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Jamil Z, VanBuskirk K, Mweetwa M, Mouksassi S, Smith G, Ahmed T, Chandwe K, Denno DM, Fahim SM, Kelly P, Mahfuz M, Mallawaarachchi I, Marie C, Moore SR, Petri WA, Ali SA. Anthropometry relationship with duodenal histologic features of children with environmental enteric dysfunction: a multicenter cross-sectional study. Am J Clin Nutr 2024; 120 Suppl 1:S65-S72. [PMID: 39300664 DOI: 10.1016/j.ajcnut.2024.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/11/2024] [Accepted: 02/22/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Environmental enteric dysfunction (EED) is a precursor of growth faltering in children living in impoverished conditions who are frequently exposed to environmental toxins and enteropathogens, leading to small bowel inflammatory, malabsorptive, and permeability derangements and low-grade chronic systemic inflammation. OBJECTIVES We explored the association between anthropometrics and duodenal histologic features of EED among children from 3 lower middle-income country centers. METHODS In this cross-sectional study, Pakistani children (n = 63) with wasting, Bangladesh children (n = 116) with stunting or at risk for stunting (height-for-age Z score [HAZ] <-1 but ≥-2), and Zambian children (n = 108) with wasting or stunting received nutritional intervention. Children with anthropometric status refractory to intervention underwent endoscopy. Linear regression models included anthropometric around endoscopy, scores of histology parameters, and a global index score of EED-the total score percent-5 (TSP-5). Multivariable models were adjusted for center, age, sex, and histology slide quality. RESULTS Intersite variation was observed while exploring the association between anthropometrics and the TSP-5; for example, Pakistani children had the worst HAZ, yet their median TSP-5 score was lower than that of the other 2 centers. Even within each site, no overall pattern of higher TSP-5 score was observed with worsening HAZ. During univariate analysis, TSP-5 (coefficient: 0.01; 95% confidence interval [CI]: 0, 0.02), goblet cell depletion (coefficient: 0.22; 95% CI: 0.06, 0.37), and Paneth cell depletion (coefficient: 0.14; 95% CI: 0.01, 0.27) were associated with HAZ scores; however, they lost statistical significance in the multivariable models, with study center most strongly confounding the relationships seen in univariate models between anthropometry and histology. CONCLUSIONS This study contributes a crucial negative finding that duodenal morphological features did not associate with anthropometric phenotypes; hence, anthropometric measurements may not be a suitable outcome measure for use in EED trials. Trial outcomes may need to be defined by combining the functional and structural elements of the gut to monitor EED.
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Affiliation(s)
- Zehra Jamil
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Kelley VanBuskirk
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Monica Mweetwa
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | | | | | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kanta Chandwe
- Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Donna M Denno
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - S Mohammad Fahim
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Paul Kelly
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Mustafa Mahfuz
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Chelsea Marie
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Sean R Moore
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - William A Petri
- Department University of Virginia, Charlottesville, VA, United States
| | - S Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Ashraf K, Huda TM, Ikram J, Ariff S, Sajid M, Khan GN, Umer M, Ahmed I, Dibley MJ, Soofi SB. The Effectiveness of Nutritional Interventions Implemented through Lady Health Workers on the Reduction of Stunting in Children under 5 in Pakistan: The Difference-in-Difference Analysis. Nutrients 2024; 16:2149. [PMID: 38999897 PMCID: PMC11243699 DOI: 10.3390/nu16132149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
In Pakistan, the 2018 National Nutrition Survey reported that 40% of children under five years old were stunted. This study assessed the effectiveness of nutritional supplementation in reducing stunting among children under five years old in two rural districts in Sindh, Pakistan. This was a mixed-method quasi-experimental study comprising intervention and control populations, with 3397 and 3277 children under five years old participating in the baseline and end-line surveys, respectively. The study areas were similar in terms of demographic and economic circumstances. In the intervention group, pregnant and lactating women (first six months post-partum) received wheat soy blend, children 6-23 months old received Wawamum (lipid-based supplement), and children 24-59 months old received micronutrient powders, all through lady health workers. This was underpinned by nutrition behaviour change communication for appropriate complementary feeding practices and hygiene promotion targeted at primary caregivers. The control group received no intervention. The impact was assessed using the difference-in-difference analysis with kernel propensity score matching to adjust the differences among the control and intervention populations. The overall DID analysis indicated that the intervention did not significantly reduce the prevalence of stunting (under 5 years) [DID = -5.1, p = 0.079]. The adjusted DID indicated a significant decrease of 13% [DID = -13.0, p = 0.001] in the number of stunted children 24-59 months of age at the endline survey. A significant reduction in underweight among children 24-59 months old was also observed (DID = -9.4%, p = 0.014). In conclusion, this evidence further establishes that nutrient uptake through an intervention for a short duration cannot effectively reduce stunting. It requires continuous nutritional supplementation for mothers during the pregnancy and an initial six months of lactation and then nutritional supplementation for children 6-59 months of age underpinned by effective behaviour change communication targeting mothers and other caregivers for improving complementary feeding practices and hygiene promotion.
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Affiliation(s)
- Khizar Ashraf
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.A.); (M.J.D.)
- South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - Tanvir M. Huda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.A.); (M.J.D.)
| | - Javeria Ikram
- The Tweed Valley Hospital, Cudgen, NSW 2487, Australia;
| | - Shabina Ariff
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi 74800, Pakistan;
| | - Muhammad Sajid
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan (I.A.)
| | - Gul Nawaz Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan (I.A.)
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan (I.A.)
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan (I.A.)
| | - Michael J. Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.A.); (M.J.D.)
| | - Sajid Bashir Soofi
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi 74800, Pakistan;
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan (I.A.)
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Wang F, Puentes E, Behrman J, Cunha F. You are What Your Parents Expect: Height and Local Reference Points. JOURNAL OF ECONOMETRICS 2024; 243:105269. [PMID: 39328300 PMCID: PMC11424033 DOI: 10.1016/j.jeconom.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Recent estimates are that about 150 million children under five years of age are stunted, with substantial negative consequences for their schooling, cognitive skills, health, and economic productivity. Therefore, understanding what determines such growth retardation is significant for designing public policies that aim to address this issue. We build a model for nutritional choices and health with reference-dependent preferences. Parents care about the health of their children relative to some reference population. In our empirical model, we use height as the health outcome that parents target. Reference height is an equilibrium object determined by earlier cohorts' parents' nutritional choices in the same village. We explore the exogenous variation in reference height produced by a protein-supplementation experiment in Guatemala to estimate our model's parameters. We use our model to decompose the impact of the protein intervention on height into price and reference-point effects. We find that the changes in reference points account for 65% of the height difference between two-year-old children in experimental and control villages in the sixth annual cohort born after the initiation of the intervention.
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Affiliation(s)
- Fan Wang
- Department of Economics, University of Houston, Houston, Texas, USA
| | - Esteban Puentes
- Department of Economics, Universidad de Chile, Santiago, Chile
| | - Jere Behrman
- Departments of Economics and Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Flávio Cunha
- Department of Economics, Rice University, Houston, Texas, USA
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Mostafa I, Hibberd MC, Hartman SJ, Hafizur Rahman MH, Mahfuz M, Hasan SMT, Ashorn P, Barratt MJ, Ahmed T, Gordon JI. A microbiota-directed complementary food intervention in 12-18-month-old Bangladeshi children improves linear growth. EBioMedicine 2024; 104:105166. [PMID: 38833839 PMCID: PMC11179573 DOI: 10.1016/j.ebiom.2024.105166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Globally, stunting affects ∼150 million children under five, while wasting affects nearly 50 million. Current interventions have had limited effectiveness in ameliorating long-term sequelae of undernutrition including stunting, cognitive deficits and immune dysfunction. Disrupted development of the gut microbiota has been linked to the pathogenesis of undernutrition, providing potentially new treatment approaches. METHODS 124 Bangladeshi children with moderate acute malnutrition (MAM) enrolled (at 12-18 months) in a previously reported 3-month RCT of a microbiota-directed complementary food (MDCF-2) were followed for two years. Weight and length were monitored by anthropometry, the abundances of bacterial strains were assessed by quantifying metagenome-assembled genomes (MAGs) in serially collected fecal samples and levels of growth-associated proteins were measured in plasma. FINDINGS Children who had received MDCF-2 were significantly less stunted during follow-up than those who received a standard ready-to-use supplementary food (RUSF) [linear mixed-effects model, βtreatment group x study week (95% CI) = 0.002 (0.001, 0.003); P = 0.004]. They also had elevated fecal abundances of Agathobacter faecis, Blautia massiliensis, Lachnospira and Dialister, plus increased levels of a group of 37 plasma proteins (linear model; FDR-adjusted P < 0.1), including IGF-1, neurotrophin receptor NTRK2 and multiple proteins linked to musculoskeletal and CNS development, that persisted for 6-months post-intervention. INTERPRETATION MDCF-2 treatment of Bangladeshi children with MAM, which produced significant improvements in wasting during intervention, also reduced stunting during follow-up. These results suggest that the effectiveness of supplementary foods for undernutrition may be improved by including ingredients that sponsor healthy microbiota-host co-development. FUNDING This work was supported by the BMGF (Grants OPP1134649/INV-000247).
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Affiliation(s)
- Ishita Mostafa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh; Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Matthew C Hibberd
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, 63110, USA; The Newman Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO, 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Steven J Hartman
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, 63110, USA; The Newman Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO, 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Md Hasan Hafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Mustafa Mahfuz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh; Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - S M Tafsir Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Per Ashorn
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Michael J Barratt
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, 63110, USA; The Newman Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO, 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Jeffrey I Gordon
- Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, MO, 63110, USA; The Newman Center for Gut Microbiome and Nutrition Research, Washington University School of Medicine, St. Louis, MO, 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Wubetie BY, Tsunekawa A, Haregeweyn N, Tsubo M, Nigussie Z, Meshesha TM, Abe T. Analysis of Malnutrition among Children under Five Years across Contrasting Agroecosystems of Northwest Ethiopia: Application of Structural Equation Modeling. Nutrients 2024; 16:1208. [PMID: 38674898 PMCID: PMC11054005 DOI: 10.3390/nu16081208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Child malnutrition remains a public health challenge in developing countries, but a comprehensive understanding of its burden and its determinants in specific local contexts is generally lacking. This study examined the prevalence of malnutrition and its determinants among children aged <5 years across contrasting agroecosystems in northwest Ethiopia. A community-based cross-sectional study involving 400 respondents was employed. Data were collected through semi-structured questionnaires and anthropometric measurements, complemented with focus group discussions and key informant interviews. The direct and indirect effects of the determinants of malnutrition were examined using structural equation modeling (SEM). The overall prevalence of child malnutrition, measured using the Composite Index of Anthropometric Failure, was 49%, with notable variation across agroecosystems (from 36.1% [midland with red soil] to 59% [lowland and valley fragmented]). Disease experience had significant positive direct effects on malnutrition. Dietary intake had negative and significant total (direct and indirect) effects on malnutrition, partially mediated through disease experience. Serial mediation in SEM analysis revealed significant indirect relationships between malnutrition and food security, feeding and care practices, household environment, health services, maternal diet, maternal empowerment, household wealth, and nutrition-sensitive agricultural practices. In conclusion, child malnutrition was highly prevalent and higher among children in the lowland and valley fragmented agroecosystem, characterized by unfavorable agro-climatic conditions, lower wealth status, poor health services access, and higher disease (particularly malaria) exposure. This study demonstrates the dynamics and multifaceted nature of malnutrition, highlighting the importance of considering geographical differences when planning interventions for childhood malnutrition and its determinants.
