1
|
Zhang S, Wang L, Luo R, Rozelle S, Sylvia S. The medium-term impact of a micronutrient powder intervention on anemia among young children in Rural China. BMC Public Health 2024; 24:426. [PMID: 38336627 PMCID: PMC10858501 DOI: 10.1186/s12889-024-17895-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Poor development of young children is a common issue in developing countries and it is well established that iron deficiency anemia is one of the risk factors. Research has shown that iron deficiency is a common micronutrient deficiency among children in rural China and can result in anemia. A previous paper using data from the same trial as those used in the current study, but conducted when sample children were younger, found that after 6 months of providing caregivers of children 6-11 months of age free access to iron-rich micronutrient powder (MNP) increased the hemoglobin concentrations (Hb) of their children. However, no effects were found 12 and 18 months after the intervention. The current study followed up the children four years after the start of the original intervention (when the children were 4-5 years old) and aims to assess the medium-term impacts of the MNP program on the nutritional status of the sample pre-school-aged children, including their levels of Hb, the prevalence of anemia, and the dietary diversity of the diets of the children. METHODS At baseline, this study sampled 1,802 children aged 6-11 months in rural Western China. The intervention lasted 18 months. In this medium-term follow-up study that successfully followed 81% (n = 1,464) of children (aged 49-65 months) from the original study population 4 years after the start of the intervention, we used both intention-to-treat (ITT) effect and average treatment on the treated effect (ATT) analyses to assess the medium-term impacts of the MNP distribution program on the nutritional status of sample children. RESULTS The ITT analysis shows that the MNP intervention decreased the prevalence of anemia of young children in the medium run by 8% (4 percentage points, p < 0.1). The ATT analysis shows that consuming 100 (out of 540) MNP sachets during the initial intervention led to a decrease in anemia of 4% (2 percentage points, p < 0.1). Among children with moderate anemia at baseline (Hb < 100 g/L), the intervention reduced the probability of anemia by 45% (9 percentage points, p < 0.1), and, for those families that complied by consuming 100 (out of 540) sachets, a 25% (5 percentage points, p < 0.05) reduction in the anemia rate was found. The MNP intervention also led to a persistent increase in dietary diversity among children that were moderately anemic at baseline. The results from the quantile treatment effect analysis demonstrated that children with lower Hb levels at baseline benefited relatively more from the MNP intervention. CONCLUSIONS The findings of the current study reveal that the MNP intervention has medium-term effects on the nutritional status of children in rural China. The impacts of the MNP program were relatively higher for children that initially had more severe anemia levels. Hence, the implications of this study are that programs that aim to increase caregiver knowledge of nutrition and improve their feeding practices should be encouraged across rural China. Families, policymakers, and China's society overall need to continue to pay more attention to problems of childhood anemia in rural areas. This is particularly crucial for families with moderately anemic children at an early age as it can significantly contribute to improving the anemia status of children across rural areas of China. TRIAL REGISTRATION ISRCTN44149146 (15/04/2013).
Collapse
Affiliation(s)
- Siqi Zhang
- International Business School, Shaanxi Normal University, Xi'an, China
| | - Lei Wang
- International Business School, Shaanxi Normal University, Xi'an, China.
| | - Renfu Luo
- Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Scott Rozelle
- Stanford Center On China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Sean Sylvia
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Momo Cabrera P, Rachmühl C, Derrien M, Bourdet-Sicard R, Lacroix C, Geirnaert A. Comparative prebiotic potential of galacto- and fructo-oligosaccharides, native inulin, and acacia gum in Kenyan infant gut microbiota during iron supplementation. ISME COMMUNICATIONS 2024; 4:ycae033. [PMID: 38774131 PMCID: PMC11107946 DOI: 10.1093/ismeco/ycae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/10/2024] [Indexed: 05/24/2024]
Abstract
Iron fortification to prevent anemia in African infants increases colonic iron levels, favoring the growth of enteropathogens. The use of prebiotics may be an effective strategy to reduce these detrimental effects. Using the African infant PolyFermS gut model, we compared the effect of the prebiotics short-chain galacto- with long-chain fructo-oligosaccharides (scGOS/lcFOS) and native inulin, and the emerging prebiotic acacia gum, a branched-polysaccharide-protein complex consisting of arabinose and galactose, during iron supplementation on four Kenyan infant gut microbiota. Iron supplementation did not alter the microbiota but promoted Clostridioides difficile in one microbiota. The prebiotic effect of scGOS/lcFOS and inulin was confirmed during iron supplementation in all investigated Kenyan infant gut microbiota, leading to higher abundance of bifidobacteria, increased production of acetate, propionate, and butyrate, and a significant shift in microbiota composition compared to non-supplemented microbiota. The abundance of the pathogens Clostridium difficile and Clostridium perfringens was also inhibited upon addition of the prebiotic fibers. Acacia gum had no effect on any of the microbiota. In conclusion, scGOS/lcFOS and inulin, but not acacia gum, showed a donor-independent strong prebiotic potential in Kenyan infant gut microbiota. This study demonstrates the relevance of comparing fibers in vitro prior to clinical studies.
Collapse
Affiliation(s)
- Paula Momo Cabrera
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| | - Carole Rachmühl
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| | - Muriel Derrien
- Danone Global Research & Innovation Center, 91190 Gif sur Yvette, France
- Present address: Department of Microbiology and Immunology, Laboratory of Molecular Bacteriology, Rega Institute KU, 3000 Leuven, Belgium
| | | | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| | - Annelies Geirnaert
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, 8092 Zurich, Switzerland
| |
Collapse
|
3
|
Lobo LMDC, Hadler MCCM. Vitamin E deficiency in childhood: a narrative review. Nutr Res Rev 2023; 36:392-405. [PMID: 35929460 DOI: 10.1017/s0954422422000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vitamin E is an important nutrient from the earliest stages of life. It plays key roles as an antioxidant and in the maintenance of the immune system, among others. Vitamin E deficiency (VED), which occurs more frequently in children, is rarely addressed in the literature. This narrative review aims to summarise the chemistry, biology, serum indicators and clinical trials that have evaluated the impact of fortification and other relevant aspects of vitamin E, in addition to the prevalence of its deficiency, in children worldwide. Vitamin E intake in recommended amounts is essential for this nutrient to perform its functions in the body. Serum α-tocopherol is the most widely used biochemical indicator to assess the prevalence of VED. VED has been associated with symptoms secondary to fat malabsorption and may lead to peripheral neuropathy and increased erythrocyte haemolysis. Reduced concentrations of α-tocopherol may be caused by the combination of diets with low amounts of vitamin E and inadequate consumption of fats, proteins and calories. The lowest prevalence of VED was found in Asia and the highest in North America and Brazil. High proportions of VED provide evidence that this nutritional deficiency is a public health problem in children and still little addressed in the international scientific literature. The planning, evaluation and implementation of health policies aimed at combatting VED in the paediatric population are extremely important.
Collapse
Affiliation(s)
| | - Maria Claret Costa Monteiro Hadler
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
- Graduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goiás, Goiânia, Goiás, Brazil
| |
Collapse
|
4
|
Locks LM, Newell KB, Imohe A, Moloney GM, Shaker-Berbari L, Paudyal N, Jefferds MED. The effect of interventions distributing home fortification products on infant and young child feeding (IYCF) practices: A systematic narrative review. MATERNAL & CHILD NUTRITION 2023:e13488. [PMID: 36842164 DOI: 10.1111/mcn.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/14/2022] [Accepted: 01/26/2023] [Indexed: 02/27/2023]
Abstract
Interventions distributing micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements (SQ-LNS), or home fortification products (HFPs), have the potential to improve infant and young child feeding (IYCF) practices and children's nutrition. We systematically searched for studies on the effect of interventions distributing HFP on IYCF practices. We identified 12 (8 MNP, 4 SQ-LNS) studies: seven programmes with IYCF behaviour change communications (BCC) and MNP (IYCF-MNP) and one provided MNP without IYCF BCC (MNP only). Three SQ-LNS studies came from randomised trials without an IYCF component (SQ-LNS only) and one from a programme with both IYCF BCC and SfQ-LNS (IYCF-SQ-LNS). Five IYCF-MNP programmes reported positive associations with some IYCF practices-four with minimum dietary diversity, two with minimum meal frequency, four with minimum acceptable diet, and three with the initiation of complementary foods at 6 months. Two reported no association between MNP and IYCF indicators, and one reported a decline in IYCF practices during the intervention, although it also reported significant changes to the IYCF programme during the evaluation period. Two studies from interventions that distributed SQ-LNS (one from a related set of randomised controlled trials and the sole IYCF-SQ-LNS programme) reported a positive association with IYCF practices; one trial reported no change in breast milk intake with the provision of SQ-LNS and one found no association with IYCF practices. SQ-LNS and MNP can address nutrient gaps for young children in low-resource settings; our findings indicate that programmes that combine HFP with IYCF interventions may also contribute to improved IYCF practices in some settings.
Collapse
Affiliation(s)
- Lindsey M Locks
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA.,Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Katharine B Newell
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
| | - Annette Imohe
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Grainne M Moloney
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Linda Shaker-Berbari
- United Nation Children's Fund (UNICEF) Headquarters, New York City, New York, USA
| | - Naveen Paudyal
- United Nation Children's Fund (UNICEF) Nepal Country Office, Kathmandu, Nepal
| | | |
Collapse
|
5
|
Anemia among Syrian Refugee Children Aged 6 to 23 Months Living in Greater Beirut, Lebanon, including the Voices of Mothers' and Local Healthcare Staff: A Mixed-Methods Study. Nutrients 2023; 15:nu15030700. [PMID: 36771406 PMCID: PMC9920708 DOI: 10.3390/nu15030700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow's milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.
Collapse
|
6
|
Sun C, Ye R, Akhtar M, Dill SE, Yuan P, Zhou H, Rozelle S. Adherence to micronutrient powder for home fortification of foods among infants and toddlers in rural China: a structural equation modeling approach. BMC Public Health 2022; 22:2250. [DOI: 10.1186/s12889-022-14731-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Background
The WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework.
Methods
Cross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework.
Results
Mean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (β = 0.440, P < 0.001), intention (β = 0.374, P < 0.001), knowledge and skills (β = 0.214, P < 0.001), personal agency (st. effect = 0.172, P < 0.001), environmental constraints (β=-0.142, P < 0.001), and caregiver generation (β = 0.119, P < 0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen’s f2 = 0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P < 0.001), and behavioral inputs were consistent among both parent and grandparent caregivers.
Conclusion
There is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence.
Collapse
|
7
|
Sneak-peek into iron deficiency anemia in India: The need for food-based interventions and enhancing iron bioavailability. Food Res Int 2022; 162:111927. [DOI: 10.1016/j.foodres.2022.111927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022]
|
8
|
The association between micronutrient powder delivery patterns and caregiver feeding behaviors in rural China. BMC Public Health 2022; 22:1366. [PMID: 35842633 PMCID: PMC9287899 DOI: 10.1186/s12889-022-13726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background High adherence and proper usage of micronutrient powder (MNP) influence child nutritional outcomes, yet few studies explore the role of delivery patterns. This study explores the association between MNP delivery patterns and MNP feeding behaviors among Han and minority caregivers in rural Western China. Methods In August 2019, a total of 1021 caregiver-child pairs were selected through a four-stage cluster sampling process. A cross-sectional survey collected information on caregiver demographics, MNP delivery patterns (channel and frequency), and MNP feeding behaviors (proper usage and adherence). Using logistic regression, we examined which delivery channels and delivery frequencies were associated with proper usage and high adherence. Results The results indicated that minority caregivers had lower levels of proper MNP usage than did Han caregivers (89.2%), with Tibetan caregivers’ reporting the lowest rates of adherence (32.6%). Logistic regression revealed that that township-based channel was significantly correlated with proper usage among Tibetan and Yi caregivers (Odds Ratio, OR = 2.0, p < 0.01; and OR = 3.5, p < 0.001). Overall, the township-based and home-visit channels were significantly correlated with high adherence (OR = 1.7 and OR = 2.3, respectively; p < 0.001); delivery frequency was significantly correlated with high adherence (2 months: OR = 2.2, p < 0.001 and ≤ 1 month: OR = 3.5, p < 0.001) but not correlated with proper usage among the whole sample and individual ethnic groups. Conclusions In conclusion, the study finds evidence of a correlation between MNP delivery channel and both proper usage and high adherence as well as a correlation between MNP delivery frequency and high adherence. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13726-4.
Collapse
|
9
|
Preparation, Characterization and Iron Absorption by Caco-2 Cells of the Casein Peptides-Iron Chelate. Int J Pept Res Ther 2022. [DOI: 10.1007/s10989-022-10423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Serum Ferritin Threshold for Iron Deficiency Screening in One-Year-Old Children. J Pediatr 2022; 245:217-221. [PMID: 35114287 DOI: 10.1016/j.jpeds.2022.01.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
Abstract
The American Academy of Pediatrics recommends universal hemoglobin screening for iron deficiency anemia using hemoglobin <110 g/L at the 1-year-old well child visit. Our retrospective study suggests the need for combined hemoglobin and serum ferritin iron deficiency screening and raising the diagnostic serum ferritin threshold to 24-25 μg/L.
