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Chen Y, Guo Y, Wu Y, Medina A, Zhou H, Darmstadt GL. Maternal empowerment, feeding knowledge, and infant nutrition: Evidence from rural China. J Glob Health 2024; 14:04094. [PMID: 38845456 PMCID: PMC11157471 DOI: 10.7189/jogh.14.04094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Background Maternal empowerment - the capacity to make decisions within households - is linked to better child feeding and nutritional outcomes, but few studies have considered the mediating role of caregiver knowledge. Further, existing literature centres primarily on the husband-wife dyad while overlooking grandmothers as important childcare decision-makers. Methods We collected primary data through household surveys in 2019 and 2021 from 1190 households with infants zero to six months living in rural western China. We identified the primary and secondary caregivers for each infant and assessed their feeding knowledge and practices, as well as infant nutritional status. We constructed a maternal empowerment index using a seven-item decision-making questionnaire and examined the relationship between maternal empowerment in childcare and household decisions, caregivers' feeding knowledge, and infant feeding practices and nutritional outcomes. Results Mothers had significantly higher levels of feeding knowledge than secondary caregivers (most were grandmothers, 72.7%), with average knowledge scores of 5.4 vs. 4.1, respectively, out of 9. Mothers and secondary caregivers with higher levels of feeding knowledge had significantly higher exclusive breastfeeding rates by 13-15 percentage points (P < 0.01) and 11-13 percentage points (P < 0.01), respectively. The knowledge of secondary caregivers was even more strongly associated with not feeding formula (15 percentage points, P < 0.01). Mothers empowered to make childcare decisions were more likely to exclusively breastfeed (12-13 percentage points, P < 0.01), less likely to formula feed (9-10 percentage points, P < 0.05), and more likely to have children with higher Z-scores for length-for-age (0.32-0.33, P < 0.01) and weight-for-age (0.24-0.25, P < 0.05). Effects remained after controlling for maternal feeding knowledge. Conclusions While mothers' and grandmothers' feeding knowledge was both important for optimal infant feeding, grandmothers' knowledge was particularly critical for practicing exclusive breastfeeding. Given the disparity in feeding knowledge between the two caregivers, our study further shows that mothers empowered in childcare decision-making were more likely to exclusively breastfeed their infants. This implies that some mothers with adequate knowledge may not practice optimal feeding because of lower decision-making power. Overall, our study highlights the role of secondary caregivers (grandmothers) in infant care and suggests that future child nutritional interventions may benefit from involving secondary caregivers (grandmothers). Registration Parent trial registration: ISRCTN16800789.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yian Guo
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, California, USA
| | - Yuju Wu
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Alexis Medina
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, California, USA
| | - Huan Zhou
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Basrowi RW, Zulfiqqar A, Sitorus NL. Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review. Nutrients 2024; 16:1285. [PMID: 38732532 PMCID: PMC11085192 DOI: 10.3390/nu16091285] [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: 03/28/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.
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Affiliation(s)
- Ray Wagiu Basrowi
- Danone Specialized Nutrition Indonesia, Jakarta 12940, Indonesia;
- Occupational Medicine Program, Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 12300, Indonesia
| | - Andy Zulfiqqar
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia;
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Yang J, Liu Z, Guo H, Reheman Z, Ye J, Song S, Wang N, Nie W, Nie J. Prevalence and influencing factors of anaemia among pregnant women in rural areas of Northwestern China. Public Health 2023; 220:50-56. [PMID: 37269588 DOI: 10.1016/j.puhe.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/22/2023] [Accepted: 04/26/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Anaemia during pregnancy is a significant public health problem that adversely impacts both the mother and foetus. However, the factors influencing maternal anaemia in deprived areas of Northwestern China have not yet been thoroughly investigated. This study aimed to describe the prevalence and potential influencing factors of anaemia among expectant mothers in rural areas of Northwestern China. STUDY DESIGN This was a cross-sectional survey. METHODS A cross-sectional survey of 586 expectant mothers was conducted to investigate the prevalence of anaemia, prenatal healthcare coverage, dietary diversity and nutrient supplementation intake. The study population was selected from the sample areas using a random sampling method. Data were collected through a questionnaire, and haemoglobin concentrations were measured by a capillary blood test. RESULTS The results show that 34.8% of the study population were anaemic, with 13% having moderate-to-severe anaemia. The results of the regression analysis showed that diet was not significantly associated with haemoglobin concentrations or the prevalence of anaemia. However, regular prenatal healthcare attendance was found to be an important influencing factor for both haemoglobin concentration (β = 3.67, P = 0.002) and the prevalence of anaemia (odds ratio = 0.59, P = 0.011). CONCLUSIONS Pregnant women receiving regular prenatal care were less likely to be anaemic; thus, it is essential to implement strategies to improve attendance at maternal public health services to reduce the prevalence of maternal anaemia.
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Affiliation(s)
- J Yang
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
| | - Z Liu
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
| | - H Guo
- School of Philosophy and Government, Shaanxi Normal University, Xian, China.
| | - Z Reheman
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
| | - J Ye
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
| | - S Song
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
| | - N Wang
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
| | - W Nie
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
| | - J Nie
- Center for Experimental Economics in Educational, Shaanxi Normal University, Xi'an, China.
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Xu M, Zhang H, Liu A, Zhao C, Huang X, Berman S, Fang H, Guan H. Effectiveness and cost-effectiveness of a group-based intervention to improve social-emotional development of young children in poverty-stricken areas: A cluster randomized controlled trial. J Glob Health 2023; 13:04017. [PMID: 36734398 PMCID: PMC9896863 DOI: 10.7189/jogh.13.04017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Social-emotional ability is key to the well-being and future success of children; however, disparities in social-emotional development during an individual's early age can last a lifetime, which is particularly evident among children living in poverty-stricken areas. We aimed to determine the effectiveness, cost-effectiveness, and feasibility of a group-based intervention called the Care Group on social-emotional development for families living in poverty-stricken counties. Methods We conducted a cluster (township) randomized controlled trial (C-RCT) every two weeks from July 2019 to June 2020 in a poverty-stricken area located in Shanxi, China. The outbreak of the COVID-19 pandemic suspended the implementation of the intervention in January 2020. The caregiver-child pairs in the intervention group participated in 12 group-based sessions with a structured curriculum and learning materials emphasizing nurturing ability and early childhood development. We applied a difference-in-differences (DID) model to estimate the intervention's impact. The analysis follows the intention-to-treat (ITT) principle. We used standard economic costing methods to estimate the cost of implementing the Care Group over the intervention period and adopted a societal perspective in the analysis. Results We included 322 eligible caregiver-child pairs in the baseline (intervention n = 136, control n = 186) and surveyed 258 pairs in the endline (intervention n = 117, control n = 141). Compared with the control group, children in the intervention group had significantly fewer social-emotional problems (adjusted mean difference of Z score = -0.374, 95% CI = -0.718, -0.030, P = 0.033) six months after intervention. In the first year, the annual cost of implementing Care Group was US$146.10 per child, reduced to US$47.20 per child in the second year due to the exclusion of non-recurrent costs. The incremental cost-effectiveness ratio (ICER) was US$390.60. Conclusions Care Group is an effective approach for promoting children's social-emotional development in poverty-stricken areas at an affordable cost and with high feasibility for scale-up. Considering the planned per capita health expenditure of the Chinese government for 2022, we believe that the presented evidence makes a solid scientific and financial case for integrating the Care Group intervention into the basic public health services (BPHS) package. Registration Chinese Clinical Trials Registry (ChiCTR): ChiCTR1900022894.
