bluuebunny/crossref_metadata_2025_split huggingface dataset:
Iodine Nutrition Status of Pregnant Women in an Iodine-Sufficient Area
Authors: Tahirović Husref , Toromanović Alma , Balić Adem , Grbić Sanja , Gnat Daniella 
Published: November 2015

Background Iodine is necessary for the synthesis of thyroid hormones, which play a decisive role in the development of the brain during fetal and early postnatal life. Objective To evaluate whether prophylaxis with 20 to 30 mg of iodine per kilogram of salt is enough to ensure optimal iodine nutrition during pregnancy in an iodinesufficient area. Methods A cross-sectional study of pregnant women was conducted in 2007. The urinary iodine concentration (UIC) was measured in 300 randomly selected women in Tuzla, Bosnia, and Herzegovina, in all three trimesters of pregnancy. Results The median UIC of the pregnant women was 142 μg/L, ranging from 27 to 1,080 μg/L. The median UIC of the pregnant women in each trimester of pregnancy who were not restricting their salt intake was consistent with adequate iodine nutrition, as defined by the World Health Organization Technical Consultation, whereas the median UIC of women who were restricting their salt intake was insufficient. Conclusions Pregnant women in the urban area of Tuzla had adequate iodine status except for those with restricted salt intake, which presents an increased risk to the mother as well to as the unborn child. Women in the rural area of Tuzla were found to be iodine-deficient, regardless of whether they had restricted their salt intake or not. However, for those pregnant women who have been advised to restrict their salt intake and who thus face the risk of iodine deficiency, the use of salt with higher concentrations of iodine could be advised.
Stunting Associated with Poor Socioeconomic and Maternal Nutrition Status and Respiratory Morbidity in Colombian Schoolchildren
Authors: Dekker Louise H. , Mora-Plazas Mercedes , Marín Constanza , Baylin Ana , Villamor Eduardo 
Published: November 2015

Background There are few recent reports on the prevalence and risk factors of stunting and thinness among schoolchildren in Latin America. Objective To determine the prevalence and sociodemographic correlates of stunting and thinness among school-age children in Bogotá, Colombia, and to examine whether these nutritional indices are associated with the risk of respiratory and diarrheal morbidity symptoms, visits to the doctor, and school absenteeism during the school year in a prospective study. Methods We obtained information on anthropometric and maternal sociodemographic characteristics of 3,100 children 5 to 12 years of age who attended public primary schools in 2006 and who came from low- and middle-income households. Data on the incidence of common gastrointestinal and respiratory symptoms were collected prospectively on morbidity diaries throughout the year. Results The prevalence rates of stunting and thinness were 9.9% and 8.7%, respectively. There were inverse, statistically significant trends in the prevalence of stunting by categories of child's birth and current weight; maternal education level, height, and body mass index (BMI); and household socioeconomic stratum. A strong positive association was found with maternal parity ( p for trend < .0001). Thinness was positively associated with the child's and the mother's age and inversely associated with birthweight and maternal BMI. Stunting was associated with a 44% increase in the incidence of cough with fever during the school year ( p = .04). Conclusions Child stunting in Bogotá is associated with poor socioeconomic and maternal nutritional status and predicts symptoms of respiratory infection.
Determinants of Infant and Young Child Feeding Practices in Sri Lanka: Secondary Data Analysis of Demographic and Health Survey 2000
Authors: Senarath Upul , Dibley Michael J. , Godakandage S. S. P. , Jayawickrama Hiranya , Wickramasinghe Aravinda , Agho Kingsley E. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background Poor feeding practices in early childhood contribute to the burden of childhood malnutrition and morbidity. Objective To estimate the key indicators of breastfeeding and complementary feeding and the determinants of selected feeding practices in Sri Lanka. Methods The sample consisted of 1,127 children aged 0 to 23 months from the Sri Lanka Demographic and Health Survey 2000. The key infant feeding indicators were estimated and selected indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results Breastfeeding was initiated within the first hour after birth in 56.3% of infants, 99.7% had ever been breastfed, 85.0% were currently being breastfed, and 27.2% were being bottle-fed. Of infants under 6 months of age, 60.6% were fully breastfed, and of those aged 6 to 9 months, 93.4% received complementary foods. The likelihood of not initiating breastfeeding within the first hour after birth was higher for mothers who underwent cesarean delivery (OR = 3.23) and those who were not visited by a Public Health Midwife at home during pregnancy (OR = 1.81). The rate of full breastfeeding was significantly lower among mothers who did not receive postnatal home visits by a Public Health Midwife. Bottle-feeding rates were higher among infants whose mothers had ever been employed (OR = 1.86), lived in a metropolitan area (OR = 3.99), or lived in the South-Central Hill country (OR = 3.11) and were lower among infants of mothers with secondary education (OR = 0.27). Infants from the urban (OR = 8.06) and tea estate (OR = 12.63) sectors were less likely to receive timely complementary feeding than rural infants. Conclusions Antenatal and postnatal contacts with Public Health Midwives were associated with improved breastfeeding practices. Breastfeeding promotion strategies should specifically focus on the estate and urban or metropolitan communities.
The Contribution of Child Health Days to Improving Coverage of Periodic Interventions in Six African Countries
Authors: Oliphant Nicholas P. , Mason John B. , Doherty Tanya , Chopra Mickey , Mann Pamela , Tomlinson Mark , Nsibande Duduzile , Mebrahtu Saba 
Published: November 2015

