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Poix S, Elmusharaf K. The cost of inaction on preconception health in Nigeria: An economic impact analysis. Glob Public Health 2024; 19:2361782. [PMID: 38837785 DOI: 10.1080/17441692.2024.2361782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/25/2024] [Indexed: 06/07/2024]
Abstract
A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.
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Affiliation(s)
- Sébastien Poix
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Khalifa Elmusharaf
- Public Health, Applied Health Research, University of Birmingham Dubai, Dubai, United Arab Emirates
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Tulem TG, Hordofa MA. Prevalence of food insecurity and associated factors among households in Waliso town, Oromia, Ethiopia. BMC Nutr 2023; 9:139. [PMID: 38012785 PMCID: PMC10683113 DOI: 10.1186/s40795-023-00787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Food insecurity is the underlying cause of malnutrition. In addition, it is a condition where people lack consistent access to enough food for every person in a household to live an active and healthy life. Recently, urban food insecurity has been on the top agenda in Ethiopia, as households prone to food insecurity are rising because of various factors. Hence, we aimed to assess the prevalence of food insecurity and associated factors among households in Waliso town, Oromia, Ethiopia. METHODS A community-based cross-sectional study design was used from December 17, 2021, to January 16, 2022, among 397 randomly selected households in Waliso town. Study participants were selected using a simple random sampling technique. Data collection was performed using a structured questionnaire, and data were entered using Epi Info 7 and exported to SPSS version 20 software for analysis. To identify factors associated with household food insecurity, multivariable binary logistic regression analyses were done. An adjusted odds ratio along with a 95% confidence interval were estimated to measure the strength of the association. In this study, the level of statistical significance was declared at p < 0.05. RESULTS The prevalence of household food insecurity was 63.4%, 95% CI (58.60%, 68.20%). Factors associated with household food insecurity were family sizes 6 + [AOR = 3.06, 95% CI: (1.35, 6.94)], dependents 1-2 [AOR = 2.62, 95% CI: (1.35, 5.10)], dependents 3 + [AOR = 3.07, 95% CI: (1.38, 7.40)], unemployed [AOR = 6.86, 95% CI: (2.76, 17.04)], self-employed [AOR = 3.27, 95% CI: (1.50, 7.14)], wage laborers [AOR = 13.01, 95% CI: (4.93, 34.38)], low wealth index [AOR = 4.08, 95% CI: (2.18, 7.64)], and a medium wealth index [AOR = 2.08, 95% CI: (1.18, 3.69)]. CONCLUSION Nearly two in three households were food insecure in Waliso Town. Large family sizes, a high dependency ratio, unemployment, low wage employment, and a low wealth index were significantly associated with food insecurity. Hence, the implementation of actions to improve household income and livelihoods, minimize dependency rates, by strengthen the use of family planning and encourage urban agriculture is vital to alleviate household food insecurity problems in the town.
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Affiliation(s)
| | - Mulatu Ayana Hordofa
- Department of Public Health, College of Medicine and Health Science, Ambo University, PO.BOX.240, Ambo, Ethiopia.
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Mdege ND, Masuku SD, Musakwa N, Chisala M, Tingum EN, Boachie MK, Shokraneh F. Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002551. [PMID: 37939029 PMCID: PMC10631642 DOI: 10.1371/journal.pgph.0002551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.
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Affiliation(s)
- Noreen Dadirai Mdege
- Department of Health Sciences, University of York, York, United Kingdom
- Centre for Research in Health and Development, York, United Kingdom
| | - Sithabiso D. Masuku
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nozipho Musakwa
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mphatso Chisala
- Department of Population, Policy and Practice, Great Ormond Street Hospital, Institute of Child Health, University College London, London, United Kingdom
| | | | - Micheal Kofi Boachie
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Farhad Shokraneh
- Department of Evidence Synthesis, Systematic Review Consultants LTD, Nottingham, United Kingdom
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Triatmaja NT, Mahmudiono T, Mamun AA, Abdullah NA. Effectiveness of Positive Deviance Approach to Reduce Malnutrition among under Five Children: A Systematic Review and Meta-Analysis of Interventional Studies. Nutrients 2023; 15:nu15081961. [PMID: 37111180 PMCID: PMC10143095 DOI: 10.3390/nu15081961] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The high malnutrition rate in children under five makes this problem one of the public health problems. Various efforts have been made to reduce malnutrition in children under five, one of which is the implementation of community programs with a positive deviance approach which is considered an effective way because the solution to the problem comes from the local community. Thus, we conducted a systematic review and meta-analysis to determine the effect of interventions with a positive deviance approach to reducing under-five children's malnutrition. Systematic searches were conducted using the following journal databases: Science Direct, Pubmed, Proquest, SAGE journal, Web of Science, and Scopus. The article was included if using an intervention design. Data analysis used Review Manager 5.4 software, random effect model, outcome mean of difference, and 95% confidence interval. There were no significant differences between the intervention and control groups on the length for age z-scores (LAZ), weight for age z-scores (WAZ), and weight for height z-scores (WHZ) indicators. There was an increase in LAZ, WAZ, and WHZ scores in the intervention group, with a greater z-score than in the control group. In conclusion, interventions with the positive deviance approach can be used as an alternative to improving the nutritional status of under-five children. However, further research is needed to determine the effective duration of interventions in improving the nutritional status of children.
