bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Effect of School Meals with Micronutrient Supplementation and Deworming
Authors: Gopaldas Tara 
Published: November 2015

A mid-day meal or school lunch program commenced in Gujarat, India from the sixties. In 1994, it was serving approximately 3 million schoolchildren. In 1994, the program was improved with the addition of a “package” of health inputs, including anthelmintics and micronutrient supplementation of iron and vitamin A, and iodine fortified salt. Tara Consultancy Services (TCS), India, a member of the Partnership of Child Development, Oxford University, evaluated Gujarat's improved midday meal program from 1993 to 1996. The program was implemented by the Commissionerate of the mid-day meal program, part of the government of Gujarat. The cost of the 'health package' in 1994, per child per year was 35 US cents (1 US $ = Rs.30). The study to evaluate the improved program included the following components: Focus group discussions Government officials, teachers, students, parents, and community members participated in focus groups to elicit opinions on the proposed program which were predominantly positive. Process evaluation Logistical delivery defined as the adequacy, timeliness and cost of procurement of the anthelmintic drugs and micronutrients and the cost of this 'health package' per schooler per school year by the pharmaceutical companies was 100%. Efficiency of logistics to the schools, defined as the efficiency and cost of logistical delivery of the 'Health Package', from the State Head Quarters to the District to the Taluka to the School was 100%. Coverage defined as consumption of the 'Health Package' by schooler at least once in the 6–9 months of the school year, as stated by the implementing agency was 94%–100% (urban) and 42%–94% (rural); coverage as stated by the schoolchildren was 71%–79% (urban) and 50%–67% (rural). Impact evaluation On average, students who received supplements were 1.1 kg heavier and 1.1 cm taller than those who did not; hemoglobin (Hb) levels were > 12 g/dL intestinal parasite prevalence rates dropped from 71% to 39%; prevalence of night blindness and vitamin A deficiency were reduced from 67% to 34%. Lesson learned Since 2003, 4 states in India, namely, Gujarat, Andhra Pradesh, Karnataka, and Tamil Nadu covering approximately 30 million schoolers have adopted the “Gujarat Model.”
Quantifiable Impact on Poverty in Trinidad and Tobago of the Uruguay Round Agreement on Agriculture
Authors: Pemberton Carlisle , Ramnarine Deokie 
Published: November 2015

Background The agreement on agriculture and the World Trade Organization were major outcomes of the 1986–1994 Uruguay Round (UR) negotiations within the General Agreement on Tariffs and Trade (GATT). The measures under the UR were predicted to increase poverty in developing countries, a serious cause for concern since poverty alleviation is a major goal of developing countries. Thus this paper simulated the impact on poverty of the UR for a net food importing country, Trinidad and Tobago. Objective The objectives of the study were to determine the changes in poverty levels in Trinidad and Tobago that we expected would result from changes in the price levels of food commodities after the removal of trade protection following the UR, and to examine recent trends in poverty in Trinidad and Tobago and the prices of major agricultural exports from the United States, its principal trading partner. Methods A regression model (poverty model) was used to determine the relationship between poverty levels and the prices of sensitive imported food commodities (SIFCs) and other key economic variables. Impact models were used to project changes in world market prices of the SIFCs due to the UR, and these price changes were used to predict changes in poverty in Trinidad and Tobago. Results The results showed a positive elasticity between poverty and the prices of SIFCs. The study also predicted that the average projected increase in price levels of the SIFCs of less than 9% by the year 2000 would cause an increase in poverty in Trinidad and Tobago of less than 4%. Conclusions There has been, in fact, a small decline in poverty in Trinidad and Tobago since 1996. The prices of major agricultural exports from the United States have also been falling since 1995. Thus, so far the UR has had no perceptible effects in increasing the prices of food exports from the United States. Also, so far the UR has had no perceptible effect on the poverty level in Trinidad and Tobago.
Protective Effect of Multimicronutrient Supplementation against Anemia among Children, Women, and Adolescent Girls in Lower-Income Areas of Chiclayo, Peru
Authors: de Romaña Daniel López , Verona Sara , Vivanco Oscar Aquino , Gross Rainer 
Published: November 2015

