron , Francischi Rachel
Published: November 2015

background

It is not known whether the social protection networks in the Central American subregion and the Dominican Republic have a nutritional dimension.

Objective

To explore whether the social protection networks in Central America and the Dominican Republic have a nutritional dimension.

Methods

A survey was conducted during 2009 of 110 social protection programs and 10 national plans in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic.

Results

Most of the social protection programs did not have a nutritional dimension.

Conclusions

With few exceptions, the social protection programs were not prepared to prevent undernutrition. There may be a similar situation in other regions. It is recommended to incorporate the nutritional dimension into all social protection programs and social safety nets in Central America and the Dominican Republic as well as in all other countries with low-income populations, worldwide.
Meat Consumption is Associated with Less Stunting among Toddlers in Four Diverse Low-Income Settings
Authors: Krebs Nancy F. , Mazariegos Manolo , Tshefu Antoinette , Bose Carl , Sami Neelofar , Chomba Elwyn , Carlo Waldemar , Goco Norman , Kindem Mark , Wright Linda L. , Hambidge K. Michael ,   Complementary Feeding Study Group
Published: November 2015

Background

Early growth faltering is common but is difficult to reverse after the first 2 years of life.

Objective

To describe feeding practices and growth in infants and young children in diverse low-income settings prior to undertaking a complementary feeding trial.

Methods

This cross-sectional study was conducted through the Global Network for Women's and Children's Health Research in Guatemala, Democratic Republic of Congo, Zambia, and Pakistan. Feeding questionnaires were administered to convenience samples of mothers of 5- to 9-month old infants and 12- to 24-month-old toddlers. After standardized training, anthropometric measurements were obtained from the toddlers. Following the 2006 World Health Organization Growth Standards, stunting was defined as length-for-age < −2SD, and wasting as weight-for-length < −2SD. Logistic regression was applied to evaluate relationships between stunting and wasting and consumption of meat (including chicken and liver and not including fish).

Results

Data were obtained from 1,500 infants with a mean (± SD) age of 6.9 ± 1.4 months and 1,658 toddlers with a mean age of 17.2 ± 3.5 months. The majority of the subjects in both age groups were breastfed. Less than 25% of the infants received meat regularly, whereas 62% of toddlers consumed these foods regularly, although the rates varied widely among sites. Stunting rate ranged from 44% to 66% among sites; wasting prevalence was less than 10% at all sites. After controlling for covariates, consumption of meat was associated with a reduced likelihood of stunting (OR = 0.64; 95% CI, 0.46 to 0.90).

Conclusions

The strikingly high stunting rates in these toddlers and the protective effect of meat consumption against stunting emphasize the need for interventions to improve complementary feeding practices, beginning in infancy.
On the Transition to Sustainability: An Analysis of the Costs of School Feeding Compared with the Costs of Primary Education
Authors: Bundy Donald , Burbano Carmen , Gelli Aulo , Risley Claire , Neeser Kristie
Published: November 2015

Background

The current food, fuel, and financial crises have highlighted the importance of school feeding programs both as a social safety net for children living in poverty and food insecurity, and as part of national educational policies and plans.

Objective

To examine the costs of school feeding, in terms of both the absolute cost per child and the cost per child relative to overall education expenditure and gross domestic product (GDP) in low-, middle-, and high-income countries.

Methods

Data on the costs of school feeding in different countries were collected from multiple sources, including World Food Programme project data, reports from government ministries, and, where such searches failed, newspaper articles and other literature obtained from internet searches. Regression models were then used to analyze the relationships between school feeding costs, the per capita costs of primary education and GDP per capita.

Results

School feeding programs in low-income countries exhibit large variations in cost, with concomitant opportunities for cost containment. As countries get richer, however, school feeding costs become a much smaller proportion of the investment in education. The per capita costs of feeding relative to education decline nonlinearly with increasing GDP.

