4151
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Shelton JD. The centrality of behavior change in health systems development – Author's response. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:134. [PMID: 25276570 PMCID: PMC4168605 DOI: 10.9745/ghsp-d-14-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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4152
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Salam RA, Das JK, Ali A, Lassi ZS, Bhutta ZA. Maternal undernutrition and intrauterine growth restriction. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2013.850857] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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4153
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Lindenmayer GW, Stoltzfus RJ, Prendergast AJ. Interactions between zinc deficiency and environmental enteropathy in developing countries. Adv Nutr 2014; 5:1-6. [PMID: 24425714 PMCID: PMC3884090 DOI: 10.3945/an.113.004838] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Zinc deficiency affects one-fifth of the world's population and leads to substantial morbidity and mortality. Environmental enteropathy (EE), a subclinical pathology of altered intestinal morphology and function, is almost universal among people living in developing countries and affects long-term growth and health. This review explores the overlapping nature of these 2 conditions and presents evidence for their interaction. EE leads to impaired zinc homeostasis, predominantly due to reduced absorptive capacity arising from disturbed intestinal architecture, and zinc deficiency exacerbates several of the proposed pathways that underlie EE, including intestinal permeability, enteric infection, and chronic inflammation. Ongoing zinc deficiency likely perpetuates the adverse outcomes of EE by worsening malabsorption, reducing intestinal mucosal immune responses, and exacerbating systemic inflammation. Although the etiology of EE is predominantly environmental, zinc deficiency may also have a role in its pathogenesis. Given the impact of both EE and zinc deficiency on morbidity and mortality in developing countries, better understanding the relation between these 2 conditions may be critical for developing combined interventions to improve child health.
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Affiliation(s)
| | | | - Andrew J. Prendergast
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and,Centre for Paediatrics, Queen Mary University of London, UK,To whom correspondence should be addressed. E-mail:
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4154
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Black MM, Dewey KG. Promoting equity through integrated early child development and nutrition interventions. Ann N Y Acad Sci 2014; 1308:1-10. [PMID: 24571211 DOI: 10.1111/nyas.12351] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sustainable development, a foundation of the post-2015 global agenda, depends on healthy and productive citizens. The origins of adult health begin early in life, stemming from genetic-environmental interactions that include adequate nutrition and opportunities for responsive learning. Inequities associated with inadequate nutrition and early learning opportunities can undermine children's health and development, thereby compromising their productivity and societal contributions. Transactional theory serves as a useful framework for examining the associations that link early child development and nutrition because it emphasizes the interplay that occurs between children and the environment, mediated through caregiver interactions. Although single interventions targeting early child development or nutrition can be effective, there is limited evidence on the development, implementation, evaluation, and scaling up of integrated interventions. This manuscript introduces a special edition of papers on six topics central to integrated child development/nutrition interventions: (1) review of integrated interventions; (2) methods and topics in designing integrated interventions; (3) economic considerations related to integrated interventions; (4) capacity-building considerations; (5) examples of integrated interventions; and (6) policy implications of integrated interventions. Ensuring the health and development of infants and young children through integrated child development/nutrition interventions promotes equity, a critical component of sustainable development.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
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4155
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Jee YH, Baron J, Phillip M, Bhutta ZA. Malnutrition and catch-up growth during childhood and puberty. World Rev Nutr Diet 2014; 109:89-100. [PMID: 24457569 PMCID: PMC4803287 DOI: 10.1159/000356109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Youn Hee Jee
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey Baron
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Moshe Phillip
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petach-Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zulfiqar A. Bhutta
- Robert Harding Chair in Global Child Health & Policy, Sick Kids Center for Global Child Health, Toronto, ON, Canada and Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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4156
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Iannotti LL, Dulience SJL, Green J, Joseph S, François J, Anténor ML, Lesorogol C, Mounce J, Nickerson NM. Linear growth increased in young children in an urban slum of Haiti: a randomized controlled trial of a lipid-based nutrient supplement. Am J Clin Nutr 2014; 99:198-208. [PMID: 24225356 PMCID: PMC3862455 DOI: 10.3945/ajcn.113.063883] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Haiti has experienced rapid urbanization that has exacerbated poverty and undernutrition in large slum areas. Stunting affects 1 in 5 young children. OBJECTIVE We aimed to test the efficacy of a daily lipid-based nutrient supplement (LNS) for increased linear growth in young children. DESIGN Healthy, singleton infants aged 6-11 mo (n = 589) were recruited from an urban slum of Cap Haitien and randomly assigned to receive: 1) a control; 2) a 3-mo LNS; or 3) a 6-mo LNS. The LNS provided 108 kcal and other nutrients including vitamin A, vitamin B-12, iron, and zinc at ≥80% of the recommended amounts. Infants were followed monthly on growth, morbidity, and developmental outcomes over a 6-mo intervention period and at one additional time point 6 mo postintervention to assess sustained effects. The Bonferroni multiple comparisons test was applied, and generalized least-squares (GLS) regressions with mixed effects was used to examine impacts longitudinally. RESULTS Baseline characteristics did not differ by trial arm except for a higher mean age in the 6-mo LNS group. GLS modeling showed LNS supplementation for 6 mo significantly increased the length-for-age z score (±SE) by 0.13 ± 0.05 and the weight-for-age z score by 0.12 ± 0.02 compared with in the control group after adjustment for child age (P < 0.001). The effects were sustained 6 mo postintervention. Morbidity and developmental outcomes did not differ by trial arm. CONCLUSION A low-energy, fortified product improved the linear growth of young children in this urban setting. The trial was registered at clinicaltrials.gov as NCT01552512.
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Affiliation(s)
- Lora L Iannotti
- Institute for Public Health, George Warren Brown School of Social Work, Washington University, St Louis, MO (LLI, SJLD, JG, SJ, JF, M-LA, CL, and JM); the Notre Dame de la Sagesse Nursing School, Cap-Haïtien, Haiti (SJLD and SJ); Konbit Sante, Portland, ME (NMN); and Konbit Sante, Cap-Haïtien, Haiti (NMN)
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4157
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Skau JKH, Bunthang T, Chamnan C, Wieringa FT, Dijkhuizen MA, Roos N, Ferguson EL. The use of linear programming to determine whether a formulated complementary food product can ensure adequate nutrients for 6- to 11-month-old Cambodian infants. Am J Clin Nutr 2014; 99:130-8. [PMID: 24153341 DOI: 10.3945/ajcn.113.073700] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A new software tool, Optifood, developed by the WHO and based on linear programming (LP) analysis, has been developed to formulate food-based recommendations. OBJECTIVE This study discusses the use of Optifood for predicting whether formulated complementary food (CF) products can ensure dietary adequacy for target populations in Cambodia. DESIGN Dietary data were collected by 24-h recall in a cross-sectional survey of 6- to 11-mo-old infants (n = 78). LP model parameters were derived from these data, including a list of foods, median serving sizes, and dietary patterns. Five series of LP analyses were carried out to model the target population's baseline diet and 4 formulated CF products [WinFood (WF), WinFood-Lite (WF-L), Corn-Soy-Blend Plus (CSB+), and Corn-Soy-Blend Plus Plus (CSB++)], which were added to the diet in portions of 33 g/d dry weight (DW) for infants aged 6-8 mo and 40 g/d DW for infants aged 9-11 mo. In each series of analyses, the nutritionally optimal diet and theoretical range, in diet nutrient contents, were determined. RESULTS The LP analysis showed that baseline diets could not achieve the Recommended Nutrient Intake (RNI) for thiamin, riboflavin, niacin, folate, vitamin B-12, calcium, iron, and zinc (range: 14-91% of RNI in the optimal diets) and that none of the formulated CF products could cover the nutrient gaps for thiamin, niacin, iron, and folate (range: 22-86% of the RNI). Iron was the key limiting nutrient, for all modeled diets, achieving a maximum of only 48% of the RNI when CSB++ was included in the diet. Only WF and WF-L filled the nutrient gap for calcium. WF-L, CSB+, and CSB++ filled the nutrient gap for zinc (9- to 11-mo-olds). CONCLUSIONS The formulated CF products improved the nutrient adequacy of complementary feeding diets but could not entirely cover the nutrient gaps. These results emphasize the value of using LP to evaluate special CF products during the intervention planning phase. The WF study was registered at controlled-trials.com as ISRCTN19918531.
