bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Impact and Impact Pathways of a Homestead Food Production Program on Household and Child Nutrition in Cambodia
Authors: Olney Deanna K. , Talukder Aminuzzaman , Iannotti Lora L. , Ruel Marie T. , Quinn Victoria 
Published: November 2015

Background Homestead food production programs have the potential to improve maternal and child health and nutrition through multiple pathways. Objective To evaluate the impact of a homestead food production program in Cambodia on household production and consumption of micronutrient-rich foods and on maternal and child health and nutrition (intake of micronutrient-rich foods, anthropometry, hemoglobin, and anemia prevalence); and to assess pathways of impact on maternal and child health and nutrition. Methods Two cross-sectional surveys (baseline and endline) were used to assess differences between intervention ( n = 300) and control ( n = 200) households using t-tests and chi-square tests. Using endline data and multivariate analyses, we examined the pathways of impact of the program on maternal and child health and nutrition. Results Intervention and control households were similar at baseline in sociodemographic characteristics, but more intervention households owned animals, earned income from homestead food production, and produced and consumed micronutrient-rich foods. At endline, some of these differences had widened; more intervention households produced and consumed more vegetables, had higher dietary diversity, and had a lower prevalence of fever among children under 5 years of age. In the intervention group, more children consumed more eggs and more mothers consumed micronutrient-rich food more frequently than in the control group. There were no other differences between the groups in maternal and child health and nutrition. Greater household production of fruits and vegetables was associated with greater household dietary diversity, which was associated with dietary diversity among mothers and children. Dietary diversity was not associated with other maternal and child health and nutrition outcomes. Conclusions Cambodia's homestead food production program increased household production and consumption of micronutrient-rich foods and maternal and child intake (or frequency of intake) of some of these foods. Weaknesses in the evaluation design (e.g., lack of comparability between groups at baseline, failure to control for self-selection of households into the intervention, and collection of baseline and endline data during different seasons) prevent drawing firm conclusions about the program impacts. Analysis of impact pathways also shows that household-level benefits from the program did not translate into significant improvements in maternal and child health and nutrition. A careful redesign and rigorous assessment of the program using a program theory framework would help unleash its true potential to improve maternal and child health and nutrition outcomes.
The Effect of Therapeutic Zinc Supplementation among Young Children with Selected Infections: A Review of the Evidence
Authors: Haider Batool A. , Bhutta Zulfiqar A. 
Published: November 2015

Background Zinc deficiency is now widely recognized as a leading risk factor for morbidity and mortality and is estimated to be responsible for approximately 800,000 excess deaths annually among children under 5 years of age. Objective To evaluate the impact of zinc supplementation as an adjunct in the treatment of diarrhea, pneumonia, malaria, and tuberculosis in children under 5 years of age. Methods A comprehensive literature search of electronic databases to identify randomized, controlled trials on the topic was undertaken in January 2008. Eligible studies identified on search were reviewed by the authors and data extraction was done. Statistical analyses were performed with the use of Review Manager software. Results Current analysis of the adjunctive therapeutic benefit of zinc in acute diarrhea corroborates existing reviews and provides evidence of reduction in the duration of acute diarrhea by 0.5 day (p = .002) in children under 5 years of age. However, zinc supplementation is found to have no beneficial impact in infants under 6 months of age. A beneficial effect of zinc as an adjunctive treatment is also found in persistent diarrhea, the duration of which is reduced by 0.68 day (p < .0001). Evidence of the benefit of zinc supplementation in pneumonia and malaria is insufficient, whereas no studies are available in children with tuberculosis. Conclusions The existing literature provides evidence of a beneficial effect of therapeutic zinc supplementation in the reduction of the duration of acute and persistent diarrhea. However, evidence for its impact on pneumonia, malaria. and tuberculosis in children under 5 years of age is insufficient and needs further evaluation.
The Effectiveness of Quality Protein Maize in Improving the Nutritional Status of Young Children in the Ethiopian Highlands
Authors: Akalu Girma , Taffesse Samson , Gunaratna Nilupa S. , De Groote Hugo 
Published: November 2015

