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Diamond-Smith N, Baer RJ, Jelliffe-Pawlowski L. Impact of being underweight before pregnancy on preterm birth by race/ethnicity and insurance status in California: an analysis of birth records. J Matern Fetal Neonatal Med 2024; 37:2321486. [PMID: 38433400 DOI: 10.1080/14767058.2024.2321486] [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: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The US still has a high burden of preterm birth (PTB), with important disparities by race/ethnicity and poverty status. There is a large body of literature looking at the impact of pre-pregnancy obesity on PTB, but fewer studies have explored the association between underweight status on PTB, especially with a lens toward health disparities. Furthermore, little is known about how weight, specifically pre-pregnancy underweight status, and socio-economic-demographic factors such as race/ethnicity and insurance status, interact with each other to contribute to risks of PTB. OBJECTIVES The objective of this study was to measure the association between pre-pregnancy underweight and PTB and small for gestational age (SGA) among a large sample of births in the US. Our secondary objective was to see if underweight status and two markers of health disparities - race/ethnicity and insurance status (public vs. other) - on PTB. STUDY DESIGN We used data from all births in California from 2011 to 2017, which resulted in 3,070,241 singleton births with linked hospital discharge records. We ran regression models to estimate the relative risk of PTB by underweight status, by race/ethnicity, and by poverty (Medi-cal status). We then looked at the interaction between underweight status and race/ethnicity and underweight and poverty on PTB. RESULTS Black and Asian women were more likely to be underweight (aRR = 1.0, 95% CI: 1.01, 1.1 and aRR = 1.4, 95% CI: 1.4, 1.5, respectively), and Latina women were less likely to be underweight (aRR = 0.7, 95% CI: 0.7, 0.7). Being underweight was associated with increased odds of PTB (aRR = 1.3, 95% CI 1.3-1.3) and, after controlling for underweight, all nonwhite race/ethnic groups had increased odds of PTB compared to white women. In interaction models, the combined effect of being both underweight and Black, Indigenous and People of Color (BIPOC) statistically significantly reduced the relative risk of PTB (aRR = 0.9, 95% CI: 0.8, 0.9) and SGA (aRR = 1.0, 95% CI: 0.9, 1.0). The combined effect of being both underweight and on public insurance increased the relative risk of PTB (aRR = 1.1, 95% CI: 1.1, 1.2) but there was no additional effect of being both underweight and on public insurance on SGA (aRR = 1.0, 95% CI: 1.0, 1.0). CONCLUSIONS We confirm and build upon previous findings that being underweight preconception is associated with increased risk of PTB and SGA - a fact often overlooked in the focus on overweight and adverse birth outcomes. Additionally, our findings suggest that the effect of being underweight on PTB and SGA differs by race/ethnicity and by insurance status, emphasizing that other factors related to inequities in access to health care and poverty are contributing to disparities in PTB.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Rebecca J Baer
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
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Zeng Y, He G. Association of blood parameters in early pregnancy with anemia during late pregnancy: a multicenter cohort study in China. J Matern Fetal Neonatal Med 2024; 37:2299110. [PMID: 38185625 DOI: 10.1080/14767058.2023.2299110] [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: 08/07/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Low-hemoglobin concentration and anemia are important risk factors for the health and development of women and children. The aim of this study was to investigate the correlation between blood indicators in early pregnancy among non-anemia women and anemia in the third trimester among pregnant women in China with uncomplicated pregnancies >36 weeks. METHODS This was a multicenter, prospective cohort study. Pregnant women registered at the survey hospitals from May 2019 to December 2020 were included and followed up until delivery and discharge. The predictive value of serum ferritin (SF) and routine blood indexes (platelet count, red blood cell count, hemoglobin level, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration) were analyzed using a receiver operating characteristic (ROC) curve for the occurrence of anemia in the third trimester. RESULTS The area under the ROC curve of the first trimester hemoglobin for predicting anemia during late pregnancy (cutoff value 128 g/L, sensitivity 82.3%, specificity 49.6%) and iron deficiency anemia (cutoff value 124 g/L, sensitivity 66.3%, specificity 66.4%) in the third trimester was larger than those of other blood variables. CONCLUSIONS Hemoglobin levels in the first trimester were significantly better predictors of anemia during the third trimester than the other indices. Our study contributes to the clinical practice of early intervention for anemia, thus taking effective measures to improve maternal and infant outcomes.
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Affiliation(s)
- Yue Zeng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, China
| | - Guolin He
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
- Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, China
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Duarte MR, de Moraes Heredia AS, Arantes VC, de Barros Reis MA, Rodrigues PRM, Gorgulho BM, Fregadolli CH, Latorraca MQ. The interaction of the FTO gene and age interferes with macronutrient and vitamin intake in women with morbid obesity. Exp Gerontol 2024; 193:112463. [PMID: 38789015 DOI: 10.1016/j.exger.2024.112463] [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: 11/25/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Fat mass and obesity-related (FTO) gene single nucleotide polymorphisms (SNPs) interferes with food preferences that impact macronutrient intake. Few studies have investigated the relationship of this polymorphisms with the intake of micronutrients. Moreover, studies have shown multiple micronutrient deficiencies in patients with obesity. This work evaluated the effect of the FTO rs9939609 gene polymorphism on dietary nutritional quality and food intake of macronutrients and vitamins in of women with obesity candidates for metabolic surgery. The study included 106 women (24 to 60 years old) with BMIs of 36.1 to 64.8 kg/m2. A food frequency questionnaire validated for the local population was applied to obtain information about food intake. The Index of Nutritional Quality (INQ) was used to assess the adequacy of macronutrient and vitamin intake. Energy, protein and lipid intakes were higher in carriers of the A allele compared to TT in the younger age groups but were similar in the class of subjects aged ≥45 years. The INQ for protein was higher in carriers of the A allele than in carriers of the TT allele. The INQs for protein, carbohydrate, vitamins B2, B3 and B6 decreased, whereas the INQ for vitamin C increased with advancing age. The INQ for vitamin A was lower in AA than in TT, regardless of age, whereas vitamin E was higher in younger AA than in older AA. The INQ for vitamin B9 was higher in younger women than in older women. In conclusion, the FTO gene contributed to the intake of more energy, protein and lipids and interfered with the intake of vitamins B9, A and E. With the exception of vitamin A, the effect of the genotype was attenuated with ageing.
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Affiliation(s)
- Miriam Ribeiro Duarte
- Master in Nutrition, Food and Metabolism, Faculty of Nutrition, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | - Aline Souza de Moraes Heredia
- Master in Nutrition, Food and Metabolism, Faculty of Nutrition, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | - Vanessa Cristina Arantes
- Department of Food Nutrition, Faculty of Nutrition, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | | | | | - Bartira Mendes Gorgulho
- Department of Food Nutrition, Faculty of Nutrition, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | - Carlos Henrique Fregadolli
- Master in Nutrition, Food and Metabolism, Faculty of Nutrition, Federal University of Mato Grosso, Cuiabá, MT, Brazil
| | - Márcia Queiroz Latorraca
- Department of Food Nutrition, Faculty of Nutrition, Federal University of Mato Grosso, Cuiabá, MT, Brazil.
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Jannati N, Mahmoodi MR, Azadbakht L. Protein and fat intake impact on growth of primary school girls in Kerman, Iran. Sci Rep 2024; 14:15288. [PMID: 38961253 PMCID: PMC11222480 DOI: 10.1038/s41598-024-66001-4] [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: 08/06/2023] [Accepted: 06/26/2024] [Indexed: 07/05/2024] Open
Abstract
The school age period is characterized by significant physical and intellectual growth, necessitating the monitoring of macronutrient intake and its impact on weight and height. The objective of this study is to investigate the association between the quality and quantity of protein and fat consumption with anthropometric indices in primary school girls in Kerman. This cross-sectional analysis was conducted on primary school girls aged 6-12 (n 330) from ten schools in Kerman, Iran. A validated and reliable dish-based 185-item food frequency questionnaire was used. We calculated the amount of proteins and fats as the percentage of daily calories and grams per day. Plant-based and animal-based proteins were used to assess the protein quality. To assess the fat quality, we considered trans fatty acids (TFA), cholesterol, vegetable oils, solid vegetable oils, animal oils, omega-6 Polyunsaturated fatty acids (PUFAs), omega-3 PUFA, and (PUFAs + Monounsaturated fatty acids (MUFAs))/Saturated fatty acids (SFAs), PUFAs/SFA, and (MUFA + PUFA)/(SFA + TFA). There was a significant positive association between height-for-age z-score (HAZ) and plant protein (p < 0.001) and vegetable oils (p = 0.038) after adjustment. In higher tertiles of animal protein, weight-for-age z-score (WAZ) (p = 0.024) were significantly higher. A significant positive association was observed between omega-3 PUFA and mid-upper arm circumference (MUAC) (p = 0.039) and BMI-for-age z-score (BAZ) (p = 0.016). Our study emphasizes the importance of monitoring protein and fat intake in primary school girls for optimal growth. Positive associations were found between plant-based protein, vegetable oils and HAZ, as well as animal protein and WAZ, highlighting the impact of protein quality on growth indicators.
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Affiliation(s)
- Nooshin Jannati
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Reza Mahmoodi
- Physiology Research Center, Institute of Neuropharmacology and Department of Nutrition, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Rice I, Opondo C, Nyesigomwe L, Ekude D, Magezi J, Kalanzi A, Kerac M, Hayes J, Robello M, Halfman S, DeLacey E. Children with disabilities lack access to nutrition, health and WASH services: A secondary data analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13642. [PMID: 38563355 PMCID: PMC11168356 DOI: 10.1111/mcn.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.
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Affiliation(s)
- Isabel Rice
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
| | | | | | | | | | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH)University of LondonLondonUK
| | | | | | | | - Emily DeLacey
- Department of Population Health, London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population HealthUniversity of LondonLondonUK
- London School of Hygiene & Tropical Medicine, Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH)University of LondonLondonUK
- Holt InternationalEugeneOregonUSA
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Lecot-Connan T, Jeannin AC, Baptiste A, Dechartres A, Genser L, Oppert JM, Nizard J, Ciangura C. Pregnancy Outcomes After Bariatric Surgery: Importance of Maternal Ferritin on Birth Weight. Obes Surg 2024; 34:2305-2314. [PMID: 38842761 DOI: 10.1007/s11695-024-07285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The risks carried by pregnancy after bariatric surgery (BS) include small-for-gestational age (SGA) newborn and prematurity. However, the underlying mechanisms are not yet fully understood in pregnant women after BS. MATERIAL AND METHODS This single-center retrospective observational cohort study includes all women with a first and single pregnancy after BS who completed at least one clinical and biological nutritional assessment during pregnancy between 2010 and 2016. The quarterly biological assessment comprised blood count, ferritin, calcium, 25OH vitamin D, parathyroid hormone, fasting glucose, albumin, prealbumin, vitamin A, vitamin B12, folic acid, and zinc. RESULTS Among 120 pregnancies analysed, two-thirds underwent gastric bypass (Roux-en-Y and one-anastomosis) and one-third a restrictive procedure (adjustable gastric band or sleeve gastrectomy). The median [Q1-Q3] preoperative BMI was 43.8 [41.1-47.7] kg/m2 and the mean age at pregnancy was 32.6 ± 5.3 years. Weight loss and time from surgery to pregnancy were 35.1 ± 15.4 kg and 2.9 [1.3-4.5] years, respectively. Ten women (8%) gave birth prematurely, and 22 newborns (19%) were SGA. Univariate analysis shows that ferritin was significantly higher in mothers with SGA than in those without SGA (35.5 [22.3-69.5] vs. 15 [10-32] ng/ml) at third trimester of pregnancy. Women who received pre-pregnancy nutritional assessment seemed less likely to give birth to a SGA newborn (32% vs. 54%, p = 0.07). CONCLUSION Iron supplementation should be carefully prescribed and closely monitored during pregnancy in women who have undergone BS.
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Affiliation(s)
- Tatiana Lecot-Connan
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Anne-Caroline Jeannin
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Amandine Baptiste
- Clinical Research Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Agnès Dechartres
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Department of Public Health, 75013, Paris, France
| | - Laurent Genser
- Department of Digestive Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Jean-Michel Oppert
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Jacky Nizard
- Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Cécile Ciangura
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France.
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Singh SK, Chauhan A, Alderman H, Avula R, Dwivedi LK, Kapoor R, Meher T, Menon P, Nguyen PH, Pedgaonker S, Puri P, Chakrabarti S. Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India. MATERNAL & CHILD NUTRITION 2024; 20:e13644. [PMID: 38586943 PMCID: PMC11168363 DOI: 10.1111/mcn.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.
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Affiliation(s)
- Shri K. Singh
- International Institute for Population SciencesMumbaiIndia
| | - Alka Chauhan
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Harold Alderman
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Rasmi Avula
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Rati Kapoor
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Trupti Meher
- International Institute for Population SciencesMumbaiIndia
| | - Purnima Menon
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Phuong H. Nguyen
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Parul Puri
- International Institute for Population SciencesMumbaiIndia
| | - Suman Chakrabarti
- The International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
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Mbhenyane X, Kgatle M, Tambe A, Mushaphi F. Maternal Feeding Practices of Children One to Three Years in Collins Chabane Municipality of South Africa. Ecol Food Nutr 2024; 63:281-303. [PMID: 38770798 DOI: 10.1080/03670244.2024.2354691] [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: 05/22/2024]
Abstract
The aim was to assess maternal feeding practices of children one to three years. A descriptive observational design was employed. The sample consisted of mothers-child dyads. A validated structured questionnaire was used. Data was analyzed using SPSS version 26.0. The nutrition status of the children at birth indicated 11.6% underweight as compared to the time of the study (7.2%), 7.9% were stunted increased to 38.0%, while wasting decreased from 11.4%-2.4%. Early cessation of breastfeeding and inappropriate complementary feeding practices were the factors influencing growth. The prevalence of underweight and wasting were low while stunting and overweight were high.
