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Lowe C, Sarma H, Gray D, Kelly M. Perspective: Connecting the dots between domestic livestock ownership and child linear growth in low- and middle-income countries. MATERNAL & CHILD NUTRITION 2024; 20:e13618. [PMID: 38192051 PMCID: PMC10981488 DOI: 10.1111/mcn.13618] [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: 10/18/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
Child stunting due to linear growth faltering remains a pervasive issue in low- and middle-income countries. Two schools of thought have existed pertaining to the role of domestic livestock ownership (DLO) in child linear growth. On one hand, it is argued that DLO leads to greater income and financial security, resulting in better child-raising conditions, including greater animal-source food (ASF) consumption, having protective effects towards child stunting. On the other hand, researchers argue that DLO contributes to faecal contamination and transmission of zoonotic enteric infections from animals to children, thus having destructive effects on child growth. Reviews of this association have revealed ambiguous findings. In this perspective, we argue that measuring the association between exposures to domesticated animals and child stunting is difficult and the ambiguous associations revealed are a result of confounding and differences in the management of DLO. We also argue that the increasingly prominent area of research of environmental enteric dysfunction, a sub-clinical condition of the small intestine thought to be due to frequent faecal pathogen exposure and associated with stunting, will be a useful tool to measure the potential destructive effects of DLO on child growth. We present our argument and identify challenges and considerations and directions for future research.
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Affiliation(s)
- Callum Lowe
- Department of Applied Epidemiology, National Centre for Epidemiology and Population Health, College of Health and MedicineAustralian National UniversityActonAustralian Capital TerritoryAustralia
| | - Haribondhu Sarma
- Department of Applied Epidemiology, National Centre for Epidemiology and Population Health, College of Health and MedicineAustralian National UniversityActonAustralian Capital TerritoryAustralia
| | - Darren Gray
- Population Health ProgramQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Matthew Kelly
- Department of Applied Epidemiology, National Centre for Epidemiology and Population Health, College of Health and MedicineAustralian National UniversityActonAustralian Capital TerritoryAustralia
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Marshak A, Young H, Naumova EN. The Complexity of the Seasonality of Nutritional Status: Two Annul Peaks in Child Wasting in Eastern Chad. Food Nutr Bull 2023; 44:S109-S118. [PMID: 37850930 DOI: 10.1177/03795721231181715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Understanding seasonal patterns in nutritional status is critical for achieving and tracking global nutrition goals. However, the majority of nutrition seasonality research design draws on 2 or 3 within-year time points based on existing assumptions of seasonality, missing a more nuanced pattern. OBJECTIVE We aimed to identify the intra-year variability of childhood wasting, severe wasting, and weight-for-height z-scores (WHZ) in a dryland single wet-season context and illustrate an analytical approach for improving analysis of the seasonality of nutritional status. METHODS To quantify the intra-year variability in nutritional status, we use data from a 23-month panel study (May 2018 to March 2020) following 231 children (6-59 months of age) in eastern Chad. We apply a mixed-effects harmonic regression with child- and village-level fixed effects on the odds of being wasted, severely wasted, and on WHZ, testing for multiple and nonsymmetrical seasonal peaks, adjusted for child sex and age. We triangulate our findings using climate data on temperature, vegetation, and precipitation. RESULTS We identify 2 annual peaks of wasting and severe wasting. Wasting peaks at 14.7% (confidence interval [CI], 11.8-18.2) at the end of the dry season, while the smaller peak corresponds to the start of the harvest period at 13.4% (CI, 10.7-16.6). The odds of being wasted decline during the rainy season to 11.8% (CI, 9.4-14.7), with the lowest prevalence of 8.8% (CI, 6.9-11.1) occurring during the start of the dry season. In addition, a 1°C monthly increase in temperature is significantly associated with a 5% (CI, 1.4-8.7) and 12% (CI, 3.0-20.3) increase in the odds that a child is wasted and severely wasted, respectively. CONCLUSIONS Intra-year variability of child wasting is far more complex and nuanced than identified by the literature, with 2 peaks, as opposed to 1, likely corresponding to different seasonal drivers, such as food insecurity, disease, water contamination, and care practices at different times of year. Better seasonality analysis can go a long way in improving the timing and content of programming with the goal of reducing child wasting.
