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Nassar AAH, Al-Haddad A. The role of community health and nutrition volunteers in improving the health and nutrition status of infant and young children in remote areas, Hajjah, Yemen. BMC Pediatr 2024; 24:481. [PMID: 39068418 PMCID: PMC11282619 DOI: 10.1186/s12887-024-04958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND In Yemen, morbidity and malnutrition are major public health problems. The Community Health and Nutrition Volunteers (CHNVs) program was launched to tackle these problems through providing services to mothers and their children residing in remote villages. Since establishment of the CHNVs program in Yemen, its outcome has never been evaluated. Therefore, the aim of this study was to assess the role of CHNVs in improving the immunization, morbidity and nutritional status of infant and young children (IYC). METHODS A comparative cross-sectional study design was conducted in Al-Maghrabah and Bani-Qais districts, Hajjah governorate. It was carried out between January and April 2023. A three-stage cluster sampling method was used. A total of 926 IYC with their mothers were interviewed using a pre-tested questionnaire. SPSS 26 was used for data analysis. The multinomial logistic regression and chi-square or fisher exact tests were used to compare the vaccination, morbidity and nutritional status of IYC between the volunteer and non-volunteer villages. Odds Ratio (OR) with 95% Confidence Interval (CI) were calculated. A p value < 0.05 was considered statistically significant. RESULTS The IYC in volunteer villages were more likely to be fully or partially vaccinated compared to those in non-volunteer villages [OR = 2.3, 95% CI: 1.5-3.7, p < 0.0001, and OR = 1.9, 95% CI: 1.3-2.8, p = 0.001, respectively]. The specific coverage rates for BCG, and the 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines were significantly higher in the volunteer compared to non-volunteer villages [(OR = 1.8, 95% CI: 1.3-2.5, p < 0.0001), (OR = 1.5, 95% CI: 1.2-2.1, p = 0.003), and (OR = 1.5, 95% CI: 1.2-2.0, p = 0.002), respectively]. Moreover, the prevalence of diarrhea and fever among IYC was significantly lower in the volunteer compared to non-volunteer villages [(OR = 0.7, 95% CI: 0.5-0.9, p = 0.004) and (OR = 0.7 95% CI: 0.5-0.9, p = 0.045), respectively]. CONCLUSIONS The study found that CHNVs play a significant role in improving vaccination status and the coverage rate for BCG, and 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines, and reducing the prevalence of diarrhea and fever among IYC in their villages compared to non-volunteer villages, in Hajjah governorate. Future follow-up study and expansion to other settings in different governorates is recommended.
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Affiliation(s)
| | - Ahmed Al-Haddad
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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McDonald CM, Wessells KR, Stewart CP, Dewey KG, de Pee S, Rana R, Hafeez-Ur-Rehman H, Mwangi MN, Hess SY. Perinatal intervention strategies providing food with micronutrients to pregnant and breastfeeding women in low- and middle-income countries: A scoping review. MATERNAL & CHILD NUTRITION 2024:e13681. [PMID: 38949186 DOI: 10.1111/mcn.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/03/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
In resource-constrained settings, pregnant and breastfeeding women and girls (PBW/G) are particularly vulnerable to undernutrition. Micronutrient-fortified balanced energy protein (BEP) supplementation may be provided to boost maternal nutritional status and improve birth and infant outcomes. We conducted a scoping review of the published literature to determine the impact of BEP and other related nutrition interventions that provided fortified food or cash along with a minimum of 3 micronutrients on maternal, birth, and infant/child outcomes in low- and middle-income countries. We conducted a PubMed search using pre-defined keywords and controlled vocabulary search terms. All titles and abstracts were reviewed for eligibility by two independent reviewers, and data were extracted according to outcome type. We identified 149 eligible research articles that reported on a total of 21 trials and/or programme evaluations which assessed the health impact of one or more products (fortified lipid-based nutrient supplement [LNS, n = 12], fortified blended flours [n = 5], milk-based beverages [n = 2], and local food/snacks [n = 3]) that provided 118-750 kcal/day and varying levels of protein and micronutrients. Only one of these programme evaluations assessed the impact of the provision of cash and fortified food. Effects on maternal outcomes such as gestational weight gain and duration of gestation were promising but inconsistent. Birth outcomes were reported in 15 studies, and the effects on birthweight and birth length were generally positive. Seven studies demonstrated sustained benefits on infant and child growth out of the 15 studies that reported at least one of these outcomes, although data were sparse. Additional research is needed to investigate issues of dose, cost-effectiveness, and incorporation into multi-component interventions.