Background Undernutrition is a persistent problem in Africa, especially in rural areas where the poor largely depend on staples and have limited access to a diverse diet. Quality protein maize (QPM) consists of maize varieties biofortified with increased lysine and tryptophan levels. Several studies in controlled settings have indicated the positive impact of QPM on the nutritional status of children. Objective Two 1-year, randomized, controlled studies were undertaken to measure the effect of QPM on the nutritional status of children consuming typical maize-based diets when QPM was cultivated by their households in the western Ethiopian highlands. Methods The first study used a cluster-randomized design with 151 children aged 5 to 29 months; the second study used a completely randomized design with 211 children aged 7 to 56 months. In both studies, half of the households were provided with QPM seed and the other half with seed of an improved conventional maize variety. Results Undernutrition was pervasive, and maize was the dominant food in the children's complementary diets. In the first study, a positive effect of QPM was observed for weight but not height, with children in the QPM group recovering from a drop in weight-for-height. In the second study, children consuming conventional maize progressively faltered in their growth, whereas children consuming QPM did not change significantly in height-for-age and had a marginal increase in weight-for-age. Conclusions These studies indicate that in major maize-producing and -consuming areas of Africa, home cultivation and use of QPM in children's diets could reduce or prevent growth faltering and may in some cases support catch-up growth in weight.
Miller's Best/Enhanced Practices for Flour Fortification at the Flour Mill
Authors: Johnson Quentin W. , Wesley Annie S. 
Published: November 2015

Background Cereal flour fortification has been identified as an effective mass fortification intervention as part of a national public health strategy to overcome micronutrient deficiencies and improve the health status of populations, especially women and children. Objective The effectiveness of cereal flour fortification programs requires the use of micronutrient premixes that provide the desired health benefits. Method The Miller's Best/Enhanced Practices for Flour Fortification at the flour mill has been developed to provide specific guidance to millers and government officials to ensure that flour fortification practices are carried out in a way that results in the anticipated public health impact. Results The paper provides information specific to the use of micronutrient premixes, feeders, the fortification process, and quality control systems to ensure that both minimum and enhanced practices can be followed by the millers. Conclusions Guidelines for basic and best/enhanced practices to be followed for each stage of the flour fortification process at the flour mill are presented. The paper is designed to be a companion to the Recommended Practices for the Production and Procurement of Premix used in Cereal Fortification Programs and supplementary to existing food quality manuals and systems, such as Good Manufacturing Practices, Food Quality Systems, and Hazard Analysis and Critical Control Points. Other stakeholders involved in flour fortification programs have the responsibility to follow best practices of their own to ensure optimum effectiveness.
Maternal Iron–Folic Acid Supplementation Programs: Evidence of Impact and Implementation
Authors: Sanghvi Tina G. , Harvey Philip W. J. , Wainwright Emily 
Published: November 2015

Background According to a World Health Organization (WHO) review of nationally representative surveys from 1993 to 2005, 42% of pregnant women have anemia worldwide. Almost 90% of anemic women reside in Africa or Asia. Most countries have policies and programs for prenatal iron–folic acid supplementation, but coverage remains low and little emphasis is placed on this intervention within efforts to strengthen antenatal care services. The evidence of the public health impact of iron–folic acid supplementation and documentation of the potential for scaling up have not been reviewed recently. Objective The purpose of this review is to examine the evidence regarding the impact on maternal mortality of iron–folic acid supplementation and the evidence for the effectiveness of this intervention in supplementation trials and large-scale programs. Methods The impact on mortality is reviewed from observational studies that were analyzed for the Global Burden of Disease Analysis in 2004. Reviews of iron–folic acid supplementation trials were analyzed by other researchers and are summarized. Data on anemia reduction from two large-scale national programs are presented, and factors responsible for high coverage with iron–folic acid supplementation are discussed. Results Iron-deficiency anemia underlies 115,000 maternal deaths per year. In Asia, anemia is the second highest cause of maternal mortality. Even mild and moderate anemia increase the risk of death in pregnant women. Iron–folic acid supplementation of pregnant women increases hemoglobin by 1.17 g/dL in developed countries and 1.13 g/dL in developing countries. The prevalence of maternal anemia can be reduced by one-third to one-half over a decade if action is taken to launch focused, large-scale programs that are based on lessons learned from countries with successful programs, such as Thailand and Nicaragua. Conclusions Iron–folic acid supplementation is an under-resourced, affordable intervention with substantial potential for contributing to Millennium Development Goal 5 (maternal mortality reduction) in countries where iron intakes among pregnant women are low and anemia prevalence is high. This can be achieved in the near term, as policies are already in place in most countries and iron–folic acid supplements are already in lists of essential drugs. What is needed is to systematically adopt lessons about how to strengthen demand and supply systems from successful programs.
Folic Acid Fortification through Existing Fortified Foods: Iodized Salt and Vitamin A—Fortified Sugar
Authors: Li Yao Olive , Diosady Levente L. , Wesley Annie S. 
Published: November 2015