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Affiliation(s)
- Nining Tyas Triatmaja
- Doctorate Degree Program in Public Health, Faculty of Public Health, Airlangga University, Surabaya 60115, Indonesia
| | - Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Airlangga University, Surabaya 60115, Indonesia
| | - Abdullah Al Mamun
- Doctorate Degree Program in Public Health, Faculty of Public Health, Airlangga University, Surabaya 60115, Indonesia
| | - Nurul Ashikin Abdullah
- Institute Biological and Science, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
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Sigh S, Roos N, Chhoun C, Laillou A, Wieringa FT. Ready-to-Use Therapeutic Foods Fail to Improve Vitamin A and Iron Status Meaningfully during Treatment for Severe Acute Malnutrition in 6-59-Month-old Cambodian Children. Nutrients 2023; 15:nu15040905. [PMID: 36839263 PMCID: PMC9961841 DOI: 10.3390/nu15040905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Severe acute malnutrition (SAM) remains a global health concern. Studies on the impact of ready-to-use therapeutic foods (RUTFs) on micronutrient status during SAM treatment are almost nonexistent. The objective was to investigate the impact of RUTFs on the iron and vitamin A status of 6-59-month-old children receiving SAM treatment. Biomarkers of vitamin A status (retinol-binding protein, RBP), iron status (ferritin and soluble transferrin receptor, sTfR), and inflammation (C-reactive protein, CRP, and alpha-1 acid glycoprotein, AGP) were collected at admission and discharge (week 8) during an RUTF effectiveness trial. Vitamin A deficiency was defined as RBP <0.70 µmol/L, low body iron as body iron (BI) <0 mg/kg and deficient iron stores as ferritin <12 µg/L. Data were available for 110 and 75 children at admission and discharge, respectively. There was no significant difference in haemoglobin, ferritin, sTfR, BI or RBP concentrations between admission and discharge. At discharge, BI was 0.2 mg/kg lower, and there was a tendency towards a slightly lower RBP concentration, but the prevalence of vitamin A deficiency was low at admission and discharge (6% and 3%, respectively). The small impact of both RUTFs on improving vitamin A and iron status during SAM treatment calls for further research on the bioavailability of micronutrients to enhance the effectiveness of SAM treatment on micronutrient status.
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Affiliation(s)
- Sanne Sigh
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
- Correspondence: ; Tel.: +855-(0)95-201-308
| | - Nanna Roos
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg C, Denmark
| | - Chamnan Chhoun
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, 186 Preah Norodom Boulevard, Phnom Penh 12101, Cambodia
| | - Arnaud Laillou
- Nutrition Section, UNICEF West and Central Africa Region, Dakar 29720, Senegal
| | - Frank T. Wieringa
- UMR QualiSud, Institut de Recherche Pour le Développement (IRD), 34394 Montpellier, France
- Qualisud, University of Montpellier, Avignon University, CIRAD, Institut Agro, IRD, Université de la Réunion, 34394 Montpellier, France
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Mutunga M, Rutishauser-Perera A, Laillou A, Prak S, Berger J, Wieringa FT, Bahwere P. The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months. PLoS One 2021; 16:e0259765. [PMID: 34794170 PMCID: PMC8601787 DOI: 10.1371/journal.pone.0259765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/27/2021] [Indexed: 01/22/2023] Open
Abstract
The interrelationship between wasting and stunting has been poorly investigated. We assessed the association between two indicators of linear growth, height-for-age Z-score (HAZ) change and occurrence of accelerated linear growth, and selected indicators of wasting and wasting reversal in 5,172 Cambodian children aged less than 24 months at enrolment in the 'MyHealth' study. The specific objectives were to evaluate the relationship between temporal changes in wasting and 1) change in HAZ and 2) episodes of accelerated linear growth. At enrolment, the stunting and wasting prevalence were 22.2 (21.0;23.3) % and 9.1 (8.1;10.1) %, respectively, and reached 41.4 (39.3;43.6) %, and 12.4 (11.5;13.3) % respectively, two years later. Between 14-19% of stunted children were also wasted throughout the whole study period. For each centimetre increase in Mid-Upper Arm Circumference (MUAC) from the previous assessment, the HAZ increased by 0.162 (0.150; 0.174) Z-score. We also observed a delayed positive association between the weight for height Z score (WHZ) unit increase and HAZ change of +0.10 to +0.22 units consistent with a positive relationship between linear growth and an increase in WHZ occurring with a lag of approximately three months. A similar positive correlation was observed for the occurrence of an episode of accelerated linear growth. These results show that interventions to prevent and treat wasting can contribute to stunting reduction and call for integrated wasting and stunting programming.
