bluuebunny/crossref_metadata_2025_split huggingface dataset:
Climate Change and Nutrition: Creating a Climate for Nutrition Security
Authors: Tirado M. C. , Crahay P. , Mahy L. , Zanev C. , Neira M. , Msangi S. , Brown R. , Scaramella C. , Coitinho D. Costa , Müller A. 
Published: November 2015

Background Climate change further exacerbates the enormous existing burden of undernutrition. It affects food and nutrition security and undermines current efforts to reduce hunger and promote nutrition. Undernutrition in turn undermines climate resilience and the coping strategies of vulnerable populations. Objectives The objectives of this paper are to identify and undertake a cross-sectoral analysis of the impacts of climate change on nutrition security and the existing mechanisms, strategies, and policies to address them. Methods A cross-sectoral analysis of the impacts of climate change on nutrition security and the mechanisms and policies to address them was guided by an analytical framework focused on the three ‘underlying causes’ of undernutrition: 1) household food access, 2) maternal and child care and feeding practices, 3) environmental health and health access. The analytical framework includes the interactions of the three underlying causes of undernutrition with climate change, vulnerability, adaptation and mitigation. Results Within broad efforts on climate change mitigation and adaptation and climate-resilient development, a combination of nutrition-sensitive adaptation and mitigation measures, climate-resilient and nutrition-sensitive agricultural development, social protection, improved maternal and child care and health, nutrition-sensitive risk reduction and management, community development measures, nutrition-smart investments, increased policy coherence, and institutional and cross-sectoral collaboration are proposed as a means to address the impacts of climate change to food and nutrition security. This paper proposes policy directions to address nutrition in the climate change agenda and recommendations for consideration by the UN Framework Convention on Climate Change (UNFCCC). Conclusions Nutrition and health stakeholders need to be engaged in key climate change adaptation and mitigation initiatives, including science-based assessment by the Intergovernmental Panel on Climate Change (IPCC), and policies and actions formulated by the UN Framework Convention on Climate Change (UNFCCC). Improved multi-sectoral coordination and political will is required to integrate nutrition-sensitive actions into climate-resilient sustainable development efforts in the UNFCCC work and in the post 2015 development agenda. Placing human rights at the center of strategies to mitigate and adapt to the impacts of climate change and international solidarity is essential to advance sustainable development and to create a climate for nutrition security.
The Global, Centralized Approach of the GAIN Premix Facility Has Made Oil Fortification in Indonesia More Affordable
Authors: Jallier Vincent , Guyondet Christophe , Provent Adeline , Laillou Arnaud , Soekirman  , Moench-Pfanner Regina 
Published: November 2015

Background Access to high-grade micronutrients is a recurring challenge that often threatens the long-term sustainability of food fortification programs. Objective To assess the efficiency of the Global Alliance for Improved Nutrition (GAIN) Premix Facility in procuring quality, affordable vitamin A for fortification of edible oil in Indonesia. Methods A global approach to procurement of standard items was used by combining volumes across various demand streams in order to reduce the total cost of acquisition through economies of scale. The GAIN Premix Facility undertook a detailed analysis of vitamin A requirements across its existing customer base, which served as a basis for developing a reliable demand forecast. A consolidated, competitive tender was launched that resulted in the setting up of a long-term commercial agreement with the selected supplier to lock in the most competitive price for a given period of time. Results The direct benefit to oil manufacturers of fortifying with vitamin A is that the cost of fortification went down significantly compared with prices they would have been offered had they ordered vitamin A individually. In Indonesia, this consolidated procurement approach has allowed a 14.5% decrease in the unit price of vitamin A. Conclusions The GAIN Premix Facility demonstrated its effectiveness in acting as a global procurement platform by aggregating demand across different customers and leveraging improved prices through increased volumes. Building on the success of this effort, the GAIN Premix Facility is replicating this global approach for procurement of other standard items being procured across fortification programs worldwide.
Regulatory Monitoring Systems of Fortified Salt and Wheat Flour in Selected Asean Countries
Authors: van den Wijngaart Annoek , Bégin France , Codling Karen , Randall Philip , Johnson Quentin W. 
Published: November 2015

