bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a User-Friendly and Rapid Method for Quantifying Iodine Content of Salt
Authors: Rohner Fabian , Garrett Greg S. , Laillou Arnaud , Frey Simone K. , Mothes Ralf , Schweigert Florian J. , Locatelli-Rossi Lorenzo 
Published: November 2015

Background Despite considerable progress made in the past decade through salt iodization programs, over 2 billion people worldwide still have inadequate iodine intake, with devastating consequences for brain development and intellectual capacity. To optimize these programs with regard to salt iodine content, careful monitoring of salt iodine content is essential, but few methods are available to quantitatively measure iodine concentration in a simple, fast, and safe way. Objective We have validated a newly developed device that quantitatively measures the content of potassium iodate in salt in a simple, safe, and rapid way. Methods The linearity, determination and detection limit, and inter- and intra-assay variability of this colorimetric method were assessed and the method was compared with iodometric titration, using salt samples from several countries. Results Linearity of analysis ranged from 5 to 75 mg/kg iodine, with 1 mg/kg being the determination limit; the intra- and interassay imprecision was 0.9%, 0.5%, and 0.7% and 1.5%, 1.7%, and 2.5% for salt samples with iodine contents of 17, 30, and 55 mg/kg, respectively; the interoperator imprecision for the same samples was 1.2%, 4.9%, and 4.7%, respectively. Comparison with the iodometric method showed high agreement between the methods ( R2 = 0.978; limits of agreement, −10.5 to 10.0 mg/kg). Conclusions The device offers a field- and user-friendly solution to quantifying potassium iodate salt content reliably. For countries that use potassium iodide in salt iodization programs, further validation is required.
Fortification of Wheat Flour and Maize Meal with Different Iron Compounds: Results of a Series of Baking Trials
Authors: Randall Philip , Johnson Quentin , Verster Anna 
Published: November 2015

Background Wheat and maize flour fortification is a preventive food-based approach to improve the micronutrient status of populations. In 2009, the World Health Organization (WHO) released recommendations for such fortification, with guidelines on the addition levels for iron, folic acid, vitamin B12, vitamin A, and zinc at various levels of average daily consumption. Iron is the micronutrient of greatest concern to the food industry, as some believe there may be some adverse interaction(s) in some or all of the finished products produced from wheat flour and maize meal. Objective To determine if there were any adverse interactions due to selection of iron compounds and, if differences were noted, to quantify those differences. Methods Wheat flour and maize meal were sourced in Kenya, South Africa, and Tanzania, and the iron compound (sodium iron ethylenediaminetetraacetate [NaFeEDTA], ferrous fumarate, or ferrous sulfate) was varied and dosed at rates according to the WHO guidelines for consumption of 75 to 149 g/day of wheat flour and > 300 g/day of maize meal and tested again for 150 to 300 g/day for both. Bread, chapatti, ugali (thick porridge), and uji (thin porridge) were prepared locally and assessed on whether the products were acceptable under industry-approved criteria and whether industry could discern any differences, knowing that differences existed, by academic sensory analysis using a combination of trained and untrained panelists and in direct side-by-side comparison. Results Industry (the wheat and maize milling sector) scored the samples as well above the minimal standard, and under academic scrutiny no differences were reported. Side-by-side comparison by the milling industry did indicate some slight differences, mainly with respect to color, although these differences did not correlate with any particular iron compound. Conclusions The levels of iron compounds used, in accordance with the WHO guidelines, do not lead to changes in the baking and cooking properties of the wheat flour and maize meal. Respondents trained to measure against a set benchmark and/or discern differences could not consistently replicate perceived difference observations.
Validity of Food Consumption Indicators in the Lao Context: Moving toward Cross-Cultural Standardization
Authors: Baumann Soo Mee , Webb Patrick , Zeller Manfred 
Published: November 2015

Background Cross-cultural validity of food security indicators is commonly presumed without questioning the suitability of generic indicators in different geographic settings. However, ethnic differences in the perception of, and reporting on, food insecurity, as well as variations in consumption patterns, may limit the comparability of results. Although research on correction factors for standardization of food security indicators is in process, so far no universal indicator has been identified. Objective The current paper considers the ability of the Food Consumption Score (FCS) developed by the World Food Programme in southern Africa in 1996 to meet the requirement of local cultural validity in a Laotian context. The analysis is based on research that seeks to identify options for correcting possible biases linked to cultural disparities. Methods Based on the results of a household survey conducted in different agroecological zones of Laos in 2009, the FCS was validated against a benchmark of calorie consumption. Changing the thresholds and excluding small amounts of food items consumed were tested as options to correct for biases caused by cultural disparities. Results The FCS in its original form underestimates the food insecurity level in the surveyed villages. However, the closeness of fit of the FCS to the benchmark classification improves when small amounts of food items are excluded from the assessment. Conclusions Further research in different cultural settings is required to generate more insight into the extent to which universal thresholds can be applied to dietary diversity indicators with or without locally determined correction factors such as the exclusion of small amounts of food items.
Associations among Dietary Zinc Intakes and Biomarkers of Zinc Status before and after a Zinc Supplementation Program in Guatemalan Schoolchildren
Authors: Bui Vinh Q. , Marcinkevage Jessica , Ramakrishnan Usha , Flores-Ayala Rafael C. , Ramirez-Zea Manuel , Villalpando Salvador , Martorell Reynaldo , Digirolamo Ann M. , Stein Aryeh D. 
Published: November 2015