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Affiliation(s)
- Jutta K H Skau
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark (JKHS, MAD, and NR); the Department of Fisheries Post-harvest Technologies and Quality Control, Fishery Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia (TB and CC); Institut de Recherche pour le Développement, Montpellier, France (FTW); and the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom (ELF)
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4158
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Turner PC. The molecular epidemiology of chronic aflatoxin driven impaired child growth. SCIENTIFICA 2013; 2013:152879. [PMID: 24455429 PMCID: PMC3881689 DOI: 10.1155/2013/152879] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 10/27/2013] [Indexed: 06/03/2023]
Abstract
Aflatoxins are toxic secondary fungal metabolites that contaminate dietary staples in tropical regions; chronic high levels of exposure are common for many of the poorest populations. Observations in animals indicate that growth and/or food utilization are adversely affected by aflatoxins. This review highlights the development of validated exposure biomarkers and their use here to assess the role of aflatoxins in early life growth retardation. Aflatoxin exposure occurs in utero and continues in early infancy as weaning foods are introduced. Using aflatoxin-albumin exposure biomarkers, five major studies clearly demonstrate strong dose response relationships between exposure in utero and/or early infancy and growth retardation, identified by reduced birth weight and/or low HAZ and WAZ scores. The epidemiological studies include cross-sectional and longitudinal surveys, though aflatoxin reduction intervention studies are now required to further support these data and guide sustainable options to reduce the burden of exposure. The use of aflatoxin exposure biomarkers was essential in understanding the observational data reviewed and will likely be a critical monitor of the effectiveness of interventions to restrict aflatoxin exposure. Given that an estimated 4.5 billion individuals live in regions at risk of dietary contamination the public health concern cannot be over stated.
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Affiliation(s)
- Paul Craig Turner
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD 20742, USA
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4159
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Wieser S, Plessow R, Eichler K, Malek O, Capanzana MV, Agdeppa I, Bruegger U. Burden of micronutrient deficiencies by socio-economic strata in children aged 6 months to 5 years in the Philippines. BMC Public Health 2013; 13:1167. [PMID: 24330481 PMCID: PMC3867423 DOI: 10.1186/1471-2458-13-1167] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 11/26/2013] [Indexed: 05/28/2023] Open
Abstract
Background Micronutrient deficiencies (MNDs) are a chronic lack of vitamins and minerals and constitute a huge public health problem. MNDs have severe health consequences and are particularly harmful during early childhood due to their impact on the physical and cognitive development. We estimate the costs of illness due to iron deficiency (IDA), vitamin A deficiency (VAD) and zinc deficiency (ZnD) in 2 age groups (6–23 and 24–59 months) of Filipino children by socio-economic strata in 2008. Methods We build a health economic model simulating the consequences of MNDs in childhood over the entire lifetime. The model is based on a health survey and a nutrition survey carried out in 2008. The sample populations are first structured into 10 socio-economic strata (SES) and 2 age groups. Health consequences of MNDs are modelled based on information extracted from literature. Direct medical costs, production losses and intangible costs are computed and long term costs are discounted to present value. Results Total lifetime costs of IDA, VAD and ZnD amounted to direct medical costs of 30 million dollars, production losses of 618 million dollars and intangible costs of 122,138 disability adjusted life years (DALYs). These costs can be interpreted as the lifetime costs of a 1-year cohort affected by MNDs between the age of 6–59 months. Direct medical costs are dominated by costs due to ZnD (89% of total), production losses by losses in future lifetime (90% of total) and intangible costs by premature death (47% of total DALY losses) and losses in future lifetime (43%). Costs of MNDs differ considerably between SES as costs in the poorest third of the households are 5 times higher than in the wealthiest third. Conclusions MNDs lead to substantial costs in 6-59-month-old children in the Philippines. Costs are highly concentrated in the lower SES and in children 6–23 months old. These results may have important implications for the design, evaluation and choice of the most effective and cost-effective policies aimed at the reduction of MNDs.
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Affiliation(s)
- Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, CH-8401 Winterthur, Switzerland.
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4160
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Dunn ML, Jain V, Klein BP. Stability of key micronutrients added to fortified maize flours and corn meal. Ann N Y Acad Sci 2013; 1312:15-25. [DOI: 10.1111/nyas.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael L. Dunn
- Nutrition, Dietetics, and Food Science Brigham Young University Provo Utah
| | - Vijaya Jain
- Nutrition Consultant Briarcliff Manor New York
| | - Barbara P. Klein
- Food Science and Human Nutrition University of Illinois at Urbana‐Champaign Urbana Illinois
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4161
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Affiliation(s)
- Zulfiqar A Bhutta
- From the Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto (Z.A.B.); the Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan (Z.A.B.); and the Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (R.E.B.)
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4162
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Li Y, Wang W, van Velthoven MH, Chen L, Car J, Rudan I, Zhang Y, Wu Q, Du X, Scherpbier RW. Text messaging data collection for monitoring an infant feeding intervention program in rural China: feasibility study. J Med Internet Res 2013; 15:e269. [PMID: 24305514 PMCID: PMC3869081 DOI: 10.2196/jmir.2906] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/07/2013] [Indexed: 11/16/2022] Open
Abstract
Background An effective data collection method is crucial for high quality monitoring of health interventions. The traditional face-to-face data collection method is labor intensive, expensive, and time consuming. With the rapid increase of mobile phone subscribers, text messaging has the potential to be used for evaluation of population health interventions in rural China. Objective The objective of this study was to explore the feasibility of using text messaging as a data collection tool to monitor an infant feeding intervention program. Methods Participants were caregivers of children aged 0 to 23 months in rural China who participated in an infant feeding health education program. We used the test-retest method. First, we collected data with a text messaging survey and then with a face-to-face survey for 2 periods of 3 days. We compared the response rate, data agreement, costs, and participants’ acceptability of the two methods. Also, we interviewed participants to explore their reasons for not responding to the text messages and the reasons for disagreement in the two methods. In addition, we evaluated the most appropriate time during the day for sending text messages. Results We included 258 participants; 99 (38.4%) participated in the text messaging survey and 177 (68.6%) in the face-to-face survey. Compared with the face-to-face survey, the text messaging survey had much lower response rates to at least one question (38.4% vs 68.6%) and to all 7 questions (27.9% vs 67.4%) with moderate data agreement (most kappa values between .5 and .75, the intraclass correlation coefficients between .53 to .72). Participants who took part in both surveys gave the same acceptability rating for both methods (median 4.0 for both on a 5-point scale, 1=disliked very much and 5=liked very much). The costs per questionnaire for the text messaging method were much lower than the costs for the face-to-face method: ¥19.7 (US $3.13) versus ¥33.9 (US $5.39) for all questionnaires, and ¥27.1 (US $4.31) versus ¥34.4 (US $5.47) for completed questionnaires. The main reasons for not replying were that participants did not receive text messages, they were too busy to reply, or they did not see text messages in time. The main reasons for disagreement in responses were that participants forgot their answers in the text messaging survey and that they changed their minds. We found that participants were more likely to reply to text messages immediately during 2 time periods: 8 AM to 3 PM and 8 PM to 9 PM. Conclusions The text messaging method had reasonable data agreement and low cost, but a low response rate. Further research is needed to evaluate effectiveness of measures that can increase the response rate, especially in collecting longitudinal data by text messaging.
