bluuebunny/crossref_metadata_2025_split huggingface dataset:
On the Transition to Sustainability: An Analysis of the Costs of School Feeding Compared with the Costs of Primary Education
Authors: Bundy Donald , Burbano Carmen , Gelli Aulo , Risley Claire , Neeser Kristie 
Published: November 2015

Background The current food, fuel, and financial crises have highlighted the importance of school feeding programs both as a social safety net for children living in poverty and food insecurity, and as part of national educational policies and plans. Objective To examine the costs of school feeding, in terms of both the absolute cost per child and the cost per child relative to overall education expenditure and gross domestic product (GDP) in low-, middle-, and high-income countries. Methods Data on the costs of school feeding in different countries were collected from multiple sources, including World Food Programme project data, reports from government ministries, and, where such searches failed, newspaper articles and other literature obtained from internet searches. Regression models were then used to analyze the relationships between school feeding costs, the per capita costs of primary education and GDP per capita. Results School feeding programs in low-income countries exhibit large variations in cost, with concomitant opportunities for cost containment. As countries get richer, however, school feeding costs become a much smaller proportion of the investment in education. The per capita costs of feeding relative to education decline nonlinearly with increasing GDP. Conclusions These analyses suggest that the main reason for this decline in the relative cost of school feeding versus primary education is a greatly increased investment per child in primary education as GDP rises, but a fairly flat investment in food. The analyses also show that there appears to be a transitional discontinuity at the interface between the lower- and middle-income countries, which tends to coincide with changes in the capacity of governments to take over the management and funding of programs. Further analysis is required to define these relationships, but an initial conclusion is that supporting countries to maintain an investment in school feeding through this transition may emerge as a key role for development partners.
Effects of Multimicronutrient Home Fortification on Anemia and Growth in Bhutanese Refugee Children
Authors: Bilukha Oleg , Howard Christopher , Wilkinson Caroline , Bamrah Sapna , Husain Farah 
Published: November 2015

Background Anemia remains a significant public health problem in refugee settings. Home fortification with micronutrient powders has been proposed as a feasible option to alleviate micronutrient deficiencies; its efficacy in reducing anemia in children aged 6 to 24 months has been demonstrated in several trials. Objective To evaluate the effectiveness of a large-scale micronutrient powder distribution program in reducing anemia prevalence and promoting growth in refugee children aged 6 to 59 months. Methods Four representative cross-sectional surveys were conducted 13 months before and 7, 14, and 26 months after initiation of the supplementation program. Data collected on children aged 6 to 59 months included hemoglobin concentration, anthropometric indicators, morbidity, feeding practices, and information on the micronutrient distribution program. The study had a pre—post design with no control group. Results The overall prevalence of anemia in children did not change significantly between baseline (43.3%) and endpoint (40.2%). The prevalence of moderate anemia decreased over the same period from 18.9% to 14.4% ( p < .05). The levels of severe anemia were negligible (< 1%) in all surveys. The prevalence of stunting decreased significantly from 39.2% at baseline to 23.4% at endpoint ( p < .001), a relative decrease of 40%. Reported coverage, use, and acceptance of micronutrient supplements remained consistently high throughout the study. Conclusions In the absence of a control group, changes in key outcomes should be interpreted with caution. The minor effect on hemoglobin status requires further investigation of underlying causes of anemia in this population. The large positive effect on linear growth may be a significant benefit of supplementation if confirmed by future studies.
Understanding Low Usage of Micronutrient Powder in the Kakuma Refugee Camp, Kenya: Findings from a Qualitative Study
Authors: Kodish Stephen , Rah Jee Hyun , Kraemer Klaus , de Pee Saskia , Gittelsohn Joel 
Published: November 2015

Background Home fortification with micronutrient powder has been shown to be a low-cost, feasible, and effective approach to address micronutrient deficiencies. A large-scale program distributing micronutrient powder to approximately 50,000 refugees was implemented at the Kakuma Refugee Camp in Kenya. Uptake of the micronutrient powder at distribution points dropped nearly 70%, from 99% to a low of 30%, and remained at 45% to 52% despite increased social marketing efforts. Objective To identify factors at the distal and proximal levels leading to the low uptake of micronutrient powder through a qualitative inquiry. Methods In-depth interviews were conducted with community leaders, stakeholders, implementing partners, and beneficiaries. Direct observations of food preparation and child feeding were conducted. Focus group discussions were employed to examine perceptions and practices of beneficiaries regarding micronutrient powder use. Results Superficial formative research and lack of interagency coordination led to insufficient social marketing prior to the program. In addition, community health workers were inadequately trained. This resulted in inadequate communication regarding the health benefits and use of micronutrient powder to the beneficiaries. Reliance on personal experiences with micronutrient powder and issues with its packaging, in part, led to confusion and deleterious rumors, resulting in decreased uptake of micronutrient powder at distribution points. Conclusions A successful micronutrient powder program requires careful design, with emphasis on conducting thorough formative research, ensuring the involvement and commitment of all stakeholders from the outset, investigating the role of cultural factors, and ensuring provision of sufficient, adequate, and timely information to the beneficiaries.
Econutrition and Utilization of Food-Based Approaches for Nutritional Health
Authors: Blasbalg Tanya L. , Wispelwey Bram , Deckelbaum Richard J. 
Published: November 2015