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Affiliation(s)
- Mueni Mutunga
- United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok, Thailand
- * E-mail:
| | | | - Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa, Ethiopia
| | - Sophonneary Prak
- National Nutrition Program, Maternal and Child Health Center, Phnom Penh, Cambodia
| | - Jacques Berger
- Institut de Recherche pour le De´veloppement, Montpellier, France
| | | | - Paluku Bahwere
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, Brussels, Belgium
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Kamruzzaman M, Rahman SA, Akter S, Shushmita H, Ali MY, Billah MA, Kamal MS, Elahi MT, Paul DK. The anthropometric assessment of body composition and nutritional status in children aged 2-15 years: A cross-sectional study from three districts in Bangladesh. PLoS One 2021; 16:e0257055. [PMID: 34499671 PMCID: PMC8428712 DOI: 10.1371/journal.pone.0257055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Early life nutrition plays a critical role in the development of better health and nutrition in adulthood. However, assessing the nutritional status of Bangladeshi children and adolescents through measurement of body composition using skinfold thickness is barely studied. The current study aims to determine children’s body composition and nutritional status, and contributing factors among children aged 2 to 15 years in the northern part of Bangladesh. Methods This is a descriptive cross-sectional study done in Bangladesh. Anthropometric methods, including multiple skinfold thickness and basic anthropometric and socio-demographic characteristics, were used. Body composition was calculated from multiple skinfold thicknesses using the standard regression equation. Nutritional status was measured using Z score according to WHO 2007 reference standard. A total of 330 children from Naogaon, Bogra and Kurigram districts in Bangladesh were examined from April 2019 to September 2019. Results The Nutritional status of 2–15 years old child is exceedingly poor in the northern part of Bangladesh. Fat mass and fat-free mass were higher among children from Kurigram district than from Bogra and Naogaon district. Body fat percentages and arm fat area were greater among female children than males. The overall prevalence of stunting, underweight and wasting was around 25%, 32% and 29%, respectively, and the rate was higher among girls and children aged 2–5 years. The average SD score for weight-for-age, height-for-age, and BMI-for-age was -1.295, -0.937 and -1.009. The median weight-for-age and height-for-age Z scores of boys and girls were below the WHO reference percentile rank. Girls were twice (OR:1.951, CI:1.150–3.331) as likely to suffer from being underweight than boys. Children who don’t practice handwashing are three times (OR:3.531, CI:1.657–7.525) more likely to be underweight. Children become underweight and stunted when their family income is not sufficient to maintain their nutritional requirements. Conclusions The children of the three northern districts had a poor nutritional status, and family income was the potential contributing factor. Therefore, interventions like the promotion of income-generating activities and integrated approaches to ensuring food diversification could be an option to address the nutritional problem of children of the three northern districts of Bangladesh.
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Affiliation(s)
- Md. Kamruzzaman
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
- * E-mail: ,
| | - Shah Arafat Rahman
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Sharmin Akter
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Humaria Shushmita
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Md. Yunus Ali
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Md Adnan Billah
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Md. Sadat Kamal
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - M. Toufiq Elahi
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Dipak Kumar Paul
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
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Perumal N, Blakstad MM, Fink G, Lambiris M, Bliznashka L, Danaei G, Sudfeld CR. Impact of scaling up prenatal nutrition interventions on human capital outcomes in low- and middle-income countries: a modeling analysis. Am J Clin Nutr 2021; 114:1708-1718. [PMID: 34320177 PMCID: PMC8574629 DOI: 10.1093/ajcn/nqab234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/18/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prenatal nutrition interventions can lead to improved birth outcomes, which in turn are associated with better education and human capital outcomes later in life. OBJECTIVE We estimated the impact of scaling up iron-folic acid (IFA), calcium, multiple micronutrient (MMS), and balanced energy protein (BEP) supplementation for pregnant women, on human capital outcomes in low- and middle-income countries (LMIC). METHODS We used mathematical modeling with proportional reductions in adverse birth outcomes to estimate the potential gains in school years and lifetime income due to scaling up each prenatal nutrition intervention. Estimates of intervention effects on birth outcomes were derived from meta-analyses of randomized trials. Estimates of the associations between birth outcomes and schooling and lifetime income were derived from de novo meta-analyses of observational studies. RESULTS Across 132 LMIC, scaling up prenatal nutrition interventions to 90% coverage was estimated to increase school years and lifetime income per birth cohort by: 2.28 million y (95% uncertainty intervals (UI): -0.44, 6.26) and $8.26 billion (95% UI: -1.60, 22.4) for IFA; 4.08 million y (95% UI: 0.12, 9.68) and $18.9 billion (95% UI: 0.59, 44.6) for calcium; 5.02 million y (95% UI: 1.07, 11.0) and $18.1 billion (95% UI: 3.88, 39.1) for MMS; and 0.53 million y (95% UI: -0.49, 1.70) and $1.34 billion (95% UI: -1.10, 3.10 billion) for BEP supplementation. South Asia and Sub-Saharan Africa tended to have the largest estimated regional gains in school years for scaling up each intervention due to the large population size and high burden of poor birth outcomes. Absolute income benefits for each intervention were estimated to be the largest in Latin America, where returns to education and incomes are higher relative to other regions. CONCLUSION Increasing coverage of prenatal nutrition interventions in LMIC may lead to substantial gains in schooling and lifetime income. Decision makers should consider the potential long-term human capital returns of investments in maternal nutrition.
