bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Third Trimester Counseling on Pregnancy Weight Gain, Birthweight, and Breastfeeding among Urban Poor Women in Bangladesh
Authors: Akter S. M. , Roy S. K. , Thakur S. K. , Sultana M. , Khatun W. , Rahman R. , Saliheen S. S. , Alam N. 
Published: November 2015

Background Maternal malnutrition and poor gestational weight gain are the most important causes of low birth weight and high rates of newborn mortality. Objective To assess the effects of nutrition counseling in the third trimester of pregnancy on maternal weight gain, birth weight of newborn, and breastfeeding practices. Methods This was a longitudinal experimental study with nutrition intervention for a period of 3 months. One hundred fifteen women (57 in the intervention group and 58 in the comparison group) who were visiting the Maternal and Child Health Training Institute at 6 months of pregnancy were randomly selected. The intervention group was given nutrition education twice in the first month and once a month for the next 2 months before delivery; the comparison group received routine hospital advice on food intake, immunization, personal hygiene, and breastfeeding. The women were weighed monthly up to delivery, the newborn infants' birth weights were measured within 24 hours after delivery, and breastfeeding practices were observed 1 month after delivery. Results Women in the intervention group gained 1.73 kg more weight during the third trimester than women in the comparison group (5.61 vs. 3.88 kg, p < 0.001). The mean birthweight of babies of women in the intervention group was 0.44 kg greater than that of babies of women in the comparison group (2.86 vs. 2.42 kg, p <0.001). In the intervention group, 10.5% of babies were born with low birthweight, compared with 48.3% of the babies of women in the comparison group ( p < 0.001). In the intervention group, 75.4% of mothers initiated breastfeeding within 1 hour after birth, compared with 34.5% of mothers in the comparison group ( p < 0.001). Conclusions Nutrition education only during the third trimester improved weight gain during pregnancy, reduced 78% of low birth weight, and improved breast-feeding practices.
Bioavailability of Zinc Oxide Added to Corn Tortilla is Similar to that of Zinc Sulfate and is not Affected by Simultaneous Addition of Iron
Authors: Rosado Jorge L. , Díaz Margarita , Muñoz Elsa , Westcott Jamie L. , González Karla E. , Krebs Nancy F. , Caamaño María C. , Hambidge Michael 
Published: November 2015

Background Corn tortilla is the staple food of Mexico and its fortification with zinc, iron, and other micronutrients is intended to reduce micronutrient deficiencies. However, no studies have been performed to determine the relative amount of zinc absorbed from the fortified product and whether zinc absorption is affected by the simultaneous addition of iron. Objective To compare zinc absorption from corn tortilla fortified with zinc oxide versus zinc sulfate and to determine the effect of simultaneous addition of two doses of iron on zinc bioavailability. Methods A randomized, double-blind, crossover design was carried out in two phases. In the first phase, 10 adult women received corn tortillas with either 20 mg/kg of zinc oxide added, 20 mg/kg of zinc sulfate added, or no zinc added. In the second phase, 10 adult women received corn tortilla with 20 mg/kg of zinc oxide added and either with no iron added or with iron added at one of two different levels. Zinc absorption was measured by the stable isotope method. Results The mean (± SEM) fractional zinc absorption from unfortified tortilla, tortilla fortified with zinc oxide, and tortilla fortified with zinc sulfate did not differ among treatments: 0.35 ± 0.07, 0.36 ± 0.05, and 0.37 ± 0.07, respectively. The three treatment groups with 0, 30, and 60 mg/kg of added iron had similar fractional zinc absorption (0.32 ± 0.04, 0.33 ± 0.02, and 0.32 ± 0.05, respectively) and similar amounts of zinc absorbed (4.8 ± 0.7, 4.5 ± 0.3, and 4.8 ± 0.7 mg/day, respectively). Conclusions Since zinc oxide is more stable and less expensive and was absorbed equally as well as zinc sulfate, we suggest its use for corn tortilla fortification. Simultaneous addition of zinc and iron to corn tortilla does not modify zinc bioavailability at iron doses of 30 and 60 mg/kg of corn flour.
Scaling up Maternal Nutrition Programs to Improve Birth Outcomes: A Review of Implementation Issues
Authors: Victora Cesar G. , Barros Fernando C. , Assunção Maria Cecilia , Restrepo-Méndez Maria Clara , Matijasevich Alicia , Martorell Reynaldo 
Published: November 2015

