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Black RE, Liu L, Hartwig FP, Villavicencio F, Rodriguez-Martinez A, Vidaletti LP, Perin J, Black MM, Blencowe H, You D, Hug L, Masquelier B, Cousens S, Gove A, Vaivada T, Yeung D, Behrman J, Martorell R, Osmond C, Stein AD, Adair LS, Fall CHD, Horta B, Menezes AMB, Ramirez-Zea M, Richter LM, Patton GC, Bendavid E, Ezzati M, Bhutta ZA, Lawn JE, Victora CG. Health and development from preconception to 20 years of age and human capital. Lancet 2022; 399:1730-1740. [PMID: 35489357 PMCID: PMC9061873 DOI: 10.1016/s0140-6736(21)02533-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/02/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022]
Abstract
Optimal health and development from preconception to adulthood are crucial for human flourishing and the formation of human capital. The Nurturing Care Framework, as adapted to age 20 years, conceptualises the major influences during periods of development from preconception, through pregnancy, childhood, and adolescence that affect human capital. In addition to mortality in children younger than 5 years, stillbirths and deaths in 5-19-year-olds are important to consider. The global rate of mortality in individuals younger than 20 years has declined substantially since 2000, yet in 2019 an estimated 8·6 million deaths occurred between 28 weeks of gestation and 20 years of age, with more than half of deaths, including stillbirths, occurring before 28 days of age. The 1000 days from conception to 2 years of age are especially influential for human capital. The prevalence of low birthweight is high in sub-Saharan Africa and even higher in south Asia. Growth faltering, especially from birth to 2 years, occurs in most world regions, whereas overweight increases in many regions from the preprimary school period through adolescence. Analyses of cohort data show that growth trajectories in early years of life are strong determinants of nutritional outcomes in adulthood. The accrual of knowledge and skills is affected by health, nutrition, and home resources in early childhood and by educational opportunities in older children and adolescents. Linear growth in the first 2 years of life better predicts intelligence quotients in adults than increases in height in older children and adolescents. Learning-adjusted years of schooling range from about 4 years in sub-Saharan Africa to about 11 years in high-income countries. Human capital depends on children and adolescents surviving, thriving, and learning until adulthood.
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Affiliation(s)
- Robert E Black
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Li Liu
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas Brazil
| | - Francisco Villavicencio
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Centre for Demographic Studies, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Rodriguez-Martinez
- Medical Research Council Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Luis P Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas Brazil
| | - Jamie Perin
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Hannah Blencowe
- Maternal Adolescent Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Data and Analytics Section, UNICEF, New York, NY, USA
| | - Lucia Hug
- Data and Analytics Section, UNICEF, New York, NY, USA
| | - Bruno Masquelier
- Centre de Recherche en Démographie, Université Catholique de Louvain, Louvain, Belgium
| | - Simon Cousens
- Maternal Adolescent Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Amber Gove
- RTI International, Research Triangle Park, NC, USA
| | - Tyler Vaivada
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Diana Yeung
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jere Behrman
- Department of Economics, Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Linda S Adair
- Nutrition Department, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Bernardo Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas Brazil
| | - Manuel Ramirez-Zea
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Linda M Richter
- Department of Science and Innovation, National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Parktown, South Africa
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Eran Bendavid
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Majid Ezzati
- Medical Research Council Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Zulfiqar A Bhutta
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Centre for Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Joy E Lawn
- Maternal Adolescent Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas Brazil
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202
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Wegmüller R, Musau K, Vergari L, Custer E, Anyango H, Donkor WES, Kiprotich M, Siegal K, Petry N, Wirth JP, Lewycka S, Woodruff BA, Rohner F. Effectiveness of an integrated agriculture, nutrition-specific, and nutrition-sensitive program on child growth in Western Kenya: a cluster-randomized controlled trial. Am J Clin Nutr 2022; 116:446-459. [PMID: 35421217 PMCID: PMC9348977 DOI: 10.1093/ajcn/nqac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stunting rates remain unacceptably high in many regions, including sub-Saharan Africa. Agricultural programs have led to increased yields and household incomes but showed limited success in improving nutritional status. OBJECTIVES We assessed whether linear growth could be improved through a potentially scalable, integrated program adding nutrition-specific and nutrition-sensitive components to an existing agricultural program. METHODS In this cluster-randomized controlled trial in rural Western Kenya, we randomized children aged 6-35 months from farming families to an agricultural intervention without (control group) or with a bundle of interventions (intervention group), including distribution of micronutrient powders (MNP), poultry to increase egg consumption, seeds of greens and onions, and soap and chlorine solution, as well as provision of monthly behavior change trainings. The primary outcome was the change in height-for-age z-score (HAZ) over 2 years of follow-up. We assessed safety through active morbidity and passive adverse event monitoring. We conducted an intention-to-treat analysis, followed by per-protocol and prespecified subgroup analyses. RESULTS From March to April 2018, we enrolled 1927 children from 126 clusters (control, 942 children in 63 clusters; intervention, 985 children in 63 clusters). Data on HAZ were available for 1672 (86.6%) children after 2 years. Adherence was >80% for use of MNP, chlorine, and greens and receipt of soap, and ∼40% for egg and red onion consumption. The intention-to-treat analysis indicated a greater change in HAZ over 2 years in the intervention group (adjusted effect size, 0.11; 95% CI: 0.02-0.19). We found a slightly stronger effect in the per-protocol analysis (adjusted effect size, 0.15; 95% CI: 0.06-0.24). Dietary diversity and consumption of iron-rich foods were improved in the intervention group, and reported instances of fever, lower respiratory tract infections, and diarrheal episodes were lower in the intervention group. CONCLUSIONS This study found a modest improvement in linear growth, indicating the need for multiple, integrated interventions to achieve benefits. The trial was registered with clinicaltrials.gov as NCT03448484.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sonia Lewycka
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK,Oxford University Clinical Research Unit, Hanoi, Vietnam
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203
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Abstract
Nonresolving inflammation contributes to many diseases, including COVID-19 in its fatal and long forms. Our understanding of inflammation is rapidly evolving. Like the immune system of which it is a part, inflammation can now be seen as an interactive component of a homeostatic network with the endocrine and nervous systems. This review samples emerging insights regarding inflammatory memory, inflammatory aging, inflammatory cell death, inflammatory DNA, inflammation-regulating cells and metabolites, approaches to resolving or modulating inflammation, and inflammatory inequity.
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Affiliation(s)
- Carl Nathan
- Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY 10065, USA.
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204
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Manley J, Alderman H, Gentilini U. More evidence on cash transfers and child nutritional outcomes: a systematic review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2021-008233. [PMID: 35365481 PMCID: PMC8977747 DOI: 10.1136/bmjgh-2021-008233] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/15/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cash transfer (CT) programmes are an increasingly common approach to alleviate poverty and inequality and improving child health and nutrition, as well as supporting other goals such as education. Evidence indicates that CTs can be effective, but overall impacts are small in magnitude. This paper substantially updates the evidence base on the effectiveness of CTs and moderating factors. METHODS Building on a prior search done in 2018, we searched articles published between January 2018 and March 2021 using Agris, Econlit, Eldis, IBSS, IDEAS, IFPRI, Google Scholar, PubMed and World Bank databases. We included studies using quantitative impact evaluation methods of CTs with sample sizes over 300, targeted to households with children under 5 years conducted with clear counterfactuals in countries with gross domestic product below US$10 000 at baseline. We performed meta-analysis using random effects models to assess the impact of CT programme on selected child nutrition outcomes. FINDINGS Out of 1561 articles identified, 55 additional articles were eligible for inclusion for a total of 129 estimates. We find that CTs have significant although modest effects on height-for-age z-scores (HAZ) (0.024, 95% CI 0.004 to 0.044; p<0.02); stunting (-1.35%, 95% CI -2.35 to - 0.35; p<0;01); wasting (-1.31%, 95% CI -2.16% to 0.46%; p<0.01); animal-source foods (6.72%, 95% CI 5.24% to 8.20%; p<0.01); diet diversity (0.55, 95% CI 0.30 to 0.81; p<0.01) and diarrhoea incidence (- 1.74%, 95% CI -2.79% to -0.68%; p<0.05). There was no significant effect of CTs on weight-for-height (WHZ) or weight-for-age z-scores (WAZ). Well-targeted behaviour change communication was also effective in improving HAZ and decreasing the prevalence of diarrhoea. INTERPRETATION CT programmes improved linear growth among young children, reducing wasting and stunting, but effects are heterogeneous and somewhat small overall. More evidence indicates that effects on dietary diversity and the consumption of animal-source foods are increasingly pronounced.
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Affiliation(s)
- James Manley
- Economics, Towson University, Towson, Maryland, USA
| | - Harold Alderman
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Ugo Gentilini
- Global Lead for Social Assistance, Social Protection and Jobs Global Practice in the World Bank Group, Washington, District of Columbia, USA
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205
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Siy Van VT, Antonio VA, Siguin CP, Gordoncillo NP, Sescon JT, Go CC, Miro EP. Predicting undernutrition among elementary schoolchildren in the Philippines using machine learning algorithms. Nutrition 2022; 96:111571. [DOI: 10.1016/j.nut.2021.111571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/23/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
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206
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Liu E, Wang D, Darling AM, Perumal N, Wang M, Urassa W, Pembe A, Fawzi WW. Multivitamin Supplementation Is Associated with Greater Adequacy of Gestational Weight Gain among Pregnant Women in Tanzania. J Nutr 2022; 152:1091-1098. [PMID: 34964890 PMCID: PMC8970983 DOI: 10.1093/jn/nxab448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is a modifiable risk factor associated with adverse birth outcomes. Studies have shown that the provision of multiple micronutrient supplements to pregnant women reduces the risk of low birth weight. However, the effect of multiple micronutrient supplements on GWG has been understudied. OBJECTIVES We examined the effect of daily supplementation of pregnant women with multivitamins on GWG in relation to the GWG recommendation by the Institute of Medicine (IOM). METHODS Pregnant women with gestational age between 12 and 27 wk were randomly assigned to receive daily multivitamins or placebo until delivery. Weight was measured at enrollment and every follow-up visit. Percentage adequacy of GWG was calculated as actual GWG divided by the recommended GWG according to the IOM recommendation. Binary outcomes included severely inadequate (<70%), inadequate (<90%), and excessive GWG (≥125%). The analysis included 7573 women with singleton pregnancies. Multiple linear regression models were used to examine the association between multivitamin supplementation and percentage adequacy of GWG, and log-binomial models were used for binary outcomes. RESULTS The mean percentage adequacy of GWG was 96.7% in the multivitamin arm and 94.4% in the placebo arm, with a mean difference of 2.3% (95% CI: 0.3%, 4.2%; P = 0.022). Compared with women in the placebo arm, those who received multivitamins had a lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.97; P = 0.008) and inadequate GWG (RR: 0.95; 95% CI: 0.91, 0.99; P = 0.018). No significant difference was found in excessive GWG. CONCLUSIONS Multivitamin supplementation increased GWG and reduced the risk of severely inadequate and inadequate GWG among pregnant women in Tanzania. Together with previously reported beneficial effects of the supplements on birth outcomes in low- and middle-income countries, our findings support scaling up the use of prenatal supplements that include multivitamins in addition to iron and folic acid.This trial was registered at clinicaltrials.gov as NCT00197548.
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Affiliation(s)
- Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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207
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Sanghvi T, Nguyen PH, Tharaney M, Ghosh S, Escobar‐Alegria J, Mahmud Z, Walissa T, Zafimanjaka M, Kim S. Gaps in the implementation and uptake of maternal nutrition interventions in antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India. MATERNAL & CHILD NUTRITION 2022; 18:e13293. [PMID: 34816602 PMCID: PMC8932725 DOI: 10.1111/mcn.13293] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/11/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence‐based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self‐efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress. Delivering nutrition services to all pregnant women is essential for maternal and child health outcomes but remains a challenge. Nutrition gaps in antenatal care (ANC) include lack of specificity in national guidelines and protocols, bottlenecks in micronutrient supplies, low ANC provider knowledge and skills, inadequate supervision to reinforce counseling, and not engaging families to encourage key practices. National protocols for ANC should be more specific for the four nutrition interventions (micronutrient supplements, weight gain monitoring, counseling on diets and counseling on breastfeeding) and assign accountability for coverage and quality. Country models are needed for improving provision and utilisation of nutrition interventions through ANC that are based on comprehensive policy frameworks.