Background Folic acid fortification of cereal-grain products has markedly improved folate status and reduced the risks of neural tube defects and other chronic diseases in the populations participating in fortification programs. To more broadly extend its benefit to affected populations in developing countries, it would seem logical to incorporate folic acid fortification into existing or planned programs to minimize the incremental cost of this intervention. Objective To examine the feasibility of providing folic acid through ongoing programs for salt iodization and vitamin A fortification of sugar. Methods Folic acid was added to iodized salt and vitamin A–fortified sugar by various methods—direct blending as a powder, spraying onto the carriers as aqueous solution or suspension, or blending as a micro-encapsulated premix. The multiple fortified samples were subjected to a prolonged storage stability test, and the retentions of the added micronutrients were followed. Results Folic acid was generally stable when incorporated into Guatemalan iodized salt and vitamin A–fortified sugar. Even in the presence of encapsulated ferrous fumarate as an iron fortificant, samples retained > 80% in salt and ∼ 70% in sugar samples respectively, after 9 months of storage at 40°C and 60% relative humidity. The addition of folic acid as a dry premix made by extrusion was most effective in retaining both folic acid and the other added micronutrients. Conclusions The fortification method had a pronounced impact on the stability of both folic acid and the other added micronutrients. Proper encapsulation may be required to ensure the stability of multiple fortified foods.
Improved Nutrition Knowledge and Practice through Intensive Nutrition Education: A Study among Caregivers of Mildly Wasted Children on Nias Island, Indonesia
Authors: Inayati Dyah Ayu , Scherbaum Veronika , Purwestri Ratna Chrismiari , Wirawan Nia Novita , Suryantan Julia , Hartono Susan , Bloem Maurice Alexander , Pangaribuan Rosnani Verba , Biesalski Hans Konrad , Hoffmann Volker , Bellows Anne Camilla 
Published: November 2015

Background Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices. Objective To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ −1.5 to < −1) aged ≥ 6 to < 60 months on Nias Island, Indonesia. Methods To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE ( n = 114) or monthly NNE ( n = 96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the intervention period. Results At admission, the knowledge and practice levels of caregivers in both groups were not statistically significantly different. After participating in the nutrition education program, the percentage of correct answers on nutrition knowledge and practice in the INE group was significantly higher than that in the NNE group. Significant improvement in knowledge and practice scores was observed in the INE group after the intervention ( p < 0.001), whereas only a significant improvement in knowledge was found in the NNE group ( p < .05). Conclusions In comparison with NNE, the INE approach was significantly better in bringing about a positive change in knowledge and practice of caregivers of mildly wasted children in the study area.
Relative Efficacy of Micronutrient Powders versus Iron—Folic Acid Tablets in Controlling Anemia in Women in the Second Trimester of Pregnancy
Authors: Choudhury Nuzhat , Aimone Ashley , Hyder S. M. Ziauddin , Zlotkin Stanley H. 
Published: November 2015

Background Iron deficiency is a major cause of anemia and the most prevalent nutrient deficiency among pregnant women in developing countries. The use of iron and folic acid supplements to treat and prevent iron-deficiency anemia has limited effectiveness, mainly due to poor adherence. Home fortification with a micronutrient powder for pregnant women may be an effective and acceptable alternative to traditional drug models. Objective To d etermine whether home fortification with micronutrient powders is at least as efficacious as iron and folic acid tablets for improving hemoglobin concentration in pregnant women. Methods A cluster-randomized noninferiority trial was conducted in the rural subdistrict of Kaliganj in central Bangladesh. Pregnant women (gestational age 14–22 weeks, n = 478), were recruited from 42 community-based Antenatal Care Centres. Each centre was randomly allocated to receive either a micronutrient powder (containing iron, folic acid, vitamin C, and zinc) or iron and folic acid tablets. Changes in hemoglobin from baseline were compared across groups using a linear mixed-effects regression model. Results At enrolment, the overall prevalence of anemia was 45% ( n = 213/478). After the intervention period, the mean hemoglobin concentrations among women receiving the micronutrient powder were not inferior to those among women receiving tablets (109.5 ± 12.9 vs 112.0 ± 11.2 g/L; 95% CI, −0.757 to 5.716). Adherence to the micronutrient powder was lower than adherence to tablets (57.5 ± 22.5% vs 76.0 ± 13.7%; 95% CI, −22.39 to −12.94); however, in both groups, increased adherence was positively correlated with hemoglobin concentration. Conclusions The micronutrient powder was at least as efficacious as the iron and folic acid tablets in controlling moderate to severe anemia during pregnancy.
Effectiveness of Fortified Flour for Enhancement of Vitamin and Mineral Intakes and Nutrition Status in Northwest Chinese Villages
Authors: Huo Junsheng , Sun Jing , Huang Jian , Li Wenxian , Wang Lijuan , Selenje Lilian , Gleason Gary R. , Yu Xiaodong 
Published: November 2015

