bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Review of Methods to Detect Cases of Severely Malnourished Children in the Community for Their Admission into Community-Based Therapeutic Care Programs
Authors: Myatt Mark , Khara Tanya , Collins Steve 
Published: November 2015

Background The complexity and cost of measuring weight-for-height make it unsuitable for use by community-based volunteers. This has led community therapeutic care programs to adopt a two-stage screening and admission procedure in which mid-upper-arm circumference (MUAC) is used for referral and weight-for-height is used for admission. Such a procedure results in many individuals being referred for care on the basis of MUAC but subsequently being refused treatment because they do not meet the weight-for-height admission criterion. This “problem of rejected referrals” has proved to be a major barrier to program uptake. Objective To systematically review methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. Methods Clinical and anthropometric methods for case detection of severely malnourished children in the community were reviewed with regard to their ability to reflect both mortality risk and nutritional status. Results MUAC, with the addition of the presence of bipedal edema, was found to be the indicator best suited to screening and case detection of malnutrition in the community. The case definition “MUAC < 110 mm OR the presence of bipedal edema,” with MUAC measured by a color-banded strap, is suitable for screening and case detection of malnutrition in the community for children aged between 6 and 59 months. Monitoring and discharge criteria were also reviewed. Conclusions There is no compelling evidence to support a move away from using weight in combination with clinical criteria for monitoring and discharge.
We Know Much about What to Do but Little about How to Do it: Experiences with a Weekly Multimicronutrient Supplementation Campaign
Authors: Gross Rainer , Gross Ursula , Lechtig Aarón , De Romaña Daniel López 
Published: November 2015

Background Global population growth is concentrated in urban areas, but there is little understanding of how to implement the necessary interventions to control food and nutrition insecurity. In the urban area of Peru, food insecurity is characterized mainly by micronutrient deficiencies and not by energy deficiency. Objective To increase the effectiveness and cost-effectiveness of weekly multimicronutrient supplementation programs in poor urban communities. Methods A series of operational studies were conducted of preventive weekly multimicronutrient supplementation to reduce micronutrient-deficiency anemia in a population consisting of 8,081 children under 5 years of age and 20,082 women and adolescent girls of reproductive age (12 through 44 years). Results This is one of a series of papers that describe in as much detail as possible the experiences of a multimicronutrient intervention program for poor urban mothers and their young children and summarizes the lessons learned for consideration of future programming. Conclusions This paper shows that such programs can achieve a high compliance with good training of program staff, involvement of the community, education and motivation of beneficiaries, adequate supplies, and careful monitoring.
Intensifying Efforts to Reduce Child Malnutrition in India: An Evaluation of the Dular Program in Jharkhand, India
Authors: Dubowitz Tamara , Levinson Dorothy , Peterman Jerusha Nelson , Verma Geeta , Jacob Sangita , Schultink Werner 
Published: November 2015

Background The Dular strategy is a unique nutrition initiative initiated by UNICEF India in collaboration with the states of Bihar and Jharkhand. Designed to complement the government's Integrated Child Development Services (ICDS) and build upon its infrastructure, one of the major goals of the Dular program is to capitalize and develop community resources at the grassroots level. The emphasis of the Dular program is on establishing a community-based tracking system of the health status of women and of children 0 to 36 months of age by neighborhood-based local resource persons (LRPs). The main objectives of the Dular program include increased prenatal attendance, improvement in breastfeeding and colostrum delivery, improved nutritional practices, and decreased malnutrition. Objectives and methods An impact evaluation of 744 women and children in Jharkhand examined antenatal and birthing practices, colostrum delivery, delivery of breastmilk as first food, reported use of iodized salt, measured iodized salt status, immunization and weight-for-age z-scores (WAZ) of children 0 to 36 months of age, controlling for various measures of socioeconomic status. Results Differences were found between Dular and non-Dular villages in all major outcomes. Particularly noteworthy is that young children in Dular areas had a 45% lower prevalence of severe malnutrition and were four times more likely to receive colostrum than those in non-Dular villages. Conclusions Our evaluation results indicate that programmatic overlays to the ICDS program, which focus primary attention on children 0 to 36 months of age and on women, have the potential to transform into a cost-effective instrument for reducing child malnutrition in India, with implications for women and children in India.
Prenatal Multiple Micronutrient Supplementation has Greater Impact on Birthweight than Supplementation with Iron and Folic Acid: A Cluster-Randomized, Double-Blind, Controlled Programmatic Study in Rural Niger
Authors: Zagré Noël M. , Desplats Gwénola , Adou Pierre , Mamadoultaibou Aïssa , Aguayo Victor M. 
Published: November 2015