Conclusions

These analyses suggest that the main reason for this decline in the relative cost of school feeding versus primary education is a greatly increased investment per child in primary education as GDP rises, but a fairly flat investment in food. The analyses also show that there appears to be a transitional discontinuity at the interface between the lower- and middle-income countries, which tends to coincide with changes in the capacity of governments to take over the management and funding of programs. Further analysis is required to define these relationships, but an initial conclusion is that supporting countries to maintain an investment in school feeding through this transition may emerge as a key role for development partners.
Effects of Multimicronutrient Home Fortification on Anemia and Growth in Bhutanese Refugee Children
Authors: Bilukha Oleg , Howard Christopher , Wilkinson Caroline , Bamrah Sapna , Husain Farah
Published: November 2015

Background

Anemia remains a significant public health problem in refugee settings. Home fortification with micronutrient powders has been proposed as a feasible option to alleviate micronutrient deficiencies; its efficacy in reducing anemia in children aged 6 to 24 months has been demonstrated in several trials.

Objective

To evaluate the effectiveness of a large-scale micronutrient powder distribution program in reducing anemia prevalence and promoting growth in refugee children aged 6 to 59 months.

Methods

Four representative cross-sectional surveys were conducted 13 months before and 7, 14, and 26 months after initiation of the supplementation program. Data collected on children aged 6 to 59 months included hemoglobin concentration, anthropometric indicators, morbidity, feeding practices, and information on the micronutrient distribution program. The study had a pre—post design with no control group.

Results

The overall prevalence of anemia in children did not change significantly between baseline (43.3%) and endpoint (40.2%). The prevalence of moderate anemia decreased over the same period from 18.9% to 14.4% ( p < .05). The levels of severe anemia were negligible (< 1%) in all surveys. The prevalence of stunting decreased significantly from 39.2% at baseline to 23.4% at endpoint ( p < .001), a relative decrease of 40%. Reported coverage, use, and acceptance of micronutrient supplements remained consistently high throughout the study.

Conclusions

In the absence of a control group, changes in key outcomes should be interpreted with caution. The minor effect on hemoglobin status requires further investigation of underlying causes of anemia in this population. The large positive effect on linear growth may be a significant benefit of supplementation if confirmed by future studies.
Understanding Low Usage of Micronutrient Powder in the Kakuma Refugee Camp, Kenya: Findings from a Qualitative Study
Authors: Kodish Stephen , Rah Jee Hyun , Kraemer Klaus , de Pee Saskia , Gittelsohn Joel
Published: November 2015

Background

Home fortification with micronutrient powder has been shown to be a low-cost, feasible, and effective approach to address micronutrient deficiencies. A large-scale program distributing micronutrient powder to approximately 50,000 refugees was implemented at the Kakuma Refugee Camp in Kenya. Uptake of the micronutrient powder at distribution points dropped nearly 70%, from 99% to a low of 30%, and remained at 45% to 52% despite increased social marketing efforts.

Objective

To identify factors at the distal and proximal levels leading to the low uptake of micronutrient powder through a qualitative inquiry.

Methods

In-depth interviews were conducted with community leaders, stakeholders, implementing partners, and beneficiaries. Direct observations of food preparation and child feeding were conducted. Focus group discussions were employed to examine perceptions and practices of beneficiaries regarding micronutrient powder use.

Results

Superficial formative research and lack of interagency coordination led to insufficient social marketing prior to the program. In addition, community health workers were inadequately trained. This resulted in inadequate communication regarding the health benefits and use of micronutrient powder to the beneficiaries. Reliance on personal experiences with micronutrient powder and issues with its packaging, in part, led to confusion and deleterious rumors, resulting in decreased uptake of micronutrient powder at distribution points.

Conclusions

A successful micronutrient powder program requires careful design, with emphasis on conducting thorough formative research, ensuring the involvement and commitment of all stakeholders from the outset, investigating the role of cultural factors, and ensuring provision of sufficient, adequate, and timely information to the beneficiaries.
Econutrition and Utilization of Food-Based Approaches for Nutritional Health
Authors: Blasbalg Tanya L. , Wispelwey Bram , Deckelbaum Richard J.
Published: November 2015

Background

Macronutrient and micronutrient deficiencies continue to have a detrimental impact in lower-income countries, with significant costs in morbidity, mortality, and productivity. Food is the primary source of the nutrients needed to sustain life, and it is the essential component that links nutrition, agriculture, and ecology in the econutrition framework.