Background Maternal nutrition interventions are efficacious in improving birth outcomes. It is important to demonstrate that if delivered in field conditions they produce improvements in health and nutrition. Objective Analyses of scaling-up of five program implemented in several countries. These include micronutrient supplementation, food fortification, food supplements, nutrition education and counseling, and conditional cash transfers (as a platform for delivering interventions). Evidence on impact and cost-effectiveness is assessed, especially on achieving high, equitable, and sustained coverage, and reasons for success or failure Methods Systematic review of articles on large-scale programs in several databases. Two separate reviewers carried out independent searches. A separate review of the gray literature was carried out including websites of the most important organizations leading with these programs. With Google Scholar a detailed review of the 100 most frequently cited references on each of the five above topics was conducted. Results Food fortification programs: iron and folic acid fortification were less successful than salt iodization initiatives, as the latter attracted more advocacy. Micronutrient supplementation programs: Nicaragua and Nepal achieved good coverage. Key elements of success are antenatal care coverage, ensuring availability of tablets, and improving compliance. Integrated nutrition programs in India, Bangladesh, and Madagascar with food supplementation and/or behavioral change interventions report improved coverage and behaviors, but achievements are below targets. The Mexican conditional cash transfer program provides a good example of use of this platform to deliver maternal nutritional interventions. Conclusions Programs differ in complexity, and key elements for success vary with the type of program and the context in which they operate. Special attention must be given to equity, as even with improved overall coverage and impact inequalities may even be increased. Finally, much greater investments are needed in independent monitoring and evaluation.
Public Health Interventions, Barriers, and Opportunities for Improving Maternal Nutrition in Northeast Nigeria
Authors: Girard Amy Webb , Dzingina Cynthia , Akogun Oladele , Mason John B. , McFarland Deborah A. 
Published: November 2015

Background Efficacious strategies to improve maternal nutrition and subsequent maternal, neonatal, and child health exist, but their utilization and application at scale is limited. Objective This study explored the gaps, barriers, and opportunities for maternal nutrition policy and programming in Nigeria, a country with a disproportionate share of the global burden of maternal and child mortality Methods Research was conducted in three phases in four Local Government Authorities in Taraba State. Phase 1 consisted of a desk review of policies, programs, and sociodemographic and health indicators pertinent to maternal nutrition. In-depth interviews were conducted with key informants in state and local ministries of health as well as international nongovernmental organizations and community- and faith-based organizations. Phase 2 utilized in-depth interviews and focus group discussions with community leaders, health promoters, and mothers. Phase 3 consisted of key informant interviews with federal policy and program leaders in government ministries and nongovernmental organizations. Results Nutrition, especially maternal nutrition, is not prioritized and is poorly funded in both the governmental and the nongovernmental systems. Perceived weak advocacy for nutrition and its role in economic development and the lack of coordination among governmental and nongovernmental actors were said to contribute to low prioritization. Dependence on health facilities as the primary platform for delivering maternal nutrition is problematic, given severe resource constraints and perceived community barriers, including cost, distance, and poor quality of care. Conclusions Advocacy for maternal nutrition that improves understanding of its consequences for health and economic development could hasten prioritization, coordination, and investment in maternal nutrition at the national, state, and local levels. Innovative, multisectoral strategies that move beyond facility-based platforms are needed to reduce the burden of maternal undernutrition in Northeast Nigeria.
Measurement of Food Consumption to Inform Food Fortification and Other Nutrition Programs: An Introduction to Methods and Their Application
Authors: Dary Omar , Imhoff-Kunsch Beth 
Published: November 2015