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Affiliation(s)
- Mengxue Xu
- Nurturing Care Research and Guidance Center, Capital Institute of Pediatrics, Beijing, China
| | - Haijun Zhang
- China Center for Health Development Studies, Peking University, Beijing, China,Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Aihua Liu
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Chunxia Zhao
- Child Development Research Centre, China Development Research Foundation
| | - Xiaona Huang
- Child Health and Development, UNICEF China, Beijing, China
| | - Stephen Berman
- Center for Global Health (CGH), University of Colorado Anschutz Medical Campus Aurora, Colorado, USA,WHO Collaborating Center to Promote Family and Child Health, University of Colorado Anschutz Medical Campus Aurora, Colorado, USA,Colorado School of Public Health, University of Colorado Anschutz Medical Campus Aurora, Colorado, USA
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China,Peking University Health Science Center – Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China
| | - Hongyan Guan
- Nurturing Care Research and Guidance Center, Capital Institute of Pediatrics, Beijing, China
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Chen Y, Wu Y, Dill SE, Guo Y, Westgard CM, Medina A, Weber AM, Darmstadt GL, Zhou H, Rozelle S, Sylvia S. Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: study protocol for a cluster randomised controlled trial. BMJ Open 2023; 13:e065403. [PMID: 36669837 PMCID: PMC9872510 DOI: 10.1136/bmjopen-2022-065403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme. METHODS AND ANALYSIS We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children's haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes. ETHICS AND DISSEMINATION Ethical approval has been provided by Stanford University, Sichuan University and the University of Nevada, Reno. Trial findings will be disseminated through national and international peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER ISRCTN16800789.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuju Wu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Sarah-Eve Dill
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Yian Guo
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Christopher Michael Westgard
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis Medina
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Ann M Weber
- Department of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Huan Zhou
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Stanford University, Stanford, CA, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chen Y, Sylvia S, Dill SE, Rozelle S. Structural Determinants of Child Health in Rural China: The Challenge of Creating Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13845. [PMID: 36360724 PMCID: PMC9654689 DOI: 10.3390/ijerph192113845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Over the past two decades, the literature has shown a clear gradient between child health and wealth. The same health-wealth gradient is also observed among children in China, with a large gap in health between rural and urban children. However, there are still unanswered questions about the main causes of China's rural-urban child health inequality. This paper aims to review the major factors that have led to the relatively poor levels of health among China's rural children. In addition to the direct income effect on children's health, children in rural areas face disadvantages compared with their urban counterparts from the beginning of life: Prenatal care and infant health outcomes are worse in rural areas; rural caregivers have poor health outcomes and lack knowledge and support to provide adequate nurturing care to young children; there are large disparities in access to quality health care between rural and urban areas; and rural families are more likely to lack access to clean water and sanitation. In order to inform policies that improve health outcomes for the poor, there is a critical need for research that identifies the causal drivers of health outcomes among children. Strengthening the pediatric training and workforce in rural areas is essential to delivering quality health care for rural children. Other potential interventions include addressing the health needs of mothers and grandparent caregivers, improving parenting knowledge and nurturing care, improving access to clean water and sanitation for remote families, and most importantly, targeting poverty itself.
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Affiliation(s)
- Yunwei Chen
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sarah-Eve Dill
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA
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Du Y, Durstenfeld A, Dill SE, Wang Q, Zhou H, Xue H, Kache S, Medina A, Rozelle S. Prevalence of Anemia and Associated Factors among Infants under Six Months in Rural China. Public Health Nutr 2022; 26:1-27. [PMID: 35920295 PMCID: PMC9989709 DOI: 10.1017/s1368980022001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine haemoglobin level and anaemia status among infants under six months of age in rural China. DESIGN A cross-sectional survey collected data among infants under six months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months). SETTING 80 townships were selected in Sichuan, China from November to December 2019. PARTICIPANTS 942 infants under six months, while haemoglobin level were tested for 577 infants. RESULTS The overall mean (±SD) haemoglobin level was 106.03 (± 12.04) g/L. About 62.6% (95%CI: 58.5, 66.6) of sample infants were anemic using the WHO threshold, and 20.5% (95%CI: 17.3, 24.1) were anemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower haemoglobin levels were significantly associated with lower birth weight (<4 months: b = 4.14, 95% CI: 0.19, 8.08; 4-5 months: b = 6.60, 95% CI: 2.94, 10.27) and delivery by cesarean section (<4 months: b = -4.64, 95%CI: -7.79, -1.49; 4-5 months: b = -4.58, 95%CI: -7.45, -1.71). CONCLUSION A large share of infants under six months in rural western China are anemic. Infants with low-birth-weight and cesarean-delivered should be prioritized for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between cesarean-section and anaemia to promote health and development in infancy.
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Affiliation(s)
- Yefan Du
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Anne Durstenfeld
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA, USA
| | - Sarah-Eve Dill
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Qingzhi Wang
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Hao Xue
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Saraswati Kache
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
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Wang Q, Zhang S. Gender inequality in nutrition intake: Evidence from a large assistance program. ECONOMICS AND HUMAN BIOLOGY 2022; 45:101111. [PMID: 35091348 DOI: 10.1016/j.ehb.2022.101111] [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: 10/04/2021] [Revised: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
This paper examines the growth effect of one of the largest nutrition assistance programs in early life. The program covers 5.8 million children in poor rural China and provides 6-24-month old children with a free nutrition supplement that contains nine essential micronutrients. We utilize a phase-in procedure by county for identification and estimate its impact on several early-life health indicators. Robust evidence shows that such nutrition supplements effectively increase boys' weight and reduce their probability of being underweight. No effect is observed on girls of similar age. These health indicators are related to long-term human capital development. The gender differences in policy impact that are identified in this paper have important implications for nutrition subsidy in the early years of life in developing countries.
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Affiliation(s)
- Qing Wang
- International School of Business and Finance, Sun Yat-sen University; Rural Development Institute, Yan'an University, China.
| | - Shiying Zhang
- School of Economics and Management, Harbin Institute of Technology, Shenzhen, China.
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Alamneh YM, Akalu TY, Shiferaw AA, Atnaf A. Magnitude of anemia and associated factors among children aged 6-59 months at Debre Markos referral hospital, Northwest Ethiopia: a hospital-based cross-sectional study. Ital J Pediatr 2021; 47:172. [PMID: 34389033 PMCID: PMC8362241 DOI: 10.1186/s13052-021-01123-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Anemia, the most common micro-nutrient deficiency disorder, is the world’s second leading cause of morbidity and morbidity, affecting 24.8% of the population, of which 47.4% are under-five children. The prevalence of anemia ranges from 44 to 56% in Ethiopia. Although its magnitude has shown decreases across regions; it continues to be a significant public health problem, particularly in developing countries including Ethiopia. Despite this evidence, the magnitude and associated factors of anemia was not systematically explored and there is a limited information or limited evidences in the study area. Hence, the aim of this study was to assess the magnitude and associated factors of anemia among children aged 6–59 months attending at Debre Markos Referral Hospital, Northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted at Debre Markos referral hospital Northwest Ethiopia from September 30 to December 30, 2019. Data on socio-demographic and socio-economic factors, health and nutritional features of children and their mothers were obtained using pre-tested structured questionnaires in a face-to-face interview with child care providers. Blood samples and stool examination for intestinal parasites were performed. Hemoglobin level was analyzed using the HemoCue device (HemoCueHb 301). The collected data were coded, cleared and entered into Epi-Data version 3.1, and analyzed using Stata version 14 software. To identify candidates and predictor variables, bivariate and multivariate logistic regressions were applied respectively. The significance level was determined at a confidence interval of 95% at p-value < 0.05. Results Of the total of 341 participants planned to be participated, about 310 mother-child pairs participated in the study, giving a response rate of 91%; and data were collected from children as well as their parents or guardians. In this study, the magnitude of anemia was 11.9% (95% CI, 8.5, 16.2%). Poor dietary diversity (AOR = 2.3; 95% CI: 1.12, 5.14), food-insecure households (AOR = 3.24; 95% CI: 1.85, 4.52), complementary feeding initiation time (AOR = 3.20; 95% CI:1.23, 6.61), intestinal parasites infection (AOR = 3.20; 95% CI:1.23, 6.61) and family income (AOR = 2.87; 95% CI:1.57, 5.0) were found to be factors significantly associated with anemia. Conclusion Overall, anemia is considered a public health problem among children aged 6–59 months attending at Debre Markos referral hospital, based on the cut-off point of the World Health Organization. Poor dietary diversity, complementary feeding initiation time, household food insecurity, intestinal parasite infection and family income were significantly associated with childhood anemia. Thus, it needs for proven interventions in public health such as food diversification, anti-helmintic drug provision and household food security. In addition, educating women about nutrition and diet diversification, as well as involving them in alternative sources of income-generating activity, can be vital in the study area.
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Affiliation(s)
- Yoseph Merkeb Alamneh
- Department of Biomedical Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos Ethiopia, P.O. Box 269, Debre Markos, Ethiopia
| | - Abtie Abebaw Shiferaw
- Department of Medical Laboratory Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Aytenew Atnaf
- Department of Medical Laboratory Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Li M, Lv Y, Ying J, Xu L, Chen W, Zheng Q, Ji C, Shao J. Effect of Daily Iron Supplementation on Infantile Iron Homeostasis in Preterm Infants. Front Pediatr 2021; 9:687119. [PMID: 34123978 PMCID: PMC8192839 DOI: 10.3389/fped.2021.687119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of this study was to investigate the effects of unified iron supplementation and identify the factors related to the iron homeostasis among preterm infants. Method: A total of 250 preterm infants were divided into neonatal anemic (NA, n = 154) and non-neonatal anemic group (NNA, n = 96). Iron supplements at a dose of 2 mg/kg per day were given from 40 weeks' gestational age to 6 months. Iron status parameters were measured at 3 and 6 months, respectively. Prevalence of iron deficiency (ID) and iron deficiency anemia (IDA), and the correlated factors were analyzed. Growth and side-effects were monitored. Results: There were no significant differences for the prevalence of ID or IDA between the two groups. Multivariate regression analyses showed that higher Hb at birth and early treatment of blood transfusion reduced the risk of ID/IDA at 3 months (all p < 0.05); while higher level of Hb at 3 months (p = 0.004) and formula feeding reduced the occurrence of ID/IDA at 6 months (p < 0.05); males had a 3.35 times higher risk to develop ID/IDA than girls (p = 0.021). No differences in growth and side effects were found. Conclusion: A daily dose of 2 mg/kg iron supplement is beneficial to maintain iron homeostasis in majority preterm infants within 6 months regardless of their neonatal anemia history. Under the routine iron supplementation, Hb level at birth and at 3 months, early treatment of blood transfusion, gender and feeding patterns are the major factors affecting the prevalence of ID/IDA among preterm infants in infancy.
