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Jana A, Singh A, Adar SD, D'Souza J, Chattopadhyay A. In-utero exposure to multiple air pollutants and childhood undernutrition in India. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00591-5. [PMID: 37563211 DOI: 10.1038/s41370-023-00591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Several studies have been conducted to understand the impact of socioeconomic and maternal factors on child undernutrition. However, the past literature has not directly examined the joint impacts of fuel use and ambient pollution and have primarily focused on PM2.5. OBJECTIVE This study explored the individual and community-level associations of both indoor (cooking fuel type) and ambient air pollution (PM2.5, NO2 and SO2) during maternal gestation on child undernutrition. METHODS This study analysed stunting, being underweight, and anaemia of children aged 0-59 months (n = 259,627) using the National Family Health Survey. In-utero exposures to ambient PM2.5, NO2, and SO2 were measured using satellite data and self-reported fuel type was a marker of indoor pollution exposure. The study used univariate and bivariate Moran's I, spatial lag model and multivariable logistic regression models after adjusting for other covariates to understand the effect of pollution on in-utero exposure and child health status at the individual and community-levels. RESULTS Higher concentration of indoor and ambient air pollution was found in the Northern and parts of Central regions of India. Estimates of spatial modelling show that each 1 μg/m-3 increase in maternal exposure to ambient PM2.5 across the clusters of India was associated with a 0.11, 9 and 19 percentage points increase in the prevalence of stunting, underweight and anaemia, respectively. The results of multi-pollutant model show that a higher ambient PM2.5 exposure during pregnancy was linked to higher odds of stunting (AOR:1.38; 95% CI:1.32-1.44), underweight (AOR:1.59; 95% CI:1.51-1.67) and anaemia (AOR:1.61; 95% CI:1.52-1.69) in children. Weaker but similar associations were observed for NO2, but not with SO2. Indoor pollution exposure during in-utero periods was also significantly associated with childhood undernutrition and this association was modified by ambient PM2.5 levels, where exposure to both indoor and ambient air pollution had even greater odds of being undernourished. IMPACT STATEMENT Our research on multi-pollutant models has revealed the initial proof of the individual impacts of indoor and outdoor pollution (PM2.5, NO2, and SO2) exposure during fetal development on children's nutrition.
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Affiliation(s)
- Arup Jana
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Akancha Singh
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India
| | - Sara D Adar
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Jennifer D'Souza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Aparajita Chattopadhyay
- Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
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Santos IS, Costa CS, Hills AP, Ariff S, Wickramasinghe VP, Norris S, Murphy-Alford AJ, Slater C, Lucas N, Nyati LH, Kurpad AV, Ahuja KDK, Kuriyan R. Infant body composition at 6 and 24 months: what are the driving factors? Eur J Clin Nutr 2023:10.1038/s41430-023-01321-8. [PMID: 37563230 DOI: 10.1038/s41430-023-01321-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND/OBJECTIVE Available evidence on infant body composition is limited. This study aimed to investigate factors associated with body composition at 6 and 24 months. SUBJECTS/METHODS Multicenter study with data from a 0 to 6-mo cohort (Australia, India and South Africa) and a 3 to 24-mo cohort (Brazil, Pakistan, South Africa, and Sri Lanka). For the 0-6-mo cohort, body composition was assessed by air-displacement plethysmography (ADP) and for the 3-24-month cohort by the deuterium dilution (DD) technique. Fat mass (FM), fat-free mass (FFM), FM index (FMI), and FFM index (FFMI) were calculated. Independent variables comprised the Gini index of the country, maternal and infant characteristics, and breastfeeding pattern at 3 months. For the 3-24-mo cohort, breastfeeding, and minimum dietary diversity (MDD) at 12 months were also included. Crude and adjusted analyses stratified by sex were conducted by multilevel modelling using mixed models. RESULTS At 6 months, every 1 kg increase in birth weight was associated with an increase of 0.716 kg in FFM and 0.582 kg/m2 in FFMI in girls, whereas in boys, the increase was of 0.277 kg in FFM. At 24 months, compared to those weaned before 12 months, girls still breastfed at 12 months presented a decrease of 0.225 kg in FM, 0.645 kg in FFM and 0.459 kg/m2 in FFMI, and in boys the decreases were of 0.467 kg in FM, 0.603 kg in FFM and 0.628 kg/m2 in FFMI. CONCLUSION Birth weight and breastfeeding are independent predictors of body composition in early life, irrespective of sex.
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Affiliation(s)
| | | | | | | | | | - Shane Norris
- University of the Witwatersrand, Johannesburg, South Africa
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103
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Hills AP, Norris SA, Byrne NM, Jayasinghe S, Murphy-Alford AJ, Loechl CU, Ismail LIC, Kurpad AV, Kuriyan R, Nyati LH, Santos IS, Costa CS, Wickramasinghe VP, Lucas MN, Slater C, Yameen A, Ariff S. Body composition from birth to 2 years. Eur J Clin Nutr 2023:10.1038/s41430-023-01322-7. [PMID: 37563231 DOI: 10.1038/s41430-023-01322-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
Providing all infants with the best start to life is a universal but challenging goal for the global community. Historically, the size and shape of infants, quantified by anthropometry and commencing with birthweight, has been the common yardstick for physical growth and development. Anthropometry has long been considered a proxy for nutritional status during infancy when, under ideal circumstances, changes in size and shape are most rapid. Developed from data collected in the Multicentre Growth Reference Study (MGRS), WHO Child Growth Standards for healthy infants and children have been widely accepted and progressively adopted. In contrast, and somewhat surprisingly, much less is understood about the 'quality' of growth as reflected by body composition during infancy. Recent advances in body composition assessment, including the more widespread use of air displacement plethysmography (ADP) across the first months of life, have contributed to a progressive increase in our knowledge and understanding of growth and development. Along with stable isotope approaches, most commonly the deuterium dilution (DD) technique, the criterion measure of total body water (TBW), our ability to quantify lean and fat tissue using a two-compartment model, has been greatly enhanced. However, until now, global reference charts for the body composition of healthy infants have been lacking. This paper details some of the historical challenges associated with the assessment of body composition across the first two years of life, and references the logical next steps in growth assessments, including reference charts.
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Affiliation(s)
| | - Shane A Norris
- University of the Witwatersrand, Johannesburg, South Africa
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Leila I Cheikh Ismail
- University of Sharjah, Sharjah, United Arab Emirates
- University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | | | | | | - Ayesha Yameen
- Pakistan Institute of Nuclear Science and Technology (PINSTECH), Nilore, Pakistan
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104
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Sherer EL, Bello Trujillo AM. Barriers to adequate nutrition in pregnant adolescent Colombian females. Int J Adolesc Med Health 2023; 35:291-297. [PMID: 37387606 DOI: 10.1515/ijamh-2023-0060] [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: 04/28/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
Pregnant adolescent females face nutritional challenges. The nutritional demands of a growing fetus, when added to the requirements for growing adolescent bodies, are risk factors for undernutrition. An adolescent expectant mother's nutritional status therefore affects both the mother's and the child's future growth, development, and potential development of diseases later in life. In Colombia, the rate of female adolescent pregnancies is higher than neighboring countries and the global average. The most recent data suggest that approximately 21 % of all pregnant adolescent females in Colombia are underweight, 27 % suffer from anemia, 20 % suffer from vitamin D deficiency, and 19 % suffer from vitamin B12 deficiency. Contributing factors to these nutritional deficiencies during pregnancy may be the region in which the female lives, the female's ethnicity, and the female's socioeconomic and educational status. In rural parts of Colombia, limitations regarding access to prenatal care and food choices that include animal source proteins may also contribute to nutritional deficiencies. To help remedy this, recommendations include encouraging nutrient dense food sources with higher protein content, eating one additional meal per day, and taking a prenatal vitamin throughout the pregnancy. Making healthy eating choices can be difficult for adolescent females with limited resources and education; therefore, it is recommended that discussions about nutrition begin at the first prenatal visit for optimum benefits. These factors should be considered for the development of future health policies and interventions in Colombia and other low-income and middle-income countries where pregnant adolescent females may be experiencing similar nutritional deficiencies.
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105
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Prado EL, Adu-Afarwuah S, Arnold CD, Adjetey E, Amponsah B, Bentil H, Dewey KG, Guyer AE, Manu A, Mensah M, Oaks BM, Ocansey M, Tan X, Hastings PD. Prenatal and postnatal small-quantity lipid-based nutrient supplements and children's social-emotional difficulties at ages 9-11 y in Ghana: follow-up of a randomized controlled trial. Am J Clin Nutr 2023; 118:433-442. [PMID: 37257564 PMCID: PMC10447494 DOI: 10.1016/j.ajcnut.2023.05.025] [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: 11/21/2022] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) during early life improves growth and development. In the International Lipid-Based Nutrient Supplements DYAD-Ghana trial, prenatal and postnatal SQ-LNS reduced social-emotional difficulties at age 5 y, with greater effects among children in less-enriched home environments. OBJECTIVES We aimed to investigate the effect of prenatal and postnatal SQ-LNS on children's social-emotional problems at age 9-11 y. METHODS In 2009-2011, 1320 pregnant women ≤20 wk gestation were randomly assigned to receive the following daily until 6 mo postpartum: 1) iron and folic acid until delivery, then placebo, 2) multiple micronutrients (MMNs), or 3) SQ-LNS (20 g/d). Children in group 3 received SQ-LNS from 6 to 18 mo. In 2021, we evaluated children's social-emotional outcomes with 6 assessment tools that used caregiver, teacher, and/or self-report to measure socioemotional difficulties, conduct problems, temperament, mood, anxiety, and emotion management. RESULTS We assessed outcomes in 966 children, comprising 79.4% of 1217 participants eligible for re-enrolment. No significant differences were found between the SQ-LNS and control (non-LNS groups combined) groups. Few children (<2%) experienced high parent-reported social-emotional difficulties at 9-11 y, in contrast to the high prevalence at age 5 in this cohort (25%). Among children in less-enriched early childhood home environments, the SQ-LNS group had 0.37 SD (-0.04 to 0.82) lower self-reported conduct problems than the control group (P-interaction = 0.047). CONCLUSIONS Overall positive effects of SQ-LNS on social-emotional development previously found at age 5 y are not sustained to age 9-11 y; however, there is some evidence of positive effects among children in less-enriched environments. The lack of effects may be owing to low prevalence of social-emotional problems at preadolescence, resulting in little potential to benefit from early nutritional intervention at this age in this outcome domain. Follow-up during adolescence, when social-emotional problems more typically onset, may yield further insights. This trial was registered at clinicaltrials.gov as NCT00970866. https://clinicaltrials.gov/ct2/show/record/NCT00970866.
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Affiliation(s)
- Elizabeth L Prado
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA.
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Charles D Arnold
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Ebenezer Adjetey
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | | | - Helena Bentil
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Amanda E Guyer
- Center for Mind and Brain, University of California-Davis, Davis, CA, USA; Department of Human Ecology, University of California-Davis, Davis, CA, USA
| | - Adom Manu
- Public Health, University of Ghana, Accra, Ghana
| | - Mavis Mensah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | | | - Xiuping Tan
- Institute for Global Nutrition, Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Paul D Hastings
- Center for Mind and Brain, University of California-Davis, Davis, CA, USA; Department of Psychology, University of California-Davis, Davis, CA, USA
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106
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Jaćimović S, Kiprovski B, Ristivojević P, Dimić D, Nakarada Đ, Dojčinović B, Sikora V, Teslić N, Pantelić NĐ. Chemical Composition, Antioxidant Potential, and Nutritional Evaluation of Cultivated Sorghum Grains: A Combined Experimental, Theoretical, and Multivariate Analysis. Antioxidants (Basel) 2023; 12:1485. [PMID: 37627480 PMCID: PMC10451854 DOI: 10.3390/antiox12081485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Sorghum grain (Sorghum bicolor L. Moench) is a gluten-free cereal with excellent nutritional value and is a good source of antioxidants, including polyphenols, as well as minerals with proven health benefits. Herein, the phenolic composition, elemental profile, and antioxidant activity of sixteen food-grade sorghum grains (S1-S16) grown under agroecological conditions in Serbia were determined. Nine phenolic compounds characteristic of sorghum grains, such as luteolinidin, 5-methoxyluteolinidin, luteolidin derivative, luteolidin glucoside, apigeninidin, 7-methoxyapigeninidin, apigeninidin glucoside, and cyanidin derivative, were quantified. The antioxidant potential of the analyzed sorghum grains was evaluated by UV/Vis (DPPH, ABTS, and FRAP) and Electron Paramagnetic Resonance spectroscopy (hydroxyl and ascorbyl radical scavenging assays). The content of macro- and microelements was determined by Inductively Coupled Plasma Optical Emission spectroscopy. Theoretical daily intakes of selected major and trace elements were assessed and compared with the Recommended Daily Allowance or Adequate Intake. Sample S8 had the highest amount of phenolic compounds, while S4, S6, and S8 exhibited the strongest antioxidative potential. The sorghum studied could completely satisfy the daily needs of macro- (K, Mg, and P) and microelements (Se, Zn, Fe). Pattern recognition techniques confirmed the discrimination of samples based on phenolic profile and elemental analysis and recognized the main markers responsible for differences between the investigated samples. The reaction between hydroxyl radicals and luteolinidin/apigeninidin was investigated by Density Functional Theory and thermodynamically preferred mechanism was determined.
