bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in low Birthweight among the Bhutanese Refugee Population in Nepal
Authors: Shrimpton Roger , Thorne-Lyman Andrew , Tripp Katie , Tomkins Andrew 
Published: November 2015

Background Although much is known about risk factors for low birthweight, an important cause of neonatal death, little is known about how to reduce or prevent low birthweight. Objective This study aimed to verify a low rate in the incidence of low birthweight reported in the Bhutanese refugee camps in Nepal and, if true, to try to understand how this came about. Methods Medical records from 1994 to 2001 were recovered for half of the refugee population, and birthweight and other maternal factors were analyzed. The adequacy of the food ration provided to the general population was assessed by comparing it with the nutrient requirements of pregnant women. Results The rates of low birthweight were indeed low in the refugee camps, averaging 11% in the years reviewed. Between 1996 and 1998, the mean rate of low birthweight fell from 16% to 8% and mean birthweight increased from 2.84 kg (SE, 2.80–2.87) to 3.0 kg (SE, 2.97–3.03). The increase in birthweight occurred following improvements in the micronutrient-to-energy ratios of the general ration. Conclusions Rates of low birthweight comparable to those in developed countries were achieved in an ethnic Nepali population within 5 years of settlement in refugee camps. These low rates were probably achieved because basic needs of mothers were met, including both the quantity and the micronutrient content of food, water and sanitation, antenatal care, and education. The improvement from 1996 to 1998 coincided with increased availability of micronutrients in the food ration. We hypothesize that increased periconceptional micronutrient intake may be responsible for the increase in birthweight.
Dietary Counseling in the Management of Moderate Malnourishment in Children
Authors: Ashworth Ann , Ferguson Elaine 
Published: November 2015

Background Dietary counseling is an integral part of treating malnutrition. A first step toward improving the management of moderate malnutrition is to evaluate dietary messages in current programs and assess their adequacy and effectiveness. Objectives To ascertain current recommendations regarding family foods for the treatment of moderate malnutrition and assess whether these are likely to meet nutritional requirements for rehabilitation; to review the effectiveness of dietary counseling in the management of moderate malnutrition. Methods Information was requested from 10 United Nations agencies or donors, 20 international non-governmental organizations, 3 pediatric associations, and 6 national programs about the dietary advice they give to caregivers of moderately malnourished children. Adequacy was assessed by comparing dietary recommendations with nutritional requirements. Linear programming was used to identify problem nutrients. A literature search was conducted of studies using family foods for rehabilitating malnourished children. Results There was a greater emphasis on providing food supplements for rehabilitation than on utilizing family foods. Dietary recommendations were mostly vague and unlikely to be effective. Those developed by the World Health Organization and the Food and Agriculture Organization for well-nourished children may meet nutritional requirements in moderate malnutrition if the recommendations are made more prescriptive. Zinc and vitamin E emerged as possible problem nutrients. Intervention studies in wasted children suggest that counseling caregivers about family foods can achieve good rates of weight gain. Conclusions Dietary counseling can be effective in managing malnutrition, but it is often weak or absent and should be strengthened. More attention will need to be given to formulating the messages and improving counseling skills.
Preventing low Birthweight through Maternal Multiple Micronutrient Supplementation: A Cluster-Randomized, Controlled Trial in Indramayu, West Java
Authors: Sunawang  , Utomo Budi , Hidayat Adi , Kusharisupeni  , Subarkah  
Published: November 2015

