bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple Micronutrient Supplementation during Pregnancy in Low-Income Countries: A Meta-Analysis of Effects on Stillbirths and on Early and Late Neonatal Mortality
Authors: Ronsmans Carine , Fisher David J. , Osmond Clive , Margetts Barrie M. , Fall Caroline H. D. 
Published: November 2015

Background Multiple micronutrient deficiencies are common among women in low-income countries and may adversely affect pregnancy outcomes Objective To conduct a meta-analysis of the effects on stillbirths and on early and late neonatal mortality of supplementation during pregnancy with multiple micronutrients compared with iron–folic acid in recent randomized, controlled trials. Methods Twelve randomized, controlled trials were included in the analysis (Bangladesh; Burkina Faso; China; Guinea-Bissau; Indramayu and Lombok, Indonesia; Mexico; Sarlahi and Janakur, Nepal; Niger; Pakistan; and Zimbabwe), all providing approximately 1 recommended dietary allowance (RDA) of multiple micronutrients or iron–folic acid to presumed HIV-negative women. Results Supplementation providing approximately 1 RDA of multiple micronutrients did not decrease the risk of stillbirth (OR = 1.01; 95% CI, 0.88 to 1.16), early neonatal mortality (OR = 1.23; 95% CI, 0.95 to 1.59), late neonatal mortality (OR = 0.94; 95% CI, 0.73 to 1.23), or perinatal mortality (OR = 1.11; 95% CI, 0.93 to 1.33). Conclusions Our meta-analysis provides consistent evidence that supplementation providing approximately 1 RDA of multiple micronutrients during pregnancy does not result in any reduction in stillbirths or in early or late neonatal deaths compared with iron–folic acid alone.
Multiple Micronutrient Supplementation during Pregnancy in Developing-Country Settings: Policy and Program Implications of the Results of a Meta-Analysis
Authors: Shrimpton Roger , Huffman Sandra L. , Zehner Elizabeth R. , Darnton-Hill Ian , Dalmiya Nita 
Published: November 2015

Background An independent Systematic Review Team performed a meta-analysis of 12 randomized, controlled trials comparing multiple micronutrients with daily iron–folic acid supplementation during pregnancy. Objective To provide an independent interpretation of the policy and program implications of the results of the meta-analysis. Methods A group of policy and program experts performed an independent review of the meta-analysis results, analyzing internal and external validity and drawing conclusions on the program implications. Results Although iron content was often lower in the multiple micronutrient supplement than in the iron–folic acid supplement, both supplements were equally effective in tackling anemia. Community-based supplementation ensured high adherence, but some mothers still remained anemic, indicating the need to concomitantly treat infections. The small, significant increase in mean birthweight among infants of mothers receiving multiple micronutrients compared with infants of mothers receiving iron-folic acid is of similar magnitude to that produced by food supplementation during pregnancy. Larger micronutrient doses seem to produce greater impact. Meaningful improvements have also been observed in height and cognitive development of the children by 2 years of age. There were no significant differences in the rates of stillbirth, early neonatal death, or neonatal death between the supplemented groups. The nonsignificant trend toward increased early neonatal mortality observed in the groups receiving multiple micronutrients may be related to differences across trials in the rate of adolescent pregnancies, continuing iron deficiency, and/or adequacy of postpartum health care and merits further investigation. Conclusions Replacing iron–folic acid supplements with multiple micronutrient supplements in the package of health and nutrition interventions delivered to mothers during pregnancy will improve the impact of supplementation on birthweight and on child growth and development.
Infant and Young Child Feeding Indicators and Determinants of Poor Feeding Practices in India: Secondary Data Analysis of National Family Health Survey 2005–06
Authors: Patel Archana , Badhoniya Neetu , Khadse Sandhya , Senarath Upul , Agho Kingsley E. , Dibley Michael J. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. Objective To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. Methods The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005–06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for ≥ 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for ≥ 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR=1.29), higher maternal education level (OR=1.32), urban residence (OR=1.46), and absence of postnatal examination (OR=1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR=0.57), and for those who watched television (OR=0.75). Conclusions Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.
The Nutritional Status of School-Aged Children: Why Should We Care?
Authors: Best Cora , Neufingerl Nicole , van Geel Laura , van den Briel Tina , Osendarp Saskia 
Published: November 2015

