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Hebert KA, Nsengiyumva E, Kayitesi C, Hariharan K, Opondo C, Ferguson E, Allen E, Uwonkunda I, Ufitinema A, Baribwira C. Before and after study of a national complementary and supplementary feeding programme in Rwanda, 2017-2021. Matern Child Nutr 2024:e13648. [PMID: 38517120 DOI: 10.1111/mcn.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
To address high rates of malnutrition among children from vulnerable households in Rwanda, the government initiated a national food supplementation programme. A before and after evaluation, using repeat cross-sectional surveys in randomly selected villages was conducted; aimed at assessing the effectiveness of providing fortified blended food (FBF) to children 18-23 months of age, pregnant and lactating women in the lowest tier of Rwanda's social support system. Data were collected in 2017, 2018 and 2021 through interviews with caregivers; anthropometric measurements and a capillary blood sample were obtained from children. The primary statistical analysis compared the nutritional status of children before and after the introduction of FBF. We enroled 724 children during each survey. The prevalence of stunting declined from 47% to 35% between 2017 and 2021; in 2018, the prevalence of stunting was 43%. Children had a 42% reduction in the odds of being stunted (adjusted odds ratio [AOR]: 0.58, 95% confidence interval [CI]: 0.47-0.74, p < 0.001) from 2017 to 2021 even after adjusting for inherent, distal, proximal, and intermediate covariates. The reduction in stunting observed within the first year of the programme was not statistically significant (AOR: 0.83, 95% CI: 0.67-1.03, p < 0.091). We observed meaningful reductions in the prevalence of stunting among children which coincided with the introduction of Government-led initiative to reduce malnutrition. The Rwandan Government has committed to improving the living conditions of vulnerable households and has made strong investments in reducing malnutrition. The impact of these investments can be seen in the overall trend towards improved nutritional status highlighted in this evaluation.
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Affiliation(s)
| | | | | | - Karen Hariharan
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Charles Opondo
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Cyprien Baribwira
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Momo Kadia B, Ramsteijn AS, Dasi T, Fahmida U, Kulkarni B, Faye B, Htet MK, Sow D, Kalashikam RR, Sharma R, Sudibya ARP, Kusuma S, Angelin TC, Nurfadilah M, Jobarteh ML, Diop NS, Gabain I, Calvo-Urbano B, Ferguson E, Haggarty P, Heffernan C, Webster JP, Walker AW, Allen S. Assessment of the role of gut health in childhood stunting in a multisite, longitudinal study in India, Indonesia and Senegal: a UKRI GCRF Action Against Stunting Hub protocol. BMJ Paediatr Open 2024; 8:e001637. [PMID: 38417928 PMCID: PMC10900321 DOI: 10.1136/bmjpo-2022-001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/15/2023] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Childhood stunting has a complex aetiology, with poor gut health being an important contributor. This study will assess inter-relationships between maternal and infant gut health indices and infant linear growth. Inter-relationships between gut health indices, systemic inflammation and growth hormones in early childhood will also be assessed. METHODS AND ANALYSIS A longitudinal observational study of cohorts of 600 newborns and their mothers in India, Indonesia and Senegal will be conducted. Women will be recruited during pregnancy and their children followed up to age 24 months. Stool, urine and blood samples will be collected from the women and children for assessments of helminthic and protozoal parasites, bacterial pathogens, faecal microbiota taxa, biomarkers of environmental enteric dysfunction, systemic inflammation and growth hormones. Child anthropometric measurements will be collected at birth and at ages 3, 6, 9, 12, 18 and 24 months. The gut health indices will be integrated with cohort data from other Action Against Stunting Hub (AASH) workstreams for interdisciplinary analyses of childhood stunting and the development of a new typology of stunting. DISCUSSION This study will advance scientific understanding of the role of gut health in childhood stunting and will contribute to a broader knowledge of the complex aetiology of this condition as part of the interdisciplinary AASH research to reduce the global burden of childhood stunting. ETHICS AND DISSEMINATION This study has been approved by the relevant Ethics Committees in Senegal, India, and Indonesia and LSHTM. The results will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Benjamin Momo Kadia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Teena Dasi
- ICMR-National Institute of Nutrition, Hyderabad, India
| | - Umi Fahmida
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | | | - Babacar Faye
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Sénégal
| | - Min Kyaw Htet
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Doudou Sow
- Service de Parasitologie-Mycologie, UFR Sciences de la Santé, Université Gaston Berger, Saint Louis, Sénégal
| | | | - Ritu Sharma
- ICMR-National Institute of Nutrition, Hyderabad, India
| | - Arienta R P Sudibya
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Sari Kusuma
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Tiffany C Angelin
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Mifa Nurfadilah
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Modou Lamin Jobarteh
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ndeye Sokhna Diop
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Sénégal
| | - Isobel Gabain
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | - Beatriz Calvo-Urbano
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Haggarty
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Claire Heffernan
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- London International Development Centre, London, UK
| | - Joanne P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | - Alan W Walker