Background The associations among dietary zinc intakes and biomarkers of zinc status are unknown in apparently healthy children at high risk for zinc deficiency. Objective To assess associations among zinc-related parameters in a sample of Guatemalan school-aged children. Methods We assessed total dietary intakes and biomarkers of zinc status before and after receiving 6 months of zinc supplementation or placebo in 691 Guatemalan schoolchildren aged 6 to 11 years. Most of the children also received zinc-fortified milk from a government program that started shortly after the trial began. We assessed associations between zinc intakes and serum zinc, alkaline phosphatase (ALP), and albumin. Results At baseline, the prevalence of serum zinc < 65 μg/dL and dietary zinc intake below Estimated Average Requirements (EAR) (< 4 and < 7 mg/day for children < 9 and ≥ 9 years, respectively) were 21.6% and 39.4%, respectively. Pearson correlations between serum zinc concentration and dietary zinc intake, serum ALP, and serum albumin were r = 0.07, 0.15, and 0.07, respectively. At the 6-month follow-up, low serum zinc and low total (diet plus fortified milk) zinc intakes were observed in 1.2% and 0.0% of children in the zinc-supplemented group and 4.0% and 34.1% in the placebo group, respectively. Pearson correlations between serum zinc concentration and total zinc intake, serum ALP, and serum albumin were 0.10, 0.06, and −0.11 in the zinc-supplemented group and −0.04, 0.05, and 0.01 in the placebo group, respectively. Conclusions Zinc intake was inconsistently associated with markers of serum zinc concentration. Zinc fortification or supplementation attenuated the associations.
Using Program Impact Pathways to Understand and Improve Program Delivery, Utilization, and Potential for Impact of Helen Keller International's Homestead Food Production Program in Cambodia
Authors: Olney Deanna K. , Vicheka Sao , Kro Meng , Chakriya Chhom , Kroeun Hou , Hoing Ly Sok , Talukder Aminzzaman , Quinn Victoria , Iannotti Lora , Becker Elisabeth , Roopnaraine Terry 
Published: November 2015

Background Evidence of the impact of homestead food production programs on nutrition outcomes such as anemia and growth is scant. In the absence of information on program impact pathways, it is difficult to understand why these programs, which have been successful in increasing intake of micronutrient-rich foods, have had such limited documented impact on nutrition outcomes. Objective To conduct a process evaluation of Helen Keller International's (HKI's) homestead food production program in Cambodia to assess whether the program was operating as planned (in terms of design, delivery, and utilization) and to identify ways in which the program might need to be strengthened in order to increase its potential for impact. Methods A program theory framework, which laid out the primary components along the hypothesized program impact pathways, was developed in collaboration with HKI and used to design the research. Semistructured interviews and focus group discussions with program beneficiaries ( n = 36 and 12, respectively), nonbeneficiaries ( n = 12), and program implementers ( n = 17 and 2, respectively) and observations of key program delivery points, including health and nutrition training sessions ( n = 6), village model farms ( n = 6), and household gardens of beneficiaries ( n = 36) and nonbeneficiaries ( n = 12), were conducted to assess the delivery and utilization of the primary program components along the impact pathways. Results The majority of program components were being delivered and utilized as planned. However, challenges with some of the key components posited to improve outcomes such as anemia and growth were noted. Among these were a gap in the expected pathway from poultry production to increased intake of eggs and poultry meat, and some weaknesses in the delivery of the health and nutrition training sessions and related improvements in knowledge among the village health volunteers and beneficiaries. Conclusions Although the program has been successful in delivering the majority of the program components as planned and has documented achievements in improving household production and intake of micronutrient-rich foods, it is likely that strengthening delivery and increasing utilization of some program components would increase its potential for nutritional impacts. This research has highlighted the importance of designing a program theory framework and assessing the components that lie along the primary program impact pathways to optimize program service delivery and utilization and, in turn, potential for impact.
Are School Feeding Programs in Low-Income Settings Sustainable? Insights on the Costs of School Feeding Compared with Investments in Primary Education
Authors: Gelli Aulo , Daryanani Roshan 
Published: November 2015