Background The nutritional status of school-aged children impacts their health, cognition, and subsequently their educational achievement. The school is an opportune setting to provide health and nutrition services to disadvantaged children. Yet, school-aged children are not commonly included in health and nutrition surveys. An up-to-date overview of their nutritional status across the world is not available. Objective To provide a summary of the recent data on the nutritional status of school-aged children in developing countries and countries in transition and identify issues of public health concern. Methods A review of literature published from 2002 to 2009 on the nutritional status of children aged 6 to 12 years from Latin America, Africa, Asia, and the Eastern Mediterranean region was performed. Eligible studies determined the prevalence of micronutrient deficiencies or child under- and overnutrition using bio-chemical markers and internationally accepted growth references. Results A total of 369 studies from 76 different countries were included. The available data indicate that the nutritional status of school-aged children in the reviewed regions is considerably inadequate. Underweight and thinness were most prominent in populations from South-East Asia and Africa, whereas in Latin America the prevalence of underweight or thinness was generally below 10%. More than half of the studies on anemia reported moderate (> 20%) or severe (> 40%) prevalence of anemia. Prevalences of 20% to 30% were commonly reported for deficiencies of iron, iodine, zinc, and vitamin A. The prevalence of overweight was highest in Latin American countries (20% to 35%). In Africa, Asia, and the Eastern Mediterranean, the prevalence of overweight was generally below 15%. Conclusions The available data indicate that malnutrition is a public health issue in school-aged children in developing countries and countries in transition. However, the available data, especially data on micronutrient status, are limited. These findings emphasize the need for nutrition interventions in school-aged children and more high-quality research to assess nutritional status in this age group.
Food Security Indicators after Humanitarian Interventions Including Food Aid in Zimbabwe
Authors: Gandure Sithabiso , Drimie Scott , Faber Mieke 
Published: November 2015

Background Rural households in contemporary Zimbabwe experience various levels of food insecurity and vulnerability. Worsening macroeconomic conditions, a fragile political environment, poor rainfall, low incomes, deteriorating environmental conditions, and the impact of HIV and AIDS characterize their livelihoods. Non-governmental organizations have responded to the situation through a number of food interventions to alleviate food insecurity and poverty. Objective To provide an analysis of food security indicators used to assess households benefiting from food interventions in 2006 in Zimbabwe. Methods A total of 60 households were chosen for each of three districts (Uzumba-Maramba-Pfungwe [UMP], Chivi, and Tsholotsho), targeting beneficiaries of the Agricultural Protracted Relief Programme. Household food security indicators calculated on the basis of data collected by questionnaire included the Household Dietary Diversity Score (HDDS), months of food shortages, and the Household Food Insecurity Access Scale (HFIAS). Districts were compared by analysis of variance and Tukey post hoc analysis. Results The mean HDDS differed between the districts; households in Chivi consumed foods from a greater variety of groups than households in Tsholotsho and UMP (4.7 vs. 2.7 and 3.0, respectively; p < .001). Food shortages during the previous year were experienced by 76.4% of the households, with UMP having the lowest occurrence of food shortages (56.7%) and Tsholotsho the highest (95%). Households in Tsholotsho experienced hunger throughout the year; for households in UMP and Chivi, October to January were the critical months when households experienced the most hunger. Spearman correlation analysis showed an inverse correlation between HFIAS and HDDS ( r = −0.425, p < .01). Households that experienced food shortages the previous year had a lower mean HDDS (3.2 vs.3.9, p = .013) and a higher mean HFIAS (17.1 vs. 12.0, p < .001) than households that did not experience food shortages. Conclusions The study demonstrated the value of using a variety and combination of indicators in the design of food security interventions. The HDDS showed that beyond availability, food security also involves access to a variety of nutritious foods. The indicator pertaining to months of food shortages allows a deeper understanding of the nature of food insecurity; hunger in Tsholotsho is experienced throughout the year, implying that the causes are chronic rather than seasonal, whereas Chivi and UMP experience seasonal hunger. The HFIAS usefully revealed the condition of food security in each site in terms of the availability, stability, and intake of food.
Vitamin A Fortification of Wheat Flour: Considerations and Current Recommendations
Authors: Klemm Rolf D. W. , West Keith P. , Palmer Amanda C. , Johnson Quentin , Randall Philip , Ranum Peter , Northrop-Clewes Christine 
Published: November 2015