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Cooper GS, Davies-Kershaw H, Dominguez-Salas P, Fahmida U, Faye B, Ferguson E, Grace D, Häsler BN, Kadiyala S, Konapur A, Kulkarni B, Chengat Prakashbabu B, Pramesthi IL, Rowland D, Selvaraj K, Sudibya ARP, Tine RC, Yadav DMD, Zahra NL, Shankar B, Heffernan C. Investigating market-based opportunities for the provision of nutritious and safe diets to prevent childhood stunting: a UKRI-GCRF action against stunting hub protocol paper. BMJ Paediatr Open 2024; 8:e001671. [PMID: 38417923 PMCID: PMC10900371 DOI: 10.1136/bmjpo-2022-001671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/13/2022] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Inadequate access to affordable, safe, desirable and convenient nutrient-dense food is one of the underlying causes of child stunting. While targeted nutrition-sensitive interventions (eg, backyard 'nutri-gardens') may increase dietary diversity within farming households, such interventions have limited scalability across the wider food system where markets remain underdeveloped. This research aims to develop and assess market-based interventions for key nutrient-dense foods to help improve the diets of women and children in the first 1000 days of life. METHODS Data collection uses four parallel approaches in each of the three study countries (India, Indonesia and Senegal). (1) A novel food environment tool will be developed to characterise the accessibility and affordability of nutrient-dense foods in the study countries. The tool will be validated through pretesting using cognitive interviewing and piloting in purposively sampled households, 10 (cognitive interviewing) and 30 (piloting) households in each country; (2) stakeholder interviews (eg, with producers, intermediaries and retailers) will be conducted to map out nutrition-sensitive entry points of key value chains (eg, animal-sourced foods), before hotspots of potential food safety hazards will be identified from food samples collected along the chains; (3) the Optifood and Agrifood tools will be used to identify foods that can address food system nutrient gaps and engage key stakeholders to prioritise market interventions to improve nutrition outcomes. Optifood and Agrifood parameters will be informed by publicly available data, plus interviews and focus groups with value chain stakeholders; (4) informed by the previous three approaches and a campaign of participatory 'group model building', a novel system dynamics model will evaluate the impact of alternative market-based solutions on the availability and affordability of nutrient-dense foods over time. ETHICS AND DISSEMINATION The study has received ethical approval in the United Kingdom, Senegal, Indonesia and India. Dissemination comprises peer-reviewed journals, international disciplinary conferences and multistakeholder dissemination workshops.
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Affiliation(s)
- Gregory S Cooper
- Institute of Sustainable Food, Department of Geography, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Hilary Davies-Kershaw
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Paula Dominguez-Salas
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Nairobi, Kenya
- Food and Markets Department, Natural Resources Institute, University of Greenwich, London, UK
| | - Umi Fahmida
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Babacar Faye
- Department of Parasitology-Mycology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Delia Grace
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Nairobi, Kenya
- Food and Markets Department, Natural Resources Institute, University of Greenwich, London, UK
| | - Barbara N Häsler
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - Suneetha Kadiyala
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Archana Konapur
- Department of Population Health, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | - Bharati Kulkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| | | | - Indriya L Pramesthi
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
| | - Dominic Rowland
- Center for International Forestry Research, Bogor Barat, Indonesia
- Centre for Environment, Development and Policy (CeDEP), SOAS, London, UK
| | | | - Arienta R P Sudibya
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
| | - Roger C Tine
- Department of Parasitology-Mycology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - D M Dinesh Yadav
- Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | - Nur L Zahra
- Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition, Jakarta, DKI Jakarta, Indonesia
| | - Bhavani Shankar
- Institute of Sustainable Food, Department of Geography, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Claire Heffernan
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
- London International Development Centre, London, UK
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Jobarteh ML, Saxena DB, Kulkarni B, Shah K, Banjara SK, Shah PA, Memon F, Chilumula M, Palepu DP, Selvaraj K, Dasi T, Madhari R, Calvo-Urbano B, Dockrell J, Antalek C, Davies-Kershaw H, Ferguson E, Heffernan C. Impact of SARS-CoV-2 infection and mitigation strategy during pregnancy on prenatal outcome, growth and development in early childhood in India: a UKRI GCRF Action Against Stunting Hub protocol paper. BMJ Paediatr Open 2024; 8:e001900. [PMID: 38417925 PMCID: PMC10900341 DOI: 10.1136/bmjpo-2023-001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/11/2023] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has offset some of the gains achieved in global health, particularly in relation to maternal, child health and nutrition. As pregnancy is a period of plasticity where insults acting on maternal environment have far-reaching consequences, the pandemic has had a significant impact on prenatal outcomes, intrauterine and postnatal development of infants. This research will investigate both the direct and indirect impacts of the COVID-19 pandemic during pregnancy on prenatal outcomes, growth and development in early childhood. METHODS AND ANALYSIS Community and hospital data in Hyderabad and Gujarat, India will be used to recruit women who were pregnant during the COVID-19 pandemic and contracted SARS-CoV-2 infection. In comparison with women who were pregnant around the same time and did not contract the virus, the study will investigate the impact of the pandemic on access to healthcare, diet, nutrition, mental health and prenatal outcomes in 712 women (356 per study arm). Children born to the women will be followed prospectively for an 18-month period to investigate the impact of the pandemic on nutrition, health, growth and neurocognition in early childhood. ETHICS AND DISSEMINATION Ethics approval was granted from the institutional ethics committees of the Indian Institute of Public Health Gandhinagar (SHSRC/2021/2185), Indian Council of Medical Research-National Institute of Nutrition (EC/NEW/INST/2021/1206), and London School of Hygiene and Tropical Medicine (72848). The findings of the study will be disseminated to policy and research communities through engagements, scientific conferences, seminars, and open-access, peer-reviewed publication.