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Affiliation(s)
- Xikombiso Mbhenyane
- Division Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Motlatso Kgatle
- Department of Nutrition, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Ayuk Tambe
- Division Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Fhumudzani Mushaphi
- Department of Nutrition, School of Health Sciences, University of Venda, Thohoyandou, South Africa
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Mardani RAD, Wu WR, Hajri Z, Thoyibah Z, Yolanda H, Huang HC. Effect of a Nutritional Education Program on Children's Undernutrition in Indonesia: A Randomized Controlled Trial. J Pediatr Health Care 2024; 38:552-563. [PMID: 38613537 DOI: 10.1016/j.pedhc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION To assess effects of a nutritional education program on improving mothers' undernutrition knowledge, self-efficacy, and complementary feeding practices, and reducing undernutrition in children aged <2 years. METHOD A randomized controlled trial was conducted at a community healthcare center in Indonesia. The intervention group participated in a 4-week nutritional education program; the control group received standard care (n = 80; 1:1 ratio). Measurements consisted of mothers' knowledge of undernutrition, self-efficacy, and complementary feeding practices, and children's anthropometric indicators. RESULTS Intervention group mothers improved their understanding of undernutrition, self-efficacy, and complementary feeding practices compared to the control group. Additionally, children in the intervention group exhibited increased mean Z-scores for stunting, wasting, and being underweight at 12 and 24 weeks following the intervention. DISCUSSION Healthcare professionals can regularly provide nutritional education programs related to managing undernutrition and complementary feeding practices for mothers with children aged <2 years to prevent and improve undernutrition.
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Mahmud I, Guesdon B, Kerac M, Grijalva‐Eternod CS. Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis. MATERNAL & CHILD NUTRITION 2024; 20:e13635. [PMID: 38433606 PMCID: PMC11168360 DOI: 10.1111/mcn.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/05/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Small and nutritionally at-risk infants aged under 6 months (<6 months) are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6 months admitted to inpatient therapeutic care. A secondary analysis of 2002-2008 data included 5034 infants aged <6 months from 12 countries. We estimated the prevalence, concurrence, and severity of wasted, stunted, and underweight, as stand-alone indicators, and using the Composite Index of Anthropometric Failure (CIAF), which combines these indicators into six subgroups of single and multiple anthropometric deficits and into one combined indicator called CIAF. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality. Among 3692 infants aged <6 months with complete data, 3539 (95.8%) were underweight, 3058 (82.8%) were wasted, 2875 (77.8%) were stunted and 3575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were presented with significantly lower anthropometric indices, that is, they were more severely wasted, stunted and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.2-2.7, p = 0.009, and OR = 3.3, 95% CI: 0.8-13.6, p = 0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR = 1.40, 95% CI: 1.02-1.92, p = 0.03). Mortality was only observed in infants <6 months presenting multiple anthropometric deficits, although their odds of mortality were not significant, for example, OR = 2.4, 95% CI: 0.5-10.0, p = 0.21 for stunted, wasted and underweight infants <6 months. In conclusion, multiple anthropometric deficits (CIAF) is common among infants <6 months and may be reported in nutrition care programmes and surveys. Both weight-for-length/height z-score and weight-for-age z-score were found to be useful indicators for programme admission and in-programme prognosis. Future work needs to explore which better accounts for admission bias. Boys appear to be most at-risk of dying while receiving malnutrition therapeutic care. Programmes should ensure that all infants receive timely, evidence-based, effective care.
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Affiliation(s)
- Imteaz Mahmud
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Department of Public HealthNorth South UniversityDhakaBangladesh
- The Power of NutritionLondonUK
| | | | - Marko Kerac
- Department of Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
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Hebert KA, Nsengiyumva E, Kayitesi C, Hariharan K, Opondo C, Ferguson E, Allen E, Uwonkunda I, Ufitinema A, Baribwira C. Before and after study of a national complementary and supplementary feeding programme in Rwanda, 2017-2021. MATERNAL & CHILD NUTRITION 2024; 20:e13648. [PMID: 38517120 PMCID: PMC11168355 DOI: 10.1111/mcn.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
To address high rates of malnutrition among children from vulnerable households in Rwanda, the government initiated a national food supplementation programme. A before and after evaluation, using repeat cross-sectional surveys in randomly selected villages was conducted; aimed at assessing the effectiveness of providing fortified blended food (FBF) to children 18-23 months of age, pregnant and lactating women in the lowest tier of Rwanda's social support system. Data were collected in 2017, 2018 and 2021 through interviews with caregivers; anthropometric measurements and a capillary blood sample were obtained from children. The primary statistical analysis compared the nutritional status of children before and after the introduction of FBF. We enroled 724 children during each survey. The prevalence of stunting declined from 47% to 35% between 2017 and 2021; in 2018, the prevalence of stunting was 43%. Children had a 42% reduction in the odds of being stunted (adjusted odds ratio [AOR]: 0.58, 95% confidence interval [CI]: 0.47-0.74, p < 0.001) from 2017 to 2021 even after adjusting for inherent, distal, proximal, and intermediate covariates. The reduction in stunting observed within the first year of the programme was not statistically significant (AOR: 0.83, 95% CI: 0.67-1.03, p < 0.091). We observed meaningful reductions in the prevalence of stunting among children which coincided with the introduction of Government-led initiative to reduce malnutrition. The Rwandan Government has committed to improving the living conditions of vulnerable households and has made strong investments in reducing malnutrition. The impact of these investments can be seen in the overall trend towards improved nutritional status highlighted in this evaluation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Cyprien Baribwira
- Institute of Human VirologyUniversity of Maryland School of MedicineBaltimoreMarylandUSA
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Iruhiriye E, Frongillo EA, Olney DK, Niyongira E, Nanama S, Blake CE, Rwibasira E, Mbonyi P. Understanding differential reductions in undernutrition among districts in Rwanda through the perspectives of mid-level and community actors on policy commitment and policy coherence. MATERNAL & CHILD NUTRITION 2024; 20:e13640. [PMID: 38494653 PMCID: PMC11168371 DOI: 10.1111/mcn.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 01/05/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024]
Abstract
Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi-structured interviews with mid-level actors (n = 38) and frontline workers (n = 20) implementing Rwanda's multi-sectoral nutrition policy in five districts in which stunting decreased (reduced districts) and five where it increased or stagnated (non-reduced districts) based on Rwanda's 2010 and 2014/15 Demographic and Health Surveys. Mid-level actors are government officials and service providers at the subnational level who represent the frontline of government policy. Interviews focused on political commitment to and policy coherence in nutrition, and contributors to nutrition changes. Responses were coded to capture themes on the changes and challenges of these topics and compared between reduced and non-reduced districts. Descriptive statistics described district characteristics. Political commitment to nutrition was high in both reduced and non-reduced districts. Respondents from reduced districts were more likely to define commitment to nutrition as an optimal implementation of policy, whereas those from non-reduced districts focused more on financial commitment. Regarding coherence, respondents from reduced compared to non-reduced districts were more likely to report the optimal implementation of multi-sectoral nutrition planning meetings, using data to assess plans and progress in nutrition outcomes and integration of nutrition into the agriculture sector. In contrast, respondents from non-reduced districts more often reported challenges in their relationships with national-level stakeholders and nutrition and/or monitoring and evaluation capacities. Enhancing the integration of nutrition in different sectors and improving mid-level actors' capacity to plan and advocate for nutrition programming may contribute to reductions in stunting.
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Affiliation(s)
- Elyse Iruhiriye
- University of South Carolina Arnold School of Public HealthColumbiaSouth CarolinaUSA
- International Food Policy Research InstituteWashington, DCDistrict of ColumbiaUSA
| | - Edward A. Frongillo
- University of South Carolina Arnold School of Public HealthColumbiaSouth CarolinaUSA
| | - Deanna K. Olney
- International Food Policy Research InstituteWashington, DCDistrict of ColumbiaUSA
| | | | | | - Christine E. Blake
- University of South Carolina Arnold School of Public HealthColumbiaSouth CarolinaUSA
| | | | - Paul Mbonyi
- Rwanda Consumer's Rights Protection Organization (ADECOR)KigaliRwanda
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Haq IU, Mehmood Z, Tahir M, Ahmad Zakki S, Siddiq K, Xu J, Wang S. Risk Factors of Wasting-Based Malnutrition in the Flood-Affected Areas of Pakistan: A Cross-Sectional Study. Ecol Food Nutr 2024; 63:343-354. [PMID: 38833628 DOI: 10.1080/03670244.2024.2361250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The current study aimed to find the risk factors of wasting in flood-affected areas of Khyber Pakhtunkhwa, Pakistan. Sociodemographic and anthropometric data was collected. Children living in large family are 2.59 times more likely to be wasted (AOR = 2.59, 95% confidence interval (CI): 1.10, 6.10; p value = .029) and children living in medium size family are 2.23 times more likely to be wasted (AOR = 2.23, 95% CI: 1.03, 4.80; p value = .04) as compared to children in small family size. The study underscores the need for targeted interventions to address the identified risk factors and mitigate the impact of flooding on child nutrition.
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Affiliation(s)
- Ijaz Ul Haq
- Department of Nursing, Children's Hospital of Fudan University, Shanghai, China
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Zafar Mehmood
- Department of Math's, Stats & Computer Science, The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Majid Tahir
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Shahbaz Ahmad Zakki
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Kalsoom Siddiq
- Department of Human Nutrition & Dietetics, Women University Mardan, Mardan, Pakistan
| | - Jielian Xu
- Department of Clinical Nutrition, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shengru Wang
- Department of Clinical Nutrition, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Lu Y, Hao YJ, Zhou X, Huang F, Li C, Wang J, Miao Z, Chen S, Zhang Y, Pan Z, Yin S, Li Y, Sun G. Effects of long-term intake of carotenoid-enriched eggs on healthy people: a randomized controlled study. Food Funct 2024; 15:7032-7045. [PMID: 38864191 DOI: 10.1039/d4fo00910j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Red palm oil, a natural repository abundant in tocotrienols, tocopherols and carotenoids, is frequently employed as a pigment and nutritional enhancer in food products. The principal aim of this study is to explore the disparities in vitamin A levels, fatty acid profiles and gut microbiota among healthy adults who consume carotenoid-enriched eggs compared to those who consume normal eggs. A total of 200 hens were randomly assigned to either the red palm oil group or the soybean oil group, with the objective of producing carotenoid-enriched eggs and normal eggs. Throughout a six-month, double-blinded, randomized controlled trial, participants were instructed to consume one carotenoid-enriched or normal egg daily at a fixed time. Fecal and blood samples were collected from the participants at the start and conclusion of the six-month intervention period for further analysis. Our findings indicated that there was no significant change in the vitamin A level for daily supplementation with one carotenoid-enriched egg, but there were significant changes in some indicators of fatty acid profiles and gut microbiota compared to the control group of the population. Nonetheless, the consumption of eggs, regardless of carotenoid-enriched eggs or normal eggs, positively influenced dietary habits by reducing the intake of saturated fatty acids and enhancing the intake of monounsaturated and polyunsaturated fatty acids of the population.
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Affiliation(s)
- Yifei Lu
- Institute of Agro-product Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, China.
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Yoong Jun Hao
- Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000, Kajang, Selangor, Malaysia
| | - Xin Zhou
- Jintan District Center for Disease Control and Prevention, Changzhou City, Chang Zhou 213200, P.R. China
| | - Feilin Huang
- Jintan Jianchang Health Center, Changzhou City, Chang Zhou 213200, P.R. China
| | - Chao Li
- Jintan Jianchang Health Center, Changzhou City, Chang Zhou 213200, P.R. China
| | - Jiao Wang
- Jintan District Center for Disease Control and Prevention, Changzhou City, Chang Zhou 213200, P.R. China
| | - Zhiyue Miao
- Palm Oil Research and Technical Service Institute of Malaysian Palm Oil Board, Shanghai, 201108, P.R. China
| | - Shiqing Chen
- Palm Oil Research and Technical Service Institute of Malaysian Palm Oil Board, Shanghai, 201108, P.R. China
| | - Yihan Zhang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Zhenyu Pan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Shiyu Yin
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
| | - Ying Li
- Institute of Agro-product Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, China.
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China.
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Bahwere P, Funnell G, Qarizada AN, Woodhead S, Bengnwi W, Le MT. Effectiveness of a nonweight-based daily dosage of ready-to-use therapeutic food in children suffering from uncomplicated severe acute malnutrition: A nonrandomized, noninferiority analysis of programme data in Afghanistan. MATERNAL & CHILD NUTRITION 2024; 20:e13641. [PMID: 38627974 PMCID: PMC11168373 DOI: 10.1111/mcn.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 06/13/2024]
Abstract
Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready-to-use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight-for-height z-score ≥ -3 or mid-upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight-based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per-protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (-0.9; 7.2) %] and length-of-stay [82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of -10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = -1.5 (-1.8, -1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain [∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight-based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource-constrained contexts.