Background Considerable efforts have been made over the past decade to address vitamin and mineral deficiencies. An increasing number of countries in the Association of Southeast Asian Nations (ASEAN) are adopting mandatory food fortification as one of the primary strategies to overcome these deficiencies. Experience shows that fortified foods can reach large parts of the population, including the poor, if the fortification is done on a mandatory rather than a voluntary basis and if the food vehicle is widely consumed. Objective To review the importance of regulatory monitoring as an essential component of food fortification efforts in selected ASEAN countries, with special focus on the available information on regulatory monitoring systems for iodized salt and fortified wheat flour. Methods The role of regulatory monitoring in strengthening food fortification programs was discussed during a joint regional meeting of the World Health Organization, UNICEF, the Flour Fortification Initiative, the Global Alliance for Improved Nutrition, the Micronutrient Initiative, and the World Bank on regulatory monitoring of salt and wheat flour fortification programs in Asia, which took place in Manila, Philippines, on 27–29 September 2011. This paper reviews the regulatory monitoring systems of selected ASEAN countries that participated in this meeting. Results Problems and challenges in regulatory monitoring systems for iodized salt and fortified wheat flour in selected ASEAN countries are identified, and a description of the role of regulatory monitoring in strengthening food fortification initiatives, particularly of salt and flour, and highlights of areas for improvement are presented. Conclusions Regulatory monitoring consists of monitoring activities conducted at the production level, at customs warehouses, and at retail stores by concerned regulatory authorities, and at the production level by producers themselves, as part of quality control and assurance efforts. Unless there are appropriate enforcement and quality assurance mechanisms in place to stimulate compliance by food producers, i.e., regulatory monitoring, having national legislation will not necessarily lead to increased coverage of fortified products and associated outcomes.
Legal Framework for Food Fortification: Examples from Vietnam and Indonesia
Authors: Dijkhuizen Marjoleine Amma , Wieringa Frank Tammo , Soekarjo Damayanti , Van Khan Tran , Laillou Arnaud 
Published: November 2015

Background Food fortification is a cost-effective, powerful, and sustainable strategy to combat micronutrient deficiency, with the potential to reach large sections of the population with minimal cost and effort. However, the implementation of food fortification on a systematic and large scale, for instance in national programs, has often been challenging. Objective This paper takes a closer look at food fortification efforts and legislation mechanisms in Vietnam and Indonesia in order to determine specific factors and components in the legal framework that are crucial to the success of fortification programs. Methods Fortification efforts in Indonesia and Vietnam are evaluated using published data as well as unpublished data from detailed evaluation reports, and compared with respect to the specific circumstances, constraints, objectives and results in each country. Results The legal framework is a crucial factor for the success of food fortification programs, as it shapes to a large extent the implementation of food fortification. The legal framework is instrumental to ensure the quality, safety, availability, cost-effectiveness, and sustainability of food fortification. In the first place, the legal framework should specify the fortificants and fortification levels, as well as the food vehicles and the fortification procedures. In addition, it should ensure the commitment of policy makers and producers to fortification, regulate the costing, describe and ensure information and communication such as product labeling, integrate social marketing into the implementation, and provide the means to monitor and enforce fortification. A clear public health objective, together with careful consideration of the choices and restrictions dictated by the specific national environments, will help to develop legal frameworks that optimize the potential success of food fortification strategies. Conclusions The lessons from these experiences show that a mandatory approach to fortification, with costing, monitoring and enforcement, and social marketing clearly defined and well embedded in the legal framework and in the implementation structures, is the best foundation for an effective, sustainable, and feasible food fortification program.
An Analysis of the Costs of Uganda's Child Days Plus: Do Low Costs Reveal an Efficient Program or an Underfinanced One?
Authors: Fiedler John L. , Semakula Richard 
Published: November 2015

