bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kpejigaou: An Indigenous, High-Protein, Low-Fat, Cowpea-Based Griddled Food Proposed for Coastal West Africa
Authors: Amonsou Eric Oscar , Sakyi-Dawson Esther , Saalia Firibu Kwesi , Houssou Paul 
Published: November 2015

Background Griddled cowpea paste foods have high nutritional potential because they are low in fat but high in protein. A good understanding of process and product characteristics of kpejigaou is necessary to improve its quality and enhance acceptability. Objective To describe the product, evaluate critical variables in traditional processing, and determine consumer quality criteria and preferences for kpejigaou. Methods A survey of kpejigaou processing was carried out among processors and regular consumers of kpejigaou. Results Kpejigaou is flat and circular in shape, with uniform thickness and porous structure. The production process of kpejigaou was found to be simple and rapid, but the quality of the finished product varied among processors and among batches. Critical processing variables affecting quality were dehulling of the cowpeas, type of griddling equipment, and griddling temperature. Texture (sponginess) is the most important quality index that determines the preference and acceptability of kpejigaou by consumers. Conclusions Traditionally processed kpejigaou does not meet current standards for high-quality foods. This study provides the basis for efforts to standardize the kpejigaou process to ensure consistent product quality and enhance the acceptability of kpejigaou among consumers. Kpejigaou has a potential for success if marketed as a low-fat, nutritious fast food.
A Strategic Approach to the Unfinished Fortification Agenda: Feasibility, Costs, and Cost-Effectiveness Analysis of Fortification Programs in 48 Countries
Authors: Fiedler John L. , Macdonald Barbara 
Published: November 2015

Background Food fortification is a promising strategy for combating micronutrient deficiencies, which plague one-third of the world's population. Which foods to fortify, with which micronutrients, and in which countries remain essential questions that to date have not been addressed at the global level. Objective To provide a tool for international agencies to identify and organize the next phase of the unfinished global fortification agenda by prioritizing roughly 250 potential interventions in 48 priority countries. By explicitly defining the structure and operations of the fortification interventions in a detailed and transparent manner, and incorporating a substantial amount of country-specific data, the study also provides a potentially useful starting point for policy discussions in each of the 48 countries, which—it is hoped—will help to catalyze the development of public–private partnerships and accelerate the introduction of fortification and reduction of micronutrient deficiencies. Methods Forty-eight high-priority countries were identified, and the feasibility of fortifying vegetable oil and sugar with vitamin A and fortifying wheat flour and maize flour with two alternative multiple micronutrient formulations was assessed. One hundred twenty-two country-, food-, and fortification formulation–specific interventions were assessed to be feasible, and the costs of each intervention were estimated. Assuming a 30% reduction in the micronutrient deficiencies of the persons consuming the food, the number of disability-adjusted life years (DALYs) saved by each of the programs was estimated. Results The cost per DALY saved was calculated for each of the 122 interventions, and the interventions were rank-ordered by cost-effectiveness. It is estimated that the 60 most cost-effective interventions would carry a 10-year price tag of US$1 billion and have costs per DALY saved ranging from US$1 to US$134. The single “best bet” intervention—i.e., the most cost-effective intervention—in each of the 48 countries was identified. Conclusions This study provides a detailed, transparent, evidence-based approach to defining and estimating the costs and cost-effectiveness of the unfinished global fortification agenda in the 48 priority countries. Other considerations in designing a strategic approach to the unfinished global fortification agenda are also discussed.
Recommendations for Improving Guatemala's Food Fortification Program Based on Household Income and Expenditure Survey (HIES) Data
Authors: Fiedler John L. , Helleranta Meri 
Published: November 2015