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Affiliation(s)
- Tina Sanghvi
- Alive & Thrive Initiative FHI Solutions Washington District of Columbia USA
| | - Phuong H. Nguyen
- Poverty, Health and Nutrition Division International Food Policy Research Institute Washington District of Columbia USA
| | - Manisha Tharaney
- Alive & Thrive Initiative FHI Solutions Washington District of Columbia USA
| | - Sebanti Ghosh
- Alive & Thrive Initiative FHI Solutions Washington District of Columbia USA
| | | | - Zeba Mahmud
- Alive & Thrive Initiative FHI Solutions Washington District of Columbia USA
| | - Tamirat Walissa
- Alive & Thrive Initiative FHI Solutions Washington District of Columbia USA
| | | | - Sunny Kim
- Poverty, Health and Nutrition Division International Food Policy Research Institute Washington District of Columbia USA
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208
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Khanna D, Yalawar M, Verma G, Gupta S. Century Wide Changes in Macronutrient Levels in Indian Mothers’ Milk: A Systematic Review. Nutrients 2022; 14:nu14071395. [PMID: 35406008 PMCID: PMC9002949 DOI: 10.3390/nu14071395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this systematic review was to understand Indian mothers’ milk composition and report changes in it over the past 100 years. A review was conducted in accordance with PRISMA and registered with PROSPERO (CRD42022299224). All records published between 1921 and 2021 were identified by searching databases Google Scholar, ResearchGate, PubMed, and the Cochrane Database of Systematic Reviews. All observational, interventional, or supplementation studies reporting macronutrients (protein, fat, lactose) in milk of Indian mothers, delivering term infants, were included. Publications on micronutrients, preterm, and methods were excluded. Milk was categorized into colostrum, transitional, and mature. In all, 111 records were identified, of which 34 were included in the final review. Fat ranged from 1.83 to 4.49 g/100 mL, 2.6 to 5.59 g/100 mL, and 2.77 to 4.78 g/100 mL in colostrum, transitional, and mature milk, respectively. The protein was higher in colostrum (1.54 to 8.36 g/100mL) as compared to transitional (1.08 to 2.38 g/100 mL) and mature milk (0.87 to 2.33 g/100 mL). Lactose was lower in colostrum (4.5–6.47 g/100 mL) as compared to transitional (4.8–7.37 g/100 mL) and mature milk ranges (6.78–7.7 g/100 mL). The older studies (1950–1980) reported higher fat and protein in colostrum as compared to subsequent time points. There were variations in maternal nutritional status, diet, socioeconomic status, and regions along with study design specific differences of time or methods of milk sampling and analysis. Additionally, advancements in methods over time make it challenging to interpret time trends. The need for conducting well-designed, multicentric studies on nutrient composition of Indian mother’s milk using standardized methods of sampling and estimation for understanding the role of various associated factors cannot be undermined.
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Affiliation(s)
- Deepti Khanna
- Independent Researcher, G-914, Jal Vayu Towers, Sector-47, Noida 201304, India
- Correspondence: ; Tel.: +91-9818697377
| | - Menaka Yalawar
- Biostatistics and Statistical Programming, Life Sciences-Digital Business Operations, Cognizant Technology Solutions India Pvt Ltd., Manyata Business Park, Nagavara, Bengaluru 560045, India;
| | - Gaurav Verma
- Abbott Nutrition, Research & Development India, Godrej BKC Plot–C, “G” Block, Bandra Kurla Complex, Bandra East, Mumbai 400051, India;
| | - Shavika Gupta
- Independent Researcher, MP-96, Maurya Enclave, Pitampura, New Delhi 110034, India;
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209
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Cliffer IR, Perumal N, Masters WA, Naumova EN, Ouedraogo LN, Garanet F, Rogers BL. Linear Growth Spurts are Preceded by Higher Weight Gain Velocity and Followed by Weight Slowdowns Among Rural Children in Burkina Faso: A Longitudinal Study. J Nutr 2022; 152:1963-1973. [PMID: 35325187 PMCID: PMC9361740 DOI: 10.1093/jn/nxac071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The temporal relationship between length (linear) and weight (ponderal) growth in early life is important to support optimal nutrition program design. Studies based on measures of attained size have established that wasting often precedes stunting, but such studies do not capture responsiveness of growth to previous compared with current conditions. As a result, the temporality of linear and ponderal growth relationships remain unclear. OBJECTIVES We used growth velocity indicators to assess the temporal bidirectional relationships between linear and ponderal growth in children. METHODS Using monthly anthropometric measurements from 5039 Burkinabè children enrolled at 6 months of age and followed until 28 months from August 2014 to December 2016, we employed multilevel mixed-effects models to investigate concurrent and lagged associations between linear and ponderal growth velocity, controlling for time trends, seasonality, and morbidity. RESULTS Faster ponderal growth is associated with faster concurrent and subsequent linear growth (0.21-0.72 increase in length velocity z-score per unit increase in weight velocity z-score), while faster linear growth is associated with slower future weight gain (0.009-0.02 decrease in weight velocity z-score per unit increase in length velocity z-score), especially among children 9-14 months. Ponderal growth slows around the same time as peaks in morbidity, followed roughly a month later by slower linear growth. CONCLUSIONS Use of velocity measures to assess temporal dependencies between linear and ponderal growth demonstrate that the same growth-limiting conditions likely affect both length and weight velocity, that slow ponderal growth likely limits subsequent linear growth, and that linear growth spurts may not be accompanied by sufficient increases in dietary intake to avoid slowdowns in weight gain.
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Affiliation(s)
| | - Nandita Perumal
- Global Health and Population Department, Harvard T.H. Chan School of Public
Health, Harvard University, Boston, MA, USA
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, USA
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, USA
| | - Laetitia Nikiema Ouedraogo
- Institut de Recherche en Sciences de la Santé, Centre National de la
Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Franck Garanet
- Institut de Recherche en Sciences de la Santé, Centre National de la
Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Beatrice L Rogers
- Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, USA
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210
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Hitchings MDT, Berthé F, Aruna P, Shehu I, Hamza MA, Nanama S, Steve-Edemba C, Grais RF, Isanaka S. Effectiveness of a monthly schedule of follow-up for the treatment of uncomplicated severe acute malnutrition in Sokoto, Nigeria: A cluster randomized crossover trial. PLoS Med 2022; 19:e1003923. [PMID: 35231024 PMCID: PMC8887725 DOI: 10.1371/journal.pmed.1003923] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Community-based management of severe acute malnutrition (SAM) involves weekly or biweekly outpatient clinic visits for clinical surveillance and distribution of therapeutic foods. Distance to outpatient clinics and high opportunity costs for caregivers can represent major barriers to access. Reducing the frequency of outpatient visits while providing training to caregivers to recognize clinical danger signs at home between outpatient visits may increase acceptability, coverage, and public health impact of SAM treatment. We investigated the effectiveness of monthly clinic visits compared to the standard weekly follow-up in the outpatient treatment of uncomplicated SAM in northwestern Nigeria. METHODS AND FINDINGS We conducted a cluster randomized crossover trial to test the noninferiority of nutritional recovery in children with uncomplicated SAM receiving monthly follow-up compared to the standard weekly schedule. From January 2018 to November 2019, 3,945 children aged 6 to 59 months were enrolled at 10 health centers (5 assigned to monthly follow-up and 5 assigned to weekly follow-up) in Sokoto, Nigeria. In total, 96% of children (n = 1,976 in the monthly follow-up group and 1,802 in the weekly follow-up group) were followed until program discharge, and 91% (n = 1,873 in the monthly follow-up group and 1,721 in the weekly follow-up group) were followed to 3 months postdischarge. The mean age at admission was 15.8 months (standard deviation [SD] 7.1), 2,097/3,945 (53.2%) were girls, and the mean midupper arm circumference (MUAC) at admission was 105.8 mm (SD 6.0). In a modified intention-to-treat analysis, the primary outcome of nutritional recovery, defined as having MUAC ≥125 mm on 2 consecutive visits, was analyzed using generalized linear models, with generalized estimating equations to account for clustering. Nutritional recovery was lower in the monthly follow-up group compared to the weekly group (1,036/1,976, 52.4% versus 1,059/1,802, 58.8%; risk difference: -6.8%), and noninferiority was not demonstrated (lower bound of the confidence interval [CI] was -11.5%, lower than the noninferiority margin of 10%). The proportion of children defaulting was lower in the monthly group than in the weekly group (109/1,976, 5.5% versus 151/1,802, 8.4%, p = 0.03). Three months postdischarge, children in the monthly group were less likely to relapse compared to those in the weekly group (58/976, 5.9% versus 78/1,005, 7.8%, p = 0.03), but cumulative mortality at 3 months postdischarge was higher in the monthly group (159/1,873, 8.5% versus 106/1,721, 6.2%, p < 0.001). Study results may depend on context-specific factors including baseline level of care and the clinical status of children presenting to health centers, and, thus, generalizability of these results may be limited. CONCLUSIONS Where feasible, a weekly schedule of clinic visits should be preferred to maintain effectiveness of SAM treatment. Where geographic coverage of programs is low or frequent travel to outpatient clinics is difficult or impossible, a monthly schedule of visits may provide an alternative model to deliver treatment to those in need. Modifications to the outpatient follow-up schedule, for example, weekly clinic visits until initial weight gain has been achieved followed by monthly visits, could increase the effectiveness of the model and add flexibility for program delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT03140904.
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Affiliation(s)
- Matt D. T. Hitchings
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | | | - Philip Aruna
- Médecins Sans Frontières–Operational Center Amsterdam, Amsterdam, the Netherlands
| | | | | | - Siméon Nanama
- UNICEF West and Central Regional Office, Dakar, Senegal
| | | | | | - Sheila Isanaka
- Epicentre, Paris, France
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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211
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O'Meara L, Turner C, Coitinho DC, Oenema S. Consumer experiences of food environments during the Covid-19 pandemic: Global insights from a rapid online survey of individuals from 119 countries. GLOBAL FOOD SECURITY 2022; 32:100594. [PMID: 34812406 PMCID: PMC8598973 DOI: 10.1016/j.gfs.2021.100594] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023]
Abstract
This study investigates consumer experiences of food environments and food acquisition practices during the Covid-19 pandemic. Our rapid assessment online survey featured a convenience sample of 2015 individuals from 119 countries, spanning Western Europe, North America, Latin America, Asia-Pacific, and Africa. Data collection took place in April 2020 during the second month of the pandemic. Participants were recruited via existing networks of the United Nations System Standing Committee on Nutrition, through social media, and by snowballing. The majority of participants were female (71.9%), from low- and middle-income countries (51.0%), and working in nutrition or healthcare (39.3%). Qualitative thematic analysis and descriptive statistics reveal a series of common global experiences related to food availability and accessibility, food prices and affordability, food acquisition practices, and food preparation and consumption. The importance of community food participation, food sharing, and resource allocation are highlighted, along with increasing awareness of healthy diets and food waste. We identify ten synergistic policy entry points to: 1) build resilient and equitable food environments resistant to stresses and shocks; 2) harness positive dietary-related behaviors manifested during the pandemic; and, 3) mitigate the projected nutrition crisis and promote sustainable healthy diets for all.
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Affiliation(s)
- Lydia O'Meara
- Natural Resources Institute, University of Greenwich, UK
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212
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Optimizing prevention and community-based management of severe malnutrition in children. PLoS Med 2022; 19:e1003924. [PMID: 35231022 PMCID: PMC8887723 DOI: 10.1371/journal.pmed.1003924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Zulfiqar A. Bhutta discusses prevention and treatment strategies for optimization of community-based management of severe acute malnutrition in children.