Collapse
|
11
|
Liu R, Ye R, Leng F, Sun C, Wang Q, Zhou H. High adherence and its influencing factors on multiple micronutrient powders (MNPs). MATERNAL & CHILD NUTRITION 2022; 18:e13278. [PMID: 34658128 PMCID: PMC8710102 DOI: 10.1111/mcn.13278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/10/2023]
Abstract
Adherence to home fortification of foods with multiple micronutrient powders (MNPs) is an essential indicator of effective implementation of MNP programmes. A meta‐analysis was conducted to evaluate the high adherence rate (HAR) to MNPs and further investigate the factors that influence HAR. We searched PubMed, Web of Science, Embase, CAB Abstracts, MEDLINE (OVID), Cochrane Library, China National Knowledge Infrastructure, Wanfang and VP, from the date of database inception to 9 November 2020. We included peer‐reviewed observational studies that investigated adherence to MNPs. Data on the HAR to MNPs and influencing factors on HAR were extracted and then pooled together. A total of 10 studies were included. The pooled HAR to MNPs was 63.28% (51.12%–74.64%). Among HARs, rates were higher in middle‐income countries (65.21%) than low‐income countries (55.23%). Parental age over 30 years (maternal age OR = 1.25, 95% CI: 1.08–1.44; paternal age OR = 1.17, 95% CI: 1.04–1.32), children aged 18–36 months (OR = 1.45, 95% CI: 1.12–1.88), maternal educational attainment of college or above (OR = 1.38, 95% CI:1.10–1.73), caregiver with the perception that other mothers use MNPs (OR = 1.52, 95% CI:1.19–1.95), caregiver being aware of the importance of iron (OR = 1.42, 95% CI: 1.18–1.71), caregiver having correct knowledge of MNPs (OR = 1.36, 95% CI:1.19–1.57) and caregiver reporting children have no side effects from MNPs (OR = 2.77, 95% CI: 2.46–3.11) were contributing factors to high adherence to MNPs. The overall HAR to MNPs was relatively low; hence, effective and trusted communication channels need to be established, along with more thorough dissemination of the knowledge of MNPs to caregivers, to improve MNPs adherence rates, especially in low‐income countries.
Collapse
Affiliation(s)
- Rong Liu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu, 610041, China.,Institute for Disaster Management and Reconstruction, Sichuan University, No. 122 Huanghe Middle Road Section 1, Chengdu, 610041, China
| | - Ruixue Ye
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu, 610041, China
| | - Fangqun Leng
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu, 610041, China
| | - Chang Sun
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu, 610041, China
| | - Qingzhi Wang
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu, 610041, China
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 South Renmin Road 3 Section, Chengdu, 610041, China
| |
Collapse
|
12
|
Hasan MM, Magalhaes RJS, Ahmed S, Pervin S, Tariqujjaman M, Fatima Y, Mamun AA. Geographical variation and temporal trend in anemia among children aged 6-59 months in low- and middle-income countries during 2000-2018: forecasting the 2030 SDG target. Public Health Nutr 2021; 24:6236-6246. [PMID: 34103114 PMCID: PMC11148617 DOI: 10.1017/s1368980021002482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine geographical variations, trends and projections in the prevalence of childhood anemia at national and subpopulation levels. DESIGN Repeated cross-sectional Demographic and Health Survey (DHS) conducted during 2000-2018. SETTING Fifty-three low- and middle-income countries (LMIC). PARTICIPANTS Totally, 776 689 children aged 6-59 months. RESULTS During the latest DHS rounds between 2005 and 2018, the prevalence of child anemia was > 20 % in fifty-two out of fifty-three countries and ranged from 15·9 % in Armenia in 2016 to 87·8 % in Burkina Faso in 2010. Out of thirty-six countries with at least two surveys during 2000-2018, the prevalence of child anemia decreased in twenty-two countries, highest in Zimbabwe (-4·2 %) and increased in fourteen countries, highest in Burundi (5·0 %). Based on the trend, eleven and twenty-two out of thirty-six countries are projected to experience, respectively, moderate and severe public health problem according to the WHO criteria (moderate problem: 20-39·9 % and severe problem: ≥ 40 %) due to child anemia in 2030, with the highest prevalence in Liberia (87·5 %, 95 % credible interval 52·0-98·8 %). The prevalence of child anemia varied across the mother's education and age, child sex, wealth quintiles, and place of residence, with the highest rate of child anemia among the poorest, rural and low-educated mothers. These scenarios are projected to continue. The probability of reducing child anemia at < 0·5 % by 2030 is 0 % for all study countries. CONCLUSIONS The prevalence of child anemia varied between and within countries. None of the thirty-six LMIC is likely to eradicate child anemia by 2030.
Collapse
Affiliation(s)
- Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| | - Ricardo J Soares Magalhaes
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
- UQ Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sonia Pervin
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| | - Md Tariqujjaman
- Department of Statistics, University of Dhaka, Dhaka, Bangladesh
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD4068, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD, Australia
| |
Collapse
|
13
|
Exploring behavioural factors affecting nutritional supplement use among children in Honduras. Public Health Nutr 2021; 25:323-331. [PMID: 34706788 PMCID: PMC8883763 DOI: 10.1017/s1368980021004468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study explored social and behavioural factors associated with a home fortification of complementary foods program among families of undernourished children in 14 rural communities in Honduras. DESIGN We collected and analysed survey data from a convenience sample of 196 households participating in a nutritional program using home fortification of complementary foods in 2017. The program supplied families with a soy-based atole powder fortified with micronutrients. A research team completed a face-to-face survey exploring social and behavioural factors associated with nutritional supplement use. Anthropometric measurements for participating children were abstracted from health clinic records of previous quarterly appointments. SETTING The study took place in San Jose del Negrito, Honduras. PARTICIPANTS Participants were parents or guardians of children enrolled in the nutrition program. RESULTS Nearly half of participant families shared the nutritional supplement with other family members besides the index child, while 10 % reported using the supplement as a meal replacement for the child. Low education level of mothers was associated with improper use of the supplement (P = 0·005). Poorer families were more likely to share the supplement (P = 0·013). CONCLUSIONS These results highlight the challenges of programs using home fortification of complementary foods in the context of food scarcity. Findings highlight the importance of increasing rural children's overall caloric intake, perhaps by increasing access to locally available protein sources. Results also suggest transitioning nutritional programs to family-based interventions to increase overall intended compliance to nutrition programming.
Collapse
|
14
|
Shahid S, Mahesar M, Rahim A, Sadiq Y. Experience of using home-based fortified diet in rehabilitation of malnourished children at Indus Hospital, Karachi, Pakistan: an institution based retrospective chart review study. BMC Nutr 2021; 7:49. [PMID: 34384500 PMCID: PMC8361784 DOI: 10.1186/s40795-021-00455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 07/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background Globally, it is estimated that 50 million children under five are wasted. National nutrition survey-2018 has shown that 23.3 and 45.5% of children are wasted and stunted in Pakistan. Many studies have shown that hospital-based management of malnutrition is not practical due to high cost and iatrogenic infections and currently WHO recommends community-based management of malnutrition with provision of therapeutic food. There is limited evidence of community rehabilitation of malnourished children by using home fortified diet in Pakistan. This study explores use of energy dense, home fortified diet in achieving weight gain of malnourished children in Karachi. Methods A descriptive, retrospective chart review of pediatric patients (aged 6 month–5 years) seen in Indus Hospital between January 2017 to June 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about demographic characteristics, feeding, anthropometric, micronutrient, and nutritional details at enrollment and on follow-up. Results A total of 361 patients were included in the final analysis. The median age (IQR) of children was 15 (14) months. Forty eight percent (n = 172) children had diarrhea and 54% (n = 195) children had respiratory tract infection. The median length of stay in the program was 28 days. The median (IQR) for average weight gain was 4.8 (0–10.3) g/Kg/day, 64.6% (n = 226) children defaulted, 29% (n = 102) were cured and 3% (n = 10) died. Conclusion This study showed adequate weight gain and recovery in malnourished children by using home fortified diet in real life situations without using therapeutic food or monetary support. Home fortified diets may serve as effective strategy in community-based rehabilitation of malnourished children.
Collapse
Affiliation(s)
- Saba Shahid
- Department of Pediatrics, The Indus Hospital, Karachi City, Pakistan.
| | - Marvi Mahesar
- Indus Hospital Research Center, The Indus Hospital, Karachi City, Pakistan
| | - Anum Rahim
- Indus Hospital Research Center, The Indus Hospital, Karachi City, Pakistan
| | - Yumna Sadiq
- Nutrition and Food Services Department, The Indus Hospital, Karachi City, Pakistan
| |
Collapse
|
15
|
Whitfield KC, Smith TJ, Rohner F, Wieringa FT, Green TJ. Thiamine fortification strategies in low- and middle-income settings: a review. Ann N Y Acad Sci 2021; 1498:29-45. [PMID: 33496051 PMCID: PMC8451796 DOI: 10.1111/nyas.14565] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/30/2020] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
Thiamine (vitamin B1 ) is an essential micronutrient in energy metabolism and cognitive and neurological health. Thiamine deficiency disorders (TDDs) have a range of clinical presentations that result in various morbidities and can be fatal if not promptly recognized and treated, especially in infants. To intervene, thiamine intakes by breastfeeding mothers and others at risk of thiamine deficiency should be increased to ensure adequate thiamine intake. Although thiamine fortification programs have a long history in high-income countries, there are few mandatory fortification programs to address TDDs in low- and middle-income countries (LMICs), particularly in the regions of greatest concern, South and Southeast Asia. This review highlights essential aspects for consideration in the development of a mandatory fortification program in LMICs, including an overview of the data required to model fortification dosing schemes, available thiamine fortificants, and potential fortification vehicles, as well as identifies current knowledge gaps.
Collapse
Affiliation(s)
- Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Taryn J. Smith
- Institute for Global NutritionUniversity of California DavisDavisCalifornia
| | | | - Frank T. Wieringa
- UMR‐95 QualiSud, French National Research Institute for Sustainable Development (IRD)CIRAD/IRD/University of Montpellier/SupAgro/University of Avignon/University of RéunionAvignonFrance
| | - Tim J. Green
- SAHMRI Women and KidsSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
| |
Collapse
|
16
|
Dusingizimana T, Weber JL, Ramilan T, Iversen PO, Brough L. A Mixed-Methods Study of Factors Influencing Access to and Use of Micronutrient Powders in Rwanda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:274-285. [PMID: 34048359 PMCID: PMC8324192 DOI: 10.9745/ghsp-d-20-00422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Gaps in complementary feeding practices hinder the use of multiple micronutrients powder (MNP) in Rutsiro district in Rwanda. Successful MNP program implementation requires uninterrupted availability and accessibility to the product, as well as greater understanding of health benefits of the MNP. The World Health Organization recommends point-of-use fortification with multiple micronutrients powder (MNP) for foods consumed by children aged 6–23 months in populations where anemia prevalence among children under 2 years or under 5 years of age is 20% or higher. In Rwanda, anemia affects 37% of children under 5 years. The MNP program was implemented to address anemia, but research on factors affecting the implementation of the MNP program is limited. We conducted a mixed-methods study to examine the factors influencing access to and use of MNP among mothers (N=379) in Rutsiro district, northwest Rwanda. Inductive content analysis was used for qualitative data. Logistic regression analysis was used to determine factors associated with the use of MNP. Qualitative results indicated that the unavailability of MNP supplies and distribution issues were major barriers to accessing MNP. Factors influencing the use of MNP included mothers' perceptions of side effects and health benefits of MNP, as well as inappropriate complementary feeding practices. Mothers of older children (aged 12–23 months) were more likely to use MNP than those of younger children (aged 6–11 months) (adjusted odds ratio [aOR]=3.63, P<.001). Mothers whose children participated in the supplementary food program were nearly 3 times more likely to use MNP than those whose children had never participated in the program (aOR=2.84, P=.001). Increasing household hunger score was significantly associated with lower odds of using MNP (aOR=0.80, P=.038). Mechanisms to monitor MNP supply and program implementation need to be strengthened to ensure mothers have access to the product. MNP program implementers should address gaps in complementary feeding practices and ensure mothers have access to adequate complementary foods.