Background Information on dietary intake is essential for the assessment, planning, monitoring, and evaluation of nutritional interventions. A number of methods are available, each with unique strengths and weaknesses. Dietary intake records, 24-hour recalls, and Food Frequency Questionnaires (FFQs) determine food consumption and nutrient intakes of populations based on individual assessment; few countries have such data at national or regional levels. Food and Agriculture Organization (FAO) Food Balance Sheets (FBS) and food industry data, available in most countries, permit calculations of per capita food consumption but do not provide data on individual consumption. Household Consumption and Expenditures Surveys (HCES) are available for most countries and provide data that can be used to calculate consumption of fortification vehicles and to estimate additional intakes of micronutrients delivered through them to specific population groups. Objective To introduce the reader to the set of papers included in this Supplement reviewing methods and experience with HCES to inform nutrition, and specifically food fortification programs. Methods The Monitoring, Assessment, and Data (MAD) working group and colleagues critically reviewed experiences in estimating dietary intakes, focusing on the use of secondary analysis of HCES. Results HCES predict coverage of the population that consumes a fortification vehicle and consumed amounts of fortification vehicles. HCES allow comparisons of different population strata and may also approximate micronutrient adequacy, based on nutrient density, at the household level. Conclusions HCES are useful to inform food fortification and other nutrition programs for planning interventions, but further work is necessary. Currently, combined use of traditional dietary surveys is needed for assessment and for program monitoring and evaluation.
Using Reference Nutrient Density Goals with Food Balance Sheet Data to Identify Likely Micronutrient Deficits for Fortification Planning in Countries in the Western Pacific Region
Authors: Rosalind S. Gibson , Cavalli-Sforza Tommaso 
Published: November 2015

Background Collection of nationwide food consumption data at the individual level is the preferred option for planning fortification programs. However, such data are seldom collected in low-income countries. In con- trast, Food Balance Sheets (FBS), published annually for approximately 180 countries, may provide a source of national data for program planning. Objective To explore the use of micronutrient densi- ties from FBS data to identify likely deficits for eight micronutrients in national diets. Methods Micronutrient densities in the daily avail- able food supply per capita were calculated from the micronutrient contents of 95 food commodities in 17 Western Pacific Region countries. Densities were com- pared with reference nutrient density goals developed to ensure that at least 95% of individuals, irrespective of life-stage group, are likely to have adequate intakes. Results Of the eight micronutrients, Cambodia and Korea D.P.R. had likely deficits for six; China, Fiji, Kiri- bati, Korea Republic, Lao P.D.R., Philippines, Solomon Islands, Vanuatu, and Viet Nam had likely deficits for five; Brunei Darussalam, Malaysia, Mongolia, New Zealand, and Papua New Guinea had likely deficits for four; and New Caledonia had likely deficits for three. The most frequent deficits were for iron, zinc, and calcium (all countries), followed by vitamin B2 and vitamin A ( n = 13), vitamin B1 ( n = 2), and vitamin B12 ( n = 1). Conclusions The nutrient density approach could be applied to FBS data for ranking countries according to likely micronutrient deficits, but it provides no information on distribution of nutrient supply for fortification program planning. The approach described here could be applied to data from Household Consumption and Expenditures Surveys (HCES) to characterize households at greatest risk.
Thriving Public—Private Partnership to Fortify Cooking Oil in the West African Economic and Monetary Union (UEMOA) to Control Vitamin A Deficiency: Faire Tache d'Huile en Afrique de l'Ouest
Authors: Sablah Mawuli , Klopp Jennifer , Steinberg Douglas , Touaoro Zaoro , Laillou Arnaud , Baker Shawn 
Published: November 2015