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Affiliation(s)
- Modou Lamin Jobarteh
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Deepak B Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | - Bharati Kulkarni
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Komal Shah
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | | | - Priyanka Akshay Shah
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | - Farjana Memon
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, India
| | - Monica Chilumula
- Maternal and Child Health and Nutrition, National Institute of Nutrition, Hyderabad, India
| | | | - Kiruthika Selvaraj
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Teena Dasi
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Radhika Madhari
- Clinical Division, ICMR-National Institute of Nutrition, Hyderabad, India
| | - Beatriz Calvo-Urbano
- Department of Pathobiology and Population Sciences, University of London, London, UK
| | - Julie Dockrell
- Faculty of Children and Learning, University of London Institute of Education, London, UK
| | - Catherine Antalek
- Faculty of Children and Health, University of London Institute of Education, London, UK
| | - Hilary Davies-Kershaw
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine Ferguson
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Claire Heffernan
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pathobiology and Population Sciences, London International Development Centre, London, UK
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Momo Kadia B, Khouma M, Sow D, Faye B, Ramsteijn AS, Calvo-Urbano B, Jobarteh ML, Ferguson E, Haggarty P, Webster JP, Walker AW, Heffernan C, Allen SJ. Improving gut health and growth in early life: a protocol for an individually randomised, two-arm, open-label, controlled trial of a synbiotic in infants in Kaffrine District, Senegal. BMJ Paediatr Open 2024; 8:e001629. [PMID: 38417919 PMCID: PMC10900337 DOI: 10.1136/bmjpo-2022-001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/03/2022] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Infants exposed to enteropathogens through poor sanitation and hygiene can develop a subclinical disorder of the gut called environmental enteric dysfunction (EED), characterised by abnormal intestinal histology and permeability. EED can contribute to stunting through reduced digestion and absorption of nutrients, increased susceptibility to infections, increased systemic inflammation and inhibition of growth hormones. EED can be apparent by age 12 weeks, highlighting the need for early intervention. Modulating the early life gut microbiota using synbiotics may improve resistance against colonisation of the gut by enteropathogens, reduce EED and improve linear growth. METHODS AND ANALYSIS An individually randomised, two-arm, open-label, controlled trial will be conducted in Kaffrine District, Senegal. Infants will be recruited at birth and randomised to either receive a synbiotic containing two Bifidobacterium strains and one Lactobacillus strain, or no intervention, during the first 6 months of life. The impact of the intervention will be evaluated primarily by comparing length-for-age z-score at 12 months of age in infants in the intervention and control arms of the trial. Secondary outcome variables include biomarkers of intestinal inflammation, intestinal integrity and permeability, gut microbiota profiles, presence of enteropathogens, systemic inflammation, growth hormones, epigenetic status and episodes of illness during follow-up to age 24 months. DISCUSSION This trial will contribute to the evidence base on the use of a synbiotic to improve linear growth by preventing or ameliorating EED in a low-resource setting. TRIAL REGISTRATION NUMBER PACTR202102689928613.
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Affiliation(s)
- Benjamin Momo Kadia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marietou Khouma
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Dakar, Senegal
| | - Doudou Sow
- Service de Parasitologie-Mycologie, UFR Sciences de la Santé, Université Gaston Berger, Saint Louis, Senegal
| | - Babacar Faye
- Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Beatriz Calvo-Urbano
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | - Modou L Jobarteh
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Haggarty
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Joanne P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
| | - Alan W Walker
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Claire Heffernan
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- London International Development Centre, London, UK
| | - Stephen J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Banjara SK, Challa SR, Augustine LF, Dasi T, Madhari R, Fernandez Rao S, Palika R, Pullakhandam R, Kalashikam RR, Kumar RN, Palepu DP, Chilumula M, Selvaraj K, Gopinath P, Davies-Kershaw H, Jobarteh ML, Haggarty P, Heffernan C, Ferguson E, Kulkarni B. Eggs for Improving Nutrition, cognitive development and reducing linear growth retardation among Infants and young Children (ENRICH): protocol of an egg supplementation trial among children aged 9-18 months in Hyderabad, India. BMJ Paediatr Open 2024; 8:e001892. [PMID: 38417922 PMCID: PMC10900354 DOI: 10.1136/bmjpo-2023-001892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/13/2023] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Evidence on the impact of nutrient-rich animal source foods such as eggs for improving child growth and cognition is inconsistent. This study aims to examine the impact of an egg intervention in children, along with behaviour change communication (BCC) to the mother, on linear growth and cognition, and nutritional status in children aged 9-18 months. METHODS AND ANALYSIS A 9-month open-labelled randomised controlled trial will be conducted in three urban slums in Hyderabad, India, as a substudy of an observational cohort study (n=350) following pregnant women and their children until 18 months of age in a population at risk of stunting. The children born to women enrolled during the third trimester of pregnancy will be block randomised in a 1:4 ratio into the intervention (n=70) and control (n=280) groups. Children in the intervention group will be supplemented with one egg per day starting from 9 months until 18 months of age. BCC designed to enhance adherence to the intervention will be used. The control group will be a part of the observational cohort and will not receive any intervention from the study team. The primary outcome will be length-for-age z-scores, and the secondary outcomes will include cognition, blood biomarkers of nutritional status including fatty acid profile and epigenetic signatures linked with linear growth and cognition. Multivariate intention-to-treat analyses will be conducted to assess the effect of the intervention. ETHICS AND DISSEMINATION The study is approved by the Institutional ethics committees of ICMR-National Institute of Nutrition, Hyderabad, India and London School of Hygiene and Tropical Medicine, UK. The results will be published in peer-reviewed journals and disseminated to policy-makers. Findings will also be shared with study participants and community leaders. TRIAL REGISTRATION NUMBER CTRI/2021/11/038208.