Collapse
Affiliation(s)
- Theogene Dusingizimana
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand. .,Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, Musanze, Rwanda
| | - Janet L Weber
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Hematology, Oslo University Hospital, Oslo, Norway.,Division of Human Nutrition, Faculty of Medical Health Sciences, Stellebosh University, Tygerberg, South Africa
| | - Louise Brough
- School of Food and Advanced Technology, Massey University, Palmerston North, New Zealand
| |
Collapse
|
17
|
Affonfere M, Chadare FJ, Fassinou FTK, Linnemann AR, Duodu KG. In-vitro Digestibility Methods and Factors Affecting Minerals Bioavailability: A Review. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.1928692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Marius Affonfere
- Laboratoire De Sciences Et Technologie Des Aliments Et Bio-ressources Et De Nutrition Humaine, Centre Universitaire De Sakété, Université Nationale d’Agriculture, Sakété, République Du Bénin
- Laboratory of Food Science, Faculty of Agronomic Science, University of Abomey-Calavi, Jéricho, Cotonou
| | - Flora Josiane Chadare
- Laboratoire De Sciences Et Technologie Des Aliments Et Bio-ressources Et De Nutrition Humaine, Centre Universitaire De Sakété, Université Nationale d’Agriculture, Sakété, République Du Bénin
- Laboratory of Food Science, Faculty of Agronomic Science, University of Abomey-Calavi, Jéricho, Cotonou
| | - Finagnon Toyi Kévin Fassinou
- Laboratoire De Sciences Et Technologie Des Aliments Et Bio-ressources Et De Nutrition Humaine, Centre Universitaire De Sakété, Université Nationale d’Agriculture, Sakété, République Du Bénin
- Laboratory of Food Science, Faculty of Agronomic Science, University of Abomey-Calavi, Jéricho, Cotonou
| | - Anita Rachel Linnemann
- Food Quality and Design, (FQD/WUR), Wageningen University and Research, Wageningen, The Netherlands
| | - Kwaku Gyebi Duodu
- Department of Consumer and Food Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
18
|
Nikooyeh B, Neyestani TR. Effectiveness of various methods of home fortification in under-5 children: where they work, where they do not. A systematic review and meta-analysis. Nutr Rev 2021; 79:445-461. [PMID: 33011799 DOI: 10.1093/nutrit/nuaa087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT The common approaches of home fortification (HF) for prevention and/or treatment of micronutrient deficiencies are micronutrient powders (MNPs), foodlets, and lipid-based nutrient supplements (LNSs). There are mixed results for the impact of HF on growth and nutritional status of young children. OBJECTIVE This systematic review was prepared in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to evaluate current evidence from randomized controlled trials including children younger than 5 years to assess the effect of strategies of HF on growth and micronutrient status. METHODS The MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar databases were searched to July 2018. A total of 1301 studies were found in a preliminary search. After screening of titles and abstracts, 30 studies were selected. RESULTS Treatment with MNPs, foodlets, and LNSs effectively increased hemoglobin concentrations by at least 2.52 g/L, 4.59 g/L, and 4.4 g/dL, respectively, as compared with a control. There was a significant decrease in risk of anemia development after foodlet intervention compared with a control or iron drops (odds ratio, 0.27; 95%CI, 0.10-0.74; P = 0.01). However, these interventions did not result in any significant improvement in z-scores for changes of height for age, weight for age, and weight for height. The results indicated that MNP (7.16; 95%CI, 0.31-14.01; P = 0.04) and foodlet treatment (4.92; 95%CI, 0.28-9.57; P = 0.04) could increase serum zinc levels. However, none of the home fortification methods improved vitamin A status in the target group. CONCLUSION Home fortification can be used as an effective method to improve hemoglobin, iron, and zinc status, although in this study it had no effect on vitamin A or anthropometric indicators of the target population. More investigations are warranted for newer approaches of HF to improve a broader range of micronutrients as well as child growth indices and for evaluation of the coverage, compliance, and consistency of such interventions at the population level. PROSPERO REGISTRATION NO CRD42018109279.
Collapse
Affiliation(s)
- Bahareh Nikooyeh
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tirang R Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Mikulic N, Uyoga MA, Paganini D, Mwasi E, Stoffel NU, Zeder C, Karanja S, Zimmermann MB. Consumption of a Single Dose of Prebiotic Galacto-Oligosaccharides Does Not Enhance Iron Absorption from Micronutrient Powders in Kenyan Infants: A Stable Iron Isotope Study. J Nutr 2021; 151:1205-1212. [PMID: 33693741 DOI: 10.1093/jn/nxab007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/04/2020] [Accepted: 01/07/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Long-term feeding of prebiotic galacto-oligosaccharides (GOS) increases iron absorption in African infants, but the underlying mechanism and how long GOS need to be fed to infants to achieve an increase in absorption is uncertain. OBJECTIVES In Kenyan infants, we tested whether the addition of GOS to a single test meal would affect iron absorption from a micronutrient powder (MNP) containing ferrous sulfate (FeSO4) and another MNP containing ferrous fumarate (FeFum) and sodium iron ethylenediaminetetraacetate (NaFeEDTA). METHODS In a randomized-entry, prospective crossover study, iron deficient (87%) and anemic (70%) Kenyan infants (n = 23; mean ± SD age, 9.9 ± 2.1 months) consumed 4 stable iron isotope-labeled maize porridge meals fortified with MNPs containing 5 mg iron as FeFum + NaFeEDTA, or FeSO4, either without or with 7.5 g GOS. The primary outcome, fractional iron absorption (FIA), was assessed by erythrocyte incorporation of isotopic labels. Data were analyzed using a 2-way repeated-measures ANOVA. RESULTS There was no significant interaction between GOS and the iron compounds on FIA, and the addition of GOS did not have a significant effect on FIA. There was a statistically significant difference in FIA between the meals fortified with FeSO4 and with FeFum + NaFeEDTA (P < 0.001).Given with GOS, FIA from FeSO4 was 40% higher than from FeFum + NaFeEDTA (P < 0.001); given without GOS, it was 51% higher (P < 0.01). CONCLUSIONS The addition of GOS to a single iron-fortified maize porridge test meal in Kenyan infants did not significantly increase iron absorption, suggesting long-term feeding of GOS may be needed to enhance iron absorption at this age. This study was registered at clinicaltrials.gov as NCT02666417.
Collapse
Affiliation(s)
- Nadja Mikulic
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Mary A Uyoga
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Daniela Paganini
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Edith Mwasi
- Pediatrics Department, Msambweni County Referral Hospital, Msambweni, Kenya
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Simon Karanja
- Public and Community Health Department, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| |
Collapse
|
20
|
Lopez de Romaña D, Greig A, Thompson A, Arabi M. Successful delivery of nutrition programs and the sustainable development goals. Curr Opin Biotechnol 2021; 70:97-107. [PMID: 33812278 DOI: 10.1016/j.copbio.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
Malnutrition affects millions of people globally, especially women, children, and other vulnerable populations. Sustainable Development Goals (SDGs) were set in 2015 to end poverty, protect the planet, and improve the lives and prospects of everyone by 2030. To achieve the SDG goals effective nutrition interventions and programs need to be efficiently delivered to those most in need. Nutrition directly affects 2 SDGs (2 and 3) and indirectly influences five others. In addition, almost all SDGs influence nutrition and thus attaining the SDG goals is also a pre-requisite to achieving the Global Nutrition targets set in 2012. Evidence-based nutrition interventions, for which there is strong evidence of their biological impact, have the potential to directly influence SDGs 2 and 3 if successfully delivered at scale in high-burden countries. Nevertheless, delivery of nutrition programs is a complex process, where policy, government commitment, adequate budget allocation, supplies and delivery systems, training of service providers, informed beneficiaries and program monitoring and evaluation all need to be in place and aligned with each other. Although in the past decade there has been progress in the SDGs that nutrition directly affects, many goals are still off-track, likely due to several pending gaps at policy-level, program-level, and intervention-level. To accelerate the progress toward reaching the SDG goals that are directly influenced by nutrition, countries need to be supported to successfully and sustainably deliver proven interventions and to scale-up and deliver new interventions in new and innovative ways, and the evidence base should be built in promising areas especially integrating (rather than prioritizing over each other) nutrition-specific and sensitive approaches.
Collapse
Affiliation(s)
| | - Alison Greig
- Nutrition International, 180 Elgin Street, Suite 1000, Ottawa, Ontario K2P 2K3, Canada
| | - Andrew Thompson
- Nutrition International, 180 Elgin Street, Suite 1000, Ottawa, Ontario K2P 2K3, Canada
| | - Mandana Arabi
- Nutrition International, 180 Elgin Street, Suite 1000, Ottawa, Ontario K2P 2K3, Canada.
| |
Collapse
|
21
|
Olson R, Gavin-Smith B, Ferraboschi C, Kraemer K. Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs. Nutrients 2021; 13:1118. [PMID: 33805305 PMCID: PMC8066912 DOI: 10.3390/nu13041118] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022] Open
Abstract
Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life's global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring.
Collapse
Affiliation(s)
- Rebecca Olson
- Sight and Life, P.O. Box 2116, 4002 Basel, Switzerland; (B.G.-S.); (C.F.); (K.K.)
| | | | | | | |
Collapse
|
22
|
Buzigi E, Pillay K, Siwela M. Potential of pumpkin to combat vitamin A deficiency during complementary feeding in low and middle income countries: variety, provitamin A carotenoid content and retention, and dietary reference intakes. Crit Rev Food Sci Nutr 2021; 62:6103-6112. [PMID: 33683154 DOI: 10.1080/10408398.2021.1896472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The risk of child vitamin A deficiency (VAD) in low and middle income countries (LMICs) begins during the age range of complementary feeding (6-24 months), when children are fed complementary foods (CFs) deficient in vitamin A. However, pumpkin, a source of provitamin A carotenoids (PVACs) is widely cultivated in LMICs, but underutilized as a complementary food. Moreover, when consumed by humans, PVACs are bioconverted to retinol, the active form of vitamin A used by the body. This study evaluated the potential of pumpkin toward combating VAD by reviewing varieties of pumpkin cultivated in LMICs and their provitamin A carotenoid (PVAC) content; retention of PVACs in pumpkin during processing it as a CF; and the extent to which a CF prepared from pumpkin may meet the dietary reference intakes (DRIs) for vitamin A for children aged 6-24 months old. Pumpkin may combat VAD because the varieties cultivated have high β-carotene content, it is a provitamin A biofortifiable food crop, and 100% retention of PVACs was observed when processed using home cooking methods. Feeding less than 50 g of cooked pumpkin per day meets 100% of the recommended dietary allowance (RDA) and adequate intake (AI) of vitamin A for children 6 to 24 months old. Consumption of pumpkin may be used to complement vitamin A supplementation, fortification, and diversification of CFs with animal source foods. For better yield of pumpkin in LMICs, nutrition sensitive agricultural programmes such as biofortification and agronomic management of pumpkin need to be promoted and supported.
Collapse
Affiliation(s)
- Edward Buzigi
- Department of Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa.,Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.,Department of Human Nutrition & Home Economics, Kyambogo University, Kyambogo, Kampala Uganda
| | - Kirthee Pillay
- Department of Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Muthulisi Siwela
- Department of Dietetics and Human Nutrition, School of Agricultural, Earth and Environmental Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| |
Collapse
|
23
|
Olatoye K, Olusanya O, Olaniran A. The nutritional characteristics and acceptability of Baobab (Adansonia digitata L) pulp as nutrient concentrate substitute in custard powder. POTRAVINARSTVO 2021. [DOI: 10.5219/1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Micronutrient deficiency in the human diet is of serious concern in developing nations. The utilization potential of Baobab pulp (BP) as a micronutrient source in custard formulation was evaluated. Custard powder was formulated from corn-starch, salt, flavor, colorant, and a commercial nutrient concentrate (NC) using a standard recipe, as a control sample. The nutrient concentrate was substituted by 20 – 50% of Baobab pulp in custard formulation. Custard powder was characterized by chemical, physicochemical, pasting, and sensory properties, using standard procedures. Substitution of Baobab pulp for nutrient concentrate in custard formulation resulted in a significant (p ≤0.05) increase in the crude protein (2.23 – 3.67%), fat (1.49 – 2.40%), fiber (2.95 – 4.85%), and ash (2.21 – 3.63%) contents of custard powder. The vitamins A, C, and Beta-carotene contents of Baobab pulp-fortified custard varied (p ≤0.05) significantly. Substitution of Baobab pulp for nutrient concentrate increased the mineral composition (Calcium (1.16 – 5.75 ppm), Magnesium (1.09 – 1.83 ppm), Potassium (0.81 – 2.68 ppm), and Iron (0.12 – 0.39 ppm)) of custard samples significantly (p ≤0.05). The addition of Baobab pulp in the custard powder formulation enhanced its chemical composition and sensory attributes. The enhancement level increases with an increase in the proportion of baobab pulp.