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Affiliation(s)
- Christine M McDonald
- Departments of Pediatrics, and Epidemiology & Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
| | - Saskia de Pee
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | - Ritu Rana
- Nutrition Division, World Food Programme HQ, Rome, Italy
| | | | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, California, USA
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Namukose S, Maina GW, Kiwanuka SN, Makumbi FE. Effect of nutrition assessment, counselling and support integration on mother-infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non-equivalent quasi-experimental study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:84. [PMID: 38867332 PMCID: PMC11170817 DOI: 10.1186/s41043-024-00559-7] [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: 03/11/2024] [Accepted: 04/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Malnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda. METHODS A comparative non-equivalent quasi-experimental design was employed with two groups; Comprehensive NACS (Tororo) and Routine NACS (Butaleja). Pregnant mothers were enrolled spanning various trimesters and followed through the antenatal periods and post-delivery to monitor their health and nutrition status. Infants were followed for feeding practices, health and nutritional status at birth and weeks 6, 10, 14 and at months 6, 9 and 12 post-delivery. Propensity score matching ensured study group comparability. The NACS effect was estimated by nearest neighbour matching and the logistic regression methods. Statistical analysis utilised STATA version 15 and R version 4.1.1. RESULTS A total of 666/784 (85%) with complete data were analysed (routine: 412, comprehensive: 254). Both groups were comparable by mothers' age, Mid Upper Arm Circumference, prior antenatal visits, meal frequency, micronutrient supplementation and instances of maternal headache, depression and diarrhoea. However, differences existed in gestation age, income, family size, education and other living conditions. Comprehensive NACS infants exhibited higher infant birth weights, weight-for-age z-scores at the 3rd -6th visits (p < 0.001), length-for-age z scores at the 4th -7th visits (p < 0.001) and weight-for-length z-scores at the 3rd - 5th (p < = 0.001) visits. Despite fewer episodes of diarrhoea and fever, upper respiration infections were higher. CONCLUSIONS The comprehensive NACS demonstrated improved mother-infant nutritional and other health outcomes suggesting the need for integrated and holistic care for better maternal, infant and child health.
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Affiliation(s)
- Samalie Namukose
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Gakenia Wamuyu Maina
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Gernand AD, Gallagher K, Bhandari N, Kolsteren P, Lee AC, Shafiq Y, Taneja S, Tielsch JM, Abate FW, Baye E, Berhane Y, Chowdhury R, Dailey-Chwalibóg T, de Kok B, Dhabhai N, Jehan F, Kang Y, Katz J, Khatry S, Lachat C, Mazumder S, Muhammad A, Nisar MI, Sharma S, Martin LA, Upadhyay RP, Christian P. Harmonization of maternal balanced energy-protein supplementation studies for individual participant data (IPD) meta-analyses - finding and creating similarities in variables and data collection. BMC Pregnancy Childbirth 2023; 23:107. [PMID: 36774497 PMCID: PMC9919738 DOI: 10.1186/s12884-023-05366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Public health and clinical recommendations are established from systematic reviews and retrospective meta-analyses combining effect sizes, traditionally, from aggregate data and more recently, using individual participant data (IPD) of published studies. However, trials often have outcomes and other meta-data that are not defined and collected in a standardized way, making meta-analysis problematic. IPD meta-analysis can only partially fix the limitations of traditional, retrospective, aggregate meta-analysis; prospective meta-analysis further reduces the problems. METHODS We developed an initiative including seven clinical intervention studies of balanced energy-protein (BEP) supplementation during pregnancy and/or lactation that are being conducted (or recently concluded) in Burkina Faso, Ethiopia, India, Nepal, and Pakistan to test the effect of BEP on infant and maternal outcomes. These studies were commissioned after an expert consultation that designed recommendations for a BEP product for use among pregnant and lactating women in low- and middle-income countries. The initiative goal is to harmonize variables across studies to facilitate IPD meta-analyses on closely aligned data, commonly called prospective meta-analysis. Our objective here is to describe the process of harmonizing variable definitions and prioritizing research questions. A two-day workshop of investigators, content experts, and advisors was held in February 2020 and harmonization activities continued thereafter. Efforts included a range of activities from examining protocols and data collection plans to discussing best practices within field constraints. Prior to harmonization, there were many similar outcomes and variables across studies, such as newborn anthropometry, gestational age, and stillbirth, however, definitions and protocols differed. As well, some measurements were being conducted in several but not all studies, such as food insecurity. Through the harmonization process, we came to consensus on important shared variables, particularly outcomes, added new measurements, and improved protocols across studies. DISCUSSION We have fostered extensive communication between investigators from different studies, and importantly, created a large set of harmonized variable definitions within a prospective meta-analysis framework. We expect this initiative will improve reporting within each study in addition to providing opportunities for a series of IPD meta-analyses.
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Affiliation(s)
- Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA.
