bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Costs and Cost-Efficiency of Providing Food through Schools in Areas of High Food Insecurity
Authors: Gelli Aulo , Al-Shaiba Najeeb , Espejo Francisco 
Published: November 2015

Background The provision of food in and through schools has been used to support the education, health, and nutrition of school-aged children. The monitoring of financial inputs into school health and nutrition programs is critical for a number of reasons, including accountability, transparency, and equity. Furthermore, there is a gap in the evidence on the costs, cost-efficiency, and cost-effectiveness of providing food through schools, particularly in areas of high food insecurity. Objective To estimate the programmatic costs and cost-efficiency associated with providing food through schools in food-insecure, developing-country contexts, by analyzing global project data from the World Food Programme (WFP). Methods Project data, including expenditures and number of schoolchildren covered, were collected through project reports and validated through WFP Country Office records. Yearly project costs per schoolchild were standardized over a set number of feeding days and the amount of energy provided by the average ration. Output metrics, such as tonnage, calories, and micronutrient content, were used to assess the cost-efficiency of the different delivery mechanisms. Results The average yearly expenditure per child, standardized over a 200-day on-site feeding period and an average ration, excluding school-level costs, was US$21.59. The costs varied substantially according to choice of food modality, with fortified biscuits providing the least costly option of about US$11 per year and take-home rations providing the most expensive option at approximately US$52 per year. Comparisons across the different food modalities suggested that fortified biscuits provide the most cost-efficient option in terms of micronutrient delivery (particularly vitamin A and iodine), whereas on-site meals appear to be more efficient in terms of calories delivered. Transportation and logistics costs were the main drivers for the high costs. Conclusions The choice of program objectives will to a large degree dictate the food modality (biscuits, cooked meals, or take-home rations) and associated implementation costs. Fortified biscuits can provide substantial nutritional inputs at a fraction of the cost of school meals, making them an appealing option for service delivery in food-insecure contexts. Both costs and effects should be considered carefully when designing the appropriate school-based intervention. The costs estimates in this analysis do not include all school-level costs and are therefore lower-bound estimates of full implementation costs.
Nutritional Monitoring of Preschool-Age Children by Community Volunteers during Armed Conflict in the Democratic Republic of the Congo
Authors: Bisimwa Ghislain , Mambo Thierry , Mitangala Prudence , Schirvel Carole , Porignon Denis , Dramaix Michèle , Donnen Philippe 
Published: November 2015

Background The coverage of preschool preventive medical visits in developing countries is still low. Consequently, very few children benefit from continuous monitoring during the first 5 years of life. Objective To assess community volunteers' effectiveness in monitoring the growth of preschool-age children in a context of endemic malnutrition and armed conflict. Methods Community volunteers were selected by village committees and trained to monitor children's growth in their respective villages. Community volunteers monitored 5,479 children under 5 years of age in the Lwiro Health Sector of the Democratic Republic of the Congo from January 2004 to December 2005 under the supervision of the district health office. Children's weight was interpreted according to weight-for-age curves drawn on the growth sheet proposed by the World Health Organization and adopted by the Democratic Republic of the Congo. Results During the 2-year program, the volunteers weighed children under 5 years of age monthly. The median percentage of children weighed per village varied between 80% and 90% for children of 12–59 months, and 80% and 100% for children of less than 12 months even during the conflict period. The median percentage of children between 12 and 59 months of age per village ranked as highly susceptible to malnutrition by the volunteers decreased from 4.2% (range, 0% to 35.3%) in 2004 to 2.8% (range, 0.0% to 18.9%) in 2005. Conclusions The decentralization of weighing of children to the community level could be an alternative for improving growth monitoring of preschool-age children in situations of armed conflict or political instability. This option also offers an opportunity to involve the community in malnutrition care and can be an entry point for other public health activities.
Effective Nutrition Programming for Children and the Role of UNICEF: Consensus Points from an Expert Consultation
Authors: Schultink Werner , Arabi Mandana 
Published: November 2015