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Affiliation(s)
- Mingyan Li
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ying Lv
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jionghuan Ying
- Department of Pediatrics, Cixi People's Hospital, Cixi, China
| | - Lin Xu
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weijun Chen
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Quan Zheng
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chai Ji
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jie Shao
- Department of Pediatric Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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11
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Regional Differences in the Prevalence of Anaemia and Associated Risk Factors among Infants Aged 0-23 Months in China: China Nutrition and Health Surveillance. Nutrients 2021; 13:nu13041293. [PMID: 33919830 PMCID: PMC8070845 DOI: 10.3390/nu13041293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Infantile anaemia has been a severe public health problem in China for decades. However, it is unclear whether there are regional differences in the prevalence of anaemia. In this study, we used data from the China Nutrition and Health Surveillance (CNHS) to assess the prevalence of anaemia and the risk factors associated with its prevalence in different regions. We included 9596 infants aged 0–23 months from the CNHS 2013 database. An infant was diagnosed with anaemia if he/she had a haemoglobin concentration of <110 g/L. We used multivariate logistic regression to investigate the potential risk factors associated with the development of anaemia. We found that anaemia was present in 2126 (22.15%) of the infants assessed. Approximately 95% of these cases were classified as mild anaemia. Based on the guidelines laid out by the World Health Organization, 5.5% and 43.6% of the surveillance sites were categorized as having severe and moderate epidemic levels of anaemia, respectively. The prevalence of infantile anaemia in Eastern, Central and Western China was 16.67%, 22.25% and 27.44%, respectively. Premature birth, low birth weight, breastfeeding and residence in Western China were significantly associated with higher odds of developing anaemia. Female sex and having mothers with high levels of education and maternal birth age >25 years were associated with lower odds of developing anaemia. In conclusion, we observed significant regional disparities in the prevalence of infantile anaemia in China. Western China had the highest prevalence of infantile anaemia, and rural regions showed a higher prevalence of anaemia than urban regions.
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Xu M, Liu A, Zhao C, Fang H, Huang X, Berman S, Guan H. Group-based intervention to improve developmental status among children age 6-18 months in rural Shanxi province, China: a study protocol for a cluster randomised controlled trial. BMJ Open 2020; 10:e037156. [PMID: 33077560 PMCID: PMC7574939 DOI: 10.1136/bmjopen-2020-037156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/20/2020] [Accepted: 09/17/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Early childhood development (ECD) is a critical component for building the foundation of future physical and emotional health and subsequent academic success. The quality of the home environment to promote development is an important factor in ECD. Since large rural-urban disparities in the home environment exist in China, there is a critical need to develop and evaluate interventions to promote ECD in rural areas. Individual center-based or home-based interventions dominate the current ECD programmes in rural China. However, group-based interventions offer potential advantages in terms of both effectiveness and cost. Thus, we aim to: (1) evaluate the effectiveness of an integrated group-based intervention, the Care Group Intervention, in enhancing ECD among children age 6-18 months and (2) conduct a cost-effectiveness analysis. METHODS AND ANALYSIS The Care Group Intervention uses a cluster (by township) randomised controlled trial conducted in Fenxi county, Shanxi province, China, from July 2019, for 1 year. The intervention focuses on five key components of nurturing care including good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for early learning. The intervention comprises small groups of 3-10 children within a certain age range and their primary caregivers that are led by well-trained local facilitators. Outcomes includes infants' developmental quotient (Bayley Scales of Infant Development III, Ages & Stages Questionnaire: Social-Emotional, second edition); anaemia (HemoCue Hb 301+); nurturing environment (Infant/Toddler Home Observation for Measurement of the Environment), parent-child interaction (Teaching Scale) and caregiver depression (Center for Epidemiological Studies Depression). Cost data are collected throughout the entire study to carry out a cost-effectiveness analysis. ETHICS AND DISSEMINATION This study was approved by the Ethical Committee of Capital Institute of Pediatrics, Beijing, China on 10 July 2018 (SHERLL2018014). Findings and results from this project will be disseminated via publications and presentations. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry: ChiCTR1900022894. Registered on 30 April 2019.
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Affiliation(s)
- Mengxue Xu
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Aihua Liu
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | | | - Stephen Berman
- Center for Global Health (CGH), Colorado School of Public Health, Aurora, Colorado, USA
| | - Hongyan Guan
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Beijing, China
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13
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Zhao C, Guan H, Shi H, Zhang J, Huang X, Wang X. Relationships between dietary diversity and early childhood developmental outcomes in rural China. MATERNAL AND CHILD NUTRITION 2020; 17:e13073. [PMID: 32902154 PMCID: PMC7729803 DOI: 10.1111/mcn.13073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 12/19/2022]
Abstract
The period from birth to 2years of age is highly sensitive with respect to the relationship between nutrition and neurodevelopment, but data regarding the association between dietary diversity and early childhood neurodevelopment are limited. We sought to examine the association of two feeding indicators-minimum dietary diversity (MDD) and minimum meal frequency (MMF)-with the neurodevelopment of children aged 6-23 months, using data from a cross-sectional survey conducted in six rural counties in China. Data on 1,534 children were analysed using logistic regression to explore the associations between dietary diversity and early neurodevelopment, with adjustments for the age, sex and prematurity of the child; the age, sex and educational level of the caregiver; and family size, income and simulative care practices and resources. We found that 32.4% of children had suspected developmental delays based on the Chinese version of the Ages and Stages Questionnaires Version 3, whereas 77.0% and 39.2% failed to meet the MDD and MMF, respectively. Meeting the MDD was associated with a 39% lower risk of developmental delays (AOR = 0.61, 95% CI [0.43, 0.86]). There was a significant association between MDD and reduced likelihood of developmental delays in gross motor, fine motor, problem-solving and personal social subscales, whereas MMF was only associated with a lower risk of developmental delays in the gross motor subscale (AOR = 0.63, 95% CI [0.42, 0.94]). We observed an inverse dose-response relationship between the number of food groups consumed and the risk of developmental delays (P < .001).
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Affiliation(s)
- Chunxia Zhao
- Ministry of Health Key Laboratory of Reproductive Health, Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hongyan Guan
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Huifeng Shi
- Ministry of Health Key Laboratory of Reproductive Health, Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jingxu Zhang
- Ministry of Health Key Laboratory of Reproductive Health, Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xiaona Huang
- Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoli Wang
- Ministry of Health Key Laboratory of Reproductive Health, Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, Beijing, China
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14
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Li H, Xiao J, Liao M, Huang G, Zheng J, Wang H, Huang Q, Wang A. Anemia prevalence, severity and associated factors among children aged 6-71 months in rural Hunan Province, China: a community-based cross-sectional study. BMC Public Health 2020; 20:989. [PMID: 32576157 PMCID: PMC7310416 DOI: 10.1186/s12889-020-09129-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background In recent 10 years, with the rapid socioeconomic development and the extensive implementation of children nutrition improvement projects, the previous epidemiological data cannot reflect the actual level of anemia among children in China, especially in rural areas. Therefore, this study analyzed the prevalence, severity and associated factors of anemia among children aged 6–71 months in rural Hunan Province. Methods A community-based cross-sectional study was conducted. Through multistage stratified cluster sampling, 5229 children aged 6 to 71 months and their caregivers were randomly selected from 72 villages across 24 towns in 12 counties from rural Hunan. The demographic characteristics of children and their caregivers, feeding practice, nutritional status of children, caregivers’ anemia-related feeding knowledge, and gestational conditions of mothers were acquired by using a unified questionnaire. Peripheral blood from the left-hand middle fingertip was sampled from each child, and hemoglobin concentration was measured using a HemoCue301 portable hemoglobin analyzer (Sweden). Associated factors analyses involving overall anemia and anemia severities were conducted on multivariate logistic regression models. Results The overall anemia prevalence was 8.8%, and the prevalence of mild, moderate and severe anemia was 6.3, 2.5 and 0.1%, respectively. Children age groups of 6–11 months, 12–23 months and 36–47 months, exclusive breast-feeding within 6 months after birth, and maternal moderate/severe anemia were significantly associated with an increased risk of overall anemia in children. Children age groups of 6–11 months and 12–23 months were significantly associated with an increased risk of mild anemia in children. Children age groups of 6–11 months, 12–23 months and 36–47 months, low caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia were significantly associated with an increased risk of moderate/severe anemia in children. Children who underwent regular physical examination were less likely to have moderate/severe anemia. The common protective factor for overall, mild and moderate/severe anemia in children was high family income. Conclusions The anemia status of preschool children in rural Hunan Province was a mild public health problem and associated with children age group, feeding practice, regular physical examination, family income, caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia.