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Affiliation(s)
- Ye Li
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
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4163
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Roberts TJ, Carnahan E, Gakidou E. Can breastfeeding promote child health equity? A comprehensive analysis of breastfeeding patterns across the developing world and what we can learn from them. BMC Med 2013; 11:254. [PMID: 24305597 PMCID: PMC3896843 DOI: 10.1186/1741-7015-11-254] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/29/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In 2010 more than 7.7 million children died before their fifth birthday. Over 98% of these deaths occurred in developing countries, and recent estimates have attributed hundreds of thousands of these deaths to suboptimal breastfeeding. METHODS This study estimated prevalence of suboptimal breastfeeding for 137 developing countries from 1990 to 2010. These estimates were compared against WHO infant feeding recommendations and combined with effect sizes from existing literature to estimate associated disease burden using a standard comparative risk assessment approach. These prevalence estimates were disaggregated by wealth quintile and linked with child mortality rates to assess how improved rates of breastfeeding may affect child health inequalities. RESULTS In 2010, the prevalence of exclusive breastfeeding ranged from 3.5% in Djibouti to 77.3% in Rwanda. The proportion of child Disability Adjusted Life Years (DALYs) attributable to suboptimal breastfeeding is 7.6% at the global level and as high as 20.2% in Swaziland. Suboptimal breastfeeding is a leading childhood risk factor in all developing countries and consistently ranks higher than water and sanitation. Within most countries, breastfeeding prevalence rates do not vary considerably across wealth quintiles. CONCLUSIONS Breastfeeding is an effective child health intervention that does not require extensive health system infrastructure. Improvements in rates of exclusive and continued breastfeeding can contribute to the reduction of child mortality inequalities in developing countries.
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Affiliation(s)
| | | | - Emmanuela Gakidou
- The Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA 98121, USA.
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4164
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Stein AD, Barros FC, Bhargava SK, Hao W, Horta BL, Lee N, Kuzawa CW, Martorell R, Ramji S, Stein A, Richter L. Birth status, child growth, and adult outcomes in low- and middle-income countries. J Pediatr 2013; 163:1740-1746.e4. [PMID: 24064150 PMCID: PMC3849851 DOI: 10.1016/j.jpeds.2013.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/16/2013] [Accepted: 08/08/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the impact of being born preterm or small for gestational age (SGA) on several adult outcomes. STUDY DESIGN We analyzed data for 4518 adult participants in 5 birth cohorts from Brazil, Guatemala, India, the Philippines, and South Africa. RESULTS In the study population, 12.8% of males and 11.9% of females were born preterm, and 26.8% of males and 22.4% of females were born term but SGA. Adults born preterm were 1.11 cm shorter (95% CI, 0.57-1.65 cm), and those born term but SGA were 2.35 cm shorter (95% CI, 1.93-2.77 cm) compared with those born at term and appropriate size for gestational age. Blood pressure and blood glucose level did not differ by birth category. Compared with those born term and at appropriate size for gestational age, schooling attainment was 0.44 years lower (95% CI, 0.17-0.71 years) in those born preterm and 0.41 years lower (95% CI, 0.20-0.62 years) in those born term but SGA. CONCLUSION Being born preterm or term but SGA is associated with persistent deficits in adult height and schooling, but is not related to blood pressure or blood glucose level in low- and middle-income settings. Increased postnatal growth is associated with gains in height and schooling regardless of birth status, but not with increases in blood pressure or blood glucose level.
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Affiliation(s)
- Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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4165
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Requejo J, Merialdi M, Althabe F, Keller M, Katz J, Menon R. Born too soon: care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby. Reprod Health 2013; 10 Suppl 1:S4. [PMID: 24625215 PMCID: PMC3842748 DOI: 10.1186/1742-4755-10-s1-s4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Pregnancy and childbirth represent a critical time period when a woman can be reached through a variety of mechanisms with interventions aimed at reducing her risk of a preterm birth and improving her health and the health of her unborn baby. These mechanisms include the range of services delivered during antenatal care for all pregnant women and women at high risk of preterm birth, services provided to manage preterm labour, and workplace, professional and other supportive policies that promote safe motherhood and universal access to care before, during and after pregnancy. The aim of this paper is to present the latest information about available interventions that can be delivered during pregnancy to reduce preterm birth rates and improve the health outcomes of the premature baby, and to identify data gaps. The paper also focuses on promising avenues of research on the pregnancy period that will contribute to a better understanding of the causes of preterm birth and ability to design interventions at the policy, health care system and community levels. At minimum, countries need to ensure equitable access to comprehensive antenatal care, quality childbirth services and emergency obstetric care. Antenatal care services should include screening for and management of women at high risk of preterm birth, screening for and treatment of infections, and nutritional support and counselling. Health workers need to be trained and equipped to provide effective and timely clinical management of women in preterm labour to improve the survival chances of the preterm baby. Implementation strategies must be developed to increase the uptake by providers of proven interventions such as antenatal corticosteroids and to reduce harmful practices such as non-medically indicated inductions of labour and caesarean births before 39 weeks of gestation. Behavioural and community-based interventions that can lead to reductions in smoking and violence against women need to be implemented in conjunction with antenatal care models that promote women's empowerment as a strategy for reducing preterm delivery. The global community needs to support more discovery research on normal and abnormal pregnancies to facilitate the development of preventive interventions for universal application. As new evidence is generated, resources need to be allocated to its translation into new and better screening and diagnostic tools, and other interventions aimed at saving maternal and newborn lives that can be brought to scale in all countries.
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Affiliation(s)
- Jennifer Requejo
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | | | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Joanne Katz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ramkumar Menon
- The University of Texas Medical Branch at Galveston, Galveston, USA
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4166
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Ayoya MA, Heidkamp R, Ngnie-Teta I, Pierre JM, Stoltzfus RJ. Child malnutrition in Haiti: progress despite disasters. GLOBAL HEALTH: SCIENCE AND PRACTICE 2013; 1:389-96. [PMID: 25276552 PMCID: PMC4168596 DOI: 10.9745/ghsp-d-13-00069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/01/2013] [Indexed: 11/15/2022]
Abstract
Undernutrition, a chief child killer in developing countries, has been a major public health problem in Haiti. Following the 2010 disasters (earthquake and cholera) and the intensive relief efforts to address them, we sought to determine the trends of child undernutrition in Haiti using data from the 2005-06 Haiti Demographic and Health Survey (HDHS) and from a Standardized Monitoring and Assessment of Relief and Transitions (SMART) survey in 2012. Growth data analyses included 2,463 (HDHS) and 4,727 (SMART) children ages 0-59 months. We calculated the prevalence of stunting, wasting, and underweight for each survey using World Health Organization 2006 growth standards. To account for sampling design, probability weights were applied to all analyses. Statistical significance was determined by non-overlapping confidence intervals around estimates. Stunting prevalence declined from 28.5% (95% confidence interval [CI] = 25.9, 31.3) in 2005-06 to 22.2% (95% CI = 20.2, 24.3) in 2012; wasting, from 10.1% (95% CI = 8.2, 12.7) to 4.3% (95% CI = 3.6, 5.2); and underweight, from 17.7 % (95% CI = 15.6, 20.1) to 10.5% (95% CI = 9.3, 11.9). Additionally, stunting declined more in rural areas, from 33.6% (95% CI = 30.1, 37.2) in 2005-06 to 25% (95% CI = 23.4, 26.7) in 2012, than in urban areas, from 18.6% (95% CI = 15.3, 22.5) in 2005-06 to 18.4% (95% CI = 16.7, 20.1) in 2012, for reasons that remain unknown. Results of the 2012 HDHS confirmed the observed trends. Thus, undernutrition among Haitian children under 5 declined significantly between 2005-06 and 2012. Our results should be interpreted in view of investments and changes that occurred in different sectors (within and outside health and nutrition) before and after the earthquake.
