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de Mello E Silva JF, de Jesus Silva N, Carrilho TRB, Jesus Pinto ED, Rocha AS, Pedroso J, Silva SA, Spaniol AM, da Costa Santin de Andrade R, Bortolini GA, Paixão E, Kac G, de Cássia Ribeiro-Silva R, Barreto ML. Identifying biologically implausible values in big longitudinal data: an example applied to child growth data from the Brazilian food and nutrition surveillance system. BMC Med Res Methodol 2024; 24:38. [PMID: 38360575 PMCID: PMC10868032 DOI: 10.1186/s12874-024-02161-1] [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: 04/24/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Several strategies for identifying biologically implausible values in longitudinal anthropometric data have recently been proposed, but the suitability of these strategies for large population datasets needs to be better understood. This study evaluated the impact of removing population outliers and the additional value of identifying and removing longitudinal outliers on the trajectories of length/height and weight and on the prevalence of child growth indicators in a large longitudinal dataset of child growth data. METHODS Length/height and weight measurements of children aged 0 to 59 months from the Brazilian Food and Nutrition Surveillance System were analyzed. Population outliers were identified using z-scores from the World Health Organization (WHO) growth charts. After identifying and removing population outliers, residuals from linear mixed-effects models were used to flag longitudinal outliers. The following cutoffs for residuals were tested to flag those: -3/+3, -4/+4, -5/+5, -6/+6. The selected child growth indicators included length/height-for-age z-scores and weight-for-age z-scores, classified according to the WHO charts. RESULTS The dataset included 50,154,738 records from 10,775,496 children. Boys and girls had 5.74% and 5.31% of length/height and 5.19% and 4.74% of weight values flagged as population outliers, respectively. After removing those, the percentage of longitudinal outliers varied from 0.02% (<-6/>+6) to 1.47% (<-3/>+3) for length/height and from 0.07 to 1.44% for weight in boys. In girls, the percentage of longitudinal outliers varied from 0.01 to 1.50% for length/height and from 0.08 to 1.45% for weight. The initial removal of population outliers played the most substantial role in the growth trajectories as it was the first step in the cleaning process, while the additional removal of longitudinal outliers had lower influence on those, regardless of the cutoff adopted. The prevalence of the selected indicators were also affected by both population and longitudinal (to a lesser extent) outliers. CONCLUSIONS Although both population and longitudinal outliers can detect biologically implausible values in child growth data, removing population outliers seemed more relevant in this large administrative dataset, especially in calculating summary statistics. However, both types of outliers need to be identified and removed for the proper evaluation of trajectories.
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Affiliation(s)
| | - Natanael de Jesus Silva
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- ISGlobal, Hospital Clínic. Universitat de Barcelona, Barcelona, Spain
| | - Thaís Rangel Bousquet Carrilho
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Elizabete de Jesus Pinto
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, BA, Brazil
| | - Aline Santos Rocha
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | - Jéssica Pedroso
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | - Sara Araújo Silva
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | - Ana Maria Spaniol
- Food and Nutrition Coordinating Unit, Ministry of Health, Brasília, DF, Brazil
| | | | | | - Enny Paixão
- London School of Hygiene & Tropical Medicine, London, UK
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
- School of Nutrition, Federal University of Bahia, Av. Araújo Pinho, nº 32, Canela, Salvador, Bahia, CEP: 40.110-150, BA, Brazil.
| | - Maurício L Barreto
- Centre for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, BA, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, BA, Brazil
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Peters R, Li B, Swinburn B, Allender S, He Z, Lim SY, Chea M, Ding G, Zhou W, Keonakhone P, Vongxay M, Khamphanthong S, Selamat R, Dayanghirang A, Abella E, Da Costa F, Chotivichien S, Ungkanavin N, Truong MT, Nguyen SD, Poh BK. National nutrition surveillance programmes in 18 countries in South-East Asia and Western Pacific Regions: a systematic scoping review. Bull World Health Organ 2023; 101:690-706F. [PMID: 37961057 PMCID: PMC10630730 DOI: 10.2471/blt.23.289973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/21/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
Objective To identify and analyse ongoing nutrition-related surveillance programmes led and/or funded by national authorities in countries in South-East Asian and Western Pacific Regions. Methods We systematically searched for publications in PubMed® and Scopus, manually searched the grey literature and consulted with national health and nutrition officials, with no restrictions on publication type or language. We included low- and middle-income countries in the World Health Organization South-East Asia Region, and the Association of Southeast Asian Nations and China. We analysed the included programmes by adapting the United States Centers for Disease Control and Prevention's public health surveillance evaluation framework. Findings We identified 82 surveillance programmes in 18 countries that repeatedly collect, analyse and disseminate data on nutrition and/or related indicators. Seventeen countries implemented a national periodic survey that exclusively collects nutrition-outcome indicators, often alongside internationally linked survey programmes. Coverage of different subpopulations and monitoring frequency vary substantially across countries. We found limited integration of food environment and wider food system indicators in these programmes, and no programmes specifically monitor nutrition-sensitive data across the food system. There is also limited nutrition-related surveillance of people living in urban deprived areas. Most surveillance programmes are digitized, use measures to ensure high data quality and report evidence of flexibility; however, many are inconsistently implemented and rely on external agencies' financial support. Conclusion Efforts to improve the time efficiency, scope and stability of national nutrition surveillance, and integration with other sectoral data, should be encouraged and supported to allow systemic monitoring and evaluation of malnutrition interventions in these countries.