Background Micronutrient deficiencies during pregnancy are associated with adverse pregnancy outcomes, including reduced birthweight. Low birthweight is associated with increased risk of infant mortality and growth failure. Objectives To assess the effects of prenatal supplementation with UNIMMAP (United Nations International Multiple Micronutrient Preparation) compared with iron/folic acid on average birthweight and incidence of low birthweight. Methods Pregnant women from 78 villages in Niger were included in a cluster-randomized, double-blinded, controlled supplementation trial. Baseline, monthly follow-up, and birth data were collected. Cluster analysis was conducted to assess differences in mean birthweight and incidence of low birthweight between groups using multiple linear regression models. Analyses were stratified by nutrition status and duration of supplementation. Results Of the 3,670 women recruited, 2,550 completed the study and provided complete birthweight data (1,328 received multiple micronutrients and 1,222 received iron/folic acid). Mean birthweight was significantly higher (67 g, p < .001) with multiple micronutrients (3,092 ± 190 g) than with iron/folic acid (3,025 ± 205 g); this corresponded to a 14% fall in the incidence of low birthweight (from 8.4% with multiple micronutrients to 7.2% with folic acid fortification). The impact of multiple micronutrients was greater when the supplements were taken for more than 150 days. The incidence of low birthweight was further reduced in women who entered pregnancy with a poorer nutrition status. Conclusions Prenatal supplementation with multiple micronutrients had a greater positive impact on birthweight than supplementation with iron/folic acid. Our data suggest that prenatal supplementation with multiple micronutrients as part of a prenatal care package in addition to interventions to promote improved maternal prepregnancy nutrition status is an important strategy to increase birthweight and reduce the incidence of low birthweight.
An Analysis of the Etiology of Anemia and Iron Deficiency in Young Women of Low Socioeconomic Status in Bangalore, India
Authors: Thankachan Prashanth , Muthayya Sumithra , Walczyk Thomas , Kurpad Anura V. , Hurrell Richard F. 
Published: November 2015

Background Anemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic. Objectives Few studies have comprehensively assessed etiologic factors contributing to anemia and iron deficiency in India. Hence, this study assessed the relative importance of various factors contributing to these problems in young women of low socioeconomic status in Bangalore, India. Methods A random sample of 100 nonpregnant, nonlactating women 18 to 35 years of age, selected from among 511 women living in a poor urban settlement, participated in this study. Data were obtained on demography, socioeconomic status, anthropometry, three-day dietary intake, blood hemoglobin, hemoglobinopathies, serum ferritin, serum C-reactive protein, and stool parasites. Results The prevalence rates of anemia and iron deficiency were 39% and 62%, respectively; 95% of the anemic women were iron deficient. The mean dietary iron intake was 9.5 mg per day, predominantly from the consumption of cereals, pulses, and vegetables (77%). The estimated bioavailability of nonheme iron in this diet was 2.8%. Dietary intakes were suboptimal for several nutrients. Blood hemoglobin was significantly correlated with dietary intake of fat, riboflavin, milk and yogurt, and coffee. Serum ferritin was significantly correlated with intake of niacin, vitamin B12, and selenium. Parasitic infestation was low. Conclusions An inadequate intake of dietary iron, its poor bioavailability, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for the high prevalence of anemia and iron deficiency in this population.
Ensuring the Supply of and Creating Demand for a Biofortified Crop with a Visible Trait: Lessons Learned from the Introduction of Orange-Fleshed Sweet Potato in Drought-Prone Areas of Mozambique
Authors: Low Jan W. , Arimond Mary , Osman Nadia , Cunguara Benedito , Zano Filipe , Tschirley David 
Published: November 2015