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Affiliation(s)
- Mohamed Ag Ayoya
- UNICEF Country Office, Nutrition Section , Port-au-Prince , Haiti
| | - Rebecca Heidkamp
- Johns Hopkins Bloomberg School of Public Health, Department of International Health , Baltimore, MD , USA
| | | | - Joseline Marhone Pierre
- Haiti Ministry of Public Health and Population, National Food and Nutrition Program Coordination Unit , Port-au-Prince , Haiti
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4167
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Nii Okai Aryeetey R, Antwi CL. Re-assessment of selected Baby-Friendly maternity facilities in Accra, Ghana. Int Breastfeed J 2013; 8:15. [PMID: 24216173 PMCID: PMC3832220 DOI: 10.1186/1746-4358-8-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative (BFHI) has been implemented in Ghana since 1995. At the end of 2011, about 325 maternity facilities in Ghana had been designated Baby Friendly. However, none had been re-assessed for adherence to the Ten Steps to successful breastfeeding (Ten Steps). The current study re-assessed six maternity facilities in Accra for adherence to the Ten Steps and the International Code of Marketing of breast milk substitutes (the Code). METHODS Three independent assessors performed the re-assessment using the revised WHO/UNICEF external re-assessment tool (ERT) between April and June, 2011. All sections of the ERT were implemented, except for the HIV/infant feeding section. Assessors interviewed 90 clinical staff of the facilities, 60 pregnant women, and 150 women who had given birth and waiting to be discharged from the hospital. Additionally, observations were completed on neonate feeding and compliance with the Code. Data was analyzed to assess adherence to the Ten Steps and the Code. RESULTS In 2010, the six facilities recorded a total of 26,339 deliveries. At discharge, the weighted exclusive breastfeeding rate was 93.8%. None of the facilities adhered completely to the Ten Steps. Overall, the rate of adherence to the Ten Steps was 42% (range = 30 - 70%). No facility met the criteria for Steps One and Two. Only Step Seven was adhered to by all facilities. Overall compliance with the Code was about 54%. Trained staff attrition, high client-staff ratios, inadequate in-service training for new staff, and inadequate support for regional and national program monitoring were identified as barriers to adherence. CONCLUSION Poor adherence to Baby-Friendly practices in designated BFHI facilities was observed in urban Accra. Renewed efforts to support monitoring of designated facilities is recommended.
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4168
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Affiliation(s)
- André Briend
- Department for International Health, University of Tampere School of Medicine, Tampere 33014, Finland.
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4169
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Affiliation(s)
- Chessa K Lutter
- Pan American Health Organization/World Health Organization, Washington, DC 20037, USA.
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4170
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Tanner S, Leonard WR, Reyes-García V. The consequences of linear growth stunting: Influence on body composition among youth in the bolivian amazon. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2013; 153:92-102. [DOI: 10.1002/ajpa.22413] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Susan Tanner
- Department of Anthropology, University of Georgia; Athens GA 30602
| | | | - Victoria Reyes-García
- ICREA and Institut de Ciència I Technologia Ambientals; Universitat Autònoma de Barcelona; 08193 Cerdanyola del Valles Spain
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4171
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Affiliation(s)
- Joanne Katz
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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4172
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Hoddinott J, Behrman JR, Maluccio JA, Melgar P, Quisumbing AR, Ramirez-Zea M, Stein AD, Yount KM, Martorell R. Adult consequences of growth failure in early childhood. Am J Clin Nutr 2013; 98:1170-8. [PMID: 24004889 PMCID: PMC3798075 DOI: 10.3945/ajcn.113.064584] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Growth failure is associated with adverse consequences, but studies need to control adequately for confounding. OBJECTIVE We related height-for-age z scores (HAZs) and stunting at age 24 mo to adult human capital, marriage, fertility, health, and economic outcomes. DESIGN In 2002-2004, we collected data from 1338 Guatemalan adults (aged 25-42 y) who were studied as children in 1969-1977. We used instrumental variable regression to correct for estimation bias and adjusted for potentially confounding factors. RESULTS A 1-SD increase in HAZ was associated with more schooling (0.78 grades) and higher test scores for reading and nonverbal cognitive skills (0.28 and 0.25 SDs, respectively), characteristics of marriage partners (1.39 y older, 1.02 grade more schooling, and 1.01 cm taller) and, for women, a higher age at first birth (0.77 y) and fewer number of pregnancies and children (0.63 and 0.43, respectively). A 1-SD increase in HAZ was associated with increased household per capita expenditure (21%) and a lower probability of living in poverty (10 percentage points). Conversely, being stunted at 2 y was associated with less schooling, a lower test performance, a lower household per capita expenditure, and an increased probability of living in poverty. For women, stunting was associated with a lower age at first birth and higher number of pregnancies and children. There was little relation between either HAZ or stunting and adult health. CONCLUSION Growth failure in early life has profound adverse consequences over the life course on human, social, and economic capital.
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Affiliation(s)
- John Hoddinott
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC (JH and ARQ); the Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA (JRB); the Department of Economics, Middlebury College, Middlebury, VT (JAM); The Institute of Nutrition of Central America and Panama, Guatemala City, Republic of Guatemala (PM and MR-Z); and the Hubert Department of Global Health, Rollins School of Public Health (ADS, KMY, and RM), and the Department of Sociology (KMY), Emory University, Atlanta, GA
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4173
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Paciorek CJ, Stevens GA, Finucane MM, Ezzati M. Children's height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data. Lancet Glob Health 2013; 1:e300-9. [PMID: 25104494 PMCID: PMC4547325 DOI: 10.1016/s2214-109x(13)70109-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Urban living affects children's nutrition and growth, which are determinants of their survival, cognitive development, and lifelong health. Little is known about urban-rural differences in children's height and weight, and how these differences have changed over time. We aimed to investigate trends in children's height and weight in rural and urban settings in low-income and middle-income countries, and to assess changes in the urban-rural differentials in height and weight over time. METHODS We used comprehensive population-based data and a Bayesian hierarchical mixture model to estimate trends in children's height-for-age and weight-for-age Z scores by rural and urban place of residence, and changes in urban-rural differentials in height and weight Z scores, for 141 low-income and middle-income countries between 1985 and 2011. We also estimated the contribution of changes in rural and urban height and weight, and that of urbanisation, to the regional trends in these outcomes. FINDINGS Urban children are taller and heavier than their rural counterparts in almost all low-income and middle-income countries. The urban-rural differential is largest in Andean and central Latin America (eg, Peru, Honduras, Bolivia, and Guatemala); in some African countries such as Niger, Burundi, and Burkina Faso; and in Vietnam and China. It is smallest in southern and tropical Latin America (eg, Chile and Brazil). Urban children in China, Chile, and Jamaica are the tallest in low-income and middle-income countries, and children in rural areas of Burundi, Guatemala, and Niger the shortest, with the tallest and shortest more than 10 cm apart at age 5 years. The heaviest children live in cities in Georgia, Chile, and China, and the most underweight in rural areas of Timor-Leste, India, Niger, and Bangladesh. Between 1985 and 2011, the urban advantage in height fell in southern and tropical Latin America and south Asia, but changed little or not at all in most other regions. The urban-rural weight differential also decreased in southern and tropical Latin America, but increased in east and southeast Asia and worldwide, because weight gain of urban children outpaced that of rural children. INTERPRETATION Further improvement of child nutrition will require improved access to a stable and affordable food supply and health care for both rural and urban children, and closing of the the urban-rural gap in nutritional status. FUNDING Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council.