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Affiliation(s)
- Anastasia Marshak
- Feinstein International Center, Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Helen Young
- Feinstein International Center, Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Elena N Naumova
- Division of the Nutrition Epidemiology and Data Science, Tufts University Friedman School of Nutrition Science and Policy, Boston, MA, USA
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3
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Zerfu TA, Nguyen G, Duncan AJ, Baltenweck I, Brown F, Iannotti LL, McNeill G. Associations between livestock keeping, morbidity and nutritional status of children and women in low- and middle-income countries: a systematic review. Nutr Res Rev 2023; 36:526-543. [PMID: 36522652 DOI: 10.1017/s0954422422000233] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Livestock keeping can positively influence the nutritional status of populations and households through increased consumption of animal-source foods (ASF) and other indirect pathways, but can also adversely affect health by increasing the risk of diseases. We conducted a systematic review synthesising the current state of knowledge on the associations among livestock keeping, infectious disease and the nutritional status of children under 5 years and women of reproductive age in low- and lower-middle-income countries (LMICs). A comprehensive search of 12 electronic databases and grey literature sources published from 1991 to the end of December 2020 was conducted. Investigations exploring relationships between livestock keeping and risk of infectious disease transmission and nutritional status were selected using pre-defined inclusion criteria. After screening and filtering of 34,402 unique references, 176 references were included in the final synthesis. Most (160/176, 90.1%) of the references included in the final synthesis were from sub-Saharan Africa (SSA) and Asia. About two out of every five (42%) studies reviewed showed that livestock production is associated with improved height-for-age Z scores (HAZ) and weight-for-length/height Z scores (WHZ), while close to a third (30.7%) with improved weight-for-age Z scores (WAZ). Similarly, livestock production showed a positive or neutral relationship with women's nutritional status in almost all the references that reported on the topic. Conversely, four-fifths (66/81, 79.5%) of the references reporting on infection and morbidity outcomes indicated that livestock keeping is linked to a wide range of infectious disease outcomes, which are spread primarily through water, food and insects. In conclusion, in many LMIC settings, livestock production is associated with better nutritional outcomes but also a higher risk of disease transmission or morbidity among women and children.This review was prospectively registered on PROSPERO 2020 [CRD42020193622].
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Affiliation(s)
- Taddese Alemu Zerfu
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Giang Nguyen
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
| | - Alan J Duncan
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | | | - Fiona Brown
- Library and University Collections, Information Services, University of Edinburgh, Edinburgh, UK
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Geraldine McNeill
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
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Muema J, Mutono N, Kisaka S, Ogoti B, Oyugi J, Bukania Z, Daniel T, Njuguna J, Kimani I, Makori A, Omulo S, Boyd E, Osman AM, Gwenaelle L, Jost C, Thumbi SM. The impact of livestock interventions on nutritional outcomes of children younger than 5 years old and women in Africa: a systematic review and meta-analysis. Front Nutr 2023; 10:1166495. [PMID: 37485389 PMCID: PMC10358768 DOI: 10.3389/fnut.2023.1166495] [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: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background Nutrition-sensitive livestock interventions have the potential to improve the nutrition of communities that are dependent on livestock for their livelihoods by increasing the availability and access to animal-source foods. These interventions can also boost household income, improving purchasing power for other foods, as well as enhance determinants of health. However, there is a lack of synthesized empirical evidence of the impact and effect of livestock interventions on diets and human nutritional status in Africa. Objective To review evidence of the effectiveness of nutrition-sensitive livestock interventions in improving diets and nutritional status in children younger than 5 years old and in pregnant and lactating women. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of published studies reporting on the effect of livestock interventions on maternal and child nutrition in Africa. Data were extracted, synthesized, and summarized qualitatively. Key outcomes were presented in summary tables alongside a narrative summary. Estimation of pooled effects was undertaken for experimental studies with nutritional outcomes of consumption of animal-source foods (ASFs) and minimum dietary diversity (MDD). Fixed effects regression models and pooled effect sizes were computed and reported as odds ratios (ORs) together with their 95% confidence intervals (CI). Results After the screening, 29 research papers were included in the review, and of these, only 4 were included in the meta-analysis. We found that nutrition-sensitive livestock interventions have a significant positive impact on the consumption of ASFs for children < 5 years (OR = 5.39; 95% CI: 4.43-6.56) and on the likelihood of meeting minimum dietary diversity (OR = 1.89; 95% CI: 1.51-2.37). Additionally, the impact of livestock interventions on stunting, wasting, and being underweight varied depending on the type of intervention and duration of the program/intervention implementation. Therefore, because of this heterogeneity in reporting metrics, the pooled estimates could not be computed. Conclusion Nutrition-sensitive livestock interventions showed a positive effect in increasing the consumption of ASFs, leading to improved dietary diversity. However, the quality of the evidence is low, and therefore, more randomized controlled studies with consistent and similar reporting metrics are needed to increase the evidence base on how nutrition-sensitive livestock interventions affect child growth outcomes.