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Affiliation(s)
| | - Mia M Blakstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - Mark Lambiris
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Laillou A, Baye K, Meseret Z, Darsene H, Rashid A, Chitekwe S. Wasted Children and Wasted Time: A Challenge to Meeting the Nutrition Sustainable Development Goals with a High Economic Impact to Ethiopia. Nutrients 2020; 12:E3698. [PMID: 33266008 PMCID: PMC7760409 DOI: 10.3390/nu12123698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022] Open
Abstract
Despite some progress in the reduction of the prevalence of child wasting in Ethiopia, the pace of progress has been slow. Despite millions of dollars being spent on the treatment of wasting every year, the increased frequency and magnitude of environmental and anthropogenic shocks has halted progress. This study aimed to present the trends of child wasting in Ethiopia and estimate the economic losses related to the slow progress towards meeting the sustainable development goal (SDG) targets. Weather shocks and civil unrest between 2015 and 2018 have halted progress. We used a "consequence model" to apply the coefficient risk-deficit on economic losses established in the global scientific literature to the Ethiopian health, demographic, and economic data to estimate economic losses related to child wasting. The impact of wasting on the national economy of Ethiopia is estimated to be 157.8-230.2 million United States dollars (USD), annually. The greatest contributor to the economic burden (43.5-63.5% of the burden depending on the discount rate) is the cost of supplies and human resources to treat wasting. To reach the 2030 SDGs, Ethiopia should increase its annual average reduction rate (AARR) in the numbers of child (<59 months) wasting from 0.1% to 5.4%. This will avert the wasting in 7.9 million cases and prevent additional economic costs of up to 803.7 million USD over the next decade. Increasing the reach of therapeutic interventions, but also identifying and implementing wasting prevention interventions, will be critical if the SDG targets are to be met and the opportunity of the children to thrive is not to be wasted.
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Affiliation(s)
- Arnaud Laillou
- United Nations Children’s Fund (UNICEF), Addis Ababa 12000, Ethiopia; (A.R.); (S.C.)
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa 12000, Ethiopia;
| | - Zelalem Meseret
- Department for Maternal, Child Health and Nutrition, Federal Ministry of Health, Addis Ababa 12000, Ethiopia; (Z.M.); (H.D.)
| | - Hiwot Darsene
- Department for Maternal, Child Health and Nutrition, Federal Ministry of Health, Addis Ababa 12000, Ethiopia; (Z.M.); (H.D.)
| | - Abdulai Rashid
- United Nations Children’s Fund (UNICEF), Addis Ababa 12000, Ethiopia; (A.R.); (S.C.)
| | - Stanley Chitekwe
- United Nations Children’s Fund (UNICEF), Addis Ababa 12000, Ethiopia; (A.R.); (S.C.)
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10
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Njuguna RG, Berkley JA, Jemutai J. Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review. Wellcome Open Res 2020; 5:62. [PMID: 33102783 PMCID: PMC7569484 DOI: 10.12688/wellcomeopenres.15781.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs and cost-effectiveness of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods: We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. We also assessed the cost effectiveness of community-based management of malnutrition programs (CMAM). Cost per disability adjusted life year (DALY) averted for a CMAM program integrated into existing health services in Malawi was $42. Overall, cost per DALY averted for CMAM ranged between US$26 and US$53, which was much lower than facility-based management (US$1344). Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.
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Affiliation(s)
- Rebecca G Njuguna
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Public Health, School of Health and Human Sciences, Pwani University, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Julie Jemutai
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
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Laillou A, Gauthier L, Wieringa F, Berger J, Chea S, Poirot E. Reducing malnutrition in Cambodia. A modeling exercise to prioritize multisectoral interventions. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 2:e12770. [PMID: 32835454 PMCID: PMC7591311 DOI: 10.1111/mcn.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/16/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022]
Abstract
Undernutrition is a major contributor to child morbidity and mortality and poses a large burden to the economy, in Cambodia. This study explored factors contributing to child stunting and wasting and their regional inequalities among 1,938 Cambodian children aged 6-23.9 months. Data were drawn from a longitudinal study (year 2017) conducted in six districts of two north-eastern provinces and the capital and used as cross-sectional. Socio-demographic and household characteristics, children's feeding practices during the previous 24 hr, and children's length and weight measurements were collected. Gradient boosting models were used to calculate the contribution of determinants to child undernutrition whereas concentration index was used to assess the impact of those determinants on stunting and wasting inequalities among socioeconomic groups. It was found that low-household wealth could predict 21% to 45% of child stunting and 23% to 36% of wasting across regions. After wealth, source and treatment of drinking water were found the second major predictor for stunting (15%) and wasting (21%). Combining child nutrition and household water, sanitation and hygiene indicators predicted around 30% of child undernutrition, either in the form of stunting or wasting. Mothers' education predicted >30% of stunting in the north-eastern region. Results highlight that a complex interplay of factors contributes to child stunting and wasting. An integrated, intersectoral, equity-focused approach that addresses children's dietary quality, household's water, sanitation and hygiene conditions, mother's education, and poverty is likely to yield the highest impact in achieving further gains in nutritional status among Cambodian children.
