bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Median Urinary Iodine Concentration as an Indicator of Iodine Status among Pregnant Women, School-Age Children, and Nonpregnant Women
Authors: Wong Esther M. , Sullivan Kevin M. , Perrine Cria G. , Rogers Lisa M. , Peña-Rosas Juan Pablo 
Published: November 2015

Background Most surveys that assess the iodine status of populations target school-age children, whereas others may target nonpregnant women with the assumption that the iodine status of these groups is representative of other groups in the same population. Objective To assess whether the median urinary iodine concentration (UIC) of school-age children or nonpregnant women can be used to accurately represent the iodine status of pregnant women. Methods Using the World Health Organization Vitamin and Mineral Nutrition Information System and a literature review, we identified urinary iodine surveys that included pregnant women and school-age children and/or nonpregnant women in the same location and year using estimates from the smallest geographic level to increase the number of data points. Linear regression was used to assess the relationships between the median UIC for the comparisons. Results There were 48 survey pairs with pregnant women and school-age children (total sample sizes of 8,622 and 16,844, respectively), and 26 pairs with pregnant and nonpregnant women (sample sizes of 3,222 and 5,520, respectively). The country contributing the most data points was China. When the median UIC in school-age children or nonpregnant women indicated iodine intake was adequate or above requirements, approximately half the time pregnant women had inadequate iodine intake. Conclusions Adequate iodine nutrition status of school-age children or nonpregnant women may not indicate adequate iodine nutrition status among pregnant women. In order to assess the iodine status of pregnant women, the iodine status would need to be assessed in this group.
Beyond Food Insecurity: How Context Can Improve Complementary Feeding Interventions
Authors: Paul Keriann H. , Muti Monica , Khalfan Sabra S. , Humphrey Jean H. , Caffarella Rosemary , Stoltzfus Rebecca J. 
Published: November 2015

Background The role of context has not been elaborated with respect to current recommendations for complementary feeding interventions, apart from a gross distinction based on food security. Objective Our objective was to compare two food-insecure settings in sub-Saharan Africa to determine how context (i.e., the set of local social, cultural, and physical circumstances) influences complementary feeding practices and nutrient intakes and how the results can help in the design of a suitable intervention strategy. Methods We conducted formative research using 24-hour dietary recalls, household interviews, and focus group discussions with mothers of 6- to 12-month-old infants in rural Zimbabwe ( n = 32) and Pemba Island, Zanzibar, Tanzania (n = 44). Results In both settings, many infants had suboptimal nutrient intakes, poor dietary diversity, and poor hygiene. Breastfeeding practices were poor in Pemba, and the infants' diet had low energy density in Zimbabwe. Beyond food insecurity, contextual determinants of practices included inaccurate indigenous knowledge, time-consuming maternal livelihoods, family eating behaviors, local agriculture, and the local ecosystem. Both settings would require nutrition education, but it should target the broader indigenous ways of learning and family eating behaviors in order to achieve the necessary behavior change. A home-based fortificant would probably be enough for Pemban children, because the ecosystem of the island provides sufficient sources of macronutrients. However, Zimbabwean children appear to need a fortified food-based supplement to overcome the poor agricultural and economic context. Conclusions Assessing context was essential to intervention design. A framework to guide future formative research is proposed.
Effectiveness of Fortification of Drinking Water with Iron and Vitamin C in the Reduction of Anemia and Improvement of Nutritional Status in Children Attending Day-Care Centers in Belo Horizonte, Brazil
Authors: da Silva Rocha Daniela , Capanema Flávio Diniz , Netto Michele Pereira , de Almeida Carlos Alberto Nogueira , Franceschini Sylvia do Carmo Castro , Lamounier Joel Alves 
Published: November 2015