Background Orange-fleshed sweet potato (OFSP) is a promising biofortified crop for sub-Saharan Africa because it has high levels of provitamin A carotenoids, the formed vitamin A is bioavailable, and white-fleshed sweet potato is already widely grown. Objectives To examine whether farmers will adopt varieties with a distinct visible trait, young children will eat OFSP in sufficient quantities to improve vitamin A intake, OFSP can serve as an entry point for promoting a more diversified diet, and lessons can be drawn to assure sustained adoption. Methods The 2-year quasi-experimental intervention study followed households and children ( n = 741; mean age, 13 months at baseline) through two agricultural cycles in drought prone-areas of Mozambique. Results OFSP is acceptable to farmers when introduced by using an integrated approach. In the second year, intervention children ( n = 498) were more likely than control children ( n = 243) to have consumed OFSP (54% vs. 4%), dark-green leaves (60% vs. 46%), or ripe papaya (65% vs. 42%) on 3 or more days in the previous week ( p < .001 for all comparisons). Their vitamin A intakes were nearly eight times higher than those of control children (median, 426 vs. 56 μg RAE [retinol activity equivalents], p < .001). Diet diversification was limited by difficult agroecological conditions and low purchasing power. However, dietary diversity was higher among intervention than control children (32% vs. 9% consuming food from more than four groups; p < .001). Conclusions An integrated OFSP-based approach had a positive impact on the vitamin A intake of young children. A market development component and improved vine multiplication systems are recommended to assure sustained adoption.
Traditional Lebanese Recipes Based on Wild Plants: An Answer to Diet Simplification?
Authors: Batal Malek , Hunter Elizabeth 
Published: November 2015

Background The challenge posed by the nutrition transition occurring throughout the world is enormous: rates of chronic disease, particularly overweight and obesity and cardiovascular disease, have reached alarming levels—often occurring in parallel with high levels of micronutrient deficiencies. Lebanon is no exception. And yet this Mediterranean country enjoys a rich biodiversity, with thousands of endemic species and an equally rich culinary history, largely based on its local biodiversity, including wild edible plants. Objectives To record traditional Lebanese recipes based on wild edible plants and to investigate their potential to contribute to a more diversified diet. Methods A series of nine focus group meetings was conducted with key informants knowledgeable in wild edible plant identification, harvesting, and use. Results Common recipes based on wild edible plants were collected and standardized from rural communities where collection of wild edible plants is common. Nutrient analysis and food-composition analysis were performed, including comparisons with processed dishes that are increasingly common in the Lebanese diet, revealing that the wild edible plant-based dishes offered a healthier alternative. Conclusions Since traditional recipes often use items from several food groups in one dish, they can be a good model for diet diversification. The promotion of the collection and use of wild edible plants and their derived products can lead to improved nutrition.
Avian Influenza H5N1: Risks at the Human–Animal Interface
Authors: Mumford Elizabeth , Bishop Jennifer , Hendrickx Saskia , Embarek Peter Ben , Perdue Michael 
Published: November 2015

Background Great concern has arisen over the continued infection of humans with highly pathogenic avian influenza (HPAI) of the H5N1 subtype. Ongoing human exposure potentially increases the risk that a pandemic virus strain will emerge that is easily transmissible among humans. Although the pathogenicity of a pandemic strain cannot be predicted, the high mortality seen in documented H5N1 human infections thus far has raised the level of concern. Objectives To define the three types of influenza that can affect humans, discuss potential exposure risks at the human–animal interface, and suggest ways to reduce exposure and help prevent development of a pandemic virus. Methods This review is based on data and guidelines available from the World Health Organization, the scientific literature, and official governmental reports. Results Epidemiological data on human exposure risk are generally incomplete. Transmission of HPAI to humans is thought to occur through contact with respiratory secretions, feces, contaminated feathers, organs, and blood from live or dead infected birds and possibly from contaminated surfaces. Consumption of properly cooked poultry and eggs is not thought to pose a risk. Use of antiviral containment and vaccination may protect against development of a pandemic. Conclusions To most effectively decrease the risk of a pandemic, the public health and animal health sectors—those which are responsible for protecting and improving the health of humans and animals, respectively—must collaborate to decrease human exposure to HPAI virus, both by controlling virus circulation among poultry and by assessing the risks of human exposure to avian influenza virus at the human—animal interface from primary production through consumption of poultry and poultry products, and implementing risk-based mitigation measures.
Dietary Intake and Clinical Response of Hospitalized Patients with Acute Diarrhea
Authors: Islam Mahfuza , Roy S.K. , Begum Muktara , Chisti M. Jobayer 
Published: November 2015