Background Vitamin A deficiency is a major public health nutrition problem, affecting an estimated 190 million preschool-aged children and 19 million pregnant and lactating women globally, and 83 million adolescents in Southeast Asia alone. Its consequences (disorders) include xerophthalmia (the leading cause of early childhood blindness), increased severity of infection, anemia, and death. Because vitamin A deficiency is largely due to chronic dietary insufficiency of preformed vitamin A and proactive carotenoids, food fortification can offer an effective approach to prevention. Objective To provide guidance on fortifying wheat and maize flour milled in industrial rollers for national fortification programs in countries where vitamin A deficiency is considered a public health problem. Methods Critical review of the literature on the dietary gap in vitamin A intake and levels of wheat flour intake among risk groups as a basis for determining vitamin A fortificant levels. Additional review of efficacy evidence, safety and cost considerations, and country experiences related to wheat-flour fortification with vitamin A. Results Mill-rolled wheat flour is a technically fortifiable, centrally processed food vehicle that, where routinely and adequately consumed by target groups, should be considered a candidate for fortification. Vitamin A can be stable in flour under typical, ambient conditions, with processing losses estimated at approximately 30%, depending on source and premix conditions. Conclusions Factors to guide a decision to fortify flour with vitamin A include the extent of deficiency, availability of other food vehicle options, the centrality of milling, market reach and population intake distributions of the flour products, the dietary vitamin A intake required, and associated costs. Large gaps persist in knowledge of these factors, which are needed to enable evidence-based fortification in most countries, leaving most decisions to fortify guided by assumptions. Where flour can and should be fortified, guidelines are given for providing nearly 25% of the Recommended Dietary Allowance for vitamin A to vulnerable groups consuming varying ranges of flour products. The costs will vary according to the level of fortification.
Identifying Priorities for Emergency Intervention from Child Wasting and Mortality Estimates in Vulnerable Areas of the Horn of Africa
Authors: Mason John B. , Chotard Sophie , Cercone Emily , Dieterich Megan , Oliphant Nicholas P. , Mebrahtu Saba , Hailey Peter 
Published: November 2015

Background The relation between anthropometric measures and mortality risk in different populations can provide a basis for deciding how malnutrition prevalences should be interpreted. Objective To assess criteria for deciding on needs for emergency interventions in the Horn of Africa based on associations between child wasting and mortality from 2000 to 2005. Methods Data were analyzed on child global acute malnutrition (GAM) prevalences and mortality estimates from about 900 area-level nutrition surveys from Ethiopia, Kenya, Somalia, Sudan, and Uganda; data on drought, floods, and food insecurity were added for Kenya (Rift Valley) and Ethiopia, from Food and Agriculture Organization (FAO) reports at the time. Results Higher rates of GAM were associated with increased mortality of children under 5 years of age (U5MR), more strongly among populations with pastoral livelihoods than with agricultural livelihoods. In all groups spikes of GAM and U5MR corresponded with drought (and floods). Different GAM cutoff points are needed for different populations. For example, to identify 75% of U5MRs above 2/10,000/day, the GAM cutoff point ranged from 20% GAM in the Rift Valley (Kenya) to 8% in Oromia or SNNPR (Ethiopia). Conclusions Survey results should be displayed as time series within geographic areas. Variable GAM cutoff points should be used, depending on livelihood or location. For example, a GAM cutoff point of 15% may be appropriate for pastoral groups and 10% for agricultural livelihood groups. This gives a basis for reexamining the guidelines currently used for interpreting wasting (or GAM) prevalences in terms of implications for intervention.
Role of Nutrition in HIV Infection: Review of Evidence for more Effective Programming in Resource-Limited Settings
Authors: de Pee Saskia , Semba Richard D. 
Published: November 2015

Background HIV infection and malnutrition negatively reinforce each other. Objective For program guidance, to review evidence on the relationship of HIV infection and malnutrition in adults in resource-limited settings. Results and conclusions Adequate nutritional status supports immunity and physical performance. Weight loss, caused by low dietary intake (loss of appetite, mouth ulcers, food insecurity), malabsorption, and altered metabolism, is common in HIV infection. Regaining weight, particularly muscle mass, requires antiretroviral therapy (ART), treatment of opportunistic infections, consumption of a balanced diet, physical activity, mitigation of side effects, and perhaps appetite stimulants and growth hormone. Correcting nutritional status becomes more difficult as infection progresses. Studies document widespread micronutrient deficiencies among HIV-infected people. However, supplement composition, patient characteristics, and treatments vary widely across intervention studies. Therefore, the World Health Organization (WHO) recommends ensuring intake of 1 Recommended Nutrient Intake (RNI) of each required micronutrient, which may require taking micronutrient supplements. Few studies have assessed the impact of food supplements. Because the mortality risk in patients receiving ART increases with lower body mass index (BMI), improving the BMI seems important. Whether this requires provision of food supplements depends on the patient's diet and food security. It appears that starting ART improves BMI and that ready-to-use fortified spreads and fortified-blended foods further increase BMI (the effect is somewhat less with fortified-blended foods). The studies are too small to assess effects on mortality. Once ART has been established and malnutrition treated, the nutritional quality of the diet remains important, also because of ART's long-term metabolic effects (dyslipidemia, insulin resistance, obesity). Food insecurity should also be addressed if it prevents adequate energy intake and reduces treatment initiation and adherence (due to the opportunity costs of obtaining treatment and mitigating side effects).
Shelf Stability, Sensory Qualities, and Bioavailability of Iron-Fortified Nepalese Curry Powder
Authors: Karn Sanjeev Kumar , Chavasit Visith , Kongkachuichai Ratchanee , Tangsuphoom Nattapol 
Published: November 2015