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Affiliation(s)
- Paluku Bahwere
- Center for Epidemiology, Biostatistics and Clinical Research (CR2), School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
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Nyarko MJ, Ten Ham-Baloyi W, van Rooyen DRM. Qualitative Exploration of Health Professionals' Perceptions of Addressing Malnutrition Within the First 1,000 Days. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:442-451. [PMID: 38639691 DOI: 10.1016/j.jneb.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Explore health professionals' perceptions toward how to address malnutrition within the first 1,000 days of life in underresourced communities. DESIGN A qualitative explorative-descriptive study using 8 face-to-face focus group discussions. SETTING Health facilities serving underresourced communities within Nelson Mandela Bay, Eastern Cape Province, South Africa. PARTICIPANTS Fifty-six health professionals (n = 13 doctors, n = 28 nurses, n = 6 dietitians, and n = 9 social workers) aged between 20 and 60 years, with 1-16 years (5 years average) of working experience. The majority (n = 53; 94.6%) were women. PHENOMENON OF INTEREST Health professionals' perceptions of effective methods or strategies to address malnutrition are referred to as undernutrition. ANALYSIS Content analysis. RESULTS Health professionals perceived socioeconomic conditions; caregiver lack of nutrition knowledge; and behavioral, cultural, and generational infant feeding practices as contributing factors to malnutrition. Participants recommended efforts to strengthen the availability, accessibility, and utilization of contraception, especially for teenagers, increase support to caretakers of children from families, health facilities, and communities, and a multisector and multidisciplinary approach to improve social determinants of health in underresourced communities. CONCLUSIONS AND IMPLICATIONS To address malnutrition within the first 1,000 days of life, data supports that health professionals in underresourced communities require a multisector, multidisciplinary approach. This approach entails educational interventions, peer mentoring and community empowerment through support to and involvement of caregivers of children.
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Affiliation(s)
- Marian Joyce Nyarko
- Department of Nursing Science, Nelson Mandela University, Gqeberha, South Africa
| | - Wilma Ten Ham-Baloyi
- Department of Nursing Science, Nelson Mandela University, Gqeberha, South Africa.
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Mekonen EG, Workneh BS, Ali MS, Gonete AT, Alemu TG, Tamir TT, Tekeba B, Techane MA, Wassie M, Kassie AT, Zegeye AF. Minimum milk feeding frequency and its associated factors among non-breastfed children aged 6-23 months in sub-saharan Africa: a multilevel analysis of the recent demographic and health survey data. BMC Public Health 2024; 24:1734. [PMID: 38943130 PMCID: PMC11214211 DOI: 10.1186/s12889-024-19275-2] [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: 12/25/2023] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Poor infant and child feeding practices, in combination with increased rates of infectious diseases, are the main immediate causes of malnutrition during the first two years of life. Non-breastfed children require milk and other dairy products, as they are rich sources of calcium and other nutrients. As far as our search is concerned, there is no evidence on the pooled magnitude and determinants of minimum milk feeding frequency among non-breastfed children in sub-Saharan Africa conducted using the most recent indicators for assessing infant and young child feeding practices published in 2021. Therefore, this study is intended to determine the magnitude and associated factors of minimum milk feeding frequency among non-breastfed children aged 6-23 months in sub-Saharan Africa using the most recent guideline and demographic and health survey dataset. METHODS Data from the most recent health and demographic surveys, which were carried out between 2015 and 2022 in 20 sub-Saharan African countries, were used. The study comprised a weighted sample consisting of 13,315 non-breastfed children between the ages of 6 and 23 months. STATA/SE version 14.0 statistical software was used to clean, recode, and analyze data that had been taken from DHS data sets. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Model comparison and fitness were assessed using deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. RESULTS The pooled magnitude of minimum milk feeding frequency among non-breastfed children aged 6-23 months in sub-Saharan African countries was 12.39% (95% CI: 11.85%, 12.97%). Factors like maternal educational level [AOR = 1.61; 95% CI (1.35, 1.91)], marital status of the mother [AOR = 0.77; 95% CI (0.67, 0.89)], maternal working status [AOR = 0.80; 95% CI (0.71, 0.91)], media exposure [AOR = 1.50; 95% CI (1.27, 1.77)], wealth index [AOR = 1.21; 95% CI (1.03, 1.42)], place of delivery [AOR = 1.45; 95% CI (1.22, 1.72)], ANC visit attended during pregnancy [AOR = 0.49; 95% CI (0.39, 0.62)], PNC checkup [AOR = 1.57; 95% CI (1.40, 1.76)], child's age [AOR = 0.70; 95% CI (0.53, 0.93)], and residence [AOR = 2.15; 95% CI (1.87, 2.46)] were significantly associated with minimum milk feeding frequency. CONCLUSIONS In sub-Saharan Africa, the proportion of minimum milk feeding frequency among non-breastfed children aged between 6 and 23 months was low. The likelihood of minimum milk feeding frequency increases with high levels of education, unemployment, media exposure, rich wealth status, being unmarried, having a child born in a health facility, getting PNC checks, being between 6 and 8 months old, and living in an urban area. Hence, promoting women's education, increasing the economic status of the household, disseminating nutrition information through media, strengthening maternal health service utilization like health facility delivery and PNC services, and giving prior attention to mothers with older children and from rural areas are strongly recommended.
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Affiliation(s)
- Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Cichon B, López-Ejeda N, Mampindu MB, Bagayoko A, Samake M, Cuellar PC. Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300431. [PMID: 38901972 PMCID: PMC11216703 DOI: 10.9745/ghsp-d-23-00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/14/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Enabling community health workers (CHWs) to treat acute malnutrition improves treatment access and coverage. However, data on the cost and cost-effectiveness of this approach is limited. We aimed to cost the treatment at scale and determine the cost-effectiveness of different levels of supervision and technical support. METHODS This economic evaluation was part of a prospective nonrandomized community intervention study in 3 districts in Mali examining the impact of different levels of CHW and health center supervision and support on treatment outcomes for children with severe acute malnutrition. Treatment admission and outcome data were extracted from the records of 120 participating health centers and 169 CHW sites. Cost data were collected from accountancy records and through key informant interviews. Results were presented as cost per child treated and cured. Modeled scenario sensitivity analyses were conducted to determine how cost-efficiency and cost-effectiveness estimates change in an equal scale scenario and/or if the supervision had been done by government staff. RESULTS In the observed scenario, with an unequal number of children, the average cost per child treated was US$203.40 in Bafoulabé where a basic level of supervision and support was provided, US$279.90 in Kayes with a medium level of supervision, and US$253.9 in Kita with the highest level of supervision. Costs per child cured were US$303.90 in Bafoulabé, US$324.90 in Kayes, and US$311.80 in Kita, with overlapping uncertainty ranges. CONCLUSION Additional supervision has the potential to be a cost-effective strategy if supervision costs are reduced without compromising the quality of supervision. Further research should aim to better adapt the supervision model and associated tools to the context and investigate where efficiencies can be made in its delivery.
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Affiliation(s)
| | - Noemí López-Ejeda
- EPINUT Research Group, Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | | | - Aliou Bagayoko
- Nutrition Direction of the Ministry of Hygiene and Public Health, Bamako, Mali
| | - Mahamadou Samake
- Nutrition Direction of the Ministry of Hygiene and Public Health, Bamako, Mali
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Kitil GW, Butta FW, Tadesse S, Degefa BD, Feyisa GT, Demsash AW, Shibabaw AA, Marami SN, Walle AD, Dube GN, Wedajo LF, Dirirsa DE, Jifar WW, Chereka AA. Effective breastfeeding techniques and associated factors among lactating women in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0306167. [PMID: 38935684 PMCID: PMC11210781 DOI: 10.1371/journal.pone.0306167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Effective breastfeeding is crucial for maternal and child health, particularly in low-resource settings like Ethiopia. It encompasses a range of skills and strategies, including proper latch, positioning, and frequency of feeding. These techniques not only ensure sufficient milk transfer but also foster bonding between mother and child, enhancing the breastfeeding experience. To effectively prioritize maternal and child health, it is crucial to comprehensively understand the prevalence and factors influencing effective breastfeeding nationwide. Therefore, this study aimed to provide a pooled prevalence of effective breastfeeding techniques and associated factors among lactating mothers in Ethiopia. METHODS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, focusing on studies conducted in Ethiopia. We identified eight relevant studies through Google Scholar, Medline, PubMed, Scopus, and the Cochrane Library. Analysis was conducted using STATA version 11, and systematic data extraction employed a checklist to extract relevant data. I2 tests and the Cochrane Q test statistic were used to evaluate heterogeneity. To explore potential publication bias, Egger's weighted regression, Begg's test, and a funnel plot were utilized. RESULTS We identified a total of 955 research articles. Eight studies meeting the eligibility criteria were incorporated into this meta-analysis and systematic review. The pooled prevalence of effective breastfeeding techniques was 41.99% [95% CI 32.16-51.81]. According to the results of the current meta-analysis, effective breastfeeding techniques were significantly associated with antenatal care follow-up [OR = 1.75, 95% CI 1.10-2.78], maternal educational status [OR = 2.70, 95% CI 1.55-4.71], breastfeeding technique counseling [OR = 2.02, 95% CI 1.41-2.90], the absence of breast problems [OR = 2.26, 95% CI 1.49-3.43], breastfeeding experience [OR = 1.98, 95% CI 1.14-3.46], and immediate skin-to-skin contact [OR = 2.32, 95% CI 1.56-3.44]. CONCLUSION Our findings highlight the vital role of various factors in shaping effective breastfeeding. IMPLICATIONS To improve practices and health outcomes, we recommend targeted interventions, such as strengthening antenatal care, implementing maternal education, and providing comprehensive breastfeeding counseling. Proactively addressing breast problems and prioritizing immediate skin-to-skin contact is crucial for successful breastfeeding.
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Affiliation(s)
- Gemeda Wakgari Kitil
- Department of Midwifery, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Fikadu Wake Butta
- Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Shimelis Tadesse
- Department of Midwifery, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Bekem Dibaba Degefa
- Department of Midwifery, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Gizu Tola Feyisa
- Department of Midwifery, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | | | - Adamu Ambachew Shibabaw
- Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | | | - Agmasie Damtew Walle
- Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Geleta Nenko Dube
- Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Lema Fikadu Wedajo
- Department of Midwifery, College of Medicine and Health Sciences, Wallagga University, Nekemte, Ethiopia
| | - Dejene Edosa Dirirsa
- Department of Midwifery, College of Health and Medical Sciences, Salale University, Fiche, Ethiopia
| | - Wakuma Wakene Jifar
- Department of Pharmacy, College of Health Sciences, Mattu University, Mattu, Ethiopia
| | - Alex Ayenew Chereka
- Department of Health Informatics, College of Health Sciences, Mattu University, Mattu, Ethiopia
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Thompson L, Becher E, Adams KP, Haile D, Walker N, Tong H, Vosti SA, Engle-Stone R. Modeled impacts of bouillon fortification with micronutrients on child mortality in Senegal, Burkina Faso, and Nigeria. Ann N Y Acad Sci 2024. [PMID: 38922959 DOI: 10.1111/nyas.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Micronutrient interventions can reduce child mortality. By applying Micronutrient Intervention Modeling methods in Senegal, Burkina Faso, and Nigeria, we estimated the impacts of bouillon fortification on apparent dietary adequacy of vitamin A and zinc among children and folate among women. We then used the Lives Saved Tool to predict the impacts of bouillon fortification with ranges of vitamin A, zinc, and folic acid concentrations on lives saved among children 6-59 months of age. Fortification at 250 µg vitamin A/g and 120 µg folic acid/g was predicted to substantially reduce vitamin A- and folate-attributable deaths: 65% for vitamin A and 92% for folate (Senegal), 36% for vitamin A and 74% for folate (Burkina Faso), and >95% for both (Nigeria). Zinc fortification at 5 mg/g would avert 48% (Senegal), 31% (Burkina Faso), and 63% (Nigeria) of zinc-attributable deaths. The addition of all three nutrients at 30% of Codex nutrient reference values in 2.5 g bouillon was predicted to save an annual average of 293 child lives in Senegal (3.5% of deaths from all causes among children 6-59 months of age), 933 (2.1%) in Burkina Faso, and 18,362 (3.7%) in Nigeria. These results, along with evidence on program feasibility and costs, can help inform fortification program design discussions.
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Affiliation(s)
- Lauren Thompson
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
| | - Emily Becher
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
| | - Katherine P Adams
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Demewoz Haile
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hannah Tong
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen A Vosti
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA
| | - Reina Engle-Stone
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Department of Nutrition, University of California, Davis, Davis, California, USA
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21
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Muhammad A, Shafiq Y, Nisar MI, Balouch B, Pasha A, Yazdani NS, Rizvi A, Sajid M, Jehan F. Effect of maternal post-natal Balanced Energy Protein supplementation and infant Azithromycin on infant growth outcomes- An Open-label randomized controlled trial. Am J Clin Nutr 2024:S0002-9165(24)00542-2. [PMID: 38925354 DOI: 10.1016/j.ajcnut.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Maternal undernutrition is a direct risk factor for infant growth faltering. OBJECTIVE We evaluated the effect of postnatal Balanced Energy Protein (BEP) supplementation in lactating women and Azithromycin (AZ) in infants on infant growth outcomes. DESIGN A randomized controlled superiority trial of lactating mother-newborn dyads was conducted in Karachi, Pakistan. Mothers intending to breastfeed their newborns with mid-upper arm circumference of less than 23 cm and live infants between 0-6 days of life were randomly assigned to one of three arms in a 1:1:1 ratio. Lactating mothers in the control arm received standard-of-care counseling on exclusive breastfeeding, nutrition, infant immunization and health promotion plus iron-folate supplementation until the infant was 6 months of age. In intervention arm 1, mothers additionally received two 75-gram sachets of BEP per day, while in intervention arm 2 along with the standard-of-care and BEP, the infant also received one dose of Azithromycin (at 20 mg per kilogram) at 42 days of life. The primary outcome was infant length velocity at 6 months. The total sample size was 957 (319 in each arm). RESULTS From August 1, 2018 to May 19, 2020, 319 lactating mother-newborn dyads were randomized in each arm, and the last follow-up was completed on November 20, 2020. The mean difference in length velocity (cm per month) between BEP alone and control was 0.01 (95% CI: -0.03, 0.06), BEP plus AZ and control was 0.08 (95% CI:0.03,0.13) and between BEP+AZ and BEP alone was 0.06 (95% CI: 0.01, 0.11). There were 1.46% (14/957) infant deaths in the trial, and 17.9% (171/957) non-fatal events (injectable treatment and/or hospitalizations) were recorded. CONCLUSION Postnatal maternal BEP supplementation and infant AZ administration could modestly improve infant growth outcomes at 6 months, suggesting potential benefits in simultaneously addressing maternal and infant undernutrition. CLINICAL TRIAL DATA This trial is registered on ClinicalTrials.gov NCT03564652 on June 21, 2018.