Background Child Health Days have been implemented since the early 2000s in a number of sub-Saharan African countries with support from UNICEF and other development partners with the aim to reduce child morbidity and mortality. Objective To estimate the effect of Child Health Days on preventive public health intervention coverage, and possible trade-offs of Child Health Days with facility-based health systems coverage, in sub-Saharan Africa. Methods Data were assembled and analyzed from population-based sample surveys and administrative records and from local government sources, from six countries. Field observations (published elsewhere) provided context. Results Child Health Days contributed to improving measles immunization coverage by about 10 percentage points and, importantly, provided an opportunity for a second dose. Child Health Days achieved high coverage of vitamin A supplementation and deworming, and improved access to insecticide-treated nets. Reported measles cases declined to near zero by 2003–5—a result of the combined efforts of routine immunizations and supplementary immunization activities, often integrated with Child Health Days. Collectively these activities were successful in reaching and sustaining a high enough proportion of the child population to achieve herd immunity and prevent measles transmission. Conclusions Additional efforts and resources are needed to continue pushing coverage up, particularly for measles immunization, in rural/hard-to-reach areas, amongst younger children, and less educated/poorer groups. In countries with low routine immunization coverage, Child Health Days are still needed.
A Community Perspective on Changes in Health Related to Diarrhea in Northeastern Brazil
Authors: Machado Márcia Maria Tavares , Lindsay Ana Cristina , Mota Gabriela Maia , Arruda Carlos André Moura , do Amaral João Joaquim Freitas , Forsberg Birger Carl 
Published: November 2015

Background Diarrhea is a major cause of death in children in developing countries. However, in Brazil, diarrhea-related morbidity and mortality have declined over the past decades. Objective To explore community perspectives in Brazil on changes in health related to diarrhea and factors that may have contributed to these changes. Methods This qualitative study included 12 focus group sessions held with 50 mothers and 42 grandmothers in the state of Ceará. Results Most grandmothers reported having lost at least one child to diarrhea, and all participants had witnessed children dying from diarrhea in the past. The participants saw a clear decline in diarrhea over the past 20 years. They felt that this was due to social, economic, and cultural progress. The participants also considered government-supported outreach programs very important for health improvement. Conclusions Knowledge of diarrhea and its causes in the community is broad, but many traditional beliefs about the illness still prevail. The Brazilian experience is an example of the critical effect that policies to promote income redistribution and universal access to education, health, water supply, and sanitation services may have on the reduction of undernutrition and diarrhea among children.
Home-Based Treatment of Acute Malnutrition in Cambodian Urban Poor Communities
Authors: Harris Stephen , Jack Susan 
Published: November 2015