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Affiliation(s)
- Josphat Muema
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
| | - Nyamai Mutono
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Stevens Kisaka
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Brian Ogoti
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Joseph Njuguna
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Irene Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Anita Makori
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Sylvia Omulo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Washington State University Global Health Program–Kenya, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
| | - Erin Boyd
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
| | - Abdal Monium Osman
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Luc Gwenaelle
- Emergency and Resilience Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Christine Jost
- United States Agency for International Development’s Bureau for Humanitarian Assistance, Washington, DC, United States
- Global Health Support Initiative III, Social Solutions International, Washington, DC, United States
| | - SM Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Feed the Future Innovation Lab for Animal Health, Washington State University, Pullman, WA, United States
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States
- South African Center for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
- Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom
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Nassur AM, Daanouni O, Luc G, Humphreys A, Blanarova L, Heymsfield G, Kouassi F, Kangas ST, N’Diaye DS. Factors associated with acute malnutrition among children aged 6-59 months in Haiti, Burkina Faso and Madagascar: A pooled analysis. PLoS One 2022; 17:e0278980. [PMID: 36508472 PMCID: PMC9744306 DOI: 10.1371/journal.pone.0278980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acute malnutrition is one of the main causes of morbidity and mortality among children under 5 years worldwide, and Action Contre la Faim (ACF) aims to address its causes and consequences. To better tailor humanitarian programs, ACF conducts standardized contextual studies called Link NCAs (Nutrition Causal Analysis), to identify factors associated with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Data from three Link NCAs performed in 2018 and 2019 in Haiti, Burkina Faso and Madagascar were used to explore the prevalence of malnutrition by different indicators and associated risk factors among children aged 6-59 months. METHODS Cross-sectional data, collected via household surveys applying two-stage cluster sampling, were pooled to build a sample of 1,356 children. Recommended anthropometric thresholds were used to define SAM (Weight-for-Height Z-score (WHZ) <-3 or Mid-upper Arm Circumference (MUAC) <115 mm and/or presence oedema), MAM (-3≤WHZ<-2 or 115≤MUAC<125 mm) and global acute malnutrition GAM (SAM or MAM) among children. Multivariate analyses for each anthropometric indicator were performed using logistic mixed models and adjusting for potential confounders. RESULTS The prevalence of acute malnutrition was the highest in Madagascar. The risk of having GAM and MAM varied across countries, while the risk of having SAM varied across clusters. Being male, suffering from diarrhea, and having unwashed face and hands, were significantly associated with GAM by WHZ with adjusted odds ratio of 1.9 [95%Confidence interval (CI):1.1-3.2], 1.7 (95%CI: 1.0-3.1) and 1.9 (95%CI: 1.0-3.6) respectively. These factors were also associated with MAM by WHZ. None of the studied factors was significantly associated with SAM, which could be due to a small sample size. CONCLUSION These results obtained from a large sample contribute to the evidence of the factors associated with undernutrition in children aged 6-59 months. Further research with larger sample sizes is needed to confirm these results.