Background Fortification offers great potential for reducing the enormous disease burden of micronutrient deficiencies. The lack of information on food consumption patterns has been a major impediment to the development of fortification programs. In some countries, the absence of this information has been an obstacle to the introduction of fortification. In countries that have fortification, governments are increasingly being challenged to provide evidence that programs are well designed and effective. Objective To examine the usefulness of household income and expenditure surveys (HIES) as a means for addressing this information gap and making fortification programs more evidence-based and more accountable. Methods Data from Guatemala's 2005/6 Living Standards Measurement Survey are used to develop a measure of “apparent food consumption.” The measure is used to assess Guatemala's fortification program by analyzing the coverage and the additional micronutrient intake attributable to different food vehicles, combinations of food vehicles, and fortification formulations. Results There are three key findings. The impact of the wheat flour fortification program is considerably greater than had previously been estimated; the level at which sugar is currently fortified with vitamin A may be excessive and should be reviewed; and fortifying semolina flour (used to make pasta) would extend the benefits of wheat flour fortification to 60,000 households that currently do not benefit from it and would increase the amount of fortified food consumed by 68% of the population. Beneficiaries would include 63% of the extreme poor, and the greatest benefits would go to those wheat flour consumers who currently benefit the least from consuming fortified wheat flour products. Conclusions HIES data should be used more routinely as a tool in the designing, monitoring, and assessing of fortification programs.
Revised Recommendations for Iron Fortification of Wheat Flour and an Evaluation of the Expected Impact of Current National Wheat Flour Fortification Programs
Authors: Hurrell Richard , Ranum Peter , de Pee Saskia , Biebinger Ralf , Hulthen Lena , Johnson Quentin , Lynch Sean 
Published: November 2015

Background Iron fortification of wheat flour is widely used as a strategy to combat iron deficiency. Objective To review recent efficacy studies and update the guidelines for the iron fortification of wheat flour. Methods Efficacy studies with a variety of iron-fortified foods were reviewed to determine the minimum daily amounts of additional iron that have been shown to meaningfully improve iron status in children, adolescents, and women of reproductive age. Recommendations were computed by determining the fortification levels needed to provide these additional quantities of iron each day in three different wheat flour consumption patterns. Current wheat flour iron fortification programs in 78 countries were evaluated. Results When average daily consumption of low-extraction (≤ 0.8% ash) wheat flour is 150 to 300 g, it is recommended to add 20 ppm iron as NaFeEDTA, or 30 ppm as dried ferrous sulfate or ferrous fumarate. If sensory changes or cost limits the use of these compounds, electrolytic iron at 60 ppm is the second choice. Corresponding fortification levels were calculated for wheat flour intakes of < 150 g/day and > 300 g/day. Electrolytic iron is not recommended for flour intakes of < 150 g/day. Encapsulated ferrous sulfate or fumarate can be added at the same concentrations as the non-encapsulated compounds. For high-extraction wheat flour (> 0.8% ash), NaFeEDTA is the only iron compound recommended. Only nine national programs (Argentina, Chile, Egypt, Iran, Jordan, Lebanon, Syria, Turkmenistan, and Uruguay) were judged likely to have a significant positive impact on iron status if coverage is optimized. Most countries use non-recommended, low-bioavailability, atomized, reduced or hydrogen-reduced iron powders. Conclusion Most current iron fortification programs are likely to be ineffective. Legislation needs updating in many countries so that flour is fortified with adequate levels of the recommended iron compounds.
Marketing Complementary Foods and Supplements in Burkina Faso, Madagascar, and Vietnam: Lessons Learned from the Nutridev Program
Authors: Bruyeron Olivier , Denizeau Mirrdyn , Berger Jacques , Trèche Serge 
Published: November 2015

