bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
Effectiveness of Distribution of Multimicronutrient Supplements in Children and in Women and Adolescent Girls of Childbearing Age in Chiclayo, Peru
Authors: Gross Ursula , Valle Claudia , Diaz Marita Mamani 
Published: November 2015

Background There is a need to better understand the coverage of scaled-up multimicronutrient supplementation programs. Objective The coverage of the distribution of multimicronutrient supplements in 26 urban communities among women and adolescent girls 12 through 44 years of age and children under 5 years of age was evaluated for purposes of scaling-up. Methods Formative research and descriptive statistics were used to analyze the distribution of supplements. Results Despite a delayed memorandum of understanding with the health sector and delayed delivery by the producer of the supplement, a high coverage rate of supplement distribution to the children (88% on average during the 3 months of supplementation) was still achieved as a result of the strong commitment of the community and the Integrated Food Security Program. The lower coverage rate among women and adolescent girls (47% on average) was the result of too short a period of enrollment in the program. There was no decrease of coverage during the 3 months of supplementation in both groups. Conclusions Effective, sustainable, large-scale micronutrient supplementation programs require broad partnerships with commitments of governmental and nongovernmental organizations, communities, and the private sector. Availability of the supplements and communication materials must be secured well ahead of the supplementation campaign and distribution of the supplement.
Lessons Learned from the Scaling-Up of a Weekly Multimicronutrient Supplementation Program in the Integrated Food Security Program (Pisa)
Authors: Lechtig Aarón , Gross Rainer , Vivanco Oscar Aquino , Gross Ursula , de Romaña Daniel López 
Published: November 2015

Background Weekly multimicronutrient supplementation was initiated as an appropriate intervention to protect poor urban populations from anemia. Objective To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru. Methods Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost. Results Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program. Conclusions To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.
Does Provision of Food in School Increase Girls' Enrollment? Evidence from Schools in Sub-Saharan Africa
Authors: Gelli Aulo , Meir Ute , Espejo Francisco 
Published: November 2015

Background The problem of low female literacy rates in Africa starts with low primary school enrollment, particularly in areas of high food insecurity. The provision of food in, and through, schools is considered to be one way of enrolling more girls in school, keeping them enrolled, and enhancing their adult well-being and pro- ductivity as a result. Objective To investigate the effects of provision of food and additional take-home rations in schools on girls' enrollment. Methods A retrospective cross-sectional study was designed based on school-level surveys in 32 African countries between 2002 and 2005. The study population consisted of girls and boys in primary schools targeted by the World Food Programme (WFP) and located in food-insecure areas that also suffered from lack of access to education. Results Provision of food in schools through the Food for Education (FFE) program contributed to increasing absolute enrollment in WFP-assisted schools by 28% for girls and 22% for boys in the first year. Post year-one enrollment patterns varied according to the type of FFE program. Where provision of take-home rations for girls was combined with on-site feeding for all pupils, the increase in girls' absolute enrollment was sustained at 30% after the first year. However, in schools providing on-site feeding alone, the rate of increase in absolute enrollment after the first year reverted to the rates of increase found in the year prior to FFE implementation. The provision of take-home rations also appeared to reduce the dropout rate of female students, particularly in the higher grades. Conclusions FFE programs can have a lasting positive influence on school enrollment and, by providing extra take-home rations to girls, in addition to on-site feeding, can make a strong contribution to the Millennium Development Goals.
Dialyzability of Minerals in Corn Masa Gruel (Atole) Fortified with Different Iron Compounds: Effects of Ascorbic Acid, Disodium EDTA, and Phytic Acid
Authors: De-Regil Luz Maria , Casanueva Esther , Killilea David W. , Viteri Fernando E. 
Published: November 2015