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Affiliation(s)
| | - Sai Ram Challa
- ICMR - National Institute of Nutrition, Hyderabad, India
| | | | - Teena Dasi
- ICMR - National Institute of Nutrition, Hyderabad, India
| | | | | | | | | | | | | | | | | | | | | | | | - Modou Lamin Jobarteh
- Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Claire Heffernan
- Department of Pathobiology and Population Sciences, University of London, London, UK
- London International Development Centre (LIDC), London, UK
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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7
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Davies-Kershaw H, Fahmida U, Htet MK, Kulkarni B, Faye B, Yanti D, Shinta D, Zahra NL, Angelin TC, Madhari R, Pullakhandam R, Palika R, Dasi T, Fernandez Rao S, Banjara SK, Selvaraj K, Palepu DP, Yadev D, Diouf S, Lopez-Sall P, Diallo B, Mouissi P, Fall S, Diallo I, Djigal A, Immerzeel TDV, Tairou F, Diop A, Pradeilles R, Strout S, Momo Kadia B, Tata DT, Jobarteh ML, Allen S, Walker A, Webster JP, Haggarty P, Heffernan C, Ferguson E. Anthropometric, biochemical, dietary, morbidity and well-being assessments in women and children in Indonesia, India and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper. BMJ Paediatr Open 2024; 8:e001683. [PMID: 38417920 PMCID: PMC10910654 DOI: 10.1136/bmjpo-2022-001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/28/2023] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Child stunting has a complex aetiology, especially in the first 1000 days of life. Nutrition interventions alone have not produced expected impacts in reducing/preventing child stunting, indicating the importance of understanding the complex interplay between environmental, physiological and psychological factors influencing child nutritional status. This study will investigate maternal and child nutrition, health and well-being status and associated factors through the assessment of: (1) anthropometry, (2) biomarkers of nutrition and health status, (3) dietary intakes, (4) fetal growth and development, (5) infant morbidity, (6) infant and young child feeding (IYCF) and (7) perinatal maternal stress, depression and social support. METHODS This study will be conducted in a prospective pregnancy cohort in India, Indonesia and Senegal. Pregnant women will be recruited in the second (Indonesia, Senegal) and third (India) trimester of pregnancy, and the mother and infant dyads followed until the infant is 24 months of age. During pregnancy, anthropometric measures will be taken, venous blood samples will be collected for biochemical assessment of nutrition and health status, dietary intakes will be assessed using a 4-pass-24-hour dietary recall method (MP24HR), fetal ultrasound for assessment of fetal growth. After birth, anthropometry measurements will be taken, venous blood samples will be collected, MP24HR will be conducted, infant morbidity and IYCF practices will be assessed and a sample of breastmilk will be collected for nutrient composition analyses. Perinatal maternal stress, depression, social support and hair cortisol levels (stress) will be measured. The results from this study will be integrated in an interdisciplinary analysis to examine factors influencing infant growth and inform global efforts in reducing child stunting. ETHICS AND DISSEMINATION Ethical approval was granted by the Ethics Committee of the London School of Hygiene and Tropical Medicine (17915/RR/17513); National Institute of Nutrition (ICMR)-Ministry of Health and Family Welfare, Government of India (CR/04/I/2021); Health Research Ethics Committee, University of Indonesia and Cipto Mangunkusumo Hospital (KET-887/UN2.F1/ETIK/PPM.00.02/2019); and the Comité National d'Ethique pour la Recherche en Santé, Senegal (Protocole SEN19/78); the Royal Veterinary College (URN SR2020-0197) and the International Livestock Research Institute Institutional Research Ethics Committee (ILRI-IREC2020-33). Results will be published in peer-reviewed journals and disseminated to policy-makers and participating communities.
