bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Undernutrition among Children in the Garhwal Himalayas
Authors: Dutta Anuradha , Pant Kiran , Puthia Rekha , Sah Archana 
Published: November 2015

Background Nutritional status is the best indicator of the global well-being of children. In India every third child is underweight, whereas in the Garhwal Himalayas only one-fifth of the children are nutritionally normal. Information regarding the causes of such low nutritional status in children of Garhwal is lacking. Objective The present study was designed to identify factors that may influence the nutritional status of the children of the Garhwal Himalayas. Stunting, signifying long-term irreversible chronic undernutrition, was studied, along with wasting, which signifies acute undernutrition among children. Methods Forty families from one town and one village in each of the three major agroclimatic situations (high, middle, and low hills) were selected at random (total 240 families). The nutritional status of 353 children (0 to 12 years of age) was assessed by nutritional anthropometry and compared with tables of weight-for-age and height-for-age z-scores (WAZ and HAZ) identifying wasting and stunting, respectively, and compared with the World Health Organization (WHO) Growth Reference charts 2007. Chi-square test was applied to analyze the effects of age, sex, altitude, and area on the nutritional status of children. Results Of the 353 children studied, 38.2% belonged to the school-aged group, with 7% more girls than boys. Only 11.3% of the children had normal HAZ while 10.3% had normal WAZ. The largest percentages of children (31.8% HAZ and 29.1% WAZ) were clustered in the SD1 group, that is the severely stunted or wasted group. In every age group except the 9- to 12-year group, most of the children were found in the WAZ SD1 category. Gender appeared to influence the SD1 category significantly. There were 17.0% severely stunted girls (SD1), as compared to 14.8% boys; while the percentages of WAZ girls was 16.1% and boys was 13%. The situation in the urban areas was slightly better: 6.4% of the sample had normal HAZ and 7.1% had normal WAZ, compared with 4.4% and 4.6% of the rural children. In all three agroclimatic situations, the largest percentage of children fell in the HAZ SD1 (stunted) category (15.3% in the high hills, 7.3% in the middle hills, and 9.5% in the low hills). There is a significant effect of area (rural vs. urban) on stunting and wasting among children. The child's sex affects stunting only. The other two variables, altitude and age, do not show a significant relationship with stunting or wasting. Conclusions The rate of malnutrition among children in the Garhwal is very high. The majority are severely stunted and wasted, indicating a high prevalence of both chronic and acute malnutrition. Only the area of residence (rural or urban) had an influence on a child's nutritional status.
In Vitro Estimates of Iron Bioavailability in Some Kenyan Complementary Foods
Authors: Lung'aho Mercy G. , Glahn Raymond P. 
Published: November 2015

Background Iron-deficiency anemia is by far the most widespread micronutrient deficiency disease in the world, affecting more than 2 billion people. Although there are multiple causes of anemia, its high prevalence among children—especially in developing countries such as Kenya—is attributed to an inadequate intake of dietary iron. Objective The main objective of this study was to assess the amount of bioavailable iron in Kenyan complementary foods and to determine whether strategies such as food diversification using locally available foods would improve the bioavailability of iron from these foods. Methods The in vitro iron bioavailability system/ Caco-2 cell model that mirrors the gastric and intestinal digestion of humans was used in this study to estimate the amount of bioavailable iron in the porridges. Results The addition of cassava significantly increased the amount of ferritin formation in a cereal-based home recipe from 36.74 to 67.58 ng/mg. The in vitro data suggests that home recipes can provide an equal or greater amount of bioavailable iron as the commercially available nonfortified porridge products. However, in vitro assessment showed that the nonfortified recipes had less bioavailable iron than Cerelac, a commercially available fortified complementary food that provides about 26% of the RDA of iron for infants 6 and 7 months of age per serving ( p < .0001). Conclusions In addition to diet diversity, more approaches to address iron inadequacy of complementary foods are required to improve the bioavailability of iron from the Kenyan complementary foods analyzed.
School Feeding: Outcomes and Costs
Authors: Galloway Rae , Kristjansson Elizabeth , Gelli Aulo , Meir Ute , Espejo Francisco , Bundy Donald 
Published: November 2015