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Affiliation(s)
- Arnaud Laillou
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition sectionPhnom PenhCambodia
| | | | - Frank Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD‐UM2‐UM1MontpellierFrance
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD‐UM2‐UM1MontpellierFrance
| | - Samnang Chea
- Council of Agriculture and Development (CARD), Office of the Council of MinistersPhnom PenhCambodia
| | - Etienne Poirot
- United Nations Children's Fund (UNICEF), Maternal, Newborn and Child Health and Nutrition sectionPhnom PenhCambodia
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Codling K, Laillou A, Rudert C, Borath M, Gorstein J. Universal Salt Iodisation: Lessons learned from Cambodia for ensuring programme sustainability. MATERNAL AND CHILD NUTRITION 2020; 16 Suppl 2:e12827. [PMID: 32835437 PMCID: PMC7591303 DOI: 10.1111/mcn.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/19/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
Iodine deficiency is the leading cause of preventable intellectual disability in the world, but it has been successfully prevented in most countries through universal salt iodization (USI). In 2011, Cambodia appeared to be an example of this success story, but today, Cambodian women and children are once again iodine deficient. In 2011, Cambodia demonstrated high‐household coverage of adequately iodized salt and had achieved virtual elimination of iodine deficiency in school‐age children. However, this achievement was not sustained because the USI programme was dependent on external funding, and the national government and salt industries had not institutionalized their implementation responsibilities. Recent programmatic efforts, in particular the establishment of a regulatory monitoring and enforcement system, are turning the situation around. Although Cambodia has not yet fully regained the achievements of 2011 (only 55% of tested salt was adequately iodized in 2017 compared with 67% in 2011), the recent steps taken by the government and the salt industry point to greater sustainability of the USI programme and the long‐term prevention of iodine deficiency in children, women, and the general population.
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Affiliation(s)
- Karen Codling
- Regional Coordinator for Southeast Asia and the Pacific, Iodine Global Network, Bangkok, Thailand
| | - Arnaud Laillou
- Chidl Survival and Development, UNICEF Cambodia, Phnom Penh, Cambodia
| | | | - Mam Borath
- National Sub-Committee for Food Fortification, Ministry of Planning, Government of Cambodia, Phnom Penh, Cambodia
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Poirot E, Som SV, Wieringa FT, Treglown S, Berger J, Laillou A. Water quality for young children in Cambodia-High contamination at collection and consumption level. MATERNAL AND CHILD NUTRITION 2020; 16 Suppl 2:e12744. [PMID: 32835440 PMCID: PMC7591301 DOI: 10.1111/mcn.12744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Abstract
Unsafe drinking water is a leading cause of child morbidity, especially among young children in low‐income settings. Safe water consumption requires high‐quality water available at its source and at point of use. We examined the quality of drinking water at point of collection and point of use in 796 households in three provinces, in Cambodia. Microbiological testing for coliform and Escherichia coli contamination was conducted for samples collected. Bivariable analysis and multivariable logistic regression were used to examine associations between various factors and the deterioration in water quality (increase in the risk according coliform or E. coli concentration) between point of collection and point of use. Contamination with both coliforms and E. coli was higher at point of use than at point of collection, with contamination at point of collection to account for 76.6% (coliforms) and 46.3% (E. coli). Results suggest that child drinking water represents a considerable pathway for the ingestion of pathogens, in Cambodia. Area of residence, seasonality, type of water source, and water chlorination were associated with coliform concentration between the point of collection and point of use, whereas only seasonality was associated with E. coli contamination (OR = 1.46; 95% CI [1.05, 2.02]). Children living in rural settings were two times more likely to drink water with a deteriorating coliform concentration between the two‐time points than children living in urban settings (OR = 2.00; 95% CI [1.22, 3.30]). The increase in coliform and E. coli concentrations between point of collection and point of use indicates that water contamination mostly occurs within the household. Strengthening national legislation on water quality standards and promoting safe water management at the household are needed.
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Affiliation(s)
- Etienne Poirot
- Maternal, Newborn and Child Health and Nutrition Sections, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | | | - Frank T Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier, France
| | - Sam Treglown
- Maternal, Newborn and Child Health and Nutrition Sections, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, Montpellier, France
| | - Arnaud Laillou
- Maternal, Newborn and Child Health and Nutrition Sections, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
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Karpati J, de Neubourg C, Laillou A, Poirot E. Improving children's nutritional status in Cambodia: Multidimensional poverty and early integrated interventions. MATERNAL AND CHILD NUTRITION 2020; 16 Suppl 2:e12731. [PMID: 32621576 PMCID: PMC7591312 DOI: 10.1111/mcn.12731] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/14/2018] [Accepted: 08/23/2018] [Indexed: 01/16/2023]
Abstract
One in three Cambodian children under 5 years of age are stunted. This study adopted a multidimensional approach to understand the influence of a series of contextual factors on the nutritional status of Cambodian children. In this study, we use a multidimensional poverty framework to identify a combination of interventions likely to achieve reductions in child stunting, in Cambodia. We used the UNICEF Multiple Overlapping Deprivation Analysis tool and data from the Cambodia Demographic and Health Survey 2014 to assess children's multidimensional poverty across nutrition, health, early childhood development, water, sanitation, and housing dimensions. We found that 80% of children under age five were deprived in at least two poverty dimensions. Multivariate logistic regression analysis revealed that reducing the likelihood of being deprived in three or more poverty dimensions was associated with a significant reduction of the probability of being stunted, after controlling for potential confounders. The combined probability of nondeprivation in nutrition, sanitation, and health dimensions had the largest effect on reducing the probability of stunting. The results of this study highlight the multiple, intersecting needs of children and their associated explanatory factors. Targeted and integrated cross-sectoral policies that reinforce comprehensive early childhood interventions are needed for improving nutritional status as part of a wider set of child poverty reduction measures in Cambodia.