Objective

To present evidence and analysis of food-based approaches for improving nutritional and health outcomes in lower-income countries.

Methods

Review of existing literature.

Results and conclusions

The benefits of food-based approaches may include nutritional improvement, food security, cost-effectiveness, sustainability, and human productivity. Food-based approaches require additional inputs, including nutrition education, gender considerations, and agricultural planning. Although some forms of malnutrition can be addressed via supplements, food-based approaches are optimal to achieve sustainable solutions to multiple nutrient deficiencies.
Assessment of Epidemiologic, Operational, and Sociopolitical Domains for Mainstreaming Nutrition
Authors: Menon Purnima , Frongillo Edward A. , Pelletier David L. , Stoltzfus Rebecca J. , Ahmed A.M. Shamsir , Ahmed Tahmeed
Published: November 2015

Although undernutrition impacts a range of short- and long-term outcomes, nutrition often has low priority on global and national development policy agendas because of overemphasis on technical solutions without adequate consideration of contextual and political factors. An approach is needed for strategic development of nutrition agendas that embraces the contexts influencing policy and program planning and implementation, while addressing salient causes of undernutrition. We describe a simple, comprehensive assessment approach to enable development of sound nutrition strategies and well-grounded effective and appropriate actions for nutrition in a given context. The conceptual framework for this assessment approach incorporates three domains, each essential for defining strategic actions for nutrition: epidemiologic, pertaining to the nutritional situation and the evidence about the efficacy and effectiveness of nutrition interventions; operational, pertaining to coverage, quality, and utilization of nutrition-related interventions and programs as well as capacities, opportunities, and constraints to improving these; and sociopolitical, pertaining to social, political, cultural, and organizational factors at various levels, which may enhance or inhibit efforts to create positive changes in policies and programs. The domains are interlinked, and the sociopolitical domain often underlies the other two domains. Using this framework can reveal important insights for the nutrition policy agenda that were hitherto not considered explicitly in efforts to advance nutrition. This is highlighted in an example from Vietnam and through other papers in this Supplement. Use of this three-domain assessment framework can greatly aid development of feasible and actionable nutrition strategies that are grounded in epidemiologic, operational, and sociopolitical realities.
Enhancing Processes for Introduction, Production, Quality Assurance, and Delivery of US Title II Food Aid Products
Authors: Schlossman Nina , Webb Patrick , Bagriansky Jack , Johnson Quentin , Rogers Beatrice , Tilahun Jessica , Masterson Amelia Reese
Published: November 2015

Background

Enacted in 1950, Public Law 480 (PL480) dramatically increased the volume of U.S. food aid and the scope of interventions it supports. Billions of dollars have been invested, both to enhance the diets of chronically undernourished people in development settings, and to support nutritional needs during conflicts and natural disasters.

Objective

Review the institutional processes—from procurement to delivery—that support this programming.

Methods

We examined the systems that govern and oversee the many components of food aid programming and the extent to which they support a whole-of-government, multi-agency food aid agenda. We conducted consultations with US government employees and contractors, academics, industry representatives, donor agency staff, United Nations personnel, and field-level food aid programming technical staff from many countries. A survey of USAID implementing partners conducted among 64 responding offices in 40 countries provided data on the use and effectiveness of enriched, fortified, or blended Title II commodities, the use of new commodities, and related procurement or logistics aspects. Expert panels provided input and feedback throughout the process.

Results

We identified potential improvements to overall delivery and cost-effectiveness of USAID programming to better meet the nutrition needs of beneficiaries. Options include changes in product formulation, the range of products provided, and/or the modes of product approval, processing, procurement, and distribution. This research points to several improvements in processes related to food aid: 1) Establish an interagency committee to oversee all government interests in the food aid agenda through an ongoing review process. 2) Enhance processes and quality assurance along the product value chain including the importance of effective interaction with the private sector to incorporate industry best practices and create public—private partnerships to promote product innovations. 3) Strengthen the evidence base for innovations in products, programming approaches, and institutional processes.

Conclusion

Successful programming requires knowledge and understanding of the unit cost of impact, not simply tonnage and “numbers of hungry people fed”. Empirical rigor is essential; any significant program changes, including those recommended here, should be tested and monitored.