Collapse
|
24
|
Rahman S, Kortman GAM, Boekhorst J, Lee P, Khan MR, Ahmed F. Effect of low-iron micronutrient powder (MNP) on the composition of gut microbiota of Bangladeshi children in a high-iron groundwater setting: a randomized controlled trial. Eur J Nutr 2021; 60:3423-3436. [PMID: 33634319 PMCID: PMC8354964 DOI: 10.1007/s00394-021-02523-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/16/2021] [Indexed: 12/25/2022]
Abstract
Purpose Adverse effects of iron fortification/supplements such as Micronutrient Powder (MNP) on gut microbiota have previously been found in infection-prone African settings. This study examined the adversaries of a low-iron MNP compared with the standard MNP on the composition of gut microbiota in Bangladeshi children exposed to a high concentration of iron from potable groundwater. Methods A randomized controlled trial was conducted in 2- to 5-year-old children, drinking groundwater with a high concentration of iron (≥ 2 mg/L). Children were randomized to receive one sachet per day of either standard MNP (12.5 mg iron) or low-iron MNP (5 mg iron), for 2 months. A sub-sample of 53 children was considered for paired assessment of the gut microbiome by 16S rRNA amplicon sequencing. Results At baseline, the gut microbiota consisted of Bifidobacteriaceae (15.6%), Prevotellaceae (12.2%), Lactobacillaceae (3.6%), Clostridiaceae (4.1%) and Enterobacteriaceae (2.8%). Overall, there was no significant treatment effect of the low-iron MNP compared to the standard MNP. However, an apparent treatment effect was observed in children with a relative adult-like microbiota, with a higher relative abundance of potentially pathogenic Enterobacteriaceae after receiving the standard MNP compared to the low-iron MNP. This effect, however, was statistically non-significant (p = 0.07). Conclusion In Bangladeshi children drinking iron-rich groundwater, a low-iron MNP supplementation did not have a significant impact on their gut microbiota profile/composition compared to the standard MNP. The trial registration number is ISRCTN60058115; Date of registration 03/07/2019; retrospectively registered. Supplementary Information The online version of this article (10.1007/s00394-021-02523-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sabuktagin Rahman
- Public Health, School of Medicine, Griffith University, Gold Coast Campus, Parklands Dr., Gold Coast, QLD, 4222, Australia
| | | | - Jos Boekhorst
- NIZO Food Research B.V., Ede, The Netherlands
- Host-Microbe Interactomics Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Patricia Lee
- Public Health, School of Medicine, Griffith University, Gold Coast Campus, Parklands Dr., Gold Coast, QLD, 4222, Australia
| | - Moududur R Khan
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Faruk Ahmed
- Public Health, School of Medicine, Griffith University, Gold Coast Campus, Parklands Dr., Gold Coast, QLD, 4222, Australia.
| |
Collapse
|
25
|
Mithra P, Khatib MN, Sinha AP, Kumar N, Holla R, Unnikrishnan B, Vijayamma R, Nair NS, Gaidhane A, Quazi Zahiruddin S. Interventions for Addressing Anemia Among Children and Adolescents: An Overview of Systematic Reviews. Front Pediatr 2021; 8:549549. [PMID: 33665173 PMCID: PMC7921152 DOI: 10.3389/fped.2020.549549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/18/2020] [Indexed: 01/08/2023] Open
Abstract
Context: Anemia is a public health problem that can lead to growth, cognitive, and motor impairments. Objective: To collate evidence on interventions for addressing childhood and adolescent anemia. Methods: In this overview of systematic reviews, we included Cochrane as well as non-Cochrane systematic reviews (SRs) irrespective of language and publication status. Two sets of review authors independently screened articles for eligibility and extracted data from relevant SRs. We present data in a tabular format and summarize results based on outcome reported, age of participants, and type of interventions. We also adopt a "measurement for change" approach to assess the utility of measurement for development of interventions in childhood and adolescent anemia. Results: Our search yielded 2,601 records of which 31 SRs were found eligible for inclusion. Results were favorable for fortification and supplementation with clear reduction in the risk of anemia and increase in hemoglobin levels across all age groups. Other interventions reported by the SRs were inconclusive and suggest further research. Conclusions: Current evidence suggests that fortification or supplementation with iron and micronutrients leads to better reduction in the risk of anemia and improvements in hemoglobin levels among children and adolescents. Results of this overview can help decision makers in informing selection of interventions to address childhood and adolescent anemia. Review Registration: PROSPERO CRD42016053687.
Collapse
Affiliation(s)
- Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Anju Pradhan Sinha
- Division of Reproductive, Maternal and Child Health, Indian Council of Medical Research, New Delhi, India
| | - Nithin Kumar
- Department of Community Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ratheebhai Vijayamma
- Manipal Institute of Communication, Manipal Academy of Higher Education, Manipal, India
| | - N. Sreekumaran Nair
- Medical Biometrics & Informatics (Biostatistics), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Abhay Gaidhane
- Department of Community Medicine, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Syed Quazi Zahiruddin
- Department of Community Medicine, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| |
Collapse
|
26
|
Larson LM, Cyriac S, Djimeu EW, Mbuya MNN, Neufeld LM. Can Double Fortification of Salt with Iron and Iodine Reduce Anemia, Iron Deficiency Anemia, Iron Deficiency, Iodine Deficiency, and Functional Outcomes? Evidence of Efficacy, Effectiveness, and Safety. J Nutr 2021; 151:15S-28S. [PMID: 33582785 PMCID: PMC7882357 DOI: 10.1093/jn/nxaa192] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/24/2020] [Accepted: 06/12/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Anemia, iron deficiency, and iodine deficiency are problems of important public health concern in many parts of the world, with consequences for the health, development, and work capacity of populations. Several countries are beginning to implement double fortified salt (DFS) programs to simultaneously address iodine and iron deficiencies. OBJECTIVE Our objective was to summarize the evidence for efficacy and effectiveness of DFS on the full range of status and functional outcomes and across different implementation and evaluation designs essential to successful interventions. METHODS We conducted a systematic review and meta-analysis of published and gray literature examining the effects of DFS on nutritional status, cognition, work productivity, development, and morbidity of all population groups. We searched for articles in Medline, Embase, CINAHL, Cochrane Central Register, and ProQuest for randomized trials, quasi-randomized trials, and program effectiveness evaluations. RESULTS A total of 22 studies (N individuals = 52,758) were included. Efficacy studies indicated a significant overall positive effect on hemoglobin concentration [standardized mean difference (95% CI): 0.33 (0.18, 0.48)], ferritin [0.42 (0.08, 0.76)], anemia [risk ratio (95% CI): 0.80 (0.70, 0.92)], and iron deficiency anemia [0.36 (0.24, 0.55)]. Effects on urinary iodine concentration were not significantly different between DFS and iodized salt. The impact on functional outcomes was mixed. Only 2 effectiveness studies were identified. They reported programmatic challenges including low coverage, suboptimal DFS quality, and storage constraints. CONCLUSIONS Given the biological benefits of DFS across several populations in efficacy research, additional evaluations of robust DFS programs delivered at scale, which consider effective implementation and measure appropriate biomarkers, are needed.
Collapse
Affiliation(s)
- Leila M Larson
- University of South Carolina, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, Columbia, SC, USA
| | - Shruthi Cyriac
- Emory University, Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Atlanta, GA, USA
| | - Eric W Djimeu
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | | | | |
Collapse
|
27
|
Tchum SK, Arthur FK, Adu B, Sakyi SA, Abubakar LA, Atibilla D, Amenga-Etego S, Oppong FB, Dzabeng F, Amoani B, Gyan T, Arhin E, Poku-Asante K. Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana. PLoS One 2021; 16:e0246362. [PMID: 33571267 PMCID: PMC7877575 DOI: 10.1371/journal.pone.0246362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana's malaria endemic area.
Collapse
Affiliation(s)
- Samuel Kofi Tchum
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
- * E-mail:
| | - Fareed Kow Arthur
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Adu
- Department of Immunology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Dorcas Atibilla
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Felix Boakye Oppong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Francis Dzabeng
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Benjamin Amoani
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Gyan
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Emmanuel Arhin
- Faculty of Earth and Environmental Sciences, Department of Earth Science, C K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Kwaku Poku-Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| |
Collapse
|
28
|
Albelbeisi A, Shariff ZM, Mun CY, Rahman HA, Abed Y. Multiple micronutrient supplementation improves growth and reduces the risk of anemia among infants in Gaza Strip, Palestine: a prospective randomized community trial. Nutr J 2020; 19:133. [PMID: 33278899 PMCID: PMC7719238 DOI: 10.1186/s12937-020-00652-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants and young children 6-24 months of age are the most nutritionally vulnerable groups, as their needs for vitamins and minerals are high relative to the amount of food they consume. This study determines the effect of Micronutrient Powder Supplementation (MNP) on growth and hemoglobin of infants in Gaza Strip, Palestine. METHOD This was a two-arm parallel-group randomized controlled trial conducted in two health care clinics of the United Nations Relief and Work Agency (UNRWA) at the Middle Area governorate of Gaza Strip, Palestine. A total of 200 healthy infants aged 6-month-old were recruited and randomized to receive 3 sachets/week of MNP for 12 months alongside with the National Micronutrient Supplement (NMS) (n = 100) or NMS alone (n = 100). Weight, length, blood hemoglobin, and dietary intakes were measured at 6, 9, 12, 15, 18, and 21 (3 months after the end of intervention) months of age. Analysis was by intention to treat. RESULTS The experimental group had a higher concentration of hemoglobin at 12 and 15 months than did the control group, and a significant difference (p < 0.05) was observed at 15 months only. Significantly greater weight, length, weight-for-age, length-for-age, and weight-for-length z-scores were observed in the experimental group than that in the control group at 12 and 15 months (p < 0.05). The prevalence of anemia (18% vs. 52%) and stunting (1% vs. 11%) were higher in the control than the experimental group, respectively. After controlling for sex, similar findings were reported. CONCLUSIONS Addition of MNP to the existing NMS program improved the nutritional status of young children. The potential benefits of MNP supplementation on physical growth and hemoglobin should be considered in the existing NMS program. TRIAL REGISTRATION ISRCTN57594793 ; Date of registration: 20-03-2018 (Retrospectively registered).
Collapse
Affiliation(s)
- Ali Albelbeisi
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia.
| | - Zalilah Mohd Shariff
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Chan Yoke Mun
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Hejar Abdul Rahman
- Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Malaysia
| | - Yehia Abed
- Faculty of Public Health, Al Quds University of Gaza- Palestine, Jerusalem, Palestinian Territory
| |
Collapse
|
29
|
Adu‐Afarwuah S. Impact of nutrient supplementation on maternal nutrition and child growth and development in Sub-Saharan Africa: the case of small-quantity lipid-based nutrient supplements. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 3:e12960. [PMID: 33347727 PMCID: PMC7752123 DOI: 10.1111/mcn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/20/2019] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Micronutrient deficiencies remain common among women and children in Sub-Saharan Africa (SSA); in pregnant/lactating women, the intakes of essential fatty acids may also be low. Enriching home-prepared foods with small-quantity lipid-based nutrient supplements (SQ-LNSs) is a promising new strategy of delivering additional micronutrients, essential fatty acids and good quality protein to women and children. This narrative review aimed to examine the impact of SQ-LNSs supplementation among women and infants and young children in SSA, and to discuss the differential impact of SQ-LNS consumption across different settings. Papers reporting randomized trials conducted in SSA in which apparently healthy women and/or ≥6-mo-old children received SQ-LNSs were identified through electronic and manual searches. Prenatal SQ-LNS consumption reduced the prevalence of low gestational weight gain in Ghana when compared with multiple micronutrients supplementation, and was associated with poorer iron/hemoglobin status when compared with iron-plus-folic acid supplementation. SQ-LNSs received alone or as intervention package improved infant/child growth in two trials in Ghana and one trial each in Burkina Faso, Kenya, Zimbabwe and South Africa, but had no impact on growth in two trials in Malawi. SQ-LNSs supplementation improved motor development in Ghana, Burkina Faso, Malawi, Kenya, and South Africa, but had no impact on language, socio-emotional, and executive functions in Ghana and Malawi and on Griffiths' developmental scores in Malawi. SQ-LNSs may contribute to improving child growth in SSA. More research is needed to determine the iron level in SQ-LNSs effective for improving both maternal hemoglobin/iron status and birth outcomes.
Collapse
Affiliation(s)
- Seth Adu‐Afarwuah
- Department of Nutrition and Food ScienceUniversity of GhanaAccraGhana
| |
Collapse
|
30
|
Zhang YY, Stockmann R, Ng K, Ajlouni S. Opportunities for plant-derived enhancers for iron, zinc, and calcium bioavailability: A review. Compr Rev Food Sci Food Saf 2020; 20:652-685. [PMID: 33443794 DOI: 10.1111/1541-4337.12669] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/08/2020] [Accepted: 10/20/2020] [Indexed: 12/31/2022]
Abstract
Understanding of the mechanism of interactions between dietary elements, their salts, and complexing/binding ligands is vital to manage both deficiency and toxicity associated with essential element bioavailability. Numerous mineral ligands are found in both animal and plant foods and are known to exert bioactivity via element chelation resulting in modulation of antioxidant capacity or micobiome metabolism among other physiological outcomes. However, little is explored in the context of dietary mineral ligands and element bioavailability enhancement, particularly with respect to ligands from plant-derived food sources. This review highlights a novel perspective to consider various plant macro/micronutrients as prospective bioavailability enhancing ligands of three essential elements (Fe, Zn, and Ca). We also delineate the molecular mechanisms of the ligand-binding interactions underlying mineral bioaccessibility at the luminal level. We conclude that despite current understandings of some of the structure-activity relationships associated with strong mineral-ligand binding, the physiological links between ligands as element carriers and uptake at targeted sites throughout the gastrointestinal (GI) tract still require more research. The binding behavior of potential ligands in the human diet should be further elucidated and validated using pharmacokinetic approaches and GI models.