Background Micronutrient deficiencies may contribute to a higher incidence of low birthweight (LBW). UNICEF/United Nations University/World Health Organization jointly proposed a formulation for a multiple micronutrient supplement for pregnant women, and several effectiveness trials were conducted to assess its impact. Objective To evaluate the efficacy of prenatal multiple micronutrient supplementation for improving birth size, pregnancy outcome, and maternal micronutrient status in comparison with iron–folic acid supplementation. Methods We carried out a cluster-randomized, controlled trial in Indramayu, Indonesia, involving 843 pregnant women. Of these, 432 received multiple micronutrients and 411 received iron–folic acid. Fieldworkers visited the women daily to observe supplement consumption and record fetal loss and mortality. Results The mean number of supplements consumed during pregnancy and 30 days postpartum was high (136 in the group receiving multiple micronutrients and 140 in the iron–folic acid group). The women consumed the supplements on average 5 days per week. Although there were no significant differences between the groups in the percentage of infants with LBW, there was a trend toward a lower incidence of LBW in the group receiving multiple micronutrients (6.3% vs. 7.3%), and the mean birthweight was 40 g higher in the group receiving multiple micronutrients than in the iron–folic acid group, although the difference was not significant. Among those who consumed 90 or more supplements during pregnancy, women taking multiple micronutrients had a 3.3% combined rate of miscarriage, stillbirth, or neonatal death, as compared with 6.9% for those taking iron–folic acid only (p < .049). The anemia rates in the two groups were similar after supplementation, even though the amount of iron in the multiple micronutrient supplement was half that in the iron–folic acid supplement. Serum retinol was higher in the group receiving multiple micronutrients. Conclusions Multivitamin supplementation use among pregnant women is as effective as iron–folic acid in improving anemia status and appears to have other benefits for maternal and child nutritional status.
INCAP Studies of Endemic Goiter and its Prevention
Authors: Scrimshaw Nevin S. 
Published: November 2015

The high prevalence of goiter among adults in its member countries of Central America and Panama was observed as soon as INCAP began field studies. This led to systematic studies of goiter in schoolchildren in all of the countries as described, beginning with Guatemala where the rate was 38% nationally. However, efforts to eliminate the consequences of iodine with iodized salt using the water soluble potassium iodate and a process that had proved successful in Switzerland and the United States could not be used with the crude moist salt of the region. INCAP identified potassium iodate that is insoluble in water, and in four schools (two each in El Salvador and Guatemala) proved that the iodine in this compound was as available as that in potassium iodate. It remained evenly distributed in moist salt. When added to salt in Guatemala, goiter rate dropped to 15% in four years and less than 5% in eight years. Compulsory iodation of salt in other developing countries followed with comparable results. This method is now used in worldwide campaigns against iodine deficiency in developing countries.
Iodine Status and Availability of Iodized Salt: An Across-Country Analysis
Authors: Horton Sue , Miloff Alexander 
Published: November 2015

Background Iodine deficiency has serious consequences, and the Universal Salt Iodization initiative has attempted to reduce the extent of deficiency. Objective We aim to see how far across-country variations in urinary iodine in school-age children can be explained by environmental factors, particularly soil iodine and the availability of iodized salt. Methods We use simple multivariate regression for two separate datasets, one for 30 developing countries, and one for 13 developed countries, using data on availability of iodized salt and soil iodine levels. Results Median urinary iodine excretion is significantly and positively related to household availability of iodized salt (elasticity, 0.73) for developing countries, but the soil coefficient is not significant, probably because the dummy variable is not well measured. For the developed countries, there is a positive and significant effect of salt penetration rates (elasticity, 0.83) and a positive and significant effect of soil iodine (elasticity, 0.77). There is also a suggestion that countries with more serious soil deficits are more likely to iodize salt, so that univariate regressions of urinary iodine excretion on salt availability or penetration rates underestimate the beneficial effects of iodized salt availability on iodine nutrition. Conclusions There are limitations to cross-sectional (ecologic) studies such as this, and the data are not perfect. Nevertheless, the results provide support for policies to iodize salt, given the widespread deficiency of iodine in diets worldwide.
Determinants of Infant and Young Child Feeding Practices in Nepal: Secondary Data Analysis of Demographic and Health Survey 2006
Authors: Pandey Sharada , Tiwari Kalpana , Senarath Upul , Agho Kingsley E. , Dibley Michael J. ,   for the South Asia Infant Feeding Research Network (SAIFRN)*
Published: November 2015