Background School-feeding programs are popular development assistance programs in developing countries but have previously had few sound, empirical analyses of their effectiveness and costs. Objective The goals of this study were to provide a realistic estimate of the costs of school feeding and combine these estimates with outcome information to obtain the cost per outcome. Methods Cost studies were conducted in three African countries by reviewing school-feeding costs provided by the World Food Programme and interviewing stakeholders in ministries of education and in the community. In another African country, existing costing information was used. To compare across the countries, costs were standardized for a 200-day school year, a 700-kcal per day ration, and when children were not fed. To obtain cost per outcome data, outcomes were obtained from a review of school-feeding studies. Results The cost of school feeding ranged from US$28 to US$63 per child per year (weighted mean cost of US$40 per child per year). The cost for an extra day of attendance was less than US$10 per student, while the cost per extra kilogram of weight ranged from US$38 to US$252. Costs for cognitive outcomes were similarly variable. Conclusions This analysis estimates a higher average cost but a narrower range of costs when compared with previous estimates, reflecting the greater precision of the current analyses. The cost per outcome was high, but this analysis does not capture the full range of outcomes (e. g., social protection, educational achievement) potentially derived from school feeding.
Growth and Body Composition of Peruvian Infants in a Periurban Setting
Authors: Iannotti Lora L. , Zavaleta Nelly , León Zulema , Caulfield Laura E. 
Published: November 2015

Background Previous growth studies of Peruvian children have featured high stunting rates and limited information about body composition. Objective We aimed to characterize anthropometric measures of Peruvian infants 0 to 12 months of age in relation to the international growth references and biological, environmental, and socioeconomic factors. Methods Infants ( n = 232) were followed longitudinally from birth through 12 months of age from a prenatal zinc supplementation trial conducted in Lima, Peru, between 1995 and 1997. Anthropometric measures of growth and body composition were obtained at enrollment from mothers and monthly through 1 year of age from infants. Weekly morbidity and dietary intake surveillance was carried out during the second half of infancy. Results The prevalence rates of stunting, underweight, and wasting did not exceed 4% based on the World Health Organization growth references. Infants of mothers from high-altitude regions had larger chest circumference ( p = .006) and greater length ( p = .06) by 12 months. Significant predictors of growth and body composition throughout infancy were age, sex, anthropometric measurements at birth, breastfeeding, maternal anthropometric measurements, primiparity, prevalence of diarrhea among children, and the altitude of the region of maternal origin. No associations were found for maternal education, asset ownership, or sanitation and hygiene factors. Conclusions Peruvian infants in this urban setting had lower rates of stunting than expected. Proximal and familial conditions influenced growth throughout infancy.
INCAP Studies of Energy, Amino Acids, and Protein
Authors: Viteri Fernando E. 
Published: November 2015