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Affiliation(s)
| | - Oussama Daanouni
- Action Contre la Faim, Paris, France
- Université de Montpellier, Montpellier, France
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6
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Griswold SP, Marshak A, Fitzpatrick M, Lantagne D, Shoenmakers K, Hebie M, Radday A, De Groote H, Mehta S, Gottlieb G, Webb P, Ghosh S. The One Nutrition in Complex Environments (ONCE) study protocol: a cluster-randomized multi-level multi-sectoral intervention to improve nutrition in Uganda. Trials 2022; 23:244. [PMID: 35365180 PMCID: PMC8972632 DOI: 10.1186/s13063-022-06170-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To implement and measure the effects of a multi-level multi-sectoral social behavior change (SBC) intervention in Agago District of Northern Uganda and to determine the potential for scale-up. Intervention Compare the Nutrition Impact and Positive Practice (NIPP) approach to a NIPP+ approach. The NIPP approach involves nutrition education and SBC, whereas the NIPP+ adds agricultural inputs, training, and tools to support improved farm and water quality practices. The intervention effect will be measured through lower levels of aflatoxin in grain, lower water contamination, and improved knowledge on nutrition and health. Design This is a three-arm cluster-randomized controlled superiority trial (cRCT). The study arms include the following: group 1: NIPP; group 2: NIPP+, and group 3: control. Groups 1 and 2 will receive a 12-week intervention (NIPP or NIPP+) with active monitoring and longitudinal follow-up at 2, 6, and 12 months post-intervention. Additionally, an in-depth process and performance evaluation of each intervention arm will be undertaken using quantitative and qualitative methods. A total of 60 clusters from 5 subcounties of the Agago district will be randomly selected, and 15 households per cluster will be recruited using specific inclusion/exclusion criteria for a total of 900 households (300/arm). Respondents for the qualitative portion will be purposely selected. Analysis We will collect data from all participants at 3 time points: baseline, endline, and 12 months post-intervention. The analysis will utilize intent-to-treat (ITT) using the initial randomization of the treatment arms to determine the overall impact of having the NIPP vs. NIPP+ vs. control. Mixed effects models will be used to determine the role of time-variant and invariant individual household, and community characteristics, as well as measures of exposure and integration on key outcome indicators. A difference-in-difference analysis (baseline/endline, baseline/12 months post-intervention, endline/12 months post-intervention) will also be used to triangulate findings. Trial registration NCT04209569. One Nutrition in Complex Environments (ONCE) Registered 24 December 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06170-7.
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Affiliation(s)
- Stacy P Griswold
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Anastasia Marshak
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Feinstein International Center, Tufts University, Boston, MA, USA
| | - Merry Fitzpatrick
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Feinstein International Center, Tufts University, Boston, MA, USA
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | | | | | - Anne Radday
- Feinstein International Center, Tufts University, Boston, MA, USA
| | - Hugo De Groote
- International Maize and Wheat Improvement Centre (CIMMYT), Nairobi, Kenya
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Greg Gottlieb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Feinstein International Center, Tufts University, Boston, MA, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Marshak A, Young H, Radday A, Naumova EN. Sustained nutrition impact of a multisectoral intervention program two years after completion. MATERNAL AND CHILD NUTRITION 2020; 17:e13103. [PMID: 33145931 PMCID: PMC7988880 DOI: 10.1111/mcn.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/10/2020] [Accepted: 09/29/2020] [Indexed: 11/27/2022]
Abstract
Progress on the nutrition Sustainable Development Goals has been slow. More attention is needed on the 'sustainable' part, focused on impact lasting beyond programme implementation. To determine sustained impact of a multisectoral nutrition intervention that provided water, sanitation, hygiene, livelihood, health and nutrition support (2013-2015) in eastern Chad, we utilize longitudinal household data collected 2 years (2017) after the intervention ended. Between 2013 and 2015, children (6-59 months) in the multisectoral intervention were less likely to be severely wasted, underweight and had a higher weight-for-height z-score (WHZ) compared with the control. To measure sustained programme impact, we use data on six nutrition indicators from 517 children between 2015 and 2017. We ran three models: a generalized linear model on cross-sectional child cohorts; a mixed-effects model on household panel data; and a mixed-effects model on child panel data. For children who were born during the programme, we saw significant improvement in underweight, weight for age z-scores (WAZs) and height-for-age z-scores (HAZs). Boys 6-23 months born after the end of the programme, on the other hand, were significantly more likely to be underweight or wasted and had lower WHZ and WAZ compared with boys born during the programme and girls born during and after the programme. Corresponding to the literature from sub-Saharan Africa, boys appear to be more vulnerable to malnutrition, which might be why they are more sensitive to programme cessation. Future monitoring, evaluations and research need to consider impact sustainability and that it might not be homogeneous across age and gender.