Collapse
Affiliation(s)
- Yianna Y Zhang
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia.,CSIRO Agriculture & Food, Werribee, VIC, Australia
| | | | - Ken Ng
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Said Ajlouni
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
31
|
Scott N, Delport D, Hainsworth S, Pearson R, Morgan C, Huang S, Akuoku JK, Piwoz E, Shekar M, Levin C, Toole M, Homer CSE. Ending malnutrition in all its forms requires scaling up proven nutrition interventions and much more: a 129-country analysis. BMC Med 2020; 18:356. [PMID: 33183301 PMCID: PMC7661178 DOI: 10.1186/s12916-020-01786-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/16/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sustainable Development Goal (SDG) 2.2 calls for an end to all forms of malnutrition, with 2025 targets of a 40% reduction in stunting (relative to 2012), for wasting to occur in less than 5% of children, and for a 50% reduction in anaemia in women (15-49 years). We assessed the likelihood of countries reaching these targets by scaling up proven interventions and identified priority interventions, based on cost-effectiveness. METHODS For 129 countries, the Optima Nutrition model was used to compare 2019-2030 nutrition outcomes between a status quo (maintained intervention coverage) scenario and a scenario where outcome-specific interventions were scaled up to 95% coverage over 5 years. The average cost-effectiveness of each intervention was calculated as it was added to an expanding package of interventions. RESULTS Of the 129 countries modelled, 46 (36%), 66 (51%) and 0 (0%) were on track to achieve the stunting, wasting and anaemia targets respectively. Scaling up 18 nutrition interventions increased the number of countries reaching the SDG 2.2 targets to 50 (39%), 83 (64%) and 7 (5%) respectively. Intermittent preventative treatment of malaria during pregnancy (IPTp), infant and young child feeding education, vitamin A supplementation and lipid-based nutrition supplements for children produced 88% of the total impact on stunting, with average costs per case averted of US$103, US$267, US$556 and US$1795 when interventions were consecutively scaled up, respectively. Vitamin A supplementation and cash transfers produced 100% of the total global impact on prevention of wasting, with average costs per case averted of US$1989 and US$19,427, respectively. IPTp, iron and folic acid supplementation for non-pregnant women, and multiple micronutrient supplementation for pregnant women produced 85% of the total impact on anaemia prevalence, with average costs per case averted of US$9, US$35 and US$47, respectively. CONCLUSIONS Prioritising nutrition investment to the most cost-effective interventions within the country context can maximise the impact of funding. A greater focus on complementing nutrition-specific interventions with nutrition-sensitive ones that address the social determinants of health is critical to reach the SDG targets.
Collapse
Affiliation(s)
- Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Dominic Delport
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Samuel Hainsworth
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Ruth Pearson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Christopher Morgan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Jhpiego, Baltimore, MD USA
| | - Shan Huang
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | | | - Ellen Piwoz
- Nutrition Global Development Program, Bill and Melinda Gates Foundation, Seattle, USA
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, USA
| | - Mike Toole
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Caroline SE Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| |
Collapse
|
32
|
Samuel A, Brouwer ID, Pamungkas NP, Terra T, Lelisa A, Kebede A, Osendarp SJM. Determinants of adherence to micronutrient powder use among young children in Ethiopia. MATERNAL AND CHILD NUTRITION 2020; 17:e13111. [PMID: 33169528 PMCID: PMC7988858 DOI: 10.1111/mcn.13111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
In Ethiopia, home fortification of complementary foods with micronutrient powders (MNPs) was introduced in 2015 as a new approach to improve micronutrient intakes. The objective of this study was to assess factors associated with intake adherence and drivers for correct MNP use over time to inform scale‐up of MNP interventions. Mixed methods including questionnaires, interviews and focus group discussions were used. Participants, 1,185 children (6–11 months), received bimonthly 30 MNP sachets for 8 months, with instruction to consume 15 sachets/month, that is, a sachet every other day and maximum of one sachet per day. Adherence to distribution (if child receives ≥14 sachets/month) and adherence to instruction (if child receives exactly 15[±1] sachets/month) were assessed monthly by counting used sachets. Factors associated with adherence were examined using generalized estimating equations. Adherence fluctuated over time, an average of 58% adherence to distribution and 28% for adherence to instruction. Average MNP consumption was 79% out of the total sachets provided. Factors positively associated with adherence included ease of use (instruction), child liking MNP and support from community (distribution and instruction) and mother's age >25 years (distribution). Distance to health post, knowledge of correct use (OR = 0.74, 95% CI = 0.66–0.81), perceived negative effects (OR = 0.73, 95% CI = 0.54–0.99) and living in Southern Nations, Nationalities and People Region (OR = 0.59, 95% CI = 0.52–0.67) were inversely associated with adherence to distribution. Free MNP provision, trust in the government and field staff played a role in successful implementation. MNP is promising to be scaled‐up, by taking into account factors that positively and negatively determine adherence.
Collapse
Affiliation(s)
- Aregash Samuel
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Nindya P Pamungkas
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Tosca Terra
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Azeb Lelisa
- Nutrition International, Ethiopia, C/O Ethiopia-Canada Cooperation Office (CIDA-ECCO), Addis Ababa, Ethiopia
| | - Amha Kebede
- Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| |
Collapse
|
33
|
|
34
|
Uyoga MA, Mikulic N, Paganini D, Mwasi E, Stoffel NU, Zeder C, Karanja S, Zimmermann MB. The effect of iron dosing schedules on plasma hepcidin and iron absorption in Kenyan infants. Am J Clin Nutr 2020; 112:1132-1141. [PMID: 32678434 DOI: 10.1093/ajcn/nqaa174] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/11/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In adults, oral iron doses increase plasma hepcidin (PHep) for 24 h, but not for 48 h, and there is a circadian increase in PHep over the day. Because high PHep decreases fractional iron absorption (FIA), alternate day iron dosing in the morning may be preferable to consecutive day dosing. Whether these effects occur in infants is uncertain. OBJECTIVE Using stable iron isotopes in Kenyan infants, we compared FIA from morning and afternoon doses and from consecutive, alternate (every second day) and every third day iron doses. METHODS In prospective studies, we measured and compared FIA and the PHep response from 1) meals fortified with a 12-mg iron micronutrient powder given in the morning or afternoon (n = 22); 2) the same given on consecutive or alternate days (n = 21); and 3) a 12-mg iron supplement given on alternate days or every third day (n = 24). RESULTS In total, 65.7% of infants were anemic. In study 1, PHep did not differ between morning and afternoon (P = 0.072), and geometric mean FIA[-SD, +SD](%) did not differ between the morning and afternoon doses [15.9 (8.9, 28.6) and 16.1 (8.7, 29.8), P = 0.877]. In study 2, PHep was increased 24 h after oral iron (P = 0.014), and mean FIA [±SD](%) from the baseline dose [23.3 (10.9)] was greater than that from the consecutive day dose (at 24 h) [20.1 (10.4); P = 0.042] but did not differ from the alternate day dose (at 48 h) [20.9 (13.4); P = 0.145]. In study 3, PHep was not increased 48 and 72 h after oral iron (P = 0.384), and the geometric mean FIA[-SD, +SD](%) from doses given at baseline, alternate days, and every third day did not differ [12.7 (7.3, 21.9), 13.8 (7.8, 24.2), and 14.8 (8.8, 24.8), respectively; P = 0.080]. CONCLUSIONS In Kenyan infants given 12 mg oral iron, morning and afternoon doses are comparably absorbed, dosing on consecutive days increases PHep and modestly decreases iron absorption compared with alternate day dosing, and dosing on alternate days or every third day does not increase PHep or decrease absorption. This trial was registered at clinicaltrials.gov as NCT02989311 and NCT03617575.
Collapse
Affiliation(s)
- Mary A Uyoga
- Laboratory of Human Nutrition, ETH Zurich, Switzerland
| | - Nadja Mikulic
- Laboratory of Human Nutrition, ETH Zurich, Switzerland
| | | | - Edith Mwasi
- Pediatric Department, Msambweni County Referral Hospital, Msambweni, Kenya
| | | | | | - Simon Karanja
- Public and Community Health Department, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | |
Collapse
|
35
|
Park JJH, Harari O, Siden E, Dron L, Zannat NE, Singer J, Lester RT, Thorlund K, Mills EJ. Interventions to improve linear growth during complementary feeding period for children aged 6-24 months living in low- and middle-income countries: a systematic review and network meta-analysis. Gates Open Res 2020; 3:1660. [PMID: 32259047 PMCID: PMC7096089 DOI: 10.12688/gatesopenres.13083.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Optimizing linear growth in children during complementary feeding period (CFP) (6-24 months) is critical for their development. Several interventions, such as micronutrient and food supplements, deworming, maternal education, and water, sanitation and hygiene (WASH), could potentially be provided to prevent stunting, but their comparative effectiveness are currently unclear. In this study, we evaluated comparative effectiveness of interventions under these domains on child linear growth outcomes of height-for-age z-score (HAZ) and stunting (HAZ <-2SD) Methods: For this study, we searched for low- and middle-income country (LMIC)-based randomized clinical trials (RCTs) of aforementioned interventions provided to children during CFP. We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We performed random-effects network meta-analysis (NMA) for HAZ and stunting. Results: The evidence base for our NMA was based on 79 RCTs (96 papers) involving 81,786 children. Among the micronutrients, compared to standard-of-care, iron + folic acid (IFA) (mean difference =0.08; 95% credible interval [CrI]: 0.01, 0.15) and multiple micronutrients (MMN) (mean difference =0.06; 95%CrI: 0.01, 0.11) showed improvements for HAZ; MMN also reduced the risks for stunting (RR=0.86; 95%Crl: 0.73, 0.98), whereas IFA did not (RR=0.92; 95%Crl: 0.64, 1.23). For food supplements, flour in the caloric range of 270-340 kcal (RR=0.73; 95%Crl: 0.51, 1.00) and fortified lipid-based nutrient supplements (LNS) containing 220-285 kcal (RR=0.80; 95%Crl: 0.66, 0.97) decreased the risk of stunting compared to standard-of-care, but these interventions and other food supplements did not show improvements for HAZ. Deworming, maternal education, and WASH interventions did not show improvements for HAZ nor stunting. Conclusion: While we found micronutrient and food supplements to be effective for HAZ and/or stunting, the evidence base for other domains in this life stage was limited, highlighting the need for more investigation. Registration: PROSPERO CRD42018110449; registered on 17 October 2018.
Collapse
Affiliation(s)
- Jay J. H. Park
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | - Ofir Harari
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | - Ellie Siden
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | - Louis Dron
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | | | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Data and Methodology Program, CIHR Canadian HIV Trials Network, Vancouver, BC, V6Z 1Y6, Canada
| | - Richard T. Lester
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Kristian Thorlund
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Edward J. Mills
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
| |
Collapse
|
36
|
Briguglio M, Hrelia S, Malaguti M, Lombardi G, Riso P, Porrini M, Perazzo P, Banfi G. The Central Role of Iron in Human Nutrition: From Folk to Contemporary Medicine. Nutrients 2020; 12:nu12061761. [PMID: 32545511 PMCID: PMC7353323 DOI: 10.3390/nu12061761] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Iron is a fundamental element in human history, from the dawn of civilization to contemporary days. The ancients used the metal to shape tools, to forge weapons, and even as a dietary supplement. This last indication has been handed down until today, when martial therapy is considered fundamental to correct deficiency states of anemia. The improvement of the martial status is mainly targeted with dietary supplements that often couple diverse co-factors, but other methods are available, such as parenteral preparations, dietary interventions, or real-world approaches. The oral absorption of this metal occurs in the duodenum and is highly dependent upon its oxidation state, with many absorption influencers possibly interfering with the intestinal uptake. Bone marrow and spleen represent the initial and ultimate step of iron metabolism, respectively, and the most part of body iron circulates bound to specific proteins and mainly serves to synthesize hemoglobin for new red blood cells. Whatever the martial status is, today’s knowledge about iron biochemistry allows us to embrace exceedingly personalized interventions, which however owe their success to the mythical and historical events that always accompanied this metal.
Collapse
Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20161 Milan, Italy;
- Correspondence:
| | - Silvana Hrelia
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (S.H.); (M.M.)
| | - Marco Malaguti
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy; (S.H.); (M.M.)
| | - Giovanni Lombardi
- IRCCS Orthopedic Institute Galeazzi, Laboratory of Experimental Biochemistry and Molecular Biology, 20161 Milan, Italy;
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, 61-871 Poznań, Poland
| | - Patrizia Riso
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, 20133 Milan, Italy; (P.R.); (M.P.)
| | - Marisa Porrini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Division of Human Nutrition, University of Milan, 20133 Milan, Italy; (P.R.); (M.P.)
| | - Paolo Perazzo
- IRCCS Orthopedic Institute Galeazzi, Postoperative Intensive Care Unit & Anesthesia, 20161 Milan, Italy;
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, 20161 Milan, Italy;
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
37
|
D'Agostino A, Ssebiryo F, Murphy H, Cristello A, Nakiwala R, Otim K, Sarkar D, Ngalombi S, Schott W, Katuntu D, Griffiths M, Namaste SML. Facility- and community-based delivery of micronutrient powders in Uganda: Opening the black box of implementation using mixed methods. MATERNAL AND CHILD NUTRITION 2020; 15:e12798. [PMID: 31622038 DOI: 10.1111/mcn.12798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 01/09/2023]
Abstract
Micronutrient powders (MNP) have the potential to increase micronutrient intake, yet documentation of implementation lessons remains a gap. This paper presents results of a pilot in Uganda comparing community- and facility-based delivery of MNP and documenting experiences of caregivers and distributors. The pilot's mixed method evaluation included a cross-sectional endline survey, monthly household visits, and midline and endline interviews. Primary outcomes were ever-covered (received ≥1 MNP packet), repeat-coverage (received ≥2 MNP packets), and adherence (consumed no more than 1 MNP sachet per day, consumed MNP with food, and consumed MNP 3+ days in past week). An adjusted Wald chi-square test compared differences in programme outcomes between arms, and logit regression identified predictors to adherence. Key informant interviews were coded thematically. Most programme outcomes in the endline survey were statistically significantly higher in the community arm, although in both arms, adherence was lower than other outcomes (adherence 31.4% in facility vs. 58.3% in community arm). Counselling, receipt of communication materials, perceived positive effects, MNP knowledge, and child liking MNP were consistent predictors of adherence in both arms. Qualitative findings corroborated survey results, revealing that social encouragement and advocacy facilitated use and that forgetting to give MNP was a barrier. Facility arm caregivers also cited distance, time, and transportation cost as barriers. Distributors had positive experiences with training and supervision but experienced increased workloads in both arms. MNP programme design is context-specific but could benefit from strengthened community sensitization, continued and more effective counselling for caregivers, and increased support for distributors.