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Affiliation(s)
- Remco Peters
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, BristolBS8 1TH, England
| | - Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, BristolBS8 1TH, England
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Zouyan He
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Sim Yee Lim
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mary Chea
- National Maternal and Child Health Centre, Ministry of Health, Phnom Penh, Cambodia
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiwen Zhou
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Phonesavanh Keonakhone
- National Nutrition Centre, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Maikho Vongxay
- National Nutrition Centre, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | | | - Rusidah Selamat
- Nutrition Division, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Ellen Abella
- National Nutrition Council, Taguig City, Philippines
| | | | | | | | | | | | - Bee Koon Poh
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Alam MM, Das R, Clara AA, Mohsin FM, Rumi MAH, Wahab A, Hasan MA, Hawlader MDH. The assessment of geriatric malnutrition, geriatric depression and associated co-morbidities among forcibly displaced Myanmar nationals in Bangladesh. Public Health Nutr 2023; 26:2048-2055. [PMID: 37529859 PMCID: PMC10564601 DOI: 10.1017/s1368980023001556] [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: 10/19/2022] [Revised: 07/01/2023] [Accepted: 07/29/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To assess the nutritional status and depression of the elderly forcibly displaced Myanmar nationals (FDMN) in Bangladesh and determine the associated factors of geriatric depression (GD). DESIGN This was a community-based, cross-sectional study among elderly FDMN. The Mini Nutritional Assessment Short-Form (MNA@-SF) and Geriatric Depression Scale Short-Form (GDS-15 SF) were used to determine malnutrition and GD, respectively. SETTING The study was conducted between November 2021 and March 2022 in Kutupalong Refugee Camp, Cox's Bazar, Bangladesh. PARTICIPANTS The study participants were elderly FDMN aged ≥ 60 years (n 430). RESULTS The mean age and BMI were 71·7(±7·8) years and 21·94(±2·6) kg/m2, respectively. There was a high prevalence of self-reported diabetes mellitus (32·1 %), hypertension (26·7 %), hypotension (20 %), skin diseases (28·4 %) and chronic obstructive pulmonary disease (16·5 %). The prevalence of malnutrition was 25·3 %, and another 29·1 % were at risk. The prevalence of GD was 57·9 %, and co-occurrences of GD and malnutrition were seen in 17·5 % of participants. GD was significantly higher among elderly people with malnutrition (adjusted OR, AOR = 1·71, 95 % CI: 1·01, 2·89). FDMN aged ≥ 80 years were at higher risk of GD (AOR = 1·84, 95 % CI: 1·01, 3·37), and having fewer than five members in the household was an independent predictor of GD. Diabetes mellitus (AOR = 1·95, 95 % CI: 1·24, 3·08) and hypotension (AOR = 2·17, 95 % CI: 1·25, 2·78) were also significantly associated with an increased risk of GD. CONCLUSION A high prevalence of GD and malnutrition was observed among elderly FDMN in Bangladesh. The agencies working in Cox's Bazar should focus on geriatric malnutrition and GD for the improvement of the health situation of FDMN in Bangladesh.
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Affiliation(s)
- Mohammad Morshad Alam
- Department of Public Health, North South University, Dhaka1213, Bangladesh
- Health Nutrition and Population Global Practice, The World Bank, Dhaka, Bangladesh
| | - Rajib Das
- International Organization for Migration, Dhaka, Bangladesh
| | - Afrin Ahmed Clara
- Department of Public Health, North South University, Dhaka1213, Bangladesh
| | - Faroque Md Mohsin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Abrar Wahab
- Department of Public Health, North South University, Dhaka1213, Bangladesh
| | - Md Abeed Hasan
- International Organization for Migration, Dhaka, Bangladesh
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Al Jawaldeh A, El Hajj Hassan O, Qureshi AB, Zerbo FC, Alahnoumy S, Bozo M, Al-Halaika M, Al-Dakheel MH, Alhamdan L, Mujib SA, El Ammari L, Aguenaou H, Alqaoud N, Almaamari S, Alshamkhi S, Dureab F. Qualitative Review of National Nutrition Surveillance Systems in the Eastern Mediterranean Region. Nutrients 2023; 15:3689. [PMID: 37686721 PMCID: PMC10490415 DOI: 10.3390/nu15173689] [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: 07/25/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023] Open
Abstract
The World Food Conference in 1974 emphasized the significance of establishing global nutrition surveillance to monitor and address nutritional challenges effectively. However, many countries, especially in the EMRO region, continue to encounter substantial difficulties in regularly generating disaggregated data on nutrition. The current study aimed to review the existing nutrition surveillance systems in the region and to identify their strengths and weaknesses, as well as the challenges they face in functioning optimally. METHODS This study focused on the functional nutrition surveillance systems in eight Arab countries; namely Kuwait, Morocco, Oman, Palestine, Saudi Arabia, Sudan, Syria, and Yemen. The study's analysis involved utilizing primary data collected from both published and unpublished reports. Additionally, a structured checklist was employed to gather information from all countries involved in the study. Furthermore, interviews were conducted with the EMRO offices to gain deeper insights into the challenges, if any, that these nutrition surveillance systems face in functioning optimally. RESULTS All countries use health facilities as a basic source of data for their nutrition surveillance, some countries triangulate their nutrition surveillance reports with data from other sources of information such as community or school surveys. Identified nutrition surveillance approaches are closely split between those who operate in stable settings and use routine health information systems (Morocco, Saudi Arabia, Oman, and Kuwait) and other countries that operate in fragile settings; for example, Yemen, Syria, Palestine, and Sudan struggle to provide early warning reports for rapid nutritional responses. CONCLUSIONS Nutrition surveillance systems that utilize existing health information systems are the most sustained in the EMRO region. However, by integrating data from multiple sources, such as health facilities, surveys, and population censuses, countries can provide a holistic view of the nutritional situation, enhance their response to any emergency, and can leverage the infrastructure and resources already in place for health data collection and reporting. Collaboration between countries in the region through sharing experiences and success stories is important in order to reach a standardized system that can be implemented in different settings.