Background Childhood undernutrition and mortality are high in Nepal, and therefore interventions on infant and young child feeding practices deserve high priority. Objective To estimate infant and young child feeding indicators and the determinants of selected feeding practices. Methods The sample consisted of 1,906 children aged 0 to 23 months from the Demographic and Health Survey 2006. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results Breastfeeding was initiated within the first hour after birth in 35.4% of children, 99.5% were ever breastfed, 98.1% were currently breastfed, and 3.5% were bottle-fed. The rate of exclusive breastfeeding among infants under 6 months of age was 53.1%, and the rate of timely complementary feeding among those 6 to 9 months of age was 74.7%. Mothers who made antenatal clinic visits were at a higher risk for no exclusive breastfeeding than those who made no visits. Mothers who lived in the mountains were more likely to initiate breastfeeding within 1 hour after birth and to introduce complementary feeding at 6 to 9 months of age, but less likely to exclusively breastfeed. Cesarean deliveries were associated with delay in timely initiation of breastfeeding. Higher rates of complementary feeding at 6 to 9 months were also associated with mothers with better education and those above 35 years of age. Risk factors for bottle-feeding included living in urban areas and births attended by trained health personnel. Conclusions Most breastfeeding indicators in Nepal are below the expected levels to achieve a substantial reduction in child mortality. Breastfeeding promotion strategies should specifically target mothers who have more contact with the health care delivery system, while programs targeting the entire community should be continued.
Prevalence of Prehypertension and Hypertension among Adolescent High School Girls in Tabriz, Iran
Authors: Rafraf Maryam , Gargari Bahram Pourghassem , Safaiyan Abdolrasol 
Published: November 2015

Background There are few studies of the prevalence of elevated blood pressure that include Iranian adolescent girls. Objective The aim of this cross-sectional study was to determine the blood pressure status and its relationship with body mass index (BMI) in adolescent girls attending high school in Tabriz, Iran. Methods A sample of 985 girls was selected by stepwise random sampling from five districts of Tabriz. Blood pressure, weight, and height of the subjects were measured and BMI was calculated. Blood pressure measurements were categorized as normal, prehypertension, or hypertension using the 2004 Fourth Report blood pressure screening recommendations. Overweight and obesity were defined according to International BMI Cut Off Points for adolescents. Results The prevalence rates of of prehypertension and hypertension were 13.9% and 19.4%, respectively. Obesity and overweight were seen in 2.8% and 16.4% of subjects, respectively. The prevalence rates of hypertension and prehypertension increased with increasing BMI. Conclusions Hypertension and prehypertension were highly prevalent in the studied adolescent girls. Obesity was associated with an increased risk of elevated blood pressure. Further studies are needed to identify other risk factors for high blood pressure in our studied population. Routine blood pressure measurements in adolescent girls of our community are suggested to prevent high blood pressure in adolescence and its complications in later life.
Household Food Insecurity and Nutritional Status of Children Aged 6 to 23 Months in Kailali District of Nepal
Authors: Osei Akoto , Pandey Pooja , Spiro David , Nielson Jennifer , Shrestha Ram , Talukder Zaman , Quinn Victoria , Haselow Nancy 
Published: November 2015

Background Food insecurity and malnutrition among children are common in Nepal. However, inadequate data exist on the association between household food insecurity and the nutritional status of children. Objective To assess the relationship between household food insecurity and malnutrition among children aged 6 to 23 months in Kailali District of Nepal. Methods We analyzed data from families of 368 children 6 to 23 months of age who completed a cross-sectional survey in January 2009. The data contained information on sociodemographic characteristics, food insecurity, child feeding practices, use of preventive health services, and height, weight, and hemoglobin levels of children and mothers. Results More than two-thirds (69%) of households were classified as food insecure (had insufficient access to adequate food). The prevalence rates of stunting, underweight, and wasting among children were 41%, 24%, and 9%, respectively. The prevalence of anemia was 58%. There were no significant associations between household food insecurity and stunting, underweight, or anemia. Stunting and underweight were associated with maternal height and household wealth ( p < .05). Underweight was also associated with maternal education ( p < .05). Anemia was associated with low maternal hemoglobin concentration ( p < .05). Conclusions Food insecurity was common in households with children 6 to 23 months of age in Kailali District of Nepal. The rates of stunting, underweight, wasting, and anemia were also high. However, there was no significant association between household food insecurity and malnutrition among children. Therefore, not just access to food, but an integrated approach that improves the overall socioeconomic well-being of families, maternal education, and knowledge of optimal nutrition practices, together with adequate maternal nutrition, is needed to address malnutrition among young children.
Correspondence of Hemoglobin Values Obtained by a Noninvasive, Cutaneous-Contact Method with Values Obtained by Conventional Methods from Whole Blood Samples in a Guatemalan Field Setting
Authors: Crowley Caitlin , Montenegro-Bethancourt Gabriela , Arriaga Claudia , Solomons Noel W. , Schümann Klaus 
Published: November 2015