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Affiliation(s)
| | - Gretchen A Stevens
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Mariel M Finucane
- Gladstone Institutes, University of California, San Francisco, CA, USA
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
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4174
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Bryce J, Black RE, Victora CG. Millennium Development Goals 4 and 5: progress and challenges. BMC Med 2013; 11:225. [PMID: 24228742 PMCID: PMC3852291 DOI: 10.1186/1741-7015-11-225] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 12/22/2022] Open
Abstract
The Millennium Development Goals have galvanized efforts to improve child survival (MDG-4) and maternal health (MDG-5). There has been important progress on both MDGs at global level, although it now appears that few countries will reach them by the target date of 2015. There are known and efficacious interventions to address most of the major causes of these deaths, but important gaps remain. The biggest challenge is to ensure that all women and children have access to life-saving interventions. Current levels of intervention coverage are too low, representing missed opportunities. Providing services at the community level is an important emerging priority, but preventing maternal and neonatal deaths also requires access to health facilities. Readers of the Medicine for Global Health collection in BMC Medicine are urged to make maternal and child health one of their key concerns, even if they work on other topics.
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Affiliation(s)
- Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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4175
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Scovronick N, Chalabi Z, Wilkinson P. Four issues in undernutrition-related health impact modeling. Emerg Themes Epidemiol 2013; 10:9. [PMID: 24073617 PMCID: PMC3852289 DOI: 10.1186/1742-7622-10-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
Undernutrition modeling makes it possible to evaluate the potential impact of such events as a food-price shock or harvest failure on the prevalence and severity of undernutrition. There are, however, uncertainties in such modeling. In this paper we discuss four methodological issues pertinent to impact estimation: (1) the conventional emphasis on energy intake rather than dietary quality; (2) the importance of the distribution of nutrient intakes; (3) the timing of both the 'food shock' and when the response is assessed; and (4) catch-up growth and risk accumulation.
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Affiliation(s)
- Noah Scovronick
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, UK
| | - Zaid Chalabi
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, UK
| | - Paul Wilkinson
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, UK
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4176
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Affiliation(s)
- Danzhen You
- Division of Policy and Strategy, UNICEF, New York, NY 10017, USA.
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4177
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Abstract
10 years ago, The Lancet published a Series about child survival. In this Review, we examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era. Many countries are now making good progress and need the time and support required to finish the task. The global health community should show its steadfast commitment to child survival by amassing knowledge and experience as a basis for ever more effective programmes. Leadership and accountability for child survival should be strengthened and shared among the UN system; governments in high-income, middle-income, and low-income countries; and non-governmental organisations.
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Affiliation(s)
- Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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4178
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Hoddinott J, Alderman H, Behrman JR, Haddad L, Horton S. The economic rationale for investing in stunting reduction. MATERNAL & CHILD NUTRITION 2013; 9 Suppl 2:69-82. [PMID: 24074319 PMCID: PMC6860695 DOI: 10.1111/mcn.12080] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This paper outlines the economic rationale for investments that reduce stunting. We present a framework that illustrates the functional consequences of stunting in the 1000 days after conception throughout the life cycle: from childhood through to old age. We summarize the key empirical literature around each of the links in the life cycle, highlighting gaps in knowledge where they exist. We construct credible estimates of benefit-cost ratios for a plausible set of nutritional interventions to reduce stunting. There are considerable challenges in doing so that we document. We assume an uplift in income of 11% due to the prevention of one fifth of stunting and a 5% discount rate of future benefit streams. Our estimates of the country-specific benefit-cost ratios for investments that reduce stunting in 17 high-burden countries range from 3.6 (DRC) to 48 (Indonesia) with a median value of 18 (Bangladesh). Mindful that these results hinge on a number of assumptions, they compare favourably with other investments for which public funds compete.
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Affiliation(s)
- John Hoddinott
- PovertyHealth and Nutrition DivisionInternational Food Policy Research InstituteWashingtonDCUSA
| | - Harold Alderman
- PovertyHealth and Nutrition DivisionInternational Food Policy Research InstituteWashingtonDCUSA
| | - Jere R. Behrman
- Departments of Economics and Sociology and Population Studies CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Susan Horton
- Balsillie School of International AffairsUniversity of WaterlooOntarioCanada
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4179
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de Onis M, Dewey KG, Borghi E, Onyango AW, Blössner M, Daelmans B, Piwoz E, Branca F. The World Health Organization's global target for reducing childhood stunting by 2025: rationale and proposed actions. MATERNAL & CHILD NUTRITION 2013; 9 Suppl 2:6-26. [PMID: 24074315 PMCID: PMC6860845 DOI: 10.1111/mcn.12075] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In 2012, the World Health Organization adopted a resolution on maternal, infant and young child nutrition that included a global target to reduce by 40% the number of stunted under-five children by 2025. The target was based on analyses of time series data from 148 countries and national success stories in tackling undernutrition. The global target translates to a 3.9% reduction per year and implies decreasing the number of stunted children from 171 million in 2010 to about 100 million in 2025. However, at current rates of progress, there will be 127 million stunted children by 2025, that is, 27 million more than the target or a reduction of only 26%. The translation of the global target into national targets needs to consider nutrition profiles, risk factor trends, demographic changes, experience with developing and implementing nutrition policies, and health system development. This paper presents a methodology to set individual country targets, without precluding the use of others. Any method applied will be influenced by country-specific population growth rates. A key question is what countries should do to meet the target. Nutrition interventions alone are almost certainly insufficient, hence the importance of ongoing efforts to foster nutrition-sensitive development and encourage development of evidence-based, multisectoral plans to address stunting at national scale, combining direct nutrition interventions with strategies concerning health, family planning, water and sanitation, and other factors that affect the risk of stunting. In addition, an accountability framework needs to be developed and surveillance systems strengthened to monitor the achievement of commitments and targets.
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Affiliation(s)
- Mercedes de Onis
- Department of NutritionWorld Health OrganizationGenevaSwitzerland
| | - Kathryn G. Dewey
- Department of NutritionUniversity of California, DavisDavisCaliforniaUSA
| | - Elaine Borghi
- Department of NutritionWorld Health OrganizationGenevaSwitzerland
| | | | - Monika Blössner
- Department of NutritionWorld Health OrganizationGenevaSwitzerland
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent HealthWorld Health OrganizationGenevaSwitzerland
| | - Ellen Piwoz
- Global Health ProgramBill and Melinda Gates FoundationSeattleWashingtonUSA
| | - Francesco Branca
- Department of NutritionWorld Health OrganizationGenevaSwitzerland
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4180
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The year 2013: nutrition at the top of the global agenda. Public Health Nutr 2013; 16:1531-2. [DOI: 10.1017/s1368980013002061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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4181
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del Carmen Casanovas M, Lutter CK, Mangasaryan N, Mwadime R, Hajeebhoy N, Aguilar AM, Kopp C, Rico L, Ibiett G, Andia D, Onyango AW. Multi-sectoral interventions for healthy growth. MATERNAL & CHILD NUTRITION 2013; 9 Suppl 2:46-57. [PMID: 24074317 PMCID: PMC6860720 DOI: 10.1111/mcn.12082] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The risk of stunted growth and development is affected by the context in which a child is born and grows. This includes such interdependent influences as the political economy, health and health care, education, society and culture, agriculture and food systems, water and sanitation, and the environment. Here, we briefly review how factors linked with the key sectors can contribute to healthy growth and reduced childhood stunting. Emphasis is placed on the role of agriculture/food security, especially family farming; education, particularly of girls and women; water, sanitation, and hygiene and their integration in stunting reduction strategies; social protection including cash transfers, bearing in mind that success in this regard is linked to reducing the gap between rich and poor; economic investment in stunting reduction including the work with the for-profit commercial sector balancing risks linked to marketing foods that can displace affordable and more sustainable alternatives; health with emphasis on implementing comprehensive and effective health care interventions and building the capacity of health care providers. We complete the review with examples of national and subnational multi-sectoral interventions that illustrate how critical it is for sectors to work together to reduce stunting.