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Affiliation(s)
- Julia Karpati
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands.,Poverty and Social Protection, Social Policy Research Institute, Broechem, Belgium
| | - Chris de Neubourg
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, Netherlands.,Poverty and Social Protection, Social Policy Research Institute, Broechem, Belgium
| | - Arnaud Laillou
- Maternal, Newborn and Child Health and Nutrition, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
| | - Etienne Poirot
- Maternal, Newborn and Child Health and Nutrition, United Nations Children's Fund (UNICEF), Phnom Penh, Cambodia
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Njuguna RG, Berkley JA, Jemutai J. Cost and cost-effectiveness analysis of treatment for child undernutrition in low- and middle-income countries: A systematic review. Wellcome Open Res 2020; 5:62. [DOI: 10.12688/wellcomeopenres.15781.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Undernutrition remains highly prevalent in low- and middle-income countries, with sub-Saharan Africa and Southern Asia accounting for majority of the cases. Apart from the health and human capacity impacts on children affected by malnutrition, there are significant economic impacts to households and service providers. The aim of this study was to determine the current state of knowledge on costs of child undernutrition treatment to households, health providers, organizations and governments in low and middle-income countries (LMICs). Methods: We conducted a systematic review of peer-reviewed studies in LMICs up to September 2019. We searched online databases including PubMed-Medline, Embase, Popline, Econlit and Web of Science. We identified additional articles through bibliographic citation searches. Only articles including costs of child undernutrition treatment were included. Results: We identified a total of 6436 articles, and only 50 met the eligibility criteria. Most included studies adopted institutional/program (45%) and health provider (38%) perspectives. The studies varied in the interventions studied and costing methods used with treatment costs reported ranging between US$0.44 and US$1344 per child. The main cost drivers were personnel, therapeutic food and productivity loss. Conclusion: There is a need to assess the burden of direct and indirect costs of child undernutrition to households and communities in order to plan, identify cost-effective solutions and address issues of cost that may limit delivery, uptake and effectiveness. Standardized methods and reporting in economic evaluations would facilitate interpretation and provide a means for comparing costs and cost-effectiveness of interventions.
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Tran NT, Nguyen LT, Berde Y, Low YL, Tey SL, Huynh DTT. Maternal nutritional adequacy and gestational weight gain and their associations with birth outcomes among Vietnamese women. BMC Pregnancy Childbirth 2019; 19:468. [PMID: 31801514 PMCID: PMC6894140 DOI: 10.1186/s12884-019-2643-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/27/2019] [Indexed: 01/08/2023] Open
Abstract
Background During pregnancy, a mother’s nutritional needs increase to meet the added nutrient demands for fetal growth and development. An enhanced understanding of adequate nutrition and sufficient weight gain during pregnancy can guide development of policies and strategies for maternal nutrition care, actions that will ultimately promote better pregnancy outcomes. In a sample of pregnant women in Vietnam, this study characterized maternal nutrition status and gestational weight gain at a mid-pregnancy baseline, then examined the association of these variables with specific birth outcomes. Methods The study used baseline data from a randomized, controlled trial that compared pregnant Vietnamese women who received a nutritional intervention group with those who received only standard dietary counseling (control group). At baseline (26–29 weeks gestation), mothers’ dietary reports were collected, and intake of 10 macro- and micronutrients was estimated; data for baseline gestational weight gain was collected for all pregnant women enrolled into the study (n = 228). This analysis also used weights, lengths, and head circumferences at birth for infants of mothers in the control group. Results At baseline, 95% of the pregnant women had concurrent inadequacies for more than five nutrients, and nearly half had concurrent inadequacies for more than ten nutrients. Almost two-thirds of the pregnant women did not meet recommendations for gestational weight gain. We found a significant, inverse association between the number of nutrient inadequacies and gestational weight gain (overall p ≤ 0.045). After adjusting for potential confounders, gestational weight gain was positively associated with birth weight, length at birth, birth weight-for-age z-score and length-for-age z-score (all p ≤ 0.006). Conclusions Our findings raise concern over the high proportion of pregnant women in Vietnam who have multiple concurrent nutrient inadequacies and who fall short of meeting recommended gestational weight gain standards. To ensure better birth outcomes in this population, policies and strategies to improve the status of maternal nutrition are greatly needed. Trial registration The trial was retrospectively registered at clinicaltrials.gov on December 20, 2013, registration identifier: NCT02016586.