Background The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia. Until recently, there has been a consensus that the treatment and rehabilitation of acutely severely malnourished children should take place in hospitals; however, limited local health resources often place constraints upon the inpatient management of these children. Objective This study reviews the outcomes of a community nutrition program designed to rehabilitate children under the age of 5 years with moderate or severe acute malnutrition living in a poor urban community in Phnom Penh, Cambodia. Methods Clinical records of the program participants during the period from January 1999 to November 2006 were reviewed. Attainment of recovery weight-for-height z-scores, the length of time taken to achieve this recovery, rates of weight gain, mortality rate, and rate of default were determined from the data. Results One hundred fifty-nine children aged 4 years or younger with a mean admission weight-for-height z-score of −3.3 were treated. The mean outcome weight-for-height z-score was −1.5. Eighty-seven children (55%) reached a weight-for-height z-score ≥ −1 over a mean period of 14 weeks of rehabilitation. The average rate of weight gain was 4 g/kg/day. The case fatality rate was 5.6%. Conclusions This program is an example of effective, community-based rehabilitation of children with moderate or severe acute malnutrition in an urban, Southeast Asian, non-humanitarian-relief context, through a combination of nutritional education, regular home visiting, and food support.
Indian Social Safety Net Programs as Platforms for Introducing Wheat Flour Fortification: A Case Study of Gujarat, India
Authors: Fiedler John L. , Babu Sunil , Smitz Marc-Francois , Lividini Keith , Bermudez Odilia 
Published: November 2015

Background Micronutrient deficiencies exact an enormous health burden on India. The release of the National Family Health Survey results—showing the relatively wealthy state of Gujarat having deficiency levels exceeding national averages—prompted Gujarat officials to introduce fortified wheat flour in their social safety net programs (SSNPs). Objective To provide a case study of the introduction of fortified wheat flour in Gujarat's Public Distribution System (PDS), Integrated Child Development Scheme (ICDS), and Mid-Day Meal (MDM) Programme to assess the coverage, costs, impact, and cost-effectiveness of the initiative. Methods India's 2004/05 National Sample Survey data were used to identify beneficiaries of each of Gujarat's three SSNPs and to estimate usual intake levels of vitamin A, iron, and zinc. Comparing age- and sex-specific usual intakes to Estimated Average Requirements, the proportion of the population with inadequate intakes was estimated. Postfortification intake levels and reductions in inadequate intake were estimated. The incremental cost of fortifying wheat flour and the cost-effectiveness of each program were estimated. Results When each program was assessed independently, the proportion of the population with inadequate vitamin A intakes was reduced by 34% and 74% among MDM and ICDS beneficiaries, respectively. Both programs effectively eliminated inadequate intakes of both iron and zinc. Among PDS beneficiaries, the proportion with inadequate iron intakes was reduced by 94%. Conclusions Gujarat's substitution of fortified wheat flour for wheat grain is dramatically increasing the intake of micronutrients among its SSNP beneficiaries. The incremental cost of introducing fortification in each of the programs is low, and, according to World Health Organization criteria, each program is “highly cost-effective.” The introduction of similar reforms throughout India would largely eliminate the inadequate iron intake among persons participating in any of the three SSNPs and would have a significant impact on the global prevalence rate of inadequate iron intake.
Building Global Advocacy for Nutrition: A Review of the European and US Landscapes
Authors: Dangour Alan D. , Diaz Zoey , Sullivan Lucy Martinez 
Published: November 2015