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Affiliation(s)
- Simona Jaćimović
- Institute of Field and Vegetable Crops, National Institute of the Republic of Serbia, Maksima Gorkog 30, 21000 Novi Sad, Serbia; (S.J.); (B.K.); (V.S.)
| | - Biljana Kiprovski
- Institute of Field and Vegetable Crops, National Institute of the Republic of Serbia, Maksima Gorkog 30, 21000 Novi Sad, Serbia; (S.J.); (B.K.); (V.S.)
| | - Petar Ristivojević
- Department of Analytical Chemistry, Faculty of Chemistry, University of Belgrade, Studentski trg 12-16, 11158 Belgrade, Serbia;
| | - Dušan Dimić
- Faculty of Physical Chemistry, University of Belgrade, Studentski trg 12-16, 11000 Belgrade, Serbia; (D.D.); (Đ.N.)
| | - Đura Nakarada
- Faculty of Physical Chemistry, University of Belgrade, Studentski trg 12-16, 11000 Belgrade, Serbia; (D.D.); (Đ.N.)
| | - Biljana Dojčinović
- Department of Chemistry, Institute of Chemistry, Technology and Metallurgy, University of Belgrade, Studentski trg 14, 11000 Belgrade, Serbia;
| | - Vladimir Sikora
- Institute of Field and Vegetable Crops, National Institute of the Republic of Serbia, Maksima Gorkog 30, 21000 Novi Sad, Serbia; (S.J.); (B.K.); (V.S.)
| | - Nemanja Teslić
- Institute of Food Technology, University of Novi Sad, Bulevar cara Lazara 1, 21000 Novi Sad, Serbia;
| | - Nebojša Đ. Pantelić
- Department of Chemistry and Biochemistry, Faculty of Agriculture, University of Belgrade, Nemanjina 6, 11080 Belgrade, Serbia
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107
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Jhaveri NR, Poveda NE, Kachwaha S, Comeau DL, Nguyen PH, Young MF. Opportunities and barriers for maternal nutrition behavior change: an in-depth qualitative analysis of pregnant women and their families in Uttar Pradesh, India. Front Nutr 2023; 10:1185696. [PMID: 37469540 PMCID: PMC10352842 DOI: 10.3389/fnut.2023.1185696] [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: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
Background Maternal undernutrition during pregnancy remains a critical public health issue in India. While evidence-based interventions exist, poor program implementation and limited uptake of behavior change interventions make addressing undernutrition complex. To address this challenge, Alive & Thrive implemented interventions to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India. Objective This qualitative study aimed to: (1) examine pregnant women's experiences of key nutrition-related behaviors (ANC attendance, consuming a diverse diet, supplement intake, weight gain monitoring, and breastfeeding intentions); (2) examine the influence of family members on these behaviors; and (3) identify key facilitators and barriers that affect behavioral adoption. Methods We conducted a qualitative study with in-depth interviews with 24 pregnant women, 13 husbands, and 15 mothers-in-law (MIL). We analyzed data through a thematic approach using the Capability-Opportunity-Motivation-Behavior (COM-B) framework. Results For ANC checkups and maternal weight gain monitoring, key facilitators were frontline worker home visits, convenient transportation, and family support, while the primary barrier was low motivation and lack understanding of the importance of ANC checkups. For dietary diversity, there was high reported capability (knowledge related to the key behavior) and most family members were aware of key recommendations; however, structural opportunity barriers (financial strain, lack of food availability and accessibility) prevented behavioral change. Opportunity ranked high for iron and folic acid supplement (IFA) intake, but was not consistently consumed due to side effects. Conversely, lack of supply was the largest barrier for calcium supplement intake. For breastfeeding, there was low overall capability and several participants described receiving inaccurate counseling messages. Conclusion Key drivers of maternal nutrition behavior adoption were indicator specific and varied across the capability-opportunity-motivation behavior change spectrum. Findings from this study can help to strengthen future program effectiveness by identifying specific areas of program improvement.
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Affiliation(s)
- Neha R. Jhaveri
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Natalia E. Poveda
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Shivani Kachwaha
- Program in Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Dawn L. Comeau
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Phuong H. Nguyen
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Melissa F. Young
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
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Cooke R, Goulet O, Huysentruyt K, Joosten K, Khadilkar AV, Mao M, Meyer R, Prentice AM, Singhal A. Catch-Up Growth in Infants and Young Children With Faltering Growth: Expert Opinion to Guide General Clinicians. J Pediatr Gastroenterol Nutr 2023; 77:7-15. [PMID: 36976274 PMCID: PMC10259217 DOI: 10.1097/mpg.0000000000003784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
Faltering growth (FG) is a problem regularly seen by clinicians in infants and young children (<2 years of age). It can occur due to non-disease-related and disease-related causes and is associated with a wide range of adverse outcomes, including shorter-term effects such as impaired immune responses and increased length of hospital stay, and longer-term consequences, including an impact on schooling and cognitive achievements, short stature, and socioeconomic outcomes. It is essential to detect FG, address underlying causes and support catch-up growth where this is indicated. However, anecdotal reports suggest misplaced fear of promoting accelerated (too rapid) growth may deter some clinicians from adequately addressing FG. An invited international group of experts in pediatric nutrition and growth reviewed the available evidence and guidelines on FG resulting from disease-related and non-disease-related effects on nutritional status in healthy term and small for gestational age infants and children up to the age of 2 years in low-, middle-, and high-income countries. Using a modified Delphi process, we developed practical consensus recommendations to provide clarity and practical recommendations for general clinicians on how FG should be defined in different young child populations at risk, how FG should be assessed and managed, and the role of catch-up growth after a period of FG. We also suggested areas where further research is needed to answer remaining questions on this important issue.
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Affiliation(s)
| | | | | | - Koen Joosten
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | | | - Meng Mao
- Sichuan University, Chengdu, China
| | - Rosan Meyer
- Imperial College, London, United Kingdom
- Winchester University, Winchester, United Kingdom
| | | | - Atul Singhal
- the Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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109
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Santa-Ramírez HA, Otálvaro-Castro GJ, Joost S, Melgar-Quiñonez H, Bilal U, Stringhini S. Small area vulnerability, household food insecurity and child malnutrition in Medellin, Colombia: results from a repeated cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100521. [PMID: 37275622 PMCID: PMC10238747 DOI: 10.1016/j.lana.2023.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Abstract
Background Malnutrition and food insecurity might be driven not only by individual factors but also by contextual conditions, such as area-level deprivation or vulnerability. This study aimed to analyze the association between area-level vulnerability and i) household food insecurity and ii) malnutrition in children in Medellin, Colombia, during the years 2017 and 2018. Methods We obtained data from two different sources: the Living Standards Measurement Survey (LSMS) and the nutrition surveillance system of Medellin. The main outcomes were food insecurity in households with children and anthropometric indicators for children under five. The main predictor was area-level vulnerability. Mixed effects Poisson regression with robust standard errors models were conducted to test the association of quintiles of deprivation with each outcome. Findings Households with children living in areas with the highest deprivation had 1.9 times the prevalence of food insecurity as compared to those living in areas with the lowest deprivation (PR 1.91, 95% CI 1.42-2.57). Similar results were observed for underweight/risk of underweight (PR 1.26, 95% CI 1.11-1.42), stunting/risk of stunting (PR 1.36, 95% CI 1.22-1.53) and stunting (PR 1.93 95% CI 1.55-2.39) among children under five. We found no consistent associations with wasting/risk of wasting or excess weight/risk of overweight across quintiles of deprivation. Interpretation This study sheds light on the role of area-level vulnerability on malnutrition in children in Medellin, Colombia, showing a pattern of increasing prevalence of food insecurity, underweight and stunting by quintile of deprivation. Funding Swiss School of Public Health (SSPH+) and Centre for Global Health Inequalities Research (CHAIN).
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Affiliation(s)
- Hugo-Alejandro Santa-Ramírez
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Gabriel-Jaime Otálvaro-Castro
- Health Policy and Management Research Group, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Stéphane Joost
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Group of Geographic Information Research and Analysis in Population Health (GIRAPH), Geneva, Switzerland
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Hugo Melgar-Quiñonez
- McGill Institute for Global Food Security, School of Human Nutrition, McGill University, Montreal, Canada
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University Centre for General Medicine and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
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Cheek JZ, Lambrecht NJ, den Braber B, Akanchha N, Govindarajulu D, Jones AD, Chhatre A, Rasmussen LV. Wild foods contribute to women's higher dietary diversity in India. NATURE FOOD 2023:10.1038/s43016-023-00766-1. [PMID: 37349564 DOI: 10.1038/s43016-023-00766-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/09/2023] [Indexed: 06/24/2023]
Abstract
Wild foods, from forests and common lands, can contribute to food and nutrition security. Most previous studies have established correlations between wild food consumption and children's dietary diversity in Africa, but other groups and geographic contexts remain understudied. Here a rigorous quasi-experimental method was combined with monthly interval data to assess the contribution of wild foods to women's diets. We collected 24 h diet recall data monthly, from November 2016 to November 2017, from 570 households in East India. We found that wild foods contributed positively to diets, especially in June and July (when consumption of wild foods was highest). Women who consumed wild foods had higher average dietary diversity scores (13% and 9% higher in June and July, respectively) and were more likely to consume nutrient-dense, dark-green leafy vegetables than those who did not. Our results underscore the importance of policies that increase knowledge of wild foods and protect people's rights to access forests and other common lands for improved nutrition.
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Affiliation(s)
- Jennifer Zavaleta Cheek
- South Dakota State University, Department of Natural Resources, Brookings, SD, USA.
- University of Michigan, School for Environment and Sustainability, Ann Arbor, MI, USA.
| | - Nathalie J Lambrecht
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Bowy den Braber
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Laura Vang Rasmussen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark
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Braxton ME, Larson KL, Melendez CR. Understanding Time-to-Recovery among Guatemalan Children before and during COVID-19. GLOBAL PEDIATRICS 2023; 5:100066. [PMID: 37366518 PMCID: PMC10286525 DOI: 10.1016/j.gpeds.2023.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Purpose To understand malnutrition recovery at a Guatemalan Nutrition Rehabilitation Center (NRC) before and during the COVID-19 pandemic. Design and Methods A retrospective chart review was conducted on-site in November 2022. The NRC is located on the outskirts of Antigua, Guatemala. They manage the care of 15-20 children at a time, providing food, medicine, and health assessments. A total of 156 records were included (126 prior to the onset of COVID; 30 after the onset of COVID). Descriptive variables collected were age, gender, severity of malnutrition, height, weight, amoxicillin, multivitamins, nebulizer/bronchodilator, and zinc. Principal Results There was no significant difference in time-to-recovery between COVID cohorts. Mean time-to-recovery was 5.65 weeks, or 39.57 days (SD = 25.62, 95% CI [35.5, 43.7]) among all recovered cases (n =149). The cohort admitted after the onset of COVID-19 (March 1, 2020) had a significantly higher weight gain and discharge weight. In the total sample, amoxicillin was the only significant predictor variable for recovery time; with children receiving it being more likely to recover in >6 weeks. The few differences between cohorts was possibly attributed to the sample after the onset of COVID-19. These records had minimal sociocultural data. Major Conclusions Conducting a family needs assessment on admission could identify sociocultural factors that may facilitate nutritional recovery, such as housing conditions and potable water access. Further research is needed to more fully understand the complexities that the COVID-19 pandemic has had on childhood malnutrition recovery.
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Affiliation(s)
- Morgan E Braxton
- Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004-0698
| | - Kim L Larson
- East Carolina University, 2205 W 5th St, Greenville, NC 27834
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Rahman MT, Jahangir Alam M, Ahmed N, Roy DC, Sultana P. Trend of risk and correlates of under-five child undernutrition in Bangladesh: an analysis based on Bangladesh Demographic and Health Survey data, 2007-2017/2018. BMJ Open 2023; 13:e070480. [PMID: 37308267 PMCID: PMC10277110 DOI: 10.1136/bmjopen-2022-070480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES The objectives of this study are to identify the trend of undernutrition risk among under-five children (U5C) in Bangladesh and the trend of its correlates. DESIGN Multiple cross-sectional data sets from different time points were used. SETTING Nationally representative Bangladesh Demographic and Health Surveys (BDHSs) were conducted in 2007, 2011, 2014 and 2017/2018. PARTICIPANTS In the BDHSs, the sample sizes for ever-married women (age: 15-49 years) were 5300 in 2007, 7647 in 2011, 6965 in 2014 and 7902 in 2017/2018. OUTCOMES Extant indicators of undernutrition (stunted, wasted and underweight) have been considered as the outcome variables. MATERIALS AND METHODS Descriptive statistics, bivariate analysis and factor loadings from factor analysis have been used to determine the prevalence of undernutrition over the years and find the trend of risk and its correlates. RESULTS Risks of stunting among the U5C were 41.70%, 40.67%, 36.57% and 31.14%; that of wasting were 16.94%, 15.48%, 14.43% and 8.44%; and that of underweight were 39.79%, 35.80%, 32.45% and 22.46% in 2007, 2011, 2014 and 2017/2018, respectively. From the factor analysis, it has been found that the top five potential correlates of undernutrition are the wealth index, the education of the father and mother, the frequency of antenatal visits during pregnancy, the father's occupation and/or the type of place of residence in the last four consecutive surveys. CONCLUSION This study helps us gain a better understanding of the impact of the top correlates on child undernutrition. To accelerate the reduction of child undernutrition more by 2030, Government and non-government organisations should focus on improving education and household income-generating activities among poor households and raising awareness among women about the importance of receiving antenatal care during pregnancy.