Background Because of the high prevalence of iron-deficiency anemia in Brazil, individual control measures tend to be ineffective, and fortification of foods with iron is considered the most effective method to fight anemia. Objective To evaluate the effectiveness of fortification of drinking water with iron and vitamin C in the reduction of anemia in children in day-care centers in Belo Horizonte, Brazil. Methods This before-and-after study evaluated 318 children aged 6 to 74 months. Identification data and data on socioeconomic variables were collected; anthropometric and biochemical measurements were performed before and after 5 months of fortification of water with 5 mg of elemental iron and 50 mg of ascorbic acid per liter. The fortified water was used for drinking and cooking at the day-care center. Wilcoxon's nonparametric test was used to evaluate the differences in continuous variables, and McNemar's test was used to compare the prevalence rates of anemia. Results The prevalence of anemia decreased signifi- cantly from 29.3% before fortification to 7.9% at the end of the study, with a significant increase in hemoglobin levels. Reductions in the prevalence rates of stunting and underweight were observed. Conclusions Fortification of water with iron and vitamin C significantly reduced the prevalence of anemia and improved nutritional status among children attending day-care centers.
Nutritional Enhancement of US Title II Food Aid Products
Authors: Rosenberg Irwin , Tilahun Jessica , Schlossman Nina , Bagriansky Jack , Johnson Quentin , Webb Patrick , Rogers Beatrice , Masterson Amelia Reese 
Published: November 2015

Background Food aid provided by the United States has saved the lives of the vulnerable for many years. Recognizing the need for a thorough review of product formulations and specifications, the US Agency for International Development (USAID) commissioned a 2-year assessment of quality issues relating to Title II food aid products. This article presents findings and recommendations of that review relating to product enhancements. Objective The core question addressed was: Are current commodity specifications for enriched FBFs appropriate in light of evolving nutritional science and food fortification technology, or do they need to be updated? Methods Empirical data were derived from a number of sources, including a survey of Title II implementing partners focusing on procurement and logistics, and uses of FBFs and other foods. Input of implementing partners, civil society, and donor organizations was obtained through individual consultations, international and small group meetings. More than 400 individuals accessed the project's website. The project convened a panel of experts in food technology and science, food policy, law, industry, medicine, development and humanitarian work, and the maritime industry, and held regular joint meetings with USDA and USAID. The draft report was widely disseminated and posted on the website. Results and conclusions The findings of this research led to the following broad areas of improvement in US Title II food aid products: 1) Improve the formulation of existing FBF products used in Title II programming. This includes the addition of a dairy source of protein to products targeted to children 6 to 24 months of age, pregnant and lactating women, wasted children, and wasted individuals undergoing HIV/AIDS treatment. 2) Upgrade the vitamin and mineral mixes used and diversify approaches to addressing micronutrient needs. Enhance the composition of premixes used to fortify blended foods as well as milled grains and vegetable oil; facilitate shipping of fortificant premix with bulk cereals for in-country fortification; and develop micronutrient powders (sachets) and other point-of-use fortification options. 3) Develop or adopt non-cereal-based (e.g., lipid-based) products for the management of nutritional deficiencies. This is an argument for more choice among appropriate tools, not for discarding products that have already shown their value over many years. It also does not reduce the need to maintain a focus on supplying high volumes of quality grains as the main staple in food aid baskets.
Universal Salt Iodization in the Central and Eastern Europe, Commonwealth of Independent States (CEE/CIS) Region during the Decade 2000–09: Experiences, Achievements, and Lessons Learned
Authors: van der Haar Frits , Gerasimov Gregory , Tyler Vilma Qahoush , Timmer Arnold 
Published: November 2015