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Affiliation(s)
- Ma del Carmen Casanovas
- Department of Nutrition for Health and DevelopmentWorld Health OrganizationGenevaSwitzerland
| | - Chessa K. Lutter
- Department of Family, Gender and Life CoursePan American Health OrganizationWashington DCUSA
| | - Nune Mangasaryan
- Infant and Young Child NutritionUnited Nations Children's FundNew YorkNew YorkUSA
| | | | | | | | - Ciro Kopp
- Programa Desayuno EscolarLa PazBolivia
| | - Luis Rico
- Comité Técnico del Consejo Nacional de Alimentación y NutriciónLa PazBolivia
| | | | - Doris Andia
- Comité Técnico del Consejo Nacional de Alimentación y NutriciónLa PazBolivia
| | - Adelheid W. Onyango
- Department of Nutrition for Health and DevelopmentWorld Health OrganizationGenevaSwitzerland
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4182
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Arnold BF, Null C, Luby SP, Unicomb L, Stewart CP, Dewey KG, Ahmed T, Ashraf S, Christensen G, Clasen T, Dentz HN, Fernald LCH, Haque R, Hubbard AE, Kariger P, Leontsini E, Lin A, Njenga SM, Pickering AJ, Ram PK, Tofail F, Winch PJ, Colford JM. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open 2013; 3:e003476. [PMID: 23996605 PMCID: PMC3758977 DOI: 10.1136/bmjopen-2013-003476] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Enteric infections are common during the first years of life in low-income countries and contribute to growth faltering with long-term impairment of health and development. Water quality, sanitation, handwashing and nutritional interventions can independently reduce enteric infections and growth faltering. There is little evidence that directly compares the effects of these individual and combined interventions on diarrhoea and growth when delivered to infants and young children. The objective of the WASH Benefits study is to help fill this knowledge gap. METHODS AND ANALYSIS WASH Benefits includes two cluster-randomised trials to assess improvements in water quality, sanitation, handwashing and child nutrition-alone and in combination-to rural households with pregnant women in Kenya and Bangladesh. Geographically matched clusters (groups of household compounds in Bangladesh and villages in Kenya) will be randomised to one of six intervention arms or control. Intervention arms include water quality, sanitation, handwashing, nutrition, combined water+sanitation+handwashing (WSH) and WSH+nutrition. The studies will enrol newborn children (N=5760 in Bangladesh and N=8000 in Kenya) and measure outcomes at 12 and 24 months after intervention delivery. Primary outcomes include child length-for-age Z-scores and caregiver-reported diarrhoea. Secondary outcomes include stunting prevalence, markers of environmental enteropathy and child development scores (verbal, motor and personal/social). We will estimate unadjusted and adjusted intention-to-treat effects using semiparametric estimators and permutation tests. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by human subjects review boards at the University of California, Berkeley, Stanford University, the International Centre for Diarrheal Disease Research, Bangladesh, the Kenya Medical Research Institute, and Innovations for Poverty Action. Independent data safety monitoring boards in each country oversee the trials. This study is funded by a grant from the Bill & Melinda Gates Foundation to the University of California, Berkeley. REGISTRATION Trial registration identifiers (http://www.clinicaltrials.gov): NCT01590095 (Bangladesh), NCT01704105 (Kenya).
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Affiliation(s)
- Benjamin F Arnold
- School of Public Health, University of California, Berkeley, California, USA
| | - Clair Null
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Innovations for Poverty Action, New Haven, Connecticut, USA
| | - Stephen P Luby
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Stanford University, Stanford, California, USA
| | - Leanne Unicomb
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Christine P Stewart
- Program in International and Community Nutrition, University of California, Davis, California, USA
| | - Kathryn G Dewey
- Program in International and Community Nutrition, University of California, Davis, California, USA
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- BRAC University, James P Grant School of Public Health, Dhaka, Bangladesh
| | - Sania Ashraf
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Garret Christensen
- Innovations for Poverty Action, New Haven, Connecticut, USA
- Department of Economics, Swarthmore College, Swarthmore, Pennsylvania, USA
| | - Thomas Clasen
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Holly N Dentz
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Innovations for Poverty Action, New Haven, Connecticut, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, California, USA
| | - Rashidul Haque
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Centre for Communicable Diseases and Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Alan E Hubbard
- School of Public Health, University of California, Berkeley, California, USA
| | - Patricia Kariger
- School of Public Health, University of California, Berkeley, California, USA
| | - Elli Leontsini
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Audrie Lin
- School of Public Health, University of California, Berkeley, California, USA
| | - Sammy M Njenga
- Eastern & Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Amy J Pickering
- Civil and Environmental Engineering, Stanford University, Stanford, California, USA
| | - Pavani K Ram
- School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA
| | - Fahmida Tofail
- Centre for Nutrition & Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, California, USA
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4183
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Affiliation(s)
- David Nabarro
- SUN Movement Secretariat, Villa La Pelouse 2nd Floor, Palais Des Nations, 1201 Geneva, Switzerland.
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4184
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Fischer Walker CL, Perin J, Liu JL, Katz J, Tielsch JM, Black R. Does comorbidity increase the risk of mortality among children under 3 years of age? BMJ Open 2013; 3:e003457. [PMID: 23965935 PMCID: PMC3753509 DOI: 10.1136/bmjopen-2013-003457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Diarrhoea and pneumonia remain leading causes of morbidity and mortality in children under 5 years of age. Little data is available to quantify the burden of comorbidity and the relationship between comorbid diarrhoea and pneumonia infections and mortality. We sought to quantify the relationship between comorbidity and risk of mortality among young children in two community-based studies conducted among South Asian children. DESIGN Secondary data analysis of two cohort studies. PARTICIPANTS We identified two cohort studies of children under 3 years of age with prospective morbidity at least once every 2 weeks and ongoing mortality surveillance. OUTCOME MEASURES We calculated the mortality risk for diarrhoea and acute lower respiratory infection (ALRI) episodes and further quantified the risk of mortality when both diseases occur at the same time using a semiparametric additive model. RESULTS Among Nepali children, the estimated additional risk of mortality for comorbid diarrhoea and ALRI was 0.0014 (-0.0033, 0.0060). Among South Indian children, the estimated additional risk of mortality for comorbid diarrhoea and ALRI was 0.0032 (-0.0098, 0.0162). This risk is in addition to the single infection risk of mortality observed among these children. CONCLUSIONS We observed an additional risk of mortality in children who experienced simultaneous diarrhoea and ALRI episodes though the CI was wide indicating low statistical support. Additional studies with adequate power to detect the increased risk of comorbidity on mortality are needed to improve confidence around the effect size estimate.
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Affiliation(s)
- Christa L Fischer Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jodi L Liu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James M Tielsch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Global Health, George Washington University, School of Public Health and Health Services, Washington, DCUSA
| | - Robert Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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4185
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Affiliation(s)
- Anna Taylor
- UK Department for International Development, London SW1A 2EG, UK.