This Special Issue summarizes the results of several studies aimed at providing information on a series of questions related to the adequate protein and energy intakes that allow adequate growth and function in children and work performance and productivity in adults. The effect of different sources of protein on nitrogen balance and the requirements of essential amino acids in young children were also explored in fully recovered, previously malnourished children housed in the Metabolic Ward of the Biomedical Division of INCAP. The following are the main results of these investigations: » Animal experiments and studies in children recovering from protein–energy malnutrition (PEM) strongly suggest that even when requirements of all nutrients are satisfied, inactivity reduces the rate of linear growth and physical activity improves it as well as lean body mass repletion. » The effects of different energy intakes on nitrogen balance demonstrated how energy intake modifies the need to ingest different amounts of protein to satisfy protein requirements. » Insensible nitrogen losses in preschool children and their relation to protein intake was demonstrated. » The quality of even “good protein sources” modifies the amount needed to satisfy nitrogen requirements, and corn and bean-based diets can satisfy protein needs for health and even growth of young children. » Essential amino acid requirements of 2-year-old children was assessed by diverse measurements of nitrogen metabolism and amino acid levels in blood, and were found lower than those recommended by FAO-WHO. » In rural adult populations the relationship between energy and protein intake, productivity and body composition, and the impact of environmental hygiene on nitrogen balance was demonstrated and measured.
Across-Country Comparisons of Selected Infant and Young Child Feeding Indicators and Associated Factors in Four South Asian Countries
Authors: Dibley Michael J. , Roy S. K. , Senarath Upul , Patel Archana , Tiwari Kalpana , Agho Kingsley E. , Mihrshahi Seema ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background Information on infant and young child feeding is widely available in Demographic and Health Surveys and National Family Health Surveys for countries in South Asia; however, infant and young child feeding indicators from these surveys have not been compared between countries in the region. Objective To compare the key indicators of breastfeeding and complementary feeding and their determinants in children under 24 months of age between four South Asian countries. Methods We selected data sets from the Bangladesh Demographic and Health Survey 2004, the India National Family Health Survey (NFHS-03) 2005–06, the Nepal Demographic and Health Survey 2006, and the Sri Lanka 2000 Demographic and Health Survey. Infant feeding indicators were estimated according to the key World Health Organization indicators. Results Exclusive breastfeeding rates were 42.5% in Bangladesh, 46.4% in India, and 53.1% in Nepal. The rate of full breastfeeding ranged between 60.6% and 73.9%. There were no factors consistently associated with the rate of no exclusive breastfeeding across countries. Utilization of health services (more antenatal clinic visits) was associated with higher rates of exclusive breastfeeding in India but lower rates in Nepal. Delivery at a health facility was a negative determinant of exclusive breastfeeding in India. Postnatal contacts by Public Health Midwives were a positive factor in Sri Lanka. A considerable proportion of infants under 6 months of age had been given plain water, juices, or other nonmilk liquids. The rate of timely first suckling ranged from 23.5% in India to 56.3% in Sri Lanka. Delivery by cesarean section was found to be a consistent negative factor that delayed initiation of breastfeeding. Nepal reported the lowest bottle-feeding rate of 3.5%. Socioeconomically privileged mothers were found to have higher bottle-feeding rates in most countries. Conclusions Infant and young child feeding practices in the South Asia region have not reached the expected levels that are required to achieve a substantial reduction in child mortality. The countries with lower rates of exclusive breastfeeding have a great potential to improve the rates by preventing infants from receiving water and water-based or other nonmilk liquids during the first 6 months of life.
Risk Factors Associated with High Prevalence of Anemia among Children under 5 Years of Age in Paddy-Farming Households in Sri Lanka
Authors: Malkanthi R. L. D. K. , Silva K. D. R. R. , Jayasinghe-Mudalige Udith K. 
Published: November 2015

Background The prevalence of anemia among pre- school-aged children remains relatively high in developing countries. Determination of the risk factors associated with anemia is important to develop appropriate interventions. Objective To determine the prevalence of anemia among children under 5 years of age and to evaluate the risk factors associated with anemia. Methods The subjects were 300 children 0 to 60 months of age from 300 subsistence paddy-farming households from nine divisional secretariats across five districts of Sri Lanka (Anuradhapura, Polonnaruwa, Hambantota, Ratnapura, and Kurunegala). The HaemoCue method was used to measure hemoglobin concentration, and anemia was defined as hemoglobin < 11 g/dl. A 24-hour dietary recall was used to determine nutrient intakes. Results Overall, 52% of the children were anemic and 18% were severely anemic. Hemoglobin measurements were strongly positively correlated with age ( r = 0.41, p < .0001) and modestly negatively correlated with duration of exclusive breastfeeding ( r = −0.18, p < .0001). Factors that were significantly associated with anemia were age, duration of exclusive breastfeeding, father's and mother's education, monthly household income, iron intake, and consumption of fruits on the previous day. In multivariate logistic regression, only duration of exclusive breastfeeding, iron intake, and father's education remained significantly associated with anemia ( r2 = 0.060, p = .002). Children with a long duration of exclusive breastfeeding, less educated fathers, and low iron intake were more likely to be anemic. Conclusions Anemia is associated with factors reflecting poor socioeconomic and educational status and a less diverse, poor-quality diet among children in paddy-farming households.
Fortification of Flour with Folic Acid
Authors: Berry Robert J. , Bailey Lynn , Mulinare Joe , Bower Carol , Dary Omar 
Published: November 2015