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Affiliation(s)
- Anastasia Marshak
- Feinstein International Center, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Helen Young
- Feinstein International Center, Tufts University, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Anne Radday
- Feinstein International Center, Tufts University, Boston, Massachusetts, USA
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Robertson LJ, Johansen ØH, Kifleyohannes T, Efunshile AM, Terefe G. Cryptosporidium Infections in Africa-How Important Is Zoonotic Transmission? A Review of the Evidence. Front Vet Sci 2020; 7:575881. [PMID: 33195574 PMCID: PMC7580383 DOI: 10.3389/fvets.2020.575881] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/27/2020] [Indexed: 01/25/2023] Open
Abstract
Cryptosporidium, a protozoan parasite in the phylum Apicomplexa, is the etiological agent of cryptosporidiosis, an intestinal infection characterized by profuse watery diarrhea. Over 30 species of Cryptosporidium are recognized, some host specific whereas others infect a broader host range. Cryptosporidium hominis and Cryptosporidium parvum are the species most commonly associated with human infection; C. hominis is largely associated only with human infections, but C. parvum is also associated with infection in animals, especially young ruminants. In some regions, cryptosporidiosis is a serious veterinary problem, particularly for calves, and lambs. Many outbreaks of human cryptosporidiosis have been associated with zoonotic transmission following contact with infected animals. In Africa, where cryptosporidiosis is a major contributor to pediatric morbidity and mortality, evidence suggests transmission is principally anthroponotic. Given the frequent close contact between humans and animals in Africa, the apparent predominance of human-to-human transmission is both interesting and puzzling. In this article, after a brief "text book" introduction to the parasite, we consider in separate sections the different aspects of relevance to Cryptosporidium transmission in African countries, describing different aspects of the various species and subtypes in human and animal infections, considering livestock management practices in different African countries, and looking for any characteristic "hot spots" where zoonotic transmission has apparently occurred. Studies where transmission networks have been investigated are particularly relevant. Finally, in a separate section, we try to gather these different strands of evidence together in order to assess the reasons behind the apparent predominance of anthroponotic transmission in Africa. Reviewing the available evidence provides an opportunity to re-think transmission pathways, not only in Africa but also elsewhere, and also to pose questions. Does the predominance of human-to-human transmission in Africa reflect a relative absence of zoonotic C. parvum in African livestock? Are Africans less susceptible to zoonotic Cryptosporidium infection, perhaps resulting from early immunostimulation by C. hominis or due to inherent genetic traits? Is the African environment-in all its variety-simply more detrimental to oocyst survival? Will the so-called hypertransmissible subtypes, currently relatively rare in Africa, be introduced from Europe or elsewhere, and, if so, will they fade out or establish and spread? Our intention with this manuscript is not only to summarize and consolidate diverse data, thereby providing an overview of data gaps, but also to provide food for thought regarding transmission of a parasite that continues to have a considerable impact on both human and animal health.
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Affiliation(s)
- Lucy J. Robertson
- Parasitology Laboratory, Department of Paraclinical Science, Faculty of Veterinary Medicine Norwegian University of Life Sciences, Oslo, Norway
| | - Øystein Haarklau Johansen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tsegabirhan Kifleyohannes
- Parasitology Laboratory, Department of Paraclinical Science, Faculty of Veterinary Medicine Norwegian University of Life Sciences, Oslo, Norway
- Department of Veterinary Basic and Diagnostic Sciences, College of Veterinary Medicine, Mekelle University, Mekelle, Ethiopia
| | - Akinwale Michael Efunshile
- Department of Medical Microbiology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
- Department of Medical Microbiology, Ebonyi State University, Abakaliki, Nigeria
| | - Getachew Terefe
- College of Veterinary Medicine and Agriculture, Department of Pathology and Parasitology, Addis Ababa University, Bishoftu, Ethiopia
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Laillou A, Gauthier L, Wieringa F, Berger J, Chea S, Poirot E. Reducing malnutrition in Cambodia. A modeling exercise to prioritize multisectoral interventions. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 2:e12770. [PMID: 32835454 PMCID: PMC7591311 DOI: 10.1111/mcn.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/16/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022]
Abstract
Undernutrition is a major contributor to child morbidity and mortality and poses a large burden to the economy, in Cambodia. This study explored factors contributing to child stunting and wasting and their regional inequalities among 1,938 Cambodian children aged 6-23.9 months. Data were drawn from a longitudinal study (year 2017) conducted in six districts of two north-eastern provinces and the capital and used as cross-sectional. Socio-demographic and household characteristics, children's feeding practices during the previous 24 hr, and children's length and weight measurements were collected. Gradient boosting models were used to calculate the contribution of determinants to child undernutrition whereas concentration index was used to assess the impact of those determinants on stunting and wasting inequalities among socioeconomic groups. It was found that low-household wealth could predict 21% to 45% of child stunting and 23% to 36% of wasting across regions. After wealth, source and treatment of drinking water were found the second major predictor for stunting (15%) and wasting (21%). Combining child nutrition and household water, sanitation and hygiene indicators predicted around 30% of child undernutrition, either in the form of stunting or wasting. Mothers' education predicted >30% of stunting in the north-eastern region. Results highlight that a complex interplay of factors contributes to child stunting and wasting. An integrated, intersectoral, equity-focused approach that addresses children's dietary quality, household's water, sanitation and hygiene conditions, mother's education, and poverty is likely to yield the highest impact in achieving further gains in nutritional status among Cambodian children.