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Affiliation(s)
- Ayoub Al Jawaldeh
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean, Cairo 7608, Egypt
| | - Ola El Hajj Hassan
- Heidelberg Institute of Global Health, Hospital University Heidelberg, 69120 Heidelberg, Germany
| | | | | | | | - Mahmoud Bozo
- World Health Organization (WHO), Damascus 3946, Syria
| | - Mousa Al-Halaika
- Nutrition Department, Ministry of Health, Ramallah 4284, Palestine
| | | | - Lamya Alhamdan
- Nutrition Department, Ministry of Health, Riyadh 11176, Saudi Arabia
| | | | - Laila El Ammari
- Nutrition Department, Ministry of Health, Rabat 335, Morocco
| | - Hassan Aguenaou
- Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Ibn Tofaïl University-CNESTEN, Rabat-Kénitra 242, Morocco
| | - Nawal Alqaoud
- Food and Nutrition Administration, Ministry of Health, Kuwait City 13001, Kuwait
| | | | | | - Fekri Dureab
- Heidelberg Institute of Global Health, Hospital University Heidelberg, 69120 Heidelberg, Germany
- Institute of Research for International Assistance, Akkon Hochschule, 12099 Berlin, Germany
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Caleyachetty R, Kumar NS, Bekele H, Manaseki-Holland S. Socioeconomic and urban-rural inequalities in the population-level double burden of child malnutrition in the East and Southern African Region. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000397. [PMID: 37097991 PMCID: PMC10128925 DOI: 10.1371/journal.pgph.0000397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 02/28/2023] [Indexed: 04/26/2023]
Abstract
Socioeconomic and urban-rural inequalities in the population-level double burden of child malnutrition threatens global nutrition targets 2025, especially in East and Southern Africa. We aimed to quantify these inequalities from nationally representative household surveys in the East and Southern African region. 13 Demographic and Health Surveys between 2006 and 2018 including 72,231 children under five years old were studied. Prevalence of stunting, wasting and overweight (including obesity) were disaggregated by wealth quintiles, maternal education categories and urban-rural residence for visual inspection of inequalities. The slope index of inequality (SII) and the relative index of inequality (RII) were estimated for each country. Regional estimates of child malnutrition prevalence and socioeconomic and urban-rural inequalities were generated from pooling country-specific estimates using random-effects meta-analyses. Regional stunting and wasting prevalence were higher among children living in the poorest households, with mothers with the lowest educational level and in rural areas. In contrast, regional overweight (including obesity) prevalence was higher among children living in the richest households, with mothers with the highest educational level and urban areas. This study indicates pro-poor inequalities are present in child undernutrition and pro-rich inequalities are present in child overweight including obesity. These findings re-emphasise the need for an integrated approach to tackling the population-level double burden of child malnutrition in the region. Policy makers must target specific populations that are vulnerable to child malnutrition, to avoid further widening of socioeconomic and urban-rural inequalities.
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Affiliation(s)
- Rishi Caleyachetty
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Niraj S. Kumar
- University College London Medical School, University College London, London, United Kingdom
| | - Hana Bekele
- World Health Organization, Inter-Country Support Team, Zimbabwe WHO Country Office, Harare, Zimbabwe
| | - Semira Manaseki-Holland
- Institute for Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Ricci JMS, Romito ALZ, Silva SAD, Carioca AAF, Lourenço BH. Food intake markers in Sisvan: temporal trends in coverage and integration with e-SUS APS, Brazil 2015-2019. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023283.10552022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil’s Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman’s correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.
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Ricci JMS, Romito ALZ, Silva SAD, Carioca AAF, Lourenço BH. Food intake markers in Sisvan: temporal trends in coverage and integration with e-SUS APS, Brazil 2015-2019. CIENCIA & SAUDE COLETIVA 2023; 28:921-934. [PMID: 36888874 DOI: 10.1590/1413-81232023283.10552022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/03/2022] [Indexed: 03/08/2023] Open
Abstract
The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil's Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman's correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.
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Affiliation(s)
- Joanna Manzano Strabeli Ricci
- Programa de Pós-Graduação Nutrição em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo (USP). Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | | | - Sara Araújo da Silva
- Coordenação-Geral de Alimentação e Nutrição, Ministério da Saúde. Brasília DF Brasil
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Moyo SA, Mashau NS, Makhado L. Development of a growth monitoring and promotion index to improve child health in Zimbabwe. MethodsX 2022; 10:101958. [PMID: 36606121 PMCID: PMC9807990 DOI: 10.1016/j.mex.2022.101958] [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: 09/19/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
In Zimbabwe, growth monitoring and promotion as conducted by community health workers are part of the nutritional surveillance system. This study seeks to develop a new index which will combine both caregiver behaviours, attitudes and CHW growth monitoring and promotion activities. An explanatory sequential mixed method design will be conducted in three phases. Phase one will comprise a scoping literature review. The second phase will comprise a needs analysis through quantitative data collection using two surveys of community health workers and caregivers of children under five years. Thereafter, qualitative data will be collected from caregivers of children under five years. The quantitative data will be analysed using SPSS while qualitative data will be collected and analysed using Atlas-ti. Phase three will be the development phase for the growth monitoring and promotion Index. The growth monitoring and promotion Index will be used to classify the GMP performance of districts through the DHIS2 thus strengthening the quality of growth monitoring and promotion. Recommendations on the findings and the adoption of the Index will be shared with the Ministry of Health and Child Care and key stakeholders implementing maternal, newborn and child health programmes in Zimbabwe for adoption and use in growth monitoring and promotion programming.
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Rodas-Moya S, Giudici FM, Mudyahoto B, Birol E, Kodish SR, Lachat C, Abreu TC, Melse-Boonstra A, van het Hof KH, Brouwer ID, Osendarp S, Feskens EJM. Critical review of indicators, metrics, methods, and tools for monitoring and evaluation of biofortification programs at scale. Front Nutr 2022; 9:963748. [PMID: 36313073 PMCID: PMC9607891 DOI: 10.3389/fnut.2022.963748] [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: 06/10/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Sound monitoring and evaluation (M&E) systems are needed to inform effective biofortification program management and implementation. Despite the existence of M&E frameworks for biofortification programs, the use of indicators, metrics, methods, and tools (IMMT) are currently not harmonized, rendering the tracking of biofortification programs difficult. We aimed to compile IMMT for M&E of existing biofortification programs and recommend a sub-set of high-level indicators (HLI) for a harmonized global M&E framework. We conducted (1) a mapping review to compile IMMT for M&E biofortification programs; (2) semi-structured interviews (SSIs) with biofortification programming experts (and other relevant stakeholders) to contextualize findings from step 1; and (3) compiled a generic biofortification program Theory of Change (ToC) to use it as an analytical framework for selecting the HLI. This study revealed diversity in seed systems and crop value chains across countries and crops, resulting in differences in M&E frameworks. Yet, sufficient commonalities between implementation pathways emerged. A set of 17 HLI for tracking critical results along the biofortification implementation pathway represented in the ToC is recommended for a harmonized global M&E framework. Further research is needed to test, revise, and develop mechanisms to harmonize the M&E framework across programs, institutions, and countries.