Background By 2000, the global track record on universal salt iodization (USI) indicated 26% access to adequately iodized salt in the Central and Eastern Europe, Commonwealth of Independent States (CEE/ CIS) Region. Objective Aimed at extracting lessons learned, this study examined experiences, achievements, and outcomes of USI strategies in CEE/CIS countries during the subsequent decade. Methods Information from the design, timing, execution, outputs, multi-sector management and results of actions by national stakeholders yielded 20 country summaries. Analysis across countries used a LogFrame Analysis typical for public nutrition development. Results By 2009, USI strategies had reached the target and population iodine nutrition shown adequate levels in 9 countries, while in 6 others, USI was close and/or population iodine status showed only minor imperfection. True USI, i.e., iodization of salt destined both for the food industry and the household, had been made mandatory in 13 of these 15 countries. In the Balkan area, USI and iodine nutrition advanced more than in CIS. Of the 20 sample countries, 17 (85%) had exceeded the mark of 50% adequate access, while the overall regional score reached 55% by 2010. Conclusions Experience from this region suggests that strong partnership collaboration, a new concept in post-Soviet societies, was a major success factor. Voluntary iodization or focusing on household salt alone was less likely conducive for success. Achieving optimum iodine nutrition required the setting of proper iodine standards. Weak political leadership insistence in the Russian Federation and Ukraine to embrace USI is the main factor why the region remains behind in the global progress.
Agriculture and Malnutrition in India
Authors: Gulati Ashok , Kumar A. Ganesh , Shreedhar Ganga , Nandakumar T. 
Published: November 2015

Background Despite the high and relatively stable overall growth of the economy, India's agriculture sector is underperforming and a vast section of the population remains undernourished. Objective To explore the possible interplay between agricultural performance and malnutrition indicators to see whether states that perform better in agriculture record better nutritional outcomes. Methods Correlation analysis and a simple linear regression model were used to study the relationship between agricultural performance and malnutrition among children under 5 years of age and adults from 15 to 49 years of age at 20 major states using data from the National Family Health Survey-3 for the year 2005/06 and the national accounts. Results Indicators of the level of agricultural performance or income have a strong and significant negative relationship with indices of undernutrition among adults and children, a result suggesting that improvement of agricultural productivity can be a powerful tool to reduce undernutrition across the vast majority of the population. In addition to agriculture, access to sanitation facilities and women's literacy were also found to be strong factors affecting malnutrition. Access to healthcare for women and child-care practices, in particular breast-feeding within 1 hour after birth, are other important determinants of malnutrition among adults and children. Conclusions Malnutrition is a multidimensional problem that requires multisectoral interventions. The findings show that improving agricultural performance can have a positive impact on nutritional outcomes. However, improvements in agriculture alone cannot be effective in combating malnutrition if several other mediating factors are not in place. Interventions to improve education, health, sanitation and household infrastructure, and care and feeding practices are critical. Innovative strategies that integrate agriculture and nutrition programs stand a better chance of combating the malnutrition problem.
Performance of Iron Spot Test with Arabic Bread Made from Fortified White Wheat Flour
Authors: Nichols Erin , Aburto Nancy , Masa'd Hanan , Wirth James , Sullivan Kevin , Serdula Mary 
Published: November 2015

Background The iron spot test (IST) is a simple qualitative technique for determining the presence of added iron in fortified flour. IST performance in bread has never been investigated. If found to perform well, the IST has the potential to provide a field-friendly method for testing bread and thus support the monitoring and evaluation of flour fortification programs. Objective To assess the performance of the IST in Arabic bread made from white wheat flour. Methods Bread samples were collected from 1,737 households during a national micronutrient survey in Jordan. A subsample of Arabic bread ( n = 44) was systematically selected for testing by both the IST and spectrophotometry (criterion reference). Performance measures (sensitivity, specificity, and positive and negative predictive values) were calculated using five cutoffs to define the presence of added iron, including ≥ 15.0 ppm (approximate level of natural iron in Arabic bread) and four additional cutoffs based on test performance. Results The iron contents of samples testing negative by IST ranged from 10.4 to 18.4 ppm, with one outlier at 41.0 ppm, which was excluded from subsequent analyses. The iron contents of samples testing positive by IST ranged from 16.1 to 38.4 ppm. With the exception of negative predictive values for the two lowest cutoffs (≥ 15.0 and ≥ 16.1 ppm), all performance measures exceeded 83.3%. Conclusions These results show promise for the IST as an inexpensive, field-friendly method for testing bread that could have a useful role in the monitoring and evaluation process for flour fortification programs.
Effect on School Attendance and Performance of Iron and Multiple Micronutrients as Adjunct to Drug Treatment of Schistosoma-Infected Anemic Schoolchildren
Authors: Ayoya Mohamed Ag , Spiekermann-Brouwer Gerburg Maria , Traoré Abdel Kader , Garza Cutberto 
Published: November 2015