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Affiliation(s)
- Biruk Yazie Wubetie
- The United Graduate School of Agricultural Sciences, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
- College of Agriculture and Environmental Sciences, Bahir Dar University, Bahir Dar P.O. Box 5501, Ethiopia
| | - Atsushi Tsunekawa
- Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Nigussie Haregeweyn
- International Platform for Dryland Research and Education, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Mitsuru Tsubo
- Arid Land Research Center, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
| | - Zerihun Nigussie
- College of Agriculture and Environmental Sciences, Bahir Dar University, Bahir Dar P.O. Box 5501, Ethiopia
| | - Taye Minichil Meshesha
- The United Graduate School of Agricultural Sciences, Tottori University, 4-101 Koyama-Minami, Tottori 680-8553, Japan
- School of Civil and Water Resources Engineering, Debre Markos Institute of Technology, Debre Markos University, Debre Markos P.O. Box 269, Ethiopia
| | - Takeshi Abe
- International Platform for Dryland Research and Education, Tottori University, 1390 Hamasaka, Tottori 680-0001, Japan
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Eidelman AI. Breastfeeding Is Essential but Not Enough for the Growing Infant. Breastfeed Med 2024; 19:139-140. [PMID: 38489528 DOI: 10.1089/bfm.2024.29268.editorial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
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Karlsson O, Kim R, Subramanian SV. Prevalence of Children Aged 6 to 23 Months Who Did Not Consume Animal Milk, Formula, or Solid or Semisolid Food During the Last 24 Hours Across Low- and Middle-Income Countries. JAMA Netw Open 2024; 7:e2355465. [PMID: 38345819 PMCID: PMC10862155 DOI: 10.1001/jamanetworkopen.2023.55465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024] Open
Abstract
Importance The introduction of solid or semisolid foods alongside breast milk plays a vital role in meeting nutritional requirements during early childhood, which is crucial for child growth and development. Understanding the prevalence of zero-food children (defined for research purposes as children aged 6 to 23 months who did not consume animal milk, formula, or solid or semisolid food during the last 24 hours) is essential for targeted interventions to improve feeding practices. Objective To estimate the percentage of zero-food children in 92 low- and middle-income countries. Design, Setting, and Participants This cross-sectional study analyzed nationally representative cross-sectional household data of children aged 6 to 23 months from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys conducted between May 20, 2010, and January 27, 2022. Data were obtained from 92 low- and middle-income countries. Standardized procedures were followed to ensure data comparability and reliability. Both percentage and number of zero-food children were estimated. Main Outcomes and Measures The outcome studied was defined as a binary variable indicating children aged 6 to 23 months who had not been fed any animal milk, formula, or solid or semisolid foods during the 24 hours before each survey, as reported by the mother or caretaker. Results A sample of 276 379 children aged 6 to 23 months (mean age, 14.2 months [95% CI, 14.15-14.26 months]) in 92 low- and middle-income countries was obtained, of whom 51.4% (95% CI, 51.1%-51.8%) were boys. The estimated percentage of zero-food children was 10.4% (95% CI, 10.1%-10.7%) in the pooled sample, ranging from 0.1% (95% CI, 0%-0.6%) in Costa Rica to 21.8% (95% CI, 19.3%-24.4%) in Guinea. The prevalence of zero-food children was particularly high in West and Central Africa, where the overall prevalence was 10.5% (95% CI, 10.1%-11.0%), and in India, where the prevalence was 19.3% (95% CI, 18.9%-19.8%). India accounted for almost half of zero-food children in this study. Conclusions and Relevance In this cross-sectional study of 276 379 children aged 6 to 23 months, substantial disparities in the estimates of food consumption across 92 low- and middle-income countries were found. The prevalence of zero-food children underscores the need for targeted interventions to improve infant and young child feeding practices and ensure optimal nutrition during this critical period of development. The issue is particularly urgent in West and Central Africa and India.
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Affiliation(s)
- Omar Karlsson
- Duke University Population Research Institute, Duke University, Durham, North Carolina
- Centre for Economic Demography, School of Economics and Management, Lund University, Lund, Sweden
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Korea
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Korea
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Picauly I, Adi AAAM, Meiyetriani E, Mading M, Weraman P, Nashriyah SF, Boeky DLA, Lobo V, Saleh A, Peni JA, Hidayat AT, Marni M. Determinants of child stunting in the dryland area of East Nusa Tenggara Province, Indonesia: insights from a national-level survey. J Med Life 2024; 17:147-156. [PMID: 38813363 PMCID: PMC11131646 DOI: 10.25122/jml-2023-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/07/2023] [Indexed: 05/31/2024] Open
Abstract
Stunting remains a critical public health issue in Indonesia, particularly in the province of East Nusa Tenggara. This region, characterized by its archipelagic dryland geography, has reported the highest prevalence of stunting among children under five from 2007 to 2021. The study aimed to examine the relationship between various characteristics of children under five and household factors with the occurrence of stunting. This observational study, with a cross-sectional design, used secondary data from the 2021 Indonesian Nutrition Status Survey, covering 7,835 children under five. We analyzed the data to identify patterns and relationships, using univariate analysis to display percentage distributions and bivariate analysis through multiple binary logistic regression tests. The results of the multiple logistic regression test showed that indicators of family characteristics such as age, gender, low birth weight, body length, possession of birth certificates, and receiving complementary feeding were all related to stunting. Additionally, household factors such as toilet type, National Health Insurance coverage, ownership of a Prosperous Family Card, and residential area were significant determinants. Factors contributing to stunting in dryland areas include a range of elements from both family characteristics-such as age, gender, birth certification, low birth weight, and initial body length, to the introduction of supplementary feeding-and household indicators, including the use of specific types of latrines (Plengsengan and Cemplung types without covers), health insurance coverage, possession of Prosperous Family Cards, and the family's residential area.
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Affiliation(s)
- Intje Picauly
- Department of Public Health, Nusa Cendana University, Kupang, Indonesia
| | | | - Eflita Meiyetriani
- SEAMEO RECFON, Center for Regional Nutrition Studies, Jakarta, Indonesia
| | - Majematang Mading
- Institute of Research and Development Waikabubak, Sumba Barat, Indonesia
| | - Pius Weraman
- Department of Public Health, Nusa Cendana University, Kupang, Indonesia
| | | | | | - Varry Lobo
- Institute of Research and Development Waikabubak, Sumba Barat, Indonesia
| | - Asmulyati Saleh
- Department of Nutrition, Kupang Ministry of Health Health Polytechnic, Kupang, Indonesia
| | - Jane Austen Peni
- Department of Nutrition, Kupang Ministry of Health Health Polytechnic, Kupang, Indonesia
| | | | - Marni Marni
- Department of Public Health, Nusa Cendana University, Kupang, Indonesia
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9
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Beatty A, Borkum E, Leith W, Null C, Suriastini W. A cluster randomized controlled trial of a community-based initiative to reduce stunting in rural Indonesia. MATERNAL & CHILD NUTRITION 2024; 20:e13593. [PMID: 38041533 PMCID: PMC10750001 DOI: 10.1111/mcn.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 12/03/2023]
Abstract
We evaluate the impacts of a $120 million project in Indonesia conducted between 2014 and 2018 that sought to reduce stunting through a combination of (1) community-driven development grants targeted at health and education outcomes, (2) training for health providers on infant and young child feeding and growth monitoring and (3) training for sanitarians on a local variation of community-led total sanitation. This cluster randomized controlled trial involved 95 treatment and 95 control subdistricts across South Sumatra, West Kalimantan, and Central Kalimantan provinces. Overall, we find no significant impacts on stunting, the study's primary outcome measure (0.5 pp; 95% confidence interval [CI]: -3.0 to 4.1 percentage points [pp]), or other longer-term undernutrition outcomes about 1 year after the end of the project. The project had a modest impact on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of iron-folic acid pills during pregnancy (8.7 pp; 95% CI: 4.1-13.3 pp), 0-5-month-olds being exclusively breastfed (8.7 pp; 95% CI: 1.8-15.6 pp) and 6-23-month-olds receiving the number of recommended meals per day (8.5 pp; 95% CI: 3.8-13.2 pp). However, there were no significant impacts on other proximal outcomes like the number of pre-natal and post-natal checkups, child dietary diversity, child vitamin A receipt or the incidence of child diarrhoea. Our findings highlight that successfully implementing an integrated package of interventions to reduce child stunting may be challenging in practice. Project design needs to consider implementation reality along with best practice-for example, by piloting the synchronous implementation of multifaceted interventions or phasing them in more gradually over a longer timeframe.
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Manohar S, Colantuoni E, Thorne-Lyman AL, Shrestha B, Adhikari RK, KC A, Bhattarai A, West KP. Evaluating preschool linear growth velocities: an interim reference illustrated in Nepal. Public Health Nutr 2023; 26:2704-2716. [PMID: 37932904 PMCID: PMC10755438 DOI: 10.1017/s1368980023002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE An annualised linear growth velocity (LGV) reference can identify groups of children at risk of growing poorly. As a single velocity reference for all preschool ages does not exist, we present an interim tool, derived from published, normative growth studies, for detecting growth faltering, illustrating its use in Nepali preschoolers. DESIGN The WHO Child Growth Velocity Standard was adapted to derive 12-month increments and conjoined to the Tanner-Whitehouse Height Velocity Reference data yielding contiguous preschool linear growth annualised velocities. Linear restricted cubic spline regressions were fit to generate sex-specific median and standard normal deviate velocities for ages 0 through 59 months. LGV Z-scores (LGVZ) were constructed, and growth faltering was defined as LGVZ < –2. SETTING Use of the reference was illustrated with data from Nepal’s Tarai region. PARTICIPANTS Children contributing the existing growth references and a cohort of 4276 Nepali children assessed from 2013 to 2016. RESULTS Fitted, smoothed LGV reference curves displayed monotonically decreasing 12-month LGV, exemplified by male/female annual medians of 26·4/25·3, 12·1/12·7, 9·1/9·4, 7·7/7·8 and 7/7 cm/years, starting at 0, 12, 24, 36 and 48 months, respectively. Applying the referent, 31·1 %, 28·6 % and 29·3 % of Nepali children <6, 6–11 and 12–23 months of age, and ∼6 % of children 24–59 months, exhibited growth faltering. Under 24 months, faltering velocities were more prevalent in girls (34·4 %) than boys (25·3 %) (P < 0·05) but comparable (∼6 %) in older preschoolers. CONCLUSIONS A LGV reference, concatenated from extant data, can identify preschool groups at-risk of growth faltering. Application and limitations are discussed.
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Affiliation(s)
- Swetha Manohar
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Global Food Ethics & Policy Program, Johns Hopkins School of Advanced International Studies, Washington, DC20036, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Lucian Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Binod Shrestha
- PoSHAN Study Team, Johns Hopkins University, Patan Dhoka, Lalitpur, Nepal
- Blitz Media Pvt. Ltd., Tripureshwor, Maharajgunj, Kathmandu, Nepal
| | - Ramesh Kant Adhikari
- Global Food Ethics & Policy Program, Johns Hopkins School of Advanced International Studies, Washington, DC20036, USA
| | - Angela KC
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abhigyna Bhattarai
- Department of Child Health, Institute of Medicine, Tribhuvan University, Nepal
- Blitz Media Pvt. Ltd., Tripureshwor, Maharajgunj, Kathmandu, Nepal
| | - Keith Parker West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Matias SL, Anderson CE, Koleilat M. Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain. MATERNAL & CHILD NUTRITION 2023; 19:e13545. [PMID: 37357364 PMCID: PMC10483944 DOI: 10.1111/mcn.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/08/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023]
Abstract
Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2-4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%-5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.