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Affiliation(s)
- Md Tahidur Rahman
- Department of Statistics, Islamic University, Kushtia, Bangladesh
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Jahangir Alam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Noyon Ahmed
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Dulal Chandra Roy
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Papia Sultana
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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Puett C, Anderson JD, Bagamian KH, Muhib F, Scheele S, Hausdorff WP, Pecenka C. Projecting the long-term economic benefits of reducing Shigella-attributable linear growth faltering with a potential vaccine: a modelling study. Lancet Glob Health 2023; 11:e892-e902. [PMID: 37202024 PMCID: PMC10205973 DOI: 10.1016/s2214-109x(23)00050-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Linear growth is an important outcome of child development with implications for economic productivity. Enteric infections, particularly Shigella, have been linked to linear growth faltering (LGF). However, benefits from potential reductions in LGF are rarely included in economic analyses of enteric infections. We aimed to quantify the economic benefits of vaccination related to reduced Shigella-attributable disease and associated LGF compared with the net costs of a vaccine programme. METHODS In this benefit-cost analysis, we modelled productivity benefits in 102 low-income and middle-income countries that had recent stunting estimates available, at least one Shigella-attributable death annually, and available economic data, particularly on gross national income and growth rate projections. We modelled benefits strictly related to linear growth improvements and no other benefits associated with reducing diarrhoeal burden. The effect size in each country was calculated as shifts in height-for-age Z score (HAZ), representing population average changes for preventing Shigella-attributable less-severe diarrhoea and moderate-to-severe diarrhoea separately for children younger than 5 years. Benefits data were calculated per country and combined with estimated net costs of the vaccine programme in the form of benefit-cost ratios (BCRs); BCRs above parity, or $1 in benefits per $1 in costs (with a 10% margin representing borderline results: 1·10:1), were considered cost-beneficial. Countries were aggregated for analysis by WHO region, World Bank income category, and eligibility for support from Gavi, the Vaccine Alliance. FINDINGS In the base-case scenario, all regions exhibited cost-beneficial results, with the South-East Asia region and Gavi-eligible countries exhibiting the highest BCRs (21·67 for the South-East Asia region and 14·45 for Gavi-eligible countries), and the Eastern Mediterranean region yielding the lowest BCRs (2·90). All regions exhibited cost-beneficial results from vaccination, except in more conservative scenarios (eg, those assuming early retirement ages and higher discount rates). Our findings were sensitive to assumed returns for increased height, assumptions about vaccine efficacy against linear growth detriments, the anticipated shift in HAZ, and discount rate. Incorporating the productivity benefits of LGF reduction into existing cost-effectiveness estimates resulted in longer-term cost-savings in nearly all regions. INTERPRETATION LGF is a secondary outcome of Shigella infection and reduction in LGF is not often quantified as a health or economic benefit of vaccination. However, even under conservative assumptions, a Shigella vaccine only moderately effective against LGF could pay for itself from productivity gains alone in some regions. We recommend that LGF be considered in future models assessing the economic and health impacts of interventions preventing enteric infections. Further research is needed on vaccine efficacy against LGF to inform such models. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust.
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Affiliation(s)
- Chloe Puett
- Department of Family, Population & Preventive Medicine, Program in Public Health, Health Sciences Center, Stony Brook University, Stony Brook, NY, USA.
| | | | - Karoun H Bagamian
- Bagamian Scientific Consulting, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | | | | | - William P Hausdorff
- PATH, Washington, DC, USA; Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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Anwar F, Yalawar M, Suryawanshi P, Ghosh A, Jog P, Khadilkar AV, Kishore B, Paruchuri AK, Pote PD, Mandyam RD, Shinde S, Shah A. Effect of Oral Nutritional Supplementation on Adequacy of Nutrient Intake among Picky-Eating Children at Nutritional Risk in India: A Randomized Double Blind Clinical Trial. Nutrients 2023; 15:nu15112528. [PMID: 37299491 DOI: 10.3390/nu15112528] [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: 04/19/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Nutrient inadequacies among picky-eaters have adverse effects on growth and development. Oral nutritional supplements (ONS) along with dietary counseling (DC), rather than DC alone as reported in our earlier publication, promoted growth among picky-eating Indian children aged from >24 m to ≤48 m with weight-for-height percentiles lying between the 5th and 25th (based on WHO Growth Standards) over 90 days. This paper presents the contribution of ONS to nutrient adequacy, dietary diversity, and food consumption patterns in children (N = 321). Weight, height, and dietary intakes, using 24-h food recalls, were measured at baseline (Day 1) and at Days 7, 30, 60, and 90. Nutrient adequacy, dietary diversity score (DDS), and food intake adequacy were calculated in both the supplementation groups (ONS1 + DC and ONS2 + DC; n = 107 in each group) and the control group (DC-only; n = 107). Supplements increased nutrient adequacy in both of the ONS + DC groups relative to control (p < 0.05). The proportions of children with adequate nutrient intakes increased significantly at Day 90 in the supplemented groups as compared to in the control group (p < 0.05), especially for total fat, calcium, vitamin A, vitamin C, and thiamin. Although no significant differences were observed in DDS in any of the groups, the percentage of children consuming ≥4 food groups in a day had increased in all the groups. Consumption of fruit and vegetables and cereals had increased significantly from baseline to Day 90. ONS along with dietary counseling was found to have improved nutritional adequacy without interfering with the normal food consumption patterns of picky-eating children at nutritional risk.
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Affiliation(s)
- Fahmina Anwar
- Abbott Nutrition, Research & Development India, Mumbai 400051, India
| | - Menaka Yalawar
- Biostatistics and Statistical Programming, Life Sciences-Digital Business Operations, Cognizant Technology Solutions India Private Limited, Bengaluru 560045, India
| | - Pranali Suryawanshi
- Biostatistics and Statistical Programming, Life Sciences-Digital Business Operations, Cognizant Technology Solutions India Private Limited, Navi Mumbai 400708, India
| | - Apurba Ghosh
- Institute of Child Health, Kolkata 700017, India
| | | | | | - Bala Kishore
- Saint Theresa's Hospital, Hyderabad 500018, India
| | | | | | | | - Sandeep Shinde
- Pune Sterling Multispecialty Hospital, Pune 411044, India
| | - Atish Shah
- Sangini Hospital, Sangini Complex, Ahmedabad 380006, India
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115
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Abera M, Hanlon C, Fedlu H, Fewtrell M, Tesfaye M, Wells JCK. Stress and resilience during pregnancy: A comparative study between pregnant and non-pregnant women in Ethiopia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001416. [PMID: 37216320 DOI: 10.1371/journal.pgph.0001416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/10/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Stress during pregnancy is associated with perturbances in maternal psychology and physiology, and results in adverse pregnancy and birth outcomes. However, little attention has been given to understand maternal stress and its potential negative consequences in many low- and middle-income countries. We aimed to investigate whether pregnancy is associated with greater stress and lower psychological resilience among women living in Jimma, Southwest Ethiopia. METHOD An institution-based comparative cross-sectional study design was implemented in Jimma University Medical Center and Jimma health centers from 15 September to 30 November 2021. Women attending antenatal care and family planning services were invited to participate in the study. Participants were interviewed using the Perceived Stress Scale (PSS-10), Brief Resilience Scale (BRS), distress questionnaire-5, and the Household Food Insecurity Access Scale (HFIAS). Linear regression analysis was used to test associations between pregnancy (exposure) and outcomes of interest (stress and resilience scores), while adjusting for potential confounders. Stress and resilience were mutually adjusted for one another in the final model. RESULTS A total of 166 pregnant and 154 non-pregnant women participated, with mean age of 27.0 SD 5.0 and 29.5 SD 5.3 years respectively. Pregnancy was associated with increased stress score by 4.1 points (β = 4.1; 95% CI: 3.0, 5.2), and with reduced resilience by 3.3 points (β = -3.3; 95% CI: -4.5, -2.2) in a fully adjusted model. In mutually-adjusted models, pregnancy was independently associated with greater stress (β = 2.9, 95% CI 1.8, 3.9) and lower resilience (β = -1.3, 95% CI: -2.5, -0.2) compared to non-pregnant women. CONCLUSION In this low income setting, pregnancy is associated with greater vulnerability in the mental health of women, characterized by greater perceived stress and diminished resilience. Context-relevant interventions to improve resilience and reduce stress could help improve the health and wellbeing of mothers, with potential benefits for their offspring.
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Affiliation(s)
- Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Charlotte Hanlon
- Department of Health Services and Population Research, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hikma Fedlu
- Department of Public health officer, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mary Fewtrell
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jonathan C K Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Ozen M, Piloquet H, Schaubeck M. Limosilactobacillus fermentum CECT5716: Clinical Potential of a Probiotic Strain Isolated from Human Milk. Nutrients 2023; 15:2207. [PMID: 37432320 DOI: 10.3390/nu15092207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 07/12/2023] Open
Abstract
Breastfeeding provides the ideal nutrition for infants. Human milk contains a plethora of functional ingredients which foster the development of the immune system. The human milk microbiota predominantly contributes to this protective effect. This is mediated by various mechanisms, such as an antimicrobial effect, pathogen exclusion and barrier integrity, beneficial effects on the gastrointestinal microbiota, vitamin synthesis, immunity enhancement, secreted probiotic factors, and postbiotic mechanisms. Therefore, human milk is a good source for isolating probiotics for infants who cannot be exclusively breastfed. One such probiotic which was isolated from human milk is Limosilactobacillus fermentum CECT5716. In this review, we give an overview of available interventional studies using Limosilactobacillus fermentum CECT5716 and summarise preclinical trials in several animal models of different pathologies, which have given first insights into its mechanisms of action. We present several randomised clinical studies, which have been conducted to investigate the clinical efficacy of the Limosilactobacillus fermentum CECT5716 strain in supporting the host's health.
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Affiliation(s)
- Metehan Ozen
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Türkiye
| | - Hugues Piloquet
- Department of Paediatric Chronic Diseases, Nantes University Hospital, 44000 Nantes, France
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Dwomoh D, Sewor C, Annim SK, Stranges S, Kandala NB, Amegah AK. Do dietary practices and household environmental quality mediate socio-economic inequalities in child undernutrition risk in West Africa? Public Health Nutr 2023; 26:1022-1033. [PMID: 36259140 PMCID: PMC10346084 DOI: 10.1017/s1368980022002269] [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: 01/14/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We investigated the relationship between socio-economic status and child undernutrition in West Africa (WA), and further examined the mediating role of dietary practices (measured as minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)) and household environmental quality (HEQ) in the observed relationship. DESIGN Thirteen countries were included in the study. We leveraged the most recent Demographic and Health Surveys datasets ranging from 2010 to 2019. Poisson regression model with robust standard errors was used to estimate prevalence ratios and their corresponding 95 % CI. Structural equation modelling was used to conduct the mediation analysis. SETTING West Africa. PARTICIPANTS 132 448 under-five children born within 5 years preceding the survey were included. RESULTS Overall, 32·5 %, 8·2 %, 20·1 % and 71·7 % of WA children were stunted, wasted, underweight and anaemic, respectively. Prevalence of undernutrition decreased with increasing maternal education and household wealth (Trend P-values < 0·001). Secondary or higher maternal education and residence in rich households were associated with statistically significant decrease in the prevalence of stunting, wasting, underweight and anaemia among children in WA. MAD was found to mediate the association of low maternal education and poor household wealth with childhood stunting and underweight by 35·9 % to 44·5 %. MDD, MMF and HEQ did not mediate the observed relationship. CONCLUSIONS The study findings enables an evaluation and improvement of existing intervention strategies through a socio-economic lens to help address the high burden of child undernutrition in WA and other developing regions.