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213
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Di Prima S, Wright EP, Sharma IK, Syurina E, Broerse JE. Implementation and scale-up of nutrition-sensitive agriculture in low- and middle-income countries: a systematic review of what works, what doesn't work and why. GLOBAL FOOD SECURITY 2022. [DOI: 10.1016/j.gfs.2021.100595] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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214
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Sanjeev RK, Nuggehalli Srinivas P, Krishnan B, Basappa YC, Dinesh AS, Ulahannan SK. Eco-geographic patterns of child malnutrition in India and its association with cereal cultivation: An analysis using demographic health survey and agriculture datasets. Wellcome Open Res 2022; 5:118. [PMID: 35720193 PMCID: PMC9194519 DOI: 10.12688/wellcomeopenres.15934.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background: High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Cereals, particularly millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. Methods: The previous round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more fine-scale characterisation of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Results: Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed relatively higher prevalence at six months of age. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet and foxtail millet). District level stunting was associated with higher district level cultivation of wheat. In multivariable analysis, wasting was positively associated with women's body mass index and stunting with women's short stature. Conclusions: Well-designed intervention studies will be required to confirm causal pathways contributing to ecogeographic patterns of child malnutrition. The cultivation of other millets has a strong association with prevalence of wasting. State-of-the-art studies that improve our understanding of bio-availability of amino acids and other nutrients from the prevalent dietary matrices of rural poor communities will be needed to confirm causal pathways contributing to potential eco-geographic patterns.
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Affiliation(s)
- Rama Krishna Sanjeev
- Pediatrics, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | | | - Bindu Krishnan
- Physiology, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | - Yogish Channa Basappa
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
| | | | - Sabu K. Ulahannan
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
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215
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Factors influencing quality nutrition service provision at antenatal care contacts: Findings from a public health facility-based observational study in 21 districts of Bangladesh. PLoS One 2022; 17:e0262867. [PMID: 35085319 PMCID: PMC8794200 DOI: 10.1371/journal.pone.0262867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022] Open
Abstract
Malnutrition during pregnancy is associated with increased maternal morbidity and mortality and has a long-term negative impact on child growth and development. Antenatal care (ANC) is the formal point of contact for pregnant women to receive preventive health and nutrition services. We assessed the quality of nutrition service delivery during ANC and examined its influencing factors related to the health facility, health care provider (HCP) and client characteristics. We conducted a cross-sectional assessment in 179 facilities, including 1,242 ANC observations and exit interviews of pregnant women from 21 districts in Bangladesh. We considered four essential nutrition services at each ANC contact including maternal weight measurement, anaemia assessment, nutrition counselling and iron-folic acid (IFA) supplement provision. We defined a composite ‘quality nutrition service’ outcome by counting the number of services (out of four) provided at each ANC from observation data. We explored both the supply-side and the client-level factors of quality nutrition service using multilevel Poisson regression. Overall, only 15% of clients received all four nutrition services. Performance of weight measurement (79%) was higher than IFA provision (56%), anaemia assessment (52%) and nutrition counselling (52%). The multivariable analysis showed that quality nutrition service delivery is positively associated with good logistical readiness of the facilities (aIRR: 1.23, 95% CI: 1.08–1.39), consultation by paramedics (aIRR 1.23, 95% CI: 1.06–1.42) and community health care providers (aIRR 1.32, 95% CI: 1.12–1.57), HCPs’ knowledge on maternal nutrition (aIRR 1.04; 95% CI: 1.01–1.08), better HCP-client communication (aIRR 1.14; 95% CI: 1.04–1.26) and use visual aids or ANC card (aIRR 1.18; 95% CI: 1.11–1.27). We found limited associations between HCP training and external supervision with the quality of nutrition services. In conclusion, the quality of nutrition service provision during ANC is suboptimal. Public health nutrition programmers should ensure the facilities’ logistical readiness, and revisit and reinforce the content and modality of training and supportive supervision of the HCPs. They should also emphasize positive HCP-client communication and the use of job aids to improve the quality of nutrition service provision during ANC.
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Haile D, Brown KH, McDonald CM, Luo H, Jarvis M, Teta I, Ndjebayi A, Martial GAJ, Vosti SA, Engle-Stone R. Applying Zinc Nutrient Reference Values as Proposed by Different Authorities Results in Large Differences in the Estimated Prevalence of Inadequate Zinc Intake by Young Children and Women and in Cameroon. Nutrients 2022; 14:nu14040883. [PMID: 35215534 PMCID: PMC8879783 DOI: 10.3390/nu14040883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/06/2023] Open
Abstract
Nutrient reference values (NRVs) for zinc set by several expert groups differ widely and may affect the predicted prevalence of inadequate zinc intake. We examined this possibility using NRVs published by four different authorities and nationally representative dietary intake data collected among children aged 12–59 months and women in Cameroon. Usual zinc intake was estimated from 24 h recall data using the National Cancer Institute method. Prevalences of total zinc intake below the dietary requirement and of “absorbable zinc intake” below the physiological requirement were estimated using NRVs published by the World Health Organization (WHO), US Institute of Medicine (IOM), International Zinc Nutrition Consultative Group (IZiNCG), and European Food Safety Authority (EFSA). The prevalence of inadequate zinc intake ranged from 10% (IZiNCG—physiological requirement, 95% CI 7–13%) to 81% (EFSA—physiological requirement, 95% CI 78–84%) among children and 9% (WHO—physiological requirement, 95% CI 8–11.0%) to 94% (IOM—physiological requirement, 95% CI 92–95%) among women These differences in the prevalence of inadequate intake translated into sizeable differences in the predicted benefit and cost-effectiveness of zinc fortification programs. Depending on the NRVs applied, assessments differ regarding the need for and design of zinc fortification programs. Efforts are needed to harmonize NRVs for zinc.
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Affiliation(s)
- Demewoz Haile
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Correspondence: ; Tel.: +1-530-601-3869
| | - Kenneth H. Brown
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
| | - Christine M. McDonald
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Departments of Pediatrics, and Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA 94143, USA
| | - Hanqi Luo
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Michael Jarvis
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
| | - Ismael Teta
- Helen Keller International, Yaoundé 1771, Cameroon; (I.T.); (A.N.)
| | - Alex Ndjebayi
- Helen Keller International, Yaoundé 1771, Cameroon; (I.T.); (A.N.)
| | | | - Stephen A. Vosti
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Department of Agricultural and Resource Economics, University of California, Davis, CA 95616, USA
| | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
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217
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Jiang S, Liu J, Qi X, Wang R, Wang X, Wang K, Xu Q, Chen P, Meng N, Wu Q, Shan L. Global, Regional, and National Estimates of Nutritional Deficiency Burden among Reproductive Women from 2010 to 2019. Nutrients 2022; 14:832. [PMID: 35215481 PMCID: PMC8877546 DOI: 10.3390/nu14040832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/30/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023] Open
Abstract
Women of reproductive age (15-49 years) are often considered a vulnerable population affected by nutritional deficiencies, impairing their health and that of their offspring. We briefly introduced (a) the incidence and disability-adjusted life years (DALYs) trends from 2010 to 2019 and (b) the correlation between sex differences and income levels and nutritional deficiencies of reproductive women firstly. Notably, the burden of overall nutritional deficiencies among reproductive women remained generally stable from 2010 to 2019, whereas the iodine and vitamin A deficiencies as a subcategory were associated with increased incidence rates and DALYs, respectively. A significant increasing trend occurred in South Asia, Southeast Asia, and Turkey for incidence, and Western Sub-Saharan Africa and Zimbabwe had a strong increase for DALYs. Further analysis of the correlation between nutritional deficiency incidence and economic capacity showed that they were not correlated with the income of women themselves, as was the result of income difference with men. The results of this study will help to identify gaps in nutritional deficiency burden among reproductive women and facilitate the development of regional or national responses. Compared with economic capital, macroscopic political guarantees and social and cultural capital are important measures to remedy the nutritional deficiencies of reproductive women.
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Affiliation(s)
- Shengchao Jiang
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Jingjing Liu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Xinye Qi
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Rizhen Wang
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Xing Wang
- The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310014, China;
| | - Kexin Wang
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Qiao Xu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Peiwen Chen
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Nan Meng
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Qunhong Wu
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
| | - Linghan Shan
- Department of Health Policy, Health Management College, Harbin Medical University, Harbin 150081, China; (S.J.); (J.L.); (X.Q.); (R.W.); (K.W.); (Q.X.); (P.C.); (N.M.)
- Department of Social Medicine, School of Public Health, Harbin Medical University Harbin, Harbin 150081, China
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Mihrshahi S, Ara G, Khanam M, Rasheed S, Agho KE, Kabir AI, Roy SK, Haider R, Derakhshani Hamadani J, Tofail F, Alam A, Dibley MJ. The Shishu Pushti Trial-Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e31475. [PMID: 35129457 PMCID: PMC8861872 DOI: 10.2196/31475] [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: 07/14/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. OBJECTIVE Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. METHODS This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). RESULTS We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. CONCLUSIONS This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. TRIAL REGISTRATION ClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31475.
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Affiliation(s)
- Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Gulshan Ara
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mansura Khanam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | - S K Roy
- Bangladesh Breastfeeding Foundation, Institute of Public Health, Dhaka, Bangladesh
| | - Rukhsana Haider
- Training and Assistance for Health and Nutrition Foundation, Dhaka, Bangladesh
| | - Jena Derakhshani Hamadani
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Factors associated with minimum dietary diversity failure among Indian children. J Nutr Sci 2022; 11:e4. [PMID: 35291273 PMCID: PMC8889227 DOI: 10.1017/jns.2022.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022] Open
Abstract
Recognising the importance of infant and young child feeding practices during the first 2 years of life, the World Health Organization's Global Nutrition Monitoring Framework developed a minimum dietary diversity (MDD) indicator for feeding children aged 6–23 months. MDD is defined as the consumption of food items from five or more groups out of a total of eight food groups. Food intake from less than five food groups is considered minimum dietary diversity failure (MDDF). Using the nationally representative National Family Health Survey (NFHS) dataset, the present study assessed the trend in MDDF between 2005–6 and 2015–16 and the factors associated with MDDF among children aged 6–23 months during 2015–16. The NFHS conducted in 2005–6 and 2015–16 covered a sample of 14 419 and 74 078 children aged 6–23 months, respectively. Overall, the MDDF reduced from 87⋅4 % (95 % confidence interval (95 % CI) 86⋅8 %, 87⋅9 %) in 2005–6 to 80⋅6 % (95 % CI 80⋅1 %, 81⋅0 %) in 2015–16. Multivariable logistic regression analysis revealed that increased child's age, second and third birth order children, higher maternal age and education, mass media exposure of mothers and more than four antenatal care visits had a negative association with the MDDF. Children living in rural areas and residing in high-focus states of India were observed with higher odds of experiencing MDDF. Exposure to community healthcare services was negatively associated with MDDF, and anaemic children were more likely to have MDDF. Socioeconomic status of mothers and children and encouragement of maternal and child healthcare use could be helpful in devising context-specific intervention to mitigate MDDF.
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Lowery CM, Craig HC, Litvin K, Dickin KL, Stein M, Worku B, Martin SL. Experiences Engaging Family Members in Maternal, Child, and Adolescent Nutrition: A Survey of Global Health Professionals. Curr Dev Nutr 2022; 6:nzac003. [PMID: 35224418 PMCID: PMC8866103 DOI: 10.1093/cdn/nzac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Family members influence maternal, child, and adolescent nutrition and are increasingly engaged in nutrition interventions and research. However, there remain gaps in the literature related to programmatic experiences and lessons learned from engaging these key influencers in nutrition activities. OBJECTIVES This research aimed to document global health professionals' experiences engaging family members in nutrition activities, and their perceived barriers, facilitators, and recommendations for nutrition activities that engage family members. METHODS Global health and nutrition professionals were invited to complete an online survey about their experiences engaging family members in nutrition activities. The survey included 42 multiple-choice questions tabulated by frequency and 4 open-response questions, which were analyzed thematically. RESULTS More than 180 respondents (n = 183) in 49 countries with experience engaging fathers, grandmothers, and other family members in nutrition activities participated in the survey. Participants highlighted the importance of conducting formative research with all members of the family system and using participatory processes in intervention design and implementation. Respondents reported engaging family members increases support for recommended behaviors, improves program sustainability, and facilitates family and community ownership. Some respondents also shared experiences with positive and negative unintended consequences when engaging family members; for example, one-fifth of participants reported that mothers were uncomfortable with involving men in discussions. Common challenges centered on limited resources for program delivery, not involving all influential family members, and traditional gender norms. Recommendations included incorporating family members in the project design phase and ensuring sufficient project resources to engage family members throughout the project lifecycle. CONCLUSIONS Surveying global health professionals provides an opportunity to learn from their experiences and fill gaps in the peer-reviewed literature to strengthen intervention design and implementation. Community ownership and sustainability emerged as key benefits of family engagement not previously reported in the literature, but responses also highlighted potential negative unintended consequences.