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Affiliation(s)
- Hilary Davies-Kershaw
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Umi Fahmida
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Min Kyaw Htet
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Bharati Kulkarni
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Babacar Faye
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Dwi Yanti
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Dewi Shinta
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Nur L Zahra
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Tiffany C Angelin
- Regional Centre for Food and Nutrition, SEAMEO, University of Indonesia, Jakarta, Indonesia
| | - Radhika Madhari
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Raghu Pullakhandam
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Ravindranadh Palika
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Teena Dasi
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Sylvia Fernandez Rao
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Santosh Kumar Banjara
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Kiruthika Selvaraj
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Dharani Pratyusha Palepu
- Deparments of Maternal and Child Health and Dietetics Division, National Institute of Nutrition, Hyderabad, India
| | - Dinesh Yadev
- Department of Public Health, London International Development Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Saliou Diouf
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Philomene Lopez-Sall
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Babacar Diallo
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Princillia Mouissi
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Sally Fall
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Ibrahima Diallo
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Aicha Djigal
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | | | - Fassia Tairou
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Assana Diop
- Service de Parasitologie-Mycologie- Pédiatrie, Faculté de médecine, UCAD, Dakar, Senegal
| | - Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- UMR, MOISA, Montpellier, France
| | - Sara Strout
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Benjamin Momo Kadia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Darius Tetsa Tata
- Department of Public Health, London International Development Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Modou Lamin Jobarteh
- Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Alan Walker
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Joanne P Webster
- Department of Pathobiology and Population Sciences, University of London, London, UK
| | - Paul Haggarty
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Claire Heffernan
- Department of Public Health, London International Development Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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8
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Pongutta S, Ferguson E, Davey C, Tangcharoensathien V, Limwattananon S, Borghi J, Wong CKH, Lin L. The impact of a complex school nutrition intervention on double burden of malnutrition among Thai primary school children: a 2-year quasi-experiment. Public Health 2023; 224:51-57. [PMID: 37734276 DOI: 10.1016/j.puhe.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/22/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE This study assessed the impacts of the Dekthai Kamsai programme on overweight/obesity, underweight and stunting among male and female primary school students. STUDY DESIGN A quasi-experiment was conducted in 16 intervention and 19 control schools across Thailand in 2018 and 2019. In total, 896 treated and 1779 control students from grades 1 to 3 were recruited. In intervention schools, a set of multifaceted intervention components were added into school routine practices. Anthropometric outcomes were measured at baseline and at the beginning and end of every school term. METHODS Propensity score matching with linear and Poisson difference-in-difference analyses were used to adjust for the non-randomisation and to analyse the intervention's effects over time. RESULTS Compared with controls, the increases in mean BMI-for-age Z-score (BAZ) and the incidence rate of overweight/obesity were lower in the intervention schools at the 3rd, 4th and 8th measurements and the 3rd measurement, respectively. The decrease in mean height-for-age Z-score (HAZ) was lower at the 4th measurement. The decrease in the incidence rate of wasting was lower at the 5th, 7th and 8th measurements. The favourable impacts on BAZ and HAZ were found in both sexes, while the favourable impact on overweight/obesity and unfavourable impact on wasting were found in girls. CONCLUSIONS This intervention might be effective in reducing BAZ, overweight/obesity, poor height gain, but not wasting. These findings highlight the benefits of a multifaceted school nutrition intervention and a need to incorporate tailor-made interventions for wasting to comprehensively address the double burden of malnutrition.
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Affiliation(s)
- S Pongutta
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand; London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - E Ferguson
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK
| | - C Davey
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - V Tangcharoensathien
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - S Limwattananon
- International Health Policy Program, Tiwanon Rd, Muang, Nonthaburi 11000, Thailand.
| | - J Borghi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK.
| | - C K H Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Science Park, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
| | - L Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E7HT, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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9
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de la Revilla LS, Ferguson E, Dooley C, Osman G, Ander L, Joy EJ. The availability and geographic location of open-source food composition data used to estimate micronutrient intakes in sub-Saharan Africa: A scoping review. J Food Compost Anal 2023. [DOI: 10.1016/j.jfca.2023.105322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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10
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O'Meara L, de Bruyn J, Dominguez-Salas P, Hope T, Turner C, Stoynova M, Wellard K, Ferguson E. Characteristics of food environments that influence food acquisition and diets of women in low-and middle-income countries: a scoping review protocol. JBI Evid Synth 2023:02174543-990000000-00123. [PMID: 36642974 DOI: 10.11124/jbies-22-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This scoping review aims to identify and map characteristics of food environments that influence food-acquisition practices and dietary intake of women of reproductive age in low- and middle-income countries. INTRODUCTION Due to the disproportionate burden of malnutrition on women of reproductive age in low- and middle-income countries, accelerated progress in improving women's nutrition is required to achieve Sustainable Development Goal 2 "Zero hunger" by 2030. Food environments are increasingly recognized as the key interface between consumers and food systems; however, little is known about the characteristics that influence women's food acquisition and diets in low- and middle-income countries, especially during physiological stages of heightened nutritional requirement, such as pre-conception, pregnancy, and breastfeeding. INCLUSION CRITERIA This review will consider quantitative, qualitative, mixed method, or review studies that report on the influence of food environment characteristics on food-acquisition practices and dietary intakes of women aged 15 to 49 years in any low- and middle-income country, as defined by the World Bank in 2021. Studies published in English, Spanish, Portuguese, or French from January 2010 onwards will be included. METHODS Twenty-one databases across EBSCO, Web of Science Core Collection, and PubMed will be searched. Screening, selection, and data extraction will be performed in duplicate by 2 members of the team, with any discrepancies resolved by group discussion. The patterns of food-acquisition and dietary intake in relation to food environment characteristics will be charted, mapped, and summarized in tabular and graphical formats. Findings will inform the refinement of effective food environment conceptual frameworks for this nutritionally vulnerable group.