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Affiliation(s)
- Susana L. Matias
- Department of Nutritional Sciences and ToxicologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | | | - Maria Koleilat
- Department of Public HealthCalifornia State UniversityFullertonCaliforniaUSA
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12
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Murphy KN, Boyce LK, Ortiz E, Santos M, Balseca G. Dietary Patterns of Children from the Amazon Region of Ecuador: A Descriptive, Qualitative Investigation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1568. [PMID: 37761529 PMCID: PMC10528603 DOI: 10.3390/children10091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Many young children in Ecuador suffer from high rates of malnutrition and stunting that affect their long-term growth and development. Little is known about the dietary patterns of children from the Amazon region who experience some of the highest rates of stunting (height-for-age) within Ecuador. Semi-structured interviews were conducted with 50 mothers of young children living in the Ecuadorian Amazon. In addition to descriptions of overall dietary patterns, three themes emerged from the interviews relating to strengths mothers have in feeding their children healthy diets: knowledge, autonomous and independent children, and supportive and responsive parenting. Five themes were found relating to barriers mothers have in feeding their children healthy diets. The first four themes concerned barriers (lack of knowledge of healthy foods, lack of access to healthy foods, not enough money, and child's health) related to multidimensional poverty. All these influenced the last theme found, namely, how difficult of an eater the child was. The implications of intervention efforts to reduce undernutrition and promote children's development by building on specific family and community strengths and identified barriers are also discussed in this paper.
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Affiliation(s)
- Kristin N. Murphy
- Department of Human Development and Family Studies, Utah State University, Logan, UT 84322, USA;
| | - Lisa K. Boyce
- Department of Human Development and Family Studies, Utah State University, Logan, UT 84322, USA;
| | - Eduardo Ortiz
- Institute for Disability Research, Policy and Practice, Utah State University, Logan, UT 84322, USA;
| | - Marcela Santos
- Facultad de Postgrado, Universidad Casa Grande, Guayaquil 090613, Ecuador
| | - Gloria Balseca
- Facultad de Postgrado, Universidad Casa Grande, Guayaquil 090613, Ecuador
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13
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Erfina E, Hariati S, Tawali S. Development and evaluation of nursing intervention in preventing stunting in children of adolescent mothers: A mixed-methods research protocol. Nutr Health 2023; 29:369-375. [PMID: 37331967 DOI: 10.1177/02601060231181712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background: Adolescent pregnancies are a global problem occurring in many countries. Adolescent pregnancy is a risk factor for stunting in children. Aim: This study was designed to develop and evaluation of nursing interventions to prevent stunting in children of adolescent mothers. Methods: A mixed-methods explanatory sequential design with two phases approach will be applied. Phase I is a qualitative phenomenology descriptive study that will be used. Participants will be adolescent pregnant women from several community health centers (Puskesmas) and healthcare staff in a community public center (Puskesmas) will be selected by purposive sampling. The study will be conducted at community health centers (Puskesmas) in Makassar, South Sulawesi, Indonesia. Data will be gathered through in-depth interviews and focus group discussions and analyzed using thematic analysis. Subsequently, an experimental pre-post-test design with a control group will be used to measure the effectiveness of the nursing intervention on preventing stunting among adolescent mothers in the quantitative phase by behavior toward stunting prevention for adolescent pregnancy and the nutritional status of children. Conclusion: This study will provide insight from both adolescent mothers' and healthcare staff's perspectives on stunting prevention including nutrition of adolescent pregnancy and breastfeeding. We will evaluate the effectiveness and acceptability of nursing intervention in preventing stunting. This will contribute to the international literature on the use of healthcare staff at community health services (puskesmas) to achieve linear growth due to prolonged food insecurity and illnesses in childhood.
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Affiliation(s)
- Erfina Erfina
- Maternity Nursing Department, Faculty of Nursing, Hasanuddin University, Tamalanrea, Makassar, Indonesia
| | - Suni Hariati
- Pediatric Nursing Department, Faculty of Nursing, Hasanuddin University, Tamalanrea, Makassar, Indonesia
| | - Suryani Tawali
- Community Medicine Department, Faculty of Medicine, Hasanuddin University, Tamalanrea, Makassar, Indonesia
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14
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Weldegebriel SG, Beyene SA, Tela FG, Gufue ZH, Hailu HT. Maternal dietary pattern and its association with birthweight in Northern Ethiopia: A hospital-based cross-sectional study. Food Sci Nutr 2023; 11:3820-3832. [PMID: 37457182 PMCID: PMC10345722 DOI: 10.1002/fsn3.3368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 07/18/2023] Open
Abstract
Birthweight is a useful public health measure of maternal health, nutrition, healthcare delivery, and child morbidity and mortality. Previous research did not focus on dietary patterns but rather on a single or a few foods or nutrients. This study aimed to assess the maternal dietary pattern and its association with birthweight in northern Ethiopia. A hospital-based cross-sectional study was conducted among 373 pregnant mothers in their third trimester of pregnancy who came to attend their routine antenatal care service. The food frequency questionnaire was collected from the previous week, and the birthweight data were collected from the medical records after delivery. Three maternal dietary patterns were identified; dietary pattern includes eggs, milk, milk products, and certain fruits and roots. Dietary pattern 2 includes certain vegetables, green leafy vegetables, vitamin A-rich vegetables, pulses such as beans, peas, and chickpeas, and drinks like coffee, tea, and soda. Dietary pattern 3 includes meat, nuts, and grains such as teff, corn, wheat, and white flour. Dietary pattern 1 (β = 52.45, p = .03) and dietary pattern 2 (β = 66.76, p = .01), residency (β = 287.08, p < .001), a mid-upper-arm circumference of 21-23 cm (β = 187.10, p = .02), a mid-upper-arm circumference of >23 cm (β = 272, p = .01), and gestational age at delivery (β = 12.58, p = .004) were the factors significantly associated with increased birthweight. The maternal dietary pattern has a significant association with birthweight. The focus should be given to maternal dietary patterns to prevent suboptimal and high birthweight.
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Affiliation(s)
| | - Selemawit Asfaw Beyene
- Department of Nutrition and Dietetics, School of Public Health, College of Health SciencesMekelle UniversityTigrayEthiopia
| | - Freweini Gebrearegay Tela
- Department of Nutrition and Dietetics, School of Public Health, College of Health SciencesMekelle UniversityTigrayEthiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health SciencesAdigrat UniversityTigrayEthiopia
| | - Helen Teweldebrhan Hailu
- Department of Public Health, College of Medicine and Health SciencesAdigrat UniversityTigrayEthiopia
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15
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Barffour MA, Bernstein RM, Hinnouho GM, Wessells KR, Arnold CD, Kounnavong S, Hess SY. Insulin-like Growth Factor 1 (IGF1), IGF Binding Protein-3 (IGFBP3) and Growth Response to Daily Zinc Supplementation: A Randomized Trial in Rural Laotian Children. Nutrients 2023; 15:nu15112590. [PMID: 37299552 DOI: 10.3390/nu15112590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES To assess (a) the impact of daily preventive zinc tablets (7 mg; PZ), zinc-containing multiple micronutrient powder (10 mg zinc, and 13 other micronutrients; MNP) or placebo, delivered for 9 months, on Insulin-like Growth Factor 1 (IGF1) and IGF Binding Protein 3 (IGFBP3) among Laotian children 6-23 months, and (b) whether the effects of PZ and MNP on length-for-age z-scores (LAZ) and weight-for-age z-scores (WAZ) are modified by baseline IGF1 and IGFBP3. DESIGN A double-blind, placebo-controlled trial (N = 419). METHODS Plasma IGF1 and IGFBP3 concentrations at baseline and 36 weeks were analyzed by automated chemiluminescent assay. Anthropometry was assessed at baseline, at 18 and 36 weeks. Intervention effects were estimated using ANCOVA. RESULTS At 36 weeks, geometric mean IGF1 (~39.0-39.2 ng/mL; p = 0.99) and IGFBP3 (2038-2076 ng/mL; p = 0.83) did not differ by group. At 18 weeks (but not at 36 weeks), LAZ in the PZ group (-1.45) was higher than the MNP (-1.70) and control (-1.55) groups (p = 0.01) among children in the highest baseline IGF1 tertile (p for interaction = 0.006). At 36 weeks (but not at 18 weeks), WAZ in the PZ group (-1.55) was significantly higher than the MNP (-1.75) and control (-1.65) groups (p = 0.03), among children in the lowest baseline IGFBP3 tertile (p for interactions = 0.06). CONCLUSIONS Although IGF1 and IGFBP3 did not respond to PZ and MNP, baseline IGF1 and IGFBP3 significantly modified the impact of PZ on linear and ponderal growth, suggesting that IGF1 bioavailability may drive catch-up growth in zinc-supplemented children.
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Affiliation(s)
- Maxwell A Barffour
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Public Health Program, McQueary College of Health and Human Services, Missouri State University, Springfield, MO 65897, USA
| | - Robin M Bernstein
- Department of Anthropology, University of Colorado, Boulder, CO 80309, USA
- Health and Society Program, Institute for Behavioral Science, University of Colorado, Boulder, CO 80309, USA
| | - Guy-Marino Hinnouho
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
- Helen Keller International, Washington, DC 20006, USA
| | - K Ryan Wessells
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
| | - Charles D Arnold
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ban Kaognot, Sisattanack District, Vientiane 01030, Laos
| | - Sonja Y Hess
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
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Teng Y, Jing H, Chacha S, Wang Z, Huang Y, Yang J, Yan H, Dang S. Maternal Dietary Diversity and Birth Weight in Offspring: Evidence from a Chinese Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3228. [PMID: 36833922 PMCID: PMC9960126 DOI: 10.3390/ijerph20043228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Studies on the association between maternal dietary diversity and birth weight in offspring are limited, and the impact of such an adjustable factor on birth weight requires investigation to promote neonatal health. This study used data from a larger-scale population-based survey conducted in northwest China to evaluate the association of maternal dietary diversity with neonatal birth weight with a generalized estimating equation model. The results found that maternal dietary diversity was positively associated with neonate birth weight. Furthermore, a higher minimum dietary diversity for women (MDD-W) score during pregnancy was related to a lower risk of low birth weight (LBW) in offspring. The mothers with the highest MDD-W score had a 38% (OR = 0.62, 95% CI: 0.43-0.89) lower risk of LBW than those with the lowest score. Similarly, the mothers with the highest animal-based food dietary diversity score (DDS) had 39% (OR = 0.61, 95% CI: 0.38-0.98) lower risk of LBW in offspring compared with those with the lowest animal-based food DDS. Moreover, the ratio of animal-based food DDS to non-animal-based food DDS could play an important role in predicting neonate birth weight. In conclusion, increasing maternal dietary diversity would improve birth weight in offspring, especially by increasing the intake of animal-based foods among the Chinese population.
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Affiliation(s)
| | | | | | | | | | | | | | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
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17
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Historical and hunter-gatherer perspectives on fast-slow life history strategies. EVOL HUM BEHAV 2023. [DOI: 10.1016/j.evolhumbehav.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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18
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Association of BCC Module Roll-Out in SHG meetings with changes in complementary feeding and dietary diversity among children (6-23 months)? Evidence from JEEViKA in Rural Bihar, India. PLoS One 2023; 18:e0279724. [PMID: 36602987 DOI: 10.1371/journal.pone.0279724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Child dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups. METHODS The study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6-23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase. RESULTS During the pre-intervention phase, 19% of the children (6-23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events. CONCLUSION BCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity.