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Affiliation(s)
- Duah Dwomoh
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Christian Sewor
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel K Annim
- Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
- Ghana Statistical Service, Accra, Ghana
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics and Africa Institute, Western University, London, ON, Canada
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics and Africa Institute, Western University, London, ON, Canada
- University of Warwick, Division of Health Sciences, Warwick Medical School, Coventry, UK
- University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
| | - A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
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Woldeyohannes M, Girma M, Petros A, Hussen A, Samuel A, Dinssa DA, Challa F, Laillou A, Chitekwe S, Baye K, Noor R, Donze AS, Tollera G, Dangiso MH, Tadesse L, Zelalem M, Tessema M. Ethiopia National Food and Nutrition Survey to inform the Ethiopian National Food and Nutrition Strategy: a study protocol. BMJ Open 2023; 13:e067641. [PMID: 37185190 PMCID: PMC10151871 DOI: 10.1136/bmjopen-2022-067641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Ethiopia has made significant progress in reducing malnutrition in the past two decades. Despite such improvements, a substantial segment of the country's population remains chronically undernourished and suffers from micronutrient deficiencies and from increasing diet-related non-communicable diseases such as diabetes, hypertension and cancer. This survey aims to assess anthropometric status, dietary intake and micronutrient status of Ethiopian children, women and adolescent girls. The study will also assess coverage of direct and indirect nutrition-related interventions and map agricultural soil nutrients. The survey will serve as a baseline for the recently developed Ethiopian Food System Transformation Plan and will inform the implementation of the National Food and Nutrition Strategy. METHODS AND ANALYSIS As a population-based, cross-sectional survey, the study will collect data from the 10 regions and 2 city administrations of Ethiopia. The study population will be women of reproductive age, children aged 0-59 months, school-aged children and adolescent girls. A total of 16 596 households will be surveyed, allowing the generation of national and regional estimates. A two-stage stratified cluster sampling procedure will be used to select households. In the first stage, 639 enumeration areas (EAs) will be selected using probability-proportional-to-size allocation. In the second stage, 26 eligible households will be selected within each EA using systematic random selection. Primary outcomes include coverage of direct and indirect nutrition interventions, infant and young child feeding (IYCF) practices, food insecurity, dietary intakes, mental health, anthropometric status, micronutrient status and soil nutrient status. ETHICS AND DISSEMINATION The protocol was fully reviewed and approved by the Institutional Review Board of the Ethiopian Public Health Institute (protocol no: EPHI-IRB-317-2020). The study is based on voluntary participation and written informed consent is required from study participants. The findings will be disseminated via forums and conferences and will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Meseret Woldeyohannes
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Meron Girma
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Alemnesh Petros
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Alemayehu Hussen
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Aregash Samuel
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Danial Abera Dinssa
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Feyissa Challa
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | | | | | - Kaleab Baye
- Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Getachew Tollera
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Mesay Hailu Dangiso
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
| | - Lia Tadesse
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Masresha Tessema
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
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Martinez L, Gray DM, Botha M, Nel M, Chaya S, Jacobs C, Workman L, Nicol MP, Zar HJ. The Long-Term Impact of Early-Life Tuberculosis Disease on Child Health: A Prospective Birth Cohort Study. Am J Respir Crit Care Med 2023; 207:1080-1088. [PMID: 36746196 PMCID: PMC10112440 DOI: 10.1164/rccm.202208-1543oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/06/2023] [Indexed: 02/08/2023] Open
Abstract
Rationale: There is growing concern that post-tuberculosis disease (TB) sequelae and morbidity are substantial, but no studies have controlled for preexisting factors before disease. Whether children have post-TB morbidity is not well characterized. Objectives: To assess the effect of a TB diagnosis on wheezing episodes, lung function, and anthropometric measurements among children enrolled in a prospective birth cohort study in South Africa. Methods: We prospectively followed children from birth through 5 years for TB using diagnostic tests including chest radiography and repeated induced sputum sample testing with Xpert MTB/RIF and liquid culture. We longitudinally measured health outcomes including growth, wheezing, and lung function up to 5 years. Mixed-effects linear regression models were used to assess growth and lung function after TB. Poisson regression was used to assess risk of subsequent wheezing. Measurements and Main Results: Among 1,068 participants, 96 TB cases occurred (1,228 cases per 100,000 person-years [95% confidence interval (CI), 1,006-1,500]) occurred over 7,815 child-years of follow-up. TB was associated with lower length-for-age (-0.40 [95% CI, -0.68 to -0.11]), weight-for-age (-0.30 [95% CI, -0.59 to -0.01]), and body mass index (-0.54 [95% CI, -0.83 to -0.25]) z-scores at 5 years. Children developing TB were consistently more likely to wheeze regardless of the timing of TB. Children with diagnoses of TB between 0 and 1 year of age had reduced time to peak tidal expiratory flow over total expiratory time (-2.35% [95% CI, -4.86% to -0.17%]) and higher fractional exhaled nitric oxide (2.88 ppb [95% CI, 0.57-5.19 ppb]) at 5 years. Children with diagnoses of TB between 1 and 4 years of age had impaired Vt (-9.32 ml [95% CI, -14.89 to -3.75 ml]) and time to peak tidal expiratory flow over total expiratory time (-2.73% [95% CI, -5.45% to -0.01%]) at 5 years. Conclusions: Prevention of TB disease in the first few years of life may have substantial long-term benefits through childhood.
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Affiliation(s)
- Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Diane M. Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital
- SA–Medical Research Council Unit on Child and Adolescent Health, and
| | - Maresa Botha
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital
- SA–Medical Research Council Unit on Child and Adolescent Health, and
| | - Michael Nel
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital
- SA–Medical Research Council Unit on Child and Adolescent Health, and
| | - Shaakira Chaya
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital
- SA–Medical Research Council Unit on Child and Adolescent Health, and
| | - Carvern Jacobs
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital
- SA–Medical Research Council Unit on Child and Adolescent Health, and
| | - Lesley Workman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital
- SA–Medical Research Council Unit on Child and Adolescent Health, and
| | - Mark P. Nicol
- SA–Medical Research Council Unit on Child and Adolescent Health, and
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; and
- Marshall Centre for Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital
- SA–Medical Research Council Unit on Child and Adolescent Health, and
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Nommsen-Rivers L, Black MM, Christian P, Groh-Wargo S, Heinig MJ, Israel-Ballard K, Obbagy J, Palmquist AEL, Stuebe A, Barr SM, Proaño GV, Moloney L, Steiber A, Raiten DJ. An equitable, community-engaged translational framework for science in human lactation and infant feeding-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 5. Am J Clin Nutr 2023; 117 Suppl 1:S87-S105. [PMID: 37173062 DOI: 10.1016/j.ajcnut.2023.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all.
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Affiliation(s)
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - M Jane Heinig
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Julie Obbagy
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Washington, DC, USA
| | - Aunchalee E L Palmquist
- Department of Maternal & Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison Stuebe
- Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Imdad A, Rogner J, Sherwani RN, Sidhu J, Regan A, Haykal MR, Tsistinas O, Smith A, Chan XHS, Mayo-Wilson E, Bhutta ZA. Zinc supplementation for preventing mortality, morbidity, and growth failure in children aged 6 months to 12 years. Cochrane Database Syst Rev 2023; 3:CD009384. [PMID: 36994923 PMCID: PMC10061962 DOI: 10.1002/14651858.cd009384.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Zinc deficiency is prevalent in low- and middle-income countries, and is considered a significant risk factor for morbidity, mortality, and linear growth failure. The effectiveness of preventive zinc supplementation in reducing prevalence of zinc deficiency needs to be assessed. OBJECTIVES To assess the effects of zinc supplementation for preventing mortality and morbidity, and for promoting growth, in children aged 6 months to 12 years. SEARCH METHODS A previous version of this review was published in 2014. In this update, we searched CENTRAL, MEDLINE, Embase, five other databases, and one trials register up to February 2022, together with reference checking and contact with study authors to identify additional studies. SELECTION CRITERIA Randomized controlled trials (RCTs) of preventive zinc supplementation in children aged 6 months to 12 years compared with no intervention, a placebo, or a waiting list control. We excluded hospitalized children and children with chronic diseases or conditions. We excluded food fortification or intake, sprinkles, and therapeutic interventions. DATA COLLECTION AND ANALYSIS Two review authors screened studies, extracted data, and assessed the risk of bias. We contacted study authors for missing information and used GRADE to assess the certainty of evidence. The primary outcomes of this review were all-cause mortality; and cause-specific mortality, due to all-cause diarrhea, lower respiratory tract infection (LRTI, including pneumonia), and malaria. We also collected information on a number of secondary outcomes, such as those related to diarrhea and LRTI morbidity, growth outcomes and serum levels of micronutrients, and adverse events. MAIN RESULTS We included 16 new studies in this review, resulting in a total of 96 RCTs with 219,584 eligible participants. The included studies were conducted in 34 countries; 87 of them in low- or middle-income countries. Most of the children included in this review were under five years of age. The intervention was delivered most commonly in the form of syrup as zinc sulfate, and the most common dose was between 10 mg and 15 mg daily. The median duration of follow-up was 26 weeks. We did not consider that the evidence for the key analyses of morbidity and mortality outcomes was affected by risk of bias. High-certainty evidence showed little to no difference in all-cause mortality with preventive zinc supplementation compared to no zinc (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.84 to 1.03; 16 studies, 17 comparisons, 143,474 participants). Moderate-certainty evidence showed that preventive zinc supplementation compared to no zinc likely results in little to no difference in mortality due to all-cause diarrhea (RR 0.95, 95% CI 0.69 to 1.31; 4 studies, 132,321 participants); but probably reduces mortality due to LRTI (RR 0.86, 95% CI 0.64 to 1.15; 3 studies, 132,063 participants) and mortality due to malaria (RR 0.90, 95% CI 0.77 to 1.06; 2 studies, 42,818 participants); however, the confidence intervals around the summary estimates for these outcomes were wide, and we could not rule out a possibility of increased risk of mortality. Preventive zinc supplementation likely reduces the incidence of all-cause diarrhea (RR 0.91, 95% CI 0.90 to 0.93; 39 studies, 19,468 participants; moderate-certainty evidence) but results in little to no difference in morbidity due to LRTI (RR 1.01, 95% CI 0.95 to 1.08; 19 studies, 10,555 participants; high-certainty evidence) compared to no zinc. There was moderate-certainty evidence that preventive zinc supplementation likely leads to a slight increase in height (standardized mean difference (SMD) 0.12, 95% CI 0.09 to 0.14; 74 studies, 20,720 participants). Zinc supplementation was associated with an increase in the number of participants with at least one vomiting episode (RR 1.29, 95% CI 1.14 to 1.46; 5 studies, 35,192 participants; high-certainty evidence). We report a number of other outcomes, including the effect of zinc supplementation on weight and serum markers such as zinc, hemoglobin, iron, copper, etc. We also performed a number of subgroup analyses and there was a consistent finding for a number of outcomes that co-supplementation of zinc with iron decreased the beneficial effect of zinc. AUTHORS' CONCLUSIONS Even though we included 16 new studies in this update, the overall conclusions of the review remain unchanged. Zinc supplementation might help prevent episodes of diarrhea and improve growth slightly, particularly in children aged 6 months to 12 years of age. The benefits of preventive zinc supplementation may outweigh the harms in regions where the risk of zinc deficiency is relatively high.
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Affiliation(s)
- Aamer Imdad
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jaimie Rogner
- Departments of Medicine and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Rida N Sherwani
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jasleen Sidhu
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Allison Regan
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Maya R Haykal
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Olivia Tsistinas
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Abigail Smith
- Health Sciences Library, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Xin Hui S Chan
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Evan Mayo-Wilson
- Department of Epidemiology, UNC Gillings School of Global Public HealthMcGavran-Greenberg Hall, Chapel Hill, NC, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for SickKids, Toronto, Canada
- Center of Excellence for Women and Child Health, Aga Khan University, Karachi, Pakistan
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Watson D, Mushamiri P, Beeri P, Rouamba T, Jenner S, Proebstl S, Kehoe SH, Ward KA, Barker M, Lawrence W. Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000401. [PMID: 36996036 PMCID: PMC10062616 DOI: 10.1371/journal.pgph.0000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Mushamiri
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Paula Beeri
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Sarah Jenner
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Simone Proebstl
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sarah H Kehoe
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Kate A Ward
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
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Sey-Sawo J, Sarr F, Bah HT, Senghore T. Women's empowerment and nutritional status of children in the Gambia: further analysis of the 2020 Gambia demographic and health survey. BMC Public Health 2023; 23:583. [PMID: 36978053 PMCID: PMC10053724 DOI: 10.1186/s12889-023-15494-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Empowering women and the promotion of children's health are key components of the Sustainable Development Goals targeted for achievement by 2030. The survival of young children, which depends on their nutrition, is influenced by an interaction of factors at the household level. This study aims to investigate the association between women's empowerment and undernutrition among children under age 5 using The Gambia Demographic Health Survey (GDHS) 2019-20.Children's undernutrition was measured with two indicators: stunting and underweight. The women's empowerment indicators were educational status, employment, decision making, age at first sex and age at first birth, and acceptance of wife beating. StataSE software Version 17 was used for data analysis. Analyses were cluster-adjusted, sample-weighted, with confounding/moderating variables. Descriptive statistics and cross-tabulations were computed for all variables. Bivariate and multivariate analysis of the outcomes and women's empowerment were conducted.The prevalence of stunting and underweight among the children under age 5 was 17% and 12%, respectively. The results of the multiple logistic regression show that women with no education had 51% (OR = 1.51; 95% CI = 1.11-2.07; p = 0.009), and 52% (OR = 1.52; 95% CI = 1.06-2.14; p = 0.022) greater odds of having children under age 5 who were stunted or underweight compared to those women with primary and higher level of education, respectively. Mothers with a body mass index classified as thin were associated with an increased odds of having stunted (OR = 1.44; 95% CI 1.01-2.05; p = 0.033) and underweight (OR = 1.69; 95% CI = 1.58-3.52; P < 0.001) children. In addition, women who reported accepting wife beating had 69% (OR = 1.69; 95% CI 1.22-2.35; p = 0.002) and 66% (OR = 1.66; 95% CI 1.15-2.40; p = 0.006) greater odds of having stunted and underweight children respectively compared to those who did not accept wife beating.In conclusion, the result of this study shows that women's empowerment is associated with undernutrition among children under age 5 in The Gambia. This is suggesting that implementing policies and interventions that increase the empowerment of women will contribute to the improvement of child nutrition in the country.