Background After randomized, controlled trials established that consumption of folic acid before pregnancy and during the early weeks of gestation reduces the risk of a neural tube defect (NTD)-affected pregnancy, the United States Public Health Service recommended in 1992 that all women capable of becoming pregnant consume 400 μg folic acid daily. In 1998, folic acid fortification of all enriched cereal grain product flour was fully implemented in the United States and Canada. Objective To provide guidance on national fortification of wheat and maize flours to prevent 50 to 70% of the estimated 300,000 NTD-affected pregnancies worldwide. Methods An expert workgroup reviewed the latest evidence of effectiveness of folic acid flour fortification and the safety of folic acid. Results Recent estimates show that in the United States and Canada, the additional intake of about 100 to 150 μg/day of folic acid through food fortification has been effective in reducing the prevalence of NTDs at birth and increasing blood folate concentrations in both countries. Most potential adverse effects associated with folic acid are associated with extra supplement use not mandatory fortification. Fortification of wheat flour has a proven record of prevention in other developed countries. In 2009, 51 countries had regulations written for mandatory wheat flour fortification programs that included folic acid. Conclusions NTDs remain an important cause of perinatal mortality and infantile paralysis worldwide. Mandatory fortification of flour with folic acid has proved to be one of the most successful public health interventions in reducing the prevalence of NTD-affected pregnancies. Most developing countries have few, if any, common sources of folic acid, unlike many developed countries, which have folic acid available from ready-to-eat cereals and supplements. Expanding the number of developed and developing countries with folic acid flour fortification has tremendous potential to safely eliminate most folic acid-preventable NTDs.
Formative Research Exploring Acceptability, Utilization, and Promotion in Order to Develop a Micronutrient Powder (Sprinkles) Intervention among Luo Families in Western Kenya
Authors: Jefferds Maria Elena D. , Ogange Lorraine , Owuor Mercy , Cruz Kari , Person Bobbie , Obure Alfredo , Suchdev Parminder S. , Ruth Laird J. 
Published: November 2015

Background There is a lack of peer-reviewed literature describing in detail the formative research to develop Sprinkles interventions. Objective To describe community members' reactions to and experiences using Sprinkles, with an emphasis on acceptability, utilization, and promotion. Methods Fourteen initial focus group discussions on Sprinkles and a 25-family home study were conducted. For the home study, each child 6 to 59 months of age in the household received 30 sachets (1 per day). The initial 14 focus group discussions included mothers, grandmothers, vendors, women who purchased from vendors, and adults in the general population. Home study families were recruited from participants in the initial 14 focus group discussions who had at least one child 6 to 59 months of age. Results Sprinkles were highly acceptable to adults and most children; some children thought Sprinkles were sugar. Most home study families prepared and used Sprinkles correctly. All families reported positive effects, particularly increased appetite, and recommended Sprinkles; none experienced major problems. Potential barriers identified were lack of knowledge of and experience with Sprinkles, availability of Sprinkles, and cost. Promotional messages targeted to mothers, fathers, all child-care providers, and doctors focused on the positive health effects of Sprinkles. Conclusions Issues related to Sprinkles preparation, use, and barriers required attention before implementation. Locally appropriate visual and written instructions were developed for dissemination. Intervention training sessions and promotions were tailored to answer frequently asked questions, increase knowledge of Sprinkles, and provide tangible evidence of health benefits. Information needs and perceptions changed quickly after use of Sprinkles. Existing levels of Sprinkles awareness and knowledge should be considered when designing interventions.
Food Insecurity in the Context of HIV/AIDS: A Framework for a New Era of Programming
Authors: Frega Romeo , Duffy Francesca , Rawat Rahul , Grede Nils 
Published: November 2015