Background Twice annually, Uganda implements Child Days Plus (CDP), a month-long outreach activity that distributes vitamin A capsules to preschool children and deworms children 6 months to 14 years old. Introduced initially as a temporary, interim strategy, CDP is now a decade old. Objective To assess how well CDP is implemented using an activity-based cost analysis. Methods In the absence of a cost-accounting system for CDP, we defined the six major CDP activities as cost centers and identified five important subactivities required to implement a round of CDP. Based on a purposive sample, we conducted a structured interview survey of 59 Ministry of Health facilities, 9 district offices, and national-level CDP staff. Results Only one-third of the facilities implemented all 11 CDP core activities. The survey revealed that Ministry of Health staff and volunteers are frequently paid substantially less in allowances than they are entitled to for their CDP outreach activities. Viewing these two practices—nonimplementation and less-than-full-reimbursement—as indicators of CDP's underfinancing, we estimate the program is underfinanced by the equivalent of 37% of its “full implementation” costs. Two-thirds of underfinancing is manifested in nonimplementation and one-third as less-than full-reimbursement. CDP exploits economies of scale and scope and has an average cost per child served of US$0.22. We estimate that it annually saves 367,000 disability-adjusted life-years (DALYs) at an average cost of US$12.5, making it—despite its underfinancing—highly cost-effective. Conclusions and recommendations Increased CDP funding would enable its vitamin A coverage rate of 58% and its deworming coverage rate of 62% to be increased, thereby increasing its effectiveness and efficiency. CDP should be “relaunched,” as part of an effort to improve the structure of the program, set expectations about it, and earmark a minimum of resources for CDP. The Ministry of Health should demonstrate its new, greater commitment to CDP by introducing a program-specific budget line item, increasing CDP's budget allocation, and developing and implementing a training program that identifies the minimum uniform activities required to implement CDP.
Changing Dietary Patterns in the Canadian Arctic: Frequency of Consumption of Foods and Beverages by Inuit in Three Nunavut Communities
Authors: Sheehy Tony , Kolahdooz Fariba , Roache Cindy , Sharma Sangita 
Published: November 2015

Background Inuit in Arctic regions are experiencing a rapid diet and lifestyle transition. There are limited data on food consumption patterns among this unique population, raising concerns about assessing the risk for the development of diet-related chronic diseases. Objective To assess the current frequency of consumption of foods and beverages among Inuit in Nunavut, Arctic Canada. Methods A cross-sectional dietary study was con- ducted among randomly selected Inuit adults from three communities in Nunavut using a validated quantitative food frequency questionnaire. The participants were 175 women and 36 men with median (IQR) ages of 41.0 (32.5–48.5) and 40.1 (30.0–50.0) years, respectively. The mean and median frequencies of consumption over a 30-day period were computed for 147 individual food items and grouped as foods or beverages. Results The 30 most frequently consumed foods were identified. Non-nutrient-dense foods (i.e., high-fat and high-sugar foods) were the most frequently consumed food group (median intake, 3.4 times/day), followed by grains (2.0 times/day) and traditional meats (1.7 times/ day). The frequency of consumption of fruits (0.7 times/ day) and vegetables (0.4 times/day) was low. The median values for the three most frequently consumed food items were sugar or honey (once/day), butter (0.71 times/day), and Coffee-mate (0.71 times/day). Apart from water, coffee, and tea, the most frequently consumed beverages were sweetened juices (0.71 times/day) and regular pop (soft drinks) (0.36 times/day). This study showed that non-nutrient-dense foods are consumed most frequently in these Inuit communities. Conclusions The results have implications for dietary quality and provide useful information on current die- tary practices to guide nutritional intervention programs.
Mid-Upper-Arm and Calf Circumferences are Useful Predictors of Underweight in Women of Reproductive Age in Northern Vietnam
Authors: Nguyen Phuong , Ramakrishnan Usha , Katz Benjamin , Gonzalez-Casanova Ines , Lowe Alyssa E. , Nguyen Hieu , Pham Hoa , Truong Truong , Nguyen Son , Martorell Reynaldo 
Published: November 2015