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Affiliation(s)
- Santiago Rodas-Moya
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands,*Correspondence: Santiago Rodas-Moya,
| | - Francesca M. Giudici
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Bho Mudyahoto
- HarvestPlus, c/o International Food Policy Research Institute, Washington, DC, United States
| | - Ekin Birol
- Edmund A. Walsh School of Foreign Service, Global Human Development Program, Washington, DC, United States
| | - Stephen R. Kodish
- Department of Nutritional Sciences and Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Taymara C. Abreu
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands,Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Karin H. van het Hof
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Saskia Osendarp
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands,The Micronutrient Forum, Washington, DC, United States
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
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Checchi F, Frison S, Warsame A, Abebe KT, Achen J, Ategbo EA, Ayoya MA, Kassim I, Ndiaye B, Nyawo M. Can we predict the burden of acute malnutrition in crisis-affected countries? Findings from Somalia and South Sudan. BMC Nutr 2022; 8:92. [PMID: 36038942 PMCID: PMC9421106 DOI: 10.1186/s40795-022-00563-2] [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: 01/11/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sample surveys are the mainstay of surveillance for acute malnutrition in settings affected by crises but are burdensome and have limited geographical coverage due to insecurity and other access issues. As a possible complement to surveys, we explored a statistical approach to predict the prevalent burden of acute malnutrition for small population strata in two crisis-affected countries, Somalia (2014-2018) and South Sudan (2015-2018). METHODS For each country, we sourced datasets generated by humanitarian actors or other entities on insecurity, displacement, food insecurity, access to services, epidemic occurrence and other factors on the causal pathway to malnutrition. We merged these with datasets of sample household anthropometric surveys done at administrative level 3 (district, county) as part of nutritional surveillance, and, for each of several outcomes including binary and continuous indices based on either weight-for-height or middle-upper-arm circumference, fitted and evaluated the predictive performance of generalised linear models and, as an alternative, machine learning random forests. RESULTS We developed models based on 85 ground surveys in Somalia and 175 in South Sudan. Livelihood type, armed conflict intensity, measles incidence, vegetation index and water price were important predictors in Somalia, and livelihood, measles incidence, rainfall and terms of trade (purchasing power) in South Sudan. However, both generalised linear models and random forests had low performance for both binary and continuous anthropometric outcomes. CONCLUSIONS Predictive models had disappointing performance and are not usable for action. The range of data used and their quality probably limited our analysis. The predictive approach remains theoretically attractive and deserves further evaluation with larger datasets across multiple settings.
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Affiliation(s)
- Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Séverine Frison
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdihamid Warsame
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kiross Tefera Abebe
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Jasinta Achen
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Eric Alain Ategbo
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Mohamed Ag Ayoya
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Ismail Kassim
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Biram Ndiaye
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Mara Nyawo
- East and Southern Africa Regional Office, United Nations Children's Fund, Nairobi, Kenya
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Manger MS, Brown KH, Osendarp SJM, Atkin RA, McDonald CM. Barriers to and Enablers of the Inclusion of Micronutrient Biomarkers in National Surveys and Surveillance Systems in Low- and Middle-Income Countries. Nutrients 2022; 14:nu14102009. [PMID: 35631149 PMCID: PMC9145664 DOI: 10.3390/nu14102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Including biomarkers of micronutrient status in existing or planned national surveys or surveillance systems is a critical step in improving capacity to promote, design, monitor, and evaluate micronutrient policies and programs. We aimed to identify the barriers to and enablers of the inclusion of micronutrient biomarker assessment in national surveys and surveillance systems, to identify the main challenges faced during the survey process, and to review experiences using existing platforms for micronutrient surveys. We conducted a series of key informant interviews with in-country and external representatives from six countries where national-level data on micronutrient status were collected in the past 5 years: Cambodia, Pakistan, Malawi, Uganda, Ghana, and Uzbekistan. Micronutrients associated with specific public health programs were always prioritized for inclusion in the survey. If funding, time, and/or logistics allowed, other considered micronutrients were also included. The most important and frequently reported barrier to inclusion of a more comprehensive panel of micronutrient biomarkers was inadequate funding to cover the laboratory analysis cost for all micronutrients considered at the planning stage. Government support and commitment was stressed as the most important enabling factor by all key informants. Advocacy for funding for micronutrient status assessment is needed.
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Affiliation(s)
- Mari S. Manger
- International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA;
- Correspondence:
| | - Kenneth H. Brown
- Department of Nutrition, Institute for Global Nutrition, University of California Davis, Davis, CA 95616, USA;
| | | | - Reed A. Atkin
- Micronutrient Forum, Washington, DC 20005, USA; (S.J.M.O.); (R.A.A.)
| | - Christine M. McDonald
- International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA;
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
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Manners R, Adewopo J, Niyibituronsa M, Remans R, Ghosh A, Schut M, Egoeh SG, Kilwenge R, Fraenzel A. Leveraging Digital Tools and Crowdsourcing Approaches to Generate High-Frequency Data for Diet Quality Monitoring at Population Scale in Rwanda. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2021.804821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diet quality is a critical determinant of human health and increasingly serves as a key indicator for food system sustainability. However, data on diets are limited, scattered, often project-dependent, and current data collection systems do not support high-frequency or consistent data flows. We piloted in Rwanda a data collection system, powered by the principles of citizen science, to acquire high frequency data on diets. The system was deployed through an unstructured supplementary service data platform, where respondents were invited to answer questions regarding their dietary intake. By combining micro-incentives with a normative nudge, 9,726 responses have been crowdsourced over 8 weeks of data collection. The cost per respondent was < $1 (system set-up, maintenance, and a small payment to respondents), with interactions taking <15 min. Exploratory analyses show that >70% of respondents consume tubers and starchy vegetables, leafy vegetables, fruits, legumes, and wholegrains. Women consumed better quality diets than male respondents, revealing a sex-based disparity in diet quality. Similarly, younger respondents (age ≤ 24 years) consumed the lowest quality diets, which may pose significant risks to their health and mental well-being. Middle-income Rwandans were identified to have consumed the highest quality diets. Long-term tracking of diet quality metrics could help flag populations and locations with high probabilities of nutrition insecurity, in turn guiding relevant interventions to mitigate associated health and social risks.