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Affiliation(s)
| | - Yasir Shafiq
- Center of Excellence for Trauma and Emergencies and Community Health Sciences, The Aga Khan University, Karachi, Pakistan; Global Advancement of Infants and Mothers (AIM), Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health (CRIMEDIM), Università degli Studi del Piemonte Orientale "Amedeo Avogadro", Vercelli, Italy
| | - Muhammad Imran Nisar
- Department of Pediatrics & Child Health Medical College, Aga Khan University, Karachi, Pakistan
| | - Benazir Balouch
- Department of Pediatrics & Child Health Medical College, Aga Khan University, Karachi, Pakistan
| | - Aneela Pasha
- Department of Pediatrics & Child Health Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Arjumand Rizvi
- Centre of Excellence in Maternal and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Sajid
- Centre of Excellence in Maternal and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics & Child Health Medical College, Aga Khan University, Karachi, Pakistan.
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22
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Lai WK, Palaniveloo L, Mohd Sallehuddin S, Ganapathy SS. Double burden of malnutrition and its socio-demographic determinants among children and adolescents in Malaysia: National Health And Morbidity Survey 2019. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:94. [PMID: 38915044 PMCID: PMC11197233 DOI: 10.1186/s41043-024-00583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/09/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Malaysia faces the threat of a double burden of malnutrition where undernutrition and overweight (including obesity) coexist in the same population. This study aimed to determine the anthropometric assessment among children and adolescents aged 5 to 17 years and its association with socio-demographic factors. METHODS Data were extracted from the National Health and Morbidity Survey conducted in 2019. This cross-sectional survey applied a two-stage stratified sampling design. Socio-demographic characteristics were obtained. Weight and height were measured, age- and sex-specific standard scores for height and BMI were calculated to establish individual's anthropometric assessment. Having either stunting or thinness was considered undernutrition, while being overweight (including obesity) was considered overnutrition. If someone had undernutrition and/or overnutrition, they were classified as having malnutrition. The prevalence was determined using complex sampling analysis, while the association was assessed through logistic regression. The analysis included a total of 3,185 respondents. RESULTS The prevalence of stunting, thinness, overweight and obesity among the respondents aged 5 to 17 years was 12.7%, 10.0%, 15.0% and 14.8%, respectively. The overall prevalence of malnutrition was 48.3%. Respondents residing in rural had 1.35 times more likelihood of experiencing undernutrition [AOR = 1.35, 95% CI (1.04, 1.77)] compared to their urban counterparts. Boys exhibited a greater likelihood of being overweight and obese than girls [AOR = 1.40, 95% CI (1.13, 1.73)]. Respondents aged 10 to 14 years were 1.37 times more likely to be overnutrition than those aged 5 to 9 years old [AOR = 1.37, 95% CI (1.09, 1.73)]. CONCLUSION There is growing evidence of the increasing prevalence of coexistence of undernutrition along with overweight and obesity among children and adolescents in Malaysia. Moving forward, greater initiatives and efforts are required to formulate strategies for planning and implementing programs and policies to expedite progress in improving nutrition.
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Affiliation(s)
- Wai Kent Lai
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia.
- Raub Health District Office, Pahang State Health Deparment, Ministry of Health, Raub, Malaysia.
| | - Lalitha Palaniveloo
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
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Jenkins M, Jefferds MED, Aburto NJ, Ramakrishnan U, Hartman TJ, Martorell R, Addo OY. Development of a population-level dichotomous indicator of minimum dietary diversity as a proxy for micronutrient adequacy in U.S. adolescents aged 10-19 years. J Nutr 2024:S0022-3166(24)00341-9. [PMID: 38917947 DOI: 10.1016/j.tjnut.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Diversity is a key component of diet quality and health, but no indicator exists for adolescents under the age of 15 years. OBJECTIVE To establish a dichotomous indicator for population-level assessment of adolescent dietary diversity as a proxy for micronutrient adequacy. METHODS We used the probability approach to construct mean probability of adequacy (MPA) of 11 micronutrients from 2 days of 24-hour dietary recall data from NHANES, 2007-2018. For each micronutrient, probability of adequacy was calculated using the best linear unbiased predictor of usual intake. Adolescent dietary diversity score (ADDS) was derived with a maximum score of 10 food groups. Generalized linear mixed models were used to examine associations between ADDS and MPA. Receiver operating characteristic analysis was used to establish a cutoff for minimum dietary diversity for adolescents (MDD-A), using an energy-adjusted logistic model with ADDS predicting MPA > 0.6. RESULTS Probability of adequacy was greater than 80% for all nutrients except vitamin C (42.1%), folate (65.7%), and calcium (23.8%). Population MPA was 79.4%, and nearly 92% of adolescents had an MPA > 0.6. ADDS was positively associated with MPA, and energy was a significant confounder. Area under the curve was > 0.8 on both days with sensitivity and specificity ranging from 0.71-0.80. The MDD-A cutoff was calculated as 5.12 and 5.10 food groups on day 1 and 2, respectively. CONCLUSIONS In U.S. adolescents, the best cutoff for a dichotomous indicator of dietary diversity as a proxy for micronutrient adequacy is 6 food groups in a given day. Future research could validate MDD-A and its associated cutoff for use across country contexts.
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Affiliation(s)
- Mica Jenkins
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
| | - Maria Elena D Jefferds
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nancy J Aburto
- Food and Nutrition Division, Food and Agriculture Organization, Rome, Italy
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Terryl J Hartman
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reynaldo Martorell
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - O Yaw Addo
- International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Schanz WR, Akhter A, Richardson G, Story WT, Samuelson R, Imdad A. Perceptions of families and healthcare providers about feeding preterm infants in the neonatal intensive care unit: protocol for a qualitative systematic review. BMJ Open 2024; 14:e084884. [PMID: 38908851 DOI: 10.1136/bmjopen-2024-084884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION The underdevelopment of preterm infants can lead to delayed progression through key early milestones. Demonstration of safe oral feeding skills, constituting proper suck-swallow reflex are requirements for discharge from the neonatal intensive care unit (NICU) to ensure adequate nutrition acquisition. Helping an infant develop these skills can be draining and emotional for both families and healthcare staff involved in the care of preterm infants with feeding difficulties. Currently, there are no systematic reviews evaluating both family and healthcare team perspectives on aspects of oral feeding. Thus, we first aim to evaluate the current knowledge surrounding the perceptions, experiences and needs of families with preterm babies in the context of oral feeding in the NICU. Second, we aim to evaluate the current knowledge surrounding the perceptions, experiences and needs of healthcare providers (physicians, advanced practice providers, nurses, dietitians, speech-language pathologists and occupational therapists) in the context of oral feeding in the NICU. METHODS AND ANALYSIS A literature search will be conducted in multiple electronic databases from their inception, including PubMed, CINHAL, Embase, the Cochrane Central Register for Controlled Trials and PsycINFO. No restrictions will be applied based on language or data of publication. Two authors will screen the titles and abstracts and then review the full text for the studies' inclusion in the review. The data will be extracted into a pilot-tested data collection sheet by three independent authors. To evaluate the quality, reliability and relevance of the included studies, the Critical Appraisal Skills Programme checklist will be used. The overall evidence will be assessed using the Grading of Recommendation Assessment, Development and Evaluation criteria. We will report the results of the systematic review by following the Enhancing Transparency in Reporting the synthesis of Qualitative research checklist. ETHICS AND DISSEMINATION Ethical approval of this project is not required as this is a systematic review using published and publicly available data and will not involve contact with human subjects. Findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023479288.
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Affiliation(s)
- Willow R Schanz
- The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Aunum Akhter
- Division of Neonatology, The University of Iowa Health Care, Stead Family Department of Pediatrics, Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Georgette Richardson
- Division of Pediatric Psychology, The University of Iowa Health Care, Stead Family Department of Pediatrics, Iowa City, Iowa, USA
| | - William T Story
- Department of Community and Behavioral Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Riley Samuelson
- University of Iowa Hardin Library for the Health Sciences, Iowa City, Iowa, USA
| | - Aamer Imdad
- Division of Gastroenterology, Hepatology, Pancreatology and Nutrition, University of Iowa Health Care, Stead Family Department of Pediatrics, Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
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25
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Ali A, Islam J, Paul R, Parvin S, Mohammed Mohiuddin Chowdhury AT, Islam R, Siddique S, Rahman A, Tasnim ST, Hasna S. Geographic inequalities and determinants of anaemia among preeclamptic women: a cross-sectional sample-based study in Bangladesh. BMC Public Health 2024; 24:1650. [PMID: 38902634 PMCID: PMC11191240 DOI: 10.1186/s12889-024-18176-8] [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: 07/30/2023] [Accepted: 02/21/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Anaemia among preeclamptic (PE) women is a major undefined health issue in Bangladesh. This study explored the risk factors associated with anaemia and mapped the regional influences to understand the geographical inequalities. METHODS Data from 180 respondents were prospectively collected from the Preeclampsia ward of Dhaka Medical College Hospital (DMCH), Bangladesh. Anaemia was defined as a blood haemoglobin level less than 11.0 g/dl. Preeclampsia was defined as systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) ≥ 90 mmHg with proteinuria. Factors associated with anaemia were explored using the chi-square test. Logistic regression (LR) was done to determine the level of association with the risk factors. RESULTS Among the participants, 28.9% were identified as having early onset and 71.1% reported late onset of PE. 38.9% of the subjects were non-anaemic, whereas mild, moderate, and severe anaemia was found among 38.3%, 17.8%, and 5% of patients respectively. The following factors were identified; including age range 25-34 (OR: 0.169, p < 0.05), a lower education level (OR: 3.106, p < 0.05), service-holder mothers (OR: 0.604, p < 0.05), pregnancy interval of less than 24 months (OR: 4.646, p < 0.05), and gestational diabetes mellitus (OR: 2.702, p < 0.05). Dhaka district (IR: 1.46), Narayanganj district (IR: 1.11), and Munshiganj district (IR: 0.96) had the highest incidence rates. CONCLUSION Determinants of anaemia must be considered with importance. In the future, periodic follow-ups of anaemia should be scheduled with a health care program and prevent maternal fatality and fetus morbidity in patients with PE.
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Affiliation(s)
- Ahasan Ali
- Department of Physiology and Pathophysiology, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Jahirul Islam
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
| | - Ratna Paul
- Department of Gynecology and Obstetrics, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh
| | - Shahinur Parvin
- Department of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | | | - Rafiqul Islam
- Daffodil International University Dhaka, Dhaka, Bangladesh
| | - Sharmina Siddique
- Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Atiqur Rahman
- Plastic, Aesthetic and Maxillofacial surgery, Xian Jiaotong University, Xi'an, Shaanxi, P.R. China
| | | | - Suraiya Hasna
- Ad-din Women Medical College Hospital Dhaka, Dhaka, Bangladesh
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Ruchitha BG, Kumar D, Chandrakanth M, Farooq I, Kumar N, Sura C, Chetan S, Tung S. Effect of developmental and adult diet composition on reproductive aging in Drosophila melanogaster. Exp Gerontol 2024; 194:112501. [PMID: 38897017 DOI: 10.1016/j.exger.2024.112501] [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: 05/26/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/21/2024]
Abstract
Diet significantly affects reproductive outcomes across species, yet the precise effects of macronutrient compositions beyond caloric intake on reproductive aging are understudied. Existing literature presents conflicting views on the fertility impacts of nutrient-rich versus nutrient-poor developmental diets, underscoring a notable research gap. This study addresses these gaps by examining effects of isocaloric diets with varied protein-to-carbohydrate ratios during both developmental and adult stages on reproductive aging of a large, outbred Drosophila melanogaster population (n = ∼2100). Our results clearly demonstrate an age-dependent dietary impact on reproductive output, initially dominated by the developmental diet, then by a combination of developmental and adult diets in early to mid-life, and ultimately by the adult diet in later life. Importantly, we found that the effects of developmental and adult diets on reproductive output are independent, with no significant interaction. Further investigations into the mechanisms revealed that the effect of developmental diet on fecundity is regulated via ovarioles formation and vitellogenesis; while, the effect of adult diet on fecundity is mostly regulated only via vitellogenesis. These insights resolve disputes in the literature about dietary impacts on fertility and offer valuable perspectives for optimizing fertility strategies in improving public health and conservation efforts in this changing world.
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Affiliation(s)
- B G Ruchitha
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029; Indian Institute of Science Education and Research (IISER) Pune, Pune, Maharashtra, India, 411008.
| | - Devashish Kumar
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029.
| | - Mohankumar Chandrakanth
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029.
| | - Itibaw Farooq
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029
| | - Nishant Kumar
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029.
| | - Chand Sura
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029.
| | - S Chetan
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029.
| | - Sudipta Tung
- Integrated Genetics and Evolution Laboratory (IGEL), Department of Biology, Ashoka University, Sonipat, Haryana, India, 131029.