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Affiliation(s)
- Lydia O'Meara
- Natural Resources Institute, University of Greenwich, Kent, United Kingdom
| | - Julia de Bruyn
- ARC Centre of Excellence for Children and Families over the Life Course, University of Melbourne, Melbourne, Vic, Australia
| | - Paula Dominguez-Salas
- Natural Resources Institute, University of Greenwich, Kent, United Kingdom.,International Livestock Research Institute, Nairobi, Kenya
| | - Tammy Hope
- School of Health, Medical and Applied Sciences, CQUniversity, Bundaberg, Queensland, Australia
| | - Christopher Turner
- Natural Resources Institute, University of Greenwich, Kent, United Kingdom
| | - Mina Stoynova
- Natural Resources Institute, University of Greenwich, Kent, United Kingdom
| | - Kate Wellard
- Natural Resources Institute, University of Greenwich, Kent, United Kingdom
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Abou Zeinab M, Ferguson E, Kaviani A, Tuna Beksac A, Covas Moschovas M, Morgantini L, Hemal S, Josehp J, Kim M, Crivellaro S, Patel V, Nix J, Kaouk J. Single-port extraperitoneal vs. transperitoneal robotic-assisted radical prostatectomy: A multi-institutional matched-pair comparison of perioperative outcomes. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Titaley CR, Dibley MJ, Ariawan I, Mu'asyaroh A, Paramashanti BA, Alam A, Damayanti R, Do TT, Ferguson E, Htet MK, Li M, Sutrisna A, Fahmida U. The impact of a package of behaviour change interventions on breastfeeding practices in East Java Province, Indonesia. Matern Child Nutr 2022; 18:e13362. [PMID: 35488406 PMCID: PMC9218323 DOI: 10.1111/mcn.13362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
Suboptimal infant young child feeding practices are frequently reported globally, including in Indonesia. This analysis examined the impact of a package of behaviour change interventions on breastfeeding practices in Malang and Sidoarjo Districts, East Java Province, Indonesia. The BADUTA study (which in the Indonesian Language is an acronym for BAwah DUa TAhun, or children aged less than 2 years) was an impact evaluation using a cluster‐randomized controlled trial with two parallel treatment arms. We conducted household surveys in 12 subdistricts from Malang and Sidoarjo. We collected information from 5175 mothers of children aged 0–23 months: 2435 mothers at baseline (February 2015) and 2740 mothers at endline (January to February 2017). This analysis used two indicators for fever and diarrhoea and seven breastfeeding indicators (early initiation of breastfeeding, prelacteal feeding, exclusive breastfeeding under 6 months, predominant breastfeeding, continued breastfeeding, age‐appropriate breastfeeding and bottle‐feeding). We used multilevel logistic regression analysis to assess the effect of the intervention. After 2 years of implementation of interventions, we observed an increased odds of exclusive breastfeeding under 6 months (adjusted odds ratio [aOR] = 1.85; 95% confidence interval [CI]: 1.35–2.53) and age‐appropriate breastfeeding (aOR = 1.39; 95% CI: 1.07–1.79) in the intervention group than in the comparison group, at the endline survey. We found significantly lower odds for prelacteal feeding (aOR = 0.52; 95% CI: 0.41–0.65) in the intervention than in the comparison group. Our findings confirmed the benefits of integrated, multilayer behaviour change interventions to promote breastfeeding practices. Further research is required to develop effective interventions to reduce bottle use and improve other breastfeeding indicators that did not change with the BADUTA intervention. The integrated package of behaviour change interventions in the BADUTA study (which in the Indonesian Language is an acronym for BAwah DUa TAhun, or children aged less than 2 years) increased exclusive and age‐appropriate breastfeeding practices in children under 2 years old in Indonesia. The BADUTA study interventions did not significantly affect early breastfeeding initiation, breastfeeding in the last 24 h, ever breastfed, continued breastfeeding, predominant breastfeeding, bottle‐feeding practices, fever and diarrhoea 2 weeks before the interview. Further research is required to develop effective interventions to improve continued breastfeeding after 12 months of age and reduce predominant breastfeeding for children aged 0–5 months and bottle‐feeding practices.
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Affiliation(s)
| | - Michael J Dibley
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Iwan Ariawan
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Anifatun Mu'asyaroh
- Alian Health Center, District Health Office of Kebumen, Central Java, Indonesia
| | - Bunga Astria Paramashanti
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.,Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta, Indonesia
| | - Ashraful Alam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Rita Damayanti
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Tran Thanh Do
- National Institute of Nutrition, Hai Bà Trưng, Hanoi, Vietnam
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Min Kyaw Htet
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.,South-East Asian Ministers of Education Organization, Regional Center for Food and Nutrition, Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Mu Li
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Aang Sutrisna
- Global Alliance for Improved Nutrition (GAIN), Jakarta, Indonesia
| | - Umi Fahmida
- South-East Asian Ministers of Education Organization, Regional Center for Food and Nutrition, Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
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13
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Knight F, Bourassa MW, Ferguson E, Walls H, de Pee S, Vosti S, Martinez H, Levin C, Woldt M, Sethurman K, Bergeron G. Nutrition modeling tools: a qualitative study of influence on policy decision making and determining factors. Ann N Y Acad Sci 2022; 1513:170-191. [PMID: 35443074 PMCID: PMC9546113 DOI: 10.1111/nyas.14778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nutrition modeling tools (NMTs) generate evidence to inform policy and program decision making; however, the literature is generally limited to modeling methods and results, rather than use cases and their impacts. We aimed to document the policy influences of 12 NMTs and identify factors influencing them. We conducted semistructured interviews with 109 informants from 30 low‐ and middle‐income country case studies and used thematic analysis to understand the data. NMTs were mostly applied by international organizations to inform national government decision making. NMT applications contributed to enabling environments for nutrition and influenced program design and policy in most cases; however, this influence could be strengthened. Influence was shaped by processes for applying the NMTs; ownership of the analysis and data inputs, and capacity building in NMT methods, encouraged uptake. Targeting evidence generation at specific policy cycle stages promoted uptake; however, where advocacy capacity allowed, modeling was embedded ad hoc into emerging policy discussions and had broader influence. Meanwhile, external factors, such as political change and resource constraints of local partner organizations, challenged NMT implementation. Importantly, policy uptake was never the result of NMTs exclusively, indicating they should be nested persistently and strategically within the wider evidence and advocacy continuum, rather than being stand‐alone activities.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Walls