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Affiliation(s)
- Caitlin M Lowery
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hope C Craig
- Master of Public Health Program, Population Medicine & Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Kate Litvin
- USAID Advancing Nutrition, Arlington, VA, USA
| | - Katherine L Dickin
- Master of Public Health Program, Population Medicine & Diagnostic Sciences, Cornell University, Ithaca, NY, USA
- USAID Advancing Nutrition, Arlington, VA, USA
| | - Maggie Stein
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beamlak Worku
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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221
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Wang D, Schwinger C, Urassa W, Berhane Y, Strand TA, Fawzi WW. Comparing Attained Weight and Weight Velocity during the First 6 Months in Predicting Child Undernutrition and Mortality. J Nutr 2022; 152:319-330. [PMID: 34549299 PMCID: PMC8754579 DOI: 10.1093/jn/nxab338] [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: 08/15/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The first 6 mo of life are critical for subsequent risk of undernutrition and mortality. The predictive abilities of attained weight at the end of each month and monthly weight velocity for undernutrition and mortality need to be compared. OBJECTIVES This study aimed to examine the predictive abilities of different weight metrics during the first 6 mo of life in predicting undernutrition and mortality. METHODS This study used a cohort of infants in Tanzania. Weight and length were measured monthly from birth to 18 mo of age. Three weight metrics during the first 6 mo of life were considered as predictors, including attained weight-for-age z score (WAZ) at the end of each month, monthly change in WAZ, and monthly weight velocity z score (WVZ). Logistic models were used with undernutrition (at 6 or 12 mo) and mortality (over the first 18 mo) as outcomes. AUC values were compared across metrics. RESULTS For predicting wasting at 6 mo, WVZ (AUC: 0.80) had a greater predictive ability than attained WAZ (AUC: 0.76) and change in WAZ (AUC: 0.71) during the second month of life. After 2 mo, attained WAZ (AUC: 0.81-0.89) had greater predictive abilities than WVZ (AUC: 0.71-0.77) and change in WAZ (AUC: 0.65-0.67). For predicting stunting at 6 mo, attained WAZ (AUC: 0.75-0.79) had consistently greater predictive abilities than WVZ (AUC: 0.56-0.66) and change in WAZ (AUC: 0.50-0.57). The weight metrics had similar abilities in predicting mortality, with the AUC rarely reaching >0.65. CONCLUSIONS Attained weight at the end of each month had greater abilities than monthly weight velocity in the same month in predicting undernutrition. Attained weight remains a useful indicator for identifying infants at greater risk of undernutrition.
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Affiliation(s)
- Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Catherine Schwinger
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Tor A Strand
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Voraphani N, Stern DA, Zhai J, Wright AL, Halonen M, Sherrill DL, Hallberg J, Kull I, Bergström A, Murray CS, Lowe L, Custovic A, Morgan WJ, Martinez FD, Melén E, Simpson A, Guerra S. The role of growth and nutrition in the early origins of spirometric restriction in adult life: a longitudinal, multicohort, population-based study. THE LANCET. RESPIRATORY MEDICINE 2022; 10:59-71. [PMID: 34843665 PMCID: PMC8855728 DOI: 10.1016/s2213-2600(21)00355-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Spirometric restriction, defined as a reduced forced vital capacity (FVC) with a preserved FEV1/FVC ratio, is associated with increased respiratory and non-respiratory comorbidities and all-cause mortality in adulthood. Little is known about the early origins of this condition. We sought to identify early-life risk factors for spirometric restriction in adult life. METHODS In this longitudinal, multicohort, population-based study, we used data from the Tucson Children's Respiratory Study (TCRS), which recruited 1246 healthy infants at birth between April 1980, and October 1984, in Tucson, AZ, USA. Questionnaires were answered by the primary caregiver at enrolment, immediately after the child's birth, and multiple follow-up questionnaires were completed through childhood and adulthood. At the age of 22, 26, 32, and 36 years, lung function was measured with spirometry. At each survey, three mutually exclusive spirometric patterns were defined: (1) normal (FEV1/FVC ≥10th percentile and FVC ≥10th percentile); (2) restrictive (FEV1/FVC ≥10th percentile and FVC <10th percentile); and (3) obstructive (FEV1/FVC <10th percentile, independent of FVC). Data on demographic features and parental health factors were collected from questionnaires; pregnancy and perinatal data (including nutritional problems) and birth measurements were obtained from medical records; and weight, height, and body-mass index (BMI) during childhood (age 6-16 years) were measured by study nurses. The associations between early-life risk factors and spirometric patterns were assessed by multivariate multinomial logistic regression analysis, adjusted for survey year, sex, and race-ethnicity. Significant risk factors were further tested for replication in the Swedish Child (Barn), Allergy, Milieu, Stockholm, Epidemiological (BAMSE; n=1817; spirometry surveys were done at age 24 years) survey and the UK Manchester Asthma and Allergy Study (MAAS; n=411; spirometry surveys were done at age 18 years) birth cohorts, and fixed-effect meta-analyses of relative risk ratios (RRRs) from multinomial logistic regression models were done to generate a pooled estimate of the effect across the three cohorts. Measurements of body composition (MAAS; n=365) and total lung capacity (TCRS; n=173 and MAAS; n=407) were also available for a subset of participants. FINDINGS Of 1246 healthy infants included in TCRS, for the present study we included data for 652 participants who had at least one set of spirometry data, contributing up to 1668 observations. In the TCRS cohort, results from the multivariate models showed that maternal nutritional problems during pregnancy (RRR 2·48 [95% CI 1·30-4·76]; p=0·0062), being born small for gestational age (birthweight <10th percentile; 3·26 [1·34-7·93]; p=0·0093), and being underweight in childhood (BMI-for-age <5th percentile; 3·54 [1·35-9·26]; p=0·010) were independent predictors of spirometric restriction in adult life. Associations between being small for gestational age (p=0·0028) and underweight in childhood (p<0·0001) with adult spirometric restriction were supported by the results of meta-analysis of data from all three cohorts. In the MAAS cohort, having a low lean BMI (ie, <10th percentile) at age 11 years predicted adult (age 18 years) spirometric restriction (RRR 3·66 [1·48-9·02]; p=0·0048). These associations of spirometric restriction with small for gestational age, childhood underweight, and low lean BMI in childhood were verified in participants with spirometric restriction who had diminished total lung capacity, indicating that these factors specifically increase the risk of lung restriction. INTERPRETATION Poor growth and nutritional deficits in utero and throughout childhood precede and predict the development of spirometric restriction in adult life. Strategies to improve prenatal and childhood growth trajectories could help to prevent spirometric restriction and its associated morbidity and mortality burden. FUNDING National Institutes of Health.
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Affiliation(s)
- Nipasiri Voraphani
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Debra A Stern
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Jing Zhai
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Anne L Wright
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Marilyn Halonen
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Duane L Sherrill
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Jenny Hallberg
- Department of Clinical Sciences and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Sciences and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lesley Lowe
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Adnan Custovic
- Section of Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Wayne J Morgan
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Erik Melén
- Department of Clinical Sciences and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA; ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.
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Billah SM, Ferdous TE, Kelly P, Raynes‐Greenow C, Siddique AB, Choudhury N, Ahmed T, Gillespie S, Hoddinott J, Menon P, Dibley MJ, Arifeen SE. Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh. MATERNAL & CHILD NUTRITION 2022; 18:e13267. [PMID: 34467669 PMCID: PMC8710107 DOI: 10.1111/mcn.13267] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022]
Abstract
Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6-23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post-natal combinations of lipid-based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet-based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age-appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24-h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2-0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99-1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11-0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01-27) at 12 months of age. The intervention effect was non-significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11-1.57) in 6-23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06-0.49) and 0.16 (0.05-27), respectively, but not with food-secure and severely food-insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Tarana E. Ferdous
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Patrick Kelly
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | | | - Abu Bakkar Siddique
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Nuzhat Choudhury
- Nutrition and Clinical Science DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Science DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Stuart Gillespie
- Poverty, Health, And Nutrition (PHND)International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - John Hoddinott
- Poverty, Health, And Nutrition (PHND)International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Purnima Menon
- Poverty, Health, And Nutrition (PHND)International Food Policy Research Institute (IFPRI)WashingtonDistrict of ColumbiaUSA
| | - Michael John Dibley
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Shams El Arifeen
- Maternal and Child Health DivisionInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
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Menzies NA, Berthé F, Hitchings M, Aruna P, Hamza MA, Nanama S, Steve-Edemba C, Shehu I, Grais RF, Isanaka S. Cost-effectiveness of monthly follow-up for the treatment of uncomplicated severe acute malnutrition: An economic evaluation of a randomized controlled trial. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001189. [PMID: 36962786 PMCID: PMC10022243 DOI: 10.1371/journal.pgph.0001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Severe acute malnutrition (SAM) is a major source of mortality for children in low resource settings. Alternative treatment models that improve acceptability and reduce caregiver burden are needed to improve treatment access. We assessed costs and cost-effectiveness of monthly vs. weekly follow-up (standard-of-care) for treating uncomplicated SAM in children 6-59 months of age. To do so, we conducted a cost-effectiveness analysis of a cluster-randomized trial of treatment for newly-diagnosed uncomplicated SAM in northwestern Nigeria (clinicaltrials.gov ID NCT03140904). We collected empirical costing data from enrollment up to 3 months post-discharge. We quantified health outcomes as the fraction of children recovered at discharge (primary cost-effectiveness outcome), the fraction recovered 3 months post-discharge, and total DALYs due to acute malnutrition. We estimated cost-effectiveness from both provider and societal perspectives. Costs are reported in 2019 US dollars. Provider costs per child were $67.07 (95% confidence interval: $64.79, $69.29) under standard-of-care, and $78.74 ($77.06, $80.66) under monthly follow-up. Patient costs per child were $21.04 ($18.18, $23.51) under standard-of-care, and $14.16 ($12.79, $15.25) under monthly follow-up. Monthly follow-up performed worse than standard-of-care for each health outcome assessed and was dominated (produced worse health outcomes at higher cost) by the standard-of-care in cost-effectiveness analyses. This result was robust to statistical uncertainty and to alternative costing assumptions. These findings provide evidence against monthly follow-up for treatment of uncomplicated SAM in situations where weekly follow-up of patients is feasible. While monthly follow-up may reduce burdens on caregivers and providers, other approaches are needed to do so while maintaining the effectiveness of care.
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Affiliation(s)
- Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Matt Hitchings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Philip Aruna
- Médecins sans Frontières-Operational Center Amsterdam, Amsterdam, Netherlands
| | | | - Siméon Nanama
- UNICEF West and Central Regional Office, Dakar, Senegal
| | | | | | | | - Sheila Isanaka
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Epicentre, Paris, France
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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225
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Hinnouho GM, Hampel D, Shahab-Ferdows S, Barffour MA, McAnena L, Arnold CD, Ryan Wessells K, Kounnavong S, Allen LH, McNulty H, Hess SY. Daily supplementation of a multiple micronutrient powder improves folate but not thiamine, riboflavin, or vitamin B 12 status among young Laotian children: a randomized controlled trial. Eur J Nutr 2022; 61:3423-3435. [PMID: 35534778 PMCID: PMC9464137 DOI: 10.1007/s00394-022-02890-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the effects of intervention with a daily multiple micronutrient powder (MNP) on thiamine, riboflavin, folate, and B12 status among young Laotian children. METHODS Children (n = 1704) aged 6-23 mo, participating in a double-blind placebo-controlled randomized trial were individually randomized to receive daily either MNP (containing 0.5 mg of thiamine, 0.5 mg riboflavin, 150 μg folic acid, and 0.9 μg vitamin B12 along with 11 other micronutrients) or placebo and followed for ~ 36 weeks. In a randomly selected sub-sample of 260 children, erythrocyte thiamine diphosphate (eThDP), plasma folate and B12 concentrations, and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin biomarker) were assessed at baseline and endline. RESULTS There was no treatment effect on endline eThDP concentrations (110.6 ± 8.9 nmol/L in MNP vs. 109.4 ± 8.9 nmol/L in placebo group; p = 0.924), EGRac (1.46 ± 0.3 vs. 1.49 ± 0.3; p = 0.184) and B12 concentrations (523.3 ± 24.6 pmol/L vs. 515.9 ± 24.8 pmol/L; p = 0.678). Likewise, the prevalence of thiamine, riboflavin, and B12 deficiencies did not differ significantly between the two groups. However, endline folate concentration was significantly higher in the MNP compared to the placebo group (28.2 ± 0.8 nmol/L vs 19.9 ± 0.8 nmol/L, respectively; p < 0.001), and correspondingly, the prevalence of folate deficiency was significantly lower in the MNP group (1.6% vs 17.4%; p = 0.015). CONCLUSIONS Compared to a placebo, daily MNP for 9 months increased only folate but not thiamine, riboflavin, or B12 status in young Laotian children. TRIAL REGISTRATION The trial was registered at www. CLINICALTRIALS gov (NCT02428647) on April 29 2015.