Countries of the world have agreed on eradicating extreme poverty and hunger and reducing the mortality rate of children under five by two-thirds by 2015 as part of the Millennium Development Goals, and without mainstreaming maternal, infant, and young child nutrition in the development agenda, these goals cannot be achieved. Although the recent Lancet Series on Maternal and Child Undernutrition brought attention to the importance of early nutrition interventions to improve child health, nutrition, and future economic productivity, there needs to be a more concerted effort at clarifying the path forward, focusing on moving beyond projects and evidence from randomized, controlled trials towards developing large-scale programs with sound plausibility design to achieve results for children. In an effort to cast a fresh eye on nutrition programming in light of the new evidence, UNICEF Headquarters hosted an Expert Consultation on effective nutrition programming with participants from various academic organizations and United Nations agencies to discuss effective program strategies in nutrition. The consultation resulted in recommendations for UNICEF on eight focus areas for programming and recognition of six overarching themes. It is clear that more action is needed to accelerate progress: more effective global coalitions, better coordination, more coherence, and better targeting of efforts.
Implementing an Integrated Nutrition Package at Large Scale in Madagascar: The Essential Nutrition Actions Framework
Authors: Guyon Agnès B. , Quinn Victoria J. , Hainsworth Michael , Ravonimanantsoa Priscilla , Ravelojoana Voahirana , Rambeloson Zo , Martin Luann 
Published: November 2015

Background Madagascar has some of the highest rates of child stunting, maternal malnutrition, and infant mortality in sub-Saharan Africa. Objective To improve infant and young child feeding practices, increase uptake of micronutrient supplements, and improve women's dietary practices through implementation of a nutrition project based on the Essential Nutrition Actions (ENA) framework. Methods Interventions included training, interpersonal communication, community mobilization, and mass media. Changes in practices were assessed through a comparison of data for children under 2 years of age from representative cross-sectional household surveys collected at baseline in 2000 ( n = 1,200) and at the end of program implementation in 2005 ( n = 1,760). The surveys were conducted in six districts with a population of 1.4 million. Results The rate of initiation of breastfeeding within 1 hour of birth increased from 32% to 68%, the rate of exclusive breastfeeding of infants under 6 months of age increased from 42% to 70%, the rate of continuation of breastfeeding at 20 to 23 months increased from 43% to 73%, the rate of feeding children the minimum recommended number of meals per day at 6 to 23 months increased from 87% to 93%, the rate of iron–folic acid supplementation during pregnancy increased from 32% to 76%, and the rate of postpartum vitamin A supplementation increased from 17% to 54% ( p <.001 for all changes). Modest improvement was achieved in maternal dietary practices during lactation and feeding of the sick child after illness. The results were inconclusive regarding food diversity for complementary feeding. No improvements were reported in increasing food intake during child illness or pregnancy. Conclusions The ENA framework allows broad-scale improvement of nutritional practices to be achieved through the maximization of contacts using multiple program opportunities within existing health systems and community structures and through mass media.
Adoption of the WHO Child Growth Standards to Classify Indonesian Children under 2 Years of Age According to Nutrition Status: Stronger Indication for Nutritional Intervention
Authors: Julia Madarina 
Published: November 2015