Background Mid-upper-arm circumference (MUAC) and calf circumference (CC) are correlated with body mass index (BMI) in adults and may be useful for screening women with underweight (BMI < 18.5 kg/m2). However, there is no consensus on appropriate MUAC and CC cutoff points in diverse populations, especially in women of reproductive age. Objective To assess the accuracy of different MUAC and CC cutoff points to screen for underweight and to identify the most appropriate cutoff points in a sample of women of reproductive age from rural northern Vietnam. Methods Anthropometric measurements (weight, height, MUAC, CC, and triceps and subscapular skinfold thicknesses) were obtained for 4,981 women of reproductive age who participated in a micronutrient intervention trial (PRECONCEPT) in Thái Nguyên Province, Viet- nam. Receiver operating characteristic (ROC) analysis was used to evaluate different cutoff values of MUAC and CC and identify the most appropriate cutoff values to predict underweight. Results The overall prevalence of underweight was 32%. The MUAC value of 23.5 cm and the CC value of 31 cm were identified as the best cutoffs based on low misclassification (16% for MUAC and 21% for CC) and good balance of sensitivity (89% and 85%, respectively) and specificity (71% and 67%, respectively. The ROC curves were similar across different ethnic groups, with the area under the curve (AUC) values reaching 0.89 to 0.93 for MUAC and 0.83 to 0.89 for CC. Conclusions MUAC and CC perform adequately in screening for underweight in women. The utility of these measurements in predicting functional outcomes should be examined.
Challenges in the Elaboration of a Field Interview Instrument to Capture Information for the Evaluation of Adherence to the WHO/PAHO Guiding Principles for Complementary Feeding of the Breastfed Child
Authors: Vossenaar Marieke , Doak Colleen M. , Solomons Noel W. 
Published: November 2015

Background In 2003, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) published “Guiding principles for complementary feeding of the breastfed child,” which includes a series of 10 recommendations. Objective To illustrate the challenges in creating operative criteria for the evaluation of concordance with the tenets of the WHO/PAHO Guiding Principles recommendations. Methods We set out to define operative criteria for the evaluation of adherence to the tenets of the WHO/ PAHO Guiding Principles. The 10 Guiding Principles were divided into subcomponents and examined carefully. Our indicators were based on evaluation variables collected by means of our prospectively designed data collection tool. The 2008 WHO-validated infant and young child feeding (IYCF) indicators were taken as a reference for evaluation. Results After careful examination of the 10 WHO/ PAHO Guiding Principles, we were able to identify 28 specific subcomponents for evaluation. With our prospectively designed data collection tool, we were able to set evaluations for 17 of these 28 subcomponents. Conclusions The considerations for devising the criteria involved in evaluation instruments must be transparently available to clarify the interpretations and conclusions derived from their application. Evaluation criteria can be set for most, but not all, IYCF practices of the WHO/PAHO Guiding Principles. Indicators that focus on selected, food-related dimensions of child feeding can be measured in large surveys, whereas other dimensions of optimal feeding, such as hygienic food handling and adequate texture of food, are likely to require more complex measurement and evaluation approaches.
Organizational Factors, Planning Capacity, and Integration Challenges Constrain Provincial Planning Processes for Nutrition in Decentralizing Vietnam
Authors: Lapping Karin , Frongillo Edward A. , Nguyen Phuong H. , Coates Jennifer , Webb Patrick , Menon Purnima 
Published: November 2015