Background Relationships among Schistosoma haematobium, anemia, and iron deficiency have been documented, and all have been found to be associated with a decline in school attendance and lower performance. Objective To assess the effect of single or combined iron and multiple micronutrients and/or praziquantel on school attendance and achievement in randomly selected 7- to 12-year-old anemic children with documented S. haematobium infection ( n = 406) in Mali over a 3-month period. Methods Schistosomiasis infection was diagnosed by the presence of schistosome eggs in the urine. Venous blood samples (5 mL) were drawn from an antecubital vein for hemoglobin assessment. Children were randomly assigned to one of four treatment groups: praziquantel alone, praziquantel + iron, praziquantel + multiple micronutrients, and praziquantel + multiple micronutrients + iron. School attendance was defined by the number of days the child was absent from class. Achievement was defined by the child's overall school grades. Results Changes within treatment groups from baseline to the end of study were found for attendance ( p < .001) but not for achievement ( p > .05). Significant supplement treatments by age group interactions were found in 7- to 9-year-old children for attendance. Further exploration of treatment effects in this age group showed that only iron treatment's main effect was significant on attendance ( p = .049) and was of borderline significance on school grades ( p = .08). Conclusions Combined praziquantel and iron treatment improved children's school attendance and performance better than praziquantel alone, particularly among younger children.
Community-Based Management of Severe and Moderate Acute Malnutrition during Emergencies in Sri Lanka: Challenges of Implementation
Authors: Jayatissa Renuka , Bekele Aberra , Kethiswaran A. , de Silva A. H. 
Published: November 2015

Background With the documentation of high rates of acute malnutrition in children under 5 years of age, the Ministry of Health of Sri Lanka established a Nutrition Rehabilitation Program in Jaffna District of the Northern Province. Objective To assess the impact of community-based management of acute malnutrition among children under 5 years of age and its operational challenges. Methods The Nutrition Rehabilitation Program was introduced and implemented in phases covering the entire district and was integrated into the routine healthcare system from the beginning. Children were categorized into severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) groups according to World Health Organization weight-for-height growth standards. Children with SAM were given ready-to-use-therapeutic food (RUTF), and children with MAM were given 100 g (450 kcal) of high-energy biscuits (HEBs) provided by UNICEF. All children received daily supplementary food consisting of locally produced Thriposha or 50 g of corn—soya blend provided by the World Food Programme that provides approximately 200 kcal in addition to the general food ration. The children were followed up according to the guidelines stipulated in the Nutrition Rehabilitation Program manual. Results An endline representative survey conducted 2 years after implementation of the Nutrition Rehabilitation Program revealed that the prevalence of global acute malnutrition (GAM) among children under five dropped from 18% to 9.6%, a reduction of 47%, while the prevalence of SAM dropped from 3.5% to 0.7%, a reduction of 80%. However, the prevalence of anemia remained at 34%, which is higher than the national prevalence of 25%, in spite of supplementation with 200% of the Recommended Nutrient Intake of iron and vitamin A. Conclusions Proper targeting of feeding programs with good coverage can reduce the rates of acute malnutrition in emergencies. It is important also to consider the control of anemia in emergencies.
Does Greater Workload Lead to Reduced Quality of Preventive and Curative Care among Community Health Workers in Bangladesh?
Authors: Puett Chloe , Coates Jennifer , Alderman Harold , Sadruddin Salim , Sadler Kate 
Published: November 2015