Background Fortification of flour is one of the approaches for the control and prevention of vitamin and mineral deficiencies. Objective To assess the effect of fortification of flour with seven vitamins and minerals on a population of Chinese women. Methods Farmers who offered their land for reforestation in 25 northwest provinces of China received compensation in the form of wheat flour; the amount of flour given depended on the amount of land that was given up for reforestation. This study observed the effects of providing families with fortified flour in the reforestation areas in Gansu Province. The study was conducted for 3 years. Families in the intervention village who offered land for reforestation received flour fortified with seven vitamins and minerals, and those in the control village received unfortified flour. Seven surveys, spaced at least 6 months apart, were carried out in each village from 2004 to 2007. At baseline and at each annual survey, measurements and blood samples were taken from 300 adult female subjects aged 20 to 60 years to assess dietary intake, height, weight, body fat, hemoglobin, serum retinol, serum iron, free erythrocyte protoporphyrin, serum zinc. Serum folic acid was measured at baseline and 36-month only. At each 6-month survey, data were collected on anthropometric features, hemoglobin, and dietary intake. Results Consumption of fortified flour in the intervention village ranged from 158.7 to 232.7 g per person per day. Serum retinol status was significantly improved after 12-month intervention until the end of the trial compared with both the control group and the baseline level of the intervention group. Iron status expressed as FEP and SI levels showed higher than that of the control group and baseline levels only at 36-month. Hemoglobin levels of the intervention group were higher than that of the control group and baseline levels, but anemia prevalence of both the intervention and control groups remained unchanged in the intervention period. Levels of serum zinc showed increases compared with the control group and baseline data at 24-month and 36-month, and levels of serum folic acid of intervention group in 36-month was higher than that of both the control group and baseline level. Conclusions The evidence from this study confirms the positive bioeffectiveness of fortified flour in the rural female population in China, but a higher dosage of electrolytic elementary iron in flour fortification was suggested for anemia prevention and control.
Cost Analysis of Community-Based Daily and Weekly Programs for Treatment of Moderate and Mild Wasting among Children on Nias Island, Indonesia
Authors: Purwestri Ratna Chrismiari , Scherbaum Veronika , Inayati Dyah Ayu , Wirawan Nia Novita , Suryantan Julia , Bloem Maurice Alexander , Pangaribuan Rosnani Verba , Hoffmann Volker , Biesalski Hans Konrad , Qaim Matin , Bellows Anne Camilla 
Published: November 2015

Background Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score ≥ −3 to < −1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. Objective To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. Methods The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score ≥ −1.5 SD in daily and weekly programs. Results Institutional costs to the implementing organization were similar for both programs (approximately US$4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and higher weight gain (3.7 vs. 2.2 g/kg/day) than the weekly programs. About 6% to 7% of the total cost of the programs was accounted for by locally produced RUF-Nias biscuits. The social cost borne by the community for the weekly programs was about half that for the daily programs. Conclusions The daily programs achieved better results for the implementing organization than the weekly programs; however, the weekly programs were preferred by the community because of the lower time constraints and the lower opportunity cost of time. The willingness of community and household members to invest their time in more intensive activities in the daily programs led to better program outcomes.
Evaluation of Iodine Content in Table Salt Consumed in Democratic Republic of Congo
Authors: Kitwa Kayumba E. , Habimana Laurence , Lumbu Simbi J. B. , Donnen Philippe , Twite Kabange E. , Mpoyo Kasongo E. , De Nayer Philippe , Kalenga Muenze K. , Robert Annie 
Published: November 2015

Background DR Congo has adopted universal salt iodization to reduce disorders due to iodine deficiency. Since 1994, only iodized salt can be imported, but there is currently no routine monitoring of the iodine content of distributed salt. It is therefore unclear if iodine deficiency remains a health problem, particularly in pregnant women. Objective To evaluate the iodine content of salt in households of pregnant women in Lubumbashi. Methods We conducted a survey of the iodine content of salt consumed by 375 women presenting at prenatal consultations in three socially different areas of Lubumbashi: urban, semiurban, and rural. The women were questioned about where they purchased salt, how it was packaged, and how they stored the salt, and each woman provided a sample of salt for determination of its iodine content by the iodometric method. Results Most women (84.3%) bought salt in the public markets, mainly in bulk (93.6%); 80.0% stored salt in plastic boxes. The median iodine content was 27.5 ppm (IQR, 16.0–38.1) in urban areas, 19.0 ppm (IQR, 7.4–31.7) in semiurban areas, and 20.1 ppm (IQR, 5.3–31.7) in rural areas. The iodine content was less than 15 ppm (minimum threshold) in 36.3% of samples, including 13.9% without any detectable iodine. The iodine content was above 40 ppm (maximum limit) in 18.9% of samples. Only 44.8% of salt samples had adequate iodine content. Conclusions The population of Lubumbashi remains at risk for hypothyroidism and hyperthyroidism. An effective and regular system for the control of iodine content in distributed salt is needed in DR Congo.