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Affiliation(s)
- Jainaba Sey-Sawo
- Department of Nursing and Reproductive Health, University of The Gambia, Serrekunda, Gambia
| | - Francis Sarr
- Department of Nursing and Reproductive Health, University of The Gambia, Serrekunda, Gambia
| | - Haddy Tunkara Bah
- Department of Nursing and Reproductive Health, University of The Gambia, Serrekunda, Gambia.
| | - Thomas Senghore
- Department of Nursing and Reproductive Health, University of The Gambia, Serrekunda, Gambia
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Harris-Fry H, Prost A, Beaumont E, Fivian E, Mohanty S, Parida M, Pradhan R, Sahu S, Padhan S, Mishra NK, Rath S, Rath S, Koniz-Booher P, Allen E, Kadiyala S. Intrahousehold power inequalities and cooperation: Unpacking household responses to nutrition-sensitive agriculture interventions in rural India. MATERNAL & CHILD NUTRITION 2023:e13503. [PMID: 36939121 DOI: 10.1111/mcn.13503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
Nutrition-sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed-methods design to describe the links between household dynamics-specifically intrahousehold power inequalities and intrahousehold cooperation-and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster-randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross-sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision-making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family-centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate.
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Affiliation(s)
- Helen Harris-Fry
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Emma Beaumont
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Manoj Parida
- DCOR (Development Corner) Consulting Pvt. Ltd., Bhubaneswar, India
| | | | | | - Shibanath Padhan
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | - Naba K Mishra
- Voluntary Association for Rural Reconstruction and Appropriate Technology, Kendrapara, India
| | | | | | | | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suneetha Kadiyala
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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125
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Levy K, Garn JV, Cumbe ZA, Muneme B, Fagnant-Sperati CS, Hubbard S, Júnior A, Manuel JL, Mangamela M, McGunegill S, Miller-Petrie MK, Snyder JS, Victor C, Waller LA, Konstantinidis KT, Clasen TF, Brown J, Nalá R, Freeman MC. Study design and rationale for the PAASIM project: a matched cohort study on urban water supply improvements and infant enteric pathogen infection, gut microbiome development and health in Mozambique. BMJ Open 2023; 13:e067341. [PMID: 36863743 PMCID: PMC9990653 DOI: 10.1136/bmjopen-2022-067341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Despite clear linkages between provision of clean water and improvements in child health, limited information exists about the health impacts of large water infrastructure improvements in low-income settings. Billions of dollars are spent annually to improve urban water supply, and rigorous evaluation of these improvements, especially targeting informal settlements, is critical to guide policy and investment strategies. Objective measures of infection and exposure to pathogens, and measures of gut function, are needed to understand the effectiveness and impact of water supply improvements. METHODS AND ANALYSIS In the PAASIM study, we examine the impact of water system improvements on acute and chronic health outcomes in children in a low-income urban area of Beira, Mozambique, comprising 62 sub-neighbourhoods and ~26 300 households. This prospective matched cohort study follows 548 mother-child dyads from late pregnancy through 12 months of age. Primary outcomes include measures of enteric pathogen infections, gut microbiome composition and source drinking water microbiological quality, measured at the child's 12-month visit. Additional outcomes include diarrhoea prevalence, child growth, previous enteric pathogen exposure, child mortality and various measures of water access and quality. Our analyses will compare (1) subjects living in sub-neighbourhoods with the improved water to those living in sub-neighbourhoods without these improvements; and (2) subjects with household water connections on their premises to those without such a connection. This study will provide critical information to understand how to optimise investments for improving child health, filling the information gap about the impact of piped water provision to low-income urban households, using novel gastrointestinal disease outcomes. ETHICS AND DISSEMINATION This study was approved by the Emory University Institutional Review Board and the National Bio-Ethics Committee for Health in Mozambique. The pre-analysis plan is published on the Open Science Framework platform (https://osf.io/4rkn6/). Results will be shared with relevant stakeholders locally, and through publications.
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Affiliation(s)
- Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joshua V Garn
- Division of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | | | | | - Christine S Fagnant-Sperati
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Sydney Hubbard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - João Luís Manuel
- Beira Operations Research Center, National Health Institute (INS), Ministry of Health of Mozambique, Beira, Mozambique
| | | | - Sandy McGunegill
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Molly K Miller-Petrie
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Jedidiah S Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Courtney Victor
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joe Brown
- Environmental Science and Engineering, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Rassul Nalá
- Ministry of Health, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Validation of the 24-hour perceived exertion recall survey (PERS) in women in rural Tigray, Ethiopia. Curr Dev Nutr 2023. [PMID: 37547061 PMCID: PMC10401292 DOI: 10.1016/j.cdnut.2023.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Background Physical activity affects nutritional status and health. Currently, there are few validated survey tools for estimating physical activity in rural areas of low-income countries, including Ethiopia, which limits the ability of researchers to assess how physical activity affects nutritional status. Objectives This study used accelerometry to validate 2 in-person questionnaires, the global physical activity questionnaire (GPAQ) and the 24-h perceived exertion recall survey (PERS). Methods This study recruited 180 women aged between 18 and 45 y living in rural Tigray, Ethiopia. Participants had previously participated in an impact evaluation of a public work safety net. They wore an accelerometer for 8 d and responded to perceived exertion questionnaires twice. Data were collected on 89 women during the short rainy period and 91 women during the main rainy season. A survey method was considered valid if the proportion of time spent in moderate or vigorous physical activity (MVPA) levels had a Pearson's correlation coefficient of >0.40 to the proportion of time spent in MVPA recorded by accelerometry. Results The GPAQ had high reliability, but the overall validity was poorer than accelerometry. The proportion of time spent in MVPA according to the accelerometer was associated with discordance between GPAQ and accelerometry. MVPA levels, as measured by the 24-h PERS, had a fair agreement with accelerometry. The agreement increased to moderate/acceptable when adjusted for season and BMI. Conclusions The 24-h PERS is a valid tool for estimating the physical activity of women living in rural highland Ethiopia. It can be used in future research to understand the physical activity demands of living in rural highland Ethiopia, enabling more targeted programs to address undernutrition.
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Berti C, La Vecchia A. Temporal trend of child stunting prevalence and Food and Nutritional Surveillance System. J Pediatr (Rio J) 2023; 99:99-100. [PMID: 36347381 PMCID: PMC10031367 DOI: 10.1016/j.jped.2022.10.001] [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: 11/08/2022] Open
Affiliation(s)
- Cristiana Berti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Berti C, Socha P. Infant and Young Child Feeding Practices and Health. Nutrients 2023; 15:nu15051184. [PMID: 36904182 PMCID: PMC10005283 DOI: 10.3390/nu15051184] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Early childhood feeding practices are fundamental for a child's healthy growth, development and potential [...].
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Affiliation(s)
- Cristiana Berti
- Pediatric Area, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Piotr Socha
- Public Health Department, Children’s Memorial Health Institute, 04-730 Warsaw, Poland
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129
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Robertson RC, Edens TJ, Carr L, Mutasa K, Gough EK, Evans C, Geum HM, Baharmand I, Gill SK, Ntozini R, Smith LE, Chasekwa B, Majo FD, Tavengwa NV, Mutasa B, Francis F, Tome J, Stoltzfus RJ, Humphrey JH, Prendergast AJ, Manges AR. The gut microbiome and early-life growth in a population with high prevalence of stunting. Nat Commun 2023; 14:654. [PMID: 36788215 PMCID: PMC9929340 DOI: 10.1038/s41467-023-36135-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 01/12/2023] [Indexed: 02/16/2023] Open
Abstract
Stunting affects one-in-five children globally and is associated with greater infectious morbidity, mortality and neurodevelopmental deficits. Recent evidence suggests that the early-life gut microbiome affects child growth through immune, metabolic and endocrine pathways. Using whole metagenomic sequencing, we map the assembly of the gut microbiome in 335 children from rural Zimbabwe from 1-18 months of age who were enrolled in the Sanitation, Hygiene, Infant Nutrition Efficacy Trial (SHINE; NCT01824940), a randomized trial of improved water, sanitation and hygiene (WASH) and infant and young child feeding (IYCF). Here, we show that the early-life gut microbiome undergoes programmed assembly that is unresponsive to the randomized interventions intended to improve linear growth. However, maternal HIV infection is associated with over-diversification and over-maturity of the early-life gut microbiome in their uninfected children, in addition to reduced abundance of Bifidobacterium species. Using machine learning models (XGBoost), we show that taxonomic microbiome features are poorly predictive of child growth, however functional metagenomic features, particularly B-vitamin and nucleotide biosynthesis pathways, moderately predict both attained linear and ponderal growth and growth velocity. New approaches targeting the gut microbiome in early childhood may complement efforts to combat child undernutrition.
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Affiliation(s)
- Ruairi C Robertson
- Blizard Institute, Queen Mary University of London, London, UK
- Microenvironment & Immunity Unit, INSERM U1224, Institut Pasteur, 75015, Paris, France
| | | | - Lynnea Carr
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Ethan K Gough
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ceri Evans
- Blizard Institute, Queen Mary University of London, London, UK
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Hyun Min Geum
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Iman Baharmand
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandeep K Gill
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, USA
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Freddy Francis
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Joice Tome
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Jean H Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amee R Manges
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.
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Mengstie MA, Worke MD, Belay Y, Chekol Abebe E, Asmamaw Dejenie T, Abdu Seid M, Azezew MT. Undernutrition and associated factors among internally displaced lactating mothers in Sekota camps, northern Ethiopia: A cross-sectional study. Front Nutr 2023; 10:1108233. [PMID: 36866050 PMCID: PMC9971014 DOI: 10.3389/fnut.2023.1108233] [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: 11/25/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Background Undernutrition is the term used to describe when a person consumes insufficient amounts of nutrients and energy to meet their needs for maintaining health. Despite substantial progress, undernutrition remains a serious public health concern in many low and middle-income nations, including Ethiopia. Women and children are, in reality, the most nutritionally vulnerable individuals, particularly in times of crisis. In Ethiopia, 27 percent of lactating women are thin or malnourished, and 38% of children are stunted. Although the issue of undernutrition may worsen in times of emergency, like war, there are limited studies available in Ethiopia that show the nutritional status of lactating mothers in humanitarian settings. Objectives The main aim of this study was to determine the prevalence and investigate the factors associated with undernutrition among internally displaced lactating mothers in Sekota camps, in northern Ethiopia. Methods A cross-sectional study through a simple random sampling technique was conducted among 420 randomly selected lactating mothers in Sekota Internally Displaced Persons (IDP) camps. Data were collected using a structured questionnaire and anthropometric measurements. Logistic regression analysis was employed to identify independent factors associated with maternal undernutrition. Results Using a cut-off mid-upper arm circumference <23 cm, the prevalence of undernutrition among internally displaced lactating mothers was 54.8%. Large family size [adjusted odds ratio (AOR) = 4.35; 95% CI: 1.32, 10.22], short birth interval (AOR = 4.85; 95% CI: 1.24, 10.00), low maternal daily meal frequency (AOR = 2.54; 95% CI: 1.12, 5.75), and low dietary diversity score (AOR = 1.79; 95% CI: 1.03, 3.10) were all significantly associated with undernutrition. Conclusion The prevalence of undernutrition among internally displaced lactating mothers is relatively high. Governments and other concerned organizations involved in providing care and support to Sekota IDP camps should increase their efforts to improve the nutritional status of lactating mothers.