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Affiliation(s)
- Guy-Marino Hinnouho
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA. .,Helen Keller International, Washington, DC, USA.
| | - Daniela Hampel
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,USDA, ARS Western Human Nutrition Research Center, Davis, CA USA
| | | | - Maxwell A. Barffour
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,University of Missouri School of Medicine, Columbia, MO USA ,Public Health Program, College of Health and Human Services, Missouri State University, Springfield, MO USA
| | - Liadhan McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland UK
| | - Charles D. Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
| | - K. Ryan Wessells
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Lindsay H. Allen
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,USDA, ARS Western Human Nutrition Research Center, Davis, CA USA
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland UK
| | - Sonja Y. Hess
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
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226
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Zhu PH, Mhango SN, Vinnakota A, Mansour M, Coss-Bu JA. Effects of COVID-19 Pandemic on Nutritional Status, Feeding Practices, and Access to Food Among Infants and Children in Lower and Middle-Income Countries: a Narrative Review. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:197-206. [PMID: 36249489 PMCID: PMC9549037 DOI: 10.1007/s40475-022-00271-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review The COVID-19 pandemic has affected children across the planet and the consequences on their health, nutritional status, and social structure have been more pronounced in low- and middle-income countries (LMICs). This review will focus on the effects of the COVID-19 pandemic on infant growth and feeding practices and access to food and obesity prevalence among children in LMICs. An electronic search was performed on MEDLINE and Embase to identify relevant articles in the English language. Recent Findings A higher prevalence of infections by the SARS-CoV-2 virus and a lower mortality rate were found in children in LMICs compared to western countries. In 2020, 22% and 52% of the wasting and deaths in children under 5 years of age in LMICS came from the sub-Saharan Africa region, respectively. Despite the decrease in stunting from 40% in 1990 to 24.2% in 2019, the prevalence remains above 30% in LMICs. Regarding breastfeeding practices in LMICs, many organizations recommend breastfeeding for infants and children born to infected mothers with SARS-CoV-2. This pandemic has resulted in higher food insecurity and disruption to access to health care and nutrition-related programs from schools; this situation has been more detrimental for younger children from LMICs. Summary Given the devastating effects of the COVID-19 pandemic on the nutritional status, higher food insecurity, and lack of access to health care for infants and children in LMICs, efforts from government, world organizations, and non-for-profit institutions should be implemented to ameliorate the effects of this pandemic.
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Affiliation(s)
- Paola Hong Zhu
- Division of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA ,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Susan Nita Mhango
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Anirudh Vinnakota
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Marwa Mansour
- Division of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA ,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Jorge A. Coss-Bu
- Division of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA ,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
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227
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King SE, Sheffel A, Heidkamp R, Xu YY, Walton S, Munos MK. Advancing nutrition measurement: Developing quantitative measures of nutrition service quality for pregnant women and children in low‐ and middle‐income country health systems. MATERNAL & CHILD NUTRITION 2022; 18:e13279. [PMID: 34734469 PMCID: PMC8710116 DOI: 10.1111/mcn.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shannon E. King
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ashley Sheffel
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Rebecca Heidkamp
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Yvonne Yiru Xu
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Shelley Walton
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Melinda K. Munos
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
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Chan CY, Tran N, Cheong KC, Sulser TB, Cohen PJ, Wiebe K, Nasr-Allah AM. The future of fish in Africa: Employment and investment opportunities. PLoS One 2021; 16:e0261615. [PMID: 34936682 PMCID: PMC8694441 DOI: 10.1371/journal.pone.0261615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/06/2021] [Indexed: 02/01/2023] Open
Abstract
One of the most pressing challenges facing food systems in Africa is ensuring availability of a healthy and sustainable diet to 2.4 billion people by 2050. The continent has struggled with development challenges, particularly chronic food insecurity and pervasive poverty. In Africa's food systems, fish and other aquatic foods play a multifaceted role in generating income, and providing a critical source of essential micronutrients. To date, there are no estimates of investment and potential returns for domestic fish production in Africa. To contribute to policy debates about the future of fish in Africa, we applied the International Model for Policy Analysis of Agriculture Commodities and Trade (IMPACT) to explore two Pan-African scenarios for fish sector growth: a business-as-usual (BAU) scenario and a high-growth scenario for capture fisheries and aquaculture with accompanying strong gross domestic product growth (HIGH). Post-model analysis was used to estimate employment and aquaculture investment requirements for the sector in Africa. Africa's fish sector is estimated to support 20.7 million jobs in 2030, and 21.6 million by 2050 under the BAU. Approximately 2.6 people will be employed indirectly along fisheries and aquaculture value chains for every person directly employed in the fish production stage. Under the HIGH scenario, total employment in Africa's fish food system will reach 58.0 million jobs, representing 2.4% of total projected population in Africa by 2050. Aquaculture production value is estimated to achieve US$ 3.3 billion and US$ 20.4 billion per year under the BAU and HIGH scenarios by 2050, respectively. Farm-gate investment costs for the three key inputs (fish feeds, farm labor, and fish seed) to achieve the aquaculture volumes projected by 2050 are estimated at US$ 1.8 billion per year under the BAU and US$ 11.6 billion per year under the HIGH scenario. Sustained investments are critical to sustain capture fisheries and support aquaculture growth for food system transformation towards healthier diets.
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Affiliation(s)
| | | | | | - Timothy B. Sulser
- International Food Policy Research Institute, Washington, DC, United States of America
| | | | - Keith Wiebe
- International Food Policy Research Institute, Washington, DC, United States of America
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229
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Paganelli CR, Kassebaum N, Strong K, Suchdev PS, Voskuijl W, Bassat Q, Blau DM, Denno DM. Guidance for Systematic Integration of Undernutrition in Attributing Cause of Death in Children. Clin Infect Dis 2021; 73:S374-S381. [PMID: 34910171 PMCID: PMC8672773 DOI: 10.1093/cid/ciab851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Minimally invasive tissue sampling (MITS) is increasingly being used to better understand causes of death in low-resource settings. Undernutrition (eg, wasting, stunting) is prevalent among children globally and yet not consistently coded or uniformly included on death certificates in MITS studies when present. Consistent and accurate attribution of undernutrition is fundamental to understanding its contribution to child deaths. In May 2020, members of the MITS Alliance Cause of Death Technical Working Group convened a panel of experts in public health, child health, nutrition, infectious diseases, and MITS to develop guidance for systematic integration of undernutrition, as assessed by anthropometry, in cause of death coding, including as part of the causal chain or as a contributing condition, in children <5 years of age. The guidance presented here will support MITS and other researchers, public health practitioners, and clinicians with a systematic approach to assigning and interpreting undernutrition in death certification.
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Affiliation(s)
| | - Nicholas Kassebaum
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Kathleen Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Parminder S Suchdev
- Department of Pediatrics and Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Wieger Voskuijl
- University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Centre for Global Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, the Netherlands.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Dianna M Blau
- Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Donna M Denno
- Department of Global Health, University of Washington, Seattle, Washington, USA.,The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
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230
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Bliznashka L, Sudfeld CR, Garba S, Guindo O, Soumana I, Adehossi I, Langendorf C, Grais RF, Isanaka S. Prenatal supplementation with multiple micronutrient supplements or medium-quantity lipid-based nutrient supplements has limited effects on child growth up to 24 months in rural Niger: a secondary analysis of a cluster randomized trial. Am J Clin Nutr 2021; 115:738-748. [PMID: 34871344 PMCID: PMC8895211 DOI: 10.1093/ajcn/nqab404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prenatal multiple micronutrient supplementation (MMS) and lipid-based nutrient supplementation (LNS) can improve birth outcomes relative to iron-folic acid supplementation (IFA); however, effects on child postnatal growth remain unclear. OBJECTIVES The aim was to compare the effect of prenatal MMS, medium-quantity LNS (MQ-LNS), and IFA on child growth up to 2 y of age. METHODS We conducted a cluster randomized controlled trial of prenatal nutritional supplementation in Madarounfa, Niger. Villages were randomly assigned for pregnant women to receive IFA (17 villages, 1105 women), MMS (18 villages, 1083 women) or MQ-LNS (18 villages, 1144 women). Pregnant women received nutritional supplements weekly until delivery, and children were followed up monthly from 6-8 wk to 24 mo of age. We assessed the effect of prenatal MMS and MQ-LNS compared with IFA and the effect of prenatal MMS compared with MQ-LNS on child length-for-age z scores (LAZ), weight-for-age z scores (WAZ), and weight-for-length z scores (WLZ) at 24 mo of age using generalized linear models. In secondary analyses, we used mixed-effects models to assess the trajectories of anthropometric z scores longitudinally from 6-8 wk to 24 mo. RESULTS Compared with IFA, MMS and MQ-LNS had no effect on child LAZ, WAZ, or WLZ at 24 mo of age (P > 0.05). Children in the MQ-LNS arm had significantly higher mid-upper arm circumference at 24 mo than children in the MMS arm: mean difference 0.50 cm (95% CI 0.10, 0.91 cm). WAZ and WLZ trajectories were more negative in the MQ-LNS arm compared with IFA and MMS, with lower z scores from 14 to 20 mo of age. However, WAZ and WLZ trajectories converged after 20 mo of age, and there were no differences by 24 mo of age. CONCLUSIONS Prenatal MMS and MQ-LNS had limited effect on anthropometric measures of child growth up to 24 mo of age as compared with IFA in rural Niger.
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Affiliation(s)
- Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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231
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Charle-Cuéllar P, Lopez-Ejeda N, Toukou Souleymane H, Yacouba D, Diagana M, Dougnon AO, Vargas A, Briend A. Effectiveness and Coverage of Treatment for Severe Acute Malnutrition Delivered by Community Health Workers in the Guidimakha Region, Mauritania. CHILDREN 2021; 8:children8121132. [PMID: 34943328 PMCID: PMC8700149 DOI: 10.3390/children8121132] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
Geographical and economic access barriers to health facilities (HF) have been identified as some of the most important causes of the low coverage of severe acute malnutrition (SAM) treatment. The objective of this study is to assess the effectiveness and coverage of SAM treatment delivered by community health workers (CHWs) in the Guidimakha region in Mauritania, compared to the HF based approach. This study was a nonrandomized controlled trial, including two rural areas. The control group received outpatient treatment for uncomplicated SAM from HF, whilst the intervention group received outpatient treatment for uncomplicated SAM from HF or CHWs. A total of 869 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 82.3% in the control group, and 76.4% in the intervention group, we found no significant difference between the groups. Coverage in the intervention zone increased from 53.6% to 71.7%. In contrast, coverage remained at approximately 44% in the control zone from baseline to end-line. This study is the first to demonstrate in Mauritania that the decentralization model of CHWs treating SAM improves acute malnutrition treatment coverage and complies with the international quality standards for community treatment of acute malnutrition. The non-randomized study design may limit the quality of the evidence, but these results could be used by political decision-makers as a first step in revising the protocol for acute malnutrition management.