Background Anemia is a widespread public health issue, conventionally diagnosed by analyzing the hemoglobin concentration in whole blood samples. Aspects of safety, comfort, and cultural acceptability would be obviated if reliable, noninvasive anemia screening were available. Objective To determine day-to-day variations within subjects in hemoglobin measurements and the correspondence of hemoglobin values obtained by a noninvasive, photometric, cutaneous-contact method with values obtained by conventional methods from blood samples. Methods The hemoglobin level was determined in 40 pregnant women from the Guatemalan coastal plain (low values) and 40 men from the highlands (high values). Hemoglobin concentrations (g/dl) were measured in an automated cell counter and, in parallel, estimated with the use of the Rad-87™ Rainbow pulse CO-Oximeter placed over the nail bed of the ring finger. Results The mean value for invasively determined hemoglobin was 13.5 g/dl, as compared with 12.2 and 12.1 g/dl for the noninvasive nail-bed estimate at 10 and 5 minutes, respectively. Measurements using the noninvasive technology were highly stable within days and from day to day. The noninvasive screening method showed satisfactory sensitivity and specificity at hemoglobin concentrations of < 12.0 g/dl (cutoff value for nonpregnant women) and < 13.0 g/dl (cutoff value for adult men). Diagnostic discrimination was poorer for the lower cutoff criteria; the anemia cutoff values were < 11.5 g/dl for school-age children and < 11.0 g/dl for pregnant women and children under 5 years of age. Conclusions Noninvasive hemoglobin screening shows considerable promise, although improvement of sensitivity and specificity in the anemic range and determination periods of less than 10 minutes are desirable.
Validity and Reliability of Mothers' Reports of Language Development in 1-Year-Old Children in a Large-Scale Survey in Bangladesh
Authors: Hamadani Jena D. , Baker-Henningham Helen , Tofail Fahmida , Mehrin Fardina , Huda Syed N. , Grantham-McGregor Sally M. 
Published: November 2015

Background In developing countries, it is often important to have measures of development in children under 3 years of age in large-scale surveys or evaluations of nutrition and stimulation programs. However, there is a lack of suitable instruments with established validity. Objective To develop a language test for children aged 12 to 18 months based on mothers' report, suitable for use in large-scale surveys, and examine its concurrent and predictive validity. To determine whether the test is sensitive to home stimulation and nutritional status and compare the test with the Bayley Scales of Infant Development (BSID). Methods A subsample of participants in a large, prospective cohort study in rural Bangladesh (MINIMat) was selected for a study of child development ( n = 2,852). A total of 2,418 participants were interviewed concerning their children's expressive and receptive vocabulary, and children were tested using the BSID. Results The language test had reasonable short- and long-term reliability between 12 and 18 months ( r = 0.50) and concurrent validity with the Bayley Mental Development Index (MDI) ( r = 0.32 language comprehension to 0.41 language expression). Its predictive validity with IQ at age 5 years was similar to that of the Bayley MDI ( r = 0.37 to 0.41 for language and r = 0.37 for MDI). Child language was independently associated with postnatal growth, stimulation in the home, gestational age, and socioeconomic status, and a similar set of variables predicted the Bayley MDI. Conclusions The language test was reliable, had acceptable concurrent and predictive validity, and was sensitive to environmental and child characteristics. Mothers' reports of language could be useful in large-scale programs.
The Impact of Orphanhood on Food Security in the High-HIV Context of Blantyre, Malawi
Authors: Rivers Jonathan , Mason John B. , Rose Donald Diego , Eisele Thomas P. , Gillespie Stuart , Mahy Mary , Monasch Roeland 
Published: November 2015