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Affiliation(s)
- Arnaud Laillou
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition sectionPhnom PenhCambodia
| | | | - Frank Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD‐UM2‐UM1MontpellierFrance
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD‐UM2‐UM1MontpellierFrance
| | - Samnang Chea
- Council of Agriculture and Development (CARD), Office of the Council of MinistersPhnom PenhCambodia
| | - Etienne Poirot
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition sectionPhnom PenhCambodia
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Zaba T, Buene D, Famba E, Joyeux M. Factors associated with acute malnutrition among children 6-59 months in rural Mozambique. MATERNAL AND CHILD NUTRITION 2020; 17:e13060. [PMID: 32678488 PMCID: PMC7729645 DOI: 10.1111/mcn.13060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 06/08/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
Factors associated with acute malnutrition are complex and wide‐ranging particularly in developing countries. In Mozambique, contextual factors associated to children acute malnutrition are yet to be fully investigated and the evidences used to better inform prevention programme. The objective of this study is to identify key factors associated with acute malnutrition among 6‐ to 59‐month‐old children living in nine districts in rural Mozambique assessed in the 2018 seasonal nutrition assessment. We analysed Standardized Monitoring and Assessment for Relief and Transition (SMART) nutrition survey data of 1,116 children from three districts and rapid nutrition assessment (RNA) data of 3,884 children from six districts of Mozambique. We used a multiple logistic regression analysis to respond to the research question. Experiencing diarrhoea [odds ratio (OR) = 4.54; P = 0.001] was the only variable associated with acute malnutrition from the SMART survey dataset, whereas in the RNA, fever (OR = 3.0; P = 0.000) access to sanitation (OR = 0.118; P = 0.037), experiencing shock in the household (OR = 0.5; P = 0.020), diarrhoea (OR = 2.41; P = 0.001) and cough (OR = 1.75; P = 0.030) were the variables with significant association to acute malnutrition. We believe that the findings were influenced by the proportion of acute malnutrition in each survey type. Study findings confirm the association between acute malnutrition and child's health outcomes that are generally linked to poor living conditions and independent effects of shocks. This highlights the need for policy and programme to implement integrated, cross‐sectoral approaches to tackling child acute malnutrition, particularly addressing community level conditions such as water and sanitation.
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Affiliation(s)
| | | | - Elda Famba
- Nutrition Department, Ministry of Health, Maputo, Mozambique
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Sensitivity of Nutrition Indicators to Measure the Impact of a Multi-Sectoral Intervention: Cross-Sectional, Household, and Individual Level Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093121. [PMID: 32365830 PMCID: PMC7246654 DOI: 10.3390/ijerph17093121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 11/17/2022]
Abstract
Interventions tackling multiple drivers of child malnutrition have potential, yet the evidence is limited and draws on different analysis and nutrition outcomes, reducing comparability. To better understand the advantages and disadvantages of three different analytical approaches on seven common nutrition indicators, we use panel data (2012, 2014, 2015) on 1420 households from a randomized control study of a multi-sectoral intervention in Chad. We compare program impact using three types of analysis: a cross-sectional analysis of non-matched children; a panel analysis on longitudinal outcomes following the worst-off child in the household; and a panel analysis on longitudinal outcomes of matched children. We find that the sensitivity of the nutrition outcomes to program impact increases with each subsequent analytical approach, despite the reduction in sample size, as the analysis is able to control for more non-measured child and household characteristics. In the matched child panel analysis, the odds of a child being severely wasted were 76% lower (CI: 0.59-0.86, p = 0.001), the odds of being underweight were 33% lower (CI: 0.15-0.48, p = 0.012), and weight-for-height z-score was 0.19 standard deviations higher (CI: 0.09-0.28, p = 0.022) in the treatment versus control group. The study provides evidence for multi-sectoral interventions to tackle acute malnutrition and recommends the best practice analytical approach.