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Affiliation(s)
- Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia,*Correspondence: Misganaw Asmamaw Mengstie, ; orcid.org/000-0002-9711-8640
| | - Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yalemshet Belay
- Department of Physiology, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Abdu Seid
- Department of Physiology, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Muluken Teshome Azezew
- Department of Physiology, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Bechoff A, de Bruyn J, Alpha A, Wieringa F, Greffeuille V. Exploring the Complementarity of Fortification and Dietary Diversification to Combat Micronutrient Deficiencies: A Scoping Review. Curr Dev Nutr 2023; 7:100033. [PMID: 37180084 PMCID: PMC10111601 DOI: 10.1016/j.cdnut.2023.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/11/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023] Open
Abstract
Achieving a balanced and diverse diet remains a challenge for many people, contributing to an ongoing burden of micronutrient deficiencies, particularly in low-income settings. Fortification or dietary diversification are common food-based approaches. We conducted a scoping review to: 1) find evidence on whether combined food-based strategies are more effective than single strategies, and 2) understand how strategies implemented together could complement each other to achieve optimal nutritional impact on populations. Peer-reviewed articles selected (n = 21) included interventions or observational studies (n = 13) and reviews (n = 8). We found little evidence of an added nutritional impact. On the other hand, it is apparent that fortification and dietary diversification target different types of settings (urban compared with rural) and foods (that is, low priced compared with highly priced). Further research is needed to understand the complementarity of these approaches and establish evidence of the effectiveness of combined strategies to foster policy adoption.
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Affiliation(s)
- Aurélie Bechoff
- Natural Resources Institute, University of Greenwich, Chatham, United Kingdom
| | - Julia de Bruyn
- Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Melbourne, Melbourne, Australia
| | - Arlène Alpha
- Centre de Recherche Agronomique pour le Développement, Montpellier, France
| | - Frank Wieringa
- Institut de Recherche pour le Développement, Montpellier, France
- Unité Mixte de Recherche Qualisud, (alliance between Université Montpellier, Université Avignon, Centre de Recherche Agronomique pour le Développement, Institut Agro, Institut de Recherche pour le Développement and Université de la Réunion), Montpellier, France
| | - Valérie Greffeuille
- Institut de Recherche pour le Développement, Montpellier, France
- Unité Mixte de Recherche Qualisud, (alliance between Université Montpellier, Université Avignon, Centre de Recherche Agronomique pour le Développement, Institut Agro, Institut de Recherche pour le Développement and Université de la Réunion), Montpellier, France
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Goyal M, Singh N, Kapoor R, Verma A, Gedam P. Assessment of Nutritional Status of Under-Five Children in an Urban Area of South Delhi, India. Cureus 2023; 15:e34924. [PMID: 36938241 PMCID: PMC10016022 DOI: 10.7759/cureus.34924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Malnutrition among children continues to be a severe public health problem worldwide, whether in a developing country like India or a developed nation. Correct estimation of the problem is a prerequisite to planning the measures to control it. Objective To estimate the prevalence of undernutrition among children under five years of age by utilizing the Composite Index of Anthropometric Failure and the WHO growth charts. Methods From January to March 2020, 1332 children under the age of five years participated in a facility-based, descriptive, cross-sectional study at Fatehpur Beri, Urban Primary Health Center. An anthropometric assessment for each participant was done as per the WHO criteria. The data were entered into a Microsoft Office Excel spreadsheet (Microsoft Corporation, Redmond, WA) and analyzed with WHO Anthro software (WHO, Geneva, Switzerland) and a licensed version of SPSS 21 (IBM Corp., Armonk, NY). Continuous data were expressed using appropriate measures of central tendency, while categorical data were expressed in either frequency or proportions. Results The mean age of the study participants was 23.04 ± 18.24 months, and males (53.3%) were more than (46.7%) females. The prevalence of being underweight was 24.5% (327/1332), of which 24.1% (79/327) of children were severely underweight. Of the total study participants, 27.3% (362/1332) were stunted, and 17.8% (237/1332) were wasted, of which 29.1% (69/237) were severely wasted. The prevalence of anthropometric failure was 45%. Conclusions According to the findings of this study, the prevalence of undernutrition among the study participants was substantial. Furthermore, considering weight for age as the sole criterion may underestimate the true prevalence of malnutrition. The findings have critical implications for future interventions and initiatives among children in India.
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Affiliation(s)
- Mohit Goyal
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Nidhi Singh
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Richa Kapoor
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Anita Verma
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Pratima Gedam
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Fortified balanced energy-protein supplementation during pregnancy and lactation and infant growth in rural Burkina Faso: A 2 × 2 factorial individually randomized controlled trial. PLoS Med 2023; 20:e1004186. [PMID: 36745684 PMCID: PMC9943012 DOI: 10.1371/journal.pmed.1004186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/21/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Optimal nutrition is crucial during the critical period of the first 1,000 days from conception to 2 years after birth. Prenatal and postnatal supplementation of mothers with multimicronutrient-fortified balanced energy-protein (BEP) supplements is a potential nutritional intervention. However, evidence on the long-term effects of BEP supplementation on child growth is inconsistent. We evaluated the efficacy of daily fortified BEP supplementation during pregnancy and lactation on infant growth in rural Burkina Faso. METHODS AND FINDINGS A 2 × 2 factorial individually randomized controlled trial (MISAME-III) was implemented in 6 health center catchment areas in Houndé district under the Hauts-Bassins region. From October 2019 to December 2020, 1,897 pregnant women aged 15 to 40 years with gestational age <21 completed weeks were enrolled. Women were randomly assigned to the prenatal intervention arms receiving either fortified BEP supplements and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control), which is the standard of care during pregnancy. The same women were concurrently randomized to receive either of the postnatal intervention, which comprised fortified BEP supplementation during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention), or the postnatal control, which comprised IFA alone for 6 weeks postpartum (i.e., control). Supplements were provided by trained village-based project workers under direct observation during daily home visits. We previously reported the effect of prenatal BEP supplementation on birth outcomes. The primary postnatal study outcome was length-for-age z-score (LAZ) at 6 months of age. Secondary outcomes were anthropometric indices of growth (weight-for length and weight-for-age z-scores, and arm and head circumferences) and nutritional status (prevalence rates of stunting, wasting, underweight, anemia, and hemoglobin concentration) at 6 months. Additionally, the longitudinal prevalence of common childhood morbidities, incidence of wasting, number of months of exclusive breastfeeding, and trajectories of anthropometric indices from birth to 12 months were evaluated. Prenatal BEP supplementation resulted in a significantly higher LAZ (0.11 standard deviation (SD), 95% confidence interval (CI) [0.01 to 0.21], p = 0.032) and lower stunting prevalence (-3.18 percentage points (pp), 95% CI [-5.86 to -0.51], p = 0.020) at 6 months of age, whereas the postnatal BEP supplementation did not have statistically significant effects on LAZ or stunting at 6 months. On the other hand, postnatal BEP supplementation did modestly improve the rate of monthly LAZ increment during the first 12 months postpartum (0.01 z-score/month, 95% CI [0.00 to 0.02], p = 0.030), whereas no differences in growth trajectories were detected between the prenatal study arms. Furthermore, except for the trend towards a lower prevalence of underweight found for the prenatal BEP intervention at 6 months (-2.74 pp, 95% CI [-5.65 to 1.17], p = 0.065), no other secondary outcome was significantly affected by the pre- or postnatal BEP supplementation. CONCLUSIONS This study provides evidence that the benefits obtained from prenatal BEP supplementation on size at birth are sustained during infancy in terms of linear growth. Maternal BEP supplementation during lactation may lead to a slightly better linear growth towards the second half of infancy. These findings suggest that BEP supplementation during pregnancy can contribute to the efforts to reduce the high burden of child growth faltering in low- and middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov: NCT03533712.
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Sandalinas F, Filteau S, Joy EJM, Segovia de la Revilla L, MacDougall A, Hopkins H. Measuring the impact of malaria infection on indicators of iron and vitamin A status: a systematic literature review and meta-analysis. Br J Nutr 2023; 129:87-103. [PMID: 35260210 PMCID: PMC9816655 DOI: 10.1017/s0007114522000757] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 01/21/2023]
Abstract
Inflammation and infections such as malaria affect estimates of micronutrient status. Medline, Embase, Web of Science, Scopus and the Cochrane library were searched to identify studies reporting mean concentrations of ferritin, hepcidin, retinol or retinol binding protein in individuals with asymptomatic or clinical malaria and healthy controls. Study quality was assessed using the US National Institute of Health tool. Random effects meta-analyses were used to generate summary mean differences. In total, forty-four studies were included. Mean ferritin concentrations were elevated by: 28·2 µg/l (95 % CI 15·6, 40·9) in children with asymptomatic malaria; 28·5 µg/l (95 % CI 8·1, 48·8) in adults with asymptomatic malaria; and 366 µg/l (95 % CI 162, 570) in children with clinical malaria compared with individuals without malaria infection. Mean hepcidin concentrations were elevated by 1·52 nmol/l (95 % CI 0·92, 2·11) in children with asymptomatic malaria. Mean retinol concentrations were reduced by: 0·11 µmol/l (95 % CI -0·22, -0·01) in children with asymptomatic malaria; 0·43 µmol/l (95 % CI -0·71, -0·16) in children with clinical malaria and 0·73 µmol/l (95 % CI -1·11, -0·36) in adults with clinical malaria. Most of these results were stable in sensitivity analyses. In children with clinical malaria and pregnant women, difference in ferritin concentrations were greater in areas with higher transmission intensity. We conclude that biomarkers of iron and vitamin A status should be statistically adjusted for malaria and the severity of infection. Several studies analysing asymptomatic infections reported elevated ferritin concentrations without noticeable elevation of inflammation markers, indicating a need to adjust for malaria status in addition to inflammation adjustments.
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Affiliation(s)
- Fanny Sandalinas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Edward J. M. Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Amy MacDougall
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi Hopkins
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Interlinkages between Climate Change and Food Systems: The Impact on Child Malnutrition-Narrative Review. Nutrients 2023; 15:nu15020416. [PMID: 36678287 PMCID: PMC9865989 DOI: 10.3390/nu15020416] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.
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Ahmed F, Malik NI, Zia S, Akbar AS, Li X, Shahid M, Tang K. Rural mothers' beliefs and practices about diagnosis, treatment, and management of children health problems: A qualitative study in marginalized Southern Pakistan. Front Public Health 2023; 10:1001668. [PMID: 36684927 PMCID: PMC9845559 DOI: 10.3389/fpubh.2022.1001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Appropriate health-seeking beliefs and practices are indispensable for the survival and development of children. In this study, we explore childcare beliefs and practices of rural mothers and analyze the different ways childhood illness is diagnosed and managed in a marginalized rural community in Southern Pakistan. Methods Using purposive sampling, in-depth interviews are conducted to obtain qualitative data from 20 illiterate and rural mothers in addition to 15 healthcare providers in the district Rajanpur of South Punjab. Results and discussion The findings reveal that rural mothers' access to healthcare and therapeutic programs is impeded due to geographical isolation, structural inequalities, poverty, and illiteracy. Consequently, evil eyes, witchcraft, and spirits are recognized as potential threats to children's health and nutrition. Therefore, the treatment of childhood morbidity and malnutrition is mostly performed with folk, domestic, herbal, magico-religious remedies, and spiritual healing methods. The current study also highlights that many low-income and rural mothers tend to normalize childhood illness when they become unable to advocate for their children's health and nutrition. Besides improving low-income mothers' access to healthcare facilities, health education and risk communication at the field level through field health staff could be most effective for health promotion.