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Affiliation(s)
- Nga Thuy Tran
- Micronutrient Research and Application, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Lam Thi Nguyen
- Clinical Nutrition, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam
| | - Yatin Berde
- Statistical Services, Cognizant Technologies Solution Pvt. Ltd, Hiranandani Business Park, Mumbai, 400076, India
| | - Yen Ling Low
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore, 138668, Singapore
| | - Siew Ling Tey
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore, 138668, Singapore
| | - Dieu Thi Thu Huynh
- Abbott Nutrition Research and Development Asia-Pacific Center, 20 Biopolis Way, Unit 09-01/02 Centros Building, Singapore, 138668, Singapore.
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Kuong K, Tor P, Perignon M, Fiorentino M, Chamnan C, Berger J, Burja K, Dijkhuizen MA, Parker M, Roos N, Wieringa FT. Multi-Micronutrient Fortified Rice Improved Serum Zinc and Folate Concentrations of Cambodian School Children. A Double-Blinded Cluster-Randomized Controlled Trial. Nutrients 2019; 11:E2843. [PMID: 31756911 PMCID: PMC6949998 DOI: 10.3390/nu11122843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Within Cambodia, micronutrient deficiencies continue to be prevalent in vulnerable groups, such as women and children. Fortification of staple foods such as rice could be a promising strategy for Cambodia to improve micronutrient status. OBJECTIVE Our objective was to investigate the impact of multiple-micronutrient fortified rice (MMFR), distributed through a World Food Program school-meals program (WFP-SMP) on serum zinc concentrations and folate status in a double-blind, cluster-randomized, placebo-controlled trial. METHODS Sixteen schools were randomly assigned to receive one of three different types of extruded-fortified rice (UltraRice Original (URO), UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. A total of 1950 schoolchildren (6-16 years old) participated in the study. Serum zinc (all groups) and folate (only in NutriRice and placebo group) concentrations were assessed from morning non-fasting antecubital blood samples and were measured at three time points (baseline and after three and six months). RESULTS After six months of intervention, serum zinc concentrations were significantly increased in all fortified rice group compared to placebo and baseline (0.98, 0.85 and 1.40 µmol/L for URO, URN and NutriRice, respectively) (interaction effect: p < 0.001 for all). Children in the intervention groups had a risk of zinc deficiencies of around one third (0.35, 039, and 0.28 for URO, URN, and NutriRice, respectively) compared to the placebo (p < 0.001 for all). The children receiving NutriRice had higher serum folate concentrations at endline compared to children receiving normal rice (+ 2.25 ng/mL, p = 0.007). CONCLUSIONS This study showed that the high prevalence of zinc and folate deficiency in Cambodia can be improved through the provision of MMFR. As rice is the staple diet for Cambodia, MMFR should be considered to be included in the school meal program and possibilities should be explored to introduce MMFR to the general population.
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Affiliation(s)
- Khov Kuong
- Department of Fisheries Post-Harvest Technologies and Quality control (DFPTQ), Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia;
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Denmark; (M.A.D.); (N.R.)
| | - Pety Tor
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Marlene Perignon
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
| | - Marion Fiorentino
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
| | - Chhoun Chamnan
- Department of Fisheries Post-Harvest Technologies and Quality control (DFPTQ), Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia;
| | - Jacques Berger
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
| | - Kurt Burja
- World Food Programme (WFP), Phnom Penh, Cambodia;
| | - Marjoleine A. Dijkhuizen
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Denmark; (M.A.D.); (N.R.)
| | - Megan Parker
- PATH (Program for Appropriate Technology in Health), 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA;
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Rolighedsvej 26, 1958 Frederiksberg, Denmark; (M.A.D.); (N.R.)
| | - Frank T. Wieringa
- UMR-204 Nutripass, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, 34394 Montpellier, France; (M.P.); (M.F.); (J.B.)
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Nutritional Status of Children Aged 12 to 36 Months in a Rural District of Hungyen Province, Vietnam. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6293184. [PMID: 31111061 PMCID: PMC6487150 DOI: 10.1155/2019/6293184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/08/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023]
Abstract
Objective To evaluate the nutritional status of children from 12 to 36 months of age in Kimdong, a rural district in Hungyen Province, Northern Vietnam, in 2017. Subjects and Methods A cross-sectional study was carried out on 327 children aged 12-36 months. The data collected included anthropometric measurement, serum hemoglobin (Hb), and vitamin D concentration. Blood analysis was done at the Center Laboratory of Hungyen Obstetrics and Pediatrics Hospital. Underweight, stunted, and wasted children were classified based on z-scores cut-off less than -2 SD of weight for age (WAZ), height for age (HAZ), and weight for height (WHZ), respectively. Overweight and obese children were defined if WHZ was more than + 2SD. Anemic child was applied when Hb concentration was less than 110 g/L while vitamin D deficiency was termed for level less than 20 ng/L. Results The prevalence of underweight, stunted, wasted, and overweight/obese children was 7.6%, 23.5%, 6.7%, and 1.2%, respectively. The prevalence of anemia and vitamin D deficiency was 33.3% and 47.7%, respectively. Malnutrition, anemia, and vitamin D deficiency were not statistically different by sex. Malnutrition and vitamin D deficiency were not statistically different by age group but anemia by age groups was significantly different. Conclusions Stunting is still prevalent in children aged 12-36 months in Kimdong. Moreover, anemia and vitamin D deficiency also affected children in this area. Some interventions should be conducted to improve the nutritional status of children in Kimdong district.