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Affiliation(s)
- Huixia Li
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China.,NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Juan Xiao
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China
| | - Minghui Liao
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China
| | - Guangwen Huang
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China.
| | - Jianfei Zheng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Hua Wang
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China. .,Department of Maternal Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China.
| | - Qun Huang
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China
| | - Aihua Wang
- Department of Information Management, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
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Luo R, Emmers D, Warrinnier N, Rozelle S, Sylvia S. Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial. Soc Sci Med 2019; 239:112545. [PMID: 31568997 DOI: 10.1016/j.socscimed.2019.112545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/26/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022]
Abstract
Inadequate care during early childhood can lead to long-term deficits in skill development. Parenting programs are promising tools for improving parenting practices and opportunities for healthy development. We implemented a non-masked cluster-randomized controlled trial in rural China in order to assess the effectiveness of an integrated home-visitation program that includes both psychosocial stimulation and health promotion at fostering development and health outcomes of infants and toddlers in rural China. All 6-18 month-old children of two rural townships and their main caregiver were enrolled. Villages were stratified by township and randomly assigned to intervention or control. Specifically, in September 2015 we assigned 43 clusters to treatment (21 villages, 222 caregiver-child dyads) or control (22 villages, 227 caregiver-child dyads). In the intervention group, community health workers delivered education and training on how to provide young children with psychosocial stimulation and health care (henceforth psychosocial stimulation and health promotion) during bi-weekly home visits over the period of one year. The control group received no home visits. Primary outcomes include measures of child development (i.e. the Bayley Scales of Infant and Toddler Development, third edition-or Bayley-III) and health (i.e. measures of morbidity, nutrition, and growth). Secondary outcomes are measures of parenting practices. Intention-to-treat (ITT) effects show that the intervention led to an improvement of 0·24 standard deviations (SD) [95% CI 0·04 SD-0·44 SD] in cognitive development and to a reduction of 8·1 [95% CI 3·8-12·4] percentage points in the risk of diarrheal illness. In addition, we find positive effects on parenting practices mirroring these results. We conclude that an integrated psychosocial stimulation and health promotion program improves development and health outcomes of infants and toddlers (6-30 month-old children) in rural China. Because of low incremental costs of adding program components (that is, adding health promotion to psychosocial stimulation programs), integrated programs may be cost-effective.
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Affiliation(s)
- Renfu Luo
- China Centre for Agricultural Policy (CCAP), School of Advanced Agricultural Sciences (SAAS), Peking University (PKU), Beijing, China
| | | | | | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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16
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Siziba LP, Baumgartner J, Ricci C, Jacobs A, Rothman M, Matsungo TM, Covic N, Faber M, Smuts CM. Associations of plasma total phospholipid fatty acid patterns with feeding practices, growth, and psychomotor development in 6-month-old South African infants. MATERNAL & CHILD NUTRITION 2019; 15:e12763. [PMID: 30489019 PMCID: PMC7199032 DOI: 10.1111/mcn.12763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/14/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
The objective of this study was to assess plasma fatty acid (FA) patterns of 6-month-old South African infants and to determine their association with feeding practices, growth, and psychomotor development. Plasma total phospholipid FA composition (% of total FAs) of 6-month-old infants (n = 353) from a peri-urban township was analysed, and principal component and factor analysis were performed to identify plasma FA patterns. Feeding practices, anthropometric measurements, and psychomotor development scores were determined. Four major plasma phospholipid FA patterns were identified: A plant-based C18 FA, a high n-6 long-chain polyunsaturated fatty acids (LCPUFA), a C16:1 and long-chain saturated fatty acid (SFA), and a high n-3 and low n-6 LCPUFA pattern. Formula feeding was associated with higher, whereas breastfeeding was associated with lower scores for the plant-based C18 FA and C16:1 and long-chain SFA patterns. On the other hand, breastfeeding, the consumption of cow's milk, and the consumption of semisolid foods were associated with higher scores, whereas formula feeding was associated with lower scores for the high n-6 LCPUFA pattern. Breastfeeding and the consumption of semisolids were also associated with higher high n-3 and low n-6 LCPUFA pattern scores. The C16:1 and long-chain SFA and high n-3 and low n-6 LCPUFA patterns were positively associated with psychomotor development scores. In 6-month-old South African infants, we identified distinct plasma FA patterns that presumably represent the FA quality of their diet and that are associated with psychomotor development. Our results suggest that breast milk is an important source of n-6 LCPUFAs and formula-fed infants may be at risk of inadequate LCPUFA intake.
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Affiliation(s)
- Linda P. Siziba
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Jeannine Baumgartner
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Cristian Ricci
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Adriaan Jacobs
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | - Marinel Rothman
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
| | | | - Namukolo Covic
- Poverty, Health and Nutrition DivisionInternational Food Policy Research InstituteWashingtonDCUSA
| | - Mieke Faber
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
- Non‐Communicable Disease Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Cornelius M. Smuts
- Centre of Excellence for NutritionNorth‐West UniversityPotchefstroomSouth Africa
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17
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Amano I, Murakami A. Prevalence of infant and maternal anemia during the lactation period in Japan. Pediatr Int 2019; 61:495-503. [PMID: 30895654 DOI: 10.1111/ped.13833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 01/22/2019] [Accepted: 03/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The perinatal period is associated with a high risk of infant anemia. The aim of the present study was to determine the prevalence of infant and maternal anemia during the late lactation period and the risk factors for anemia in Japan. METHODS This retrospective cohort study was based on data from health checkups of healthy infants at 6-7 and 9-10 months of age and their mothers who visited Akitsu Children's Clinic between September 2013 and August 2015. Complete blood count data from infant blood samples obtained at 6-7 months and 9-10 months and from maternal blood samples obtained at 6-7 months, information on feeding methods, and other related parameters were analyzed. RESULTS Data from 388 mother-infant pairs were analyzed. The prevalence of infant anemia was 21.1% at 6-7 months and 29.1% at 9-10 months. The prevalence of anemia in exclusively breast-fed infants was 28.4% at 6-7 months and 40.0% at 9-10 months. The risk factors for infant anemia at 9-10 months were exclusive breast-feeding, lower gestational age at birth, male sex, and high weight gain. The prevalence of maternal anemia was 10.5%. There was no correlation between infant and maternal hemoglobin in exclusively breast-fed infants. CONCLUSIONS Japanese infants who were breast-fed exclusively had a high prevalence of anemia. A nationwide strategy to prevent anemia is required to prevent infant anemia, even in a nutrition-rich country such as Japan.
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Affiliation(s)
- Izuki Amano
- Akitsu Children's Clinic, Higashimurayama, Tokyo, Japan
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18
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Malako BG, Asamoah BO, Tadesse M, Hussen R, Gebre MT. Stunting and anemia among children 6-23 months old in Damot Sore district, Southern Ethiopia. BMC Nutr 2019; 5:3. [PMID: 32153918 PMCID: PMC7050695 DOI: 10.1186/s40795-018-0268-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 12/20/2018] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Stunting and anemia are long-standing public health challenges which adversely affects the cognitive development and physical wellbeing of children in low income settings. The aim of this study was to assess the prevalence and associated factors of stunting and anemia among 6-23 months old children in Damot Sore District, Southern Ethiopia. METHODS Cross-sectional survey was conducted among 477 children aged 6-23 months, which were living in Damot Sore District, in April 2017. A multistage sampling technique was used. Villages were randomly selected and systematic random sampling method was used to select study participants. Data on socio-demographic, anthropometric, dietary, blood samples for hemoglobin were collected. Data were entered into EPI Data V. 3.1 and exported into SPSS Version 21.0 for analysis. A principal component analysis (PCA) was done to generate wealth score of households. Binary logistic regression model was used to identify factors associated with the outcome variables (stunting and anemia) separately, those variables having less than a p-value of 0.25 were chosen as candidate for multivariable analyses and finally multivariable logistic regression model was used to identify independent variables of each outcomes, with statistical significance set at p < 0.05 (95% confidence interval (CI)). RESULTS Out of 477 children studied, 31.7% were stunted and 52% were anemic. In the multivariable analyses, the number of under five children within a household (AOR = 4.18, 95% CI: 2.65-6.57), drinking water from unsafe source (AOR = 4.08, 95% CI: 1.33-12.54) and anemia (AOR = 3.13, 95% CI 2.00-4.92) were factors significantly associated with stunting. On the other hand, independent variables of anemia were early initiation of complementary feeding (AOR = 2.96, 95% CI: 1.23-4.85), poor dietary diversity (AOR = 2.95, 95% CI: 1.78-4.91), poor breast feeding practice (AOR = 2.94, 95% CI: 1.63-5.32) and stunting (AOR = 3.65, 95% CI: 2.15-6.19). CONCLUSION This study revealed higher level of stunting and anemia among children aged 6-23 months than WHO (world health organization) criteria of public health importance. Sustainable promotion of diversified diet, optimal complementary feeding, optimal and complementary breast feeding practices, improving sanitation infrastructure are measures needed to tackle these severe public health challenges.