Background Sustainable approaches to improving infant and young child feeding are needed. The Nutridev program worked in Vietnam, Madagascar, and Burkina Faso to test different strategies to improve complementary feeding using fortified products sold to families. Objective To review the experiences of programs producing and marketing fortified complementary foods and to report on the feasibility of local production and marketing of fortified complementary foods to increase usage of high-quality foods among children of low-income families in a self-sustaining manner. Methods Project documents, surveys of mothers, and production and sales reports were reviewed. Results Nutridev experience in Vietnam, Madagascar, and Burkina Faso demonstrates that it is possible to produce affordable, high-quality complementary foods and supplements locally in developing countries. Strategies to make products readily available to the targeted population and to convince this population to consume them yielded mixed results, varying greatly based on the strategy utilized and the context in which it was implemented. Conclusions In several contexts, the optimal approach appears to be strengthening the existing food distribution network to sell complementary foods and supplements, with the implementation of a temporary promotion and nutrition education network in partnership with local authorities (e.g., health services)to increase awareness among families about the fortified complementary food product and optimal feeding practices. In urban areas, where the density of the population is high, design and implementation of specific networks very close to consumers seems to be a good way to combine economic sustainability and good consumption levels.
Monitoring the Marketing, Distribution, and Use of Sprinkles Micronutrient Powders in Rural Western Kenya
Authors: Suchdev Parminder S. , Ruth Laird , Obure Alfredo , Were Vincent , Ochieng Cliff , Ogange Lorraine , Owuor Mercy , Ngure Frances , Quick Robert , Juliao Patricia , Jung Christina , Teates Kathryn , Cruz Kari , Jefferds Maria Elena D. 
Published: November 2015

Background In 2007, the US Centers for Disease Control and Prevention partnered with local Kenyan institutions to implement the Nyando Integrated Child Health and Education Project, an effectiveness study that used social marketing and a community-based distribution program to promote the sale of Sprinkles and other health products. Objective To describe monitoring of wholesale sales, household demand, promotional strategies, and perceived factors influencing Sprinkles sales among vendors. Methods Ongoing quantitative and qualitative monitoring of Sprinkles sales began in May 2007 in 30 intervention villages. Data sources included baseline and follow-up cross-sectional surveys; office records of Sprinkles sales to vendors; biweekly household monitoring of Sprinkles use; and qualitative data collection, including vendor focus groups and key informant interviews. Results A total of 550 children aged 6 to 35 months were enrolled at baseline, and 451 were available at 12-month follow-up. During this period, nearly 160,000 sachets were sold wholesale to vendors, with variability in sales influenced by the social, political, and economic context. Vendors living closer to the wholesale office purchased more Sprinkles, so a second office was opened closer to remote vendors. On average, 33% of house-holds purchased Sprinkles during household monitoring visits. Training sessions and community launches were important for community support and raising awareness about Sprinkles. Vendor incentives motivated vendors to sell Sprinkles, and consumer incentives promoted purchases. Conclusions Sprinkles program monitoring in Kenya was critically important for understanding sales and distribution trends and vendor perceptions. Understanding these trends led to strategic changes to the intervention over time.
Impact of Drought and HIV on Child Nutrition in Eastern and Southern Africa
Authors: Mason John B. , Chotard Sophie , Bailes Adam , Mebrahtu Saba , Hailey Peter 
Published: November 2015

