bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Impact of Vitamin A Supplementation Delivered with Oral Polio Vaccine as Part of the Immunization Campaign in Orissa, India
Authors: Gorstein Jonathan , Bhaskaram P. , Khanum Sultana , Hossaini Reza , Balakrishna N. , Goodman Tracey S. , deBenoist Bruno , Krishnaswamy Kamala
Published: November 2015

A study was carried out in Orissa, India, to evaluate the impact on vitamin A status of vitamin A supplementation integrated with an immunization campaign. Data were collected from a representative sample of 1,811 children, aged 12 to 48 months, at baseline and then at 4 and 16 weeks following implementation of vitamin A supplementation. The primary outcome indicator was serum retinol. The coverage of vitamin A supplementation was 97%. There was a significant decline in the prevalence of Bitot's spots from 2.9% to 1.9% at 4 weeks, but the prevalence increased to 3.6% by 16 weeks. Serum retinol concentrations increased between baseline and 4 weeks (from 0.62 ± 0.32 to 0.73 ± 0.23 μmol/L, p < .001) but then decreased to 0.50 ± 0.19 μmol/l at 16 weeks, which was significantly lower than at baseline (p < .001). The greatest increase in serum retinol from baseline to 4-week follow-up was among children with lowest baseline serum retinol and children with Bitot's spots at baseline. This study demonstrates the short-term benefits of vitamin A supplementation to be significant, especially for those whose status is most compromised. At the same time, the benefit of vitamin A supplementation in this population was transient. The impact of the vitamin A could not be sustained for the full 16 weeks in the study population. This finding calls for exploration of other means to improve vitamin A status, perhaps by adjusting the vitamin A supplementation schedule with more aggressive measures to improve intake of foods rich in bioavailable vitamin A, such as small amounts of animal foods or fortified foods. The study demonstrates the feasibility of integrating vitamin A supplementation with immunization campaigns.
Combating Hidden Hunger: The Role of International Agencies
Authors: Dalmiya Nita , Schultink Werner
Published: November 2015

The importance of micronutrient deficiencies or “hidden hunger” was clearly emphasized by the inclusion of specific goals on iron, vitamin A, and iodine deficiency at the 1990 World Summit for Children and other major international nutrition conferences. Significant progress has since been made toward eliminating vitamin A and iodine deficiencies, with less progress made toward reducing the burden of iron-deficiency anemia. The role of international agencies, such as the World Health Organization, United Nations Children's Fund, Food and Agricultural Organization, and World Bank in assisting countries to make progress toward the World Summit for Children goals has been very important. International agencies have played a critical role in advocating for and raising awareness of these issues at the international, regional, and national levels among policymakers and the general population. Using a rights-based approach, UNICEF and other agencies have been instrumental in elevating to the highest political level the discussion of every child's right to adequate nutrition. International agencies have also been very supportive at the national level in providing technical guidance for programs, including monitoring and evaluation. These agencies have played a critical role in engaging the cooperation of other partners, including bilateral donors, non-governmental organizations, and the private sector for micronutrient programs. Furthermore, international agencies provide financial and material support for micronutrient programs. In the future, such agencies must continue to be heavily involved in programs to achieve the newly confirmed goals for 2010.

The present paper focuses on the role of international agencies in combating micronutrient deficiencies, drawing on the lessons learned over the last decade. The first section of the paper summarizes the progress achieved since 1990, and the second section describes the specific role of international agencies in contributing to that progress.
Lessons from Successful Micronutrient Programs Part I: Program Initiation
Authors: Deitchler Megan , Mason John , Mathys Ellen , Winichagoon Pattanee , Tuazon Ma Antonia
Published: November 2015

Internationally recognized research findings on the potential health benefits of preventing micronutrient deficiencies—especially reduced child mortality from vitamin A deficiency and prevention of in utero developmental damage and mental retardation from iodine deficiency—have contributed to raising the awareness of deficiencies and the commitment of many governments to their reduction or near-elimination. The procedures undertaken to decide on large-scale programs followed conventional patterns in the 12 countries included in this study (11 Asian countries plus South Africa). Thus, a sequence of national surveys, institutional arrangements through intersectoral technical committees, legislation, incorporation of programs into national plans, and resource mobilization, including external assistance, was similar for all three micronutrients. Vitamin A supplementation twice yearly to children, then to women postpartum, has reached the national level. Iodized salt is universally adopted at the national level in most countries, with a need for continuing efforts to reach underserved populations and to implement legislation and quality control. Iron programs, usually aiming at daily supplementation during pregnancy, have been pursued, but with less intensity. However, it is clear that these procedures have succeeded in creating a rapid expansion of large-scale deficiency-control programs, which while evolving are generally being maintained.
Fast and Reliable Salt Iodine Measurement: Evaluation of the Wyd Iodine Checker in Comparison with Iodometric Titration
Authors: Dearth-Wesley Tracy , Makhmudov Amir , Pfeiffer Christine M. , Caldwell Kathleen
Published: November 2015