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Paramashanti BA, Dibley MJ, Alam A, Huda TM. Wealth- and education-related inequalities in minimum dietary diversity among Indonesian infants and young children: a decomposition analysis. Glob Health Action 2022; 15:2040152. [PMID: 35389332 PMCID: PMC9004518 DOI: 10.1080/16549716.2022.2040152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Over the last two decades, Indonesia has experienced remarkable economic growth. However, the percentage of infants and young children meeting the minimum dietary diversity (MDD) criteria has stagnated. Despite the growing body of evidence of the association between MDD and socioeconomic factors, there is little information about socioeconomic inequalities in MDD in Indonesia. Objectives The current study seeks to quantify the wealth- and education-related inequalities in MDD among infants and young children in Indonesia and determine the contribution of different factors to these disparities. Methods We included a total of 5038 children aged 6–23 months of the 2017 Indonesia Demographic and Health Survey. We measured wealth- and education-related inequalities using the concentration curve and Wagstaff normalised concentration index. Using a concentration index decomposition analysis, we then examined factors contributing to wealth- and education-related inequalities in MDD. Results The concentration indices by household wealth and maternal education were 0.220 (p < 0.001) and 0.192 (p < 0.001), respectively, indicating more concentration of inequalities among the advantaged population. The decomposition analysis revealed that household wealth (29.8%), antenatal care (ANC) visits (16.6%), paternal occupation (15.1%), and maternal education (11.8%) explained the pro-rich inequalities in MDD in Indonesia. Maternal education (26.1%), household wealth (19.1%), ANC visits (14.9%), and paternal occupation (10.9%) made the most considerable contribution to education-related inequalities in MDD. Conclusions There is substantial wealth- and education-related inequalities in MDD. Our findings suggest an urgent need to address the underlying causes of not reaching dietary diversity by promoting infant and young child feeding equity in Indonesia.
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Affiliation(s)
- Bunga A Paramashanti
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta, Indonesia
| | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tanvir M Huda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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20
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Metwally AM, Sallam SF, Mawla MAA, Alian KM, Abdel-Latif GA, Hasanin HM, Kamal AN, Hanna C, Shebini SME, Ahmed NH, Mabrok HB, Mahmoud MH, Ismail AS, Boseila SAW, El-Alameey IR, Mahfouz NN, Shaaban FA, Ibrahim NA, Hassan NE, El-Masry SA, Naga MM, Khalil A. Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach. BMC Pediatr 2022; 22:689. [DOI: https:/doi.org/10.1186/s12887-022-03741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 10/31/2023] Open
Abstract
AbstractBackgroundAccess to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents’ beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village.MethodsAn interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan “ enjoy meals like a baby”. The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods.ResultsThere was marked and significant improvement in the awareness and of the majority of the weaning practices’ indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3–5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the “Minimum Dietary Diversity” (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%).ConclusionTargeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.
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21
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Metwally AM, Sallam SF, Mawla MAA, Alian KM, Abdel-Latif GA, Hasanin HM, Kamal AN, Hanna C, Shebini SME, Ahmed NH, Mabrok HB, Mahmoud MH, Ismail AS, Boseila SAW, El-Alameey IR, Mahfouz NN, Shaaban FA, Ibrahim NA, Hassan NE, El-Masry SA, Naga MM, Khalil A. Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach. BMC Pediatr 2022; 22:689. [PMID: 36456920 PMCID: PMC9713754 DOI: 10.1186/s12887-022-03741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Access to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents' beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village. METHODS An interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan " enjoy meals like a baby". The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods. RESULTS There was marked and significant improvement in the awareness and of the majority of the weaning practices' indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3-5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the "Minimum Dietary Diversity" (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%). CONCLUSION Targeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.
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Affiliation(s)
- Ammal M. Metwally
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Sara F. Sallam
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Mohamed A. Abdel Mawla
- grid.419725.c0000 0001 2151 8157Pediatrics Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Khadija M. Alian
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ghada A. Abdel-Latif
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Hasanin M. Hasanin
- grid.419725.c0000 0001 2151 8157Pediatrics Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ayat N. Kamal
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Carine Hanna
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Salwa M. El Shebini
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nihad H. Ahmed
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Hoda B. Mabrok
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Maha H. Mahmoud
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ahmed S. Ismail
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Samia A. W. Boseila
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Inas R. El-Alameey
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt ,Faculty of Applied Medical Sciences, Clinical Nutrition Department, Taibahu University, Almadina almunawara, Saudi Arabia
| | - Nermine N. Mahfouz
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Fatma A. Shaaban
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nihad A. Ibrahim
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nayera E. Hassan
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Sahar A. El-Masry
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Maie M. Naga
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Aya Khalil
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
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22
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Wang CC, Abdul Jalal MI, Song ZL, Teo YP, Tan CA, Heng KV, Low MSY, Anuar Zaini A, Lum LCS. A Randomized Pilot Trial of Micronutrient Supplementation for Under-5 Children in an Urban Low-Cost Flat Community in Malaysia: A Framework for Community-Based Research Integration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113878. [PMID: 36360757 PMCID: PMC9655965 DOI: 10.3390/ijerph192113878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 06/01/2023]
Abstract
Early childhood nutritional deficiency has detrimental consequences on physical and cognitive development. We conducted a single-center, single-blind, two-arm pilot randomized no-treatment controlled trial (the Child of Urban Poverty Iron Project (CUPIP); NCT03819530) in a people’s housing project locale in Selangor, Malaysia, between September 2019 and February 2020, to assess the trial’s general feasibility and preliminary benefits of daily micronutrient supplementation for iron storage and anthropometric outcomes in under-5 children. Those with history of premature births, congenital abnormalities, or baseline hemoglobin <70 g/L were excluded. Participants received baseline deworming and were simply randomized in a 1:1 ratio to either micronutrient (4-month daily micronutrient packets) or control (no micronutrient supplementation) groups. Information on anthropometric, erythrocytic, and iron storage endpoints were collected. Overall, 45 (25 micronutrient and 20 controls) participants were enrolled and completed 4-month endpoint assessments. Micronutrient recipients demonstrated higher median mean corpuscular volume, serum ferritin level with no significant differences in all anthropometric endpoints. In conclusion, this pilot trial was implementable, demonstrating that micronutrient supplementation significantly improved hematological, but not anthropometric, endpoints, of under-5-year-old children living in an underprivileged environment. A definitive well-designed trial with larger sample sizes and greater attrition control should be contemplated in the future.
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Affiliation(s)
- Crystal C. Wang
- Weill Cornell Medicine, 1300 York Avenue, New York, NY 10021, USA
| | - Muhammad Irfan Abdul Jalal
- UKM Medical Molecular Biology Institute (UMBI), Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Zhi Liang Song
- Department of Paediatrics, Universiti Malaya Medical Center, Kuala Lumpur 59100, Malaysia
| | - Yik Pheng Teo
- Department of Paediatrics, Universiti Malaya Medical Center, Kuala Lumpur 59100, Malaysia
| | - Chin Aun Tan
- Department of Occupational Safety & Health Unit, Hospital Tunku Azizah, Kuala Lumpur 50300, Malaysia
| | - Kai Voon Heng
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur 50300, Malaysia
| | - Michelle Siu Yee Low
- Department of Paediatrics, Universiti Malaya Medical Center, Kuala Lumpur 59100, Malaysia
| | - Azriyanti Anuar Zaini
- Department of Paediatrics, Universiti Malaya Medical Center, Kuala Lumpur 59100, Malaysia
| | - Lucy Chai See Lum
- Department of Paediatrics, Universiti Malaya Medical Center, Kuala Lumpur 59100, Malaysia
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23
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Zhang J, Wu Q, Wang X, Zhang Y, Helena van Velthoven M. High response rate and low cost of WeChat-based data collection of infant and young child feeding data in rural Qinghai Province, China. J Glob Health 2022; 12:11011. [PMID: 36269216 PMCID: PMC9586143 DOI: 10.7189/jogh.12.11011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Measuring the infant and young child feeding (IYCF) indicators is key to effectively tracking the progress of child health programs and making evidence-based decisions. WeChat is the most popular mobile social media platform in China and has become a promising tool for collecting health data. This study aims to explore the response rate and costs of a WeChat-based questionnaire on IYCF information in rural China. Methods We conducted two cross-sectional surveys with caregivers of children aged 6-23 months in two rural counties in Qinghai Province (Menyuan and Datong County), China, from January to March 2022. Both surveys used the same WeChat IYCF questionnaire to collect household information, infant feeding practices, and caregivers’ feeding knowledge. Village doctors sent a quick response (QR) code to caregivers that was linked to the WeChat IYCF questionnaire. Participating caregivers scanned the QR code using their own WeChat account on their smartphone and filled in the questionnaire online. If they could not use WeChat themselves, village doctors administered the questionnaire. Once caregivers finished the questionnaires, they received a personalized report with infant feeding recommendations. Results We recruited 1274 caregivers of children aged 6-23 months in Menyuan County and 1748 caregivers in Datong County. The total response rate in the two counties was 98.2%; 77.6% of questionnaires were self-administered by caregivers and 20.6% were interviewer-administered by village doctors. The questionnaires were filled in twice by 209 (6.9%) caregivers. The cost of these two WeChat IYCF surveys was much lower than the cost of a previously conducted face-to-face survey: 11.8 yuan (US$1.85) in Menyuan County and 7.5 yuan (US$1.18) in Datong County for the WeChat survey vs 112.7 yuan (US$17.70) for the face-to-face survey in Huzhu County. Conclusions This study showed that using WeChat for IYCF surveys can achieve a very high response rate at a low cost in rural China. Village doctors played a very important role in achieving this high response rate. Providing feedback to caregivers may improve their feeding practices and this intervention could be incorporated into the data collection process.
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Affiliation(s)
- Jian Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Qiong Wu
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Xiaotong Wang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
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24
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Ali MK, Flacking R, Sulaiman M, Osman F. Effects of Nutrition Counselling and Unconditional Cash Transfer on Child Growth and Family Food Security in Internally Displaced Person Camps in Somalia-A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13441. [PMID: 36294019 PMCID: PMC9603782 DOI: 10.3390/ijerph192013441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
The effects of nutrition counselling (NC) and unconditional cash transfer (UCT) in improving growth in children under five and household food security are poorly understood in humanitarian settings. Therefore, this study aimed to evaluate the effects of NC and NC combined with unconditional cash transfer (NC + UCT) on children's growth and food security in Somalia. The study was performed with a quasi-experimental design in two districts in the Banadir region of Somalia. Caregivers (n = 255) with mildly to moderately malnourished children aged 6 to 59 months old (n = 184) were randomized to the NC, NC + UCT and control groups. The interventions consisted of weekly NC for three months alone or in combination with UCT. The outcome variables were wasting, underweight, stunting, and food security. Difference-indifferences analysis was used to estimate the effect of the interventions. Our study did not find any significant impacts of NC or NC + UCT on child wasting, underweight, stunting, food security or household expenses. In conclusion, NC, alone or in combination with UCT, did not impact children's growth or household food security. Thus, a culturally tailored NC programme over a longer period, supplemented with cash transfer, could be beneficial to consider when designing interventions to reduce malnutrition and food insecurity.