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Ávila Curiel A, Galindo Gómez C, Juárez Martínez L, García-Guerra A, Del Monte Vega MY, Martínez Domínguez J, Ávila Arcos YMA. Mala nutrición en población escolar mexicana: factores geográficos y escolares asociados. Glob Health Promot 2021; 29:126-135. [PMID: 34558364 DOI: 10.1177/17579759211038381] [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: 11/17/2022]
Abstract
OBJETIVOS Determinar prevalencias de mala nutrición [sobrepeso u obesidad (Sp+O) y talla baja (TB)] en población mexicana de 6 a 12 años de edad de nivel básico de primaria, y su asociación con características geográficas (ámbito, marginación y región del país), y de la escuela (tipo, turno y grado). MÉTODOS Con información de 10 528 676 escolares, se estimaron prevalencias (e I.C. 95%), a nivel nacional y por características de interés, y su asociación mediante modelos de regresión logística. RESULTADOS La prevalencia nacional de Sp+O fue 34.4%, 36.5% en ámbito urbano y 40.2% en escuelas privadas. La prevalencia nacional de TB fue 8.7%; en área rural, 13.7% y 28.8% en escuelas tipo indígenas. El Sp+O y la TB se asociaron significativamente con características geográficas y de escuelas. CONCLUSIONES Existe una polarización nutricional en el contexto escolar del país. Es importante continuar con sistemas de monitoreo y vigilancia nutricional.
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Affiliation(s)
- Abelardo Ávila Curiel
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, México
| | - Carlos Galindo Gómez
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, México
| | - Liliana Juárez Martínez
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, México
| | - Armando García-Guerra
- Centro de Investigación en Nutrición y Salud (CINyS), Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, México
| | | | | | - Y Marco Antonio Ávila Arcos
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, México
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14
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Seal AJ, Jelle M, Grijalva-Eternod CS, Mohamed H, Ali R, Fottrell E. Use of verbal autopsy for establishing causes of child mortality in camps for internally displaced people in Mogadishu, Somalia: a population-based, prospective, cohort study. LANCET GLOBAL HEALTH 2021; 9:e1286-e1295. [PMID: 34416214 DOI: 10.1016/s2214-109x(21)00254-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND People in humanitarian emergencies are likely to experience excess mortality but information on the causes of death is often unreliable or non-existent. This study aimed to provide evidence on the causes of death among children younger than 5 years in camps for internally displaced people in southern Somalia, during periods of protracted displacement and emergency influx amid the 2017 drought and health emergency. METHODS We did a prospective, cohort study in 25 camps in the Afgooye corridor, on the outskirts of Mogadishu, Somalia. All internally displaced children aged 6-59 months were included and followed up with monthly household visits by community health workers. Nutrition, health, and vaccination status were ascertained and verbal autopsy interviews were done with the caregivers of deceased children. We calculated death rates in these children and used verbal autopsy to establish the cause-specific mortality fraction (CSMF). Bayesian InterVA software was used to assign likely causes to each death. FINDINGS Between March, 2016, and March, 2018, 3898 children were followed up. 153 deaths were recorded during 34 746 person-months of observation. The death rate among children younger than 5 years exceeded emergency thresholds (>2 deaths per 10 000 children per day), reaching a peak of seven deaths per 10 000 children per day during the emergency influx. Verbal autopsy data were gathered for 80% of deaths, and the CSMF for the three leading causes of death were diarrhoeal diseases (25·9%), measles (17·8%), and severe malnutrition (8·8%). Coverage of measles vaccination during the first 3 months of the emergency was 42% and the CSMF for measles doubled during the influx. During protracted displacement, symptoms that could be attributable to HIV/AIDS related deaths accounted for 1·6% of the CSMF. INTERPRETATION It is feasible to establish a health and nutrition surveillance system that ascertains causes of death, using verbal autopsy, in this humanitarian context. These data can inform policy, response planning, and priority setting. The high mortality rate from infectious diseases and malnutrition among children younger than 5 years suggests the need for strengthening a range of public health interventions, including vaccination and provision of water, sanitation, and hygiene. FUNDING UK Department of International Development.
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Affiliation(s)
- Andrew J Seal
- Institute for Global Health, University College London, London, UK.
| | - Mohamed Jelle
- Institute for Global Health, University College London, London, UK
| | | | | | - Raha Ali
- Concern Worldwide Somalia, Mogadishu, Somalia
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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15
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Yorick R, Khudonazarov F, Gall AJ, Pedersen KF, Wesson J. Volunteer Community Health and Agriculture Workers Help Reduce Childhood Malnutrition in Tajikistan. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:S137-S150. [PMID: 33727326 PMCID: PMC7971367 DOI: 10.9745/ghsp-d-20-00325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/02/2020] [Indexed: 12/03/2022]
Abstract
Paired agricultural and health interventions led by volunteer community health workers and community agricultural workers through home visits, community events, and peer support groups proved successful in improving nutrition of children and may be applicable in other contexts. Childhood malnutrition is a nationally-recognized problem in Tajikistan. In 2017, 6% of children under 5 years were wasted and 18% were stunted. Through the Tajikistan Health and Nutrition Activity (THNA), funded by the U.S. Agency for International Development's Feed the Future, IntraHealth International trained 1,370 volunteer community health workers (CHWs) and 500 community agricultural workers (CAWs) in 500 rural communities to improve nutrition among children and pregnant and breastfeeding women. CHWs and CAWs mutually encourage health behavior change, reinforce better agricultural practices, and promote maternal and child health and nutritious diets through household visits, community events, and peer support groups. CHWs refer children with malnutrition and diarrhea and pregnant women who are not registered for antenatal care to health facilities. THNA supported CHWs/CAWs through peer learning, refresher trainings, supportive supervision, and quarterly material incentives. We observed gains in knowledge, attitudes, and practices across health; nutrition; water, sanitation, and hygiene (WASH); and agriculture in target communities. From 2016 to 2019, we observed statistically significant (P<.05) improvements in children receiving a minimum acceptable diet; children with diarrhea receiving more liquids; women making 4 or more antenatal care visits; women reporting improved WASH; and farmers demonstrating improved agricultural practices. A February 2020 screening of 94.6% of children under 5 years in target communities found the prevalence of children with signs of wasting at 2.2%. Partnerships between CHWs, CAWs, and rural health workers facilitated these results. Paired agricultural and health interventions proved successful in improving nutrition of children and may be applicable in other contexts. Although effective in delivering interventions, CHWs/CAWs experience attrition, need motivation, and require intensive support. Assuming responsibility for this community-based volunteer workforce presents a major challenge for Tajikistan's national and local governments.
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Affiliation(s)
- Roman Yorick
- IntraHealth International, Dushanbe, Tajikistan.