Background The Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) implemented a campaign to promote weekly multimicronutrient supplementation among women and adolescent girls of childbearing age and children under 5 years of age. Objectives To assess the impact of the campaign on the growth of children and on anemia among children and among women and adolescent girls of childbearing age. Methods Weekly multimicronutrient supplementation was provided for 8 weeks. Weights, heights, and hemoglobin concentrations were assessed at the beginning and end of the campaign. Results and conclusions Although supplementation did not significantly increase the hemoglobin concentrations of children (p = .80) or women and adolescent girls (p = .65) in the intervention group, the hemoglobin concentrations of the comparison groups were significantly lower after 8 weeks (p = .001 for children and p = .03 for women and adolescent girls). Furthermore, the percentage of anemic children in the comparison group increased significantly (p < .001), and the final value was significantly higher than that for the intervention group (p = .004). There were no significant effects of weekly multimicronutrient supplementation on the growth of children, but the study was too short to reliably determine any effects on growth.
Economic Inequality and Undernutrition in Women: Multilevel Analysis of Individual, Household, and Community Levels in Cambodia
Authors: Hong Rathavuth , Hong Rathmony 
Published: November 2015

Background Many people in developing countries are still struggling to emerge from the realm of extreme poverty, where economic improvements tend to benefit a small, affluent group of the population and cause growing inequality in health and nutrition that affects the most vulnerable groups of the population, including women and children. Objective To examine how household and community economic inequality affects nutritional status in women using information on 6,922 nonpregnant women aged 15 to 49 years included in the 2000 Cambodia Demographic and Health Survey. Methods Nutritional status is defined with the use of the body-mass index (BMI). BMI less than 18.5 kg/m 2 is defined as undernourishment. The household wealth index was calculated from household ownership of durable assets and household characteristics. Community wealth is an average household wealth index at the community level. Household and community economic inequalities were measured by dividing the wealth index into quintiles. The effects of household and community economic inequality were estimated by multilevel analysis. Results Independently of community economic status and other risk factors, women in the poorest 20% of households are more likely to be undernourished than women in the richest 20% of households (RR = 1.63; p = .008). The results also show variation among communities in the nutritional status of women. Age, occupation, and access to safe sources of drinking water are significantly associated with women's nutritional status. Conclusions Improving household income and creating employment opportunities for women, in particular poor women, may be a key to improving the nutritional status of women in Cambodia.
Mediterranean Diet, Traditional Foods, and Health: Evidence from the Greek EPIC Cohort
Authors: Trichopoulou Antonia 
Published: November 2015

Background For more than 50 years, the traditional Mediterranean diet has been considered health- promoting, but it was not until the mid-1990s that the topic began to receive increased scrutiny and prominence. Objective To highlight the health benefits of the Mediterranean diet as documented by studies undertaken mostly within a large countrywide general population cohort in Greece. Methods The Greek EPIC (European Prospective Investigation into Cancer) cohort, a prospective study based on volunteers from the general population of Greece, and other investigations with converging objectives. In the Greek EPIC cohort of more than 28,000 volunteers being followed for more than 10 years, several findings on the association of diet with chronic diseases have been published in the international scientific literature. Results The traditional Mediterranean diet of Greece is associated with reduced total mortality as well as reduced mortality from coronary heart disease and cancer. It is applicable in other Western populations, where it has also been shown to be inversely related to total mortality. Moreover, the traditional Mediterranean diet may be optimal for patients who have suffered a coronary infarct, and it does not promote obesity. Tra- ditional foods are integral components of the Mediter- ranean diet and may contribute to its health-promoting attributes. Conclusions The traditional Mediterranean diet may be an optimal diet both for healthy people and for patients with coronary heart disease and other chronic conditions.
Utilization of Positive Deviance Analysis in Evaluating Community-Based Nutrition Programs: An Application to the Dular Program in Bihar, India
Authors: Levinson F. James , Barney Jessica , Bassett Lucy , Schultink Werner 
Published: November 2015

Background Positive deviance is increasingly employed in international development activities to permit the utilization of proven local solutions. Including positive deviance methods in evaluation analysis, particularly in places like Bihar, India, where the rates of child underweight hover at 55%, can help identify project activities and household characteristics that affect key outcomes. These can, in turn, inform decision-making regarding the intensification of particularly promising activities. Objectives To apply positive deviance analysis to the Dular program in Bihar, a community-based nutrition program that seeks to improve the impact of India's Integrated Child Development Services on young children. Methods In order to assure that desired program outcomes were not dependent on higher economic status, the analysis isolated a subset of program beneficiaries—the poorest children with the best nutritional outcomes—and examined the behavioral and project factors that may have brought about positive results in this subgroup. The data for this analysis were drawn from a 2005 program evaluation with a sample of 1,560 children. Results The analysis found that positive deviant children with normal nutritional status in the poorest 50% of Dular households were introduced to complementary food almost 2 months earlier (7.18 vs. 9.02 months of age) than severely malnourished children, were more than twice as likely to use soap for handwashing after defecation (25.0% vs. 11.8%), and were more than seven times as likely to have literate mothers (25.0% vs. 3.5%). Conclusions The analysis suggests that programmatic efforts relating to these activities have been particularly effective and may well deserve increased investment.
Prevalence of Goiter in Children 6 to 12 Years of Age in Ethiopia
Authors: Abuye Cherinet , Berhane Yemane , Akalu Girma , Getahun Zewditu , Ersumo Tesema 
Published: November 2015