| | - Kelly Gallagher
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sunita Taneja
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - James M Tielsch
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, D.C, USA
| | - Firehiwot Workneh Abate
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Estifanos Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Adaba, Ethiopia
| | - Ranadip Chowdhury
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Neeta Dhabhai
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Subarna Khatry
- Nepal Nutrition Intervention Project-Sarlahi, Lalitpur, Nepal
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | | | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sitanshi Sharma
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Leigh A Martin
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
| | - Ravi Prakash Upadhyay
- Centre for Health Research and Development Society for Applied Studies, New Delhi, India
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dynamics of human milk oligosaccharides in early lactation and relation with growth and appetitive traits of Filipino breastfed infants. Sci Rep 2022; 12:17304. [PMID: 36243744 PMCID: PMC9569346 DOI: 10.1038/s41598-022-22244-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/12/2022] [Indexed: 01/10/2023] Open
Abstract
Human milk oligosaccharides play a key role in the maturation of the infant gut microbiome and immune system and are hypothesized to affect growth. This study examined the temporal changes of 24 HMOs and their associations to infant growth and appetitive traits in an exploratory, prospective, observational, study of 41 Filipino mother-infant dyads. Exclusively breastfed, healthy, term infants were enrolled at 21-26 days of age (≈ 0.75 mo) and followed for 6 months. Infant growth measures and appetitive traits were collected at visit 1 (V1) (≈ 0.75 mo), V2 (≈ 1.5 mo), V3 (2.5 mo), V4 (2.75 mo), V5 (4 mo), and V6 (6 mo), while HMOs were measured at V1, V2, V3 and V5. Overall exposure to each HMO was summarized as area under the curve from baseline to 4 months of age and examined in association with each measure of growth at 6 months using linear regression adjusted for maternal age at birth, infant sex, birth weight, and mode of delivery. We saw modest associations between several HMOs and infant growth parameters. Our results suggest that specific HMOs, partly as proxy for milk groups (defined by Secretor and Lewis status), may be associated with head circumference and length, increasing their relevance especially in populations at the lower end of the WHO growth curve. We did not identify the same HMOs associated with infant appetitive traits, indicating that at least in our cohort, changes in appetite were not driving the observed associations between HMOs and growth.Clinical trial registration: NCT03387124.
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Lan QY, Huang SY, Jiang CY, Yang MT, Wu T, Chen XY, Liu ZY, Wei W, Wang XG, Zhu HL. Profiling of triacylglycerol composition in the breast milk of Chinese mothers at different lactation stages. Food Funct 2022; 13:9674-9686. [PMID: 36040052 DOI: 10.1039/d2fo01877b] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Triacylglycerol (TAG) is the primary constituent of human milk fat and plays a vital role in the healthy development of infants. But few studies reported the sophisticated profile of TAG molecular species in human breast milk and its temporal changes during a prolonged lactation period. An efficient ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) method was adopted to examine TAGs. A total of 128 TAGs in 296 human breast milk samples collected during postnatal 0 to 400 days were identified. The changes in the human milk TAG profile mainly took place in the early stages of lactation (postnatal 0-45 days), and the TAG profile became stable in mature milk after 200 days of lactation. Odd chain fatty acids (OC-FAs) may be important markers for identifying human breast milk of different lactation stages. This study could provide evidence for developing safe and efficacious human-milk substitutes for children without access to human breast milk.
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Affiliation(s)
- Qiu-Ye Lan
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Si-Yu Huang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Chen-Yu Jiang
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China.
| | - Meng-Tao Yang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Tong Wu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Xiao-Yan Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Zhao-Yan Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Wei Wei
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China.
| | - Xing-Guo Wang
- Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, School of Food Science and Technology, Jiangnan University, Wuxi, China.
| | - Hui-Lian Zhu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Haridas S, Ramaswamy J, Natarajan T, Nedungadi P. Micronutrient interventions among vulnerable population over a decade: A systematic review on Indian perspective. Health Promot Perspect 2022; 12:151-162. [PMID: 36276418 PMCID: PMC9508398 DOI: 10.34172/hpp.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Micronutrient deficiency has long been recognized as a public health problem, particularly among vulnerable groups such as children, adolescents, pregnant and lactating women. Micronutrient deficiency could not be ruled out in spite of the implementation of various intervention strategies. Different interventions are being used to prevent and treat micronutrient deficiencies at the national and global level. The aim of this study is to systematically review the intervention strategies among different vulnerable age groups in India. Methods: The review was focused on identifying various interventions published based on the internet databases and the peer-reviewed papers from 2011 to 2021, on the predefined inclusive/exclusive criteria. The major intervention strategies implemented in India were recognized and evaluated based on dietary supplementation, micronutrient supplementation, knowledge interventions and food fortification among various age groups. Results: The results show that there are still considerable gaps in identifying the effective intervention strategies, research initiatives, programs and policies addressing to tackle micronutrient deficiencies in India. Multiple interventions are effective that could lead the road to innovations in approaches with diverse dietary intake, developing multiple micronutrient supplements, fortifying foods and nutrition interventions to address calcium, zinc, iodine, vitamin D and vitamin A deficiencies among the vulnerable population. Conclusion: Evidence-based multiple intervention studies covering a large population, in the long term cross-sectional, is the need for the hour to design policies and programs for improving the micronutrient status of vulnerable population in the community.
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Affiliation(s)
- Soorya Haridas
- Department of Sciences, Amrita School of Physical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
| | - Jancirani Ramaswamy
- Department of Sciences, Amrita School of Physical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
| | - Tharanidevi Natarajan
- Department of Sciences, Amrita School of Physical Sciences, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India
| | - Prema Nedungadi
- Amrita Create, Amrita School of Computing, Amritapuri, Amrita Vishwa Vidyapeetham, Kerala, India
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