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16
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Sadeghi M, Langarizadeh M, Olang B, Seddighi H, Sheikhtaheri A. A Survey of implementation status of child nutrition surveillance systems, registry systems and information systems: a scoping literature review protocol. BMJ Paediatr Open 2021; 5:e001164. [PMID: 34485706 PMCID: PMC8372877 DOI: 10.1136/bmjpo-2021-001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/03/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Child malnutrition in all forms is known globally as the leading cause of poor health. Planning and solving this challenge require sources that collect data accurately. Nutrition surveillance systems (NSS), nutrition registry systems (NRS) and nutrition information systems (NIS) collect and analyse data on nutrition status. Unfortunately, these systems only exist in a few countries. The methods that these systems use significantly differ and their effectiveness is also scarcely researched. This scoping literature review aimed to conduct a survey on NSS, NRS and NIS that collect data on children's nutrition at national and international levels, along with their attributes. METHODS AND ANALYSIS The methods and analyses of this scoping review follow the Arksey and O'Malley's methodology. This scoping literature review will be conducted in five stages based on this method. (1) The main research question and subquestions are identified. (2) Relevant studies are extracted. In this step, we will search electronic databases including PubMed, Scopus and ISI Web of Science. A manual search will also be performed in Google Scholar, grey literature, and the websites of organisations such as WHO, UNICEF, Centers for Disease Control and Prevention, National Health Service, International Food Policy Research Institute, Food and Agriculture Organization, Food and Nutrition Technical Assistance, United Nations World Food Programme, and United Nations System Standing Committee on Nutrition. (3) Extracted studies are separately reviewed by two reviewers based on inclusion and exclusion criteria, and eligible studies are then selected. A third reviewer resolves disagreements. (4) A checklist is developed to extract the features. Data of included systems are separately extracted and entered into a checklist by two reviewers. A third reviewer then resolves any disagreement. (5) Data are summarised and analysed and are presented in tables and figures. DISCUSSION This scoping literature review provides strong evidence of the status of systems that collect data on the status of child nutrition. This evidence can help select best practices which can be applied to develop future systems. It can also be a positive step towards achieving an integrated system.
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Affiliation(s)
- Malihe Sadeghi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- Health Management and Economics Research Center, Health management research institute, Iran University of Medical Sciences, Tehran, Iran
| | - Beheshteh Olang
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Seddighi
- Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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17
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Anderson JD, Bagamian KH, Muhib F, Amaya MP, Laytner LA, Wierzba T, Rheingans R. Burden of enterotoxigenic Escherichia coli and shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: a modelling analysis. LANCET GLOBAL HEALTH 2020; 7:e321-e330. [PMID: 30784633 PMCID: PMC6379821 DOI: 10.1016/s2214-109x(18)30483-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/08/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022]
Abstract
Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that cause moderate-to-severe diarrhoea in children younger than 5 years. Diarrhoea is associated with an increased risk of stunting, which puts children at risk of death due to other infectious diseases. Methods We modelled ETEC-related and shigella-related mortality and the effect of moderate-to-severe diarrhoea episodes to determine the number of children with stunting due to these infections in 79 low-income and lower middle-income countries. We applied population attributable risk for increased number of deaths due to other infectious diseases in children who are stunted. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings In children younger than 5 years, we estimate 196 million (95% UI 135–269) episodes of ETEC and shigella diarrhoea occur annually, resulting in 3·5 million (0·8–5·4) cases of moderate-to-severe stunting and 44 400 (29 400–59 800) total ETEC deaths and 63 100 (44 000–81 900) total shigella deaths in 2015. Additional infectious disease mortality due to stunting resulted in increases of 24% (8–34; for ETEC) and 28% (10–39; for shigella) over direct deaths due to diarrhoeal episodes. The distribution of mortality and morbidity varied geographically, with African Region and Eastern Mediterranean Region countries bearing the greatest burden. Interpretation The expanded effects of non-fatal ETEC and shigella-related diarrhoeal episodes can have lasting consequences. Prevention of these infections could reduce the risk of direct death and stunting and deaths due to other infectious diseases. Understanding the countries and populations with the highest disease risk helps to target interventions for the most vulnerable populations. Funding The Bill & Melinda Gates Foundation.
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Affiliation(s)
- John D Anderson
- Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USA; Emerging Pathogens Institute, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA.
| | - Karoun H Bagamian
- Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA; Bagamian Scientific Consulting, Gainesville, FL, USA
| | | | - Mirna P Amaya
- Emerging Pathogens Institute, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | - Lindsey A Laytner
- Emerging Pathogens Institute, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA
| | | | - Richard Rheingans
- Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USA; Emerging Pathogens Institute, Gainesville, FL, USA
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18
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Rhodes EC, Hennink M, Jefferds MED, Williams AM, Suchdev PS, Mapango C, Nyirenda E, Mshali G, Tripp K. Integrating micronutrient status assessment into the 2015-2016 Malawi Demographic and Health Survey: A qualitative evaluation. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 1:e12734. [PMID: 30748109 DOI: 10.1111/mcn.12734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Abstract
Demand for national-level micronutrient status data continues to grow, yet little is known about the implementation of different approaches for collecting these data. We conducted an evaluation of the process of linking the 2015-2016 Malawi Demographic and Health Survey (MDHS) and 2015-2016 Malawi Micronutrient Survey (MNS). We conducted 24 in-depth interviews with stakeholders from the Malawi government and international agencies and field staff. Interview questions explored perceptions of what worked and what was challenging during three phases of implementation: preparation; data collection; and data analysis, reporting, and dissemination. Data were analysed using thematic analysis. Results showed that there was strong government interest to integrate the MDHS and MNS. Perceived benefits included potential cost savings and lower respondent burden. However, government and international agency stakeholders did not view the linkage of the surveys to be a fully integrated approach. The lack of full integration produced challenges throughout implementation, such as complex field logistics and duplication in nutrition indicators assessed and reported. Some stakeholders believed integration was not attainable primarily due to timing. The MDHS and MNS were originally designed as stand-alone surveys, and planning for each survey was at an advanced stage once the government sought to integrate the surveys. Additionally, the MNS could not be incorporated as a module within the MDHS given the complexity of the MNS data collection and short timeframe for planning. These findings can inform decisions about implementing the next MNS and may be transferable to other countries that are conducting micronutrient surveys to address data gaps.