Background Macronutrient and micronutrient deficiencies continue to have a detrimental impact in lower-income countries, with significant costs in morbidity, mortality, and productivity. Food is the primary source of the nutrients needed to sustain life, and it is the essential component that links nutrition, agriculture, and ecology in the econutrition framework. Objective To present evidence and analysis of food-based approaches for improving nutritional and health outcomes in lower-income countries. Methods Review of existing literature. Results and conclusions The benefits of food-based approaches may include nutritional improvement, food security, cost-effectiveness, sustainability, and human productivity. Food-based approaches require additional inputs, including nutrition education, gender considerations, and agricultural planning. Although some forms of malnutrition can be addressed via supplements, food-based approaches are optimal to achieve sustainable solutions to multiple nutrient deficiencies.
Enhancing Processes for Introduction, Production, Quality Assurance, and Delivery of US Title II Food Aid Products
Authors: Schlossman Nina , Webb Patrick , Bagriansky Jack , Johnson Quentin , Rogers Beatrice , Tilahun Jessica , Masterson Amelia Reese 
Published: November 2015

Background Enacted in 1950, Public Law 480 (PL480) dramatically increased the volume of U.S. food aid and the scope of interventions it supports. Billions of dollars have been invested, both to enhance the diets of chronically undernourished people in development settings, and to support nutritional needs during conflicts and natural disasters. Objective Review the institutional processes—from procurement to delivery—that support this programming. Methods We examined the systems that govern and oversee the many components of food aid programming and the extent to which they support a whole-of-government, multi-agency food aid agenda. We conducted consultations with US government employees and contractors, academics, industry representatives, donor agency staff, United Nations personnel, and field-level food aid programming technical staff from many countries. A survey of USAID implementing partners conducted among 64 responding offices in 40 countries provided data on the use and effectiveness of enriched, fortified, or blended Title II commodities, the use of new commodities, and related procurement or logistics aspects. Expert panels provided input and feedback throughout the process. Results We identified potential improvements to overall delivery and cost-effectiveness of USAID programming to better meet the nutrition needs of beneficiaries. Options include changes in product formulation, the range of products provided, and/or the modes of product approval, processing, procurement, and distribution. This research points to several improvements in processes related to food aid: 1) Establish an interagency committee to oversee all government interests in the food aid agenda through an ongoing review process. 2) Enhance processes and quality assurance along the product value chain including the importance of effective interaction with the private sector to incorporate industry best practices and create public—private partnerships to promote product innovations. 3) Strengthen the evidence base for innovations in products, programming approaches, and institutional processes. Conclusion Successful programming requires knowledge and understanding of the unit cost of impact, not simply tonnage and “numbers of hungry people fed”. Empirical rigor is essential; any significant program changes, including those recommended here, should be tested and monitored.
Prevalence of Overweight, Obesity, and Thinness among Urban School-Aged Children and Adolescents in Southern Nigeria
Authors: Ene-Obong Henrietta , Ibeanu Vivian , Onuoha Nneola , Ejekwu Ada 
Published: November 2015