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.,Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, Washington
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia.,Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Kavita Sethurman
- Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- New York Academy of Sciences, New York, New York.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia
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14
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Prosser NS, Green MJ, Ferguson E, Tildesley MJ, Hill EM, Keeling MJ, Kaler J. Cattle farmer psychosocial profiles and their association with control strategies for bovine viral diarrhea. J Dairy Sci 2022; 105:3559-3573. [PMID: 35094853 PMCID: PMC9092459 DOI: 10.3168/jds.2021-21386] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/05/2021] [Indexed: 12/02/2022]
Abstract
Bovine viral diarrhea (BVD) is endemic in the United Kingdom and causes major economic losses. Control is largely voluntary for individual farmers and is likely to be influenced by psychosocial factors, such as altruism, trust, and psychological proximity (feeling close) to relevant “others,” such as farmers, veterinarians, the government, and their cows. These psychosocial factors (factors with both psychological and social aspects) are important determinants of how people make decisions related to their own health, many of which have not been studied in the context of infectious disease control by farmers. Farmer psychosocial profiles were investigated using multiple validated measures in an observational survey of 475 UK cattle farmers using the capability, opportunity, motivation-behavior (COM-B) framework. Farmers were clustered by their BVD control practices using latent class analysis. Farmers were split into 5 BVD control behavior classes, which were tested for associations with the psychosocial and COM-B factors using multinomial logistic regression, with doing nothing as the baseline class. Farmers who were controlling disease both for themselves and others were more likely to do something to control BVD (e.g., test, vaccinate). Farmers who did not trust other farmers, had high psychological capability (knowledge and understanding of how to control disease), and had high physical opportunity (time and money to control disease) were more likely to have a closed, separate herd and test. Farmers who did not trust other farmers were also more likely to undertake many prevention strategies with an open herd. Farmers with high automatic motivation (habits and emotions) and reflective motivation (decisions and goals) were more likely to vaccinate and test, alone or in combination with other controls. Farmers with high psychological proximity (feeling of closeness) to their veterinarian were more likely to undertake many prevention strategies in an open herd. Farmers with high psychological proximity to dairy farmers and low psychological proximity to beef farmers were more likely to keep their herd closed and separate and test or vaccinate and test. Farmers who had a lot of trust in other farmers and invested in them, rather than keeping everything for themselves, were more likely to be careful introducing new stock and test. In conclusion, farmer psychosocial factors were associated with strategies for BVD control in UK cattle farmers. Psychological proximity to veterinarians was a novel factor associated with proactive BVD control and was more important than the more extensively investigated trust. These findings highlight the importance of a close veterinarian-farmer relationship and are important for promoting effective BVD control by farmers, which has implications for successful nationwide BVD control and eradication schemes.
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Affiliation(s)
- N S Prosser
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, United Kingdom.
| | - M J Green
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, United Kingdom
| | - E Ferguson
- School of Psychology, University Park, University of Nottingham, Nottingham, NG7 2RD, United Kingdom
| | - M J Tildesley
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, United Kingdom; Joint UNIversities Pandemic and Epidemiological Research (JUNIPER; https://maths.org/juniper/)
| | - E M Hill
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, United Kingdom; Joint UNIversities Pandemic and Epidemiological Research (JUNIPER; https://maths.org/juniper/)
| | - M J Keeling
- Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences and Mathematics Institute, University of Warwick, Coventry, CV4 7AL, United Kingdom; Joint UNIversities Pandemic and Epidemiological Research (JUNIPER; https://maths.org/juniper/)
| | - J Kaler
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, LE12 5RD, United Kingdom
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15
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Chittchang U, Rojroongwasiukul N, Winnichagoon P, Watson L, Ferguson E. Mathematical modeling to inform the development of national guidelines on infant feeding in Thailand. Ann N Y Acad Sci 2022; 1511:142-153. [PMID: 35061914 PMCID: PMC9303245 DOI: 10.1111/nyas.14738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
The development of national dietary guidelines promoting healthy food choices is a public health priority in Thailand. In developing the recent national complementary feeding guidelines (CFGs) for 6‐ to 12‐month‐old children, mathematical modeling was used to inform decisions. Model parameters were derived from nationally representative dietary data and analyzed for 11 micronutrients by age group, using linear programming analysis in Optifood. Models were run to identify micronutrients whose nutrient reference values could not be met using local foods as consumed (problem nutrients), evaluate the original 2012 Thai CFGs, and predict the nutritional benefits of a specific fortified complementary food. The results identified three problem nutrients (iron, calcium, and zinc), which, for 9‐ to 11‐month‐olds, were reduced to one when the fortified food was modeled. The number of servings/week of vegetables and meat, fish or eggs were higher, and of oil and fruit were lower, in the modeled nutritionally best rather than observed diets (medians). When modeled, the original Thai CFGs were not feasible because the energy constraint was exceeded; hence, in revising them, the recommended number of servings/week of oil and fruit were reduced. This study demonstrates the advantages of using mathematical modeling, when revising national CFGs, to evaluate and improve them.