Iodine deficiency persists as the leading cause of preventable brain damage and reduced intellectual capacity in the world. The most effective method for the elimination of iodine deficiency is the consumption of adequately iodized salt. Ensuring that a population receives adequately iodized salt demands careful monitoring of the salt iodine content. We evaluated the WYD Iodine Checker, a hand-held instrument that quantitatively measures the salt iodine content on the basis of a colorimetric method, and compared its performance with iodometric titration. Performance testing results indicated that the WYD Iodine Checker is a highly precise, accurate, and sensitive tool for measuring salt iodine content. It is a user-friendly instrument that is based on a simple methodology and a straightforward salt sample preparation and testing procedure. We recommend further testing to examine the field performance of the WYD Iodine Checker when measuring iodate salt samples.
Adding An Oxidant Increases the Stability of Iodine in Iodized Salt
Authors: Shi Huimin
Published: November 2015

It has been shown that moisture plays a critical role in the stability of iodine and that reducing agents in iodized salt reduce the stability of iodine. We question whether this is valid in all cases, and have found that the reducing agent may play a more important role than moisture in decreasing the stability of iodine.

We reviewed current methods to enhance iodine retention in iodized salt, and propose methods to produce stable iodized salt and to analyze its stability. Our experiments showed that when reducing impurities are removed, iodine remains stable in iodized salt, even when the salt is “wet.”

We suggest that the stability of iodine in iodized salt can be improved by oxidizing iodized salt with sodium hypochloride, and that the iodine content of iodized salt, after heating at 120°C for one hour, can be used to reflect the quality of iodized salt. We have demonstrated that reducing agents play a critical role in the stability of iodine in iodized salt.

We have shown a method of purifying salt by removing reducing materials, which can be used to produce iodized salt with sufficient stability at lower cost. We also propose an analytical method to determine the stability of iodine in iodized salt. These methods could be further developed to achieve better accuracy, precision, and reliability and be applied to a greater variety of iodized salts.
The National Vitamin A Supplementation Program and Subclinical Vitamin A Deficiency among Preschool Children in the Philippines
Authors: Pedro M. R. A. , Madriaga J. R. , Barba C. V. C. , Habito R. C. F. , Gana A. E. , Deitchler M. , Mason J. B.
Published: November 2015

The prevalence of vitamin A deficiency (serum retinol [SR] < 20 μg/dl) in children from one to five years of age in the Philippines rose from 35.8% to 38% between 1993 and 1998, despite a twice-yearly universal vitamin A capsule distribution program. The Philippines 1998 National Nutrition Survey, with one-time SR measurements from 11,620 children from one to four years of age, collected over an eight-month period from one month to more than six months after distribution of vitamin A capsules, was an opportunity to examine the impact of the program on the children's vitamin A status, using post hoc analysis. Overall, a detectable impact of vitamin A capsules on SR was limited to groups with the highest prevalence of vitamin A deficiency and lasted up to four months after dose administration. In highly urban cities in Visayas, where very high prevalences of deficient SR (SR < 10 μg/dl) were found, the prevalence of deficient SR was reduced from 27% to 9% one to two months after distribution of vitamin A capsules, and to 16% at three to four months. In Mindanao, a statistically significant reduction from 38% to 32% was seen in the prevalence of deficient to low SR (SR < 20 μg/dl) one to four months after distribution of vitamin A capsules. There was no overall reduction in the prevalence of vitamin A deficiency or deficient and low SR (SR < 20 μg/dl) in Luzon, but a significant interaction with stunting was observed in Luzon non-highly urbanized cities. Two aspects are of concern. First, the magnitude of the effect of high-dose vitamin A capsules on SR, and hence on the extent of reduction in deficiency, is limited. Second, the effect does not persist for six months, which is the interval between doses. Thus there is no decrease in the prevalence of deficiency over time. With more frequent dosing (especially to those most deficient in SR), a progressive reduction in vitamin A deficiency could, however, be expected; this hypothesis could be tested. The policy implication arising from these results is that a shift in resources is warranted. In areas of low prevalence of vitamin A deficiency, distribution of vitamin A capsules should be targeted to stunted children. In areas of high prevalence, vitamin A capsules should be distributed to children one to five years old at least three times a year.
Measurement and Standardization Protocols for Anthropometry Used in the Construction of a New International Growth Reference
Authors: de Onis Mercedes , Onyango Adelheid W. , Van den Broeck Jan , Chumlea Wm. Cameron , Martorell Reynaldo
Published: November 2015

Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings.
Managing Data for a Multicountry Longitudinal Study: Experience from the who Multicentre Growth Reference Study
Authors: Onyango Adelheid W. , Pinol Alain J. , de Onis Mercedes
Published: November 2015