Background An estimated two billion people globally suffer from undernutrition, and yet, despite consensus that improving nutrition is one of the best investments for promoting health and alleviating poverty, nutrition remains chronically underfunded and under-prioritized. Successfully scaling global efforts to address undernutrition requires an understanding of the landscape of potential donors and partners that can be mobilized toward improving nutrition globally. Objective To conduct independent reviews of the European and US landscapes of donors and partners focused on undernutrition, and identify opportunities to leverage outreach and advocacy efforts toward increased engagement and funding for nutrition. Methods We present the primary findings from two independent landscaping studies conducted between September 2010 and March 2011. Research methods included desk-based research and interviews with stakeholders in bilateral and multilateral organizations ( n = 19), private industries ( n = 46), private funders ( n = 16), and civil society organizations ( n = 29). We report the key thematic findings by sector and the challenges and opportunities for increased engagement and funding for nutrition. Results Nutrition is a growing priority for a number of stakeholders across sectors. Strategic commitment to nutrition is emerging across multilateral and bilateral donor agencies; the private sector is increasingly interested in engaging in addressing undernutrition; and nongovernmental and civil society groups are engaged in nutrition advocacy. Key opportunities to increase funding and partnership across sectors include leveraging bilateral and multilateral investments for nutrition across development priorities while ensuring sound commitments within donor policies, focusing on engaging the private sector across the food value chain, mobilizing new resources from private funders through effective communication and outreach, and continuing to prioritize ongoing impact assessment across a range of interventions. Conclusions Understanding the current European and US landscape of nutrition stakeholders helps to inform efforts to scale the type of investments and partnership needed to make effective impacts on undernutrition globally. Turning the existing opportunities into results will require effective coordination, strong communication, and active participation across sectors.
Consumer Preferences for Maize Products in Urban Kenya
Authors: De Groote Hugo , Kimenju Simon Chege 
Published: November 2015

Background New maize varieties have been biofortified with provitamin A, mainly β-carotene, which renders the grain yellow or orange. Unfortunately, many African consumers prefer white maize. The maize consumption patterns in Africa are, however, not known. Objective To determine which maize products African consumers prefer to purchase and which maize preparations they prefer to eat. Methods A survey of 600 consumers was conducted in Nairobi, Kenya, at three types of maize outlets: posho mills (small hammer mills), kiosks, and supermarkets. Results Clients of posho mills had lower incomes and less education than those of kiosks and supermarkets. The preferred maize product of the posho-mill clients was artisanal maize meal; the preferred product of the others was industrial maize meal. Maize is the preferred staple for lunch and dinner, eaten as a stiff porridge ( ugali), followed by boiled maize and beans ( githeri), regardless of socioeconomic background. For breakfast, only half the consumers prefer maize, mostly as a soft porridge ( uji). This proportion is higher in low-income groups. Consumers show a strong preference for white maize over yellow, mostly for its organoleptic characteristics, and show less interest in biofortified maize. Conclusions Maize is the major food staple in Nairobi, mostly eaten in a few distinct preparations. For biofortified yellow maize to be accepted, a strong public awareness campaign to inform consumers is needed, based on a sensory evaluation and the mass media, in particular on radio in the local language.
Association of Elevated α1-Acid Glycoprotein (AGP) and the Prevalence of Anemia in Nicaraguan Preschool Children
Authors: Sullivan Kevin M. , Venugopalan Balalakshmi , Jefferds Maria E. , Boy Eric , Bonilla Josefina , Sandino Ivette , Halleslevens Patricia 
Published: November 2015