Collapse
Affiliation(s)
- Alexis D'Agostino
- Strengthening Partnerships, Results, and Innovation in Nutrition Globally (SPRING) project, JSI Research & Training Institute, Inc., Rosslyn, Virginia, USA
| | - Francis Ssebiryo
- SPRING project, JSI Research & Training Institute, Inc., Kampala, Uganda
| | - Hillary Murphy
- Strengthening Partnerships, Results, and Innovation in Nutrition Globally (SPRING) project, JSI Research & Training Institute, Inc., Rosslyn, Virginia, USA
| | - Angelica Cristello
- Independent Consulant, Strengthening Partnerships, Results, and Innovation in Nutrition Globally (SPRING) project, JSI Research & Training Institute, Inc., Rosslyn, Virginia, USA
| | - Rose Nakiwala
- SPRING project, JSI Research & Training Institute, Inc., Kampala, Uganda
| | - Katherine Otim
- SPRING project, JSI Research & Training Institute, Inc., Kampala, Uganda
| | - Danya Sarkar
- Strengthening Partnerships, Results, and Innovation in Nutrition Globally (SPRING) project, JSI Research & Training Institute, Inc., Rosslyn, Virginia, USA
| | - Sarah Ngalombi
- Nutrition Division, Uganda Ministry of Health, Kampala, Uganda
| | - Whitney Schott
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Katuntu
- SPRING project, JSI Research & Training Institute, Inc., Kampala, Uganda
| | | | | |
Collapse
|
38
|
Tumilowicz A, Vossenaar M, Kjaer K, Vettersand J, Possolo E, Pelto GH, Jefferds ME, Norte A, Dos Santos Dias K, Osman N, Gonzalez W, Poonawala A, Neufeld LM. Mixed methods evaluation explains bypassing of vouchers in micronutrient powder trial in Mozambique. MATERNAL AND CHILD NUTRITION 2020; 15:e12718. [PMID: 31622037 PMCID: PMC6856962 DOI: 10.1111/mcn.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Abstract
Micronutrient powders (MNP) are recommended by the World Health Organization as an effective intervention to address anaemia in children. A formative process evaluation was conducted to assess the viability of a model using free vouchers in two districts of Mozambique to deliver MNP and motivate adherence to recommendations regarding its use. The evaluation consisted of (a) an examination of programme outcomes using a cross-sectional survey among caregivers of children 6-23 months (n = 1,028) and (b) an ethnographic study to investigate delivery experiences and MNP use from caregiver perspectives (n = 59), programme managers (n = 17), and programme implementers (n = 168). Using a mixed methods approach allowed exploration of unexpected programme outcomes and triangulation of findings. The survey revealed that receiving a voucher was the main implementation bottleneck. Although few caregivers received vouchers (11.5%, CI [9.7, 13.6]), one-fourth received MNP by bypassing the voucher system (26.3%, CI [23.6, 29.0]). Caregivers' narratives indicated that caregivers were motivated to redeem vouchers but encountered obstacles, including not knowing where or how to redeem them or finding MNP were not available at the shop. Observing these challenges, many programme implementers redeemed vouchers and distributed MNP to caregivers. Virtually, all caregivers who received MNP reported ever feeding it to their child. This study's findings are consistent with other studies across a range of contexts suggesting that although programmes are generally effective in motivating initial use, more attention is required to improve access to MNP and support continued use.
Collapse
Affiliation(s)
| | | | | | | | - Edna Possolo
- Department of Nutrition, Ministry of Health, Maputo, Mozambique
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Maria Elena Jefferds
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Augusto Norte
- A-Consultants Statistical Services, Mendoza, Argentina
| | | | - Nadia Osman
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Wendy Gonzalez
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Alia Poonawala
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | |
Collapse
|
39
|
Roschnik N, Diarra H, Dicko Y, Diarra S, Stanley I, Moestue H, McClean J, Verhoef H, Clarke SE. Adherence and acceptability of community-based distribution of micronutrient powders in Southern Mali. MATERNAL AND CHILD NUTRITION 2020; 15:e12831. [PMID: 31622044 PMCID: PMC6856685 DOI: 10.1111/mcn.12831] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/11/2019] [Accepted: 04/02/2019] [Indexed: 11/29/2022]
Abstract
Home fortification with micronutrient powders (MNP) has been shown to reduce anaemia, with high overall acceptability and adherence, but there is limited evidence from West Africa. Around 80% of children younger than 5 years are anaemic in Mali, and new interventions are needed. This paper reports on the adherence and acceptability of a community‐led MNP intervention targeting children aged 6–59 months in Southern Mali. The MNP were delivered by a multidisciplinary group of community volunteers using community‐based preschools, cooking demonstrations, and traditional communication networks to promote MNP, nutrition, hygiene, and child stimulation. The MNP were delivered alongside early childhood development interventions and seasonal malaria chemoprevention. Adherence and acceptability were evaluated through two cross‐sectional surveys in 2014 and 2016 and a qualitative evaluation in 2015. Over 80% of parents reported ever having given MNP to their child, with 65% having given MNP for four or more days in the last week. Likely contributors to uptake include: perceived positive changes in the children following MNP use, the selection of a food vehicle that was already commonly given to children (morning porridge or bouillie) and the community driven, decentralized and integrated delivery approach. These findings support recommendations from recent reviews of MNP implementation to use community‐based delivery approaches and behaviour change components.
Collapse
Affiliation(s)
| | - Hawa Diarra
- Sponsorship programmes, Save the Children International, Bamako, Mali
| | - Yahia Dicko
- Sponsorship programmes, Save the Children International, Bamako, Mali
| | - Seybou Diarra
- Sponsorship programmes, Save the Children International, Bamako, Mali
| | - Isobel Stanley
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Moestue
- Department of Education and Child Protection, Save the Children USA, Washington, DC
| | - Judy McClean
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hans Verhoef
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, London, UK.,Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands.,Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Sian E Clarke
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
40
|
Locks LM, Dahal P, Pokharel R, Joshi N, Paudyal N, Whitehead RD, Chitekwe S, Mei Z, Lamichhane B, Garg A, Jefferds ME. Predictors of micronutrient powder (MNP) knowledge, coverage, and consumption during the scale-up of an integrated infant and young child feeding (IYCF-MNP) programme in Nepal. MATERNAL AND CHILD NUTRITION 2020; 15:e12712. [PMID: 31622040 PMCID: PMC6856851 DOI: 10.1111/mcn.12712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Abstract
Large-scale programmes using micronutrient powders (MNPs) may not achieve maximum impact due to limited/inappropriate MNP coverage, consumption, and use. We identify predictors of MNP coverage, maternal knowledge of appropriate use, and child MNP consumption in Nepal. A cross-sectional survey was conducted in 2,578 mother-child pairs representative of children 6-23 months in two districts that were part of the post-pilot, scale-up of an integrated infant and young child feeding-MNP (IYCF-MNP) programme. Children aged 6-23 months were expected to receive 60 MNP sachets every 6 months from a female community health volunteer (FCHV) or health centre. Outcomes of interest were MNP coverage (ever received), maternal knowledge of appropriate use (correct response to seven questions), repeat coverage (receipt ≥ twice; among children 12-23 months who had received MNP at least once, n = 1342), and high intake (child consumed ≥75% of last distribution, excluding those with recent receipt/insufficient time to use 75% at recommended one-sachet-per-day dose, n = 1422). Multivariable log-binomial regression models were used to identify predictors of the four outcomes. Coverage, knowledge of appropriate use, and repeat coverage were 61.3%, 33.5%, and 45.9%, respectively. Among MNP receivers, 97.9% consumed MNP at least once and 38.9% of eligible children consumed ≥75% of last distribution. FCHV IYCF-MNP counselling was positively associated with knowledge, coverage, repeat coverage, and high intake; health worker counselling with knowledge and coverage indicators; and radio messages with coverage indicators only. FCHV counselling had the strongest association with knowledge, coverage, and high intake. Community-based counselling may play a vital role in improving coverage and intake in MNP programmes.
Collapse
Affiliation(s)
- Lindsey M Locks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Nutrition Section, United Nations Children's Fund (UNICEF) Headquarters, New York, New York, USA
| | - Pradiumna Dahal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Rajkumar Pokharel
- Nutrition Section, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | | | - Naveen Paudyal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Ralph D Whitehead
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers of Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Zuguo Mei
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers of Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bikash Lamichhane
- Child Health Division, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - Aashima Garg
- Nutrition Section, United Nations Children's Fund (UNICEF) Headquarters, New York, New York, USA
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers of Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
41
|
Ford ND, Ruth LJ, Ngalombi S, Lubowa A, Halati S, Ahimbisibwe M, Baingana R, Whitehead RD, Mapango C, Jefferds ME. An Integrated Infant and Young Child Feeding and Micronutrient Powder Intervention Does Not Affect Anemia, Iron Status, or Vitamin A Status among Children Aged 12-23 Months in Eastern Uganda. J Nutr 2020; 150:938-944. [PMID: 31923315 PMCID: PMC8127862 DOI: 10.1093/jn/nxz314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/24/2019] [Accepted: 11/26/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Micronutrient powders (MNP) can reduce iron deficiency and anemia in children. OBJECTIVE We evaluated the impact of an integrated infant and young child feeding (IYCF)-MNP intervention on anemia and micronutrient status among children aged 12-23 mo in Eastern Uganda. The intervention focused on MNP distribution, IYCF education, and caregiver behavior change. METHODS Population-based cross-sectional surveys representative of children aged 12-23 mo in Amuria (intervention) and Soroti (nonintervention) districts were collected in June/July 2015 at baseline (n = 1260) and 12 mo after implementation at endline in 2016 (n = 1490). From pooled capillary blood, we assessed hemoglobin, malaria, ferritin, retinol binding protein (RBP), C-reactive protein, and ɑ1-acid glycoprotein. Ferritin and RBP were regression-adjusted to correct for inflammation. Caregivers reported sociodemographic characteristics and MNP knowledge and practices. Linear regression estimated the difference-in-difference (DiD) effect of MNP on hemoglobin, ferritin, and RBP, and logistic regression estimated DiD effect of MNP on anemia (hemoglobin <11.0 g/dL), iron deficiency (ferritin <12.0 µg/L), iron deficiency anemia (hemoglobin <11.0 g/dL and ferritin <12.0 µg/L), and vitamin A deficiency (VAD; RBP equivalent to <0.70 µmol/L retinol: <0.79 µmol/L at baseline and RBP <0.67 µmol/L at endline). RESULTS In Amuria, 96% of children had ever consumed MNP versus <1% of children in Soroti. Fifty-four percent of caregivers reported organoleptic changes when MNP were added to foods cooked with soda ash. Adjusting for age, sex, malaria, recent morbidity, and household-level factors, the intervention was associated with -0.83 g/dL lower hemoglobin (95% CI, -1.36, -0.30 g/dL; P = 0.003) but not with anemia, ferritin, iron deficiency, iron deficiency anemia, RBP, or VAD. CONCLUSIONS Despite high program fidelity, the intervention was associated with reduced hemoglobin concentrations but not with change in anemia or micronutrient status among children aged 12-23 mo in Eastern Uganda. Contextual factors, such as cooking with soda ash, might explain the lack of effectiveness.