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Affiliation(s)
- Mohamed Kalid Ali
- School of Health and Welfare, Dalarna University, 79182 Falun, Sweden
- Food and Agriculture Organisation of the United Nations (FAO), Somalia Country Office, Nairobi P.O. Box 30470-00100, Kenya
| | - Renée Flacking
- School of Health and Welfare, Dalarna University, 79182 Falun, Sweden
| | - Munshi Sulaiman
- BRAC International, Clock Tower, Kampala P.O. Box 31817, Uganda
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, 79182 Falun, Sweden
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25
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Soofi SB, Khan GN, Ariff S, Ihtesham Y, Tanimoune M, Rizvi A, Sajid M, Garzon C, de Pee S, Bhutta ZA. Effectiveness of nutritional supplementation during the first 1000-days of life to reduce child undernutrition: A cluster randomized controlled trial in Pakistan. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 4:100035. [PMID: 37383995 PMCID: PMC10305932 DOI: 10.1016/j.lansea.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Childhood stunting can start in the womb and continue for two years. Therefore, the first 1000 days of life between a woman's pregnancy and her child's 2nd birthday offer a unique window of opportunity to build healthier and more prosperous futures. Therefore, we aimed to assess the effectiveness of nutritional supplementation during the first 1000-days to reduce the prevalence of stunting in children at 24 months of age. Methods In this cluster randomized controlled trial, we enrolled women during their pregnancy from two rural districts of Sindh, Pakistan. A cluster was one union council with a population of ∼25000 residents. Out of 29 clusters, we randomly allocated 6 clusters to the intervention and control groups each. Pregnant women received a monthly supply of 5 kg (i.e., 165 grams/day) of wheat soya blend plus (WSB+) during pregnancy and the first six months of their lactation period. In addition, their children received lipid-based nutrient supplement - medium-quantity (LNS-MQ) between 6-23 months of age. The primary outcome was a reduction in the prevalence of stunting in children at 24 months of age. Analysis was an intention to treat. The trial is registered on ClinicalTrial.gov, number NCT02422953. Findings Two thousand thirty pregnant women (1017 in the intervention group and 1013 in the control group) were enrolled between August 30, 2014, and May 25, 2016. Monthly follow-ups were conducted between October 1, 2014, and October 25, 2018. At 24 months of age, we captured data from 699 (78%) of 892 live births in the intervention group and 653 (76%) of 853 live births in the control group. There was a significant difference in mean length (49.4 cm vs 48.9 cm, p =0.027), weight (3.1 kg vs 3.0 kg, p =0.013), length for age z-scores (-1.2 vs -1.5, p =0.004) and weight for age z-scores (-1.2 vs -1.5, p =0.015) among infants in the intervention compared to control group. At 24 months of age, a significant difference in the prevalence of stunting (absolute difference, 10.2%, 95% CI 18.2 to 2.3, p =0.017) and underweight (absolute difference, 13.7%, 95% CI 20.3 to 7.0, p =0.001) were observed in the intervention as compared to the control group. The prevalence of wasting was not significantly different between the intervention and control groups (absolute difference, 6.9%, 95% CI 14.1 to 0.3, p =0.057). Interpretation Provision of WSB+ and LNS-MQ during the first 1000-days of life improved child linear growth and reduced stunting in children at 24 months. This study can be scaled-up in similar settings to lower the prevalence of stunting in children under two years of age. Funding World Food Programme, Pakistan.
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Affiliation(s)
- Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gul Nawaz Khan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Arjumand Rizvi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Sajid
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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26
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Mejía-Rodríguez F, Quezada-Sánchez AD, Gómez-Humarán IM, García-Feregrino R, García-Guerra A, Fernández-Gaxiola AC, Neufeld LM. Differential Effects of Three Nutritional Supplements on the Nutrient Intake of Pregnant Women Enrolled in a Conditional Cash Transfer Program in Mexico: A Cluster Randomized Trial. Nutrients 2022; 14:3003. [PMID: 35893857 PMCID: PMC9332738 DOI: 10.3390/nu14153003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
Supplementation in malnourished pregnant women should not displace natural healthy foods. Objective: To estimate the differential effects of three nutritional supplements on macro- and micronutrient intake of pregnant women beneficiaries of the conditional cash transfer program Prospera (CCT-POP). Methods: Prospective cluster randomized trial. Communities were randomly assigned to receive a fortified beverage (Beverage), micronutrient tablets (Tablets), or micronutrient powder (MNP). Pregnant women (at <25 weeks) were recruited. The food frequency questionnaire was applied at 25 and 37 weeks of pregnancy and at one and three months postpartum (mpp). Differential effects of the three supplements on the median change in nutrient intake from baseline to each follow-up stage were estimated. Results: Median change in protein intake from dietary and supplement sources were significantly lower for MNP and Tablets than for Beverages (baseline to 37 w: −7.80 ± 2.90 and −11.54 ± 3.00, respectively; baseline to 1 mpp: −7.34 ± 2.90 for MNP, p < 0.001). Compared to Beverages, median increases were higher for the MNP for vitamins C (31.2 ± 11.7, p < 0.01), E (1.67 ± 0.81, p < 0.05), and B12 (0.83 ± 0.27, p < 0.01) from baseline to 37 wk; from baseline to 1 mpp, there was a higher median increase in B12 (0.55 ± 0.25, p < 0.05) and folate (63.4 ± 24.3, p < 0.01); and from baseline to 3 mpp, a higher median increase in iron (2.38 ± 1.06, p < 0.05) and folate (94.4 ± 38.1, p < 0.05). Conclusions: Intake of micronutrients was higher for MNP and Tablets, likely due to food displacement among Beverage consumers. Although iron bioavailability and absorption inhibitors were not considered for the present analyses, the distribution of Tablets or MNP had several advantages in this context where micronutrient deficiency remains high among pregnant women, but macronutrient intake is generally adequate or even high.
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Affiliation(s)
- Fabiola Mejía-Rodríguez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública (INSP), Universidad N-655, Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca 62100, Mexico; (A.G.-G.); (A.C.F.-G.)
| | - Amado D. Quezada-Sánchez
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública (INSP), Universidad N-655, Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca 62100, Mexico; (A.D.Q.-S.); (R.G.-F.)
| | | | - Raquel García-Feregrino
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública (INSP), Universidad N-655, Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca 62100, Mexico; (A.D.Q.-S.); (R.G.-F.)
| | - Armando García-Guerra
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública (INSP), Universidad N-655, Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca 62100, Mexico; (A.G.-G.); (A.C.F.-G.)
| | - Ana Cecilia Fernández-Gaxiola
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública (INSP), Universidad N-655, Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca 62100, Mexico; (A.G.-G.); (A.C.F.-G.)
| | - Lynnette M. Neufeld
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy;
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27
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Sirkka O, Abrahamse-Berkeveld M, van der Beek EM. Complementary Feeding Practices among Young Children in China, India, and Indonesia: A Narrative Review. Curr Dev Nutr 2022; 6:nzac092. [PMID: 35769448 PMCID: PMC9233619 DOI: 10.1093/cdn/nzac092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
Under- and overnutrition are co-existing health issues in several countries across Asia. Poor complementary feeding (CF) is a significant determinant of malnutrition in children and a major cause of morbidity and mortality. The purpose of this narrative review is to summarize the most recent evidence regarding the CF practices in 3 countries with a high prevalence of stunting and overweight, and currently undergoing rapid economic and nutritional transition: China, India, and Indonesia. We focused particularly on the adequacy of CF, based on the WHO feeding indicators (2021) regarding timing, frequency, diversity, as well as the consumption of specific food groups. According to the findings, the majority of infants in the 3 countries are introduced to CF at an inappropriate time: either too early (particularly in urban/rural areas of China and Indonesia) or too late (India) compared with the WHO recommendation. Furthermore, in all countries, diets are characterized by a low variety and frequency of CF and consist mainly of staple foods with poor nutritional quality, such as rice, cereals, or noodles. Nutrient-dense and protein-rich foods, such as foods of animal origin, are either inadequately consumed (rural areas of China and India) or introduced too late (urban areas of China and Indonesia) in the diets of children. In all countries, the consumption of fruit and vegetables, especially during the early CF period, is poor. In contrast, a significant proportion of both urban and rural children, particularly in Indonesia and India, are consuming energy-dense/nutrient-poor snacks and sugary drinks during the CF period. The described practices may pose a significant risk for the development of energy and/or nutrient gaps, magnifying the double and triple burden of malnutrition present in these countries. Further research is warranted to understand the significance of the observed practices for stunting and/or overweight/obesity risk.
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Affiliation(s)
- Outi Sirkka
- Danone Nutricia Research, Utrecht, The Netherlands
| | | | - Eline M van der Beek
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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28
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Linger Endalifer M, Diress G, Linger Endalifer B, Wagaye B, Almaw H. Does birth season correlate with childhood stunting? An input for astrological nutrition. BMC Pediatr 2022; 22:306. [PMID: 35610626 PMCID: PMC9128290 DOI: 10.1186/s12887-022-03343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Chronic malnutrition is highly prevalent in Sub-Saharan Africa and a severe public health problem in Ethiopia.At country level in the past three decades,the prevalence of stunting is above 40%.Different researchs and intervention were implemented in the past;but the progresss is non-remarkable.Despite; the effect of birth season on childhood chronic malnutrition was not studied yet in Ethiopia. METHODS This research was extracted from the 2016 demographic health survey of Ethiopia. The data was collected based on national and international scientific protocols. A total of 645 enumeration areas were selected for the national survey.The surevey uses two stage stratified sampling technique to gather data from the sampling unit. After excluding non eligible children a total of 8855 participants were included for final analysis.Height and weight were measured based on the standards nutritional assessment procedure.SPSS version 20 was used to analyze the data.Descriptive statistics were used to present the data. Binary and multivariable logistic regression models were regressed to identify the potential predictors.A p-value of less than 0.05 with 95% CI were used to declare an association. RESULT The prevalence of stunting in Ethiopia was 38.7% (95% CI: 36.8, 40.6). Season of birth had a significant association with stunting. The odds of being stunted among children born in the spring season were decreased by 16% as compared to children born in the winter season. CONCLUSION Children born in the spring season were less likely to be stunted (the so called October effect). The clear scientific relation between the season of birth and child anthropometric indicator is not well understood. Nutritional interventions and policies are better to consider the birth season of the child.
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Affiliation(s)
- Melese Linger Endalifer
- Department of Human Nutrition, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Gedefaw Diress
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bedilu Linger Endalifer
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Birhanu Wagaye
- Department of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Hunegnaw Almaw
- Department of Public Health Nutrition and Dietetics, College of Medcine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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29
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Barratt MJ, Ahmed T, Gordon JI. Gut microbiome development and childhood undernutrition. Cell Host Microbe 2022; 30:617-626. [PMID: 35550665 PMCID: PMC9504993 DOI: 10.1016/j.chom.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Forty-five percent of deaths among children under 5 years of age are associated with undernutrition. Globally, almost 200 million children exhibit the two major forms of undernutrition-wasting (low weight-for-height) or stunting (low height-for-age), with many affected by both. Undernutrition is not due to food insecurity alone. Growing evidence indicates that perturbed postnatal gut microbiome development contributes to its pathogenesis. This perspective focuses on defining and repairing these defects in gut microbiome development. We describe an approach that involves the analysis of well-phenotyped human cohorts, followed by preclinical studies using gnotobiotic animals colonized with microbiota from these cohorts. Additionally, these models can be used to identify therapeutic targets and candidates that can then be tested clinically. Furthermore, introducing pretreatment microbiota from trial participants into gnotobiotic animals and re-enacting trial conditions allow mechanisms to be dissected. We highlight these recent advances as well as gaps in existing knowledge that present opportunities for future research.
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Affiliation(s)
- Michael J. Barratt
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University in St. Louis, St. Louis, MO 63110,Center for Gut Microbiome Research, Washington University in St. Louis, St. Louis, MO 63110
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Jeffrey I. Gordon
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University in St. Louis, St. Louis, MO 63110,Center for Gut Microbiome Research, Washington University in St. Louis, St. Louis, MO 63110
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30
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Torlesse H, Murira Z, Hoogendoorn A. Complementary feeding in South Asia: a multi-system analysis of the enabling environment and programme context. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01709-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Abstract
Aim
The links between poor complementary feeding and child malnutrition in South Asia argue for greater attention to improving young children’s diets. This study examined the status of policy and programme actions to support complementary feeding across four systems in South Asia: food, health, social protection, and water, sanitation, and hygiene (WASH).
Methods
We conducted a review to assess the status of national policy and programme actions to improve complementary feeding in children aged 6–23 months in eight South Asian countries across four systems, including the comprehensiveness of the enabling environment and the geographic scale of programmes.
Results
All countries have policy and programme commitments to improving complementary feeding; however, no country has a comprehensive set of legislation, policies, strategies, and plans that fully incorporate relevant global recommendations and guidance. The health system has the strongest enabling environment for complementary feeding, but the lack of supportive legislation, policies, strategies, and plans in other systems may hinder multisystem action. There are few examples of nationwide programmes to improve complementary feeding beyond the health system.