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Li J, Liu JX, Shen XL, Wang YQ, Yan CH. A national survey of iodine nutrition in children aged 3-6 years in China and its relationship with children's physical growth. MATERNAL & CHILD NUTRITION 2024:e13685. [PMID: 38886166 DOI: 10.1111/mcn.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/11/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
Iodine, an essential trace element for the human body, plays a pivotal role in sustaining health. Malnutrition has emerged as a pressing public health concern, posing a significant threat to human well-being. Iodine deficiency poses a substantial threat to the development of children, potentially leading to neurological developmental disorders and mental retardation. Conversely, excessive iodine intake can result in structural and functional abnormalities in the thyroid gland. In this study, we selected children aged 3-6 years through a stratified cluster sampling approach in six regions across China to explore the correlation between iodine nutrition and their physical growth. A total of 5920 preschool children participated in this study, with a median urinary iodine concentration (UIC) of 177.33 [107.06, 269.92] μg/L. Among these children, 250 (4.2%) exhibited stunting, 180 (3.0%) were underweight, 198 (3.3%) experienced wasting, 787 (3.3%) were overweight and 414 (7.0%) were classified as obese. The multivariate linear regression revealed that UIC exhibited a positive correlation with body mass index z-Score (BMIZ) in overweight children (β = 0.038; 95% CI: 0.001, 0.075). In normally growing children, the associations between UIC and height-for-age z-score, weight-for-age z-score and BMIZ displayed nonlinear patterns. Our findings suggest that iodine nutrition is adequate for Chinese children aged 3-6 years. Furthermore, iodine nutrition is intricately linked to the growth and development of these children. Consequently, it is imperative to implement decisive measures to prevent both iodine deficiency and excess.
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Affiliation(s)
- Jing Li
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun-Xia Liu
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Li Shen
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Qing Wang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chong-Huai Yan
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Prithishkumar IJ, Sappani M, Ranjan V, Garg C, Mani T, Babu M, Joy M, Rao B, Asirvatham ES, Lakshmanan J. Double burden of malnutrition among women of reproductive age: Trends and determinants over the last 15 years in India. PLoS One 2024; 19:e0304776. [PMID: 38870186 PMCID: PMC11175463 DOI: 10.1371/journal.pone.0304776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Double burden of malnutrition (DBM) has been recognized by the World Health Organisation (WHO) as an emerging Global Syndemic characterized by the simultaneous occurrence of both undernutrition and overnutrition. Women of the reproductive age group (15 to 49 years) are disproportionately affected by DBM and are at high risk of continuing the intergenerational cycle of malnutrition. This study aims to assess the changing trends and determinants of DBM among women of the reproductive age group in India. MATERIALS AND METHODS We used data from three rounds of National Family Health Surveys (NFHS-3,4,5) conducted in years 2005-06, 2015-16, and 2019-2021. Descriptive statistics and Poisson regression analysis were done using weights with log link function. RESULTS The prevalence of anaemia, underweight and overweight/obesity was 57.2%, 18.6% and 24% respectively. The combined burden of underweight and anaemia has declined by 46% (21.6% to 11.7%), whereas the combined burden of overweight/obesity and anaemia has increased by 130% (5.4% to 12.4%) in the past 15 years. The prevalence of DBM, which includes both underweight and overweight/obesity with anaemia was 24.1% in 2021, a decline of 11% in 15 years. Women who were younger, rural, less educated, poor and middle class, and women living in the eastern, western and southern regions of India had higher risk for being underweight with anaemia and lower risk for developing overweight/obesity with anaemia. CONCLUSION The significant decrease in underweight yet enormous increase in overweight/obesity over the past 15 years with the persistence of anaemia in both ends of the nutritional spectrum is characteristic of the new nutritional reality emphasizing the need to address malnutrition in all its forms. It is critical to consider geography and a population specific, double-duty targeted intervention to holistically address the risk factors associated with DBM and accomplish India's commitment to the global agenda of Sustainable Development Goals-2030.
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Affiliation(s)
- Ivan James Prithishkumar
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, UAE
| | - Marimuthu Sappani
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Varsha Ranjan
- Independent Public Health Consultant, New Delhi, India
| | - Chhavi Garg
- Faculty of Science, Global Health: Research, Vrije Universiteit, Amsterdam, Netherlands
| | - Thenmozhi Mani
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Malavika Babu
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Melvin Joy
- Biostatistician, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Bhawna Rao
- National AIDS Control Organization (NACO), New Delhi, India
| | | | - Jeyaseelan Lakshmanan
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, UAE
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Zemariam AB, Adisu MA, Habesse AA, Abate BB, Bizuayehu MA, Wondie WT, Alamaw AW, Ngusie HS. Employing advanced supervised machine learning approaches for predicting micronutrient intake status among children aged 6-23 months in Ethiopia. Front Nutr 2024; 11:1397399. [PMID: 38919392 PMCID: PMC11198118 DOI: 10.3389/fnut.2024.1397399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Background Although micronutrients (MNs) are important for children's growth and development, their intake has not received enough attention. MN deficiency is a significant public health problem, especially in developing countries like Ethiopia. However, there is a lack of empirical evidence using advanced statistical methods, such as machine learning. Therefore, this study aimed to use advanced supervised algorithms to predict the micronutrient intake status in Ethiopian children aged 6-23 months. Methods A total weighted of 2,499 children aged 6-23 months from the Ethiopia Demographic and Health Survey 2016 data set were utilized. The data underwent preprocessing, with 80% of the observations used for training and 20% for testing the model. Twelve machine learning algorithms were employed. To select best predictive model, their performance was assessed using different evaluation metrics in Python software. The Boruta algorithm was used to select the most relevant features. Besides, seven data balancing techniques and three hyper parameter tuning methods were employed. To determine the association between independent and targeted feature, association rule mining was conducted using the a priori algorithm in R software. Results According to the 2016 Ethiopia Demographic and Health Survey, out of 2,499 weighted children aged 12-23 months, 1,728 (69.15%) had MN intake. The random forest, catboost, and light gradient boosting algorithm outperformed in predicting MN intake status among all selected classifiers. Region, wealth index, place of delivery, mothers' occupation, child age, fathers' educational status, desire for more children, access to media exposure, religion, residence, and antenatal care (ANC) follow-up were the top attributes to predict MN intake. Association rule mining was identified the top seven best rules that most frequently associated with MN intake among children aged 6-23 months in Ethiopia. Conclusion The random forest, catboost, and light gradient boosting algorithm achieved a highest performance and identifying the relevant predictors of MN intake. Therefore, policymakers and healthcare providers can develop targeted interventions to enhance the uptake of micronutrient supplementation among children. Customizing strategies based on identified association rules has the potential to improve child health outcomes and decrease the impact of micronutrient deficiencies in Ethiopia.
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Affiliation(s)
- Alemu Birara Zemariam
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Molalign Aligaz Adisu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Aklilu Abera Habesse
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Molla Azmeraw Bizuayehu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Addis Wondmagegn Alamaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Habtamu Setegn Ngusie
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
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Saha M, Ng H, Odjidja EN, Saha M, Olivier P, McCaffrey TA, Thilsted SH. Small Fish Big Impact: Improving Nutrition during Pregnancy and Lactation, and Empowerment for Marginalized Women. Nutrients 2024; 16:1829. [PMID: 38931183 PMCID: PMC11206690 DOI: 10.3390/nu16121829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Undernutrition and micronutrient deficiencies such as anemia are considered significant public health challenges in Bangladesh, which enhancing fish consumption is a well-established food-based intervention to address these. This paper documents the establishment of community-based fish chutney production and reports the impact of its consumption on mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels among targeted 150 pregnant and lactating women (PLW) in rural Bangladesh. A fish chutney was developed using locally available ingredients followed by a series of laboratory tests, including nutrient composition, shelf-life and food safety. A community-based fish chutney production process was designed to: (1) supply locally available ingredients for processing; (2) establish two fish drying sites; (3) initiate a community-based production site; and (4) distribute fish chutney to PLW for one year by six women nutrition field facilitators. Then a pre- and post-intervention study was designed for a selected 150 PLW to receive 30 g of fish chutney daily for 12 months. Differences in mean MUAC and Hb levels pre- and post-consumption were analyzed using one-way analysis of variance. Consumption of 30 g of fish-chutney resulted in significant increases of the mean values of Hb levels and MUAC among the targeted PLW.
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Affiliation(s)
- Manika Saha
- Faculty of Information Technology, Monash University, Clayton 3168, Australia
| | - Heidi Ng
- Digital Nutrition Lab, Department of Nutrition, Dietetics and Food, Monash University, Notting Hill 3168, Australia;
| | | | - Mallika Saha
- Department of Biology, Texas State University, San Marcos, TX 78666, USA;
| | - Patrick Olivier
- Action Lab, Faculty of Information Technology, Monash University, Clayton 3168, Australia;
| | - Tracy A. McCaffrey
- Digital Nutrition Lab, Department of Nutrition, Dietetics and Food, Monash University, Notting Hill 3168, Australia;
| | - Shakuntala Haraksingh Thilsted
- Nutrition, Health & Food Security Impact Platform, Consortium of International Agricultural Research Centers (CGIAR), Washington, DC 20005, USA;
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Maw AA, Thwin T, Owino VO, Ward LC. Development of a bioelectrical impedance analysis-based prediction equation for body composition of rural children aged 4-8 years in Myanmar. Nutr Health 2024:2601060241260983. [PMID: 38860329 DOI: 10.1177/02601060241260983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background: Reliable and accurate estimates of body composition are essential when studying the various health correlates of disease. Bioelectrical impedance analysis (BIA) is an affordable and feasible body composition assessment technique for clinical and field settings. Total body water (TBW) and hence fat-free mass is estimated by predictive regression algorithms using anthropometric measurements plus the resistance index. Aim: The study aimed to develop a BIA prediction equation for TBW in children in Myanmar using the deuterium dilution technique as the reference method. Methods: The study design was cross-sectional in a school setting with convenience sampling of participants. One hundred and two healthy children (57 boys and 45 girls) with aged 4 and 8 years participated; randomly divided into the prediction group (29 boys and 22 girls) and cross-validation group (28 boys and 23 girls). Whole-body impedance, anthropometric and TBW (by D2O dilution) measurements. The prediction equation was cross-validated using a split-group design and compared to published equations for contemporaneous populations. Results: TBW could be predicted by the following equation. TBW = 0.4597 * Weight (kg) + 0.1564 * Impedance index + 0.6075 (R2 = 0.891, P < 0.0001) with a correlation coefficient of 0.942 and limits of agreement of 0.98 kg TBW on cross-validation. Conclusions: This equation can be used to predict body composition in young (aged 4-8 years) children in Myanmar but because the age range of the participants in the present study was relatively narrow, more research in different age groups is required to establish its broader applicability.
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Affiliation(s)
- Aye Aye Maw
- Department of Medical Research, Myanmar Ministry of Health and Sports, Yangon, Myanmar
| | - Theingi Thwin
- Department of Medical Research, Myanmar Ministry of Health and Sports, Yangon, Myanmar
| | - Victor O Owino
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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Tong Y, Ratnasiri K, Hanif S, Nguyen AT, Roh ME, Dorsey G, Kakuru A, Jagannathan P, Benjamin-Chung J. Pathways through which intermittent preventive treatment for malaria in pregnancy influences child growth faltering: a mediation analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.09.24308656. [PMID: 38947035 PMCID: PMC11213035 DOI: 10.1101/2024.06.09.24308656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background Intermittent preventive treatment for malaria in pregnancy (IPTp) can improve birth outcomes, but whether it confers benefits to postnatal growth is unclear. We investigated the effect of IPTp on infant growth in Uganda and its pathways of effects using causal mediation analyses. Methods We analyzed data from 633 infants born to mothers enrolled in a randomized trial of monthly IPTp with dihydroartemisinin-piperaquine (DP) vs sulfadoxine-pyrimethamine (SP) (NCT02793622). Weight and length were measured from 0-12 months of age. Using generalized linear models, we estimated effects of DP vs. SP on gravidity-stratified mean length-for-age (LAZ) and weight-for-length Z-scores (WLZ). We investigated mediation by placental malaria, gestational weight change, maternal anemia, maternal inflammation-related proteins, preterm birth, birth length, and birth weight. Mediation models adjusted for infant sex, gravidity, gestational age at enrollment, maternal age, maternal parasitemia at enrollment, education, and wealth. Findings SP increased LAZ by 0.18-0.28 Z from birth through age 4 months compared to DP, while DP increased WLZ by 0.11-0.28 Z from 2-8 months compared to SP among infants of multigravidae. We did not observe these differences among primigravida. Mediators of SP included increased birth weight and length and maternal stem cell factor at delivery. Mediators of DP included placental malaria and birth length, maternal IL-18, CDCP1, and CD6 at delivery. Interpretation In high malaria transmission settings, different IPTp regimens influenced infant growth among multigravidae through distinct pathways in the period of exclusive breastfeeding, when few other interventions are available. Funding Stanford Center for Innovation and Global Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bill & Melinda Gates Foundation. Research in context Evidence before this study: Intermittent Preventive Treatment in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended by the WHO for regions with moderate-to-high malaria transmission. While SP is effective in reducing neonatal mortality and low birth weight, its efficacy has diminished in some areas of sub-Saharan Africa due to widespread parasite resistance to SP. Although IPTp with dihydroartemisinin-piperaquine (IPTp-DP) has demonstrated superior efficacy in reducing malaria in pregnancy, its impact on birth outcomes has not significantly surpassed that of SP. The ultimate goal of IPTp extends beyond enhancing birth outcomes to include benefits during infancy and later stages. Yet, the effects of SP vs. DP in relation to infant growth post-birth and the underlying mechanisms remain unknown. Prior studies also found that different IPTp regimens worked through different pathways, with DP influencing birth outcomes by reducing placental malaria and SP influencing them through non-malarial pathways such as maternal weight gain. Here, we re-analyzed data from of a randomized trial in Uganda to explore the impacts of these two IPTp regimens on infant growth and to understand potential mechanisms underlying its impacts on infant growth.Added value of this study: This study quantified how IPTp with SP compared to DP influenced infants' growth trajectories, both ponderal and linear, during the first year of life. We found that SP improved linear growth of infants up to age 4 months compared to DP, and DP improved ponderal growth of infants from 2-8 months compared to SP among babies who were born to multigravidae. In addition, we identified birth size, placental malaria, and certain markers of maternal inflammation measured at delivery using the Olink Target 96 inflammation panel as pathways through which IPTp influenced infant growth. Our approach provides new insights into effects of IPTp beyond birth and the mechanisms by which IPTp impacts infant growth.Implications of all the available evidence: Our study provides evidence that different IPTp regimens can influence infant postnatal growth through distinct pathways. Our findings highlight the potential of combined SP and DP IPTp regimens and bolster the evidence base for continued delivery of IPTp to improve maternal and child health outcomes, particularly in malaria-endemic regions.