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4186
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Gillespie S, Haddad L, Mannar V, Menon P, Nisbett N. The politics of reducing malnutrition: building commitment and accelerating progress. Lancet 2013; 382:552-69. [PMID: 23746781 DOI: 10.1016/s0140-6736(13)60842-9] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the past 5 years, political discourse about the challenge of undernutrition has increased substantially at national and international levels and has led to stated commitments from many national governments, international organisations, and donors. The Scaling Up Nutrition movement has both driven, and been driven by, this developing momentum. Harmonisation has increased among stakeholders, with regard to their understanding of the main causes of malnutrition and to the various options for addressing it. The main challenges are to enhance and expand the quality and coverage of nutrition-specific interventions, and to maximise the nutrition sensitivity of more distal interventions, such as agriculture, social protection, and water and sanitation. But a crucial third level of action exists, which relates to the environments and processes that underpin and shape political and policy processes. We focus on this neglected level. We address several fundamental questions: how can enabling environments and processes be cultivated, sustained, and ultimately translated into results on the ground? How has high-level political momentum been generated? What needs to happen to turn this momentum into results? How can we ensure that high-quality, well-resourced interventions for nutrition are available to those who need them, and that agriculture, social protection, and water and sanitation systems and programmes are proactively reoriented to support nutrition goals? We use a six-cell framework to discuss the ways in which three domains (knowledge and evidence, politics and governance, and capacity and resources) are pivotal to create and sustain political momentum, and to translate momentum into results in high-burden countries.
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Affiliation(s)
- Stuart Gillespie
- International Food Policy Research Institute, Washington, DC 20006-1002, USA.
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4187
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Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 2013; 382:536-51. [PMID: 23746780 DOI: 10.1016/s0140-6736(13)60843-0] [Citation(s) in RCA: 797] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acceleration of progress in nutrition will require effective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and effectiveness of nutrition-specific interventions. We reviewed evidence of nutritional effects of programmes in four sectors--agriculture, social safety nets, early child development, and schooling. The need for investments to boost agricultural production, keep prices low, and increase incomes is undisputable; targeted agricultural programmes can complement these investments by supporting livelihoods, enhancing access to diverse diets in poor populations, and fostering women's empowerment. However, evidence of the nutritional effect of agricultural programmes is inconclusive--except for vitamin A from biofortification of orange sweet potatoes--largely because of poor quality evaluations. Social safety nets currently provide cash or food transfers to a billion poor people and victims of shocks (eg, natural disasters). Individual studies show some effects on younger children exposed for longer durations, but weaknesses in nutrition goals and actions, and poor service quality probably explain the scarcity of overall nutritional benefits. Combined early child development and nutrition interventions show promising additive or synergistic effects on child development--and in some cases nutrition--and could lead to substantial gains in cost, efficiency, and effectiveness, but these programmes have yet to be tested at scale. Parental schooling is strongly associated with child nutrition, and the effectiveness of emerging school nutrition education programmes needs to be tested. Many of the programmes reviewed were not originally designed to improve nutrition yet have great potential to do so. Ways to enhance programme nutrition-sensitivity include: improve targeting; use conditions to stimulate participation; strengthen nutrition goals and actions; and optimise women's nutrition, time, physical and mental health, and empowerment. Nutrition-sensitive programmes can help scale up nutrition-specific interventions and create a stimulating environment in which young children can grow and develop to their full potential.
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Affiliation(s)
- Marie T Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006, USA.
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4188
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Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H, Ezzati M, Bhutta ZA, Marchant T, Willey BA, Adair L, Barros F, Baqui AH, Christian P, Fawzi W, Gonzalez R, Humphrey J, Huybregts L, Kolsteren P, Mongkolchati A, Mullany LC, Ndyomugyenyi R, Nien JK, Osrin D, Roberfroid D, Sania A, Schmiegelow C, Silveira MF, Tielsch J, Vaidya A, Velaphi SC, Victora CG, Watson-Jones D, Black RE. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet 2013; 382:417-425. [PMID: 23746775 PMCID: PMC3796350 DOI: 10.1016/s0140-6736(13)60993-9] [Citation(s) in RCA: 568] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Babies with low birthweight (<2500 g) are at increased risk of early mortality. However, low birthweight includes babies born preterm and with fetal growth restriction, and not all these infants have a birthweight less than 2500 g. We estimated the neonatal and infant mortality associated with these two characteristics in low-income and middle-income countries. METHODS For this pooled analysis, we searched all available studies and identified 20 cohorts (providing data for 2,015,019 livebirths) from Asia, Africa, and Latin America that recorded data for birthweight, gestational age, and vital statistics through 28 days of life. Study dates ranged from 1982 through to 2010. We calculated relative risks (RR) and risk differences (RD) for mortality associated with preterm birth (<32 weeks, 32 weeks to <34 weeks, 34 weeks to <37 weeks), small-for-gestational-age (SGA; babies with birthweight in the lowest third percentile and between the third and tenth percentile of a US reference population), and preterm and SGA combinations. FINDINGS Pooled overall RRs for preterm were 6·82 (95% CI 3·56-13·07) for neonatal mortality and 2·50 (1·48-4·22) for post-neonatal mortality. Pooled RRs for babies who were SGA (with birthweight in the lowest tenth percentile of the reference population) were 1·83 (95% CI 1·34-2·50) for neonatal mortality and 1·90 (1·32-2·73) for post-neonatal mortality. The neonatal mortality risk of babies who were both preterm and SGA was higher than that of babies with either characteristic alone (15·42; 9·11-26·12). INTERPRETATION Many babies in low-income and middle-income countries are SGA. Preterm birth affects a smaller number of neonates than does SGA, but is associated with a higher mortality risk. The mortality risks associated with both characteristics extend beyond the neonatal period. Differentiation of the burden and risk of babies born preterm and SGA rather than with low birthweight could guide prevention and management strategies to speed progress towards Millennium Development Goal 4--the reduction of child mortality. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
| | - Anne Cc Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Joy E Lawn
- Saving Newborn Lives and Save the Children USA, Washington, DC, USA; Maternal Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Majid Ezzati
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tanya Marchant
- Maternal Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Infectious Disease and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Barbara A Willey
- Maternal Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Linda Adair
- University of North Carolina School of Public Health, NC, USA
| | - Fernando Barros
- Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil; Programa de Pós-graduação em Saúde e Comportamento, Univertsidade Católica de Pelotas, Centro, Pelotas, RS, Brazil
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Wafaie Fawzi
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Rogelio Gonzalez
- Pontificia Universidad Católica de Chile, School of Medicine, Santiago, Chile; Clínica Santa María, Santiago, Chile
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA; Zvitambo, Borrowdale, Harare, Zimbabwe
| | - Lieven Huybregts
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium; Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium; Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Jyh Kae Nien
- Fetal Maternal Medicine Unit, Clinica Davila, Santiago, Chile; Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - David Osrin
- Institute for Global Health, UCL Institute of Child Health, London, UK
| | - Dominique Roberfroid
- Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Ayesha Sania
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Institute of International Health, Immunology, and Microbiology, University of Copenhagen; Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mariangela F Silveira
- Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - James Tielsch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA; Department of Global Health, George Washington School of Public Health and Health Services, George Washington University, Washington, DC, USA
| | - Anjana Vaidya
- Institute for Global Health, UCL Institute of Child Health, London, UK
| | - Sithembiso C Velaphi
- Department of Paediatrics, Division of Neonatology, Chris Hani Baragwaneth Hospital, University of Witwatersrand, Soweto, South Africa
| | - Cesar G Victora
- Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Deborah Watson-Jones
- Malaria Centre, London School of Hygiene and Tropical Medicine, London, UK; Mwanza Intervention Trial Unit, National Institutes of Medical Research, Mwanza, Tanzania
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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4189
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Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013; 382:452-477. [PMID: 23746776 DOI: 10.1016/s0140-6736(13)60996-4] [Citation(s) in RCA: 1535] [Impact Index Per Article: 139.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Maternal undernutrition contributes to 800,000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world's children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches--ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets--they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.