Conclusion
Governments should mobilize their institutions and resources to enable a coherent and multisystem response to complementary feeding that addresses the gaps in legislation, policies, and programmes and the barriers and bottlenecks to implementation at scale, with a focus on the food, health, social protection, and WASH systems. Further operational research is needed on the factors and processes that enable multisystem action to secure nutritious, safe, affordable, and sustainable diets for young children in South Asia.
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Videman K, Hallamaa L, Heimonen O, Mangani C, Luntamo M, Maleta K, Ashorn P, Ashorn U. Child growth and neurodevelopment after maternal antenatal antibiotic treatment. Arch Dis Child 2022; 107:323-328. [PMID: 34479861 PMCID: PMC8938655 DOI: 10.1136/archdischild-2021-322043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess whether intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine (SP) and azithromycin (AZI) in a malaria-endemic area leads to sustained gains in linear growth and development in their offspring. DESIGN Follow-up study of a randomised trial. SETTING Mangochi District in rural southern Malawi. PARTICIPANTS 1320 pregnant women and their offspring. INTERVENTIONS IPTp monthly with SP and twice with AZI (AZI-SP group), monthly with SP but no AZI (monthly SP), or twice with SP (control). No intervention was given to children. MAIN OUTCOME MEASURES Cognitive performance using Raven's Coloured Progressive Matrices (CPM) at 13 years of age; mean height and height-for-age Z-score (HAZ), cumulative incidence and prevalence of stunting (HAZ <-2); weight, body mass index, mid-upper-arm circumference and head circumference. RESULTS At approximately 13 years of age, the mean CPM score was 14.3 (SD 3.8, range 6-29, maximum 36), with no differences between groups. Children in the AZI-SP group were on average 0.4 cm (95% CI -0.9 to 1.7, p=0.6) taller than those in the control group. For cumulative incidence of stunting, the HR in the AZI-SP group was 0.72 (95% CI 0.61 to 0.84, p<0.001) compared with the control and 0.76 (95% CI 0.65 to 0.90, p<0.001) compared with the monthly SP groups. There was no intergroup difference in stunting prevalence or anthropometric measurements. CONCLUSIONS In rural Malawi, maternal intensified infection control during pregnancy reduces offspring's cumulative incidence of ever being stunted by 13 years of age. In this study, there was no evidence of a positive impact on cognitive performance. TRIAL REGISTRATION NUMBER NCT00131235.
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Affiliation(s)
- Karoliina Videman
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland .,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Lotta Hallamaa
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Otto Heimonen
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Charles Mangani
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine Malawi, Blantyre, Malawi
| | - Mari Luntamo
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine Malawi, Blantyre, Malawi
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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Wilianarti PF, Wulandari Y, Ghufron M, Rahman FS. Stunting Prevention in Coastal Family with Health-Promoting Family Approach. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Stunting is a chronic nutritional problem that occurs worldwide, including in Indonesia. The impact of the COVID-19 pandemic has increasingly caused stunting to increase in coastal areas in particular.
AIM: This study aimed to obtain a stunting prevention model with a Health-Promoting Family model approach in coastal families.
METHODS: This study was quantitative research. The population in this study was mothers of toddlers aged 6–48 months in the coastal areas of Pamekasan. The sample in this study was mothers of 135 toddlers in Tlanakan and Talang villages who were selected using a simple random sampling technique. The independent variables are the history of present illness, mother’s knowledge, care patterns, literacy, cultural aspects, and family support—while the dependent variable is family prevention behavior regarding the incidence of stunting. Data collection was carried out by interview method using a questionnaire. Statistical analysis was carried out using the Logistic Regression test (=0.05)
RESULTS: The factors that affect stunting prevention are knowledge p = 0.008 (CI: 1.438–11.780), literacy p = 0.000 (CI: 2.136–17.003), cultural aspects p = 0.00 (CI: 0.039–0.366) and family support p = 0.000 (CI: 1.273–20.498).
CONCLUSION: Knowledge, family support, literacy, and culture affect stunting prevention in families. It takes the collaboration of the community, the government participation in strengthening maternal and child health programs that support the achievement of stunting prevention in families. There are opportunities to research what appropriate forms of literacy in families support the success of stunting prevention in toddlers for further studies.
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Haileselassie M, Redae G, Berhe G, Henry CJ, Nickerson MT, Mulugeta A. The influence of fasting on energy and nutrient intake and their corresponding food sources among 6-23 months old children in rural communities with high burden of stunting from Northern Ethiopia. Nutr J 2022; 21:4. [PMID: 35031028 PMCID: PMC8759242 DOI: 10.1186/s12937-022-00759-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/04/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Limited studies in Ethiopia showed that infants and young children are at high risk of inadequate intake of energy and nutrients. However, inclusive assessment of both nutrient intakes and their food sources are lacking. We aimed at assessing energy and nutrient intakes and their food sources during religious fasting and non-fasting periods among 6-23 months old children in Northern Ethiopia. METHODS Data for this longitudinal study were collected following repeated multiple-pass 24-h dietary recall technique through face-to-face interviews with primary caregivers. Using a two-stage systematic random sampling method, a total of 570 and 551 children participated respectively in the lent fasting and non-fasting periods. Energy and nutrient intakes were estimated and compared with WHO daily requirements. All foods that a child consumed on the day preceding the date of data collection were recorded and processed with database software. Chi-square and t- tests were used to analyze the data. Non-normally distributed data were analyzed using Wilcoxon signed-rank test and statistical significance was set at p < 0.05. RESULTS The overall prevalence of child stunting was 41.4%. Almost all of children (99.6%) consumed grains, roots, and tubers. The inadequacy prevalence of energy, protein and eight selected micronutrients (calcium, iron, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin C) intake were 96.2, 44.9, and 95.5%, respectively. Calcium and zinc were the highest (100%) deficits observed across all age groups. Although consumption of animal source foods (ASFs) was very low (dairy 10.1%, meat 2.3% and eggs 23.6%), there was significantly higher consumption of meat and eggs during the non-fasting compared to fasting period (p < 0.001). CONCLUSIONS Inadequate intake of energy and nutrients was common among 6-23 months old children. Cereals were found to be the main sources of many of the nutrients. The consumption of ASFs among 6-23-month-old children was low which was also affected by the religious fasting period. Hence, strengthening social and behavior change communication, supporting rural households to raise poultry and small ruminants is recommended.
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Affiliation(s)
- Mekonnen Haileselassie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Tigray National Regional State, Bureau of Science and Technology, Mekelle, Tigray, Ethiopia.
| | - Getachew Redae
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebretsadik Berhe
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Carol J Henry
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Michael T Nickerson
- Department of Food and Bioproduct Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Agushybana F, Pratiwi A, Laila Kurnia P, Nandini N, Santoso J, Setyo A. Reducing Stunting Prevalence: Causes, Impacts, and Strategies. BIO WEB OF CONFERENCES 2022. [DOI: 10.1051/bioconf/20225400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The prevalence of stunting in Indonesia was still high at 24.4% based on the 2021 Indonesian Nutritional Status Study, while at 20.9% in Central Java. Policymakers need to make quick and practical decisions to support the creation of an environment that empowers communities in stunting prevention. This current study aimed to describe the cause and effect of stunting and various applicable models of community empowerment in various regions of Indonesia to prevent stunting cases. This study used a qualitative method and focus group discussions (FDG) for data collection. It was conducted in mid-2022. The participants were the technical officers of the provincial government, National Population and Family Planning Board (BKKBN), non-government organizations, nutritionists, child health experts and academicians, as many as 2 participants from each organization selected by the purposive sampling method. The FGD results showed several good practices in some regions. One initiative to replicate is providing stunting prevention training for cadres and mothers of childbearing age and health promotion programs for prospective brides at least three months before marriage. Besides, forming a team for collecting data on prospective brides, and improving the existing recording system is required to reduce stunting prevalence.
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Saleh A, Syahrul S, Hadju V, Andriani I, Restika I. Role of Maternal in Preventing Stunting: a Systematic Review. GACETA SANITARIA 2021; 35 Suppl 2:S576-S582. [PMID: 34929905 DOI: 10.1016/j.gaceta.2021.10.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Currently, stunting is seen as a serious public health problem. Although its prevalence has decreased, the stunting rate is a large number of cases in the world. METHODS A literature search was conducted on electronic databases such as ProQuest, PubMed, ScienceDirect, and Google Scholar to identify relevant published articles from January 1, 2010, to July 1, 2020. Additional articles were identified from the reference lists and grey literature. RESULT Three main phases require the optimal mother roles to prevent stunting in children during the golden phase. These phases include the preconception phase, the prenatal phase, and the infant-toddlerhood phase. Various mother roles include fulfilling maternal, fetal, infant, and child nutrition, carrying out early breastfeeding initiation, exclusive breastfeeding, and appropriate complementary feeding, optimizing the environment for child development, optimizing family support, and avoiding various psychosocial factors that can be detrimental during growth, and child development. CONCLUSION The mother roles in the golden phase are crucial to preventing stunting in children. Although the conception period does not have a fetus, early strengthening of maternal nutrition must be done so that the mother's body is ready to undergo the prenatal phase for fetal development, which then continues in the infant phase - toddlerhood to adolescence.
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Affiliation(s)
- Ariyanti Saleh
- Faculty of Nursing, Hasanuddin University, Makassar, 90245, Indonesia.
| | - Syahrul Syahrul
- Faculty of Nursing, Hasanuddin University, Makassar, 90245, Indonesia
| | - Veni Hadju
- Faculty of Public Health, Hasanuddin University, Makassar, 90245, Indonesia
| | - Irma Andriani
- Faculty of Mathematics and Natural Sciences, Hasanuddin University, Makassar, 90245, Indonesia
| | - Indah Restika
- Faculty of Nursing, Hasanuddin University, Makassar, 90245, Indonesia
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Dewey KG, Wessells KR, Arnold CD, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Bendabenda J, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannotti LL, Jannat K, Lartey A, Le Port A, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:15S-42S. [PMID: 34590672 PMCID: PMC8560308 DOI: 10.1093/ajcn/nqab278] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < -2) by 18%, acute malnutrition (WLZ < -2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < -2) by 13%, and small head size (head circumference-for-age z score < -2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation. CONCLUSIONS The positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Jaden Bendabenda
- Department of Nutrition and Food Safety, WHO, Geneva, Switzerland
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
- Helen Keller International, New York, NY, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Minyanga Nkhoma
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Abebe H, Gashu M, Kebede A, Abata H, Yeshaneh A, Workye H, Adane D. Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia. Ital J Pediatr 2021; 47:215. [PMID: 34717712 PMCID: PMC8557568 DOI: 10.1186/s13052-021-01169-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The health and growth of children less than two years of age can be affected by the poor quality of complementary foods and poor feeding practices even with optimal breastfeeding. In Ethiopia, empirical evidence on the minimum acceptable diet and its associated factors is limited. Therefore, this study was aimed to assess the level of minimum acceptable diet and its associated factors among children aged 6-23 months in Addis Ababa Ethiopia. METHODS An institution-based Cross-sectional study was conducted among a total of 575 mother-child pairs. A simple random sampling technique was used to recruit participants. For infant and young child feeding practices, the data collection tools were adapted from world health organizations' standardized questionnaire which is developed in 2007. Data entry and analysis were performed using EPI data version 3.1 and SPSS version 20 respectively. Bivariable and multivariable logistic regression analyses were performed to determine predictor variables. Statistical significance was declared at p-value < 0.05. RESULT In this study, the level of minimum acceptable diet was found to be 74.6%.. About 90.6 and 80.2% of the children received minimum meal frequency and dietary diversity respectively. Having a husband secondary and above educational level [AOR = 4.789(95%CI:1.917-11.967)], being a housewife [AOR = 0.351(95% CI: 0.150-0.819)], having a history of more than three postnatal follow-ups [AOR = 2.616(95%CI:1.120-6.111], Having mothers age between 25 and 34 years [AOR = 2.051(95%CI:1.267-3.320)], being male child [AOR = 1.585(95%CI:1.052-2.388)] and having children age between 18 and 23 months [AOR = 3.026(95%CI:1.786-5.128)] were some of the factors significantly associated with a minimum acceptable diet. CONCLUSION In this study, the minimum acceptable diet among children aged 6-23 months was significantly associated with the educational status of the husband, mother's occupation, history of postnatal follow-up, age of the mother, sex of the child, and age of the child. Thus, attention should be given to educating the father, empowering mothers to have a job, promoting gender equality of feeding, and counseling on the benefit of postnatal care visits. In addition, the ministry of health should work on educating and advocating the benefit of feeding the recommended minimum acceptable diet to break the intergenerational cycle of malnutrition.