Background Diarrhea and malnutrition remain major health problems among children of developing countries. During diarrhea, the patient's dietary intake and absorption of nutrients are reduced while nutritional requirements are increased. Objective To determine the relationship between food intake and clinical response during the hospital stay of patients with acute diarrhea. Methods A hospital-based longitudinal study was conducted in 118 patients with acute diarrhea aged 6 to 59 months who required treatment for at least 3 days in the in-patient ward in Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B). Daily food intake was measured and anthropometric measurements were taken to assess nutritional status. Daily stool weight and clinical records were collected. The data were analyzed with SPSS/PC+, version 10, and EPI STAT, version 3.2.2. Results The duration of diarrhea was 50% greater in patients with lower energy intake (less than 50% of the recommended dietary allowance [RDA]) than in those with higher energy intake (6 vs. 4 days, p = <.001). Patients with lower energy intake had 22% greater stool output than those with higher energy intake (122.65 vs. 100.37 mL/kg body weight/day, p = .04). Among patients with lower energy intake, the weight-for-age and weight-for-height z-scores (WAZ and WHZ) at discharge from the hospital were higher than those at admission (−3.53±1.25 vs. −3.67±1.31 and 1.95±1.23 vs. −2.14±1.22, respectively; p = .001 for both comparisons), but these scores did not differ at admission and discharge among patients with higher energy intake. The Kaplan–Meier survival function showed that 80% of well-nourished children (WAZ ≥ −2), as compared with 58% of malnourished children (WAZ < −2), recovered by the 4th day of treatment ( p < .01). The length of the recovery period was related negatively with total energy intake ( p = <.001) and mid-upper-arm circumference ( p = .004) and positively with stool weight. Conclusions Food intake was reduced in the hospitalized children because of severe illness. Patients with lower energy intake as a percentaqe of RDA had delayed clinical recovery and higher stool output.
A Comparative Evaluation of Dietary Indicators Used in Food Consumption Assessments of at-Risk Populations
Authors: Rose Donald , Chotard Sophie , Oliveira Leila , Mock Nancy , Libombo Marcella 
Published: November 2015

Background Easy-to-collect dietary indicators have been used increasingly for planning and evaluation of food security interventions. Various indicators have been employed, but rarely has a full set of indicators been compared using a common framework. Objective This paper evaluates the performance of five dietary indicators for the assessment of household energy consumption using a common framework and recent data from Mozambique. Methods Data were analyzed from a 2004 household survey, Current Vulnerability Analysis in Seven Provinces of Mozambique. Households ( n = 4,358) were sampled from 42 rural districts using a two-stage design, and a quantitative 24-hour dietary recall was employed. Household energy intake ratios were calculated as the food energy consumed by household members divided by the sum of the members' recommended intakes. Five proxy indicators of household consumption in the previous day were developed: the number of meals, the number of food groups, the number of food items, a score based on a simple weighting of food groups consumed, and a predicted energy intake ratio based on weighting of food groups consumed with previously estimated regression coefficients. The performance of these indicators was assessed using correlations with energy intake, receiver operator characteristic analysis, efficiency of predictions, and prevalence estimate comparisons. Results Although the predicted energy intake ratio performed best on all these performance criteria, and the simple food-group-weighted score performed second best, differences among the indicators on many of the criteria were relatively small. Conclusions New assessment systems could take full advantage of easy-to-collect information by using one of these best-scoring indicators, although established systems could continue to use some of the other indicators explored here, such as the food item count, without much loss in accuracy.
What Difference do the new WHO Child Growth Standards make for the Prevalence and Socioeconomic Distribution of Undernutrition?
Authors: Ergo Alex , Gwatkin Davidson R. , Shekar Meera 
Published: November 2015

Background The World Health Organization has recently established revised child growth standards. Objective To assess how the use of these new standards affects the estimated prevalence and socioeconomic distribution of stunting and underweight among children in a large number of low- and middle-income countries. Methods We analyzed Demographic and Health Survey data for stunting and underweight in 41 low- and middle-income countries employing these new standards and compared the results with those produced by analyses of the same data using the old growth references. Results For all 41 countries, the prevalence of stunting increases with the adoption of the new standards, by 5.4 percentage points on average (95% CI: 5.1, 5.7). The prevalence of underweight decreases in all but two of the countries, by an average of 2.9 percentage points (95% CI: 2.7, 3.2). The impact of using the new standards on socioeconomic inequalities is mixed. For stunting, inequalities tend to rise in absolute terms but tend to decline in relative terms. The impact on underweight is inconsistent across countries. Poor children suffer most from undernutrition, but even among the better-off children in developing countries, undernutrition rates are high enough to deserve attention. Conclusions These results suggest that the adoption of the new WHO standards in itself is unlikely to affect policies dramatically. They do confirm, however, that different strategies are likely to be required in these countries to effectively address undernutrition among children at different socioeconomic levels.