Background Intermittent food insecurity due to drought and the effects of HIV/AIDS affect child nutritional status in sub-Saharan Africa. In Southern Africa in 2001–3 drought and HIV were previously shown to interact to cause substantial deterioration in child nutrition. With additional data available from Southern and Eastern Africa, the size of the effects of drought and HIV on child underweight up to 2006 were estimated. Objective To determine short- and long-term trends in child malnutrition in Eastern and Southern Africa and how these are affected by drought and HIV. Methods A secondary epidemiologic analysis was conducted of area-level data derived from national surveys, generally from the mid-1990s to the mid-2000s. Data from countries in the Horn of Africa (Ethiopia, Kenya, and Uganda) and Southern Africa (Lesotho, Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe) were compiled from available survey results. Secondary data were obtained on weight-for-age for preschool children, HIV prevalence data were derived from antenatal clinic surveillance, and food security data were obtained from United Nations sources (Food and Agriculture Organization, International Labour Office, and others). Results Overall trends in child nutrition are improving as national averages; the improvement is slowed but not stopped by the effects of intermittent droughts. In Southern Africa, the prevalence rates of underweight showed signs of recovery from the 2001–03 crisis. As expected, food production and price indicators were related (although weakly) to changes in malnutrition prevalence; the association was strongest between changes in food production and price indicators and changes in malnutrition prevalence in the following year. Areas of higher HIV prevalence had better nutrition (in both country groups), but this counterintuitive association is removed after controlling for socioeconomic status. In low-HIV areas in Eastern Africa, nutrition deteriorates during drought, with prevalence rates of underweight 5 to 12 percentage points higher than in nondrought periods; less difference was seen in high-HIV areas, in contrast to Southern Africa, where drought and HIV together interact to produce higher prevalence rates of underweight. Conclusions Despite severe intermittent droughts and the HIV/AIDS epidemic (now declining but still with very high prevalence rates), underlying trends in child underweight are improving when drought is absent: resilience may be better than feared. Preventing effects of drought and HIV could release potential for improvement and, when supported by national nutrition programs, help to accelerate the rates of improvement, now generally averaging around 0.3 percentage points per year, to those needed to meet Millennium Development Goals (0.4 to 0.9 percentage points per year).
A Review of Global Progress toward the Millennium Development Goal 1 Hunger Target
Authors: Fanzo Jessica C. , Pronyk Paul M. 
Published: November 2015

Background The hunger component of the first Millennium Development Goal (MDG) aims to reduce the proportion of people who suffer from hunger by half between 1990 and 2015. In low- and middle-income countries, progress has been mixed, with approximately 925 million people hungry and 125 million and 195 million children underweight and stunted, respectively. Objective To assess global progress on the hunger component of MDG1 and evaluate the success of interventions and country programs in reducing undernutrition. Methods We review global progress on the hunger component of MDG1, examining experience from 40 community-based programs as well as national efforts to move interventions to scale drawn from the published and gray literature, alongside personal interviews with representatives of governments and development agencies. Results Based on this review, most strategies being implemented and scaled are focusing on treatment of malnutrition and rooted within the health sector. While critical, these programs generally address disease-related effects and emphasize the immediate determinants of undernutrition. Other major strategies to tackle under-nutrition rely on the production of staple grains within the agriculture sector. These programs address hunger, as opposed to improving the quality of diets within communities. Strategies that adopt multisectoral programming as crucial to address longer-term determinants of undernutrition, such as poverty, gender equality, and functioning food and health systems, remain under-developed and under-researched. Conclusions This review suggests that accelerating progress toward the MDG1 targets is less about the development of novel innovations and new technologies and more about putting what is already known into practice. Success will hinge on linking clear policies with effective delivery systems in working towards an evidence-based and contextually relevant multisectoral package of interventions that can rapidly be taken to scale.
Dietary Patterns and Nutritional Health of Women: The Nutrition Transition in Rural Tanzania
Authors: Keding Gudrun B. , Msuya John M. , Maass Brigitte L. , Krawinkel Michael B. 
Published: November 2015