Collapse
Affiliation(s)
- Nicole D. Ford
- McKing Consulting Corp, Fairfax, Virginia,Nutrition Branch, Division of Nutrition, Physical
Activity, and Obesity, United States Centers of Disease Control and Prevention,
Atlanta, Georgia
| | - Laird J Ruth
- McKing Consulting Corp, Fairfax, Virginia,Nutrition Branch, Division of Nutrition, Physical
Activity, and Obesity, United States Centers of Disease Control and Prevention,
Atlanta, Georgia
| | | | | | - Siti Halati
- United Nations World Food Programme, Kampala, Uganda
| | | | | | - Ralph D. Whitehead
- Nutrition Branch, Division of Nutrition, Physical
Activity, and Obesity, United States Centers of Disease Control and Prevention,
Atlanta, Georgia
| | - Carine Mapango
- Nutrition Branch, Division of Nutrition, Physical
Activity, and Obesity, United States Centers of Disease Control and Prevention,
Atlanta, Georgia
| | - Maria Elena Jefferds
- Nutrition Branch, Division of Nutrition, Physical
Activity, and Obesity, United States Centers of Disease Control and Prevention,
Atlanta, Georgia
| |
Collapse
|
42
|
Role of home visits by volunteer community health workers: to improve the coverage of micronutrient powders in rural Bangladesh. Public Health Nutr 2020; 24:s48-s58. [PMID: 32131922 PMCID: PMC8042577 DOI: 10.1017/s1368980020000038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We assessed the role of home visits by Shasthya Shebika (SS) - female volunteer community health workers (CHWs) - in improving the distribution of micronutrient powder (MNP), and explored the independent effects of caregiver-provider interaction on coverage variables. DESIGN We used data from three cross-sectional surveys undertaken at baseline (n 1927), midline (n 1924) and endline (n 1540) as part of an evaluation of a home fortification programme. We defined an exposure group as one that had at least one SS visit to the caregiver's household in the 12 months preceding the survey considering three outcome variables - message (ever heard), contact (ever used) and effective coverage (regular used) of MNP. We performed multiple logistic regressions to explore the determinants of coverage, employed an 'interaction term' and calculated an odds ratio (OR) to assess the modifying effect of SS's home visits on coverage. SETTINGS Sixty-eight sub-districts from ten districts of Bangladesh. PARTICIPANTS Children aged 6-59 months and their caregivers. RESULTS A home visit from an SS positively impacts message coverage at both midline (ratio of OR 1·70; 95 % CI 1·25, 2·32; P < 0·01) and endline (ratio of OR 3·58; 95 % CI 2·22, 5·78; P < 0·001), and contact coverage both at midline (ratio of OR 1·48; 95 % CI 1·06, 2·07; P = 0·021) and endline (ratio of OR 1·74; 95 % CI 1·23, 2·47; P = 0·002). There was no significant effect of a SS's home visit on effective coverage. CONCLUSIONS The households visited by BRAC's volunteer CHWs have better message and contact coverage among the children aged 6-59 months.
Collapse
|
43
|
Suchdev PS, Jefferds MED, Ota E, da Silva Lopes K, De‐Regil LM. Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database Syst Rev 2020; 2:CD008959. [PMID: 32107773 PMCID: PMC7046492 DOI: 10.1002/14651858.cd008959.pub3] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vitamin and mineral deficiencies, particularly those of iron, vitamin A, and zinc, affect more than two billion people worldwide. Young children are highly vulnerable because of rapid growth and inadequate dietary practices. Multiple micronutrient powders (MNPs) are single-dose packets containing multiple vitamins and minerals in powder form, which are mixed into any semi-solid food for children six months of age or older. The use of MNPs for home or point-of-use fortification of complementary foods has been proposed as an intervention for improving micronutrient intake in children under two years of age. In 2014, MNP interventions were implemented in 43 countries and reached over three million children. This review updates a previous Cochrane Review, which has become out-of-date. OBJECTIVES To assess the effects and safety of home (point-of-use) fortification of foods with MNPs on nutrition, health, and developmental outcomes in children under two years of age. For the purposes of this review, home fortification with MNP refers to the addition of powders containing vitamins and minerals to semi-solid foods immediately before consumption. This can be done at home or at any other place that meals are consumed (e.g. schools, refugee camps). For this reason, MNPs are also referred to as point-of-use fortification. SEARCH METHODS We searched the following databases up to July 2019: CENTRAL, MEDLINE, Embase, and eight other databases. We also searched four trials registers, contacted relevant organisations and authors of included studies to identify any ongoing or unpublished studies, and searched the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs with individual randomisation or cluster-randomisation. Participants were infants and young children aged 6 to 23 months at the time of intervention, with no identified specific health problems. The intervention consisted of consumption of food fortified at the point of use with MNP formulated with at least iron, zinc, and vitamin A, compared with placebo, no intervention, or use of iron-containing supplements, which is standard practice. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies, and assessed the risk of bias of included studies. We reported categorical outcomes as risk ratios (RRs) or odds ratios (ORs), with 95% confidence intervals (CIs), and continuous outcomes as mean differences (MDs) and 95% CIs. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 29 studies (33,147 children) conducted in low- and middle-income countries in Asia, Africa, Latin America, and the Caribbean, where anaemia is a public health problem. Twenty-six studies with 27,051 children contributed data. The interventions lasted between 2 and 44 months, and the powder formulations contained between 5 and 22 nutrients. Among the 26 studies contributing data, 24 studies (26,486 children) compared the use of MNP versus no intervention or placebo; the two remaining studies compared the use of MNP versus an iron-only supplement (iron drops) given daily. The main outcomes of interest were related to anaemia and iron status. We assessed most of the included studies at low risk of selection and attrition bias. We considered some studies to be at high risk of performance and detection bias due to lack of blinding. Most studies were funded by government programmes or foundations; only two were funded by industry. Home fortification with MNP, compared with no intervention or placebo, reduced the risk of anaemia in infants and young children by 18% (RR 0.82, 95% CI 0.76 to 0.90; 16 studies; 9927 children; moderate-certainty evidence) and iron deficiency by 53% (RR 0.47, 95% CI 0.39 to 0.56; 7 studies; 1634 children; high-certainty evidence). Children receiving MNP had higher haemoglobin concentrations (MD 2.74 g/L, 95% CI 1.95 to 3.53; 20 studies; 10,509 children; low-certainty evidence) and higher iron status (MD 12.93 μg/L, 95% CI 7.41 to 18.45; 7 studies; 2612 children; moderate-certainty evidence) at follow-up compared with children receiving the control intervention. We did not find an effect on weight-for-age (MD 0.02, 95% CI -0.03 to 0.07; 10 studies; 9287 children; moderate-certainty evidence). Few studies reported morbidity outcomes (three to five studies each outcome) and definitions varied, but MNP did not increase diarrhoea, upper respiratory infection, malaria, or all-cause morbidity. In comparison with daily iron supplementation, the use of MNP produced similar results for anaemia (RR 0.89, 95% CI 0.58 to 1.39; 1 study; 145 children; low-certainty evidence) and haemoglobin concentrations (MD -2.81 g/L, 95% CI -10.84 to 5.22; 2 studies; 278 children; very low-certainty evidence) but less diarrhoea (RR 0.52, 95% CI 0.38 to 0.72; 1 study; 262 children; low-certainty of evidence). However, given the limited quantity of data, these results should be interpreted cautiously. Reporting of death was infrequent, although no trials reported deaths attributable to the intervention. Information on side effects and morbidity, including malaria and diarrhoea, was scarce. It appears that use of MNP is efficacious among infants and young children aged 6 to 23 months who are living in settings with different prevalences of anaemia and malaria endemicity, regardless of intervention duration. MNP intake adherence was variable and in some cases comparable to that achieved in infants and young children receiving standard iron supplements as drops or syrups. AUTHORS' CONCLUSIONS Home fortification of foods with MNP is an effective intervention for reducing anaemia and iron deficiency in children younger than two years of age. Providing MNP is better than providing no intervention or placebo and may be comparable to using daily iron supplementation. The benefits of this intervention as a child survival strategy or for developmental outcomes are unclear. Further investigation of morbidity outcomes, including malaria and diarrhoea, is needed. MNP intake adherence was variable and in some cases comparable to that achieved in infants and young children receiving standard iron supplements as drops or syrups.
Collapse
Affiliation(s)
- Parminder S Suchdev
- Emory UniversityDepartment of Pediatrics1760 Haygood DrAtlantaGAUSA30322
- Centers for Disease Control and PreventionNutrition Branch, Division of Nutrition, Physical Activity, and ObesityAtlantaGAUSA
| | - Maria Elena D Jefferds
- Centers for Disease Control and PreventionNutrition Branch, Division of Nutrition, Physical Activity, and ObesityAtlantaGAUSA
| | - Erika Ota
- St. Luke's International UniversityGlobal Health Nursing, Graduate School of Nursing Science10‐1 Akashi‐choChuo‐KuTokyoMSJapan104‐0044
| | - Katharina da Silva Lopes
- St. Luke's International UniversityGraduate School of Public Health3‐6‐2 TsukijiChuo‐KuTokyoMSJapan104‐0045
| | | | | |
Collapse
|
44
|
Mahfuz M, Alam MA, Das S, Fahim SM, Hossain MS, Petri WA, Ashorn P, Ashorn U, Ahmed T. Daily Supplementation With Egg, Cow Milk, and Multiple Micronutrients Increases Linear Growth of Young Children with Short Stature. J Nutr 2020; 150:394-403. [PMID: 31665385 DOI: 10.1093/jn/nxz253] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/15/2019] [Accepted: 09/19/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Childhood stunting is the most prevalent public health nutrition problem in low- and middle-income countries. OBJECTIVE This study aimed to determine whether daily supplementation in 12-18-mo-old undernourished Bangladeshi children with egg, cow milk, and multiple micronutrients improves linear growth. METHODS In the Bangladesh Environmental Enteric Dysfunction (BEED) study, a community-based intervention study, 12-18-mo-old children with length-for-age z score (LAZ) <1 were supplemented daily with an egg and 150 mL of milk for 90 feeding days, and 1 sachet of multiple micronutrient powder was provided daily for 60 feeding days. The change in LAZ over this period was compared with that in children of the same age and same baseline LAZ who were enrolled in the recently completed Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health (MAL-ED) Dhaka birth cohort study conducted in the same community where no nutrition intervention was provided. Difference-in-difference (DID) analysis was done and the effect size was adjusted for other possible covariates using a generalized estimating equation in a regression model. RESULTS A total of 472 children with LAZ <1 completed the intervention and data were available for 174 children in the comparison group. Compared with the comparison group, adjusted DID analysis revealed a change in LAZ in the intervention group of +0.23 (95% CI: 0.18, 0.29; P < 0.05). In a subgroup analysis, the changes were +0.27 (95% CI: 0.18, 0.35; P < 0.05) in stunted (LAZ <2) children and +0.19 (95% CI: 0.12, 0.27; P < 0.05) in children at risk of stunting (LAZ -1 to -2). No allergic reactions or other adverse events related to milk and egg consumption were observed. CONCLUSIONS Daily directly observed milk, egg, and multiple micronutrient supplementation may improve linear growth of stunted children. A randomized controlled trial with longer duration of supplementation coupled with an additional intervention aimed at reducing pathogen burden is warranted to confirm these results. This trial was registered at clinicaltrials.gov as NCT02812615.
Collapse
Affiliation(s)
- Mustafa Mahfuz
- icddr,b, Dhaka, Bangladesh.,Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | | | | | | | | | | | - Per Ashorn
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Ulla Ashorn
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | | |
Collapse
|
45
|
Park JJH, Harari O, Siden E, Dron L, Zannat NE, Singer J, Lester RT, Thorlund K, Mills EJ. Interventions to improve linear growth during complementary feeding period for children aged 6-24 months living in low- and middle-income countries: a systematic review and network meta-analysis. Gates Open Res 2019; 3:1660. [PMID: 32259047 PMCID: PMC7096089 DOI: 10.12688/gatesopenres.13083.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 08/29/2023] Open
Abstract
Background: Optimizing linear growth in children during complementary feeding period (CFP) (6-24 months) are critical for their development. Several interventions, such as micronutrient and food supplements, deworming, maternal education, and water, sanitation and hygiene (WASH), could potentially be provided to prevent stunting, but their comparative effectiveness is currently unclear. In this study, we evaluated comparative effectiveness of interventions under these domains on child linear growth outcomes of height-for-age z-score (HAZ) and stunting (HAZ <-2SD) Methods: For this study, we searched for low- and middle-income country (LMIC)-based randomized clinical trials (RCTs) of aforementioned interventions provided to children during CFP. We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We performed random-effects network meta-analysis (NMA) for HAZ and stunting. Results: The evidence base for our NMA was based on 79 RCTs (96 papers) involving 81,786 children. Among the micronutrients, compared to standard-of-care, iron + folic acid (IFA) (mean difference =0.08; 95% credible interval [CrI]: 0.01, 0.15) and multiple micronutrients (MMN) (mean difference =0.06; 95%CrI: 0.01, 0.11) showed improvements for HAZ; MMN also reduced the risks for stunting (RR=0.86; 95%Crl: 0.73, 0.98), whereas IFA did not (RR=0.92; 95%Crl: 0.64, 1.23). For food supplements, flour in the caloric range of 270-340 kcal (RR=0.73; 95%Crl: 0.51, 1.00) and fortified lipid-based nutrient supplements (LNS) containing 220-285 kcal (RR=0.80; 95%Crl: 0.66, 0.97) decreased the risk of stunting compared to standard-of-care, but these interventions and other food supplements did not show improvements for HAZ. Deworming, maternal education, and WASH interventions did not show improvements for HAZ nor stunting. Conclusion: While we found micronutrient and food supplements to be effective for HAZ and/or stunting, the evidence base for other domains in this life stage was limited, highlighting the need for more investigation. Registration: PROSPERO CRD42018110449; registered on 17 October 2018.