Background Anemia status is frequently assessed in cross-sectional surveys. Recently, the assessment of acute phase proteins (APPs) has become more common, primarily for iron and vitamin A biomarkers. Although the so-called “anemia of infection” has been known for years, the relationship between APPs and anemia has been infrequently presented. Objective To assess the relationship between elevated α1-acid glycoprotein (AGP) and the prevalence of anemia among preschool children. Methods A nationally representative household-based cross-sectional survey was conducted in 2003–05 in Nicaragua. Blood samples were collected from preschool children 6 to 59.9 months of age and tested for hemo- globin and AGP. Data were also obtained on sex, weight, height, use of iron supplements, maternal education, and urban or rural status. Results Among the 1,420 children assessed, the overall prevalence of anemia was 20.2% and the prevalence of elevated AGP was 24.0%. Children with elevated AGP had an anemia prevalence of 27.9%, compared with 17.8% among those with a normal AGP, for a crude prev- alence odds ratio (POR) of 1.8 ( p = .010). Accounting for age, maternal educational level, and year of survey using logistic regression, the adjusted POR for the association between elevated AGP and anemia was 1.5 ( p = .053). Conclusions Children in this survey with an elevated AGP had a higher prevalence of anemia, although after controlling for covariates the p-value did not indicate a statistically significant difference ( p = .053). It may be helpful to account for APPs, when this information is available, for purposes of comparing anemia prevalence across populations or within a population over time.
Effect of Wheat Flour Fortified with Sodium Iron EDTA on Urinary Zinc Excretion in School-Aged Children
Authors: Amalrajan Vani , Thankachan Prashanth , Selvam Sumithra , Kurpad Anura 
Published: November 2015

Background Foods fortified with sodium iron ethylenediaminetetraacetate (NaFeEDTA) have been shown to improve iron status in children, but little is known about the effect of this salt on urinary zinc excretion, particularly in children. This is particularly relevant, since zinc deficiency is known to limit growth and development in young children. Objective To determine the effect of NaFeEDTA-fortified wheat flour on urinary zinc excretion. Methods This study was a part of a randomized, controlled trial that was carried out among 6- to 13-year-old iron-depleted schoolchildren ( n = 179) who had received either a NaFeEDTA-fortified wheat meal (iron group) or an identical control meal without added iron (control group) for a period of 7 months. Urinary zinc concentration was assessed at the end of the intervention period by spot urine samples. Results Iron status in the iron group was significantly improved according to measurements of hemoglobin and serum ferritin ( p < .001). However, there was no significant difference in urinary zinc excretion between the iron group (median, 38.4 μg/dL; 25th–75th percentiles, 18.2–67.1 μg/dL) and the control group (median, 33.1 μg/dL; 25th–75th percentiles, 12.4–54.2 μg/dL). Conclusions Iron fortification of foods with NaFeEDTA does not affect urinary zinc excretion in children.
Iron-Fortified Wheat Flour and Iron Deficiency among Women
Authors: Grimm Kirsten A. , Sullivan Kevin M. , Alasfoor Deena , Parvanta Ibrahim , Suleiman Ali Jaffer Mohammed , Kaur Meenu , Al-Hatmi Fatima Obaid , Ruth Laird J. 
Published: November 2015

Background Iron deficiency is estimated to impact more than 1.6 billion individuals worldwide, affecting child, maternal, and perinatal mortality. Iron supplementation, fortification, and dietary diversification are strategies to reduce the prevalence of iron deficiency. However, there are relatively few studies demonstrating the effectiveness of iron-fortified wheat flour as an intervention. Objective To assess the relationship between average monthly per capita household consumption of iron-fortified wheat flour and iron deficiency among women of childbearing age in Oman. Methods Data were obtained from the National Micronutrient Status and Fortified Food Coverage Survey, 2004. Iron deficiency status was compared between women living in households with a monthly per capita consumption of iron-fortified wheat flour of 1 kg or more and women living in households with a monthly per capita consumption of iron-fortified wheat flour of less than 1 kg. The analyses excluded women with elevated or unknown levels of C-reactive protein and controlled for characteristics of the women and household demographics. Results Consumption of iron-fortified wheat flour was associated with a lower prevalence of iron deficiency among women in our sample (adjusted odds ratio, 0.60), after controlling for age, employment status, marital status, intake of iron or multivitamin supplements, self-reported presence of a blood disorder, household income, educational level of head of household, and family size. Conclusions These results suggest that women in our study living in households with a greater consumption of iron-fortified wheat flour have a lower prevalence of iron deficiency; however, additional study is needed.