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Affiliation(s)
- Haimanot Abebe
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
| | - Molla Gashu
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | | | - Habtemariam Abata
- Ethiopian Federal food, medicine, and health care administration and control authority offices, Addis Ababa, Ethiopia
| | - Alex Yeshaneh
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Haile Workye
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Daniel Adane
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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Byrd KA, Pincus L, Pasqualino MM, Muzofa F, Cole SM. Dried small fish provide nutrient densities important for the first 1000 days. MATERNAL & CHILD NUTRITION 2021; 17:e13192. [PMID: 33942983 PMCID: PMC8476445 DOI: 10.1111/mcn.13192] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
Inadequate nutrient intakes are prevalent among many populations in sub-Saharan Africa and increasing fish consumption among pregnant/lactating women and children is one strategy to improve diets and address nutrient deficiencies. We report the nutrient content of two fish-based recipes-fish powder and fish chutney-that contain dried small fish available in local markets in Zambia. The contribution of a serving of each recipe to the recommended daily intakes of iron, zinc, calcium and docosahexaenoic acid (DHA) for pregnant/lactating women and children 6-24 months was calculated because these nutrients are commonly deficient in African diets. We found that one 10-g serving of fish powder provides 20% or more of the daily calcium recommendation and 37% or more of the daily DHA recommendation for both pregnant/lactating women and children. A 30-g serving of fish chutney provides over 40% of the daily calcium recommendation for pregnant women and over 50% for lactating women. Additionally, we investigated the nutrient density (nutrients per kilocalorie) of the fish powder and compared it with the nutrient density of a small-quantity lipid-based nutrient supplement plus (SQ-LNS-plus). SQ-LNS-plus is designed to enhance children's diets by providing micronutrients and DHA. Fish powder is similar to SQ-LNS-plus in iron and zinc density and even higher in calcium and DHA density. Consuming dried small fish as part of a daily meal can be a viable strategy for combatting nutrient deficiencies in the first 1000 days.
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Affiliation(s)
| | | | - Monica M Pasqualino
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Steven M Cole
- WorldFish, Lusaka, Zambia
- International Institute of Tropical Agriculture, Dar es Salaam, Tanzania
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Dewey KG, Stewart CP, Wessells KR, Prado EL, Arnold CD. Small-quantity lipid-based nutrient supplements for the prevention of child malnutrition and promotion of healthy development: overview of individual participant data meta-analysis and programmatic implications. Am J Clin Nutr 2021; 114:3S-14S. [PMID: 34590696 PMCID: PMC8560310 DOI: 10.1093/ajcn/nqab279] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
Small-quantity lipid-based nutrient supplements (SQ-LNSs) were designed to provide multiple micronutrients within a food base that also provides energy, protein, and essential fatty acids, targeted towards preventing malnutrition in vulnerable populations. Previous meta-analyses demonstrated beneficial effects of SQ-LNSs on child growth, anemia, and mortality. To further examine the efficacy and effectiveness of SQ-LNSs, and explore study-level and individual-level effect modifiers, we conducted an individual participant data meta-analysis of 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n > 37,000). We examined growth, development, anemia, and micronutrient status outcomes. Children who received SQ-LNSs had a 12-14% lower prevalence of stunting, wasting, and underweight; were 16-19% less likely to score in the lowest decile for language, social-emotional, and motor development; had a 16% lower prevalence of anemia; and had a 64% lower prevalence of iron-deficiency anemia compared with control group children. For most outcomes, beneficial effects of SQ-LNSs were evident regardless of study-level characteristics, including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average reported compliance with SQ-LNSs. For development, the benefits of SQ-LNSs were greater in populations with higher stunting burden, in households with lower socioeconomic status, and among acutely malnourished children. For hemoglobin and iron status, benefits were greater in populations with higher anemia prevalence and among acutely malnourished children, respectively. Thus, targeting based on potential to benefit may be worthwhile for those outcomes. Overall, co-packaging SQ-LNSs with interventions that reduce constraints on response, such as the prevention and control of prenatal and child infections, improving health care access, and promotion of early child development, may lead to greater impact. Policymakers and program planners should consider including SQ-LNSs in strategies to reduce child mortality, stunting, wasting, anemia, iron deficiency, and delayed development. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592, CRD42020159971, and CRD42020156663.
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Affiliation(s)
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Wessells KR, Arnold CD, Stewart CP, Prado EL, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn P, Ashorn U, Becquey E, Brown KH, Byrd KA, Campbell RK, Christian P, Fernald L, Fan YM, Galasso E, Hess SY, Huybregts L, Jorgensen JM, Kiprotich M, Kortekangas E, Lartey A, Le Port A, Leroy JL, Lin A, Maleta K, Matias SL, Mbuya M, Mridha MK, Mutasa K, Naser AM, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Rahman M, Schulze K, Smith LE, Weber AM, Zongrone A, Dewey KG. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:68S-94S. [PMID: 34590114 PMCID: PMC8560313 DOI: 10.1093/ajcn/nqab276] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Small-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers. RESULTS SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics. CONCLUSIONS SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.
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Affiliation(s)
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA,Helen Keller International, New York, NY, USA
| | | | - Rebecca K Campbell
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yue-Mei Fan
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Josh M Jorgensen
- Nutrition Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Emma Kortekangas
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Audrie Lin
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Abu M Naser
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh,Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Mahbubur Rahman
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Kerry Schulze
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Smith
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Gene expression profiles compared in environmental and malnutrition enteropathy in Zambian children and adults. EBioMedicine 2021; 70:103509. [PMID: 34333236 PMCID: PMC8346547 DOI: 10.1016/j.ebiom.2021.103509] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Environmental enteropathy (EE) contributes to growth failure in millions of children worldwide, but its relationship to clinical malnutrition has not been elucidated. We used RNA sequencing to compare duodenal biopsies from adults and children with EE, and from children with severe acute malnutrition (SAM), to define key features of these malnutrition-related enteropathies. METHODS RNA was extracted and sequenced from biopsies of children with SAM in hospital (n=27), children with non-responsive stunting in the community (n=30), and adults living in the same community (n=37) using an identical sequencing and analysis pipeline. Two biopsies each were profiled and differentially expressed genes (DEGs) were computed from the comparisons of the three groups. DEG lists from these comparisons were then subjected to analysis with CompBio software to assemble a holistic view of the biological landscape and IPA software to interrogate canonical pathways. FINDINGS Dysregulation was identified in goblet cell/mucin production and xenobiotic metabolism/detoxification for both cohorts of children, versus adults. Within the SAM cohort, substantially greater induction of immune response and barrier function, including NADPH oxidases was noted, concordant with broadly reduced expression of genes associated with the brush border and intestinal structure/transport/absorption. Interestingly, down regulation of genes associated with the hypothalamic-pituitary-adrenal axis was selectively observed within the cohort of children with stunting. INTERPRETATION Gene expression profiles in environmental enteropathy and severe acute malnutrition have similarities, but SAM has several distinct transcriptional features. The intestinal capacity to metabolise drugs and toxins in malnourished children requires further study. FUNDING Bill & Melinda Gates Foundation (OPP1066118).
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Knez M, Stangoulis JCR. Calcium Biofortification of Crops-Challenges and Projected Benefits. FRONTIERS IN PLANT SCIENCE 2021; 12:669053. [PMID: 34335646 PMCID: PMC8323714 DOI: 10.3389/fpls.2021.669053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
Despite Calcium (Ca) being an essential nutrient for humans, deficiency of Ca is becoming an ensuing public health problem worldwide. Breeding staple crops with higher Ca concentrations is a sustainable long-term strategy for alleviating Ca deficiency, and particular criteria for a successful breeding initiative need to be in place. This paper discusses current challenges and projected benefits of Ca-biofortified crops. The most important features of Ca nutrition in plants are presented along with explicit recommendations for additional exploration of this important issue. In order for Ca-biofortified crops to be successfully developed, tested, and effectively implemented in most vulnerable populations, further research is required.
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Affiliation(s)
- Marija Knez
- College of Science and Engineering, Flinders University, Adelaide, SA, Australia
- Centre of Research Excellence in Nutrition and Metabolism, National Institute for Medical Research, University of Belgrade, Belgrade, Serbia
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Madzorera I, Ghosh S, Wang M, Fawzi W, Isanaka S, Hertzmark E, Namirembe G, Bashaasha B, Agaba E, Turyashemererwa F, Webb P, Duggan C. Prenatal dietary diversity may influence underweight in infants in a Ugandan birth-cohort. MATERNAL & CHILD NUTRITION 2021; 17:e13127. [PMID: 33595899 PMCID: PMC8189249 DOI: 10.1111/mcn.13127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022]
Abstract
Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed (NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD-W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0-4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.
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Affiliation(s)
- Isabel Madzorera
- Department of NutritionHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Shibani Ghosh
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- USAID Feed the Future Innovation Lab for NutritionTufts UniversityBostonMassachusettsUSA
| | - Molin Wang
- Departments of Epidemiology and Biostatistics, Channing Division of Network MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Wafaie Fawzi
- Department of NutritionHarvard TH Chan School of Public HealthBostonMassachusettsUSA
- Department of Global Health and PopulationHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Sheila Isanaka
- Department of NutritionHarvard TH Chan School of Public HealthBostonMassachusettsUSA
- Department of Global Health and PopulationHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Ellen Hertzmark
- Department of Global Health and PopulationHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Grace Namirembe
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Bernard Bashaasha
- Department of Agribusiness and Natural Resource Economics, College of Agricultural and Environmental SciencesMakerere UniversityKampalaUganda
| | - Edgar Agaba
- USAID Feed the Future Innovation Lab for NutritionTufts UniversityBostonMassachusettsUSA
| | - Florence Turyashemererwa
- Department of Agribusiness and Natural Resource Economics, College of Agricultural and Environmental SciencesMakerere UniversityKampalaUganda
| | - Patrick Webb
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- USAID Feed the Future Innovation Lab for NutritionTufts UniversityBostonMassachusettsUSA
| | - Christopher Duggan
- Department of NutritionHarvard TH Chan School of Public HealthBostonMassachusettsUSA
- Division of Gastroenterology, Hepatology and NutritionBoston Children's HospitalBostonMassachusettsUSA
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Mapping Geographical Differences and Examining the Determinants of Childhood Stunting in Ethiopia: A Bayesian Geostatistical Analysis. Nutrients 2021; 13:nu13062104. [PMID: 34205375 PMCID: PMC8234472 DOI: 10.3390/nu13062104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
Understanding the specific geographical distribution of stunting is essential for planning and implementing targeted public health interventions in high-burdened countries. This study investigated geographical variations in the prevalence of stunting sub-nationally, and the determinants of stunting among children under 5 years of age in Ethiopia. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) dataset for children aged 0–59 months with valid anthropometric measurements and geographic coordinates (n = 9089). We modelled the prevalence of stunting and its determinants using Bayesian geospatially explicit regression models. The prevalence of stunting among children under five years was 36.3% (95% credible interval (CrI); 22.6%, 51.4%) in Ethiopia, with wide variations sub-nationally and by age group. The prevalence of childhood stunting ranged from 56.6% (37.4–74.6%) in the Mekelle Special zone of the Tigray region to 25.5% (10.5–48.9%) in the Sheka zone of the Southern Nations, Nationalities and Peoples region. Factors associated with a reduced likelihood of stunting in Ethiopia included non-receipt of breastmilk, mother’s BMI (overweight/obese), employment status (employed), and higher household wealth, while the enablers were residence in the “arid” geographic areas, small birth size of the child, and mother’s BMI (underweight). The prevalence and determinants of stunting varied across Ethiopia. Efforts to reduce the burden of childhood stunting should consider geographical heterogeneity and modifiable risk factors.