Background Community health workers (CHWs) perform a range of important tasks; however, limited evidence is available regarding the association between their workload and the quality of care they provide. Objective To analyze the quality of preventive and curative care provided by two groups of CHWs with different workloads in southern Bangladesh. Methods One group of CHWs provided preventive care in addition to implementing community case management (CCM) of acute respiratory infection and diarrhea, and another group additionally treated severe acute malnutrition (SAM). Preventive care was measured by case management observation at a routine household visit. Curative care was measured by case scenarios. Qualitative methods were used to contextualize CHWs' performance by examining their perceptions of challenges related to their workload. A total of 338 CHWs were assessed. Results CHWs managing cases of SAM worked significantly more hours than the other group (16.7 ± 6.9 hours compared with 13.3 ± 4.6 hours weekly, p < .001) but maintained quality of care on curative and preventive work tasks. Effectively treating cases of SAM appeared to motivate CHWs. Conclusions This was one of the first trials adding the treatment of SAM to a CHW workload and suggests that adding SAM to a well-trained and supervised CHW's workload, including preventive and curative tasks, does not necessarily yield lower quality of care. However, increased workloads had consequences for CHWs' domestic life, and further increases in workload may not be possible without additional incentives.
Improving the Comparability of National Estimates of Fruit and Vegetable Consumption for Cross-National Studies of Dietary Patterns
Authors: Moore Spencer , Lloyd Beate 
Published: November 2015

Background Developing global approaches to the problem of low fruit and vegetable consumption requires cross-nationally comparable estimates of fruit and vegetable consumption. National differences in the definitions of fruits and vegetables and serving size amounts limit the comparability of estimates. Objectives To describe national differences in fruit and vegetable definitions, serving size amounts, and how these factors can influence the comparability of fruit and vegetable consumption estimates; and to provide a series of reporting recommendations that could facilitate cross-national studies of fruit and vegetable consumption. Methods A comprehensive review of national dietary guidelines, fruit and vegetable definitions, and fruit and vegetable consumption recommendations was undertaken for Canada, the United States, and the United Kingdom. Results To improve cross-national comparability, the findings suggest that researchers could report fruit and vegetable consumption separately, provide separate average fruit and vegetable intake amounts, report potato and legume or pulse consumption separately from vegetable consumption, and report consumption of 100% fruit juice separately from fruit consumption. Conclusions These four low-cost, high-value additions to conventional research reporting standards will aid in the development of cross-national research on global fruit and vegetable consumption and the design of global policies that can target low fruit and vegetable consumption in populations.
A Program Needs-Driven Approach to Selecting Dietary Assessment Methods for Decision-Making in Food Fortification Programs
Authors: Coates Jennifer , Colaiezzi Brooke , Fiedler John L. , Wirth James , Lividini Keith , Rogers Beatrice 
Published: November 2015

Background Dietary assessment data are essential for designing, monitoring, and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness, and cost tradeoffs of employing alternative dietary assessment methods, but little guidance exists. Objective To identify and apply criteria to assess the tradeoffs of using alternative dietary methods for meeting fortification programming needs. Methods Twenty-five semistructured expert interviews were conducted and literature was reviewed for information on the validity, usefulness, and cost of using 24-hour recalls, Food Frequency Questionnaires/ Fortification Rapid Assessment Tool (FFQ/FRAT), Food Balance Sheets (FBS), and Household Consumption and Expenditures Surveys (HCES) for program stage-specific information needs. Criteria were developed and applied to construct relative rankings of the four methods. Results Needs assessment: HCES offers the greatest suitability at the lowest cost for estimating the risk of inadequate intakes, but relative to 24-hour recall compromises validity. Design: HCES should be used to identify vehicles and to estimate coverage and likely impact due to its low cost and moderate-to-high validity. Baseline assessment: 24-hour recall should be applied using a representative sample. Monitoring: A simple, low-cost FFQ can be used to monitor coverage. Impact evaluation: 24-hour recall should be used to assess changes in nutrient intakes. FBS have low validity relative to other methods for all programmatic purposes. Conclusions Each dietary assessment method has strengths and weaknesses that vary by context and purpose. Method selection must be driven by the program's data needs, the suitability of the methods for the purpose, and a clear understanding of the tradeoffs involved.