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Affiliation(s)
- Yanwei Tong
- Department of Statistics, Stanford University, Stanford, United States
| | - Kalani Ratnasiri
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
- Department of Microbiology and Immunology, Stanford University, Stanford, United States
| | - Suhi Hanif
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
| | - Anna T. Nguyen
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
| | - Michelle E. Roh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States
| | - Grant Dorsey
- Department of Medicine, Division of HIV, ID, and Global Medicine, University of California San Francisco, San Francisco
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, United States
- Chan Zuckerberg Biohub, San Francisco, United States
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Tchuente BRT, Nguedjo MW, Ngoumen DJN, De Wandji GCF, Tene Mouafo H, Tambe BA, Medoua GN, Ndomo Tsamo V. Prevalence and associated factors of coexisting forms of malnutrition in children under 5 years age in a rural area of Cameroon. PLoS One 2024; 19:e0303611. [PMID: 38857288 PMCID: PMC11164324 DOI: 10.1371/journal.pone.0303611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/28/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Malnutrition of children under 5 years of age is persistent in Cameroon principally in rural areas. Moreover, there is limited knowledge of coexisting forms of malnutrition (CFM) among children of this age. Therefore, the aim of this study was to assess the prevalence of CFM in a cohort of children under 5 years and to identify the associated factors. METHODS A cross-sectional study was conducted in the Health Districts of the locality of Dschang in the West region of Cameroon between June 2021 to November 2021. Data were collected from 200 under-five children of both sexes and an interviewer-administered questionnaire was administered to consented children's mothers/guardians. Malnutrition in children was assessed by WHO growth standards (weight-for-height, weight-for-age, height-for-age and body mass index-for-age). The different CFM were defined by the presence of two autonomous forms of malnutrition in the same child. Logistic regression analyses were done to identify factors associated to different coexisting forms of malnutrition. RESULTS The results obtained showed prevalences of 4.20% for the coexistence of underweight with wasting, 7.8% for the coexistence of underweight with stunting and 14.8% for the coexistence of stunting with overweight. Lower maternal age (15-24 years old; OR = 0.09; p = 0.05) and lower education level (primary education, OR = 23.33; p = 0.00) were associated with the coexistence of underweight with wasting. Marital status (single mother, OR = 0.28; p = 0.00) was associated to the coexistence of stunting with overweight/obesity. CONCLUSION The findings of this study provide evidence on the coexistence of different forms of malnutrition among children below five years of age in rural area of Cameroon. These finding would guide future research, policies, and programs on the management of malnutrition in rural areas of Cameroon.
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Affiliation(s)
- Boris Ronald Tonou Tchuente
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | | | | | - Hippolyte Tene Mouafo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Betrand Ayuk Tambe
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Gabriel Nama Medoua
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Vigny Ndomo Tsamo
- Nkong-Ni Subdivisionnnal Medical Center, Menoua Division, West Region of Cameroon, Dschang, Cameroon
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Duffley E, Grynspan D, Scott H, Lafrenière A, Borba Vieira de Andrade C, Bloise E, Connor KL. Gestational Age, Infection, and Suboptimal Maternal Prepregnancy BMI Independently Associate with Placental Histopathology in a Cohort of Pregnancies without Major Maternal Comorbidities. J Clin Med 2024; 13:3378. [PMID: 38929907 PMCID: PMC11204067 DOI: 10.3390/jcm13123378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The placenta undergoes morphological and functional adaptations to adverse exposures during pregnancy. The effects ofsuboptimal maternal body mass index (BMI), preterm birth, and infection on placental histopathological phenotypes are not yet well understood, despite the association between these conditions and poor offspring outcomes. We hypothesized that suboptimal maternal prepregnancy BMI and preterm birth (with and without infection) would associate with altered placental maturity and morphometry, and that altered placental maturity would associate with poor birth outcomes. Methods: Clinical data and human placentae were collected from 96 pregnancies where mothers were underweight, normal weight, overweight, or obese, without other major complications. Placental histopathological characteristics were scored by an anatomical pathologist. Associations between maternal BMI, placental pathology (immaturity and hypermaturity), placental morphometry, and infant outcomes were investigated for term and preterm births with and without infection. Results: Fetal capillary volumetric proportion was decreased, whereas the villous stromal volumetric proportion was increased in placentae from preterm pregnancies with chorioamnionitis compared to preterm placentae without chorioamnionitis. At term and preterm, pregnancies with maternal overweight and obesity had a high percentage increase in proportion of immature placentae compared to normal weight. Placental maturity did not associate with infant birth outcomes. We observed placental hypermaturity and altered placental morphometry among preterm pregnancies with chorioamnionitis, suggestive of altered placental development, which may inform about pregnancies susceptible to preterm birth and infection. Conclusions: Our data increase our understanding of how common metabolic exposures and preterm birth, in the absence of other comorbidities or complications, potentially contribute to poor pregnancy outcomes and developmental programming.
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Affiliation(s)
- Eleanor Duffley
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada; (E.D.); (H.S.)
| | - David Grynspan
- Children’s Hospital of Eastern Ontario, Department of Pathology, Ottawa, ON K1H 8L1, Canada;
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Hailey Scott
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada; (E.D.); (H.S.)
| | - Anthea Lafrenière
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, ON K1H 8L6, Canada;
- Department of Pathology and Immunology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Cherley Borba Vieira de Andrade
- Histology and Embryology Department, Roberto Alcantara Gomes Institute of Biology, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil;
| | - Enrrico Bloise
- Department of Morphology, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil;
- Department of Physiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Kristin L. Connor
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada; (E.D.); (H.S.)
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Jenkins M, Amoaful EF, Abdulai M, Quartey V, Situma R, Ofosu-Apea P, Aballo J, Demuyakor ME, Gosdin L, Mapango C, Jefferds MED, Addo OY. Comparison of venous and pooled capillary hemoglobin levels for the detection of anemia among adolescent girls. Front Nutr 2024; 11:1360306. [PMID: 38912302 PMCID: PMC11191668 DOI: 10.3389/fnut.2024.1360306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/17/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Blood source is a known preanalytical factor affecting hemoglobin (Hb) concentrations, and there is evidence that capillary and venous blood may yield disparate Hb levels and anemia prevalence. However, data from adolescents are scarce. Objective To compare Hb and anemia prevalence measured by venous and individual pooled capillary blood among a sample of girls aged 10-19 years from 232 schools in four regions of Ghana in 2022. Methods Among girls who had venous blood draws, a random subsample was selected for capillary blood. Hb was measured using HemoCue® Hb-301. We used Lin's concordance correlation coefficient (CCC) to quantify the strength of the bivariate relationship between venous and capillary Hb and a paired t-test for difference in means. We used McNemar's test for discordance in anemia cases by blood source and weighted Kappa to quantify agreement by anemia severity. A multivariate generalized estimating equation was used to quantify adjusted population anemia prevalence and assess the association between blood source and predicted anemia risk. Results We found strong concordance between Hb measures (CCC = 0.86). The difference between mean venous Hb (12.8 g/dL, ± 1.1) and capillary Hb (12.9 g/dL, ± 1.2) was not significant (p = 0.26). Crude anemia prevalence by venous and capillary blood was 20.6% and 19.5%, respectively. Adjusted population anemia prevalence was 23.5% for venous blood and 22.5% for capillary (p = 0.45). Blood source was not associated with predicted anemia risk (risk ratio: 0.99, 95% CI: 0.96, 1.02). Discordance in anemia cases by blood source was not significant (McNemar p = 0.46). Weighted Kappa demonstrated moderate agreement by severity (ĸ = 0.67). Among those with anemia by either blood source (n = 111), 59% were identified by both sources. Conclusion In Ghanaian adolescent girls, there was no difference in mean Hb, anemia prevalence, or predicted anemia risk by blood source. However, only 59% of girls with anemia by either blood source were identified as having anemia by both sources. These findings suggest that pooled capillary blood may be useful for estimating Hb and anemia at the population level, but that caution is needed when interpreting individual-level data.
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Affiliation(s)
- Mica Jenkins
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Esi Foriwa Amoaful
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | - Mutala Abdulai
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | - Veronica Quartey
- Nutrition Department, Family Health Division, Ghana Health Service, Ministry of Health, Accra, Ghana
| | | | | | | | - Maku E. Demuyakor
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Lucas Gosdin
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Carine Mapango
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Maria Elena D. Jefferds
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - O. Yaw Addo
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, United States
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Takale G, Handore A, Jeyakumar A, Godbharle S. Prevalence and determinants of multiple chronic conditions (MCC) among young adults in Indian households: an analysis of NFHS-5. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:77. [PMID: 38835054 DOI: 10.1186/s41043-024-00560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Multiple chronic conditions (MCC) are defined as the presence of two or more chronic conditions, that significantly impact health status, functional capacity, quality of life, and overall healthcare management. Despite the significant evidence on chronic disease burden, the co-existence of MCC within a household in low- and middle-income countries (LMICs) is less studied. This study therefore estimates the prevalence of MCC and its determinants among adults in the Indian households. METHODS Data used in this study were drawn from the fifth round of the National Family Health Survey (NFHS) conducted in 2019-21. Data sets of men (15-54 years) and women (15-49 years) were used for the study. The total sample size of adults for this analysis was N = 239,848. The outcome variable of this study was multiple chronic conditions (MCC) in adults which included a total of nine chronic conditions (hypertension, diabetes, chronic respiratory diseases, chronic kidney disorders, cancer, thyroid disorders, obesity, and heart diseases, consuming alcohol, chewing tobacco, and smoking) documented in NFHS-5. Descriptive statistics and binary logistic regression analysis were used to quantify the results. RESULTS A prevalence of 5.5% of MCC in adults emerged from our study. Logistic regression analysis identified that younger age, males (AOR 0.36 (0.33-0.39)), urban areas (AOR 1.11 (1.02-1.17)) as the place of residence, and participants representing SC (AOR 0.89 (0.81-0.97)), and ST (AOR 1.30 (1.17-1.45)), had a higher risk of MCC irrespective of level of education, type of occupation, marital status, or wealth index, and states from any category of social progress. CONCLUSION A 5% prevalence of MCC specifically obesity, substance use, and hypertension calls for integrated efforts aiming at behavior change, and regulatory efforts to prevent further increase of MCC among young adults in India.
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Affiliation(s)
- Geetanjali Takale
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, India
| | - Avantika Handore
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, India
| | - Angeline Jeyakumar
- Food Evolution Research Laboratory (FERL), School of Tourism and Hospitality Management, College of Business and Economics, University of Johannesburg, Johannesburg, South Africa
- Department of Nutrition, University of Nevada, Reno, NV, USA
| | - Swapnil Godbharle
- Department of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Road, Pune, Maharashtra, India.
- Food Evolution Research Laboratory (FERL), School of Tourism and Hospitality Management, College of Business and Economics, University of Johannesburg, Johannesburg, South Africa.
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Stavitz J. Understanding Micronutrient Access through the Lens of the Social Ecological Model: Exploring the Influence of Socioeconomic Factors-A Qualitative Exploration. Nutrients 2024; 16:1757. [PMID: 38892693 PMCID: PMC11174576 DOI: 10.3390/nu16111757] [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: 03/25/2024] [Revised: 04/21/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Micronutrient deficiencies disproportionately affect various populations, influenced by a complex interplay of socioeconomic factors. This study delves into the intricate relationship between socioeconomic status and micronutrient access, emphasizing the perceptions of affordability, availability, and the impact of social support networks. METHODS A qualitative research design was employed, using purposive sampling to enlist a diverse cohort of participants from varied socioeconomic backgrounds. The methodology comprised semi-structured interviews and focus groups to gather detailed insights into the participants' experiences and views on micronutrient access. The analysis framework was based on the Social Ecological Model (SEM), enabling an in-depth examination of individual, interpersonal, community, and societal influences. RESULTS With 30 participants, aged 20-70, representing a range of unique characteristics such as differing health conditions, cultural backgrounds, and economic statuses, the study uncovered five key themes: Individual-Level Factors, Interpersonal Relationships, Community Environment, Societal Factors, and Intersectionality. These themes illustrate how personal dietary habits, social networks, community resources, and broader socioeconomic policies converge to shape micronutrient access, emphasizing the complex interplay of overlapping social identities and structural barriers. CONCLUSION The findings highlight the need for holistic nutrition interventions that account for the extensive spectrum of socioeconomic determinants. This study not only enriches the theoretical underpinnings of the SEM but also provides actionable insights for crafting targeted strategies to enhance micronutrient access and ameliorate dietary inequities. It advocates for comprehensive public health initiatives attuned to the nuanced needs and hurdles faced by diverse demographic sectors.