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Affiliation(s)
- Farooq Ahmed
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Department of Anthropology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha, Punjab, Pakistan
| | - Sidra Zia
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Abdul Samad Akbar
- Department of Anthropology, Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Xiaoyu Li
- School of Mathematics and Information Science, Xiangnan University, Chenzhou, Hunan, China
| | - Muhammad Shahid
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Insurance and Economics, University of International Business and Economics (UIBE), Beijing, China
- World Health Organization Sub-office, Peshawar, Pakistan
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Chen S, Richardson S, Kong Y, Ma N, Zhao A, Song Y, Lu C, Subramanian SV, Li Z. Association Between Parental Education and Simultaneous Malnutrition Among Parents and Children in 45 Low- and Middle-Income Countries. JAMA Netw Open 2023; 6:e2251727. [PMID: 36692884 PMCID: PMC10408270 DOI: 10.1001/jamanetworkopen.2022.51727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/26/2022] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Parental education is known to be associated with the health status of parents and their offspring. However, the association between parental education and the simultaneous manifestation of multiple forms of malnutrition within households remains underinvestigated globally. OBJECTIVE To assess the association between parental education and the simultaneous manifestation of malnutrition of both parent and child (either overnutrition or undernutrition)-referred to as the double burden of malnutrition (DBM)-at the household level in mother-child and father-child pairs in low- and middle-income countries (LMICs). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the US Agency for International Development Demographic and Health Surveys (January 1, 2010, to December 31, 2021) to identify mother-child pairs and father-child pairs from LMICs. The eligibility criteria were as follows: (1) children aged 0 to 59 months; (2) nonpregnant mothers at the time of the survey in the sample of mother-child pairs; and (3) valid measures of the weight, height, and hemoglobin level for the child and at least 1 of their parents. EXPOSURES Highest level of parental education obtained and number of years of education completed. MAIN OUTCOMES AND MEASURES Four sets of multivariable logistic regression models were constructed to assess the association between parental education and DBM, and analysis was performed between March 10 and May 15, 2022. RESULTS This study included 423 340 mother-child pairs from 45 LMICs and 56 720 father-child pairs from 16 LMICs. The mean (SD) age of the mother-child pairs was 28.2 (6.1) and 1.9 (1.4) years, respectively; 48.8% of the children were female. We observed that 49.0% of mother-child pairs experienced DBM. Compared with mother-child pairs with no maternal education, higher maternal education was associated with a lower risk of DBM. For example, the odds ratio (OR) for tertiary maternal education was 0.71 (95% CI, 0.67-0.74). However, the association differed by DBM subtypes: higher maternal education was associated with a lower risk of both mothers and children being undernourished but with a higher risk of almost all DBM subtypes involving overnutrition. For example, compared with mother-child pairs with no maternal education, those with secondary education were less likely to develop simultaneous maternal and child undernutrition (OR, 0.83 [95% CI, 0.80-0.86]) but were more likely to experience simultaneous maternal and child overnutrition (OR, 2.20 [95% CI, 1.61-3.00]); similar results were observed for pairs with primary and tertiary education. The results in mother-child pairs remained consistent after controlling for paternal education. Among the father-child pairs, 26.5% had DBM, with fathers with tertiary education significantly more likely to experience simultaneous paternal overnutrition and child undernutrition (OR, 1.55 [95% CI, 1.23-1.95]) compared with pairs with no paternal education; they were also less likely to have both paternal and child undernutrition (OR, 0.70 [95% CI, 0.59-0.84]). CONCLUSIONS AND RELEVANCE In this study, maternal education and paternal education were independently associated with DBM, and the associations differed by DBM subtypes. These findings suggest that the different risks of malnutrition faced by households with various levels of education should thus be considered in policy evaluation.
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Affiliation(s)
- Shaoru Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuhao Kong
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ning Ma
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - 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, Boston, Massachusetts
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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Moraes AODS, Magalhães EIDS, Orellana JDY, Gatica-Domínguez G, Neves PAR, Basta PC, Vaz JDS. Food profile of Yanomami indigenous children aged 6 to 59 months from the Brazilian Amazon, according to the degree of food processing: a cross-sectional study. Public Health Nutr 2023; 26:208-218. [PMID: 35620933 PMCID: PMC11077455 DOI: 10.1017/s1368980022001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/13/2022] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The current study aimed to characterise the food profile of Yanomami indigenous children according to the degree of food processing and its associated factors. DESIGN This is a cross-sectional study with Yanomami indigenous children aged 6 to 59 months. Socio-demographic, maternal and infant data were collected through a standardised questionnaire. The food profile was obtained by using a list of thirty-four foods to verify the child's consumption of these foods on the day preceding the interview. Foods were classified according to the degree of processing based on the NOVA system (in natura or minimally processed, processed culinary ingredients, processed and ultra-processed). In natura and minimally processed foods were subdivided into 'regional' and 'urban' foods. Poisson regression analysis was applied to estimate the associated factors according to the 90 % CI. SETTING Three villages (Auaris, Maturacá and Ariabú) in the Yanomami indigenous territory, in the Brazilian Amazon. PARTICIPANTS In total, 251 Yanomami children aged 6 to 59 months were evaluated. RESULTS The prevalence of consumption of 'regional' and 'urban' in natura or minimally processed foods was 93 % and 56 %, respectively, and consumption of ultra-processed foods was 32 %. Ultra-processed food consumption was 11·6 times higher in children of Maturacá and 9·2 times higher in Ariabú when compared with the children of Auaris and 31 % lower in children who had mothers with shorter stature. CONCLUSION Despite the high frequency of consumption of in natura and minimally processed foods, the consumption of ultra-processed foods was substantial and was associated with demographic and maternal factors in Yanomani indigenous children under 5 years of age.
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Affiliation(s)
| | | | | | | | | | - Paulo Cesar Basta
- Samuel Pessoa Department of Endemics, National School of Public
Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ,
Brazil
| | - Juliana dos Santos Vaz
- Postgraduate Program in Nutrition and Food, Federal
University of Pelotas, Pelotas, RS,
Brazil
- Faculty of Nutrition, Federal University of
Pelotas, Rua Gomes Carneiro, nº 1, 2º Andar, Sala 227, Centro,
Pelotas, RS96010-610, Brazil
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139
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González-Fernández D, Cousens S, Rizvi A, Chauhadry I, Soofi SB, Bhutta ZA. Infections and nutrient deficiencies during infancy predict impaired growth at 5 years: Findings from the MAL-ED study in Pakistan. Front Nutr 2023; 10:1104654. [PMID: 36875830 PMCID: PMC9982131 DOI: 10.3389/fnut.2023.1104654] [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: 11/21/2022] [Accepted: 01/10/2023] [Indexed: 02/19/2023] Open
Abstract
Background Socio-economic, nutritional, and infectious factors have been associated with impaired infant growth, but how the presence of these factors during infancy affects growth around 5 years is not well understood. Methods This secondary analysis of the MAL-ED cohort included 277 children from Pakistan for whom socio-demographic, breastfeeding, complementary foods, illness, nutritional biomarkers, stool pathogens and environmental enteropathy indicators between 0 and 11 months were recorded. We used linear regression models to analyze associations of these indicators with height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WLZ) at 54-66 months (~5 years), and Poisson regression with robust standard errors to estimate risk ratios for stunting and underweight ~5 years, controlling for gender, first available weight, and income. Results Among the 237 infants followed longitudinally and evaluated at about 5 years of age, exclusive breastfeeding was short (median = 14 days). Complementary feeding started before 6 months with rice, bread, noodles, or sugary foods. Roots, dairy products, fruits/vegetables, and animal-source foods were provided later than recommended (9-12 months). Anemia (70.9%), deficiencies in iron (22.0%), zinc (80.0%), vitamin A (53.4%) and iodine (13.3%) were common. Most infants (>90%) presented with diarrhea and respiratory infections in their first year. At ~5 years, low WAZ (mean-1.91 ± 0.06) and LAZ (-2.11 ± 0.06) resulted in high prevalence of stunting (55.5%) and underweight (44.4%) but a relatively low rate of wasting (5.5%). While 3.4% had concurrent stunting and wasting ~5 years, 37.8% of children had coexisting stunting and underweight. A higher income and receiving formula or dairy products during infancy were associated with a higher LAZ ~5 years, but infant's history of hospitalizations and more respiratory infections were associated with lower LAZ and higher risk of stunting ~5 years. Infants' intake of commercial baby foods and higher serum-transferrin receptors were associated with higher WAZ and lower risk of underweight ~5 years. Presence of Campylobacter and fecal neopterin >6.8 nmol/L in the first year were associated with increased risk of underweight ~5 years. Conclusion Growth indicators ~5 years were associated with poverty, inappropriate complementary feeding, and infections during the first year of life, which supports the early start of public health interventions for preventing growth delay ~5 years.
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Affiliation(s)
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arjumand Rizvi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imran Chauhadry
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Ahmed Bhutta
- SickKids Centre for Global Child Health, Toronto, ON, Canada.,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.,Institute for Global Health and Development, The Aga Khan University, London, United Kingdom
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140
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Aimone AM, Bassani DG, Qamar H, Dasiewicz A, Perumal N, Namaste SML, Shah D, Roth DE. Complementary and alternative metrics for tracking population-level trends in child linear growth. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001766. [PMID: 37068059 PMCID: PMC10109512 DOI: 10.1371/journal.pgph.0001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023]
Abstract
Stunting prevalence is commonly used to track population-level child nutritional status. However, other metrics derived from anthropometric datasets may be used as alternatives to stunting or provide complementary perspectives on the status of linear growth faltering in low- and middle-income countries (LMICs). Data from 156 Demographic and Health Surveys in 63 LMICs (years 2000 to 2020) were used to generate 2 types of linear growth metrics: (i) measures of location of height distributions (including stunting) for under-5 years (<5y) and 2 to 5 years (2-5y); (ii) model-derived metrics including predicted mean height-for-age z-score (HAZ) at 0, 2, and 5 years; interval slopes of HAZ, height-for-age difference (HAD), and growth delay (GD) from 1 month to 2 years (1mo-2y) and 2-5y; and the SITAR intensity parameter (SITAR-IP) for <5y. Using Spearman's rank correlation coefficient (r), metrics were considered alternatives to stunting if very strongly correlated with stunting (|r|≥0.95) and at least as strongly correlated as stunting with selected population indicators (under 5y mortality, gross domestic product, maternal education). Metrics were considered complementary if less strongly correlated with stunting (|r|<0.95) yet correlated with population indicators. We identified 6 of 15 candidate metrics (stunting 2-5y, mean HAZ <5y and 2-5y, p25 HAZ <5y and 2-5y, predicted HAZ at 2y) as potential alternatives to stunting and 6 as complementary metrics (SITAR-IP, predicted HAZ at 5y, HAZ slope 1m-2y, HAD slope 1m-2y, GD slopes 1m-2y and 2-5y). Three metrics (HAZ slope 2-5y, HAD slope 2-5y years and predicted HAZ at birth) had weak correlations with population indicators (|r| ≤ 0.43). In conclusion, several linear growth metrics could serve as alternatives to stunting prevalence and others may be complementary to stunting in tracking global progress in child health and nutrition. Further research is needed to explore the real-world utility of these alternative and complementary metrics.
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Affiliation(s)
- Ashley M Aimone
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Huma Qamar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison Dasiewicz
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nandita Perumal
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Devanshi Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel E Roth
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Vosti SA, Adams KP, Michuda A, Ortiz-Becerra K, Luo H, Haile D, Chou VB, Clermont A, Teta I, Ndjebayi A, Kagin J, Guintang J, Engle-Stone R. Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon. Ann N Y Acad Sci 2023; 1519:199-210. [PMID: 36471541 DOI: 10.1111/nyas.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs. We used 24-h dietary recall data from Cameroon to estimate usual intake distributions of zinc and VA for children 6-59 months and of folate for WRA. We simulated the effects on dietary inadequacy and lives saved of four fortified foods and two VA supplementation (VAS) platforms. We estimated program costs over 10 years. To promote micronutrient-specific dietary adequacy, the economic optimization model (EOM) selected zinc- and folic acid-fortified wheat flour, VA-fortified edible oils, and bouillon cubes, and VAS via Child Health Days in the North macroregion. A different set of cost-effective MIPs emerged for reducing child mortality, shifting away from VA and toward more zinc for children and more folic acid for WRA. The EOM identified more efficient sets of MIPs than the business-as-usual MIPs, especially among programs aiming to save lives.
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Affiliation(s)
- Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California Davis, Davis, California, USA
| | - Katherine P Adams
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Aleksandr Michuda
- Center for Data Science for Enterprise and Society, Cornell University, Ithaca, New York, USA
| | - Karen Ortiz-Becerra
- Department of Agricultural and Resource Economics, University of California Davis, Davis, California, USA
| | - Hanqi Luo
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Demewoz Haile
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Victoria B Chou
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adrienne Clermont
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ismael Teta
- Helen Keller International, Yaoundé, Cameroon
| | | | | | | | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
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142
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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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143
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Thurstans S, Wrottesley SV, Fenn B, Khara T, Bahwere P, Berkley JA, Black RE, Boyd E, Garenne M, Isanaka S, Lelijveld N, McDonald CM, Mertens A, Mwangome M, O'Brien KS, Stobaugh H, Taneja S, West KP, Guerrero S, Kerac M, Briend A, Myatt M. Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 months: A meta-analysis. MATERNAL & CHILD NUTRITION 2023; 19:e13431. [PMID: 36164997 PMCID: PMC9749608 DOI: 10.1111/mcn.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6-59 months by age and sex. We categorised children into younger (6-23 months) and older (24-59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-income-countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < -2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under-five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits.