Background Overweight and obesity are public health problems all over the world because of their devastating social, economic, and health consequences, and they coexist with undernutrition in developing countries. Yet, there are few data on the magnitude of these problems in Nigeria. Objective To assess the prevalence of overweight, obesity, and thinness among urban school-aged children and adolescents. Methods A cross-sectional study of 1,599 children and adolescents 5 to 18 years of age was conducted. The subjects were randomly selected from schools in four urban towns (Lagos, Port Harcourt, Nsukka, and Aba) in southern Nigeria. A validated and pretested questionnaire was used to collect information on the background of the children and adolescents and their parents' socioeconomic status. Weight and height measurements were taken, and body mass indexes were calculated. Overweight, obesity, and thinness were defined according to the International Obesity Task Force cutoff points for children and adolescents 2 to 18 years of age. The data were analyzed by descriptive statistics, cross tabulations, and chi-squared tests. Results The prevalence rates of overweight, obesity, and thinness were 11.4%, 2.8%, and 13.0%, respectively. More females (3.7%) than males (1.8%) were obese ( p < .05). The prevalence of overweight was higher among adolescents 10 to 18 years of age (13%) than among children 5 to 9 years of age (9.4%) (p < .001) and was highest (23.1%) at age 15 years. Thinness was significantly more prevalent among children (19.0%) than adolescents (8.3%) ( p < .001) and was highest (28.6%) at age 7 years. Age- and sex-related increases and decreases were observed in the prevalence of overweight, obesity, and thinness. The rates of overweight, obesity, and thinness were affected by location and income levels. Conclusions The prevalence rates of overweight and obesity are increasing among urban Nigerian children and adolescents and are of equal magnitude to the prevalence of undernutrition.
Nutritional Iodine Status in Gestation and its Relation to Geographic Features in Urmia County of Northwest Iran
Authors: Rostami Rahim , Beiranvend Asghar , Nourooz-Zadeh Jaffar 
Published: November 2015

Background Iodine is an important component for the proper function of the thyroid and fetal development. Objective To evaluate the influence of geographic variation on nutritional iodine status during pregnancy. Methods Four hundred eighty-nine women in the first trimester of pregnancy were enrolled. Of these, 419 (85.5%) were from the plain districts and 70 (14.5%) from mountainous regions. Data were obtained on demographic characteristics and accessibility of iodized salt, and samples of table salt were collected. In the third trimester, 322 women remained in the study: 281 (87.2%) from the plains and 41 (12.8%) from the mountainous regions. Salt and urine samples were analyzed for iodine content. Results All participants stated that they used iodized table salt. The proportion of salt samples with optimal iodine content (30 ppm) from the plains and mountain regions were 68.7% and 88%, respectively. The median urinary iodine content (UIC) in the plains area in the first and third trimesters was 82 and 119 μg/L, respectively. The corresponding values in the mountain region were 34.5 μg/L and 76 μg/L. The prevalence of subjects with an inadequate iodine intake (UIC < 150 μg/L) in first and third trimester in the plains and mountain regions were 84.5% and 66.9% vs 98.6% and 90.2%, respectively. Conclusions The prevalence of pregnant women exhibiting UIC < 150 μg/L in the mountain region was substantially higher than those in the plain district. Our findings also show that the current strategy for eradication of iodine deficiency in school-aged children would not fulfill iodine requirements in pregnancy and that additional source(s) of iodine are required to prevent the adverse effects of iodine deficiency in pregnancy. Further studies are needed to address the cause(s) for the rapid depletion of iodine stores in pregnancy.
Repeatability of Food Frequency Assessment Tools in Relation to the Number of Items and Response Categories Included
Authors: Bountziouka Vassiliki , Bathrellou Eirini , Zazpe Itziar , Ezquer Leyre , Martínez-González Miguel-Angel , Panagiotakos Demosthenes B. 
Published: November 2015

Background Accuracy of measurement is a cornerstone of research in order to make robust conclusions about the research hypothesis. Objective To examine whether the number of items (questions) and the number of consumption responses (the coding used to measure the frequency of consumption) included in nutritional assessment tools influence their repeatability. Methods During 2009, 400 participants (250 from Greece, mean age 37 ± 13 years, 34% males, and 150 from Spain, mean age 39 ± 17 years, 41% males) completed a diet index with 11 items and binary (yes/no) responses, a diet index with 11 items and 6-scale responses, and 36-item and 76-item food frequency questionnaires (FFQs) with 6-scale responses. The participants completed these tools twice, with 15 days between the two administrations of the tools. The Spearman-Brown coefficient ( rsb), Kendall's tau coefficients, and the Bland-Altman method were applied to answer the research hypothesis. Results The highest repeatability coefficient was observed for the diet index with 11 items and binary (yes/no) responses ( rsb = 0.948, p < .001), followed by the diet index with 11 items and 6-scale responses ( rsb = 0.943, p < .001), the 36-item FFQ with 6-scale responses ( rsb = 0.936, p < .001), and the 76-item FFQ with 6-scale responses ( rsb = 0.878, p < .001). Statistical comparisons revealed no significant differences between repeatability coefficients of the first three tools ( p > .23), whereas these three tools had significantly higher repeatability coefficients than the 76-item FFQ ( p = .002). Subgroup analyses by sex, education, smoking, and clinical status confirmed these results. Conclusions Repeatability was found for all food frequency assessment tools used, irrespective of the number of items or the number of responses included.
Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia
Authors: Saldanha Lisa S. , Buback Laura , White Jessica M. , Mulugeta Afework , Mariam Solomon G. , Roba Alemzewed Challa , Abebe Hiwot , Mason John B. 
Published: November 2015