Background In sub-Saharan Africa, more than 42% of children are at risk for vitamin A deficiency, and control of vitamin A deficiency will prevent more than 600,000 child deaths annually. In the West African Economic and Monetary Union (UEMOA), an estimated 54.3% of preschool-age children are vitamin A deficient and 13% of pregnant women have night blindness. Objective To project the achievements of this West African coalition. Methods This article documents the achievements, challenges, and lessons learned associated with the development of a public—private partnership to fortify vegetable oil in West Africa through project reports and industry assessments. Results National-level food consumption surveys identified cooking oil as a key vehicle for vitamin A. Stakeholders therefore advocated for the production of fortified vegetable oil at large scale, supported industrial assessments, and reinforced the capacity of cooking oil industries to implement vitamin A fortification through effective coordination of public and private partnerships tied with standards, regulations, and social marketing. Strong alliances for food fortification were established at the regional and national levels. Stakeholders also developed policies, adopted directives, built capacity, implemented social marketing, and monitored quality enforcement systems to sustain fortification for maximum public health impact. The synergy created resulted from the unique and complementary core competencies of all the partners under effective coordination. The initiative began with the 8 UEMOA member countries and now includes all 15 countries of the Economic Community of West African States (ECOWAS), plus Cameroon, Tanzania, and Mozambique, forming a sub-Saharan Africa-wide initiative on food fortification. All members of the Professional Association of Cooking Oil Industries of the West African Economic and Monetary Union (AIFO-UEMOA) now fortify edible oil with vitamin A. Through multisector cooperation, an estimated 70% of the population has access to vitamin A–fortified edible oil in participating countries. Conclusions Sustainable fortification of cooking oil is now a reality in all UEMOA countries.
Iron Status Biomarkers and C-Reactive Protein in Children Aged 19 to 72 Months in Chile
Authors: Brito Alex , Hertrampf Eva , Olivares Manuel 
Published: November 2015

Background The Chilean Ministry of Health has combated iron deficiency through the delivery of fortified milk by the National Complementary Feeding Program (NCFP). Objective To assess iron status and associations between biomarkers of iron status and serum C-reactive protein (CRP) in 218 beneficiaries of the NCFP aged 19 to 72 months in Santiago and Valparaiso, Chile. Methods Blood was collected from a cross-sectional representative sample. Iron status (measured by hemoglobin, zinc protoporphyrin, and serum ferritin levels) and inflammation (according to CRP level) were determined. Results Serum CRP level was positively associated with serum ferritin and zinc protoporphyrin levels ( r = 0.16 and r = 0.15; p = .0168 and p = .0290, respectively). Serum ferritin was higher among children with high CRP (> 10 mg/dL) than among those with low CRP (≤ 10 mg/dL) ( p = .003). After adjustment for 10, 6, and 5 mg/L CRP, the prevalence of low serum ferritin changed from 56.4% without adjustment to 60.6%, 61.5%, and 42.7%, respectively, and the prevalence of high zinc protoporphyrin changed from 22.9% to 21.6%, 17.4%, and 17.9%, respectively. There were no differences between regions in biomarkers of iron status. There was no association between consumption of fortified milk and the prevalence of abnormal serum ferritin (< 15 μg/L) after adjustment for sex, age, and breastfeeding (OR, 1.00; 95% CI, 0.99 to 1.01; p = .288). After adjustment for 10 mg/L CRP, 5.5% were classified as having iron-deficiency anemia, 42.7% as having iron-deficiency erythropoiesis, 17.9% as having depleted iron stores, and 35.8% as having normal iron status. Conclusions CRP level was positively associated with serum ferritin and zinc protoporphyrin levels. Chilean children aged 19 to 72 months from Santiago and Valparaiso who were beneficiaries of the NCFP had a low prevalence of iron-deficiency anemia, a high prevalence of iron-deficiency erythropoiesis, and a moderate prevalence of depleted iron stores.
Results of Fortification Rapid Assessment Tool (FRAT) Surveys in Sub-Saharan Africa and Suggestions for Future Modifications of the Survey Instrument
Authors: Hess Sonja Y. , Brown Kenneth H. , Sablah Mawuli , Engle-Stone Reina , Aaron Grant J. , Baker Shawn K. 
Published: November 2015