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Affiliation(s)
- James Stavitz
- Athletic Training Education, College of Health Professions and Human Services, Kean University, Union, NJ 07083, USA
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Rhodes IJ, Alston CC, Zhang A, Arbuiso S, Medina SJ, Liao M, Ng JJ, Romeo D, Dahir S, Rhodes WR, Otterburn DM. The Pattern and Profile of Orofacial Clefts in Somaliland: A Review of 40 Consecutive Cleft Lip and Palate Surgical Camps. J Craniofac Surg 2024:00001665-990000000-01682. [PMID: 38838366 DOI: 10.1097/scs.0000000000010340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
INTRODUCTION Somaliland is an autonomously run country that is not internationally recognized. As such, it has been largely excluded by global health development programs despite being the world's fourth poorest country. The purpose of this study was to provide the first known description of the pattern and clinical profile of patients with cleft lip and palate from this nation. METHODS The authors performed a retrospective chart review on all patients who received cleft lip and palate repair by a single surgeon in 40 separate surgical camps at Edna Adan University Hospital in Hargeisa, Somaliland, between 2011 and 2024. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. Descriptive statistical analysis was performed. RESULTS A total of 767 patients (495 male, 64.5%) received 787 surgical procedures. The average age of primary surgery was 73.7 months. The most common chief complaint was left cleft lip with cleft palate (316, 41.2%). Males received primary surgery 19.2 months later than did females (73.7 and 54.6 mo, respectively, P<0.001). Patients residing in Hargeisa received their initial procedure an average of 17.8 months younger than those who lived elsewhere in Somaliland (62.9 and 80.7 mo, respectively, P=0.004). CONCLUSIONS In this severely economically depressed region, patients received treatment at ages that lagged far beyond recommended guidelines. Our finding of earlier treatment for females than males is rare in the literature and likely relates to cultural sex expectations. Patients from rural locations were especially vulnerable to receiving delayed treatment. Further efforts to decrease the burden of craniofacial deformities in Somaliland should be pursued in earnest.
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Affiliation(s)
- Isaiah J Rhodes
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Chase C Alston
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Ashley Zhang
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Sophia Arbuiso
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Samuel J Medina
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Matthew Liao
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Jinggang J Ng
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Dominic Romeo
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Shugri Dahir
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - William R Rhodes
- Division of Plastic Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - David M Otterburn
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY
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Owoputi I, Hoddinott J, Kayanda R, Bezner Kerr R, Dickin K. Community Health Workers' Targeting of Women For Health and Nutrition Home Visits in Rural Tanzania: A Mixed-Methods Study. Curr Dev Nutr 2024; 8:103780. [PMID: 38939649 PMCID: PMC11208947 DOI: 10.1016/j.cdnut.2024.103780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/29/2024] Open
Abstract
Background Community health workers (CHWs) are utilized in many health systems to provide education and messaging to families in their catchment areas. However, CHWs responsible for large geographic areas often must make important decisions about whom to visit. Factors that influence these decisions are understudied. Objectives This study assessed coverage and targeting for home visits by CHWs within a large social and behavioral change health program in rural Tanzania. Methods This implementation research was a cross-sectional, mixed-methods study. Data collection included a census with households and surveys with females, surveys with CHWs, and interviews with CHWs. Survey data also included the collection of household location data for females and CHWs. Quantitative data were analyzed using linear probability models, and qualitative data were analyzed using inductive thematic analysis. Results Only 13% of eligible households in our study sites reported receiving a home visit from a CHW. Although CHWs were more likely to reach households with infants, other program priority populations, such as poor and food insecure households, were frequently missed. Global positioning system data showed that distance was 1 of the greatest barriers for CHWs in providing home visits. Qualitative data indicated that although CHWs were motivated and engaged to improve maternal and child health in their communities, they faced challenges in visiting households that were further away or lacked economic resources to improve their health behaviors. CHWs also found it difficult to provide health education during home visits to mothers with no formal schooling. Conclusions Programs relying on community volunteers need to set realistic workloads, especially when volunteer CHWs also work full-time in their primary occupations. Implementation could also be strengthened by providing extra support for CHWs so that they can effectively provide services to community members who are more difficult to visit but may be the most in need.
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Affiliation(s)
- Ibukun Owoputi
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Department of Global Development, Cornell University, Ithaca, NY, United States
- Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY, United States
| | | | - Rachel Bezner Kerr
- Department of Global Development, Cornell University, Ithaca, NY, United States
| | - Kate Dickin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, United States
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Blumrich L, Masiero Silva L, Dias Barreto V, Rohde LA, Polanczyk GV, Miguel EC, Grisi SJFE, Fleitlich-Bilyk B, Ferraro AA. Causal Pathways Between the Acute Experience of Violence During Pregnancy and Fetal Intrauterine Growth Restriction: A Cohort Study. J Womens Health (Larchmt) 2024; 33:765-773. [PMID: 38551182 DOI: 10.1089/jwh.2023.0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Introduction: Violence during pregnancy (VDP) is a prevalent global issue with dire consequences for the mother and the developing fetus. These consequences include prematurity, low birthweight, and intrauterine growth restriction (IUGR), but its pathways remain elusive. This study investigated the causal pathways between VDP and IUGR using mediation analysis. Methods: A prospective population-based birth cohort was followed from the beginning of the third gestational trimester to the second year of life. IUGR was defined by the Kramer index, and information on VDP was collected using the WHO-Violence Against Women (WHO VAW) questionnaire. Cases were considered positive only when no other life episodes were reported. Ten different mediators were analyzed as possible pathways based on previous research. Path analysis was conducted to evaluate these relationships. Results: The path analysis model included 755 dyads and presented an adequate fit. Violence during pregnancy showed a direct effect (β = -0.195, p = 0.041) and a total effect (β = -0.276, p = 0.003) on IUGR. Violence was associated with gestational depression or anxiety, tobacco and alcohol consumption, changes in blood pressure, and the need for emergency care, but these did not constitute mediators of its effect on IUGR. The sum of the indirect effects, however, showed a significant association with IUGR (β = -0.081, p = 0.011). Conclusion: The acute experience of violence during pregnancy was associated with IUGR, primarily via a direct pathway. An indirect effect was also present but not mediated through the variables analyzed in this study. The robust strength of these associations underscores the negative health consequences of violence against women for the succeeding generation.
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Affiliation(s)
- Lukas Blumrich
- Department of Pediatrics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul; Medical Council UniEduK; National Institute of Developmental Psychiatry & National Center for Innovation and Research in Mental Health, São Paulo, Brazil
| | | | | | | | - Bacy Fleitlich-Bilyk
- Department of Psychiatry, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
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Eom YJ, Chi H, Jung S, Kim J, Jeong J, Subramanian S, Kim R. Women's empowerment and child anthropometric failures across 28 sub-Saharan African countries: A cross-level interaction by Gender Inequality Index. SSM Popul Health 2024; 26:101651. [PMID: 38524893 PMCID: PMC10958109 DOI: 10.1016/j.ssmph.2024.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/01/2024] [Accepted: 03/02/2024] [Indexed: 03/26/2024] Open
Abstract
Background Child undernutrition remains a major global health issue, particularly in sub-Saharan Africa (SSA). Given the important role mothers play in early childhood health and development, we examined how individual-level women's empowerment and country-level Gender Inequality Index (GII) are jointly related with child undernutrition in SSA. Methods We pooled recent Demographic and Health Surveys from 28 SSA countries. For 137,699 children <5 years old, undernutrition was defined using anthropometric failures (stunting, underweight, wasting). Women's empowerment was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence, social independence, and decision-making; and country-level gender inequality was measured using GII from United Nations Development Programme. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII as well as their interactions with child anthropometric failures, after adjusting for sociodemographic covariates. Results Overall, 32.85% of children were stunted, 17.63% were underweight, and 6.68% had wasting. Children of mothers with low-level of empowerment for all domains of SWPER had higher odds of stunting (attitude to violence: OR=1.15; 95% CI, 1.11-1.19; social independence: OR=1.21; 95% CI, 1.17-1.25; decision-making: OR=1.16; 95% CI, 1.12-1.20), and consistent results were found for underweight and wasting. Independent of women's empowerment, country-level GII increased the probability of underweight (ranging ORs=1.46; 95% CI, 1.15-1.85 to 1.50; 95% CI, 1.18-1.90) and wasting (ranging ORs=1.56; 95% CI, 1.24-1.97 to 1.61; 95% CI, 1.27-2.03). Significant interaction was found between women's empowerment and country-level GII for stunting and underweight (p<0.05). Conclusions In SSA countries with greater gender inequality, improving women's social independence and decision-making power in particular can reduce their children's risk of anthropometric failures. Policies and interventions targeted at strengthening women's empowerment should consider the degree of gender inequality in each country.
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Affiliation(s)
- Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jinseo Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1516 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Kiosia A, Dagbasi A, Berkley JA, Wilding JPH, Prendergast AJ, Li JV, Swann J, Mathers JC, Kerac M, Morrison D, Drake L, Briend A, Maitland K, Frost G. The double burden of malnutrition in individuals: Identifying key challenges and re-thinking research focus. NUTR BULL 2024; 49:132-145. [PMID: 38576109 DOI: 10.1111/nbu.12670] [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: 10/30/2023] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
The 'double burden of malnutrition' is a global health challenge that increasingly affects populations in both low- and middle-income countries (LMICs). This phenomenon refers to the coexistence of undernutrition and overweight or obesity, as well as other diet-related non-communicable diseases, in the same population, household or even individual. While noteworthy progress has been made in reducing undernutrition in some parts of the world, in many of these areas, the prevalence of overweight and obesity is increasing, particularly in urban areas, resulting in greater numbers of people who were undernourished in childhood and have overweight or obesity in adulthood. This creates a complex and challenging situation for research experts and policymakers who must simultaneously address the public health burdens of undernutrition and overweight/obesity. This review identifies key challenges and limitations in the current research on the double burden of malnutrition in individuals, including the need for a more comprehensive and nuanced understanding of the drivers of malnutrition, the importance of context-specific interventions and the need for greater attention to the food environment and food systems. We advocate for the re-evaluation of research strategies and focus, with a greater emphasis on multidisciplinary and systems approaches and greater attention to the synergistic relationship between the biological, environmental, commercial and socio-economic determinants of malnutrition. Addressing these key challenges can enable us to better comprehend and tackle the multifaceted and dynamic issues of the double burden of malnutrition, particularly in individuals and work towards more effective and sustainable solutions.
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Affiliation(s)
- Agklinta Kiosia
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Health Data Research Global, HDR UK, London, UK
| | - Aygul Dagbasi
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - James A Berkley
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - John P H Wilding
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jia V Li
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Jon Swann
- School of Human Development and Health, University of Southampton Faculty of Medicine, Southampton, UK
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, William Leech Building, Newcastle University, Newcastle upon Tyne, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Douglas Morrison
- Scottish Universities Environmental Research Centre, East Kilbride, UK
| | - Lesley Drake
- Partnership for Child Development, School of Public Health, Imperial College London, London, UK
| | - Andre Briend
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Kathryn Maitland
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Gary Frost
- Section of Nutrition, Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
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O'Malley SF, Ambikapathi R, Ghosh S, Galvin L, Jeong J, Mosha D, PrayGod G, Mapendo F, Shively G, Murray-Kolb LE, Gunaratna NS. Contribution of Food from Market Purchases and Home Production to Child Nutrient Intake: Evidence from the EFFECTS Study Baseline Data. J Nutr 2024; 154:1907-1916. [PMID: 38608871 DOI: 10.1016/j.tjnut.2024.04.015] [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: 10/17/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Child undernutrition is prevalent in Tanzania, and households rely primarily on local markets and home production as food sources. However, little is known about the contribution of food market purchases to nutrient intakes among children consuming complementary foods. OBJECTIVES To quantify the relationships between diversity of foods purchased and produced by households and adequate child nutrient intake in Mara, Tanzania. METHODS Cross-sectional baseline dietary and household food source data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania study were collected from mothers of 586 children aged 9-23 mo clustered in 80 villages in Mara, Tanzania. We conducted mixed effects linear regressions to quantify the association between the diversity of foods consumed at home, from market purchases and home production, and nutrient intake adequacy (based on 24-h food recalls). RESULTS Children had inadequate diets, with fewer than half of children consuming adequate amounts of vitamin A, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B9 (folate), calcium, iron, and zinc. Breastfeeding was associated with higher overall mean adequacy (b = 0.15-0.19 across models, P < 0.001). Diversity of foods purchased was positively associated with the intake of vitamin B12 and calcium (both P < 0.001); this effect was attenuated among breastfed children. Among nonbreastfed children, production diversity was positively associated with vitamin A intake (b=0.04; P < .05) but not with intake of other nutrients. CONCLUSIONS Both household food purchase and food production diversities were positively associated with children's nutrient intake in rural Mara, Tanzania. Nutrition programming should consider the role of food markets in addition to home food production to improve child diets. This trial was registered at clinicaltrials.gov as NCT03759821, https://clinicaltrials.gov/study/NCT03759821.