Background School feeding programs are ubiquitous. Benchmarking expenditures for school feeding is an important component of program accountability and sustainability. Objective To analyze the costs of school feeding and the cost relative to education expenditure and other measures of economic growth. Methods Data on the costs of school feeding were collected from multiple sources, including United Nations databases, gray literature, and published reviews. Relationships between costs of school feeding, costs of education, and GDP per capita were analyzed through standard linear regression. Results Data on costs of school feeding were obtained for 74 countries, including 12 high-income, 40 middle-income, and 22 in low-income countries. School feeding programs were found to cost US$173 per child per year, ranging from US$54 in low-income countries to US$693 in high-income countries. In high-income countries, school feeding costs per capita were on average equivalent to 11% of the per capita investments in primary education, compared with 19% in middle-income countries and 68% in low-income countries. In middle- and low-income countries, school feeding programs covered on average 18% and 13% of the children enrolled in primary school, respectively. The total budget for school feeding in low-income countries was found to be on average 11% of the estimated total primary school education budget, compared to 4% in middle-income countries. Conclusions School feeding investments are targeted in low- and middle-income settings, reaching only a portion of primary schoolchildren, with total costs only a fraction of the overall investment in education. As countries get richer, school feeding costs become a much smaller proportion of education costs. The findings of this study provide an updated framework for benchmarking school feeding programs.
Relative Costs of 24-Hour Recall and Household Consumption and Expenditures Surveys for Nutrition Analysis
Authors: Fiedler John L. , Martin-Prével Yves , Moursi Mourad 
Published: November 2015

Background The technical and resource demands of the most precise dietary assessment methods, 24-hour recall and observed-weighed food records, have proven impractical for most low- and middle-income countries, leaving nutrition policymakers with a woefully inadequate evidence base and compromising nutrition program effectiveness. Objective To better understand the relative costs of informing food and nutrition policy-making using two different data sources: 24-hour recall survey data and Household Consumption and Expenditures Survey (HCES) data. Methods A comparative analysis of the costs of designing, implementing, and analyzing a 24-hour recall survey and the cost of secondary analysis of HCES data. Results The cost of conducting a 24-hour recall survey with a sample of the size typical of HCES would be roughly 75 times higher than the cost of analyzing the HCES data. Conclusions Although the 24-hour recall method is undoubtedly more precise, it has become self-evident that the practical choice for most countries is not between these two surveys, but between having data from less precise, but much more readily available and affordable HCES or having no nationally representative data. In the light of growing concerns about inappropriate fortification policies developed without data, there is an urgent need to begin working to strengthen HCES to provide more precise food and nutrition data. The best way forward is not likely to rest with one data source or another, but with the development of an eclectic approach that exploits the strengths and weaknesses of alternative surveys and uses them to complement one another.
Strengthening Systems to Support Mothers in Infant and Young Child Feeding at Scale
Authors: Sanghvi Tina , Martin Luann , Hajeebhoy Nemat , Abrha Teweldebrhan Hailu , Abebe Yewelsew , Haque Raisul , Tran Ha Thi Thu , Roy Sumitro 
Published: November 2015

Background Systems strengthening is essential for implementation of large-scale nutrition interventions, including infant and young child feeding (IYCF), since rapid geographic expansion places additional burdens on service delivery systems. Objective To document approaches for building capacity and supporting programs to scale up IYCF counseling in three different country contexts. Methods Situational assessments, stakeholder consultations, formative research, household and frontline health worker surveys, other related studies, and program monitoring in three countries identified gaps and opportunities for strengthening IYCF service delivery. Results Variations in program platforms, level and roles of service providers, places of service delivery, community factors, and the needs of managers and frontline workers influenced the intervention mix used for strengthening IYCF services. The programs ranged from a highly structured and standardized package of IYCF counseling services in Vietnam delivered through government health facilities to counseling delivered at the doorstep by incentivized nongovernmental organization volunteers in Bangladesh. In Ethiopia, government health extension workers based at health posts conducted outreach visits with support from volunteers. Conclusions Guidelines and standards of care, training, job aids, supportive supervision, incentives, and monitoring data can enhance performance and strengthen systems for delivering IYCF counseling services in the community or at health facilities. Leadership, financing, partnerships, and logistics support are essential to support large-scale implementation of the IYCF counseling package in diverse service delivery environments.
Learning How Programs Achieve their Impact: Embedding Theory-Driven Process Evaluation and Other Program Learning Mechanisms in Alive & Thrive
Authors: Rawat Rahul , Nguyen Phuong H. , Ali Disha , Saha Kuntal , Alayon Silvia , Kim Sunny S. , Ruel Marie , Menon Purnima 
Published: November 2015