Background Food fortification has been increasingly recognized as a promising approach to prevent micronutrient deficiencies. The Fortification Rapid Assessment Tool (FRAT) was developed to assist public health program managers to acquire the information needed to implement an effective mass food fortification program. Multiple countries have conducted FRAT surveys, but information on results and experiences with the FRAT tool has been available only at the national level. Objective To summarize the findings of the FRAT surveys previously conducted in sub-Saharan Africa. Methods Surveys from 12 sub-Saharan African countries (Burkina Faso, Cameroon, Congo, Guinea, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Uganda) were identified. Information on consumption patterns for wheat flour, vegetable oil, sugar, and bouillon cubes was reviewed and summarized. Results Most surveys found that a moderate to high proportion of women reported consuming wheat flour (48% to 93%), vegetable oil (44% to 98%), sugar (55% to 99%), and bouillon cubes (79% to 99%) in the past 7 days, although consumption was more common and more frequent in urban areas than in rural areas. Similarly, the reported amounts consumed during the previous 24 hours were generally higher in urban settings. Conclusions The FRAT instrument has been successfully used in multiple countries, and the results obtained have helped in planning national food fortification programs. However, the recommended sampling scheme may need to be reconsidered, and the guidelines should be revised to clarify important aspects of fieldworker training, implementation, data analysis and interpretation, and reporting of the results.
Sustainability and Scaling-Up Analysis of Community-Based Management of Acute Malnutrition: Lessons Learned from Burkina Faso
Authors: Somassè Yassinmè Elysée , Bahwere Paluku , Laokri Samia , Elmoussaoui Nazia , Donnen Philippe 
Published: November 2015

Background Community-based management of acute malnutrition (CMAM) is an effective strategy frequently implemented by nongovernmental organizations, but handing CMAM over to national health systems and scaling it up remains a great challenge. Objective To highlight the challenges to sustainability and scalability of a CMAM program in Burkina Faso. Methods We conducted a review of program reports to evaluate program performance and conducted individual interviews with key informants (health system fieldworkers and officials and program staff members) and focus group discussions with beneficiaries (mothers whose children were attending the program, community volunteers, and village leaders) to analyze the required conditions for scaling up using ExpandNet recommendations. Results The program coverage rate was 90% among children under 5 years of age in the 180 intervention villages. Between June 2007 and December 2010, 19,009 cases of acute malnutrition (AM) among children under 5 years of age were treated, of which 4,308 (22.7%) were cases of severe acute malnutrition (SAM). The recovery rate was 89.4% for moderate acute malnutrition (MAM) and 86.5% for SAM. The case-fatality rate was 2.8% for MAM and 4.2% for SAM. The default rate was 7% for all cases. The prevalence of SAM decreased between 2008 and 2009 from 5.4% to 1.8%. Barriers to sustainability and scaling up were underlined: management by external personnel from the health system, no financial support for the scaling-up process, insufficient national advocacy, and nonsustainable activities (e.g., free care). Conclusions The CMAM program was effective, but the handover conditions and scaling-up requirements were unsatisfactory. We identified poor integration into the health system, lack of resources, and insufficient advocacy.
Vitamin D Insufficiency in a Sunshine-Sufficient Area: Southern Ethiopia
Authors: Gebreegziabher Tafere , Stoecker Barbara J. 
Published: November 2015

Background Although the photosynthesis and bioavailability of vitamin D are influenced by various factors, vitamin D is produced in the skin by ultraviolet B (UVB) radiation from sunlight. However, vitamin D insufficiency is being recognized as a common problem, even in areas with abundant sunshine. Objective This study assessed vitamin D status by measuring plasma 25(OH)D concentrations in rural women in southern Ethiopia living in the Rift Valley at 7°3′ N latitude. Methods Nonpregnant women ( n = 202) living in three adjacent rural communities volunteered to participate in this cross-sectional study. Demographic, socioeconomic, health, and food frequency data were acquired by questionnaire. Anthropometric measurements and a fasting venipuncture blood sample were obtained by qualified professionals. Body mass index (BMI) was calculated. ELISA kits from ImmunoDiagnostic Systems were used to determine concentrations of 25(OH)D with external quality control standards from UTAK Laboratories. Results The self-reported mean ± SD age was 30.8 ± 7.8 years. The mean number of pregnancies was 4.7 ± 2.7, household size was 6.0 ± 2.6, and BMI was 20.0 ± 2.2. None of the participants reported ever consuming vitamin D–rich foods, fortified foods, or dietary supplements. Only 15.8% of the participants had 25(OH) D levels above 50 nmol/L, and 14.8% were below 30 nmol/L, which represents risk of deficiency relative to bone health. Conclusions Vitamin D insufficiency is a serious problem in the study population, and living near the Equator does not assure adequate vitamin D status.