Background Lime-treated corn gruel ( atole) is a common weaning food in iron-deficient populations, especially in Mexico and Central America, and is a potential vehicle for fortification with iron. Objective The objective of this study was to screen promising iron compounds for use in the fortification of atole, using in vitro enzymatic digestion–dialysis techniques, while also considering their response to known iron absorption enhancers and inhibitors. Methods Atole, unaltered or preincubated with phytase, was fortified with iron (10 mg/L) from ferrous sulfate, ferrous bisglycinate, or ferrous fumarate, or with ferric chloride, ferric ammonium citrate, or ferric sodium ethylenediaminetetraacetic acid (NaFeEDTA), and submitted to in vitro digestion. Dialysis of calcium, copper, iron, phosphorus, and zinc (analyzed by inductively coupled plasma atomic emission spectrometry) was measured when atole was fortified with iron compounds alone or together with ascorbic acid or disodium ethyl- enediaminetetraacetic acid (Na2 EDTA). Results Iron dialyzability was higher with NaFeEDTA ( p < .05) than with all other iron compounds, which did not differ among themselves in iron dialyzability. Addition of ascorbic acid had no significant effect on iron dialysis, whereas Na2 EDTA enhanced iron dialyzability by 7 to 10 times in unaltered atole and 15 to 20 times in phytase-preincubated atole ( p < .05). Addition of Na2 EDTA always increased intrinsic zinc dialyzability, and most of the time this increase was significant. Phytase pretreatment generally increased mineral dialysis. Conclusions Adding EDTA (either as NaFeEDTA or as Na2 EDTA) to atole can increase the dialyzability of ferrous and ferric iron compounds and enhance the dialyzability of intrinsic zinc without any negative effects on calcium, phosphorus, or copper dialysis.
Assessment of the Sustainability of the Iodine-Deficiency Disorders Control Program in Lesotho
Authors: Sebotsa Masekonyela Linono Damane , Dannhauser André , Jooste Pieter L. , Joubert Gina 
Published: November 2015

Background Evaluation of the sustainability of iodine-deficiency disorders control programs guarantees successful and sustained virtual elimination of iodine deficiency. The Lesotho universal salt iodization legislation was enacted in 2000 as an iodine-deficiency disorders control program and has never been evaluated. Objectives To assess the sustainability of the salt iodization program in Lesotho, 2 years after promulgation of the universal salt iodization legislation. Methods The proportion to population size method of sampling was used in 2002 to select 31 clusters in all ecological zones and districts of Lesotho. In each cluster, 30 women were selected to give urine and salt samples and 30 schoolchildren to give urine samples. The salt samples were analyzed by the iodometric titration method, and the ammonium persulfate method was used to analyze the urine samples. The chairperson of the iodine-deficiency disorders control program was interviewed on programmatic indicators of sustainability. SAS software was used for statistical analysis of the data. Results The urinary iodine concentrations of very few children (10.1% and 21.5%) and women (9.8% and 17.9%) were lower than 50 μg/L and 100 μg/L, respectively. At the household level, 86.9% of the households used adequately iodized salt. Only four indicators of sustainability have been attained by the salt iodization program in Lesotho. Conclusions Iodine-deficiency disorders have been eliminated as a public health problem in Lesotho, but this elimination is not sustainable. Effective regular monitoring of salt iodine content at all levels, with special attention to iodization of coarse salt, is recommended, together with periodic evaluation of the iodization program.
Undernutrition among Adult Dhimals of Naxalbari, West Bengal: Comparison with other Tribes of Eastern India
Authors: Datta Banik Sudip , Bose Kaushik , Bisai Samiran , Bhattacharya Mithu , Das Subal , Jana Arpita , Purkait Pulakesh 
Published: November 2015

Background The tribes of India comprise approximately 8% of the total population of the country, which probably has the largest number of tribal communities in the world. In general, the tribal populations are among the most underprivileged and undernourished people in India. Objectives To determine the anthropometric characteristics and prevalence of undernutrition, based on body mass index (BMI), of adult Dhimals, a tribal population of Naxalbari, West Bengal, India, and to compare these results with those from four other tribes of Eastern India: the Bathudis, Kora Mudis, Santals, and Savars. Methods A total of 305 adult (18 years or older) Dhimals (159 men and 146 women) from three villages (Maniram, Hatighisa, and Buraganj) in the Mallabari area of Naxalbari were studied. These villages are located 5 km from Siliguri town, which is approximately 580 km from Kolkata, the provincial capital of West Bengal. Anthropometric measurements included height and weight. BMI was calculated by the standard equation. Undernutrition was evaluated according to World Health Organization (WHO) cutoff points. Results The overall prevalence of undernutrition (BMI < 18.5) was very high (36.4%). The prevalence was significantly higher in women than in men (46.4% vs. 27.0%; χ2 = 12.54; p < .001; odds ratio, 2.35). According to the WHO criterion, the prevalence of undernutrition was high and the situation was serious in men. Among women, the prevalence of undernutrition was very high and the situation was critical. However, in general, compared with other tribal people of eastern India except the Santals, adult Dhimals had better anthropometric and nutritional profiles. Conclusions This study provides evidence that although the anthropometric and nutritional profiles of adult Dhimals are better than those of some of the other tribal populations of eastern India, immediate appropriate nutritional intervention programs are needed for implementation among this ethnic group.
Reaching the Goal of Universal Salt Iodization (USI): Experience of Uttar Pradesh, India
Authors: Vir Sheila C. , Dwivedi Shraddha , Singh Richa , Mukherjee Ashish 
Published: November 2015