The World Health Organization (WHO) Multicentre Growth Reference (MGRS) data management protocol was designed to create and manage a large data bank of information collected from multiple sites over a period of several years. Data collection and processing instruments were prepared centrally and used in a standardized fashion across sites. The data management system contained internal validation features for timely detection of data errors, and its standard operating procedures stipulated a method of master file updating and correction that maintained a clear trail for data auditing purposes. Each site was responsible for collecting, entering, verifying, and validating data, and for creating site-level master files. Data from the sites were sent to the MGRS Coordinating Centre every month for master file consolidation and more extensive quality control checking. All errors identified at the Coordinating Centre were communicated to the site for correction at source. The protocol imposed transparency on the sites’ data management activities but also ensured access to technical help with operation and maintenance of the system. Through the rigorous implementation of what has been a highly demanding protocol, the MGRS has accumulated a large body of very high-quality data.
Implementation of the who Multicentre Growth Reference Study in Ghana
Authors: Lartey Anna , Owusu William B. , Sagoe-Moses Isabella , Gomez Veronica , Sagoe-Moses Charles
Published: November 2015

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) African site was Accra, Ghana. Its sample was drawn from 10 affluent residential areas where earlier research had demonstrated the presence of a child subpopulation with unconstrained growth. This subpopulation could be identified on the basis of the father's education and household income. The subjects for the longitudinal study were enrolled from 25 hospitals and delivery facilities that accounted for 80% of the study area's births. The cross-sectional sample was recruited at 117 day-care centers used by more than 80% of the targeted subpopulation. Public relations efforts were mounted to promote the study in the community. The large number of facilities involved in the longitudinal and cross-sectional components, the relatively large geographic area covered by the study, and the difficulties of working in a densely populated urban area presented special challenges. Conversely, the high rates of breastfeeding and general support for this practice greatly facilitated the implementation of the MGRS protocol.
Implementation of the who Multicentre Growth Reference Study in India
Authors: Bhandari Nita , Taneja Sunita , Rongsen Temsunaro , Chetia Jyotsna , Sharma Pooja , Bahl Rajiv , Kashyap Dharmendra Kumar , Bhan Maharaj K.
Published: November 2015

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) Asian site was New Delhi, India. Its sample was drawn from 58 affluent neighborhoods in South Delhi. This community was selected to facilitate the recruitment of children who had at least one parent with 17 or more years of education, a key factor associated with unconstrained child growth in this setting. A door-to-door survey was conducted to identify pregnant women whose newborns were subsequently screened for eligibility for the longitudinal study, and children aged 18 to 71 months for the cross-sectional component of the study. A total of 111,084 households were visited over an 18-month period. Newborns were screened at birth at 73 sites. The large number of birthing facilities used by this community, the geographically extensive study area, and difficulties in securing support of pediatricians and obstetricians for the feeding recommendations of the study were among the unique challenges faced by the implementation of the MGRS protocol at this site.
Implementation of the who Multicentre Growth Reference Study in Norway
Authors: Baerug Anne , Bjoerneboe Gunn-Elin A. , Tufte Elisabeth , Norum Kaare R.
Published: November 2015

The World Health Organization (WHO) Multicentre Growth Reference Study (MRGS) European site was Oslo, Norway. Oslo has a high breastfeeding rate. Ninety-nine percent of mothers initiate breastfeeding soon after delivery, and 80% continue for at least six months. There is no evidence that socioeconomic conditions constrain growth. As in other sites, the study had two components, longitudinal and cross-sectional. Recruitment for the longitudinal component was conducted in three hospitals that account for most births in Oslo. Approximately 850 subjects were screened in one year by using a systematic allocation scheme to recruit a sample of about 300. Recruitment for the cross-sectional component was based on a systematic interval sampling scheme prepared by the National Registry. More than 4,000 subjects were screened to achieve the required sample size. One of the major challenges of the study was to achieve an acceptable participation rate; great efforts were made to motivate pregnant women via the health care system and the media.
Chile's National Nutritional Supplementation Program for Older People: Lessons Learned
Authors: Dangour Alan D. , Moreno Ximena , Albala Cecilia , Rivera-Marquez Alberto , Lera Lydia , Villalobos Alicia , Morris Saul S. , Uauy Ricardo
Published: November 2015