Background Translating national policies and guidelines into effective action at the subnational level (e.g., province or region) is a prerequisite for ensuring an impact on nutrition. In several countries, including Vietnam, the focus of this paper, this process is affected by the quality of the decentralized process of planning and action. Objective This study examined how provincial planning processes for nutrition occurred in Vietnam during 2009 and 2010. Key goals were to understand variability in processes across provinces, identify factors that influenced the process, and assess the usefulness of the process for individuals involved in planning and action. Methods A qualitative case-study methodology was used. Data were drawn from interviews with 51 government officials in eight provinces. Results The study found little variability in the planning process among these eight provinces, probably due to a planning process that was predominantly a fiscal exercise within the confines of a largely centralized structure. Respondents were almost unanimous about the main barriers: a top-down approach to planning, limited human capacity for effective planning at subnational levels, and difficulty in integrating actions from multiple sectors. Provincial-level actors were deeply dissatisfied with the nature of their role in the process. Conclusions Despite the rhetoric to the contrary, too much power is probably still retained at the central level. A strategic multiyear approach is needed to strengthen the provincial planning process and address many of the key barriers identified in this study.
Prevalence and Determinants of Vitamin A Deficiency among Brazilian Children under 2 Years of Age from the 2006 National Demographic Health Survey
Authors: Konstantyner Tulio , Warkentin Sarah , de Aguiar Carrazedo Taddei José Augusto 
Published: November 2015

Background Vitamin A deficiency is prevalent among infants, primarily in undeveloped communities, compromising immune system competence and raising morbidity and mortality rates. Understanding the risk factors associated with vitamin A deficiency is essential to create informed health policies. Objective To identify and quantify risk factors for vitamin A deficiency in a probabilistic sample of children under 2 years of age participating in a national survey in Brazil and to provide a comprehensive risk factor model to inform health strategies and policies. Methods We analyzed data from a cross-sectional study of 1,436 children from the 2006 Brazilian National Survey on Demography and the Health of Women and Children. Vitamin A deficiency was defined as retinol levels below 0.70 μg/dL. Results The prevalence of vitamin A deficiency was estimated at 16.1% (95% CI, 12.7 to 20.2). The Poisson regression model identified three risk factors for vitamin A deficiency: urban residence (prevalence ratio [PR] = 1.47, p = .023), no consumption of animal meat within the past week (PR = 1.41, p = .031), and a mother older than 25 years (PR = 1.31, p = .048). Conclusions Strategies to control infant vitamin A deficiency should include health promotion and nutrition education for families from all socioeconomic levels. Improvements in lifestyle quality, based on adequate food consumption by all infants, must be achieved by communities, especially in urban areas and for older mothers.
Assessment of a Portable Device to Quantify Vitamin A in Fortified Foods (Flour, Sugar, and Milk) for Quality Control
Authors: Laillou Arnaud , Renaud Cécile , Berger Jacques , Moench-Pfanner Regina , Fontan Laura , Avallone Sylvie 
Published: November 2015

Background Simple-to-use quantitative methods are needed to check the adequacy of vitamin A fortification levels. Objective To assess the capacity of a portable fluorometer (iCheck FLUORO) and its test kit vials (iEx Mila) to quantify retinyl palmitate in fortified milks, flours (wheat, maize), and sugar. Methods The portable fluorometer was assessed in a three-step procedure to determine its working range and linearity, intra-assay precision, and interperson precision. Measurements were compared with the results obtained by high-performance liquid chromatography (HPLC), commonly regarded as the standard method for vitamin A analysis. Results The portable fluorometer (iCheck FLUORO) and its test kit vials (iEx Mila) precisely determined the vitamin A contents in fortified flours, sugar, and milks. Its working range was 1 to 10, 0.5 to 3.0, and 5 to 15 mg retinol equivalents (RE) kg−1 for flours (wheat and corn), milks, and sugar, respectively; these values are in accordance with the World Health Organization recommendations for food fortification in least developed countries. The limits of detection are higher than those of HPLC but are all satisfactory (< 1.46 mg RE kg−1). The coefficients of variation within and between observers were satisfactory, especially for sugar and milk. Conclusions The linear relationship between the data from the portable fluorometer and the HPLC data confirms that the portable fluorometer provides a good determination of the vitamin A content of the fortified products in the tested range.