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Affiliation(s)
- Pilar Charle-Cuéllar
- Action Against Hunger, 28002 Madrid, Spain;
- Doctorate Program in Epidemiology and Public Health, Rey Juan Carlos University, 28933 Madrid, Spain
- Correspondence: ; Tel.: +34-91-394-51-12
| | - Noemí Lopez-Ejeda
- Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain;
| | | | - Diagana Yacouba
- Faculty of Science, Technology and Medicine, Nouakchott University, Nouakchott 880, Mauritania;
| | - Moussa Diagana
- Maternal and Child Health, Ministry of Health in Mauritania, Nouakchott 115, Mauritania;
| | | | | | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark;
- Center for Child Health Research, Faculty of Medicine and Medical Technology, Tampere University, 33100 Tampere, Finland
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232
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Costa JC, Blumenberg C, Victora C. Growth patterns by sex and age among under-5 children from 87 low-income and middle-income countries. BMJ Glob Health 2021; 6:bmjgh-2021-007152. [PMID: 34848439 PMCID: PMC8634205 DOI: 10.1136/bmjgh-2021-007152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Although boys tend to be more affected by linear growth faltering than girls, little is known about sex differences across distinct age groups. We aimed to compare sex differences in linear growth throughout the first 5 years of life among children from low-income and middle-income countries. Methods We analysed 87 cross-sectional Demographic and Health Surveys and Multiple Cluster Indicator Surveys (2010–2019). Growth was expressed as height-for-age z-scores (HAZ) based on the 2006 WHO Growth Standards. Sex-specific means were estimated for each country and results were pooled through random-effects meta-analysis for all children and by 12-month age groups. Using linear regression, we assessed the association between sex differences in HAZ and gross domestic product as a proxy for national economic development. Results Boys presented lower mean HAZ than girls in the first 30 months. Sex differences were mostly absent between 30 and 45 months, and in several countries, girls had lower HAZ at ages over 45 months. The pooled sex difference (boys minus girls) for the whole sample was −0.10 (95% CI −0.12 to −0.08). The difference was −0.17 (95% CI −0.20 to −0.14) at 0–11 months and −0.22 (95% CI −0.25 to −0.19) at 12–23 months. This was followed by a narrowing of the sex gap to −0.10 (95% CI −0.13 to −0.07) and −0.04 (95% CI −0.07 to −0.01) among children aged 24–35 and 36–47 months, respectively. At 48–59 months, there was evidence of female disadvantage; the mean height-for-age of boys was 0.02 (95% CI 0.00 to 0.05) SDs higher than for girls. Ecological analyses showed that in all age groups, male disadvantage decreased with increasing national income, and this was no longer present for the 4-year-old children, particularly in wealthier countries. Conclusion Male disadvantage in linear growth is most evident in the first years, but by the age of 4 years, the sex gap has mostly disappeared, and in some countries, the gap has been reversed.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil .,Postraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cauane Blumenberg
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.,Postraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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233
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Hess SY, McLain AC, Frongillo EA, Afshin A, Kassebaum NJ, Osendarp SJM, Atkin R, Rawat R, Brown KH. Challenges for Estimating the Global Prevalence of Micronutrient Deficiencies and Related Disease Burden: A Case Study of the Global Burden of Disease Study. Curr Dev Nutr 2021; 5:nzab141. [PMID: 34993390 PMCID: PMC8728001 DOI: 10.1093/cdn/nzab141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/12/2022] Open
Abstract
Information on the prevalence of micronutrient deficiencies is needed to determine related disease burden; underpin evidence-based advocacy; and design, deliver, and monitor safe, effective interventions. Assessing the global prevalence of deficiency requires a valid micronutrient status biomarker with an appropriate cutoff to define deficiency and relevant data from representative surveys across multiple locations and years. The Global Burden of Disease Study includes prevalence estimates for iodine, iron, zinc, and vitamin A deficiencies, for which recommended biomarkers and appropriate deficiency cutoffs exist. Because representative survey data are lacking, only retinol concentration is used to model vitamin A deficiency, and proxy indicators are used for the other micronutrients (goiter for iodine, hemoglobin for iron, and dietary food adequacy for zinc). Because of data limitations, complex statistical modeling is required to produce current estimates, relying on assumptions and proxies that likely understate the extent of micronutrient deficiencies and the consequent global health burden.
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Affiliation(s)
- Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Reed Atkin
- The Micronutrient Forum, Washington, DC, USA
| | - Rahul Rawat
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis
, Davis, CA, USA
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234
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Alao R, Nur H, Fivian E, Shankar B, Kadiyala S, Harris-Fry H. Economic inequality in malnutrition: a global systematic review and meta-analysis. BMJ Glob Health 2021; 6:e006906. [PMID: 34887302 PMCID: PMC8663078 DOI: 10.1136/bmjgh-2021-006906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition. METHODS We conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15-49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses. RESULTS From 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX -0.15 (95% CI -0.19 to -0.11)) and wasting (-0.03 (95% CI -0.05 to -0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI -0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (-0.02 (95% CI -0.08 to 0.05)) or North America (-0.04 (95% CI -0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)). CONCLUSIONS There is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed. PROSPERO REGISTRATION NUMBER CRD42020201572.
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Affiliation(s)
- Rotimi Alao
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hayaan Nur
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Fivian
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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235
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Win H, Wallenborn J, Probst-Hensch N, Fink G. Understanding urban inequalities in children's linear growth outcomes: a trend and decomposition analysis of 39,049 children in Bangladesh (2000-2018). BMC Public Health 2021; 21:2192. [PMID: 34847918 PMCID: PMC8631262 DOI: 10.1186/s12889-021-12181-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite significant progress in reducing child undernutrition, Bangladesh remains among the top six countries globally with the largest burden of child stunting and has disproportionately high stunting prevalence among the urban poor. We use population representative data to identify key predictors of child stunting in Bangladesh and assess their contributions to linear growth differences observed between urban poor and non-poor children. METHODS We combined six rounds of Demographic and Health Survey data spanning 2000-2018 and used official poverty rates to classify the urban population into poor and non-poor households. We identified key stunting determinants using stepwise selection method. Regression-decomposition was used to quantify contributions of these key determinants to poverty-based intra-urban differences in child linear growth status. RESULTS Key stunting determinants identified in our study predicted 84% of the linear growth difference between urban poor and non-poor children. Child's place of birth (27%), household wealth (22%), maternal education (18%), and maternal body mass index (11%) were the largest contributors to the intra-urban child linear growth gap. Difference in average height-for-age z score between urban poor and non-poor children declined by 0.31 standard deviations between 2000 and 2018. About one quarter of this observed decrease was explained by reduced differentials between urban poor and non-poor in levels of maternal education and maternal underweight status. CONCLUSIONS Although the intra-urban disparity in child linear growth status declined over the 2000-2018 period, socioeconomic gaps remain significant. Increased nutrition-sensitive programs and investments targeting the urban poor to improve girls' education, household food security, and maternal and child health services could aid in further narrowing the remaining linear growth gap.
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Affiliation(s)
- Hayman Win
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Jordyn Wallenborn
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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236
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Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh. Nutrients 2021; 13:nu13124303. [PMID: 34959855 PMCID: PMC8708397 DOI: 10.3390/nu13124303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022] Open
Abstract
Food insecurity may affect women’s health; however, pertinent research is scant among pregnant women. This study investigated the association of household food insecurity (HFI) with the nutritional status and mental health of 672 early-gestation (5–16 weeks) pregnant women with a singleton fetus, who participated in the screening activity of a community-based trial (NCT04868669) in Matlab, Bangladesh. Height (cm), weight (kg), body mass index (kg/m2), mid-upper arm circumference (MUAC) (cm), depression, anxiety, and stress were the outcomes studied. HFI was assessed using the Household Food Insecurity Access Scale. Women’s depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scales-21. Propensity score matching based weighted multivariable linear and logistic regression were used to evaluate the independent association of HFI with the outcomes. In adjusted models, pregnant women from food-insecure households in rural Matlab were on average 2.0 cm shorter (β = −2.0, 95% CI: −3.3, −0.7), 2.0 kg lighter (β = −2.0, 95% CI: −3.4, −0.7), and had 0.6 cm lower MUAC (β = −0.6, 95% CI: −1.1, −0.1) than their food-secure counterparts. HFI was associated with higher odds of depression (OR = 3.3, 95% CI: 1.8, 5.9), anxiety (OR = 6.1, 95% CI: 3.7, 10.0), and stress (OR = 4.8, 95% CI: 1.6, 14.2) among the women. Public health measures should focus on ensuring proper nutrition during the critical growth periods of life, pregnancy, and external environmental shocks, to mitigate the adverse effects of HFI on women’s health.
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237
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Methods for assessing seasonal and annual trends in wasting in Indian surveys (NFHS-3, 4, RSOC & CNNS). PLoS One 2021; 16:e0260301. [PMID: 34807959 PMCID: PMC8608332 DOI: 10.1371/journal.pone.0260301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Wasting in children under-five is a form of acute malnutrition, a predictor of under-five child mortality and of increased risk of future episodes of stunting and/or wasting. In India, national estimates of wasting are high compared to international standards with one in five children found to be wasted. National surveys are complex logistical operations and most often not planned or implemented in a manner to control for seasonality. Collection of survey data across differing months across states introduces seasonal bias. Cross-sectional surveys are not designed to collect data on seasonality, thus special methods are needed to analyse the effect of data collection by month. We developed regression models to estimate the mean weight for height (WHZ), prevalence of wasting for every month of the year for an average year and an overall weighted survey estimates controlling for the socio-demographic variation of data collection across states and populations over time. National level analyses show the mean WHZ starts at its highest in January, falls to the lowest in June/August and returns towards peak at year end. The prevalence of wasting is lowest in January and doubles by June/August. After accounting for seasonal patterns in data collection across surveys, the trends are significantly different and indicate a stagnant period followed by a decline in wasting. To avoid biased estimates, direct comparisons of acute malnutrition across surveys should not be made unless seasonality bias is appropriately addressed in planning, implementation or analysis. Eliminating the seasonal variation in wasting would reduce the prevalence by half and provide guidance towards further reduction in acute malnutrition.
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238
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Kachwaha S, Nguyen PH, Tran LM, Avula R, Young MF, Ghosh S, Forissier T, Escobar-Alegria J, Sharma PK, Frongillo EA, Menon P. Specificity Matters: Unpacking Impact Pathways of Individual Interventions within Bundled Packages Helps Interpret the Limited Impacts of a Maternal Nutrition Intervention in India. J Nutr 2021; 152:612-629. [PMID: 34792151 PMCID: PMC8826931 DOI: 10.1093/jn/nxab390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/17/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To address gaps in coverage and quality of nutrition services, Alive & Thrive (A&T) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the A&T interventions compared intensive ANC (I-ANC) with standard ANC (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight-gain monitoring. OBJECTIVES This study examined intervention-specific program impact pathways (PIPs) and identified reasons for limited impacts of the A&T maternal nutrition intervention package. METHODS We used mixed methods: frontline worker (FLW) surveys (n = ∼500), counseling observations (n = 407), and qualitative in-depth interviews with FLWs, supervisors, and block-level staff (n = 59). We assessed 7 PIP domains: training and materials, knowledge, supportive supervision, supply chains, data use, service delivery, and counseling. RESULTS Exposure to training improved in both I-ANC and S-ANC areas with more job aids used in I-ANC compared with S-ANC (90% compared with 70%), but gaps remained for training content and refresher trainings. FLWs' knowledge improvement was higher in I-ANC than S-ANC (22-36 percentage points), but knowledge of micronutrient supplement benefits and recommended foods was insufficient (<50%). Most FLWs received supervision (>90%), but supportive supervision was limited by staff vacancies and competing work priorities. Supplies of iron-folic acid and calcium supplements were low in both areas (30-50% stock-outs). Use of monitoring data during review meetings was higher in I-ANC than S-ANC (52% compared with 36%) but was constrained by time, understanding, and data quality. Service provision improved in both I-ANC and S-ANC areas, but counseling on supplement benefits and weight-gain monitoring was low (30-40%). CONCLUSIONS Systems-strengthening efforts improved maternal nutrition interventions in ANC, but gaps remained. Taking an intervention-specific perspective to the PIP analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact.