Background Iodine-deficiency disorders are a major public health problem in Ethiopia. In conjunction with implementing control programs, baseline information needs to be established. Objective To investigate the distribution and degree of severity of iodine-deficiency disorders in terms of goiter prevalence, urinary iodine excretion (UIE) levels, and proportion of households with iodated salt in Ethiopia. Methods A nationwide, community-based, cross-sectional study was conducted from February to May 2005 among 10,965 children aged 6 to 12 years. A multistage, proportional-to-population-size sampling method was used. Goiters were classified by the method recommended by the World Health Organization/UNICEF/International Council for the Control of Iodine Deficiency Disorders (WHO/UNICEF/ICCIDD), in which the thyroid gland is graded as 0 (normal), 1 (palpable goiter), or 2 (visible goiter); urinary iodine was determined by the wet digestion method; and salt samples were analyzed by a rapid test kit. Results The national total goiter weighted prevalence rate among children aged 6 to 12 years was 39.9% (95% confidence interval, 38.6% to 41.2%), representing more than 4 million children. The median UIE was 2.45 μg/dL; 45.8% of children had UIE values of 2 μg/dL or less, and 22.8% had UIE values of 2.01 to 5.0 μg/dL. Only 4.2% of the households had iodated salt. Conclusions According to the WHO/UNICEF/ICCIDD classification, both goiter prevalence and UIE levels indicate that the whole country appears to be severely affected by iodine deficiency. Furthermore, the virtual absence of iodated salt in the households shows that currently there is no salt iodization program in the country. Dietary sources of iodine in Ethiopia are not dependable, and hence a sustainable universal salt iodization program needs to be implemented without delay.
Cross-Sectoral Coordination Failure: How Significant a Constraint in National Efforts to Tackle Malnutrition in Africa?
Authors: Benson Todd 
Published: November 2015

Background Malnutrition arises from multifaceted causes and requires action from multiple sectors to address. Consequently, oversight and direction are said to be required to ensure that public goods and services needed to reduce malnutrition are delivered by the sectors responsible in a coordinated fashion. To do so, many countries have established cross-sectoral national nutrition coordination agencies. Objective The performance of such agencies established recently in three African countries is evaluated to determine how critical their intersectoral coordination function is to national public efforts to reduce malnutrition. Methods This evaluation uses qualitative information on the national institutional frameworks within which nutrition activities are carried out in Mozambique, Nigeria, and Uganda, countries with such agencies, and in Ghana, which has none. Results None of the agencies has so far effectively carried out the three functions on which they were evaluated: cross-sectoral coordination, advocacy to sustain political commitment to address malnutrition, and resource mobilization. No cross-sectoral national nutrition initiatives are being implemented. Nutrition does not feature strategically in the master development frameworks in any country. No additional government resources have been mobilized, although international resources have been. Conclusions The agencies have proven of limited value to the malnourished in these countries. However, cross-sectoral barriers are not the primary reason for this ineffectiveness. Rather, inability to maintain continued political commitment for efforts to address malnutrition—in short, advocacy—is the principal deficiency in performance. Cross-sectoral coordination only becomes important if malnutrition itself is treated as a politically important problem, thereby stimulating action in various sectors.
Nutrition Education for Student Community Volunteers: A Comparative Study of two Different Communication Methods
Authors: Vijayapushpam T. , Rao G.M. Subba , Antony Grace Maria , Rao D. Raghunatha 
Published: November 2015

Background Nutrition education for student volunteers can enhance their skills, and they can act as change agents in the community. There is a dearth of data from India on the effectiveness of different communication tools in providing nutrition education to student volunteers. Objective This study aims to examine the comparative effectiveness of two different methods of communication—lectures in the classroom aided by print material, and a televised version of a local folk-dance form—for providing nutrition education to student community volunteers in a South Indian state. Methods Interventions were conducted during two mega-camps of student volunteers (camps 1 and 2) with 70 and 137 participants, respectively. Their knowledge levels were tested at baseline. Camp 1 received the lecture intervention and camp 2 the televised folk-dance intervention. Knowledge scores were measured before and after the intervention in each camp, and the two camps were compared for significant improvements in knowledge. Results At baseline, the knowledge levels of students in both camps were comparable. Significant improvement in knowledge was observed in both camps after intervention ( p < .05). Although there was no significant difference between the camps in improvement in knowledge, a significant difference was observed when only the positive increments (improvement over baseline) were compared. Conclusions The televised version of the folk-dance form was better in bringing about positive increment.
Anemia Prevalence and Risk Factors in Pregnant Women in an Urban Area of Pakistan
Authors: Baig-Ansari Naila , Badruddin Salma Halai , Karmaliani Rozina , Harris Hillary , Jehan Imtiaz , Pasha Omrana , Moss Nancy , McClure Elizabeth M. , Goldenberg Robert L. 
Published: November 2015