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Hossain S, Ahmed F, Hossain S, Sikder T. Nutritional Status and Basic Hygiene Practices of Rural School Age Children of Savar Region, Dhaka, Bangladesh. Cent Asian J Glob Health 2019; 7:282. [PMID: 30863662 PMCID: PMC6393051 DOI: 10.5195/cajgh.2018.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction School children in the developing countries are susceptible to nutrition related health problems due to demographic and socio-economic factors, as well as limited access to food. Since BMI is a common proxy measure used to evaluate nutritional status, the aim of this study was to investigate the BMI categories in school-aged children in Dhaka, Bangladesh. Methods A cross sectional study of 155 children, aged 6–12 years was conducted at Jahangirnagar University School in Dhaka, Bangladesh. The data collection was performed by in-person interviews and semi-structured questionnaires. Descriptive statistics, χ2 test, Fisher’s exact test, and One-Way ANOVA test were performed to compare the variables based on BMI percentiles. Data were analyzed using the Microsoft Excel program (version 2010). Results Mean BMI of the students was 17.27 (SD=3.16). The prevalence of underweight and overweight/obesity was 11.0% and 25.8%, respectively. Categories of BMI percentiles were associated with birth order (p=0.026), personal hygiene practices (washing hands after coming home from outside (p<0.001) and before meal (p=0.045)), brushing teeth (p<0.001), the number of food items consumed daily (p<0.001), and mothers’ occupation (p=0.006). In context of basic hygiene practice, 61.3 % of respondents washed hands after coming home from outside, and 93.5 % reported washing hands before the meals. Conclusions This study revealed that more than one third of the students had abnormal BMI. BMI screening in rural schools needs to be recommended in early grades for all children.
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Affiliation(s)
- Sahadat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Fahad Ahmed
- Department of Environmental Sciences, Jahangirnagar University, Dhaka, Bangladesh
| | - Shakhaoat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Tajuddin Sikder
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
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van Cooten MH, Bilal SM, Gebremedhin S, Spigt M. The association between acute malnutrition and water, sanitation, and hygiene among children aged 6-59 months in rural Ethiopia. MATERNAL AND CHILD NUTRITION 2018; 15:e12631. [PMID: 29961977 DOI: 10.1111/mcn.12631] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 01/22/2023]
Abstract
The causes of acute malnutrition-or "wasting"-are complex, and a better understanding of the underlying drivers is necessary in order to design effective interventions. Water, sanitation, and hygiene (WASH) practices may play a fundamental role in acute malnutrition, but more research is needed to confirm this relationship. We investigated the association between WASH practices and acute malnutrition among children 6 to 59 months of age in rural Ethiopia, making use of the Ethiopian Demographic and Health Survey. Descriptive statistics were used to assess the WASH status of all rural children. Bivariate logistic regression analyses were performed to assess associations between nutritional status and WASH. Multivariate logistic regression analyses were used to adjust for confounders. A total of 7,209 children were included in the analysis, of which 867 (12.0%) were acutely malnourished. Proper toilet facilities (AOR = 0.63, 95% CI [0.46, 0.86]) and a water source close to home (AOR = 0.71, 95% CI [0.61, 0.83]) were associated with a lower prevalence of wasting. A safe water source for drinking (COR = 1.03, 95% CI [0.89, 1.19]) and a safe disposal of the child's stool (AOR = 0.97, 95% CI [0.84, 1.13]) were not significantly associated with acute malnutrition. These results suggest that WASH practices are related to acute malnutrition. Future studies-in particular intervention studies-should investigate whether improving WASH practices is effective in reducing malnutrition in infants and young children.
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Affiliation(s)
- Merel H van Cooten
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Selamawit M Bilal
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Samson Gebremedhin
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
| | - Mark Spigt
- CAPHRI School for Public Health and Primary Care, Department of Family Medicine Maastricht University, Maastricht, The Netherlands
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