Background The National Center for Health Statistics/World Health Organization (NCHS/WHO) reference is considered unsuitable for assessing the nutritional status of breastfed children. It is gradually being replaced by the WHO Child Growth Standards in many countries. Objective To assess the implications of adopting the WHO Child Growth Standards to classify Indonesian children according to nutrition status. Methods Data were obtained from two cross-sectional surveys in two districts in Indonesia in 1998. Children under 2 years of age were randomly selected using a two-stage cluster sampling. Z-scores of weight-for-length (WLZ), length-for-age (LAZ), and weight-for-age (WAZ) were calculated based on both the NCHS/WHO reference and the WHO Child Growth Standards. Wasting, stunting, and underweight were defined as z-scores less than −2.0. Results We included 1,374 children, of whom 693 (50.4%) were male and 681 (49.6%) were female. Almost all of the children had initiated breastfeeding and were still being breastfed when the data were collected. According to the WHO Child Growth Standards, the prevalence of wasting did not change with age, but the prevalence rates of stunting and underweight rose steadily with age. Although the contribution of wasting to the classification of underweight was relatively constant, the contribution of stunting increased as the children grew. Conclusions The WHO Child Growth Standards are a better tool for assessing the nutritional status of Indonesian children than the NCHS/WHO reference. However, low WAZ is not a suitable indicator for commencing an extra feeding program, because it reflects stunting instead of wasting. The high prevalence of stunting indicates the need to perform preventive nutritional intervention beginning earlier in life, i.e., in utero.
Effects of Lifestyle and Diet on Bone Health in Young Adult Chinese Women Living in Hong Kong and Beijing
Authors: Chan Ruth , Woo Jean , Lau Winny , Leung Jason , Xu Ling , Zhao Xihe , Yu Wei , Lau Edith , Pocock Nicholas 
Published: November 2015

Background Dietary and lifestyle variations may be too small to detect possible associations with bone mineral density (BMD) within a community. Pooled data from communities with different diets and lifestyle but of the same ethnicity may help explore these associations. Objective To examine the effects of dietary and lifestyle factors on BMD in young Chinese women. Methods Baseline data were analyzed from 441 women aged 20 to 35 years in Hong Kong and Beijing who were participating in a longitudinal study evaluating the effect of milk supplementation on bone health. Data on demographic characteristics, lifestyle, use of oral contraceptives, diet, physical activity, and BMD of total hip, femoral neck, and total spine measured by dual-energy x-ray absorptiometry were pooled for analysis. Results Hong Kong subjects had significantly lower BMD and higher body-size-adjusted dietary intakes of protein, fat, fiber, vitamins, potassium, sodium, and selenium than Beijing subjects. Multivariate regression of pooled data showed that body mass index was the most important determinant of BMD at all sites. Age was negatively associated and use of oral contraceptives was positively associated with femoral neck BMD. Carbohydrate intake was positively associated with total hip BMD. Fiber intake was negatively associated with BMD at total hip and total spine. Increased vitamin E intake was associated with greater total spine BMD. None of the nutrients were associated with BMD at the femoral neck. Conclusions Diet, lifestyle, and BMD differed greatly between young women from Hong Kong and Beijing. Body mass index was the most important determinant of BMD in young Chinese women, whereas age, use of oral contraceptives, and diet had less pronounced effects.
Investigation of the Nutrition Problems of Central America and Panama
Authors: Arroyave Guillermo , Scrimshaw Nevin S. 
Published: November 2015

From its earliest years, INCAP gave a high priority to a multidisciplinary effort to learn as much as possible about the dietary habits, nutritional status, and their consequences in the populations of Central America and Panama. Most of the papers in this Special Issue contain some of this information. The first studies were in school-children but were soon extended to preschool children, pregnant and lactating women, and other adults. This paper describes the principal findings of the initial dietary, biochemical, and clinical community-based studies. From 1965–67, very extensive studies were carried out in all six countries including dietary, biochemical, clinical, and anthological studies were carried out in all six countries, the results of which are summarized.
Vitamin A Fortification in Uganda: Comparing the Feasibility, Coverage, Costs, and Cost-Effectiveness of Fortifying Vegetable Oil and Sugar
Authors: Fiedler John L. , Afidra Ronald 
Published: November 2015