Background A 2004 UNICEF/UNAIDS/USAID survey in Blantyre, Malawi, examined methods to improve monitoring and evaluation of interventions aimed at orphans and vulnerable children. Objective A derivative of this larger study, the present study utilized the household data collected to assess differences in food security status among orphan households with the aim of helping food security programmers focus resources on the households most affected. Methods Orphan households were classified by number and type of orphans supported. Descriptive analyses and logistic regressions were performed to assess differential vulnerability to food insecurity according to these classifications. Results Multiple-orphan households and multiple-orphan households that cared for at least one foster child were 2.42 and 6.87 times more likely to be food insecure, respectively, than nonorphan households. No other category of orphan household was at elevated risk. Conclusions The food security impact of caring for orphans varied significantly among orphan households, requiring food security planners to focus resources on the households most heavily impacted by HIV/AIDS, including multiple-orphan households, rather than focusing on conventional designations of vulnerability, such as orphans and vulnerable children.
Social Protection Networks in Central America and the Dominican Republic: Do They Have a Nutritional Dimension?
Authors: Cespedes Angela , Lechtig Aaron , Francischi Rachel 
Published: November 2015

background It is not known whether the social protection networks in the Central American subregion and the Dominican Republic have a nutritional dimension. Objective To explore whether the social protection networks in Central America and the Dominican Republic have a nutritional dimension. Methods A survey was conducted during 2009 of 110 social protection programs and 10 national plans in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic. Results Most of the social protection programs did not have a nutritional dimension. Conclusions With few exceptions, the social protection programs were not prepared to prevent undernutrition. There may be a similar situation in other regions. It is recommended to incorporate the nutritional dimension into all social protection programs and social safety nets in Central America and the Dominican Republic as well as in all other countries with low-income populations, worldwide.
Meat Consumption is Associated with Less Stunting among Toddlers in Four Diverse Low-Income Settings
Authors: Krebs Nancy F. , Mazariegos Manolo , Tshefu Antoinette , Bose Carl , Sami Neelofar , Chomba Elwyn , Carlo Waldemar , Goco Norman , Kindem Mark , Wright Linda L. , Hambidge K. Michael ,   Complementary Feeding Study Group
Published: November 2015

Background Early growth faltering is common but is difficult to reverse after the first 2 years of life. Objective To describe feeding practices and growth in infants and young children in diverse low-income settings prior to undertaking a complementary feeding trial. Methods This cross-sectional study was conducted through the Global Network for Women's and Children's Health Research in Guatemala, Democratic Republic of Congo, Zambia, and Pakistan. Feeding questionnaires were administered to convenience samples of mothers of 5- to 9-month old infants and 12- to 24-month-old toddlers. After standardized training, anthropometric measurements were obtained from the toddlers. Following the 2006 World Health Organization Growth Standards, stunting was defined as length-for-age < −2SD, and wasting as weight-for-length < −2SD. Logistic regression was applied to evaluate relationships between stunting and wasting and consumption of meat (including chicken and liver and not including fish). Results Data were obtained from 1,500 infants with a mean (± SD) age of 6.9 ± 1.4 months and 1,658 toddlers with a mean age of 17.2 ± 3.5 months. The majority of the subjects in both age groups were breastfed. Less than 25% of the infants received meat regularly, whereas 62% of toddlers consumed these foods regularly, although the rates varied widely among sites. Stunting rate ranged from 44% to 66% among sites; wasting prevalence was less than 10% at all sites. After controlling for covariates, consumption of meat was associated with a reduced likelihood of stunting (OR = 0.64; 95% CI, 0.46 to 0.90). Conclusions The strikingly high stunting rates in these toddlers and the protective effect of meat consumption against stunting emphasize the need for interventions to improve complementary feeding practices, beginning in infancy.