Background Maternal undernutrition persists as a serious problem in Ethiopia. Although there are maternal nutrition interventions that are efficacious and effective in improving maternal, neonatal, and child health (MNCH) outcomes, implementation has been limited. Objective This study explored needs, perceptions, priorities, facilitating factors and barriers to implementation of relevant policies and programs to find opportunities to improve maternal nutrition in Ethiopia Methods Background information was compiled and synthesized for a situation analysis. This informed focus group discussions and in-depth interviews with mothers, community leaders, health workers, and district health officials in four woredas (districts) in Tigray and Southern Nations, Nationalities and Peoples Region. Results Findings focused on three priority issues: maternal anemia, intrauterine growth retardation (IUGR), and maternal thinness and stunting. Community-level investigations found that women's low status, food insecurity and poverty, and workload were key factors perceived to contribute to women's undernutrition. Awareness of and demand for services to improve women's nutrition were low, except for high demand for supplementary food. On the supply side, barriers included low prioritization of maternal nutrition in health and nutrition service delivery and weak technical capacity to deliver context-sensitive maternal nutrition interventions at all levels. Conclusions Community-based health and nutrition services were promising platforms for expanding access to interventions such as micronutrient supplements and social and behavior change communication. Investments are needed to support these community-based programs, including training, supplies, supervision and monitoring. To address IUGR at scale, increased access to cash or food transfers could be explored.
Household Consumption and Expenditures Surveys (HCES): A Primer for Food and Nutrition Analysts in Low- and Middle-Income Countries
Authors: Fiedler John L. , Lividini Keith , Bermudez Odilia I. , Smitz Marc-Francois 
Published: November 2015

Background The dearth of 24-hour recall and observed-weighed food record data—what most nutritionists regard as the gold standard source of food consumption data—has long been an obstacle to evidence-based food and nutrition policy. There have been a steadily growing number of studies using household food acquisition and consumption data from a variety of multipurpose, nationally representative household surveys as a proxy measure to overcome this fundamental information gap. Objective To describe the key characteristics of these increasingly available Household Consumption and Expenditures Surveys (HCES) in order to help familiarize food and nutrition analysts with the strengths and shortcomings of these data and thus encourage their use in low- and middle-income countries; and to identify common shortcomings that can be readily addressed in the near term in a country-by-country approach, as new HCES are fielded, thereby beginning a process of improving the potential of these surveys as sources of useful data for better understanding food- and nutrition-related issues. Methods Common characteristics of key food and nutrition information that is available in HCES and some basic common steps in processing HCES data for food and nutrition analyses are described. Results The common characteristics of these surveys are documented, and their usefulness in addressing major food and nutrition issues, as well as their short-comings, is demonstrated. Conclusions Despite their limitations, the use of HCES data constitutes a generally unexploited opportunity to address the food consumption information gap by using survey data that most countries are already routinely collecting.
Validation of Dietary Applications of Household Consumption and Expenditures Surveys (HCES) against a 24-Hour Recall Method in Uganda
Authors: Dary Omar , Jariseta Zo Rambeloson 
Published: November 2015

Background The benefits of food fortification depend on the proportion of the population that uses the fortified food (coverage), the amount of the food being consumed, and the additional content of micronutrients in the food. Coverage and amounts consumed can be determined by 24-hour recall or Food Frequency Questionnaires (FFQs). However, these methods are rarely applied. Secondary analysis of data from Household Consumption and Expenditures Surveys (HCES) can be used for these purposes; however, such data analysis has not been validated. Objective To compare the results of HCES and 24-hour recall for estimating the consumption profile of potential fortification vehicles in Uganda. Methods Food intake estimates for 24- to 59-month-old children and 15- to 49-year-old women derived from a one-day 24-hour recall carried out in Uganda (Kampala, North, and Southwest) were compared with data from two HCES (2006, nationwide, and 2008, coupled with the 24-hour recall). The analyzed foods were vegetable oil, sugar, wheat flour, maize flour, and rice. Results Food consumptiòn estimates calculated from HCES may be less accurate than estimates derived by 24-hour recall. Nevertheless, the HCES results are sensitive enough to differentiate consumption patterns among population strata. In Uganda, HCES predicted proportion of the population that consumes the foods, and approximated intakes of main food vehicles by the “observed” consumers (those who reported using the foods), although estimates for the latter were lower for wheat flour and rice. Conclusions HCES data offer the basic information needed to provide a rationale for, and help design, food fortification programs. Individual intake surveys are still needed, however, to assess intrahousehold use of foods.