Background Twenty-eight percent of Ugandan preschool children suffer from vitamin A deficiency. With vitamin A supplementation covering only a third of children under 5 years of age, fortification is essential to reduce their vitamin A deficiency–related disease burden. At present, the only widely consumed food in Uganda that is fortified with vitamin A is vegetable oil. Objective To compare the feasibility, coverage, costs, and cost-effectiveness of fortifying vegetable oil and sugar with vitamin A in order to assess, from a public health policy perspective, whether sugar should also be fortified. Methods The 2005/6 Uganda Household Budget Survey was used to analyze households' apparent consumption levels of sugar and vegetable oil and to model the additional intake of vitamin A, assuming the sugar and oil fortification levels are those set by the Uganda Bureau of Standards. Results The annual incremental private sector cost of vitamin fortification is US$555,668 for oil and US$2,644,765 for sugar. Assuming that oil and sugar fortification are both effective in reducing vitamin A deficiency by 30% among those who consume these foods, the estimated cost per disability-adjusted life year (DALY) averted is US$82 for sugar and US$18 for oil. Vitamin A fortification of vegetable oil is 4.6 times more cost-effective than vitamin A fortification of sugar. If sugar were to be fortified, the 17% of Ugandans who purchase sugar but do not purchase oil would become new beneficiaries of vitamin A fortification. This would increase the coverage of vitamin A–fortified foods by 31% and reduce the percentage of Ugandans without any coverage to 25%. Those most at risk for vitamin A deficiency—members of rural, poor households—would benefit disproportionately from the introduction of sugar fortification. Conclusions Although the lack of information on the vitamin A deficiency status of consumers of oil and sugar precludes making definitive conclusions, the increased coverage and cost per DALY averted due to sugar fortification suggests—based on World Health Organization guidelines—that the Government of Uganda should pursue sugar fortification.
Protein and Amino Acid Intakes in a Rural Area of Bangladesh
Authors: Heck Julia E. , Nieves Jeri W. , Chen Yu , Parvez Faruque , Brandt-Rauf Paul W. , Howe Geoffrey R. , Ahsan Habibul 
Published: November 2015

Background Few studies have described protein and amino acid intakes in rural Bangladesh, a country with considerable undernutrition. Objective The purpose of this population-based study was to assess and describe protein and amino acid intakes in Araihazar, Bangladesh. Methods The study participants were 11,170 adult men and women who participated in the Health Effects of Arsenic Longitudinal Study (HEALS), which had a 98% participation rate. Dietary exposures were assessed by a food-frequency questionnaire that had been designed and validated for the HEALS study population. Results The mean body mass index (BMI) was 19.7 among all participants, and 34.9% of women and 44.4% of men had a BMI below 18.5. The average caloric intake was 2,142 and 2,394 kcal/day among women and men, respectively, and the mean protein intake was 67.5 and 78.2 g/day. The largest sources of protein were from rice and fish. Greater protein intake was related to younger age and several socioeconomic measures, including more years of education, land and television ownership, and employment in business, farming, or as a laborer (for men) or as a homemaker (for women). Conclusions This study found a high prevalence of underweight among study participants. Nonetheless, most participants had adequate protein intake according to Food and Agriculture Organization standards for body weight.
High-Calcium Milk Prevents Overweight and Obesity among Postmenopausal Women
Authors: Angeles-Agdeppa Imelda , Capanzana Mario V. , Li-Yu Julie , Schollum Linda M. , Kruger Marlena C. 
Published: November 2015

Background The Sixth National Nutrition Survey 2003 revealed that the highest prevalence of overweight and obesity among Filipino female adults (30.8%) was found in the age group from 40 to 59 years. Obesity is associated with a number of chronic diseases, including cardiovascular disease, hypertension, and diabetes. Low calcium intake has been identified as a potential contributing factor to overweight and obesity. Objective To assess the effect of a high-calcium, fortified, low-fat milk drink with added vitamin D versus a low-calcium placebo drink on anthropometric measurements of postmenopausal women. Methods Women who were at least 5 years postmenopausal were invited to participate in the study. Potential participants underwent three stages of screening: initial interview, dual-energy x-ray absorptiometry, and blood testing for biochemical screening. Anthropometric indices were measured at baseline and the end of the study. Sixty women were qualified to participate in the study. The women were randomly assigned to two groups, one of which received 400 ml of the high-calcium milk daily for 16 weeks while the other received the placebo drink. Results No significant increases were observed in the anthropometric indices of the subjects receiving the high-calcium fortified milk at the end of the study. However, there were significant increases in the weight ( p = .008), body mass index ( p = .007), and waist ( p = .018) and hip ( p = .003) circumferences of the subjects receiving the placebo drink. Conclusions A change in dietary calcium intake may be a useful measure as part of an overall approach to prevent the occurrence of overweight and obesity among postmenopausal women.
What Knowledge and Expectations are Ethiopian Girls Bringing with Them into Parenthood?
Authors: Hadley Craig , Tessema Fasil , Belachew Tefera , Lindstrom David 
Published: November 2015