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Rahmawati W, Willcox JC, van der Pligt P, Worsley A. Nutrition information-seeking behaviour of Indonesian pregnant women. Midwifery 2021; 100:103040. [PMID: 34077814 DOI: 10.1016/j.midw.2021.103040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate Indonesian pregnant women's experiences in seeking and receiving nutrition information. DESIGN Qualitative semi-structured interviews analysed with thematic analysis. SETTING AND PARTICIPANTS Twenty-three pregnant women in Malang City, Indonesia were interviewed between December 2018 and January 2019. FINDINGS Four key themes emerged concerning pregnant women's nutrition information-seeking behaviour: (i) Most women passively received nutrition information rather than actively seeking it; (ii) Women sought and received nutrition information from multiple sources including health professionals, social networks and the Internet, with varying levels of trust; (iii) Health professionals, including doctors, midwives and nutritionists, did not provide consistent and timely information; and (iv) Most women could identify gaps between nutrition information provided by health professionals and their expectations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study identified opportunities for Indonesian health authorities to enhance their nutrition education services. This study suggests improvements that could extend the systematic provision of nutrition education to meet the needs of pregnant women in developing countries.
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Affiliation(s)
- Widya Rahmawati
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Victoria, Australia; Department of Nutrition Science, Faculty of Medicine, Universitas Brawijaya, Malang 65145, East Java, Indonesia.
| | - Jane C Willcox
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora 3083, Victoria, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Institute of Health Transformation, School of Nursing & Midwifery, Deakin University, Burwood 3125, Victoria, Australia; School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia Brisbane 4072, Australia.
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Victoria, Australia.
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Victoria, Australia.
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Sumiati, Arsin AA, Syafar M. Determinants of stunting in children under five years of age in the Bone regency. ENFERMERIA CLINICA 2021. [PMID: 32545090 DOI: 10.1016/j.enfcli.2019.10.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aims to determine the relationship between antenatal care history and the number of family members in the incidence of stunting in infants aged 6-59 months. METHODS This type of research is a cross sectional observational study in the Palakka Kahu District Health Center Working Area Bone involving 165 children selected proportionally cluster random sampling. The instrument of this research was using questionnaires and baby length board height measurements. The analysis used univariate, bivariate (chi-square test). RESULTS The results of this study indicate that based on the characteristics of toddlers obtained that male sex 53.94%, female 46.06%, the average age group of infants aged 6-15 months 20.61%, normal birth weight 70.30%, Low Birth Weight 29.70%. It is suggested that improving performance should be more active in visiting pregnant women and providing education about pregnancy and family members should help in paying attention to parenting children to avoid stunting. CONCLUSION There is a relationship between Pregnancy Examination History and the incidence of stunting in children aged 6-59 months in the Work Area of Palakka Kahu Community Health Center in Bone Regency and there is no relationship between the number of family members and stunting in children aged 6-59 months in the Peskesmas Work Area Palakka Kahu Bone Regency.
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Affiliation(s)
- Sumiati
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Indonesia
| | - A Arsunan Arsin
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Indonesia.
| | - Muhammad Syafar
- Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Hasanuddin University, Indonesia
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Chen RY, Mostafa I, Hibberd MC, Das S, Mahfuz M, Naila NN, Islam M, Huq S, Alam M, Zaman MU, Raman AS, Webber D, Zhou C, Sundaresan V, Ahsan K, Meier MF, Barratt MJ, Ahmed T, Gordon JI. A Microbiota-Directed Food Intervention for Undernourished Children. N Engl J Med 2021; 384:1517-1528. [PMID: 33826814 PMCID: PMC7993600 DOI: 10.1056/nejmoa2023294] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND More than 30 million children worldwide have moderate acute malnutrition. Current treatments have limited effectiveness, and much remains unknown about the pathogenesis of this condition. Children with moderate acute malnutrition have perturbed development of their gut microbiota. METHODS In this study, we provided a microbiota-directed complementary food prototype (MDCF-2) or a ready-to-use supplementary food (RUSF) to 123 slum-dwelling Bangladeshi children with moderate acute malnutrition between the ages of 12 months and 18 months. The supplementation was given twice daily for 3 months, followed by 1 month of monitoring. We obtained weight-for-length, weight-for-age, and length-for-age z scores and mid-upper-arm circumference values at baseline and every 2 weeks during the intervention period and at 4 months. We compared the rate of change of these related phenotypes between baseline and 3 months and between baseline and 4 months. We also measured levels of 4977 proteins in plasma and 209 bacterial taxa in fecal samples. RESULTS A total of 118 children (59 in each study group) completed the intervention. The rates of change in the weight-for-length and weight-for-age z scores are consistent with a benefit of MDCF-2 on growth over the course of the study, including the 1-month follow-up. Receipt of MDCF-2 was linked to the magnitude of change in levels of 70 plasma proteins and of 21 associated bacterial taxa that were positively correlated with the weight-for-length z score (P<0.001 for comparisons of both protein and bacterial taxa). These proteins included mediators of bone growth and neurodevelopment. CONCLUSIONS These findings provide support for MDCF-2 as a dietary supplement for young children with moderate acute malnutrition and provide insight into mechanisms by which this targeted manipulation of microbiota components may be linked to growth. (Supported by the Bill and Melinda Gates Foundation and the National Institutes of Health; ClinicalTrials.gov number, NCT04015999.).
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Affiliation(s)
- Robert Y. Chen
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Ishita Mostafa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Matthew C. Hibberd
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University in St. Louis
School of Medicine, St Louis, MO 63110 USA
| | - Subhasish Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Mustafa Mahfuz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Nurun N. Naila
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Md.Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Sayeeda Huq
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Md.Ashraful Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Mahabub Uz Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Arjun S. Raman
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University in St. Louis
School of Medicine, St Louis, MO 63110 USA
| | - Daniel Webber
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University in St. Louis
School of Medicine, St Louis, MO 63110 USA
| | - Cyrus Zhou
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Vinaik Sundaresan
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Kazi Ahsan
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Martin F. Meier
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
| | - Michael J. Barratt
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University in St. Louis
School of Medicine, St Louis, MO 63110 USA
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b),
Dhaka 1212, Bangladesh
| | - Jeffrey I. Gordon
- Edison Family Center for Genome Sciences and Systems Biology, Washington
University School of Medicine, St. Louis, MO 63110 USA
- Center for Gut Microbiome and Nutrition Research, Washington University
School of Medicine, St. Louis, MO 63110 USA
- Department of Pathology and Immunology, Washington University in St. Louis
School of Medicine, St Louis, MO 63110 USA
- Address correspondence to:
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Heidkamp RA, Piwoz E, Gillespie S, Keats EC, D'Alimonte MR, Menon P, Das JK, Flory A, Clift JW, Ruel MT, Vosti S, Akuoku JK, Bhutta ZA. Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: an agenda for action. Lancet 2021; 397:1400-1418. [PMID: 33691095 DOI: 10.1016/s0140-6736(21)00568-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition. The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries. This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade. Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments. To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda-now amplified by the COVID-19 crisis.
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Affiliation(s)
| | - Ellen Piwoz
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Stuart Gillespie
- International Food Policy Research Institute, Washington, DC, USA
| | - Emily C Keats
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Purnima Menon
- International Food Policy Research Institute, Delhi, India
| | - Jai K Das
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | | | - Marie T Ruel
- International Food Policy Research Institute, Washington, DC, USA
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, and Institute for Global Nutrition, University of California, Davis, CA, USA
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
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Kulkarni S, Frongillo EA, Cunningham K, Moore S, Blake CE. Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal. J Nutr 2021; 151:1018-1024. [PMID: 33693922 DOI: 10.1093/jn/nxaa399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/09/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. OBJECTIVES We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). METHODS We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0-59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering. RESULTS Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (β: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (β: 0.233, P < 0.001) and the model with women's and men's domains (β: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (β: -0.0503, P = 0.014) and in the model with women's and men's domains (β: -0.056, P = 0.008). Household decision making for women (β: -0.0631, P = 0.007) and for men (β: -0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ. CONCLUSIONS Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.
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Affiliation(s)
- Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kenda Cunningham
- Hellen Keller International, Kathmandu, Nepal.,London School of Hygiene and Tropical Medicine, Department of Population Health, Faculty of Epidemiology, London, United Kingdom
| | - Spencer Moore
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christine E Blake
- Department of Health Promotion, Education, and Behavior; Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Permatasari TAE, Rizqiya F, Kusumaningati W, Suryaalamsah II, Hermiwahyoeni Z. The effect of nutrition and reproductive health education of pregnant women in Indonesia using quasi experimental study. BMC Pregnancy Childbirth 2021; 21:180. [PMID: 33663418 PMCID: PMC7934425 DOI: 10.1186/s12884-021-03676-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost one-third of children under 5 years old in Indonesia suffer from stunting. Stunting can be prevented optimally during pregnancy as the initial phase of the first 1000 days of life. This study aims to determine the effect of nutrition and reproductive health education of pregnant women in Bogor Regency, Indonesia. METHODS A quasi-experimental study was conducted among 194 pregnant women from August to November 2019. The pregnant women were randomly selected from four different villages in Bogor Regency. The intervention group (n = 97) received 2 h of nutrition and reproductive health education in small groups (four or five mothers per group) every 2 weeks for 3 consecutive months. This interactive education was given by facilitators using techniques such as lectures, role-playing, simulation, and games. The control group (n = 97) received regular health care services. A structured questionnaire was applied to collect data consisting of maternal characteristics, nutritional and reproductive health knowledge, attitudes, and practices in the intervention and control groups. Data were analysed using t-test and chi-square analysis. RESULTS Pregnant women in the intervention group indicated a significant increase in knowledge, attitudes, and practices regarding nutrition and reproductive health after receiving education. The pre-test and post-test mean scores in the intervention group were 55.1 and 83.1 for overall knowledge, 40.2 and 49.0 for attitudes, and 36.2 and 40.2 for practices, respectively. In the control group, there was no significant difference between the pre-test and post-test mean scores for these three variables. There was a significant difference (P < 0.001) in the post-test mean between the intervention group and the control group, but the difference was not significant (P > 0.05) in the pre-test. CONCLUSION Providing nutrition and reproductive health education through small groups with interactive methods improves the knowledge, attitudes, and practices of pregnant women. This intervention has the potential to be replicated and developed for large-scale implementation by optimising collaboration between government, non-governmental organizations, and maternal and child health service providers.
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Affiliation(s)
- Tria Astika Endah Permatasari
- Department of Nutrition, Faculty of Medicine and Health, Universitas Muhammadiyah Jakarta, Central Jakarta, 10510, Indonesia.
| | - Fauza Rizqiya
- Department of Nutrition, Faculty of Medicine and Health, Universitas Muhammadiyah Jakarta, Central Jakarta, 10510, Indonesia
| | - Walliyana Kusumaningati
- Department of Nutrition, Faculty of Medicine and Health, Universitas Muhammadiyah Jakarta, Central Jakarta, 10510, Indonesia
| | - Inne Indraaryani Suryaalamsah
- Department of Nutrition, Faculty of Medicine and Health, Universitas Muhammadiyah Jakarta, Central Jakarta, 10510, Indonesia
| | - Zahrofa Hermiwahyoeni
- Central of the National Population and Family Planning Agency, East Jakarta, 13650, Indonesia
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