Demographic changes in developing countries have resulted in rapid increases in the size of the older population. As a result, health-care budgets face increasing costs associated with the declining health and function of older people. Some governments have responded to this situation by designing innovative programs aimed at older people. One such program, implemented by the government of Chile, distributes an instant food mix fortified with vitamins and minerals to all persons over 70 years old who are registered by the national health service. The national health service covers approximately 90% of the older population. The program specifically targets nutritional vulnerability and micronutrient deficiency, which are common among poor older people in Chile. We present here the findings of a one-year investigation into all aspects of Chile's program for the elderly. The research included in-depth interviews with policy makers and program implementers, focus group discussions with user groups, analysis of the micronutrient content of the nutritional supplement, and telephone interviews of a random sample of older people. The results demonstrate that there can be a considerable degree of self-targeting within national programs; programs need to be sufficiently flexible to permit periodic protocol change; user groups must be consulted both before and during program implementation; and the design of an effective program evaluation must be in place before program implementation. It is hoped that these results will be useful to policy makers and implementers planning programs aimed at improving the health and function of older people.
Nutrition Knowledge and Practices, and Consumption of Vitamin A–Rich Plants by Rural Nepali Participants and Nonparticipants in a Kitchen-Garden Program
Authors: Jones Katharine M. , Specio Sheila E. , Shrestha Parvati , Brown Kenneth H. , Allen Lindsay H.
Published: November 2015

Food-based nutrition interventions, including kitchen gardens and nutrition education, offer a potentially sustainable approach to reducing multiple nutritional deficiencies, but they have been poorly evaluated in developing countries. In a poor region of the terai (the flat, subtropical agricultural region that borders on India) in rural Nepal, we developed and evaluated the impact of a nutrition program added to the Market Access for Rural Development (MARD) Project. The primary objective of the MARD Project was to augment household income by increasing the production of high-economic-value crops. The objective of the nutrition program was to increase vitamin A and iron intakes by promoting kitchen gardens (training, technical assistance, and seed distribution) and nutrition education. One-third of the kitchen-garden program participants also attended nutrition education or agricultural training sessions that were part of the MARD Project. The program was evaluated after 36 months by a cross-sectional nutrition survey in 430 MARD households with kitchen gardens and 389 non-MARD control households. The lack of knowledge about nutrition, including the causes, prevention, and treatment of night-blindness and anemia, was remarkable. However, compared with control households, the kitchen-gardens group had significantly more nutrition knowledge (38% vs. 13% knew one of the causes of night-blindness, and 17% vs. 3% knew one of the causes of anemia), were more likely to feed special complementary foods to infants and to preserve food, and consumed more of 16 types of home-produced micronutrient-rich vegetables and fruits. Although the cross-sectional nature of the study limits our ability to attribute these differences to the program, we observed a striking lack of nutrition knowledge in these communities, and a clear opportunity to increase the intake of vitamin A through home production of vitamin A–rich plants.
Maternal Employment and Income Affect Dietary Calorie Adequacy in Households in Sri Lanka
Authors: Rathnayake Ishara M. , Weerahewa Jeevika
Published: November 2015

Nutritional deficiencies among children and mothers in lower-income households in Sri Lanka continue to be a major obstacle to the country's social and economic development. This study investigates the factors affecting dietary caloric adequacy in Sri Lanka, paying special attention to maternal income. An econometric analysis was performed using a household data set collected from a sample of 183 low-income households in the urban, rural, and estate sectors. The results showed that on average, mothers and children in the sample did not consume adequate levels of calories according to the recommendations of the Medical Research Institute of Sri Lanka. The mother's income and educational status, the number of children and adults in the family, and the ages, sexes, and birth orders of the children significantly influenced household and individual caloric adequacy. Specifically, the mother's income had a significant positive effect on the total caloric intake (CI) and caloric adequacy ratio (CAR) of the household, mother, and children and a significant negative effect on the relative caloric allocation (RCA) of the children. The results imply that when maternal employment generates extra income, the CIs of all individuals increase, yet the allocation of calories to the children of the household is reduced. Thus, provision of employment opportunities for mothers, along with adequate child-care facilities and nutritional educational programs, is a possible strategy to improve caloric adequacy among low-income households in Sri Lanka.
Nutrient Addition to Corn Masa Flour: Effect on Corn Flour Stability, Nutrient Loss, and Acceptability of Fortified Corn Tortillas
Authors: Rosado Jorge L. , Cassís Lorena , Solano Lourdes , Duarte-Vázquez Miguel A.
Published: November 2015

Background

Iron, zinc, and vitamin B complex are among the most prevalent nutritional deficiencies in Mexico, with iron deficiency being the leading cause of anemia. Mexico has the highest per capita consumption of corn in the world, consumed mainly as tortilla. Thus, corn flour for making tortillas has been suggested as an effective strategy to overcome malnutrition in developing countries such as Mexico where corn is a staple food. The stability of micronutrients added to food is an important factor for the success of fortification programs.

Objective

The aim of this study was to evaluate the stability of corn flour fortified with micronutrients, and to measure the effect of micronutrient fortification on the sensory quality and stability of the fortificants in fresh and stored tortilla.

Methods

A commercially homogenized nonfortified corn flour (NCFC) produced from degermed white corn was fortified with a premix containing iron, zinc, thiamin, and riboflavin. Changes in thiamin, riboflavin, iron, and zinc content in fortified corn flour (FCF) and nonfortified corn flour (NFCF) during storage were investigated. Vitamin B1 and B2 content was determined by fluorescence spectroscopy while iron and zinc content was analyzed by atomic absorption.