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Affiliation(s)
- Elizabeth C Rhodes
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Monique Hennink
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Maria Elena D Jefferds
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anne M Williams
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Parminder S Suchdev
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Carine Mapango
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eunice Nyirenda
- Demography Section, National Statistical Office of Malawi, Zomba, Malawi
| | - Glory Mshali
- Demography Section, National Statistical Office of Malawi, Zomba, Malawi
| | - Katie Tripp
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mugomeri E. Identifying Imperatives for an Effective Nutrition Surveillance Policy Framework for Maternal and Child Health in Lesotho. Food Nutr Bull 2018; 39:608-620. [PMID: 30477342 DOI: 10.1177/0379572118806708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance of nutrition indicators is critical for informing nutrition policies and programs. The failure by many sub-Saharan countries to maintain functional surveillance systems for maternal and child health (MCH) hampers their capacity to achieve the 2030 Sustainable Development Goals relevant for MCH. The nutrition surveillance system (NSS) for MCH in the southern African country of Lesotho is no exception to this problem despite the country having some of the highest maternal and child mortality ratios globally. OBJECTIVE The study reviewed Lesotho's quantitative nutrition surveillance data and qualitatively analyzed the structure and functionality of Lesotho's NSS to identify imperatives for an effective nutrition surveillance policy framework for MCH in the country. METHODS Descriptive quantitative analyses were based on NSS data and nationally representative Lesotho Demographic and Health Survey (LDHS) data while qualitative analysis on data obtained through interviews with purposefully selected key informants working in the NSS of Lesotho was based on grounded theory. RESULTS Nutrition surveillance system data were inconsistently compiled across Lesotho's 10 districts, while LDHS data suggested that stunting, maternal anemia, child overweight, and low birth weight remain high. Challenges with the NSS were linked to poor coordination of the NSS due to an indistinct organogram of nutrition offices and poor cooperation among stakeholders in the NSS. CONCLUSIONS To improve the NSS in Lesotho, the most critical imperative is to capacitate the Food & Nutrition Coordinating Office which in turn should create distinct nutrition offices yet with adequate cooperation and clear benchmarks for monitoring and evaluation of the NSS.
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Affiliation(s)
- Eltony Mugomeri
- 1 Department of Pharmacy, Faculty of Health Sciences, National University of Lesotho, Maseru, Lesotho
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20
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Gillespie S, Hoddinott J, Nisbett N, Arifeen S, van den Bold M. Evidence to Action: Highlights From Transform Nutrition Research (2012-2017). Food Nutr Bull 2018; 39:335-360. [PMID: 30079765 DOI: 10.1177/0379572118788155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Transform Nutrition ( Transform) research consortium (2012-2017), led by the International Food Policy Research Institute, sought to generate evidence to inform and inspire action to address undernutrition in 4 high-burden countries (India, Bangladesh, Kenya, and Ethiopia) and globally. OBJECTIVE Within the context of the literature, this synthesis article brings together core findings of Transform, highlighting priorities for future research. METHODS This article uses a narrative approach to synthesize diverse study findings that collectively address Transform's three primary research questions: (1) How can nutrition-specific interventions be appropriately designed, implemented, scaled, and sustained in different settings?; (2) How can the nutritional impact of social protection and agriculture be improved?; and (3) How can enabling environments be promoted so as to use existing political and economic resources more effectively? RESULTS Highlights of Transform include (1) improved understanding of the relative effectiveness of different combinations of nutrition-specific interventions and the ways in which they can be scaled for maximal impact; (2) evidence that shows that social protection and agriculture need to be explicitly linked to nutrition in order to contribute to stunting reduction; (3) identification of key components of "enabling environments" for nutrition and how they can be cultivated/sustained; (4) research that examines ways in which leaders emerge and operate to change the political and policy landscape in different settings; and (5) "stories of change" that provide in-depth contextual knowledge of how transformative change has been driven in countries that have made inroads in reducing malnutrition. The conclusion highlights the contributions of the consortium and provides recommendations for future research.
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Affiliation(s)
- Stuart Gillespie
- 1 International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - John Hoddinott
- 2 Cornell College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Nicholas Nisbett
- 3 Institute of Development Studies (IDS), Library Road, Brighton, UK
| | - Shams Arifeen
- 4 International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Mara van den Bold
- 1 International Food Policy Research Institute (IFPRI), Washington, DC, USA
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21
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Custodio E, Martin-Cañavate R, Di Marcantonio F, Molla D, Abukar Y, Kayitakire F. MUAC-for-age more useful than absolute MUAC for nutritional surveillance in Somalia: results from nineteen cross-sectional surveys (2007-2016). BMC Nutr 2018; 4:8. [PMID: 32153872 PMCID: PMC7050741 DOI: 10.1186/s40795-018-0213-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/05/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Somalia is affected by a civil war and a protracted humanitarian crisis for more than two decades. The international community has put in place nutrition surveillance systems to monitor the situation and inform decisions. However, the indicators commonly used to identify acute malnutrition, weight-for-height Z-score (WHZ) and mid upper arm circumference (MUAC), do not always converge in their estimations of acute malnutrition, creating challenges for decision making. Furthermore, the divergences are not consistent across livelihood populations within the country. We explored the MUAC-for-age Z-score (MUACAZ) as an alternative indicator in Somalia to minimize the discrepancy. METHODS We analyzed data from nineteen cross-sectional surveys conducted in Somalia between 2007 and 2016. We compared the acute malnutrition prevalence estimates by each of the indicators and the degree of overlap in the individual diagnosis of acute malnutrition between the WHZ and the MUAC-based indicators. We performed multivariate regression analysis with sex, age and stunting as independent variables and acute malnutrition as the dependent outcome, defined by WHZ, MUAC or MUACAZ. We performed all the analysis in the population overall and in each of the livelihood populations separately. RESULTS A total 255,623 measurements of children 6-59 months of age were analyzed. The overall prevalence of global acute malnutrition by MUACAZ (15.8%) was similar to the one obtained using WHZ (16%), whereas prevalence based on MUAC was much lower (7.8%). These patterns of divergence were sustained throughout the nineteen surveys and the livelihoods studied, with only few exceptions. However, the proportion of overlap in the individual diagnosis of children as acutely malnourished was low between WHZ and absolute MUAC diagnosis (18.1%) and also between WHZ and MUACAZ (28.3%). Results show that age, sex and stunting status of the child affected the likelihood of being diagnosed as acutely malnourished to varying degrees, depending on the indicator used. CONCLUSIONS The MUAC-for-age (MUACZ) indicator yielded acute malnutrition prevalence estimates convergent with those obtained by WHZ indicator. However, the degree of overlap between these two indicators for individual diagnosis of acute malnutrition is low. Further studies of MUACAZ as an alternative indicator for nutrition surveillance are needed.