Background Many developing countries are experiencing a rapid nutrition transition in urban areas. Objective To investigate whether a nutrition transition was occurring in a rural area by examining the dietary patterns of women in rural Tanzania. Methods A total of 252 women aged 16 to 45 years from three districts of northeastern and central Tanzania participated. During three different seasons in 2006–2007, the women were interviewed with the use of a structured, interviewer-administered questionnaire, including a 24-hour dietary recall. From these recalls, the mean intakes of 12 main food groups were calculated and used to establish five dietary patterns by principal component analysis. Data were also obtained on attitudes toward obesity, body mass index (BMI), hemoglobin level, and measures of socioeconomic status and analyzed for associations with dietary patterns. Results The five dietary patterns were “traditional-coast,” characterized by fruits, nuts, starchy plants, and fish; “traditional-inland,” characterized by cereals, oils and fats, and vegetables; “purchase,” characterized by bread and cakes (usually fried in oil), sugar, and black tea; “pulses,” characterized mainly by pulses, with few or no vegetables; and “animal products,” characterized by a high consumption of meat, eggs, and/or milk. Significant positive associations were found, among others, between the purchase pattern and BMI (ρ = 0.192, p = .005) and between the animal products pattern and wealth (ρ = 0.168, p = .002). Conclusions Differences between traditional and modern nutritional food patterns were evident. This study found the “traditional-inland” pattern to be the most healthy, while the “purchase” food pattern was the most prevalent. The purchase pattern, in particular, may provide some evidence for early stages of the nutrition transition in rural Tanzania.
The Importance of Milk and other Animal-Source Foods for Children in Low-Income Countries
Authors: Dror Daphna K. , Allen Lindsay H. 
Published: November 2015

Background Milk and other animal-source foods are concentrated dietary sources of macro- and micronutrients. Despite a global increase in milk production and consumption over the past decades, milk and other animal-source foods are often lacking in the diets of children in developing countries. Objective To evaluate the importance of milk and other animal-source food intake in promoting the growth, development, and health of children in low-income countries. Methods Original research articles describing observational and intervention studies with unfortified milk, fortified milk, and other animal-source foods in children were identified by searching the PubMed database. Results Consumption of milk and other animal-source foods by undernourished children improves anthropometric indices and cognitive function and reduces the prevalence of biochemical and functional nutritional deficiencies, reducing morbidity and mortality. Unfortified and fortified milk used in supplementation trials has been well tolerated and widely accepted by parents and children. Conclusions To improve the dietary quality of children in low-income countries and further the effort to eradicate extreme poverty and hunger in accordance with the United Nations Millennium Development Goals, additional research is necessary to identify and implement programs and policy supporting increased intake of milk and other animal-source foods.
Assessing the Impact of Micronutrient Intervention Programs Implemented under Special Circumstances—Meeting Report
Authors: de Pee Saskia , Spiegel Paul , Kraemer Klaus , Wilkinson Caroline , Bilukha Oleg , Seal Andrew , Macias Kathy , Oman Allison , Fall Ahmed Baba , Yip Ray , Peña-Rosas Juan Pablo , West Keith , Zlotkin Stanley , Bloem Martin W. 
Published: November 2015

Introduction and Objective The World Food Programme and the Office of the United Nations High Commissioner for Refugees organized a meeting of experts to discuss evaluation of micronutrient interventions under special circumstances, such as emergency and refugee situations. Results Multimicronutrient interventions for groups with higher needs may include home fortification products for young children or supplements for pregnant and lactating women. The choice of preparation should be guided by target group needs, evidence of efficacy of a product or its compounds, acceptability, and cost-effectiveness. Different designs can be used to assess whether an intervention has the desired impact. First, program implementation and adherence must be ascertained. Then, impact on micronutrient status can be assessed, but design options are often limited by logistic challenges, available budget, security issues, and ethical and practical issues regarding nonintervention or placebo groups. Under these conditions, a plausibility design using pre- and postintervention cross-sectional surveys, a prospective cohort study, or a step-wedge design, which enrolls groups as they start receiving the intervention, should be considered. Post hoc comparison of groups with different adherence levels may also be useful. Hemoglobin is often selected as an impact indicator because it is easily measured and tends to respond to change in micronutrient status, especially iron. However, it is not a very specific indicator of micronutrient status, because it is also influenced by inflammation, parasitic infestation, physiological status (age, pregnancy), altitude, and disorders such as thalassemia and sickle cell disease. Conclusion Given the constraints described above, replicability of impact in different contexts is key to the validation of micronutrient interventions.