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Affiliation(s)
- Bereket Geze Malako
- World Vision Ethiopia, Jimma area cluster office, Gewata area development program, Jimma, Ethiopia
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Malmo, Lund University, Lund, Sweden
| | - Minyahil Tadesse
- Health Sciences and Medicine College, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Robel Hussen
- School of public health, Dilla University, Dilla, Ethiopia
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Li S, Yue A, Abbey C, Medina A, Shi Y. Breastfeeding and the Risk of Illness among Young Children in Rural China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010136. [PMID: 30621049 PMCID: PMC6339247 DOI: 10.3390/ijerph16010136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/14/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
Poor rural areas in China exhibit the country’s highest rates of child mortality, often stemming from preventable health conditions such as diarrhea and respiratory infection. In this study, we investigate the association between breastfeeding and disease among children aged 6–24 months in poor rural counties in China. To do this, we conducted a longitudinal, quantitative analysis of socioeconomic demographics, health outcomes, and breastfeeding practices for 1802 child–caregiver dyads across 11 nationally designated poverty counties in southern Shaanxi Province in 2013–2014. We found low rates of continued breastfeeding that decreased as children developed: from 58.2% at 6–12 months, to 21.6% at 12–18 months, and finally to 5.2% at 18–24 months. These suboptimal rates are lower than all but one other country in the Asia-Pacific region. We further found that only 18.3% of children 6–12 months old met the World Health Organization (WHO)-recommended threshold for minimum dietary diversity, defined as consuming four or more of seven specific food groups. Breastfeeding was strongly associated with lower rates of both diarrhea and cough in bivariate and multivariate analyses. As the first analysis to use longitudinal data to examine the relationship between continued breastfeeding and child illness in China, our study confirms the need for programmatic interventions that promote continued breastfeeding in order to improve toddler health in the region.
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Affiliation(s)
- Shanshan Li
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi'an 710119, China.
| | - Ai Yue
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi'an 710119, China.
| | - Cody Abbey
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA 94305, USA.
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA 94305, USA.
| | - Yaojiang Shi
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi'an 710119, China.
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Li Q, Liang F, Liang W, Shi W, Han Y. Prevalence of Anemia and Its Associated Risk Factors Among 6-Months-Old Infants in Beijing. Front Pediatr 2019; 7:286. [PMID: 31355169 PMCID: PMC6640653 DOI: 10.3389/fped.2019.00286] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: The worldwide prevalence of anemia is ~24.8%. Iron deficiency anemia is common in children and women and associated with sensory, motor, cognitive, language, and socioemotional deficits. Therefore, detection and early intervention strategies for anemia in infants are urgently needed. To prevent the occurrence of iron deficiency anemia, we aimed to identify risk factors associated with anemia in infants. Methods: This investigation involved a cross-sectional study of 6-months-old infants discharged between April 2014 and September 2017 from Peking University First Hospital. We assessed birth information, maternal age, and maternal educational level as well as data on feeding style, complementary foods and primary caregivers. The infants were assessed with the Denver Developmental Screening Test (DDST). Results: A total of 1,127 6-months-old infants were enrolled at the hospital. We found that the prevalence of anemia among infants in Beijing was ~11.8%. Premature infants had a higher rate of anemia than full-term infants (χ2 = 40.103, P < 0.001). Infants born in autumn or winter were at an elevated risk of developing anemia (χ2 = 22.949, P < 0.001). Birth weight had no effect on the rate of anemia in infants (χ2 = 0.023, P = 0.568). Infants who were exclusively breastfeeding had higher anemia rates than those who were fed formula (χ2 = 38.466, P < 0.001). Infants whose caregivers added no complementary foods had higher anemia rates (24.7%) than those whose caregivers added more than two kinds of complementary food (8.2%). The type of caregiver had no effect on the anemia rate in infants (χ2 = 0.031, P = 1.000). Conclusions: The following factors resulted in a higher prevalence of anemia in our study a gestational age at birth of <37 weeks, exclusive breastfeeding, a lack of supplementation with complementary foods and a spring birth date. No significant differences in DDST pass rates were evident between infants with and without anemia.
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Affiliation(s)
- Qinrui Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Furong Liang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Weilan Liang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Wanjun Shi
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Han
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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21
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Malako BG, Teshome MS, Belachew T. Anemia and associated factors among children aged 6-23 months in Damot Sore District, Wolaita Zone, South Ethiopia. BMC HEMATOLOGY 2018; 18:14. [PMID: 29988695 PMCID: PMC6029164 DOI: 10.1186/s12878-018-0108-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/18/2018] [Indexed: 11/10/2022]
Abstract
Background Anemia affects a significant part of the population in nearly every country in the globe. Iron requirements are greatest at ages 6-23 months when growth is extremely rapid and critically essential in critical times of life. Even though infants and toddlers are highly at risk, they are not considered as separate populations in the estimation of anemia. Despite this, the prevalence of anemia among under 24 months of age is still at its highest point of severity to be a public health problem in Ethiopia. There is no study that documented the magnitude of the problem and associated factors in the study area. The main aim of this study was to assess the prevalence of anemia and to identify associated factors among children 6-23 months of age. Methods A community-based cross-sectional study was carried out among 485 children of Damot Sore, South Ethiopia from March to April 2017. Data on socio-demographic, dietary, blood samples for hemoglobin level and malaria infection were collected. Both descriptive and bivariate analyses were done and all variables having a p-value of 0.25 were selected for multivariable analyses. A multivariable logistic regression model was used to isolate independent predictors of anemia at a p-value less than 0.05. A principal component analysis was used to generate household wealth score, dietary diversity score. Results Out of 522 sampled children, complete data were captured from 485 giving a response rate of 92.91%. For altitude and persons smoking in the house adjusted prevalence of anemia was 255(52.6%). The larger proportion, 128(26.4%) of children had moderate anemia. On multivariable logistic regression analyses, household food insecurity (AOR = 2.74(95% CI: 1.62-4.65)), poor dietary diversity (AOR = 2.86(95% CI: 1.73-4.7)), early or late initiation of complementary feeding (AOR = 2.0(95% CI: 1.23-3.60)), poor breastfeeding practice (AOR = 2.6(95% CI: 1.41-4.62)), and poor utilization of folic acid by mothers (AOR = 2.75(95% CI: 1.42-5.36)) were significantly associated with anemia. Conclusion Prevalence of anemia among children (6-23 months) was a severe public health problem in the study area. Most important predictors are suboptimal child feeding practices, household food insecurity, and poor diet. Multi-sectoral efforts are needed to improve health and interventions targeting nutrition security are recommended.
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Affiliation(s)
| | - Melese Sinaga Teshome
- 2Institute of Health, Public Health Faculty, Population and Family Health Department, Nutrition Course Team, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- 2Institute of Health, Public Health Faculty, Population and Family Health Department, Nutrition Course Team, Jimma University, Jimma, Ethiopia
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Abstract
BACKGROUND Iron deficiency (ID) is the most common micronutrient deficiency worldwide, with potentially severe consequences on child neurodevelopment. Though exclusive breastfeeding (EBF) is recommended for 6 months, breast milk has low iron content. This study aimed to estimate the effect of the length of EBF on iron status at 6 - 8 months of age among a cohort of Bolivian infants. METHODS Mother-infant pairs were recruited from 2 hospitals in El Alto, Bolivia, and followed from one through 6 - 8 months of age. Singleton infants > 34 weeks gestational age, iron-sufficient at baseline, and completing blood draws at 2 and 6 - 8 months of age were eligible for inclusion (N = 270). Ferritin was corrected for the effect of inflammation. ID was defined as inflammation-corrected ferritin < 12 μg/L, and anemia was defined as altitude-corrected hemoglobin < 11 g/dL; IDA was defined as ID plus anemia. The effect of length of EBF (infant received only breast milk with no other liquids or solids, categorized as < 4, 4 - 6, and > 6 months) was assessed for ID, IDA, and anemia (logistic regression) and ferritin (Fer) and hemoglobin (Hb, linear regression). RESULTS Low iron status was common among infants at 6 - 8 months: 56% of infants were ID, 76% were anemic, and 46% had IDA. EBF of 4 months and above was significantly associated with ID as compared with EBF < 4 months (4 - 6 months: OR 2.0 [1.1 - 3.4]; > 6 months: 3.3 [1.0 - 12.3]), but not with IDA (4 - 6 months: OR 1.4 [0.8 - 2.4]; > 6 months: 2.2 [0.7 - 7.4]), or anemia (4 - 6 months: OR 1.4 [0.7 - 2.5]; > 6 months: 1.5 [0.7 - 7.2]). Fer and Hb concentrations were significantly lower with increasing months of EBF. CONCLUSIONS Results suggest a relationship between prolonged EBF and ID, but are not sufficient to support changes to current breastfeeding recommendations. More research is needed in diverse populations, including exploration of early interventions to address infant IDA.