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Affiliation(s)
- Estefania Custodio
- European Commission, Joint Research Centre, Via E. Fermi, 2749, 21027, Ispra, Varese, Italy
| | - Rocio Martin-Cañavate
- European Commission, Joint Research Centre, Via E. Fermi, 2749, 21027, Ispra, Varese, Italy
| | | | - Daniel Molla
- Food Security and Nutrition Analysis Unit - Somalia, United Nations Food and Agriculture Organization, P.O. Box 30470-00100, Ngecha Road, Nairobi, Kenya
| | - Yusuf Abukar
- Food Security and Nutrition Analysis Unit - Somalia, United Nations Food and Agriculture Organization, P.O. Box 30470-00100, Ngecha Road, Nairobi, Kenya
| | - Francois Kayitakire
- European Commission, Joint Research Centre, Via E. Fermi, 2749, 21027, Ispra, Varese, Italy
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22
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Frison S, Kerac M, Checchi F, Nicholas J. A novel, efficient method for estimating the prevalence of acute malnutrition in resource-constrained and crisis-affected settings: A simulation study. PLoS One 2017; 12:e0186328. [PMID: 29091927 PMCID: PMC5665500 DOI: 10.1371/journal.pone.0186328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The assessment of the prevalence of acute malnutrition in children under five is widely used for the detection of emergencies, planning interventions, advocacy, and monitoring and evaluation. This study examined PROBIT Methods which convert parameters (mean and standard deviation (SD)) of a normally distributed variable to a cumulative probability below any cut-off to estimate acute malnutrition in children under five using Middle-Upper Arm Circumference (MUAC). METHODS We assessed the performance of: PROBIT Method I, with mean MUAC from the survey sample and MUAC SD from a database of previous surveys; and PROBIT Method II, with mean and SD of MUAC observed in the survey sample. Specifically, we generated sub-samples from 852 survey datasets, simulating 100 surveys for eight sample sizes. Overall the methods were tested on 681 600 simulated surveys. RESULTS PROBIT methods relying on sample sizes as small as 50 had better performance than the classic method for estimating and classifying the prevalence of acute malnutrition. They had better precision in the estimation of acute malnutrition for all sample sizes and better coverage for smaller sample sizes, while having relatively little bias. They classified situations accurately for a threshold of 5% acute malnutrition. Both PROBIT methods had similar outcomes. CONCLUSIONS PROBIT Methods have a clear advantage in the assessment of acute malnutrition prevalence based on MUAC, compared to the classic method. Their use would require much lower sample sizes, thus enable great time and resource savings and permit timely and/or locally relevant prevalence estimates of acute malnutrition for a swift and well-targeted response.
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Affiliation(s)
- Severine Frison
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Francesco Checchi
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Jennifer Nicholas
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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23
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Brindle E, Lillis L, Barney R, Hess SY, Wessells KR, Ouédraogo CT, Stinca S, Kalnoky M, Peck R, Tyler A, Lyman C, Boyle DS. Simultaneous assessment of iodine, iron, vitamin A, malarial antigenemia, and inflammation status biomarkers via a multiplex immunoassay method on a population of pregnant women from Niger. PLoS One 2017; 12:e0185868. [PMID: 28982133 PMCID: PMC5628875 DOI: 10.1371/journal.pone.0185868] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
Deficiencies of vitamin A, iron, and iodine are major public health concerns in many low- and middle-income countries, but information on their status in populations is often lacking due to high costs and logistical challenges associated with assessing micronutrient status. Accurate, user-friendly, and low-cost analytical tools are needed to allow large-scale population surveys on micronutrient status. We present the expansion of a 7-plex protein microarray tool for the simultaneous measurement of up to seven biomarkers with relevance to the assessment of the key micronutrients iron, iodine, and vitamin A, and inflammation and malaria biomarkers: α-1-acid glycoprotein, C-reactive protein, ferritin, retinol binding protein 4, soluble transferrin receptor, thyroglobulin, and histidine-rich protein II. Assay performance was assessed using international reference standards and then verified by comparing the multiplexed and conventional immunoassay results on a training panel of plasma samples collected from US adults. These data were used to assign nominal concentrations to the calibrators of the assay to further improve performance which was then assessed by interrogating plasma samples from a cohort of pregnant women from Niger. The correlation between assays for each biomarker measured from this cohort was typically good, with the exception of thyroglobulin, and the sensitivity ranged from 74% to 93%, and specificity from 81% to 98%. The 7-Plex micronutrient assay has the potential for use as an affordable tool for population surveillance of vitamin A, iron, and iodine deficiencies as well as falciparum malarial parasitemia infectivity and inflammation. The assay is easy-to-use, requires minimal sample volume, and is scalable, rapid, and accurate—needing only a low-cost reader and basic equipment present in most reference laboratory settings and so may be employed by low and middle income countries for micronutrient surveillance to inform on status in key populations. Micronutrient deficiencies including iron, iodine, and vitamin A affect a significant portion of the world’s population. Efforts to assess the prevalence of these deficiencies in vulnerable populations are challenging, partly due to measurement tools that are inadequate for assessing multiple micronutrients in large-scale population surveys. We have developed a 7-plex immunoassay for the simultaneous measurement of seven biomarkers relevant to assessing iodine, iron, and vitamin A status, inflammation and Plasmodium falciparum parasitemia by measuring levels of thyroglobulin, ferritin, soluble transferrin receptor, retinol binding protein 4, α-1-acid glycoprotein, C-reactive protein, and histidine-rich protein II. This 7-plex immunoassay technique has potential as a rapid and effective tool for use in large-scale surveys and assessments of nutrition intervention programs in low- and middle-income countries.
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Affiliation(s)
- Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States of America
| | | | | | - Sonja Y. Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - K. Ryan Wessells
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - Césaire T. Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
- Helen Keller International, Niamey, Niger
| | - Sara Stinca
- Laboratory of Human Nutrition, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Roger Peck
- PATH, Seattle, WA, United States of America
| | - Abby Tyler
- Quansys Biosciences, Logan, Utah, United States of America
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24
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Frison S, Kerac M, Checchi F, Prudhon C. Anthropometric indices and measures to assess change in the nutritional status of a population: a systematic literature review. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0104-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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