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Affiliation(s)
- Susan Thurstans
- London School of Hygiene and Tropical MedicineLondonUK
- Emergency Nutrition NetworkKidlingtonUK
| | | | | | | | - Paluku Bahwere
- Epidemiology, Biostatistics and Clinical Research Centre, School of public HealthUniversité libre de BruxellesBrusselsBelgium
| | - James A. Berkley
- Centre for Tropical Medicine & Global HealthUniversity of OxfordOxfordUK
- Kenya Medical Research Institute (KEMRI)Centre for Geographic Medicine Research Coast (CGMRC) & KEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Robert E. Black
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
| | - Erin Boyd
- USAID/Bureau of Humanitarian AssistanceWashington DCUSA
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Michel Garenne
- IRDUMI RésiliencesParisFrance
- Institut PasteurEpidémiologie des Maladies EmergentesParisFrance
- FERDIUniversité d'AuvergneClermont‐FerrandFrance
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sheila Isanaka
- Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- EpicentreParisFrance
| | | | - Christine M. McDonald
- Departments of Pediatrics, and Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of NutritionUniversity of CaliforniaDavisUSA
| | - Andrew Mertens
- Division of Epidemiology & BiostatisticsUniversity of CaliforniaBerkeleyUSA
| | - Martha Mwangome
- Kenya Medical Research Institute (KEMRI)Centre for Geographic Medicine Research Coast (CGMRC) & KEMRI Wellcome Trust Research ProgrammeKilifiKenya
| | - Kieran S. O'Brien
- Francis I. Proctor FoundationUniversity of CaliforniaSan FranciscoUSA
| | - Heather Stobaugh
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- Action Against Hunger USANew YorkNew YorkUSA
| | - Sunita Taneja
- Center for Health Research and DevelopmentSociety for Applied StudiesNew DelhiIndia
| | - Keith P. West
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
| | | | - Marko Kerac
- London School of Hygiene and Tropical MedicineLondonUK
| | - André Briend
- Center for Child Health Research, Faculty of Medicine and Medical TechnologyTampere UniversityTampereFinland
- Department of Nutrition, Exercise, and SportsUniversity of CopenhagenFredericksbergDenmark
| | - Mark Myatt
- Brixton Health, LlwyngwrilGwyneddWalesUK
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Young MF, Nguyen P, Tran LM, Khuong LQ, Tandon S, Martorell R, Ramakrishnan U. Maternal hemoglobin concentrations across pregnancy and child health and development from birth through 6-7 years. Front Nutr 2023; 10:1114101. [PMID: 36875831 PMCID: PMC9978095 DOI: 10.3389/fnut.2023.1114101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Background The role of changes in maternal hemoglobin (Hb) across pregnancy on child health and development (CHD) remains unclear. Objective We examined the association between maternal Hb trajectories and CHD outcomes: (a) birth outcomes (birth weight, length, gestational age, preterm, and small for gestational age); (b) child Hb at 3, 6, 12, and 24 months; and (c) motor and mental development at 12 and 24 months and cognitive functioning at age 6-7 years. Methods We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam (N = 1,175 women enrolled during preconception with offspring follow-up through 6-7 years). Maternal Hb trajectories were developed using latent class analysis with Hb data at preconception, early (≤20 weeks), mid (21-29 weeks), and late (≥30 weeks) pregnancy. Multivariable linear and logistic regression models were used to assess the association between maternal Hb trajectories on CHD outcomes, adjusting for confounding variables at the maternal, child and household levels. Results Four distinct maternal Hb trajectories were identified. Track 1 (low initial Hb-decline) was associated with lower child Hb at 3 months (β [95% CI] -0.52 [-0.87, -0.16]), 6 months (-0.36 [-0.68, -0.05]), 12 months (-0.46 [-0.79, -0.13]), and 24 months (-0.44 [-0.72, -0.15]) and motor development at 12 months (-3.58 [-6.76, -0.40]) compared to track 4 (high initial Hb-decline). After adjustment for multiple testing, relationships remained robust with the exception of associations with child Hb at 6 months and motor development at 12 months. Track 2 (low initial Hb-improve) was the only Hb trajectory to increase across pregnancy; however, it was insufficiently powered. Track 3 (mid Hb-decline) was associated with lower child Hb at 12 months (-0.27 [-0.44, -0.10]) and 24 months (-0.20 [-0.34, -0.05]) compared to track 4 (high initial Hb-decline). Maternal Hb trajectories were not associated with birth outcomes or child development at 24 months or 6-7 years. Conclusion Maternal Hb trajectories during pregnancy are associated with child Hb concentrations across the first 1,000 days, but not with birth outcomes or later cognitive functioning. More work is needed to better understand and interpret changes in Hb levels during pregnancy especially in resource poor settings.
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Affiliation(s)
- Melissa F Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Phuong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Lan Mai Tran
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | | | - Sonia Tandon
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Reynaldo Martorell
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
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145
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Mukuria-Ashe A, Alayon S, Williams T, Sydykova G, Ali D, Milner E. Determinants of Maternal Diet Quality in Winter in the Kyrgyz Republic. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00720. [PMID: 36951287 PMCID: PMC9771469 DOI: 10.9745/ghsp-d-21-00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/10/2022] [Indexed: 11/12/2022]
Abstract
Diet quality influences maternal health and nutrition from preconception through pregnancy and lactation, as well as infant health and nutrition. Women are vulnerable to poor nutrition given their increased nutrient requirements during the prenatal period through the first 2 years postpartum. Minimum diet diversity among women, a good predictor of adequate micronutrient intake, is often used as a proxy for diet quality. The Kyrgyz Republic is experiencing a triple burden of malnutrition-stunting in children, overweight and obesity in women, and micronutrient deficiencies and anemia in both women and children. In this study, we assessed factors associated with the quality of maternal diets in winter when micronutrient-rich foods may be more difficult to access due to scarcity and price. We conducted secondary data analysis from a survey conducted in the winter of 1,359 mothers of children aged younger than 2 years. Women were asked about the types of foods they stored and preserved in the fall and whether any remained in winter. After controlling for maternal characteristics, household size, main source of income, and region (including urban and rural), women with preserved food remaining at the time of the survey, who stored more than 4 different types of food in the fall, and who lived in Jalal-Abad oblast were more likely to have consumed a minimally diverse diet. Where seasonality affects food availability, promoting culturally appropriate home processing of a variety of foods in the fall and increased market access may improve diet diversity in winter.
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Affiliation(s)
- Altrena Mukuria-Ashe
- USAID Advancing Nutrition, Arlington, VA, USA.
- Save the Children USA, Washington, DC, USA
- Formerly of Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Washington, DC, USA
| | - Silvia Alayon
- USAID Advancing Nutrition, Arlington, VA, USA
- Save the Children USA, Washington, DC, USA
| | - Tim Williams
- USAID Advancing Nutrition, Arlington, VA, USA
- Formerly of Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Washington, DC, USA
- Independent consultant, Addis Ababa, Ethiopia; Formerly of John Snow, Inc
| | - Gulshat Sydykova
- Independent consultant; Formerly of Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Bishkek, Kyrgyz Republic
| | - Disha Ali
- Independent consultant, Addis Ababa, Ethiopia; Formerly of John Snow, Inc
| | - Erin Milner
- Public Health Institute/USAID Sustaining Technical and Analytical Resources, Washington, DC, USA
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Chasekwa B, Ntozini R, Church JA, Majo FD, Tavengwa N, Mutasa B, Noble C, Koyratty N, Maluccio JA, Prendergast AJ, Humphrey JH, Smith LE. Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial. Int J Epidemiol 2022; 51:1785-1799. [PMID: 34875052 DOI: 10.1093/ije/dyab248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g). METHODS The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and 27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth. RESULTS The prevalence of adverse birth outcomes was: miscarriage: 5.0% [95% confidence interval (CI), 4.4, 5.7]; stillbirth: 2.3% (95% CI 1.9, 2.7); preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); and neonatal mortality: 31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births. CONCLUSIONS Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthened management of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles.
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Affiliation(s)
- Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - James A Church
- Blizard Institute, Queen Mary University of London, London, UK
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Christie Noble
- Blizard Institute, Queen Mary University of London, London, UK
| | - Nadia Koyratty
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY, USA
| | - John A Maluccio
- Department of Economics, Middlebury College, Middlebury, VT, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY, USA
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147
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Pérez-Mesa D, Marrero GA, Darias-Curvo S. Child health inequality in Sub-Saharan Africa. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101176. [PMID: 36108522 DOI: 10.1016/j.ehb.2022.101176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
We investigate child height inequality and inequality of predicted height in the Sub-Saharan Africa (SSA) region by socioeconomic, demographic and geographical factors. We characterize their changes in age-cohorts (from 0-1 up to 4-5 years old) and determine the contribution of each factor to these changes. We extract data from the Demographic and Health Surveys (DHS) for 33 SSA countries covering the period from 2009 to 2016. Our measure of health is the standardized height of children below the age of five, adjusted by the age and gender distribution in each country. We show that height inequality is lower for older children than for their younger peers. However, the share of inequality caused by our set of factors rises along the age distribution in more than 80% of countries. We find that family background (reflected by maternal education and the household wealth), followed by home infrastructures related to water, toilet and cooking facilities, and the region of residence contribute to explaining the differences observed in child health inequality along the age distribution in SSA.
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Affiliation(s)
- David Pérez-Mesa
- Economic Department, CEDESOG and IUDR, University of La Laguna, Tenerife, Spain; EQUALITAS.
| | - Gustavo A Marrero
- Economic Department, CEDESOG and IUDR, University of La Laguna, Tenerife, Spain; EQUALITAS.
| | - Sara Darias-Curvo
- WHO European Office for Investment for Health and Development and CEDESOG, University of La Laguna, Tenerife, Spain.
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148
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Yigletu S, Tendulkar SA, Holmes AC, Abdelmenan S, Tadesse A, Berhane HY, Kosinski KC. Key correlates of exclusive breastfeeding at three timepoints: Evidence from Ethiopia. REPRODUCTIVE, FEMALE AND CHILD HEALTH 2022; 1:99-110. [PMID: 38047292 PMCID: PMC10691011 DOI: 10.1002/rfc2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 12/05/2023]
Abstract
Aim To compare factors associated with exclusive breastfeeding (EBF) within 1 h of birth, within 3 days, and within the first 6 months post-birth. Methods We used multivariate logistic regression models and data from "The Alive and Thrive Phase 2 Amhara Baseline Survey 2015" from Ethiopia (N = 3113). Results Giving colostrum was strongly associated with EBF at all three time points, controlling for multiple confounders. Putting the baby to the breast before cleaning the baby and before cleaning the mother was significantly associated with EBF within 1 h and for the first 3 days. EBF within an hour of birth was more likely for girl babies than boy babies. Having a healthcare professional check whether the baby was sucking well was significantly associated with EBF 3 days post-birth. Conclusions The World Health Organization recommends breastfeeding within 1 h of birth and exclusively thereafter for 6 months, which can improve health outcomes for infants and children. In Ethiopia, many factors influence breastfeeding practices, but little is known about how these factors differ at various key timepoints in the 6 months after birth. Our study provides important information on correlates of EBF at three timepoints and shows that factors that are significantly correlated with EBF vary over time. Future research should assess the potential causal links among statistically significant associations between EBF and risk factors at various times between birth and 6 months of age. Ultimately, these findings have the potential to inform areas of intervention related to promoting EBF.
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Affiliation(s)
- Seblewongel Yigletu
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | | | - Ashley C. Holmes
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | | | - Amare Tadesse
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hanna Y. Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Karen C. Kosinski
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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149
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Koyratty N, Ntozini R, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Humphrey J, Smith LE. Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe. BMJ Nutr Prev Health 2022; 5:332-343. [PMID: 36619329 PMCID: PMC9813639 DOI: 10.1136/bmjnph-2022-000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.
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Affiliation(s)
- Nadia Koyratty
- Department of Poverty, Health and Nutrition, International Food Policy Research Institute, Washington DC, Washington DC, USA
| | - Robert Ntozini
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi NN Mbuya
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Naume V Tavengwa
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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150
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Adeyemi O, van den Bold M, Nisbett N, Covic N. Changes in Nigeria’s enabling environment for nutrition from 2008 to 2019 and challenges for reducing malnutrition. Food Secur 2022; 15:343-361. [PMID: 36466116 PMCID: PMC9684792 DOI: 10.1007/s12571-022-01328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
AbstractKey 2025 global nutrition targets are unlikely to be met at current rates of progress. Although actions necessary to reduce undernutrition are already mostly known, knowledge gaps remain about how to implement these actions in contextually appropriate ways, and at scales commensurate with the magnitude of the problem. This study describes the nutrition enabling environment in Nigeria, a country that contributes significantly to the global undernutrition burden, and identifies potential entry points for improving the enabling environment that could facilitate implementation and scale-up of essential intervention coverage. Study data were obtained from two sources: content analysis of 48 policies/strategies from agriculture, economic, education, environment, health, nutrition, and water/sanitation/hygiene sectors; and interviews at federal level (16) and in two states (Jigawa (10) and Kaduna (9) States). The study finds that aspects of the enabling environment improved between 2008 and 2019 and facilitated improvements in implementation of nutrition-specific and nutrition-sensitive interventions. Enabling environment components that improved included the framing of nutrition as a multisectoral issue, nutrition advocacy, political attention, evidence around intervention coverage, civil society involvement, and activity of nutrition champions. These factors have been especially important in creating and sustaining momentum for addressing malnutrition. While challenges remain in these aspects, greater challenges persist for factors needed to convert momentum into improvements in nutrition outcomes. Research and data that facilitate shared understanding of nutrition; improved multisectoral and vertical coordination; increased and improved delivery and operational capacity; and increased resource mobilization will be especially important for achieving future progress in nutrition in Nigeria.
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Affiliation(s)
- Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Mara van den Bold
- Formerly of the International Food Policy Research Institute, Washington D.C., USA
- Clark University, Worcester, MA USA
| | | | - Namukolo Covic
- Formerly of the International Food Policy Research Institute, Washington D.C., USA
- International Livestock Research Institute, Addis Ababa, Ethiopia
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