Background Traditionally, impact evaluations have focused primarily on answering what impact programs or interventions have, with less attention to how or why impacts are achieved, or not achieved. The Alive & Thrive initiative, a 6-year program that aims to improve infant and young child feeding (IYCF) practices and reduce stunting in Bangladesh, Ethiopia, and Vietnam, has a specific objective to generate learning on how to achieve and replicate Alive & Thrive's impact. Objective In Alive & Thrive, theory-driven process evaluation methods are the primary mechanism through which data are generated to address this objective. This paper focuses on the different methodological approaches that are being utilized, to answer the critical “how”; questions, and to generate information on the many processes and pathways to program impact. Methods We identify four key principles in our methodological approach that guides all process evaluation activities: 1) developing detailed program impact pathway (PIP) models, 2) linking data collection to PIPs utilizing mixed methods and multiple data sources, 3) linking evaluation activities with program implementation timelines, and 4) engaging with the program implementation and management teams. Results Beginning with the launch of the program, we outline the steps that have been taken in the design and implementation of the process evaluations of Alive & Thrive, and provide examples of how these steps have been operationalized in different country contexts. Conclusions This theory-driven and country- and component-specific approach, centered on careful analysis of PIPs, is intended to generate information on implementation and utilization pathways of Alive & Thrive's interventions, thereby answering the questions of how impacts are achieved, or why not. This evaluation approach is not without challenges, and we highlight some of these key challenges.
Effectiveness of Wetting Method for Control of Konzo and Reduction of Cyanide Poisoning by Removal of Cyanogens from Cassava Flour
Authors: Banea Jean Pierre , Bradbury J. Howard , Mandombi Chretienne , Nahimana Damien , Denton Ian C. , Kuwa N'landa , Katumbay D. Tshala 
Published: November 2015

Background Konzo is an irreversible paralysis of the legs that occurs mainly among children and young women in remote villages in tropical Africa and is associated with a monotonous diet of bitter cassava. Konzo was discovered in 1938 by Dr. G. Trolli in the Democratic Republic of Congo (DRC). It also occurs in Mozambique, Tanzania, Cameroon, Central African Republic, and Angola. It was first controlled in Kay Kalenge village, DRC, in 2011 with the use of a wetting method to remove cyanogens from cassava flour. Fourteen months later, another visit was made to Kay Kalenge. Objective To determine whether Kay Kalenge women were still using the wetting method, whether there were new cases of konzo, and whether the wetting method had spread to other villages. Methods Meetings were held with chiefs, leaders, and heads of mothers' groups, women from 30 households were interviewed, and three nearby villages were visited. Total cyanide and thiocyanate were analyzed in cassava flour and urine samples, respectively. Results The women in Kay Kalenge village still used the wetting method. There were no new cases of konzo. The mean cyanide content of the flour samples was 9 ppm, and no child had a mean urinary thiocyanate content greater than 350 μmol/L. The use of the wetting method had spread naturally to three adjacent villages. Conclusions The wetting method has been readily accepted by rural women as a simple and useful method to control konzo by removing cyanide from cassava flour, and its use has spread to nearby villages. The wetting method should be promoted by health authorities to control konzo and reduce cyanide poisoning from high-cyanide cassava flour.
Impacts of Agriculture on Nutrition: Nature of the Evidence and Research Gaps
Authors: Webb Patrick , Kennedy Eileen 
Published: November 2015

Background In the past decade, numerous exercises have been undertaken to document knowledge of the effects of agricultural development projects on human nutrition. Objective The present paper reviews 10 papers published since 2000 to synthesize current evidence of agriculture-to-nutrition linkages. Results Although there are differences in focus, methods used, and standards of evidence across the set of papers considered, three common findings emerge. First, the empirical evidence for plausible and significant impacts of agricultural interventions on defined nutrition outcomes remains disappointingly scarce. Second, absence of evidence should not be equated with evidence of no impact. Weaknesses in study design and survey methods are all too common, leading to weak results and limited generalizability. Third, the broad domains of “agriculture' on the one hand, and “nutritional status' on the other, must be unpackaged in future analyses if statistically significant findings and relevant policy or program conclusions are to be drawn. Conclusions Expectations of the potential for nutrition impact of different kinds of investment in agriculture must be set rationally, based on well-defined mechanisms and pathways. Planned and ongoing initiatives aimed at generating such evidence must hold themselves to high standards of both research and communication of findings to appropriate policy audiences globally.