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Li X, Jiang X, Sun J, Zhu C, Bai W. Recent advances of medical foods in China: The opportunities and challenges under standardization. Food Chem Toxicol 2018; 119:342-354. [PMID: 29452191 DOI: 10.1016/j.fct.2018.02.024] [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] [Received: 10/09/2017] [Revised: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 12/24/2022]
Abstract
Malnutrition with high incidence in hospitalized patients in China has brought a significant burden of disease. Although many clinical studies have demonstrated the importance of nutritional for patients with malnutrition, the application of medical foods in China is still restricted. For the classification, limits, production and registration of medical foods, the Chinese government newly enacted a series of regulations. In this review, comparing the policy, researches, and product variety of medical foods in China with other countries, although the current status of the development of medical foods in China is still far behind that of developed countries, some of regulations are stricter than those of many other countries or organizations. The medical foods in China are divided into four categories, the nutrients and environmental contaminants are limited to ensure the safety. As a prospect, the development of medical foods in China is expected to get out of the predicament of lack of emphasis, shortage of supply, backward of local processing technology and the imperfect management system. After all, in view of the huge population and the increasing demand of nutrition in China, there must be a very good prospect for the future development of the medical foods industry in China.
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Affiliation(s)
- Xusheng Li
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Xinwei Jiang
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Jianxia Sun
- School of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510090, PR China
| | - Cuijuan Zhu
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China
| | - Weibin Bai
- Department of Food Science and Engineering, Institute of Food Safety and Nutrition, Guangdong Engineering Technology Center of Food Safety Molecular Rapid Detection, Jinan University, Guangzhou 510632, PR China.
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Yue A, Zhang N, Liu X, Tang L, Luo R, Yang M, Rozelle S, Medina A. Do Infant Feeding Practices Differ Between Grandmothers and Mothers in Rural China? Evidence From Rural Shaanxi Province. FAMILY & COMMUNITY HEALTH 2018; 41:233-243. [PMID: 30134338 DOI: 10.1097/fch.0000000000000198] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The overall goal of this study is to examine whether infant feeding practices differ between mothers and grandmothers in rural China. We randomly sampled 1383 caregivers of infants aged 18 to 30 months living in 351 villages across 174 townships in nationally designated poverty counties in rural areas. Results show that a high fraction of caregivers of 18- to 30-month-old children living in low-income areas of rural China do not regularly engage in positive infant feeding practices. Only 30% of children in our sample achieved adequate dietary diversity. Only 49% of children in our sample were fed meat in the day prior to survey administration. Few caregivers reported giving any vitamin supplements (such as calcium or iron supplements) to their children. We find that 33% of the children were cared for by grandmothers rather than mothers, and that grandmothers feed a less diversified diet to children than do mothers. Most (84%) caregivers rely solely on their own experiences, friends, and family members in shaping their feeding behaviors. Overall infant feeding practices are poor in rural China. Grandmothers engage in poorer feeding practices than do mothers. Grandmothers have improved their feeding practices compared to when their own children were young. Our results suggest shortcomings in the quality of infant feeding practices, at least in part due to an absence of reliable information sources.
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Affiliation(s)
- Ai Yue
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi'an, Shaanxi, China (Drs Yue and Tang, Mr Zhang, and Ms Liu); China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China (Dr Luo); and Rural Education Action Program (REAP), Freeman Spogli Institute for International Studies, Stanford University, Stanford, California (Mss Yang and Medina and Dr Rozelle)
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Uyoga MA, Karanja S, Paganini D, Cercamondi CI, Zimmermann SA, Ngugi B, Holding P, Moretti D, Zimmermann MB. Duration of exclusive breastfeeding is a positive predictor of iron status in 6- to 10-month-old infants in rural Kenya. MATERNAL & CHILD NUTRITION 2017; 13:e12386. [PMID: 27896919 PMCID: PMC6866116 DOI: 10.1111/mcn.12386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 12/24/2022]
Abstract
The prevalence of iron-deficiency anemia (IDA) is high in infants in Sub-Saharan Africa. Exclusive breastfeeding of infants to 6 months of age is recommended by the World Health Organization, but breast milk is low in iron. Some studies suggest exclusive breastfeeding, although beneficial for the infant, may increase risk for IDA in resource-limited settings. The objective of this study was to determine if duration of exclusive breastfeeding is associated with anemia and iron deficiency in rural Kenyan infants. This was a cross-sectional study of 6-10-month-old infants (n = 134) in southern coastal Kenya. Anthropometrics, hemoglobin (Hb), plasma ferritin (PF), soluble transferrin receptor (sTfR), and C-reactive protein were measured. Body iron stores were calculated from the sTfR/PF ratio. Socioeconomic factors, duration of exclusive breastfeeding, nature of complementary diet, and demographic characteristics were determined using a questionnaire. Mean ± SD age of the infants was 7.7 ± 0.8 months. Prevalence of anemia, ID, and IDA were 74.6%, 82.1%, and 64.9%, respectively. Months of exclusive breastfeeding correlated positively with Hb (r = 0.187; p < .05) and negatively with sTfR (r = -0.246; p < .05). sTfR concentrations were lower in infants exclusively breastfed at least 6 months compared with those exclusively breastfed for less than 6 months (7.6 (6.3, 9) vs. 8.9 (6.7, 13.4); p < .05). Controlling for gender, birth weight, and inflammation, months spent exclusively breastfeeding was a significant negative predictor of sTfR and a positive predictor of Hb (p < .05). The IDA prevalence in rural Kenyan infants is high, and greater duration of exclusive breastfeeding predicts better iron status and higher Hb in this age group.
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Affiliation(s)
- Mary A. Uyoga
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
- International Centre for Behavioural StudiesMombasaKenya
| | - Simon Karanja
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Daniela Paganini
- Human Nutrition LaboratorySwiss Federal Institute of TechnologyZürichSwitzerland
| | - Colin I. Cercamondi
- Human Nutrition LaboratorySwiss Federal Institute of TechnologyZürichSwitzerland
| | | | - Benjamin Ngugi
- Centre for Microbiology ResearchKenya Medical Research Institute (KEMRI)NairobiKenya
| | - Penny Holding
- International Centre for Behavioural StudiesMombasaKenya
| | - Diego Moretti
- Human Nutrition LaboratorySwiss Federal Institute of TechnologyZürichSwitzerland
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Luo R, Yue A, Zhou H, Shi Y, Zhang L, Martorell R, Medina A, Rozelle S, Sylvia S. The effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: a cluster randomized trial. BMC Public Health 2017; 17:738. [PMID: 28946866 PMCID: PMC5613507 DOI: 10.1186/s12889-017-4755-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China. METHODS We conducted a cluster-randomized controlled trial in Shaanxi province, enrolling all children aged 6-11 months in target villages. Following a baseline survey, investigators randomly assigned each village/cluster to a control or treatment group. In the treatment group, caregivers were instructed to give MNPs daily. Follow-up was after 6, 12, and 18 months of intervention. Primary outcomes were hemoglobin concentrations and scores on the Bayley Scales of Infant Development. RESULTS One thousand, eight hundred and-two eligible children and their caregivers were enrolled. At baseline 48% (870) of children were anemic and 29% (529) were developmentally delayed. Six hundred and-ten children (117 villages) were assigned to the control group and 1192 children (234 villages) were assigned to the treatment group. Assignment to the treatment group was associated with an improvement in hemoglobin levels (marginal effect 1.77 g/L, 95% CI 0.017-3.520, p-value = 0.048) and cognitive development (marginal effect 2.23 points, 95% CI 0.061-4.399, p-value = 0.044) after 6 months but not thereafter. There were no significant effects on motor development. Zero effects after the first 6 months were not due to low compliance, low statistical power, or changes in feeding behavior. Hemoglobin concentrations improved in both the treatment and control groups over the course of the study; however, 22% (325) of children remained anemic at endline, and 48% (721) were cognitively delayed. CONCLUSIONS Providing caregivers with MNP sachets modestly hastened improvement in hemoglobin levels that was occurring absent intervention; however, this improvement did not translate into improved developmental outcomes at endline. TRIAL REGISTRATION ISRCTN44149146 ; prospectively registered on 15th April 2013.
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Affiliation(s)
- Renfu Luo
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Ai Yue
- Center for Experimental Economics in Education, Shaanxi Normal University, 620 Chang'an Road West, Xi'an, 710119, China.
| | - Huan Zhou
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, 620 Chang'an Road West, Xi'an, 710119, China
| | - Linxiu Zhang
- Center for Chinese Agricultural Policy, Chinese Academy of Sciences, Beijing, China
| | | | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, USA
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, USA
| | - Sean Sylvia
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Zeeshan F, Bari A, Farhan S, Jabeen U, Rathore AW. Correlation between maternal and childhood VitB12, folic acid and ferritin levels. Pak J Med Sci 2017; 33:162-166. [PMID: 28367192 PMCID: PMC5368300 DOI: 10.12669/pjms.331.10998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To determine the correlation between serum folic acid, vitamin B12 and ferritin of mother and child and to study various neonatal risk factors as a cause of anemia in children. METHODS One hundred eighty children two months to two years of age admitted in the department of Pediatric Medicine of The Children's Hospital and The Institute of Child Health Lahore from January 2013 to January 2015 with common medical conditions having anemia were included. Complete blood count (CBC), serum ferritin level, folic acid and Vitamin (Vit) B12 level were sent of children and their mothers. Data was analyzed using SPSS version 20. RESULTS Out of 180 children with anemia, 66.7% were males. Mean age of children was 7.3months. Fifty-five percent children were malnourished according to z scoring. The mean Hemoglobin (Hb) of children was 8 g/dl. Only 4% children had low ferritin level while 60% had low folic acid and 45% had decreased VitB12. There was significant correlation between Hb of mother and child (p =0.02), Vit B12 deficiency (p=0.008) and iron deficiency (p<0.001). Premature children had lower folic acid levels (p =0.02), while prematurity, IUGR, previous admission and history of sepsis showed no association with anemia in our study. Both breast-feeding and top feeding showed significant association with anemia with p-value of 0.042 and 0.003 respectively while dilution showed no impact on anemia. CONCLUSION Maternal anemia has a significant impact on child's hemoglobin. As compared to previous concept of increased iron deficiency in children we found increased occurrence of folic acid and VitB12 deficiency in children and their mothers.