Background In 2002, the percentage of households consuming iodized salt in the state of Uttar Pradesh (UP) in India dropped to as low as 6%. This implied that 3.5 million newborns in this non-salt producing state, with 180 million population, were at risk of brain damage unless universal accessibility and consumption of iodized salt was ensured and sustained. Objectives Urgent measures were introduced in 3 phases in the state for accelerating procurement, distribution and consumption of iodized salt. Methods In the first phase, a study on mapping of salt wholesalers and understanding the salt trading system—including understanding the knowledge, attitudes, and practices of salt traders was undertaken to accelerate efforts to influence availability, marketing, and accessibility of iodized salt. The study revealed that a total of only 344 primary wholesalers supplied salt to the entire state. Of these, 126 wholesalers marketed 80% of salt and were located in only 15 of the total 70 districts of the state. This finding became a very strong basis for the program in phase II, which focused on the critical group of wholesalers and set up a system to frequently interact with them. The salt wholesalers were equipped with Salt Testing Kits (STKs) to ensure adequate iodine content in the salt procured by them and adherence to the legal ban on the sale of non-iodized salt for human consumption. Simultaneously, a “child-to-community” approach was launched through involvement of middle and high school children to create demand and monitor consumption of iodized salt at the household level. Over 217,000 salt samples (about 26,000 samples per quarter) were brought in by school children and tested for iodine content. Results The school activities resulted not only in influencing consumption of iodized salt, but also galvanized the entire chain linking consumers, retailers, and wholesalers. In less than 2 years, salt procured with nil iodine decreased from 38% to 15.3%, and salt marketed with adequate iodine level increased from 28.6% to 64.9%. School data revealed an increase in consumption of iodized salt from 6% to 46.7%. In phase 3, additional standardized activities at the school level were included and the program was taken to scale in the state. Conclusion The findings revealed that identification and inclusion of salt wholesalers—not only the salt manufacturers—was important for achieving a rapid positive shift in iodized salt marketing and consumption practices.
Stability of Iodine in Iodized Fresh and Aged Salt Exposed to Simulated Market Conditions
Authors: Maramag Cherry C. , Tengco Lorena W. , Rayco-Solon Pura , Solon Juan Antonio A. , Maglalang Hector C. , Solon Florentino S. 
Published: November 2015

Background The salt iodization law of the Philippines required that iodized salt sold at retail not be exposed to direct sunlight, high temperature and relative humidity, and contamination with moisture and dust from the environment. However, because the majority of local consumers buy salt displayed in open heaps, it was suggested that iodized salt should be sold in the same manner for greater accessibility and availability. Objective We aimed to provide evidence on the stability of iodine in local aged and fresh salt iodized at 100 ppm iodine and exposed to various market and storage conditions. Methods Samples of salt in open heaps and repacked salt were exposed for 4 weeks, and salt packed in woven polypropylene bags was stored for 6 months. The iodine content of the salt was determined by the iodometric titration method, and the moisture content was determined by the oven-drying method. Results For all types of exposed salt, iodine levels were above 60 ppm after the end of the study (4 weeks). Within each salt type, losses were greater for open-heap salt than for repacked salt. The greatest drop in moisture content occurred in the first week for most types of salt and exposure combinations. Moisture content was linearly correlated with iodine content. Iodine levels in stored salt remained above 60 ppm even after 6 months. Conclusions Iodized salt is able to retain iodine above the recommended levels despite exposure to an open environment and use of ordinary packaging materials while being sold at retail and kept in storage.
Iron, Folate, and Vitamin B12 Stores Among Pregnant Women in a Rural Area of Haryana State, India
Authors: Pathak Priyali , Kapil Umesh , Yajnik C.S. , Kapoor S.K. , Dwivedi S.N. , Singh Rajvir 
Published: November 2015