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Affiliation(s)
| | - Jai K Das
- Aga Khan University, Karachi, Pakistan
| | | | | | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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4190
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4191
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Black RE, Alderman H, Bhutta ZA, Gillespie S, Haddad L, Horton S, Lartey A, Mannar V, Ruel M, Victora CG, Walker SP, Webb P. Maternal and child nutrition: building momentum for impact. Lancet 2013; 382:372-375. [PMID: 23746778 DOI: 10.1016/s0140-6736(13)60988-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Marie Ruel
- (International Food Policy Research Institute, USA)
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4192
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Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, Cavill S, Allen E, Uauy R. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Cochrane Database Syst Rev 2013:CD009382. [PMID: 23904195 DOI: 10.1002/14651858.cd009382.pub2] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Water, sanitation and hygiene (WASH) interventions are frequently implemented to reduce infectious diseases, and may be linked to improved nutrition outcomes in children. OBJECTIVES To evaluate the effect of interventions to improve water quality and supply (adequate quantity to maintain hygiene practices), provide adequate sanitation and promote handwashing with soap, on the nutritional status of children under the age of 18 years and to identify current research gaps. SEARCH METHODS We searched 10 English-language (including MEDLINE and CENTRAL) and three Chinese-language databases for published studies in June 2012. We searched grey literature databases, conference proceedings and websites, reviewed reference lists and contacted experts and authors. SELECTION CRITERIA Randomised (including cluster-randomised), quasi-randomised and non-randomised controlled trials, controlled cohort or cross-sectional studies and historically controlled studies, comparing WASH interventions among children aged under 18 years. DATA COLLECTION AND ANALYSIS Two review authors independently sought and extracted data on childhood anthropometry, biochemical measures of micronutrient status, and adherence, attrition and costs either from published reports or through contact with study investigators. We calculated mean difference (MD) with 95% confidence intervals (CI). We conducted study-level and individual-level meta-analyses to estimate pooled measures of effect for randomised controlled trials only. MAIN RESULTS Fourteen studies (five cluster-randomised controlled trials and nine non-randomised studies with comparison groups) from 10 low- and middle-income countries including 22,241 children at baseline and nutrition outcome data for 9,469 children provided relevant information. Study duration ranged from 6 to 60 months and all studies included children under five years of age at the time of the intervention. Studies included WASH interventions either singly or in combination. Measures of child anthropometry were collected in all 14 studies, and nine studies reported at least one of the following anthropometric indices: weight-for-height, weight-for-age or height-for-age. None of the included studies were of high methodological quality as none of the studies masked the nature of the intervention from participants.Weight-for-age, weight-for-height and height-for-age z-scores were available for five cluster-randomised controlled trials with a duration of between 9 and 12 months. Meta-analysis including 4,627 children identified no evidence of an effect of WASH interventions on weight-for-age z-score (MD 0.05; 95% CI -0.01 to 0.12). Meta-analysis including 4,622 children identified no evidence of an effect of WASH interventions on weight-for-height z-score (MD 0.02; 95% CI -0.07 to 0.11). Meta-analysis including 4,627 children identified a borderline statistically significant effect of WASH interventions on height-for-age z-score (MD 0.08; 95% CI 0.00 to 0.16). These findings were supported by individual participant data analysis including information on 5,375 to 5,386 children from five cluster-randomised controlled trials.No study reported adverse events. Adherence to study interventions was reported in only two studies (both cluster-randomised controlled trials) and ranged from low (< 35%) to high (> 90%). Study attrition was reported in seven studies and ranged from 4% to 16.5%. Intervention cost was reported in one study in which the total cost of the WASH interventions was USD 15/inhabitant. None of the studies reported differential impacts relevant to equity issues such as gender, socioeconomic status and religion. AUTHORS' CONCLUSIONS The available evidence from meta-analysis of data from cluster-randomised controlled trials with an intervention period of 9-12 months is suggestive of a small benefit of WASH interventions (specifically solar disinfection of water, provision of soap, and improvement of water quality) on length growth in children under five years of age. The duration of the intervention studies was relatively short and none of the included studies is of high methodological quality. Very few studies provided information on intervention adherence, attrition and costs. There are several ongoing trials in low-income country settings that may provide robust evidence to inform these findings.
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Affiliation(s)
- Alan D Dangour
- Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK, WC1E 7HT
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4193
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Pasricha SR, Hayes E, Kalumba K, Biggs BA. Effect of daily iron supplementation on health in children aged 4-23 months: a systematic review and meta-analysis of randomised controlled trials. LANCET GLOBAL HEALTH 2013; 1:e77-e86. [PMID: 25104162 DOI: 10.1016/s2214-109x(13)70046-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND About 47% of preschool children worldwide are anaemic. Daily oral iron supplementation is a commonly recommended intervention for treatment and prevention of anaemia, but the efficacy and safety of iron supplementation programmes is debated. Thus, we systematically reviewed the evidence for benefit and safety of daily iron supplementation in children aged 4-23 months. METHODS We searched Scopus and Medline, from inception to Feb 5, 2013, WHO databases, theses repositories, grey literature, and references. Randomised controlled trials that assigned children 4-23 months of age to daily oral iron supplementation versus control were eligible. We calculated mean difference (MD) or standard MD (SMD) for continuous variables, risk ratios for dichotomous data, and rate ratios for rates. We quantified heterogeneity with the I(2) test and synthesised all data with a random-effects model. This review is registered with the International Prospective Register of Systematic Reviews, number CRD42011001208. FINDINGS Of 9533 citations identified by the search strategy, 49 articles from 35 studies were eligible; these trials included 42,306 children. Only nine studies were judged to be at low risk of bias. In children receiving iron supplements, the risk ratio for anaemia was 0·61 (95% CI 0·50-0·74; 17 studies, n=4825), for iron deficiency was 0·30 (0·15-0·60; nine studies, n=2464), and for iron deficiency anaemia was 0·14 (0·10-0·22; six studies, n=2145). We identified no evidence of difference in mental (MD 1·65, 95% CI -0·63 to 3·94; six studies, n=1093) or psychomotor development (1·05, -1·36 to 3·46; six studies, n=1086). We noted no significant differences in final length or length-for-age, or final weight or weight-for-age. Children randomised to iron had slightly lesser length (SMD -0·83, -1·53 to -0·12; eight studies, n=868) and weight gain (-1·12, -1·19 to -0·33) over the course of the studies. Vomiting (risk ratio 1·38, 95% CI 1·10-1·73) and fever (1·16, 1·02-1·31) were more prevalent in children receiving iron. INTERPRETATION In children aged 4-23 months, daily iron supplementation effectively reduces anaemia. However, the adverse effect profile of iron supplements and effects on development and growth are uncertain. Adequately powered trials are needed to establish the non-haematological benefits and risks from iron supplementation in this group. FUNDING Victoria Fellowship (Government of Victoria, Australia); CRB Blackburn Scholarship (Royal Australasian College of Physicans); Overseas Research Experience Scholarship, University of Melbourne.
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Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, VIC, Australia; Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Thalassaemia Service, Monash Medical Centre, Clayton, VIC, Australia.
| | - Emily Hayes
- Thalassaemia Service, Monash Medical Centre, Clayton, VIC, Australia
| | - Kongolo Kalumba
- Monash Specialists Women's and Children's, Clayton, VIC, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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