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Affiliation(s)
- Savannah F O'Malley
- Department of Public Health, Purdue University, West Lafayette, IN, United States; Department of Nutrition Science, Purdue University, West Lafayette, IN, United States.
| | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, United States; Department of Global Development, Cornell University, Ithaca, NY, United States
| | - Susmita Ghosh
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Lauren Galvin
- Global Communities, Program Quality and Accountability Department, Silver Spring, MD, United States
| | - Joshua Jeong
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Dominic Mosha
- Department of Global Health, BeVera Solutions LLC, Riverdale, GA, United States
| | - George PrayGod
- National Institute for Medical Research, Muhimbili Medical Research Centre, Tanzania
| | - Frank Mapendo
- Africa Academy for Public Health, Research and Program Unit, Tanzania
| | - Gerald Shively
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, United States
| | - Laura E Murray-Kolb
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Nilupa S Gunaratna
- Department of Public Health, Purdue University, West Lafayette, IN, United States
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Adams KP, Vosti SA, Somé JW, Tarini A, Becher E, Koudougou K, Engle-Stone R. Micronutrient-fortified bouillon as a strategy to improve the micronutrient adequacy of diets in Burkina Faso. Ann N Y Acad Sci 2024; 1536:135-150. [PMID: 38809659 DOI: 10.1111/nyas.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Bouillon is a promising candidate for fortification to complement existing large-scale food fortification (LSFF) programs. We used household dietary data from Burkina Faso to model potential contributions of bouillon fortified with vitamin A (40-250 μg/g bouillon), folic acid (20-120 μg/g), vitamin B12 (0.2-2 μg/g), iron (0.6-5 mg/g), and zinc (0.6-5 mg/g) for meeting micronutrient requirements of women of reproductive age (15-49 years; WRA) and children (6-59 months). Most households (82%) reported bouillon consumption, with higher proportions of resource-constrained (84-88%) and rural households (88%) consuming bouillon. Accounting for the contributions of existing LSFF, household diets were inadequate to meet the micronutrient requirements of many WRA and children, exceeding 90% and 60% inadequacy for vitamins A and B12, respectively. Modeling results showed bouillon fortification could reduce inadequacy by up to ∼30 percentage points (pp) for vitamin A, ∼26 pp for folate among WRA (∼11 pp among children), ∼38 pp for vitamin B12, and 11-13 pp for zinc, with comparable reductions across socioeconomic strata and urban and rural residence. Predicted reductions in iron inadequacy were <3 pp. These results suggest dietary micronutrient inadequacies are a concern in Burkina Faso, and fortified bouillon can make substantial contributions to reducing micronutrient inadequacies, including among resource-constrained and rural populations.
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Affiliation(s)
- Katherine P Adams
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Stephen A Vosti
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California, USA
| | - Jérome W Somé
- Institut de Recherche en Sciences de la Santé, Centre National de Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | | | - Emily Becher
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
| | | | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, California, USA
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Wand H, Naidoo S, Govender V, Reddy T, Moodley J. Preventing Stunting in South African Children Under 5: Evaluating the Combined Impacts of Maternal Characteristics and Low Socioeconomic Conditions. JOURNAL OF PREVENTION (2022) 2024; 45:339-355. [PMID: 38416314 PMCID: PMC11033229 DOI: 10.1007/s10935-024-00766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/29/2024]
Abstract
More than 140 million children under five suffered from stunting in 2020. This highlights the ongoing challenge of addressing childhood malnutrition globally. We utilized data from a nationally representative sample of children under five years of age (n = 14,151) who participated in five cycles of the South African National Income Dynamics Study (SA-NIDS) (2008-2017). We estimated the proportion of stunted children attributed to the mothers' anthropometric characteristics and socioeconomic conditions. We also quantified the population-level burden of low-socioeconomic conditions on hunger/food insecurity among pregnant women (n = 22,814) who participated in the nine rounds of the South African General Household Surveys (GHS) (2008-2021). Results from weighted-multivariate logistic regression were incorporated into the population-level impacts of correlates of stunting and low-socioeconomic conditions. The prevalence of stunting declined from 25% in 2008 to 23% in 2017. Mothers' anthropometric measures (underweight/height < 160 cm), marital status, low education, absence of medical insurance and low-socioeconomic conditions were all identified as the most influential risk factors for stunting. Their population-level impacts on stunting increased substantially from 34% (in 2008) to 65% (in 2017). Comprehensive strategies emphasizing enhanced food security, extended breastfeeding, appropriate nutrition, and access to adequate healthcare and education are urgently needed to reduce the burden of food insecurity low-socioeconomic, malnutrition, and its long-term consequences.
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Affiliation(s)
- Handan Wand
- Biostatistics and Databases Program, Kirby Institute, University of New South Wales (UNSW Sydney), Kirby Institute Level 6, Wallace Wurth Building, Kensington, NSW, 2052, Australia.
| | | | | | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, Kwazulu-Natal, South Africa
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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses. PHARMACOECONOMICS 2024:10.1007/s40273-024-01397-5. [PMID: 38819718 DOI: 10.1007/s40273-024-01397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs. OBJECTIVE The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs. METHODS A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted. RESULTS Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers' HRQoL, and the impact of neonatal demise on mothers' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children. CONCLUSIONS Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
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47
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Xu Z, Amakye WK, Ren Z, Xu Y, Liu W, Gong C, Wong C, Gao L, Zhao Z, Wang M, Yan T, Ye Z, Zhong J, Hou C, Zhao M, Qiu C, Tan J, Xu X, Liu G, Yao M, Ren J. Soy Peptide Supplementation Mitigates Undernutrition through Reprogramming Hepatic Metabolism in a Novel Undernourished Non-Human Primate Model. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2306890. [PMID: 38816931 DOI: 10.1002/advs.202306890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/23/2024] [Indexed: 06/01/2024]
Abstract
In spite of recent advances in the field of undernutrition, current dietary therapy relying on the supply of high protein high calorie formulas is still plagued with transient recovery of impaired organs resulting in significant relapse of cases. This is partly attributed to the inadequacy of current research models in recapitulating clinical undernutrition for mechanistic exploration. Using 1636 Macaca fascicularis monkeys, a human-relevant criterion for determining undernutrition weight-for-age z-score (WAZ), with a cutoff point of ≤ -1.83 is established as the benchmark for identifying undernourished nonhuman primates (U-NHPs). In U-NHPs, pathological anomalies in multi-organs are revealed. In particular, severe dysregulation of hepatic lipid metabolism characterized by impaired fatty acid oxidation due to mitochondria dysfunction, but unlikely peroxisome disorder, is identified as the anchor metabolic aberration in U-NHPs. Mitochondria dysfunction is typified by reduced mito-number, accumulated long-chain fatty acids, and disruption of OXPHOS complexes. Soy peptide-treated U-NHPs increase in WAZ scores, in addition to attenuated mitochondria dysfunction and restored OXPHOS complex levels. Herein, innovative criteria for identifying U-NHPs are developed, and unknown molecular mechanisms of undernutrition are revealed hitherto, and it is further proved that soypeptide supplementation reprogramed mitochondrial function to re-establish lipid metabolism balance and mitigated undernutrition.
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Affiliation(s)
- Zhenzhen Xu
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - William Kwame Amakye
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Zhengyu Ren
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, 510182, China
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences (ICMS), University of Macau, Macau, 999078, China
| | - Yongzhao Xu
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Wei Liu
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
- Huazhen Laboratory Animal Breeding Center, Guangzhou, 510900, China
| | - Congcong Gong
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Chiwai Wong
- Huazhen Laboratory Animal Breeding Center, Guangzhou, 510900, China
| | - Li Gao
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Zikuan Zhao
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Min Wang
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Tao Yan
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Zhiming Ye
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, 510182, China
| | - Jun Zhong
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Chuanli Hou
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Miao Zhao
- Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Science, Central South University, Changsha, 410013, P. R. China
| | - Can Qiu
- Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Science, Central South University, Changsha, 410013, P. R. China
| | - Jieqiong Tan
- Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Science, Central South University, Changsha, 410013, P. R. China
| | - Xin Xu
- College of Food Science and Engineering, Yangzhou University, Yangzhou, 225127, China
| | - Guoyan Liu
- College of Food Science and Engineering, Yangzhou University, Yangzhou, 225127, China
| | - Maojin Yao
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, 510182, China
| | - Jiaoyan Ren
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China
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48
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Tarullo AR, Evans D, Coetzee L, Lopera-Perez DC, Brady SP, Gabard-Durnam LJ, Fink G, Hamer DH, Yousafzai AK, Rockers PC. Neonatal Physical Growth Predicts Electroencephalography Power in Rural South African Children. Brain Sci 2024; 14:552. [PMID: 38928552 PMCID: PMC11201818 DOI: 10.3390/brainsci14060552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Anthropometric measures at birth, indexing prenatal growth, are associated with later cognitive development. Children in low- and middle-income countries (LMIC) are at elevated risk for impaired prenatal and early postnatal growth and enduring cognitive deficits. However, the associations of neonatal physical growth with neural activity are not well-characterized in LMIC contexts, given the dearth of early childhood neuroimaging research in these settings. The current study examined birth length, weight, and head circumference as predictors of EEG relative power over the first three years of life in rural Limpopo Province, South Africa, controlling for postnatal growth and socioeconomic status (SES). A larger head circumference at birth predicted lower relative gamma power, lower right hemisphere relative beta power, and higher relative alpha and theta power. A greater birth length also predicted lower relative gamma power. There were interactions with timepoints such that the associations of birth head circumference and length with EEG power were most pronounced at the 7-month assessment and were attenuated at the 17- and 36-month assessments. The results identify birth head circumference and length as specific predictors of infant neural activity within an under-resourced context.
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Affiliation(s)
- Amanda R. Tarullo
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, Boston, MA 02215, USA; (D.C.L.-P.); (S.P.B.)
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2041, South Africa; (D.E.)
| | - Lezanie Coetzee
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2041, South Africa; (D.E.)
| | - Diana C. Lopera-Perez
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, Boston, MA 02215, USA; (D.C.L.-P.); (S.P.B.)
| | - Shaina P. Brady
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, Boston, MA 02215, USA; (D.C.L.-P.); (S.P.B.)
| | | | - Günther Fink
- Swiss Tropical and Public Health Institute, 4123 Basel, Switzerland;
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA; (D.H.H.); (P.C.R.)
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02120, USA;
| | - Peter C. Rockers
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA; (D.H.H.); (P.C.R.)
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49
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Kofi Amegah A, Ayinemi R, Sewor C, Fenta HM, Yeboah K, Mohammed SA, Dwomoh D, Annim SK, Stranges S, Kandala NB. Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa. Eur J Clin Nutr 2024:10.1038/s41430-024-01453-5. [PMID: 38806645 DOI: 10.1038/s41430-024-01453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa. METHODS We included recent (2010-2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis. RESULTS Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%). CONCLUSION We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Roland Ayinemi
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Christian Sewor
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Kelvin Yeboah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Seidu Awal Mohammed
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Samuel K Annim
- Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
- Ghana Statistical Service, Head Office Building, P.O. Box GP1098, Finance Close, Accra, Ghana
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
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50
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Reggi D, Alessio G, Ndereyimana A, Minuti A, Spigno G, Bertoni G. Ready-to-Use Supplementary-Food Biscuit Production with Low-Cost Ingredients for Malnourished Children in Sub-Saharan Africa. Foods 2024; 13:1614. [PMID: 38890843 PMCID: PMC11172247 DOI: 10.3390/foods13111614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 06/20/2024] Open
Abstract
In Africa, the number of children under 5 years old who suffer from stunting and wasting are, respectively, 61.4 and 12.1 million, and to manage situations like these, emergency food products like RUTF and RUSF (ready-to-use therapeutic/supplementary food) are very useful. The aim of this study was to develop an RUSF biscuit using the low-cost food resources usually present in Sub-Saharan Africa (Burundi and the DRCongo in our case study); we conducted chemical characterization, nutritional evaluation, and a stability trial simulating the usual storage conditions in a rural context to demonstrate that RUSF can be functional also using low-cost ingredients and a simple method of production. The obtained recipes showed good potential in supplying protein integration-17.81% (BUR) and 16.77% (CON) (% as food) were the protein contents-and the protein digestibility values were very high (BUR: 91.72%; CON: 92.01%). Moreover, 30% of the daily requirement was achieved with less than 50 g of both recipes in all the considered ages. Finally, a good shelf-life was demonstrated during the 35-day testing period at 30 °C, considering moisture, texture, and lipid oxidation evolution. Recipes like these, with appropriate changes, could be very useful in all contexts where child malnutrition is a serious problem.
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Affiliation(s)
- Davide Reggi
- Department of Animal, Nutrition and Food Science (DiANA), Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122 Piacenza, Italy; (G.A.); (A.N.); (A.M.); (G.B.)
| | - Gaia Alessio
- Department of Animal, Nutrition and Food Science (DiANA), Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122 Piacenza, Italy; (G.A.); (A.N.); (A.M.); (G.B.)
| | - Andrè Ndereyimana
- Department of Animal, Nutrition and Food Science (DiANA), Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122 Piacenza, Italy; (G.A.); (A.N.); (A.M.); (G.B.)
| | - Andrea Minuti
- Department of Animal, Nutrition and Food Science (DiANA), Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122 Piacenza, Italy; (G.A.); (A.N.); (A.M.); (G.B.)
| | - Giorgia Spigno
- Department for Sustainable Food Process (DiSTAS), Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122 Piacenza, Italy;
| | - Giuseppe Bertoni
- Department of Animal, Nutrition and Food Science (DiANA), Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122 Piacenza, Italy; (G.A.); (A.N.); (A.M.); (G.B.)
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