Background Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birthweight. Objective To determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan. Methods This was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewers within 1 week of enrollment. Results The prevalence of anemia (defined by the World Health Organization as hemoglobin < 11.0 g/dL) in these subjects was 90.5%; of these, 75.0% had mild anemia (hemoglobin from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9 g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/dL). Nonanemic women were significantly taller, weighed more, and had a higher body mass index. Multivariate analysis after adjustment for education, pregnancy history, iron supplementation, and height showed that drinking more than three cups of tea per day before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7; 95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated with anemia. Consumption of red meat less than twice a week prior to pregnancy was marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0 g/dL, p = .05) during the study period. A subanalysis excluding women with mild anemia found similar associations to those of the main model, albeit even stronger. Conclusions A high percentage of women at 20 to 26 weeks of pregnancy had mild to moderate anemia. Pica, tea consumption, and low intake of eggs and red meat were associated with anemia. Women of childbearing age should be provided nutritional education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.
Household Income and Expenditure Surveys: A Tool for Accelerating the Development of Evidence-Based Fortification Programs
Authors: Fiedler John L. , Smitz Marc-Francois , Dupriez Olivier , Friedman Jed 
Published: November 2015

Background One-third of the world's population suffers from micronutrient deficiencies due primarily to inadequate dietary intake. Food fortification is often touted as the most promising short- to medium-term strategy for combating these deficiencies. Despite its appealing characteristics, progress in fortification has been slow. Objective To assess the potential of household food-purchase data to fill the food-consumption information gap, which has been an important factor contributing to the slow growth of fortification programs. Methods Household income and expenditure survey (HIES) data about: (a) a population's distribution of apparent household consumption, which are essential to setting safe fortification levels, (b) the proportion of households purchasing “fortifiable” food, and (c) the quantity of food being purchased were used to proxy food-consumption data and develop suggested fortification levels. Results The usefulness of the approach in addressing several common fortification program design issues is demonstrated. HIES-based suggested fortification levels are juxtaposed with ones developed using the most common current approach, which relies upon Food and Agriculture Organization (FAO) Food Balance Sheets. Conclusions Despite its limitations, the use of HIES data constitutes a generally unexploited opportunity to address the food-consumption information gap by using survey data that nearly every country of the world is already routinely collecting. HIES data enable the design of fortification programs to become more based on country-specific data and less on general rules of thumb. The more routine use of HIES data constitutes a first step in improving the precision of fortification feasibility analyses and improving estimates of the coverage, costs, and impact of fortification programs.
Education and Improved Iron Intakes for Treatment of Mild Iron-Deficiency Anemia in Adolescent Girls in Southern Benin
Authors: Alaofè Halimatou , Zee John , Dossa Romain , O'Brien Huguette Turgeon 
Published: November 2015

Background To our knowledge, the impact of a nutrition education program combined with an increase in bioavailable dietary iron to treat iron-deficiency anemia has never been studied in adolescent girls. Objective To evaluate the impact of an intensive dietary program for the treatment of iron-deficiency anemia in 34 intervention and 34 control boarding-school girls aged 12 to 17 years from Benin. Methods A quasi-experimental design consisting of 4 weeks of nutrition education combined with an increase in the content and bioavailability of dietary iron for 22 weeks was implemented in the intervention school, but not in the control school. Data were obtained from both groups from a nutrition knowledge questionnaire, 24-hour dietary recalls, anthropometric measurements, measurement of iron status indices, and screening for malarial and intestinal parasitic infections. Results Nutrition knowledge scores and mean intakes of nutrients, including dietary iron, absorbable iron, and vitamin C, were significantly higher in the intervention group ( p < .05) than in the control group after 26 weeks. Mean hemoglobin and serum ferritin values were also significantly higher in the intervention group than in the control group (122 vs. 112 g/L [p = .0002] and 32 vs. 19 μg/L [ p = .04], respectively), whereas the prevalence of anemia (32% vs. 85% [ p = .005] and iron-deficiency anemia (26% vs. 56% [ p = .04]) was significantly lower in the intervention group than in the control group. No significant differences between the groups were observed in intestinal parasitic infections or malaria status postintervention. Conclusions A multidietary strategy aiming to improve available dietary iron can reduce iron-deficiency anemia in adolescent girls.