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Affiliation(s)
- Fatima Zeeshan
- Fatima Zeeshan, MRCPCH, FCPS. Department of Paediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Attia Bari
- Attia Bari, DCH, MCPS, FCPS. Department of Paediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Saima Farhan
- Saima Farhan, FCPS. Department of Microbiology, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Uzma Jabeen
- Uzma Jabeen, FCPS. Department of Paediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Ahsan Waheed Rathore
- Ahsan Waheed Rathore, MRCP, MRCPCH, FRCP. Department of Paediatric Medicine, The Children's Hospital and The Institute of Child Health, Lahore, Pakistan
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Age of Complementary Foods Introduction and Risk of Anemia in Children Aged 4-6 years: A Prospective Birth Cohort in China. Sci Rep 2017; 7:44726. [PMID: 28333130 PMCID: PMC5363060 DOI: 10.1038/srep44726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/14/2017] [Indexed: 12/17/2022] Open
Abstract
Age of complementary foods introduction is associated with childhood anemia, but the ideal age for the introduction of complementary foods to infants is a continuing topic of debate. We examined the longitudinal association between complementary foods introduction age and risk of anemia in 18,446 children from the Jiaxing Birth Cohort, who had detailed complementary feeding records at 3 and 6 months of age and had hemoglobin concentrations measured at 4–6 years. Early introduction of complementary foods at 3–6 months of age was significantly associated with a higher risk of anemia (odds ratio = 1.14; 95% confidence interval: 1.01–1.28) and a lower hemoglobin concentration of −0.84 g/L (95% confidence interval: −1.33 to −0.35) in children aged 4–6 years, compared with those fed complementary foods starting at 6 months of age. When it comes to the specific type of complementary foods, early introduction of all plant-based foods was associated with increased anemia risks and lower hemoglobin concentrations, while early introduction of most animal-based foods was not. These findings may be informative regarding the appropriate time to introduce complementary foods in infants.
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Huang J, Yang G. Understanding recent challenges and new food policy in China. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2017. [DOI: 10.1016/j.gfs.2016.10.002] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guo YF, Gan YY, Guo CN, Sun J, Hao LP. Nutritional status of under-five children from urban low-income families in Xiangtan and Jilin in China. ACTA ACUST UNITED AC 2017; 37:74-78. [PMID: 28224426 DOI: 10.1007/s11596-017-1697-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/29/2016] [Indexed: 11/26/2022]
Abstract
There have been many studies on the nutrition and the growth status of children from rural and remote western regions of China, whereas researches on children from urban low-income families are scarce. This study aimed to investigate the growth and nutritional status of children under five years of age from urban low-income families in China. There were 169 children aged 25-60 months recruited from Xiangtan and Jilin, two cities with a population of 2.81 million and 4.26 million respectively, in China in this cluster cross-sectional study. Data were collected on demographic and socioeconomic characteristics, the feeding practices and the incidence of anemia and diarrhea. The results showed that the prevalence of low birth weight and macrosomia was 7.1% and 9.5% for the two cities, respectively, which was higher than that for other cities in China (1.5% and 5.9%). Of all the sampled children, 14.6% and 8.2% suffered anemia and diarrhea, respectively. Multivariate analysis showed that legumes or nuts fed in a 24-h recall increased the risk of anemia (OR=4.9). Children whose caregivers began to introduce complementary foods relatively late would have high diarrhea prevalence (OR=1.4). In conclusion, the prevalence of anemia and diarrhea in under-five children from urban low-income families in China is relatively high. The growth and nutritional status of these children is greatly affected by feeding practices. A series of measures should be taken by relevant government departments to improve the health of these children.
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Affiliation(s)
- Yan-Fang Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yin-Yan Gan
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072, China
| | - Chao-Nan Guo
- Center for Monitoring and Verification of Low-Income Families, Ministry of Civil Affairs, Beijing, 100000, China
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072, China.
| | - Li-Ping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Clark KM, Li M, Zhu B, Liang F, Shao J, Zhang Y, Ji C, Zhao Z, Kaciroti N, Lozoff B. Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China. J Pediatr 2017; 181:56-61. [PMID: 27836288 PMCID: PMC5274569 DOI: 10.1016/j.jpeds.2016.10.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/25/2016] [Accepted: 10/12/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess associations between breastfeeding and iron status at 9 months of age in 2 samples of Chinese infants. STUDY DESIGN Associations between feeding at 9 months of age (breastfed as sole milk source, mixed fed, or formula fed) and iron deficiency anemia (IDA), iron deficiency, and iron sufficiency were determined in infants from Zhejiang (n = 142) and Hebei (n= 813) provinces. Iron deficiency was defined as body iron < 0 mg/kg, and IDA as iron deficiency + hemoglobin < 110 g/L. Multiple logistic regression assessed associations between feeding pattern and iron status. RESULTS Breastfeeding was associated with iron status (P < .001). In Zhejiang, 27.5% of breastfed infants had IDA compared with 0% of formula-fed infants. The odds of iron deficiency/IDA were increased in breastfed and mixed-fed infants compared with formula-fed infants: breastfed vs formula-fed OR, 28.8 (95% CI, 3.7-226.4) and mixed-fed vs formula-fed OR, 11.0 (95% CI, 1.2-103.2). In Hebei, 44.0% of breastfed infants had IDA compared with 2.8% of formula-fed infants. With covariable adjustment, odds of IDA were increased in breastfed and mixed-fed groups: breastfed vs formula-fed OR, 78.8 (95% CI, 27.2-228.1) and mixed-fed vs formula-fed OR, 21.0 (95% CI, 7.3-60.9). CONCLUSIONS In both cohorts, the odds of iron deficiency/IDA at 9 months of age were increased in breastfed and mixed-fed infants, and iron deficiency/IDA was common. Although the benefits of breastfeeding are indisputable, these findings add to the evidence that breastfeeding in later infancy identifies infants at risk for iron deficiency/IDA in many settings. Protocols for detecting and preventing iron deficiency/IDA in breastfed infants are needed. TRIAL REGISTRATION ClinicalTrials.gov: NCT00642863 and NCT00613717.
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Affiliation(s)
- Katy M. Clark
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
| | - Ming Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Bingquan Zhu
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Furong Liang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jie Shao
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Yueyang Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chai Ji
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Zhengyan Zhao
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA,Department of Pediatrics and Communicable Diseases, CS Mott Children’s Hospital, University of Michigan, USA
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Xin QQ, Chen BW, Yin DL, Xiao F, Li RL, Yin T, Yang HM, Zheng XG, Wang LH. Prevalence of Anemia and its Risk Factors among Children under 36 Months Old in China. J Trop Pediatr 2017; 63:36-42. [PMID: 27543970 DOI: 10.1093/tropej/fmw049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study aims to evaluate the prevalence and sociodemographic factors of anemia in children <36 months old in China. In this study, data of 24 235 children were investigated from 32 primary health care (PHC) facilities in 11 province-level regions. Pearson χ2-test and logistic regression model were used to estimate potential risk factors associated with anemia. The overall prevalence of anemia was 24.4%, and 32.8% children from rural areas were anemic, but no statistically significant difference was observed between male and female. Predictors of anemia are different regions of China, cesarean delivery, premature birth and neonatal asphyxia. We also found that education level and income of children's parents are important determinants of childhood anemia. In additional, feeding practice would affect anemia among children aged 6-12 months. Our results could provide some insights for prevention and control of childhood anemia in PHC facilities.