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Wieringa F, Roos N, Greffeuille V, Dijkhuizen M, Berger J. Improving Micronutrient Status of Vulnerable Groups in South-East Asia: The SMILING Experience. Matern Child Health J 2019; 23:1-3. [PMID: 30607670 DOI: 10.1007/s10995-018-02700-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Frank Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD, UM/SupAgro, Montpellier, France.
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Valerie Greffeuille
- Institute of Research for Development (IRD), UMR Nutripass IRD, UM/SupAgro, Montpellier, France
| | - Marjoleine Dijkhuizen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD, UM/SupAgro, Montpellier, France
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Mansilla J, Whittembury A, Chuquimbalqui R, Laguna M, Guerra V, Agüero Y, Piscoya J, Alarcón JO. Modelo para mejorar la anemia y el cuidado infantil en un ámbito rural del Perú. Rev Panam Salud Publica 2017; 41:e112. [PMID: 31391825 PMCID: PMC6660867 DOI: 10.26633/rpsp.2017.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 03/07/2017] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Determinar la efectividad de la Estrategia para el Crecimiento y Desarrollo Integral (ECDI) de World Vision Perú sobre la anemia, desnutrición, desarrollo psicomotor y cuidado y protección infantil en niños menores de tres años de edad que residían en tres comunidades rurales de la Región Ayacucho del Perú. Métodos. Se realizó un estudio cuasiexperimental en tres distritos rurales de la región Ayacucho, Perú. La medición de anemia se realizó con sangre capilar y el analizador HemoCue®, con ajuste de los valores de hemoglobina según a la altitud. La desnutrición se midió a través de los indicadores antropométricos de talla y peso; para ello se utilizó la herramienta Anthro de la Organización Mundial de la Salud. El desarrollo psicomotor se midió mediante el Test Abreviado del Ministerio de Salud del Perú. El cuidado y protección de los niños se midió a través de una ficha especialmente elaborada para este fin. Se realizaron tres mediciones, la línea basal en mayo del 2013, la medición intermedia en noviembre del mismo año y la final en mayo del 2014. En total, 283 niños tuvieron dos o más mediciones incluida la medición final y 205 tuvieron las tres mediciones. Resultados. El análisis multivariado para medidas repetidas mostró una efectividad estimada de la ECDI para reducir la anemia de 33,1% (intervalo de confianza del 95%: 1,0%-54,7%) ajustada para la edad, sexo, consumo de alimentos ricos en hierro, consumo de alimentos potenciadores de la absorción de hierro, consumo de alimento inhibidores de la absorción de hierro, haber recibido suplementación de hierro en los últimos seis meses y haber participado del Programa Cuna Más. Conclusiones. La ECDI fue efectiva para mejorar la nutrición de los menores de 36 meses de edad a través de la reducción de la anemia y el incremento del consumo de potenciadores de la absorción de hierro. Las intervenciones que incluyen componentes educativos y de seguimiento comunitarios podrían ser de gran ayuda para combatir la anemia en los niños menores de 36 meses de edad en comunidades rurales.
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Affiliation(s)
| | - Alvaro Whittembury
- Universidad Nacional Mayor de San Marcos, Lima, Perú. Enviar la correspondencia a Alvaro Whittembury,
| | | | | | | | - Ysela Agüero
- Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Julia Piscoya
- Universidad Nacional Mayor de San Marcos, Lima, Perú
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Rafferty ER, Schurer JM, Arndt MB, Choy RKM, de Hostos EL, Shoultz D, Farag M. Pediatric cryptosporidiosis: An evaluation of health care and societal costs in Peru, Bangladesh and Kenya. PLoS One 2017; 12:e0182820. [PMID: 28832624 PMCID: PMC5568228 DOI: 10.1371/journal.pone.0182820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022] Open
Abstract
Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering) were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01), followed by Peru ($23.32), and Bangladesh ($7.62). The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M), followed by Kenya ($37.4M; range $1.6-$804.5M) and Bangladesh ($9.6M, range $0.28-$91.5M). For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.
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Affiliation(s)
- Ellen R. Rafferty
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- * E-mail: (ER); (JMS)
| | - Janna M. Schurer
- Center for One Health Research, University of Washington, Seattle, Washington, United States of America
- * E-mail: (ER); (JMS)
| | - Michael B. Arndt
- PATH, San Francisco, California, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | | | - David Shoultz
- PATH, San Francisco, California, United States of America
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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