Results

Thiamin content in FCF and NFCF showed a significant ( p < .05) decrease (24% and 37%, respectively) after 90 days of storage. Riboflavin losses of 18% and 22% were observed for FCF and NFCF, respectively. FCF retained over 90% of iron, while zinc content remained constant. Losses of thiamin (27 to 39%) and riboflavin (37%) were produced during the process to convert corn masa flour into tortillas.

Conclusions

Storage time slightly affected the stability of riboflavin and thiamin in FCF while the cooking process produced considerable losses of both vitamins. Tortillas made from FCF were well accepted by Mexican adults. We conclude that the addition of vitamins and minerals in the forms and quantities used in this study do not modify the shelf-life of corn flour, and neither do they cause sensorial changes in tortillas made from FCF.
Assessment of the Nutritional Impact of Agricultural Research: The Case of Mungbean in Pakistan
Authors: Weinberger Katinka
Published: November 2015

Background

Evaluation of agricultural research often neglects consumption and nutrition aspects. Yet agricultural research can address micronutrient malnutrition by improving both quantity and quality of food intake.

Objective

To briefly review the conceptual linkages between agriculture and nutrition, to estimate the strength of the relationship between iron intake and productivity outcomes, and to estimate the nutritional benefit of improved mungbean varieties in terms of net present value. This paper presents a methodology for assessing the nutritional impact of mungbean, and summarizes current impact evidence on the path from mungbean research to consumption.

Methods

A consumption study was conducted among female piece-rate workers in Pakistan to analyze the impact of iron consumption on productivity, measured in wages. A two-stage least-squares analysis was used to estimate the elasticity of iron intake on wages. The results derived from this study were extrapolated to country level using secondary data sources.

Results

We found that anemia among women was widespread. Approximately two-thirds of women suffered from mild or severe anemia (Hb < 12 g/dL). We found the elasticity of bioavailable iron on productivity measured in wages was 0.056, and the marginal effect was 9.17 Pakistani rupees per additional mg of bioavailable iron consumed. Using the model results we estimated the impact of mungbean research on nutrition, in terms of productivity effects, and found it was substantial, ranging from US$7.6 to 10.1 million cumulative present value (in 1995 US$ at 5% discount rate).

Conclusions

Agriculture certainly plays an important role in the reduction of malnutrition. Agricultural research has greatly contributed to the reduction of hunger and starvation by providing millions of hungry people with access to low-cost staple foods. Now, as the challenge shifts to the reduction of micronutrient deficiencies, more efforts must be directed toward crops high in micronutrients, such as pulses and vegetables.
Effects of a Food Supplementation Program on the Nutritional Status of Pregnant Women in Bangladesh
Authors: Khan M. Mahmud , Ahmed Shakil , Protik Ali Ehsan , Dhar Badal Chandra , Roy S. K.
Published: November 2015

Background

The Government of Bangladesh implemented a comprehensive nutrition intervention in 1997 to reduce the rates of malnutrition among women and children. The pilot program, the Bangladesh Integrated Nutrition Program (BINP), adopted a multisectoral approach targeting women and children through food supplementation, home gardening, and health and nutrition education.

Objective

This paper estimates the effectiveness of BINP's food supplementation and nutrition education on the nutritional status of pregnant women.

Methods

Three effectiveness measures were considered: target efficiency, improvements in the nutritional status of beneficiaries, and the persistence of nutritional effects. To isolate the effects of the intervention, the nutritional status of participants and nonparticipants was compared after controlling for various demographic and socioeconomic characteristics. Data were collected in 2000 from a random sample of 3,262 households in a BINP intervention area.

Results

Thirty-nine percent of pregnant women were correctly targeted by the program's food supplementation activities. The nutrition program reduced the prevalence of thinness among participant pregnant women by about 3 percentage points per month of enrollment. The prevalence of thinness among program graduates was 62%, which was much higher than that of the matched (nonparticipant) group (35%). This finding is perplexing but it may simply imply that those who enrolled at the initial phase of the project were severely underweight and they fell back to their original status within a short period of time.

Conclusions

The nutrition program was intended to improve the nutritional status of women in the longer run through the provision of nutrition education during the food supplementation phase. The prevalence of thinness or severe underweight in women who exited the program after completion of the enrollment period was found to be much higher than in women of similar age and socioeconomic status in the community. This apparent lack of persistence of program benefits requires careful re-evaluation of alternative mechanisms for improving the long-term nutritional status of women.
Effect of Iron Supplementation during Pregnancy on Birthweight: Evidence from Zimbabwe
Authors: Mishra Vinod , Thapa Shyam , Retherford Robert D. , Dai Xiaolei
Published: November 2015

Background

Iron deficiency in pregnant women has been shown to reduce the oxygen supply to the fetus, cause intrauterine growth retardation, and increase the risk of premature delivery and reduced birthweight. Yet the effects of iron supplementation programs on pregnancy outcomes are not well documented for developing countries.