Background Iron, folate, and vitamin B12 deficiencies have adverse effects on pregnancy outcome. In India, data on the concomitant prevalence of these deficiencies among pregnant women are meager. Objective We conducted a community-based study to assess the prevalence of deficiencies of iron, folate, and vitamin B12 among pregnant women in a rural block of Haryana State. Methods The study was approved by the ethics committee of the All India Institute of Medical Sciences, New Delhi. A total of 283 pregnant women were enrolled in the study. After oral informed consent had been obtained from the women, blood was drawn from the antecubital vein for estimation of the levels of serum ferritin by enzyme-linked immunosorbent assay (levels < 12 ng/mL were considered as indicative of poor iron stores); serum folate was determined by radioimmunoassay (levels < 3 ng/mL were considered as indicative of poor folate stores); and serum vitamin B12 was estimated by the microbiologic method (levels < 200 pg/mL were considered as indicative of poor vitamin B12 stores). Results The results indicated that 67.7%, 26.3%, and 74.1% of the women had poor iron, folate, and vitamin B12 stores, respectively. Concomitant deficiencies of iron, folate, and vitamin B12 occurred in 16.2% of the women. We found that 59.9% of the women were consuming less than 75% of the recommended daily caloric allowance (2,175 kcal), indicating an overall poor food intake. This could be one of the predominant reasons for poor iron, folate, and vitamin B12 stores among the women. Conclusions Our findings suggest that apart from iron and folate, vitamin B12 deficiencies may play an important role in causing anemia.
Food and Nutritional Security of Children of Urban Farmers in Kampala, Uganda
Authors: Yeudall Fiona , Sebastian Renée , Cole Donald C. , Ibrahim Selahadin , Lubowa Abdelrahim , Kikafunda Joyce 
Published: November 2015

Background Urban agriculture is an important livelihood strategy to increase access to and availability of food in urban settings. Objective We examined the impact of sociodemographic and farming variables on the household food security and nutritional security of an index child aged 2 to 5 years. Our hypothesis was that dietary quality (percentage of energy from animal-source foods [%ASF] and dietary diversity) would have an impact on infection (as measured by C-reactive protein [CRP]), which in turn would have an impact on biochemical indices (hemoglobin and retinol) and anthropometric indices (weight-for-age z-score [WAZ] and body mass index z-score [ZBMI]). We examined the relationships among urban agricultural activities, household food security, and child nutritional security. Methods We conducted a cross-sectional survey of 296 households within each randomly selected study zone in Kampala, Uganda. Correlations were calculated and bivariate and exploratory path analysis was conducted to explore relationships. Results Household food security score was significantly positively correlated with the number of tropical livestock units ( r = 0.142, p = .017), dietary diversity ( r = 0.230, p < .001), %ASF ( r = 0.185, p = .002), and WAZ ( r = 0.149, p = .017). Exploratory path analysis demonstrated a significant positive relationship between household food security and %ASF, which in turn was positively associated with retinol. Consumption of animal-source food was significantly negatively associated with C-reactive protein level, which in turn was significantly negatively associated with hemoglobin level, and hemoglobin was significantly positively associated with WAZ. Conclusions Our findings are supportive of efforts to enhance access to land for urban farming and engagement in activities aimed at improving the quality of dietary intake of urban residents, in particular by increasing consumption of animal-source foods.
Infant-Feeding Practices and Beliefs about Complementary Feeding among Low-Income Brazilian Mothers: A Qualitative Study
Authors: Lindsay Ana Cristina , Machado Marcia Tavares , Sussner Katarina M. , Hardwick Cary K. , Peterson Karen E. 
Published: November 2015

Background Breastfeeding and weaning practices are important determinants of growth and development not only in infancy but also later in life. Objective To describe infant-feeding practices and beliefs about complementary feeding among low-income Brazilian mothers. Methods Qualitative methods included focus group discussions with low-income mothers enrolled in a Family Health/Community Health Workers program in Ceará, Northeast Brazil. Results Breastfeeding is widely practiced in this area, and overall, mothers are knowledgeable about the benefits of breastfeeding for their infants and themselves. Practices of prolonged breastfeeding and delayed supplementation of infants with semisolid foods emerged as a problem among very poor women. In addition, the results showed common problems related to complementary feeding practices, such as the early introduction of solid foods and the use of expensive commercial cereals and formula for weaning. Cultural factors and taboos appeared to have an important influence on mothers' infant-feeding practices and eating patterns of their children. Conclusions The results have implications for the design of breastfeeding promotion and interventions to improve complementary feeding. Improvements of the national Food Grant Program are also suggested, which are needed by low-income mothers to improve their infant-feeding practices.