Background Because of rapid population growth, many countries now have very large cohorts of young people. Despite the population health importance of early child feeding practices, little work has explored the knowledge and expectations about infant feeding that youth bring with them as they transition into parenthood. Objective To examine adolescent girls' perceptions of infant and young child feeding practices in their communities, and to assess their knowledge and expectations regarding infant and young child feeding practices and explore their overlap with current feeding recommendations. Methods Cross-sectional data were obtained from a random sample of 1,018 girls 13 to 17 years of age living in rural, semiurban, and urban sites in southwestern Ethiopia. Surveys were used to collect information on respondents' attitudes, expectations, and perceptions within the domain of infant and young child feeding practices. Descriptive and bivariate statistics were used to describe the data. Results A total of 1,018 girls aged 13 to 17 years were interviewed. The girls were able to report the age at which infants in their communities were provided liquids, semisolids, and solids as well as the perceived duration of breastfeeding in their communities. The girls were generally able to report when they themselves planned to provide liquids and solids to their infants and their expected duration of breastfeeding. The girls' attitudes and expectations were not consistent with exclusive breastfeeding to 6 months, and planned durations of breastfeeding were shorter than they currently perceived in their communities. Conclusions Young nulliparous Ethiopian women have well-formed attitudes and expectations about infant and young child feeding. These are unlikely to promote currently accepted best practices. Our results suggest both the potential that suboptimal feeding practices will be reproduced and novel intervention points.
Effects of Docosahexaenoic Acid Supplementation During Pregnancy on Gestational Age and Size at Birth: Randomized, Double-Blind, Placebo-Controlled Trial in Mexico
Authors: Ramakrishnan Usha , Stein Aryeh D. , Parra-Cabrera Socorro , Wang Meng , Imhoff-Kunsch Beth , Juárez-Márquez Sergio , Rivera Juan , Martorell Reynaldo 
Published: November 2015

Background The need for omega-3 fatty acids, especially docosahexaenoic acid (DHA), during pregnancy has received much attention, but evidence of effects on birth outcomes is limited. Objective To evaluate whether prenatal DHA supplementation increases gestational age and birth size. Methods We conducted a double-blind, randomized, placebo-controlled trial in Cuernavaca, Mexico. We randomly assigned 1,094 pregnant women (18 to 35 years of age; median DHA dietary intake, 55 mg/day) to 400 mg/day of algal DHA or placebo from 18 to 22 weeks of gestation through delivery. Birth outcomes (968 live births and 5 stillbirths) were ascertained from hospital records within 24 hours of delivery. Results Intention-to-treat analysis showed no differences between the control and DHA group (all p > .05) in mean gestational age (39.1 + 1.7 and 39.0 ± 1.9 weeks, respectively), weight (3.20 + 0.47 and 3.21 ± 0.45 kg, respectively), length (50.3 ± 2.7 and 50.3 ± 2.3 cm, respectively) and head circumference (34.3 ± 1.8 and 34.3 ± 1.5 cm, respectively) at birth. Offspring of supplemented primigravidae (n = 370) were heavier (difference, 99.4 g; 95% CI, 5.5 to 193.4) and had larger head circumferences (difference, 0.5 cm; 95% CI, 0.1 to 0.9) than controls; the differences in multigravidae (n = 603) were −53.3 g (95% CI, −126.8 to 20.2) and −0.2 cm (95% CI, −0.4 to 0.1), respectively (p < .05 for heterogeneity). Conclusions Prenatal DHA supplementation of primigravid women may result in increased birth size in a population where dietary DHA intakes are very low. Benefits of the intervention on infant health and neurodevelopment are under study.