Objective

To examine the relation between iron supplementation of mothers during pregnancy and children's birthweight using data from a national population-based survey in Zimbabwe.

Methods

The analysis uses information on 3,559 births during the five years preceding the 1999 Zimbabwe Demographic and Health Survey. The effect of iron supplementation during pregnancy on birthweight was estimated by multiple regression, controlling for potential confounding effects of prenatal care, child's sex and birth order, mother's education and nutritional status (measured by body-mass index), household living standard, smoke exposure, and other variables.

Results

Babies born to mothers who received iron supplementation during pregnancy were 103 g heavier (95% confidence interval, 42–164; p = .001), on average, than babies born to mothers who did not receive iron supplementation during pregnancy. The difference was 64 g (95% confidence interval, 2–125; p = .043) for children whose birthweights were taken from health cards and 163 g (95% confidence interval, 44–281; p = .008) for children whose birthweights were reported by their mothers.

Conclusions

Iron supplementation during pregnancy is associated with significantly higher birthweight, independent of other pregnancy care factors, mother's nutritional status, smoke exposure, and a number of demographic and socioeconomic factors. Prenatal iron supplementation programs can improve pregnancy outcomes and promote child survival in developing countries.
Power from Below: Enabling Communities to Ensure the Provision of Iodated Salt in Kyrgyzstan
Authors: Schüth Tobias , Jamangulova Tolkun , Janikeeva Shaken , Tologonov Temir
Published: November 2015

Background

In Kyrgyzstan, as in many countries around the world, progress in universal salt iodization has been slow because of difficulties in enforcing existing national regulations.

Objective

To study the effects of community testing of the iodine content of salt in households, at local retailers, and at wholesale markets on the percentage of households using iodized salt in Naryn Oblast, a region of Kyrgyzstan.

Methods

In response to a stated community priority to address iodine deficiency in Naryn Oblast, volunteers from village health committees and personnel of Primary Health Care units living in the communities were trained in testing salt using test kits. A phased introduction of two testing components was conducted in 2002–2003 in two areas with a combined population of 160,000. The two components included testing of salt for iodine content by community members in as many households as possible (Component 1) and testing of retail salt for iodate content by community members and by retailers at wholesale markets (Component 2). Results from these two components provided the data for this study.

Results

For Component 1, salt testing reached 65% of households; coverage of iodized salt increased from 87.6% to 96.8% within 5 to 7 months (averages of the two areas; p < .001), mostly owing to a great decrease in the variation among settlements. For Component 2, in area 1, the percentage of households using iodated salt increased from 71.0% to 90.3% within 5 to 7 months, whereas the percentage of households using iodinated salt decreased from 18.6% to 5.6%. In area 2, the percentage of households using iodated salt increased from 65.2% to 76.2% within 5 to 7 months, with no change in the percentage of households using iodinated salt (21.7% and 20.8%). The differences between areas 1 and 2 are highly significant ( p < .001). At 18 to 21 months, the percentage of households using iodated salt was 97.5% in area 1 and 90.2% in area 2. The intervention cost around US$1,500.

Conclusions

Testing salt in a large percentage of households is an effective, low-cost approach to increasing the percentage of households using iodized salt to satisfactory levels in a very short time. Empowering community members to check salt at retailers and retailers to check salt at wholesale markets with test kits for iodated salt can rapidly ensure almost exclusive consumption of iodated salt in households.
Schooling, Educational Achievement, and Cognitive Functioning among Young Guatemalan Adults
Authors: Stein Aryeh D. , Behrman Jere R. , DiGirolamo Ann , Grajeda Rubén , Martorell Reynaldo , Quisumbing Agnes , Ramakrishnan Usha
Published: November 2015

Quantity and quality of schooling obtained and the resulting skills and knowledge acquired are important components of human capital. We describe the distribution of selected measures of schooling, educational achievement, and cognitive functioning among individuals who participated as children in a nutrition supplementation trial in Guatemala and were followed up in 2002–04. Among 1,469 respondents (response rate 80%), who were 26–41 years of age in 2003, more than 90% of men and women had attended at least some school; more than half of men and more than one-third of women had completed sixth grade. Schooling attainment of both men and women has increased across birth cohorts but the schooling gap between men and women has increased. Parental socioeconomic status, as measured in 1975, is a strong predictor of schooling attainment. Basic literacy is high among those studied, with more than 80% able to read simple sentences. The gap in educational achievement favoring men narrowed across birth cohorts due to increases among younger women. The greater performance among men on the Raven's Progressive Matrices test persisted despite increased scores in the younger birth cohorts for both men and women. Migrants to Guatemala City have completed more years of school and scored higher on the tests of educational achievement and cognitive functioning than have cohort members who have remained in the study villages.
Accuracy of Child Growth-Monitoring Weights Obtained by Commune Volunteers in Phu Tho Province, Vietnam
Authors: Huong Van Thuy , Duc Thach Tran , Tuan Tran , Ha Tran Thu , Marsh David R.
Published: November 2015

Background

Weight-for-age is a commonly used indicator of the health of children and communities. We determined the accuracy of health volunteers' weight measurements in a nutrition project in Vietnam.