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Affiliation(s)
- Shivani Kachwaha
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | | | | | - Rasmi Avula
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | | | | | | | | | | | | | - Purnima Menon
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
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Heuven LAJ, Pyle S, Greyling A, Melse-Boonstra A, Eilander A. Gut Microbiota-Targeted Nutritional Interventions Improving Child Growth in Low- and Middle-Income Countries: A Systematic Review. Curr Dev Nutr 2021; 5:nzab124. [PMID: 34761159 PMCID: PMC8575755 DOI: 10.1093/cdn/nzab124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/19/2021] [Accepted: 09/22/2021] [Indexed: 01/14/2023] Open
Abstract
The objective of this systematic literature review was to evaluate the efficacy of probiotic, prebiotic, and synbiotic interventions compared with control on improving growth outcomes of children living in low- and middle-income countries (LMICs). Probiotics had a beneficial effect on ≥1 of the growth outcomes in 5 out of the 11 included studies. Of these, 3 studies were conducted in undernourished children, 1 in healthy children, and 1 in children without a described health status. No effect of prebiotics on growth outcomes was seen in the 4 included studies. Synbiotics had a beneficial effect on growth outcomes in 3 out of 4 studies. Although a limited number of studies with high heterogeneity indicate that probiotics and synbiotics may have the potential to improve the growth of both undernourished and healthy children living in LMICs, more research is needed to confirm the observed effects. This review was registered at www.crd.york.ac.uk/prospero/ as CRD42020212998.
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Affiliation(s)
- Lise AJ Heuven
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
- Unilever Foods Innovation Centre, Wageningen, Netherlands
| | - Simone Pyle
- Unilever Foods Innovation Centre, Wageningen, Netherlands
| | - Arno Greyling
- Unilever Foods Innovation Centre, Wageningen, Netherlands
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
| | - Ans Eilander
- Unilever Foods Innovation Centre, Wageningen, Netherlands
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240
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Sharma S. A conceptual model and framework of nutrition-sensitive and specific interventions across Life stages in India. J Family Med Prim Care 2021; 10:3976-3982. [PMID: 35136755 PMCID: PMC8797081 DOI: 10.4103/jfmpc.jfmpc_789_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
A large segment of the maternal and child population in low- and middle-income countries (LMIC) is malnourished. There has been a considerable amount of literature on different evidence-based actions that work well with pregnant women or lactating mothers. However, we lack a comprehensive framework of evidence-based nutrition interventions for LMIC that endorse actions along the life course, that is, from adolescence to lactation and childhood, for improved child health and nutrition. Considering the need, this study aimed to explore and design a model and framework for improving maternal and child nutrition. A systematic review of the literature was conducted to identify evidence-based interventions that reduce malnutrition and improve maternal and child health and nutrition. The literature search was made using Google, Google Scholar, and PubMed. The search of the literature in the last 5 years was made. Our conceptual model illustrates key nutrition approaches at different levels (from individual to system levels). The promotion, prevention, monitoring, and management framework (based on nutrition-specific interventions) sorts out actions across each set of the population (pregnant, lactating, and newly married women and adolescent girls) for improved nutrition and health. Our nutrition-sensitive intervention framework, in the way to target basic causes of undernutrition, highlight actions that may result in improved maternal and child health and nutrition in the long run. Encapsulating the wide array of interventions across the life course, our model and framework hold importance as they contain evidence-based actions as suggested by the international agencies and are contextualized for India.
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Affiliation(s)
- Shantanu Sharma
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
- MAMTA Health Institute of Mother and Child, Delhi, India
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241
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Kirolos A, Blacow RM, Parajuli A, Welton NJ, Khanna A, Allen SJ, McAllister DA, Campbell H, Nair H. The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-007411. [PMID: 34848440 PMCID: PMC8634228 DOI: 10.1136/bmjgh-2021-007411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/09/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood malnutrition is widespread in low-income and middle-income countries (LMICs) and increases the frequency and severity of infections such as pneumonia. We aimed to identify studies investigating pneumonia deaths in malnourished children and estimate mortality risk by malnutrition severity. METHODS We conducted a systematic review of MEDLINE, EMBASE and Global Health databases to identify relevant studies. We used a network meta-analysis to derive ORs of death from pneumonia for moderately and severely underweight children using low weight-for-age, the most reported measure of malnutrition. We compared meta-estimates of studies conducted before and after 2000 to assess changes in mortality risk over time. We estimated the prevalence of underweight hospitalised children from hospital-based cohort studies and calculated the population attributable fraction of in-hospital pneumonia deaths from being underweight using our results. RESULTS Our network meta-analysis included 33 544 underweight children from 23 studies. The estimated OR of death from pneumonia was 2.0 (95% CI 1.6 to 2.6) and 4.6 (95% CI 3.7 to 5.9) for children moderately and severely underweight, respectively. The OR of death from pneumonia for those severely underweight was 5.3 (95% CI 3.9 to 7.4) pre-2000 and remained high post-2000 at 4.1 (95% CI 3.0 to 6.0). Prevalence of underweight children hospitalised with pneumonia varied (median 40.2%, range 19.6-66.3) but was high across many LMIC settings. We estimated a median 18.3% (range 10.8-34.6) and 40.9% (range 14.7-69.9) of in-hospital pneumonia deaths were attributable to being moderately and severely underweight, respectively. CONCLUSIONS The risk of death from childhood pneumonia dramatically increases with malnutrition severity. This risk has remained high in recent years with an estimated over half of in-hospital pneumonia deaths attributable to child malnutrition. Prevention and treatment of all child malnutrition must be prioritised to maintain progress on reducing pneumonia deaths.
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Affiliation(s)
- Amir Kirolos
- University of Liverpool Department of Women's and Children's Health, Liverpool, UK .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,The University of Edinburgh Usher Institute, Edinburgh, UK
| | | | - Arun Parajuli
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Nicky J Welton
- University of Bristol Bristol Population Health Science Institute, Bristol, UK
| | - Alisha Khanna
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Stephen J Allen
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | | | - Harry Campbell
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Harish Nair
- The University of Edinburgh Usher Institute, Edinburgh, UK
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242
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Murphy T, Phan K, Irvine KN, Lean D. The Role of Micronutrients and Toxic Metals in the Management of Epidemics in Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11446. [PMID: 34769963 PMCID: PMC8582812 DOI: 10.3390/ijerph182111446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
The illegal trade of wildlife in SE Asia has been identified as the likely cause of the COVID-19 pandemic. We reviewed 198 papers on the current COVID pandemic in Cambodia, diseases such as avian influenza and Nipah virus, most likely to develop into a new pandemic in Cambodia, and common features of disease that require mitigation. Artisanal goldmining uses pure mercury in the areas where wildlife is smuggled to China. Moreover, 30-40% of Cambodians are zinc deficient. High levels of arsenic in irrigation water (>1000 µg/L) are associated with very low levels of zinc in rice (5 µg/g) and rice is the primary staple food for the region. Brown rice from nine of 15 paddy fields in the arsenic zone of Cambodia had double the new guidelines of 100 µg/kg inorganic arsenic for children's food in the EU and USA. The combination of deficiencies of essential micronutrients like zinc and pervasive presence of arsenic and mercury has the potential to compromise the immunity of many Cambodians. Innovative solutions are suggested to improve micronutrient nutrition. Toxins that suppress the immune system must be better managed to reduce the virulence of pathogens. Cambodia was not likely the source of the COVID-19 but does have problems that could result in a new pandemic.
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Affiliation(s)
- Thomas Murphy
- Faculty of Science and Technology, International University, Phnom Penh 12000, Cambodia;
| | - Kongkea Phan
- Faculty of Science and Technology, International University, Phnom Penh 12000, Cambodia;
| | - Kim Neil Irvine
- Faculty of Architecture & Planning, Rangsit Campus, Thammasat University, Khlong Nueng 12121, Thailand;
| | - David Lean
- Lean Environmental, Apsley, ON K0L1A0, Canada;
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243
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Cliffer IR, Masters WA, Perumal N, Naumova EN, Zeba AN, Garanet F, Rogers BL. Monthly measurement of child lengths between 6 and 27 months of age in Burkina Faso reveals both chronic and episodic growth faltering. Am J Clin Nutr 2021; 115:94-104. [PMID: 34637506 PMCID: PMC8755055 DOI: 10.1093/ajcn/nqab309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/08/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Linear growth faltering is determined primarily by attained heights in infancy, but available data consist mainly of cross-sectional heights at each age. OBJECTIVES This study used longitudinal data to test whether faltering occurs episodically in a few months of very low growth, which could potentially be prevented by timely intervention, or is a chronic condition with slower growth in every month of infancy and early childhood. METHODS Using anthropometric data collected monthly between August 2014 and December 2016, we investigated individual growth curves of 5039 children ages 6-27 mo in Burkina Faso (108,580 observations). We evaluated growth-curve smoothness by level of attained length at ∼27 mo by analyzing variation in changes in monthly growth rates and using 2-stage regressions: 1) regressing each child's length on their age and extracting R2 to represent curve smoothness, initial length, and average velocity by age; and 2) regressing extracted parameters on individual-level attained length. RESULTS Short children started smaller and remained on their initial trajectories, continuously growing slower than taller children. Growth between 9 and 11 mo was the most influential on attained length; for each 1-cm/mo increase in growth velocity during this period, attained length increased by 6.71 cm (95% CI: 6.59, 6.83 cm). Furthermore, a 0.01 increase in R2 from individual regression of length on age was associated with a 3.10-cm higher attained length (95% CI: 2.80, 3.41 cm), and having 2 consecutive months of slow growth (<15th centile relative to the sample) was associated with 1.7-cm lower attained length (95% CI: -1.80, -1.59 cm), with larger effects in younger children, suggesting that smoother growth patterns were also associated with higher attained length. CONCLUSIONS Children who experience extreme growth faltering are likely less resilient to systematic growth-limiting conditions as well as episodic insults to their growth.This trial was registered at clinicaltrials.gov as NCT02071563.
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Affiliation(s)
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Nandita Perumal
- Global Health and Population Department, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Augustin N Zeba
- Department of Nutrition, Health Sciences Research Institute, National Center for Scientific and Technological Research (Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique), Ouagadougou, Burkina Faso
| | - Franck Garanet
- Department of Nutrition, Health Sciences Research Institute, National Center for Scientific and Technological Research (Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique), Ouagadougou, Burkina Faso
| | - Beatrice L Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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244
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Nguyen PH, Kachwaha S, Tran LM, Sanghvi T, Ghosh S, Kulkarni B, Beesabathuni K, Menon P, Sethi V. Maternal Diets in India: Gaps, Barriers, and Opportunities. Nutrients 2021; 13:nu13103534. [PMID: 34684535 PMCID: PMC8540854 DOI: 10.3390/nu13103534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
Suboptimal dietary intake is a critical cause of poor maternal nutrition, with several adverse consequences both for mothers and for their children. This study aimed to (1) assess maternal dietary patterns in India; (2) examine enablers and barriers in adopting recommended diets; (3) review current policy and program strategies to improve dietary intakes. We used mixed methods, including empirical analysis, compiling data from available national and subnational surveys, and reviewing literature, policy, and program strategies. Diets among pregnant women are characterized by low energy, macronutrient imbalance, and inadequate micronutrient intake. Supply- and demand-side constraints to healthy diets include food unavailability, poor economic situation, low exposure to nutrition counselling, food restrictions and taboos, adverse family influence and gender norms, and gaps in knowledge. Intervention strategies with potential to improve maternal diets include food-based programs, behavior change communication, and nutrition-sensitive agriculture interventions. However, strategies face implementation bottlenecks and limited effectiveness in real-world at-scale impact evaluations. In conclusion, investments in systems approaches spanning health, nutrition, and agriculture sectors, with evaluation frameworks at subnational levels, are needed to promote healthy diets for women.
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Affiliation(s)
- Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20005, USA; (S.K.); (P.M.)
- Correspondence:
| | - Shivani Kachwaha
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20005, USA; (S.K.); (P.M.)
| | | | - Tina Sanghvi
- Alive & Thrive Initiative, FHI Solutions, Washington, DC 20009, USA; (T.S.); (S.G.)
| | - Sebanti Ghosh
- Alive & Thrive Initiative, FHI Solutions, Washington, DC 20009, USA; (T.S.); (S.G.)
| | | | | | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20005, USA; (S.K.); (P.M.)