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Affiliation(s)
- Qian-Qian Xin
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Bo-Wen Chen
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - De-Lu Yin
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Feng Xiao
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Rui-Li Li
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Tao Yin
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Hui-Min Yang
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Xiao-Guo Zheng
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Li-Hong Wang
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
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Burke RM, Rebolledo PA, Fabiszewski de Aceituno AM, Revollo R, Iñiguez V, Klein M, Drews-Botsch C, Leon JS, Suchdev PS. Early deterioration of iron status among a cohort of Bolivian infants. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27928891 DOI: 10.1111/mcn.12404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/18/2016] [Accepted: 10/25/2016] [Indexed: 01/12/2023]
Abstract
Iron deficiency (ID) and iron deficiency anemia (IDA) are major contributors to infant and maternal morbidity worldwide. There is limited longitudinal data on iron status in young infants and on methods to adjust iron biomarkers for inflammation. We aimed to quantify the prevalence of inflammation-adjusted ID, anemia, and IDA over the first year in a cohort of Bolivian infants and their mothers. Healthy mother-infant dyads were recruited from two peri-urban hospitals. Infants provided three blood draws (2, 6-8, and 12-18 months; N = 160); mothers provided two blood draws (1 and 6-8 months postpartum [plus third anemia measurement at 12-18 months]; N = 250). Blood was analyzed for hemoglobin, ferritin, soluble transferrin receptor, C-reactive protein (CRP), and alpha(1)-acid glycoprotein (AGP). Iron biomarkers were adjusted for inflammation using CRP and AGP; hemoglobin cutoffs were adjusted for altitude. Inflammation (elevated CRP or AGP) was 17% among toddlers 12-18 months of age. ID (inflammation-adjusted ferritin) increased with age (<1%, 56%, and 79% at each blood draw), as did anemia and IDA (anemia: 70%, 76%, and 81%; IDA: <1%, 46%, and 68%). Maternal ID declined from the first to second assessment (39% vs. 27%). Inflammation-adjusted ID prevalence was up to 15 percentage points higher than unadjusted estimates. The high prevalence of ID, anemia, and IDA in this cohort of Bolivian infants beginning at 6-8 months of age suggests that early interventions may be necessary in vulnerable populations.
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Affiliation(s)
- Rachel M Burke
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Emory School of Medicine, Atlanta, Georgia, USA
| | | | - Rita Revollo
- Servicio Departamental de Salud, La Paz, Bolivia
| | - Volga Iñiguez
- Instituto de Biotecnología y Microbiología, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Mitchel Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Juan S Leon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Emory School of Medicine, Atlanta, Georgia, USA.,Nutrition Branch, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
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Wang F, Liu H, Wan Y, Li J, Chen Y, Zheng J, Huang T, Li D. Prolonged Exclusive Breastfeeding Duration Is Positively Associated with Risk of Anemia in Infants Aged 12 Months. J Nutr 2016; 146:1707-13. [PMID: 27489010 DOI: 10.3945/jn.116.232967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The association between exclusive breastfeeding duration and infant anemia is not clear. OBJECTIVE This study aimed to assess the association of exclusive breastfeeding duration with risk of anemia in infants at 12 mo of age and in children aged 48-71 mo in mainland China. METHODS Detailed breastfeeding information and anthropometric data were obtained for 65,256 children enrolled in the Jiaxing Birth Cohort at 1, 3, and 6 mo of age. Hemoglobin was measured in 25,549 children at 12 mo and in 32,770 children between the ages of 48 and 71 mo. Anemia was defined as hemoglobin concentrations <110 g/L in children aged <60 mo and <115 g/L in children aged ≥60 mo. The associations between exclusive breastfeeding duration and risk of anemia were assessed as adjusted ORs by using multiple logistic regression. RESULTS Overall anemia prevalences at 12 and 48-71 mo were 24.9% and 9.9%, respectively. Exclusive breastfeeding for ≥6 mo, but not for 3-5 mo, was significantly associated with a higher risk of anemia in infants at age 12 mo (OR: 1.15; 95% CI: 1.02, 1.29; P = 0.02) compared with exclusive breastfeeding for <3 mo. For young children aged 48-71 mo, this finding was only marginally significant (OR: 1.13; 95% CI: 0.99, 1.29; P = 0.08). Prolonged duration of exclusive breastfeeding was also significantly associated with decreased hemoglobin concentrations of -0.56 g/L (95% CI: -1.10, -0.03; P = 0.04) in infants and -0.99 g/L (95% CI: -1.44, -0.55; P < 0.001) in young children. CONCLUSIONS Exclusive breastfeeding for ≥6 mo was associated with an increased risk of anemia in infants aged 12 mo and with lower hemoglobin concentrations in both infants aged 12 mo and young children aged 48-71 mo. Parents should provide infants with an adequate source of iron after 6 mo of exclusive breastfeeding.
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Affiliation(s)
- Fenglei Wang
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China
| | - Huijuan Liu
- Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Yi Wan
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China
| | - Jing Li
- Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Yu Chen
- Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Jusheng Zheng
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom; and
| | - Tao Huang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Duo Li
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China;
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Yue A, Marsh L, Zhou H, Medina A, Luo R, Shi Y, Zhang L, Kenny K, Rozelle S. Nutritional Deficiencies, the Absence of Information and Caregiver Shortcomings: A Qualitative Analysis of Infant Feeding Practices in Rural China. PLoS One 2016; 11:e0153385. [PMID: 27073864 PMCID: PMC4830571 DOI: 10.1371/journal.pone.0153385] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 03/29/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Development during the first two years of life is critical and has a lasting impact on a child's health. Poor infant and child nutrition can lead to deficiencies in essential micronutrients, which may cause a weakened immune system and lasting effects on children's growth and development. Recent studies in rural Shaanxi Province found an anemia prevalence of 54.3% among rural children aged six to twelve months. While new large-scale, quantitative research has begun to catalogue the extent of child malnutrition and anemia, no effort has yet been made to look more closely at the potential reasons for rural children's nutritional deficiencies through qualitative analysis. This study aims to elucidate some of the fundamental causes of poor complementary feeding practices that may lead to anemia among children in rural Shaanxi Province, China. METHODOLOGY We interviewed sixty caregivers participating in a large survey on child health and nutrition. We conducted three waves of interviews with children's primary caregivers in seventeen rural villages within four nationally-designated poverty counties in the southern part of Shaanxi Province. RESULTS The qualitative analysis reveals that poor complementary feeding practices are common across our sample. Information gathered from our interviews suggests that complementary feeding practices are impeded by two constraints: absence of understanding topics related to infant health and nutrition under caregivers, as well as inadequate sources of information on these topics. Poverty does not appear to constrain child feeding practices. CONCLUSION Our results uncover lack of proper knowledge on infant and child nutrition among rural caregivers in China. This situation causes them to fail incorporating micronutrient rich foods in their children's diet. Age-appropriate complementary feeding can stimulate children's physical and cognitive development, but in its absence it leads to iron-deficiency anemia. We suggest that steps be taken to educate caregivers to improve complementary feeding of their infants and children.
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Affiliation(s)
- Ai Yue
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi’an, Shaanxi, 710119, China
| | - Lauren Marsh
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Huan Zhou
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, United States of America
| | - Renfu Luo
- School of Advanced Agricultural Sciences, Peking University, Beijing, 100871, China
| | - Yaojiang Shi
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, Xi’an, Shaanxi, 710119, China
| | - Linxiu Zhang
- School of Advanced Agricultural Sciences, Peking University, Beijing, 100871, China
| | - Kaleigh Kenny
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, United States of America
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, United States of America
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Senbanjo IO, Olayiwola IO, Afolabi WAO. Dietary practices and nutritional status of under-five children in rural and urban communities of Lagos State, Nigeria. Niger Med J 2016; 57:307-313. [PMID: 27942096 PMCID: PMC5126741 DOI: 10.4103/0300-1652.193854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Evidence shows that urban children generally have a better nutritional status than their rural counterparts. However, data establishing whether this difference in prevalence of undernutrition could be ascribed to difference in dietary practices are few. Objective: The aim of this study was to compare dietary practices and nutritional status of children in rural and urban communities of Lagos State, Nigeria. Methods: This was a comparative-analytical study conducted using the multistage sampling technique to select the study cases. A total of 300 mother–child pairs were studied, including 150 each from rural and urban communities. Data collected include demographics, socioeconomic characteristics, feeding practices and anthropometric measurements of the participants. Food intake data were collected using 24-h dietary recall. Malnutrition in children was determined by calculating the prevalence of low height-for-age (stunting), low weight-for-age (underweight), and low weight-for-height (wasting) using the World Health Organization cutoff points. Results: The prevalence of exclusive breastfeeding for 6 months (25.3% vs. 28.7%; P = 0.516), use of formula feeds (48.7% vs. 44%; P = 0.077), and mean age of child at introduction of semisolid foods (7.54 ± 4.0 months vs. 8.51 ± 7.3 months; P = 0.117) were not significantly different between urban and rural communities. The diversity of food choices and frequencies of consumption were similar between urban and rural communities. However, prevalence levels of underweight and stunted children were significantly higher in rural than that of urban communities (19.4% vs. 9.3%, P < 0.001 and 43.3% vs. 12.6%, P < 0.001, respectively). Conclusions: Other risk factors besides inappropriate feeding practices need to be considered for higher prevalence of undernutrition among children in rural communities.
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Affiliation(s)
- Idowu O Senbanjo
- Department of Paediatrics and Child Health, Paediatrics Gastroenterology/Hepatology/Nutrition Unit, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ibiyemi O Olayiwola
- Department of Nutrition and Dietetics, College of Food Science and Human Ecology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Wasiu A O Afolabi
- Department of Nutrition and Dietetics, College of Food Science and Human Ecology, Federal University of Agriculture, Abeokuta, Nigeria
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