Objective

To report the accuracy of the volunteers' weight measurements and to assess the likely effect of any inaccuracies.

Methods

Save the Children /USA trained health volunteers to weigh children (6–36 months old) every other month from December 1999 to August 2000. Trained researchers randomly rechecked 257 weights (range, 24–114 per session). We computed nondirectional and directional differences between the weights measured by volunteers and those measured by researchers.

Results

The weights recorded by volunteers were lower than those recorded by researchers by an average of 30 g ( p < .05). Almost all of the error occurred during the first weighing session, at which the average weight recorded by volunteers was 280 g below that recorded by researchers ( p = .01). The error at subsequent weighings was minimal (< 20 g below reference at each session).

Conclusions

One-time directional error suggests bias. Perhaps some communities (or families) influenced the volunteers to report weights lower than those actually observed to justify the programmatic food supplements or to give the impression at subsequent weighings that the level of malnutrition had been successfully reduced from that at the first session. Careful supervision of measurements of weight at baseline is essential.
The Promise of a Community-Based Approach to Managing Severe Malnutrition: A Case Study from Ethiopia
Authors: Chaiken Miriam S. , Deconinck Hedwig , Degefie Tedbabe
Published: November 2015

Background

Community-based therapeutic care (CTC) is a new strategy in the arsenal of techniques to manage complex nutritional emergencies in rural communities. The CTC approach uses a newly developed ready-to-use therapeutic food, Plumpynut, to rehabilitate severely malnourished children in their home communities. Emerging literature has suggested the CTC strategy yielded results that were superior to those of programs limited to therapeutic feeding centers, as measured by rates of coverage and numbers of children rehabilitated.

Objective

To compare the effectiveness of the CTC strategy in combination with conventional treatments for acute malnutrition. The expectation was that this program would support the growing consensus on the effectiveness of CTC strategies.

Methods

Data from monitoring the initial phase of program implementation were reviewed to ascertain program impact. The number of children participating and the outcome of their participation were assessed.

Results

Families became key participants in the rehabilitation of their children, and communities became strengthened through the mobilization of local networks and the improved knowledge base of local health workers. Recovery rates were comparable with international standards, and coverage far exceeded that of traditional center-based care.

Conclusions

CTC is an important tool to effectively address nutritional emergencies and may be a valuable entry point for long-term development, since it fosters capacity building and improvement in local communities. CTC programs may eventually be viewed as the entry point for more sustained development-oriented interventions, thus helping make the transition from relief to development.
Constraints on Good Child-Care Practices and Nutritional Status in Urban Dar-Es-Salaam, Tanzania
Authors: Kulwa Kissa B. M. , Kinabo Joyce L. D. , Modest Beata
Published: November 2015

Background

Care is increasingly being recognized as a crucial input to child health and nutrition, along with food security, availability of health services, and a healthy environment. Although significant gains have been made in the fight against malnutrition in Tanzania, the nutritional status of preschool children in urban areas is not improving.

Objective

To assess child-care practices and the nutritional status of infants and young children with the aim of improving feeding practices and child nutritional status.

Methods

A cross-sectional study was undertaken in urban Dar-es-Salaam, Tanzania. The study involved 100 randomly selected mothers of children 6 to 24 months old from households in Ilala Municipality, one of the three municipalities that constitute the Dar-es-Salaam City Council. Data were collected by a structured questionnaire, spot-check observations, and anthropometric measurements.

Results

The prevalence rates of stunting, underweight, wasting, and morbidity were 43%, 22%, 3%, and 80%, respectively. The prevalence of exclusive breastfeeding was very low (9%), and most stunted children (88%) were not exclusively breastfed for the first 6 months. The mean age at which complementary foods and fluids were introduced was 3.26 ± 1.12 months (range, 1 to 5 months). The fluids given were mainly water and thin cereal-based porridge. More than half of the households practiced good hygiene. Most of the psychosocial practices (e.g., caregiver's attention, affection, and involvement in child feeding, hygiene, health care, and training) were performed by mothers, except for cooking and feeding the children and child training, which were done mostly by alternative caregivers. Nearly half of the mothers (44%) worked out of the home. The mean number of working hours per day was long (10.32 ± 2.13), necessitating the use of alternative caregivers. A negative correlation was found between height-for-age z-scores and the number of hours mothers worked outside the home.