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245
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Coile A, Wun J, Kothari MT, Hemminger C, Fracassi P, Di Dio D. Scaling up nutrition through multisectoral planning: An exploratory review of 26 national nutrition plans. MATERNAL & CHILD NUTRITION 2021; 17:e13225. [PMID: 34101997 PMCID: PMC8518575 DOI: 10.1111/mcn.13225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/27/2022]
Abstract
With a growing consensus on the need to address malnutrition in a comprehensive and multisectoral way, there has been increased attention on the processes and factors for multisectoral nutrition planning to be successful. To guide countries, the Scaling Up Nutrition (SUN) Movement developed a checklist that defined characteristics of good national nutrition plans. This exploratory review used the framework of the Checklist to assess 26 national multisectoral nutrition plans (MSNPs) developed between 2014 and 2020. The MSNPs were assessed against a subset of 31 Checklist characteristics defined as basic plan components. Although the level of detail varied across the reviewed plans, the majority included core components that are important to facilitate effective planning and implementation, such as an assessment of the nutritional status and determinants of malnutrition for children under 5 years of age, a commitment to global recommendations related to reducing malnutrition, actions consistent with global evidence and responding to identified issues/gaps, governance arrangements to facilitate coordination, and identification of capacity-building needs/actions to support effective implementation. Common gaps across plans included risk analysis and mitigation, defined responsible agencies for each action, an assessment of the financial gap and defined mechanisms for financial tracking and resource allocation, and mechanisms to coordinate operational research. These findings provide a high-level, multi-country review of multisectoral nutrition planning that can support future policymakers, technical assistance providers and regional and global stakeholders to consider the foundational elements of and further validate and address common shortcomings in developing such a plan.
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Affiliation(s)
- Amanda Coile
- PATHWashingtonDistrict of ColumbiaUSA
- JSI Research and Training Institute Inc.ArlingtonVirginiaUSA
| | | | | | | | - Patrizia Fracassi
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
- Food and Agriculture Organization of the United NationsRomeItaly
| | - Debora Di Dio
- Scaling Up Nutrition Movement SecretariatGenevaSwitzerland
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246
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Golden CD, Koehn JZ, Shepon A, Passarelli S, Free CM, Viana DF, Matthey H, Eurich JG, Gephart JA, Fluet-Chouinard E, Nyboer EA, Lynch AJ, Kjellevold M, Bromage S, Charlebois P, Barange M, Vannuccini S, Cao L, Kleisner KM, Rimm EB, Danaei G, DeSisto C, Kelahan H, Fiorella KJ, Little DC, Allison EH, Fanzo J, Thilsted SH. Aquatic foods to nourish nations. Nature 2021; 598:315-320. [PMID: 34526720 PMCID: PMC10584661 DOI: 10.1038/s41586-021-03917-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
Despite contributing to healthy diets for billions of people, aquatic foods are often undervalued as a nutritional solution because their diversity is often reduced to the protein and energy value of a single food type ('seafood' or 'fish')1-4. Here we create a cohesive model that unites terrestrial foods with nearly 3,000 taxa of aquatic foods to understand the future impact of aquatic foods on human nutrition. We project two plausible futures to 2030: a baseline scenario with moderate growth in aquatic animal-source food (AASF) production, and a high-production scenario with a 15-million-tonne increased supply of AASFs over the business-as-usual scenario in 2030, driven largely by investment and innovation in aquaculture production. By comparing changes in AASF consumption between the scenarios, we elucidate geographic and demographic vulnerabilities and estimate health impacts from diet-related causes. Globally, we find that a high-production scenario will decrease AASF prices by 26% and increase their consumption, thereby reducing the consumption of red and processed meats that can lead to diet-related non-communicable diseases5,6 while also preventing approximately 166 million cases of inadequate micronutrient intake. This finding provides a broad evidentiary basis for policy makers and development stakeholders to capitalize on the potential of aquatic foods to reduce food and nutrition insecurity and tackle malnutrition in all its forms.
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Affiliation(s)
- Christopher D Golden
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - J Zachary Koehn
- Center for Ocean Solutions, Stanford University, Stanford, CA, USA
| | - Alon Shepon
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Environmental Studies, The Porter School of the Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
- The Steinhardt Museum of Natural History, Tel Aviv University, Tel Aviv, Israel
| | - Simone Passarelli
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christopher M Free
- Bren School of Environmental Science and Management, University of California, Santa Barbara, Santa Barbara, CA, USA
- Marine Sciences Institute, University of California, Santa Barbara, CA, USA
| | - Daniel F Viana
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Betty and Gordon Moore Center for Science, Conservation International, Arlington, VA, USA
| | - Holger Matthey
- Markets and Trade Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Jacob G Eurich
- Marine Sciences Institute, University of California, Santa Barbara, CA, USA
- Department of Ecology, Evolution and Marine Biology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Jessica A Gephart
- Department of Environmental Science, American University, Washington, DC, USA
| | | | | | - Abigail J Lynch
- U.S. Geological Survey, National Climate Adaptation Science Center, Reston, VA, USA
| | | | - Sabri Bromage
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Pierre Charlebois
- Fisheries and Aquaculture Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Manuel Barange
- Fisheries and Aquaculture Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Stefania Vannuccini
- Fisheries and Aquaculture Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Ling Cao
- School of Oceanography, Shanghai Jiao Tong University, Shanghai, China
| | | | - Eric B Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Camille DeSisto
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Heather Kelahan
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kathryn J Fiorella
- Department of Population Medicine and Diagnostic Sciences and Master of Public Health Program, Cornell University, Ithaca, NY, USA
| | - David C Little
- Institute of Aquaculture, University of Stirling, Stirling, UK
| | | | - Jessica Fanzo
- Bloomberg School of Public Health and Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
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Kim J, Liu Y, Wang W, Blossom JC, Dwivedi LK, James KS, Sarwal R, Kim R, Subramanian S. Estimating the Burden of Child Undernutrition for Smaller Electoral Units in India. JAMA Netw Open 2021; 4:e2129416. [PMID: 34714345 PMCID: PMC8556624 DOI: 10.1001/jamanetworkopen.2021.29416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Geographic targeting of public health interventions is needed in resource-constrained developing countries. OBJECTIVE To develop methods for estimating health and development indicators across micropolicy units, using assembly constituencies (ACs) in India as an example. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included children younger than 5 years who participated in the fourth National Family and Health Survey (NFHS-4), conducted between January 2015 and December 2016. Participants lived in 36 states and union territories and 640 districts in India. Children who had valid weight and height measures were selected for stunting, underweight, and wasting analysis, and children between age 6 and 59 months with valid blood hemoglobin concentration levels were included in the anemia analysis sample. The analysis was performed between February 1 and August 15, 2020. EXPOSURES A total of 3940 ACs were identified from the geographic location of primary sampling units in which the children's households were surveyed in NFHS-4. MAIN OUTCOMES AND MEASURES Stunting, underweight, and wasting were defined according to the World Health Organization Child Growth Standards. Anemia was defined as blood hemoglobin concentration less than 11.0 g/dL. RESULTS The main analytic sample included 222 172 children (mean [SD] age, 30.03 [17.01] months; 114 902 [51.72%] boys) from 3940 ACs in the stunting, underweight, and wasting analysis and 215 593 children (mean [SD] age, 32.63 [15.47] months; 112 259 [52.07%] boys) from 3941 ACs in the anemia analysis. The burden of child undernutrition varied substantially across ACs: from 18.02% to 60.94% for stunting, with a median (IQR) of 35.56% (29.82%-42.42%); from 10.40% to 63.24% for underweight, with a median (IQR) of 32.82% (25.50%-40.96%); from 5.56% to 39.91% for wasting, with a median (IQR) of 19.91% (15.70%-24.27%); and from 18.63% to 83.05% for anemia, with a median (IQR) of 55.74% (48.41%-63.01%). The degree of inequality within states varied across states; those with high stunting, underweight, and wasting prevalence tended to have high levels of inequality. For example, Uttar Pradesh, Jharkhand, and Karnataka had high mean AC-level prevalence of child stunting (Uttar Pradesh, 45.29%; Jharkhand, 43.76%; Karnataka, 39.77%) and also large SDs (Uttar Pradesh, 6.90; Jharkhand, 6.02; Karnataka, 6.72). The Moran I indices ranged from 0.25 to 0.80, indicating varying levels of spatial autocorrelation in child undernutrition across the states in India. No substantial difference in AC-level child undernutrition prevalence was found after adjusting for possible random displacement of geographic location data. CONCLUSIONS AND RELEVANCE In this cross-sectional study, substantial inequality in child undernutrition was found across ACs in India, suggesting the importance of considering local electoral units in designing targeted interventions. The methods presented in this paper can be further applied to measuring health and development indicators in small electoral units for enhanced geographic precision of public health data in developing countries.
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Affiliation(s)
- Julie Kim
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Yuning Liu
- JP Morgan Chase Institute, Washington, DC
| | - Weiyu Wang
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
| | - Jeffrey C. Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Laxmi Kant Dwivedi
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
| | - K. S. James
- International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
| | - Rakesh Sarwal
- National Institution for Transforming India Aayog. Government of India, New Delhi, India
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
- National Institution for Transforming India Aayog. Government of India, New Delhi, India
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Sanjeev RK, Nuggehalli Srinivas P, Krishnan B, Basappa YC, Dinesh AS, Ulahannan SK. Eco-geographic patterns of child malnutrition in India and its association with cereal cultivation: An analysis using demographic health survey and agriculture datasets. Wellcome Open Res 2021; 5:118. [PMID: 35720193 PMCID: PMC9194519 DOI: 10.12688/wellcomeopenres.15934.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 08/30/2024] Open
Abstract
Background: High prevalence of maternal malnutrition, low birth-weight and child malnutrition in India contribute substantially to the global malnutrition burden. Rural India has disproportionately higher levels of child malnutrition. Stunting and wasting are the primary determinants of child malnutrition and their district-level distribution shows clustering in different geographies and regions. Cereals, particularly millets, constitute the bulk of protein intake among the poor, especially in rural areas in India where high prevalence of wasting persists. Methods: The last round of National Family Health Survey (NFHS4) has disaggregated data by district, enabling a more fine-scale characterisation of the prevalence of markers of malnutrition. We used data from NFHS4 and agricultural statistics datasets to analyse relationship of prevalence of malnutrition at the district level and area under cereal cultivation. We analysed malnutrition through data on under-5 stunting and wasting by district. Results: Stunting and wasting patterns across districts show a distinct geographical and age distribution; districts with higher wasting showed relatively higher prevalence before six months of age. Wasting prevalence at district level was associated with higher cultivation of millets, with a stronger association seen for jowar and other millets (Kodo millet, little millet, proso millet, barnyard millet and foxtail millet). District level stunting was associated with higher district level cultivation of all crops (except other millets). The analysis was limited by lack of fine-scale data on prevalence of low birth-weight and type of cereal consumed. Conclusions: Better cereal cultivation and consumption data will be needed to confirm causal pathways contributing to potential ecogeographic patterns. The cultivation of other millets has a strong association with prevalence of wasting. State-of-the-art studies that improve our understanding of bio-availability of amino acids and other nutrients from the prevalent dietary matrices of rural poor communities will be needed to confirm causal pathways contributing to potential eco-geographic patterns.
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Affiliation(s)
- Rama Krishna Sanjeev
- Pediatrics, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | | | - Bindu Krishnan
- Physiology, Rural Medical College, Pravara Institute of Medical Sciences, Loni (BK), Ahmednagar district, Maharashtra, 413736, India
| | - Yogish Channa Basappa
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
| | | | - Sabu K. Ulahannan
- Health equity cluster, Institute of Public Health Bengaluru, Bengaluru, Karnataka, 560070, India
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249
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Sudfeld CR, Smith ER. What works and for whom? Individual patient data meta-analyses in global nutrition research. Am J Clin Nutr 2021; 114:1S-2S. [PMID: 34590695 PMCID: PMC8560309 DOI: 10.1093/ajcn/nqab316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA,Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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250
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Denson LA. Application of mucosal functional genomics to childhood undernutrition and stunting: Insights into mechanisms and targeted interventions. EBioMedicine 2021; 71:103553. [PMID: 34482071 PMCID: PMC8426530 DOI: 10.1016/j.ebiom.2021.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Lee A Denson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine and the Cincinnati Children's Hospital Medical Center, MLC 2010, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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