Collapse
Affiliation(s)
- Jay J. H. Park
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | - Ofir Harari
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | - Ellie Siden
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | - Louis Dron
- MTEK Sciences, Vancouver, BC, V5Z1J5, Canada
| | | | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Data and Methodology Program, CIHR Canadian HIV Trials Network, Vancouver, BC, V6Z 1Y6, Canada
| | - Richard T. Lester
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Kristian Thorlund
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Edward J. Mills
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
| |
Collapse
|
46
|
Paganini D, Uyoga MA, Kortman GAM, Boekhorst J, Schneeberger S, Karanja S, Hennet T, Zimmermann MB. Maternal Human Milk Oligosaccharide Profile Modulates the Impact of an Intervention with Iron and Galacto-Oligosaccharides in Kenyan Infants. Nutrients 2019; 11:nu11112596. [PMID: 31671757 PMCID: PMC6893608 DOI: 10.3390/nu11112596] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
There is little data on human milk oligosaccharide (HMO) composition in Sub-Saharan Africa. Iron fortificants adversely affect the infant gut microbiota, while co-provision of prebiotic galacto-oligosaccharides (GOS) mitigates most of the adverse effects. Whether variations in maternal HMO profile can influence the infant response to iron and/or GOS fortificants is unknown. The aim of this study was to determine HMO profiles and the secretor/non-secretor phenotype of lactating Kenyan mothers and investigate their effects on the maternal and infant gut microbiota, and on the infant response to a fortification intervention with 5 mg iron (2.5 mg as sodium iron ethylenediaminetetraacetate and 2.5 mg as ferrous fumarate) and 7.5 g GOS. We studied mother–infant pairs (n = 80) participating in a 4-month intervention trial in which the infants (aged 6.5–9.5 months) received daily a micronutrient powder without iron, with iron or with iron and GOS. We assessed: (1) maternal secretor status and HMO composition; (2) effects of secretor status on the maternal and infant gut microbiota in a cross-sectional analysis at baseline of the intervention trial; and (3) interactions between secretor status and intervention groups during the intervention trial on the infant gut microbiota, gut inflammation, iron status, growth and infectious morbidity. Secretor prevalence was 72% and HMOs differed between secretors and non-secretors and over time of lactation. Secretor status did not predict the baseline composition of the maternal and infant gut microbiota. There was a secretor-status-by-intervention-group interaction on Bifidobacterium (p = 0.021), Z-scores for length-for-age (p = 0.022) and weight-for-age (p = 0.018), and soluble transferrin receptor (p = 0.041). In the no iron group, longitudinal prevalence of diarrhea was higher among infants of non-secretors (23.8%) than of secretors (10.4%) (p = 0.001). In conclusion, HMO profile may modulate the infant gut microbiota response to fortificant iron; compared to infants of secretor mothers, infants of non-secretor mothers may be more vulnerable to the adverse effect of iron but also benefit more from the co-provision of GOS.
Collapse
Affiliation(s)
- Daniela Paganini
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland.
| | - Mary A Uyoga
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland.
- Department of Medical Epidemiology, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, 00200 Nairobi, Kenya.
| | | | - Jos Boekhorst
- NIZO Food Research BV, 6718 ZB Ede, The Netherlands.
| | - Sacha Schneeberger
- Department of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, 8057 Zurich, Switzerland.
| | - Simon Karanja
- Department of Medical Epidemiology, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, 00200 Nairobi, Kenya.
| | - Thierry Hennet
- Department of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, 8057 Zurich, Switzerland.
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland.
| |
Collapse
|
47
|
Li Z, Li X, Sudfeld CR, Liu Y, Tang K, Huang Y, Fawzi W. The Effect of the Yingyangbao Complementary Food Supplement on the Nutritional Status of Infants and Children: A Systematic Review and Meta-Analysis. Nutrients 2019; 11:E2404. [PMID: 31597360 PMCID: PMC6835467 DOI: 10.3390/nu11102404] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023] Open
Abstract
Yingyangbao (YYB) is a nutrient-dense complementary food supplement for infants and young children in China. There has been considerable interest and research on the potential effects of YYB on hematological and anthropometric outcomes in China, but limited effort has been made to consolidate and synthesize the evidence to inform the research and policy agendas. Eight English databases and three Chinese databases were searched from January 2001 to June 2019 to identify YYB intervention studies. A total of 32 quasi-experimental, post-only, concurrent-control studies or pre-post studies were identified, and 26 were included in the meta-analyses. A pooled analysis of post-only studies with concurrent-control determined that YYB was associated with an increase of 4.43 g/L (95% confidence interval (CI) 1.55, 7.30) hemoglobin concentration, 2.46 cm (CI 0.96, 3.97) in height, and 0.79 kg (CI 0.25, 1.32) weight in infants and young children. YYB was also associated with reductions in the prevalence of anemia (risk ratio (RR) = 0.55; 95% CI: 0.45, 0.67), stunting (RR = 0.60; 95% CI: 0.44, 0.81), and underweight (RR = 0.51; 95% CI: 0.39, 0.65). Overall, YYB was found to be associated with improved hematological and anthropometric indicators among infants and young children in China; however, randomized trials are needed to causally assess the efficacy of YYB due to the inherent risk of bias in existing quasi-experimental studies; rigorous implementation and cost-effectiveness evaluations are also needed.
Collapse
Affiliation(s)
- Zhihui Li
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Xinyi Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Yuning Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Kun Tang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China.
| | - Yangmu Huang
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China.
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| |
Collapse
|
48
|
Tumilowicz A, Habicht J, Mbuya MN, Beal T, Ntozini R, Rohner F, Pelto GH, Fisseha T, Haidar J, Assefa N, Wodajo HY, Wolde TT, Neufeld LM. Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia. MATERNAL & CHILD NUTRITION 2019; 15:e12807. [PMID: 31622042 PMCID: PMC6856804 DOI: 10.1111/mcn.12807] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 02/18/2019] [Indexed: 01/23/2023]
Abstract
A theory-driven evaluation was conducted to assess performance of a trial to deliver micronutrient powder (MNP) through the Ethiopian Ministry of Health. We adapted an approach to coverage assessment, originally developed to identify bottlenecks in health service delivery, to examine sequential program outcomes and their correlates using cross-sectional survey data of caregivers of children 6-23 months (N = 1915). Separate multivariable Poisson regression models were used to estimate adjusted risk ratios of conceptually relevant determinants of coverage and adherence. Caregivers of children >11 months were more likely to have received MNP than caregivers of younger infants, yet children 12-17 months were 32% (P < 0.001) and children 18-23 months 38% (P < 0.001) less likely to have been fed MNP in the 14 days preceding the survey than children 6-11 months. Among caregivers who initiated feeding MNP, the most frequently reported reasons for discontinuing use were not obtaining additional supply (36.1%) and perceived child rejection of food with MNP (22.9%). For each additional time a caregiver met with frontline workers in the 3 months preceding the survey, they were 13% more likely to have recently fed MNP (P < 0.001). Caregivers' perception that MNP produced positive changes in children was associated with a 14% increase in the likelihood of having recently fed it (P < 0.001). These results emphasize the importance of counselling for MNP and infant and young child feeding for initial use and the importance of multiple contacts with frontline workers for continued use.
Collapse
Affiliation(s)
| | | | - Mduduzi N.N. Mbuya
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
- Global Alliance for Improved NutritionWashingtonDCUSA
| | - Ty Beal
- Global Alliance for Improved NutritionWashingtonDCUSA
- Department of Environmental Science and PolicyUniversity of CaliforniaDavisCaliforniaUSA
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | | | - Gretel H. Pelto
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Tezera Fisseha
- Institute for Education, Health and DevelopmentAddis AbabaEthiopia
| | - Jemal Haidar
- School of Public Health, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Nigussie Assefa
- School of Public Health, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Telahun Teka Wolde
- Health Services Quality DirectorateFederal Ministry of HealthAddis AbabaEthiopia
| | | |
Collapse
|
49
|
Lanou HB, Osendarp SJ, Argaw A, De Polnay K, Ouédraogo C, Kouanda S, Kolsteren P. Micronutrient powder supplements combined with nutrition education marginally improve growth amongst children aged 6-23 months in rural Burkina Faso: A cluster randomized controlled trial. MATERNAL & CHILD NUTRITION 2019; 15:e12820. [PMID: 30941887 PMCID: PMC6859995 DOI: 10.1111/mcn.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 01/18/2023]
Abstract
Micronutrients powder (MNP) can prevent anaemia amongst children 6-23 months old. However, evidence of an effect on growth is limited and concerns about the safety of iron-containing MNP interventions limits their applicability. In a cluster randomized controlled intervention, we evaluated the effectiveness of a nutritional package including counselling and provision of MNP to improve the nutritional status of children aged 6-23 months and the effect of sustained use of MNP on morbidity in a malaria-endemic area. Child feeding practises and nutritional status were assessed through cross-sectional surveys. Biweekly morbidity surveillance and anthropometry measurements were carried out in a nested cohort study. No significant differences in the prevalence of wasting (-0.7% [-6.8, 5.3] points; p = .805), stunting (+4.6% [-2.9, 12.0] points; p = .201), or mean length-for-age z-score and weight-for-length z-score scores were found between study groups. The proportion of children with a minimum dietary diversity score and those with a minimum acceptable diet significantly increased in the intervention group compared with the control by 6.5% points (p = .043) and 5.8% points (p = .037), respectively. There were no significant differences in the risk of diarrhoea (RR: 1.68, 95% CI [0.94, 3.08]), fever (RR: 1.20 [0.82, 1.77]), and malaria (RR: 0.68 [0.37, 1.26]) between study groups. In the nested study, the rate of linear growth was higher in the intervention than in the control group by 0.013 SD/month (p = .027). In a programmatic intervention, MNP and nutrition education marginally improved child feeding practises and growth, without increasing morbidity from malaria or fever.
Collapse
Affiliation(s)
- Hermann B. Lanou
- Ministry of Higher Education, Scientific Research and InnovationInstitut de Recherche en Sciences de la SantéOuagadougouBurkina Faso
- Department of Food Technology, Safety and HealthGhent UniversityGhentBelgium
| | | | - Alemayehu Argaw
- Nutrition InternationalOttawaOntarioCanada
- Department of Food Technology, Safety and HealthGhent UniversityGhentBelgium
- Department of Population and Family HealthJimma UniversityJimmaEthiopia
| | - Kirrily De Polnay
- Child Health and Nutrition Unit, Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | | | - Seni Kouanda
- Ministry of Higher Education, Scientific Research and InnovationInstitut de Recherche en Sciences de la SantéOuagadougouBurkina Faso
| | - Patrick Kolsteren
- Child Health and Nutrition Unit, Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
- Department of Food Technology, Safety and HealthGhent UniversityGhentBelgium
| |
Collapse
|
50
|
Huang Y, Wang L, Huo J, Wu Q, Wang W, Chang S, Zhang Y. Prevalence and causes of anaemia in children aged 6-23 months in rural Qinghai, China: findings from a cross-sectional study. BMJ Open 2019; 9:e031021. [PMID: 31501129 PMCID: PMC6738674 DOI: 10.1136/bmjopen-2019-031021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the current situation of anaemia among children aged 6-23 months in a rural county in China, and to explore the influencing factors and the main causes of anaemia. DESIGN A cross-sectional study. SETTING Huzhu County in Qinghai Province, China PARTICIPANTS: We selected 38 sampled villages using Proportional to Population Size sampling method. We obtained the name list of children aged 6-23 months in each sampled village and planned to survey all the eligible children aged 6-23 months and their caregivers. PRIMARY AND SECONDARY OUTCOMES MEASURES The prevalence of anaemia, the influencing factors of anaemia, the laboratory tests for biological causes of anaemia, including serum ferritin, soluble transferrin receptor, folic acid, homocysteine and vitamin B12. RESULTS A total of 754 children aged 6-23 months and their caregivers were surveyed, and 183 anaemic children aged 12-23 months were collected venous blood sample. The anaemia prevalence of children aged 6-23 months in Huzhu County was 59.1%. Children of younger age (OR=0.968, 95% CI 0.940 to 0.998), Tibetan nationality (OR=3.123, 95% CI 1.473 to 6.623) and not introducing meat (OR=0.698, 95% CI 0.499 to 0.976) were more likely to be anaemic. More than 80% of children with anaemia were due to iron deficiency (ID), and 20.2% of them had both iron and folic acid deficiencies. CONCLUSIONS The anaemia prevalence of children aged 6-23 months in Huzhu County was high and children of younger age, Tibetan nationality and not introducing meat were more likely to be anaemic. The main cause of anaemia was nutritional anaemia, with the vast majority being ID. Interventions of feeding counselling and nutrients supplements are appropriate and should be further strengthened. TRIAL REGISTRATION NUMBER ChiCTRPRC12002444.
Collapse
Affiliation(s)
- Yiwen Huang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Lijuan Wang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Junsheng Huo
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Qiong Wu
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Wei Wang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Suying Chang
- Health and Nutrition, Water, Environment and Sanitation Section, UNICEF, Beijing, China
| | - Yanfeng Zhang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| |
Collapse
|