Conclusions

The prevalence rates of chronic malnutrition and morbidity are high, and child-feeding practices are inadequate in this urban population. Maternal employment and educational characteristics constrain good child-care practices, and alternative caregivers are taking a more important role in child care as mothers join the work force. We recommend that formative research be conducted to study the actual practices of caregivers in order to form the basis for a child-care education program. There is also a need to strengthen national health system support for improved child feeding.
Weaning Foods and Their Impact on Child-Feeding Practices among Low-Income Nigerian Mothers
Authors: Ijarotimi Oluwole Steve , Ogunsemore Michael Temidayo
Published: November 2015

Background

Many children in rural communities of developing countries die of nutrition-related causes due to lack of nutrition education and low purchasing power of the families, which result in low-quality weaning foods and poor feeding practices.

Objective

To evaluate the nutritional composition of local weaning foods and their impact on child feeding practices among low-income Nigerian mothers.

Methods

A cross-sectional survey was conducted between March and June 2005 among 294 randomly selected pairs of nursing mothers and their children who attended the postnatal clinic of State Specialist Hospital and Comprehensive Health Centers in Akure community, Ondo State, Nigeria. A structured, self-or interviewer-administered questionnaire was used to collect information on infant demographic characteristics, feeding, and socioeconomic characteristics of the parents. The children's weights were recorded, and samples of the weaning foods were analyzed.

Results

The mothers' ages ranged from 22 to 37 years, and the children's from one to 12 months. Among the parents, two-fifths of the respondents worked as drivers, mechanics, carpenters, and the like, while the remaining respondents were civil servants, health professionals, teachers, merchants, and housewives. The educational attainment of the parents ranged from no formal education (1.4%) to higher education (46%); 13% had completed primary school, and 39.6% had completed secondary school. The average monthly family income was between 3,500 and 30,000 naira (US$23.3–$200). Among the children, 58.3% were of normal weight, 41.1% were mildly underweight, 0.3% moderately underweight, and 0.3% severely underweight; 23.1% were exclusively breastfed, 9.5% received breastmilk and traditional medicinal herbs, 15.6% received breastmilk and commercial weaning food, 7.4% received commercial weaning food only, 14.8% received local weaning foods only, 24.1% received local weaning foods plus breastmilk, and 5.8% received the family diet.

Conclusions

We found that a high proportion of the nursing mothers used local ingredients to formulate weaning foods for their babies. The nutritional compositions of these foods is of high quality and are suitable as weaning foods, particularly for infants of low-income parents who do not have access to commercial weaning foods.
Econutrition: Implementation Models from the Millennium Villages Project in Africa
Authors: Deckelbaum Richard J. , Palm Cheryl , Mutuo Patrick , DeClerck Fabrice
Published: November 2015

Econutrition integrates environmental health and human health, with a particular focus on the interactions among the fields of agriculture, ecology, and human nutrition. Soil loss and degradation and human undernutrition are major barriers to economic development in Africa. A primary aim of the Millennium Villages Project in Africa is to meet the Millennium Development Goals by integrated multisectoral interventions in health and nutrition, agriculture, and environmental sustainability in hunger and poverty hot spots in Africa. Econutrition is only one example of how interdisciplinary approaches are not only critical to alleviating extreme poverty but also fundamental to linking basic science understanding in multiple areas. Human health and agricultural productivity gain, and the costs of the gains are lowered, when we take the opportunity to apply different disciplines through cross-sectoral, thematically linked interventions.
Local Production and Provision of Ready-To-Use Therapeutic Food (Rutf) Spread for the Treatment of Severe Childhood Malnutrition
Authors: Manary Mark J.
Published: November 2015

Background

Ready-to-use therapeutic food (RUTF) spread has been shown to be very effective in the rehabilitation of severely malnourished children and facilitates home-based therapy of these children.

Objective

To describe how RUTF spread can be manufactured on a variety of production scales.

Principles of production

RUTF spread is an edible lipid-based paste that is energy dense, resists bacterial contamination, and requires no cooking. The primary production principles include grinding all ingredients to a particle size < 200 microns, producing the food without the introduction of water, and embedding the protein and carbohydrate components of the food into the lipid matrix. The most widely used RUTF spread is a mixture of milk powder, sugar, vegetable oil, peanut butter, vitamins, and minerals.

Scale of production

RUTF spread can be produced in quantities sufficient to treat several hundred children using a planetary mixer in a clinic. Production of larger quantities of RUTF spread can be achieved in partnership with local food companies. Production sufficient to meet the needs of several thousand children can be achieved with a dedicated production facility using technology appropriate for use in the developing world. Care must be taken to avoid aflatoxin contamination, and quality control testing of the product is essential.

Conclusions

RUTF spread can be safely and easily produced in small or large quantities in most settings worldwide. The local availability of the necessary ingredients limits its use in some settings, and further investigation of alternative ingredients is needed to overcome this limitation.