Background The prevalence of iron-deficiency anemia in Nepal is almost 50% of the whole population. Curry powder is a promising vehicle for fortification due to its use in various meals. Objective To evaluate the bioavailability of different iron fortificants in curry powder and their effects on the qualities of curry powder. Methods The serving size of curry powder was evaluated in 40 Nepalese households and 10 restaurants. The powders were fortified with iron sources of different bioavailability. Sources with good bioavailability of iron—ferrous sulfate (FS), ferrous fumarate (FF), and sodium ferric ethylenediaminetetraacetic acid (NaFeEDTA)—were added to provide one-third of the recommended daily intake (RDI) of iron per serving. Elemental iron (H-reduced [HRI] and electrolytic [EEI]), which has poor bioavailability, was added to provide two-thirds of the RDI per serving. Both fortified and unfortified products were packed in either commercial packs or low-density polyethylene bags and stored at 40 ± 2°C under fluorescent light for 3 months. The stored products were analyzed for CIE color, peroxide value, thiobarbituric acid reactive substances, moisture, water activity, iron, and sensory qualities. The contents of phenolic compounds and phytate were analyzed, and iron bioavailability was determined by the Caco-2 cell technique. Results The serving size of curry powder was 4g. Iron fortificants did not have adverse effects on the physical, chemical, and sensory qualities of curry powder packed in commercial packaging. After 3 months storage, HRI significantly affected darker colors of curry powder and the cooked dishes prepared with curry powder. The relative bioavailabilities of NaFeEDTA and EEI were 1.05 and 1.28 times that of FS, respectively. The cost of fortification with EEI was similar to that with FS and 4.6 times less than that with NaFeEDTA. Conclusions It is feasible and economical to fortify Nepalese curry powder packed in commercial packaging with EEI.
Growth and Nutritional Status of Preschool Children in India: A Study of Two Recent Time Periods
Authors: Sen Pronab , Bharati Susmita , Som Suparna , Pal Manoranjan , Bharati Premananda 
Published: November 2015

Background Preschool children call for focused attention in India because India has the highest percentage of undernourished children in the world. Objective To compare the growth and nutritional status of Indian preschool children for the periods 1998/99 and 2005/06. Subjects and methods Using data on weight and length/height as well as the sociodemographic background of preschool children from the National Family Health Surveys (NFHS) from 1998/99 and 2005/06, we determined the distribution of weight and length/height and their association with sociodemographic variables. Results The distributions of weight and length/height around the mean remained remarkably stable over age but were much greater in India than the international norms. The rates of growth of mean weight and length/height were far lower in India than the international norms up to the age of 2 years. The temporal trend indicates declines in the percentages of undernourished (low weight-for-age) and stunted (low height-for-age) children over the 7-year period, although the degree of improvement was far better for stunting than for underweight. Mother's educational status is the only variable that has been found to influence child nutrition. Conclusion The level of mothers' education needs urgent attention with top priority to reduce the prevalence of underweight and stunting of children. This also implies that, for future benefit, girls should be given more facilities for better education. Breastfeeding and weaning practices also need special attention.
Professor Rainer Gross, Benefactor to Humanity: A Tribute to His Legacy to Public Nutrition
Authors: Lechtig Aaron 
Published: November 2015

In September 2010, Angela Cespedes and Aaron Lechtig were awarded the Rainer Gross Award for “Recent Innovation in Nutrition and Health in Developing Societies” by the Hildegard Grunow Foundation. The award was for the most outstanding innovation which represents the creativity for nutritional health solutions that typified the “Rainer Gross way of doing things.” In this issue of the Bulletin, we are pleased to be pub- lishing the article,“Social protection programs in Central America and the Dominican Republic: Do they have a nutritional dimension?” by Angela Cespedes, Aaron Lechtig, and Rachel Francischi; the work outlined in this paper was the basis for the Rainer Gross award. The following is an excerpt of the remarks made by Aaron Lechtig at the II World Congress on Public Health Nutrition in Porto, Portugal on September 25, 2010 on his acceptance of the Rainer Gross Award.