Background Food insecurity can be both a consequence and a driver of HIV/AIDS. It is often difficult to disentangle these two roles of food insecurity, since the HIV epidemic has different drivers in different settings. The advent of antiretroviral treatment in resource-limited settings adds an additional layer of complexity. This paper seeks to organize current thinking by reviewing the existing literature on food insecurity and HIV/AIDS and describing the complex interactions between them. Objective Based on literature review, the paper proposes a framework to understand the linkages, distinguishing four types of interventions to address them. It is hoped that the model, albeit simplified as is any framework, will help to structure research, policy, and programming in the field of HIV/AIDS and food insecurity. Finally, the paper intends to widen the lens to regard food not just as a means to provide calories or an income transfer but also as a carrier of adequate nutrition in the context of HIV. Results and conclusions An adequate response to HIV/AIDS and food insecurity must be tailored to specific settings. Interventions distinguished in this paper are aimed at both promoting food security and providing antiretroviral treatment and nutrition support. The four types of interventions are containing HIV and preventing AIDS through comprehensive treatment regimes that include nutritional support; mitigating the effects of AIDS through support; providing HIV-sensitive, but not HIV-exclusive, safety nets at the individual, household, and community levels; and limiting the exposure to risk through HIV prevention activities.
Pilot-Scale Commercialization of Iron-Fortified Rice: Effects on Anemia Status
Authors: Angeles-Agdeppa Imelda , Saises Marcela , Capanzana Mario , Juneja Lekh R. , Sakaguchi Noboru 
Published: November 2015

Background Rice, the staple food of the Philippines, is an appropriate vehicle for iron fortification to combat the high prevalence of iron-deficiency anemia. A previous study among schoolchildren supplemented with iron-fortified rice showed a significant reduction in the rate of iron-deficiency anemia from 100% to 33%. Objective To document the processes involved in commercializing iron-fortified rice and to determine its effects on anemia prevalence. Subjects and methods This study was conducted on 766 mothers and their children aged 6 to 9 years in Orion, Bataan. Soliciting political support, networking with local organizations, market surveys, and social marketing activities were conducted. The iron content of iron-fortified rice was tested for each production run. Hemoglobin measurements were performed on the mothers and children at baseline and endline. Results A municipal ordinance to sell iron-fortified rice was issued, while the local federation provided funds to kick off the sale of iron-fortified rice. Sales of iron-fortified rice were highest when the rice was sold at Php 27 (Php 1 = US$0.025) per kilogram and lowest when the price was Php 37 per kilogram or greater. The municipal ordinance was not strictly enforced because of the global rice crisis. Social marketing activities encouraged families to buy iron-fortified rice. The iron content of the iron-rice premix was within the set specification limits of 600 to 760 mg of iron per 100 g of premix, while the iron-fortified rice was within 3 to 3.8 mg of iron and 1 to 2 mg (BC No. 2009-010) per 100 g of raw and cooked fortified rice, respectively. The decrease in the rate of anemia was significant among children (from 17.5% to 12.8%) but not among mothers (from 13.0% to 12.5%) after 9 months of study implementation. Conclusions Strong political support and intensive social marketing activities are crucial inputs in commercializing iron-fortified rice. Keeping the cost affordable and maintaining the commitment of identified partners were the key factors for providing a continuous supply of iron-fortified rice. Commercializing iron-fortified rice can be considered as one of the strategies for decreasing anemia prevalence.