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Affiliation(s)
| | | | | | - Louise Watson
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
| | - Elaine Ferguson
- Department of Population Health London School of Hygiene & Tropical Medicine London UK
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16
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Knight F, Woldt M, Sethuraman K, Bergeron G, Ferguson E. Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries. Ann N Y Acad Sci 2021; 1509:145-160. [PMID: 34850396 PMCID: PMC9299870 DOI: 10.1111/nyas.14709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022]
Abstract
A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population‐specific food‐based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual‐level 24‐h recalls (24HRs). The 24HR data from 12‐ to 23‐month‐old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES‐ and 24HR‐defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food‐group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77–100% agreement), food sources of nutrients (71–100% agreement), and FBRs (80–100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12‐ to 23‐month‐old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,United Nations World Food Programme, Rome, Italy
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia
| | - Kavita Sethuraman
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,New York Academy of Sciences, New York, New York
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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17
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Chiutsi-Phiri G, Kalimbira AA, Banda L, Nalivata PC, Sanuka M, Kalumikiza Z, Matandika L, Mfutso-Bengo J, Allen E, Ferguson E, Sturgess J, Broadley MR, Langley-Evans S, Millar K, Gashu D, Joy EJM. Preparing for a community-based agriculture-to-nutrition trial in rural Malawi: formative research to assess feasibility and inform design and implementation decisions. Pilot Feasibility Stud 2021; 7:141. [PMID: 34233757 PMCID: PMC8262007 DOI: 10.1186/s40814-021-00877-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/21/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium or control flour not biofortified with selenium for a period of 10 weeks, after which blood samples were taken to measure selenium status. METHODS Formative research was conducted in villages near to the AHHA trial study site 1 year before the planned intervention. A short questionnaire with adult women (n = 50), focus group discussions with male (n groups = 3) and female (n groups = 3) community members, and in-depth key informant interviews (n = 7) were conducted to understand community practices and perceptions. FINDINGS Meals were typically cooked and eaten at home in this community, while participants reported that maize flour would be less readily sold than maize grain - important considerations for the design of the trial. Regarding intervention delivery, we identified potential concerns around effects on fertility, links between blood sampling and witchcraft, and the potential for social stigma if community members considered participants lazy for receiving free flour. Participants reported that involvement of the Malawi government partners including health extension workers would increase trust. INTERPRETATION Following the formative research, the AHHA trial appeared feasible. However, community sensitisation would be essential to address potential fears and concerns; effective sensitisation would support recruitment and treatment adherence, and would protect the safety and wellbeing of participants and researchers. People in positions of authority and trust including village headmen, religious leaders, health and agriculture extension workers, and community care groups should be involved in community sensitisation.
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Affiliation(s)
- Gabriella Chiutsi-Phiri
- Lilongwe University of Agriculture and Natural Resources, PO BOX 143, Natural Resources College, Lilongwe, Malawi
| | - Alexander A Kalimbira
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Leonard Banda
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Patson C Nalivata
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Marion Sanuka
- Lilongwe University of Agriculture and Natural Resources, PO BOX 143, Natural Resources College, Lilongwe, Malawi
| | - Zione Kalumikiza
- Lilongwe University of Agriculture and Natural Resources, PO BOX 219, Bunda College, Lilongwe, Malawi
| | - Limbanazo Matandika
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Elaine Ferguson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Joanna Sturgess
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Martin R Broadley
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Simon Langley-Evans
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Kate Millar
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Dawd Gashu
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Edward J M Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
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Akin-Akinyosoye K, James RJE, McWilliams DF, Millar B, das Nair R, Ferguson E, Walsh DA. The Central Aspects of Pain in the Knee (CAP-Knee) questionnaire; a mixed-methods study of a self-report instrument for assessing central mechanisms in people with knee pain. Osteoarthritis Cartilage 2021; 29:802-814. [PMID: 33621705 PMCID: PMC8177001 DOI: 10.1016/j.joca.2021.02.562] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Pain is the prevailing symptom of knee osteoarthritis. Central sensitisation creates discordance between pain and joint pathology. We previously reported a Central Pain Mechanisms trait derived from eight discrete characteristics: Neuropathic-like pain, Fatigue, Cognitive-impact, Catastrophising, Anxiety, Sleep disturbance, Depression, and Pain distribution. We here validate and show that an 8-item questionnaire, Central Aspects of Pain in the Knee (CAP-Knee) is associated both with sensory- and affective- components of knee pain severity. METHODS Participants with knee pain were recruited from the Investigating Musculoskeletal Health and Wellbeing study in the East Midlands, UK. CAP-Knee items were refined following cognitive interviews. Psychometric properties were assessed in 250 participants using Rasch-, and factor-analysis, and Cronbach's alpha. Intra-class correlation coefficients tested repeatability. Associations between CAP-Knee and McGill Pain questionnaire pain severity scores were assessed using linear regression. RESULTS CAP-Knee targeted the knee pain sample well. Cognitive interviews indicated that participants interpreted CAP-Knee items in diverse ways, which aligned to their intended meanings. Fit to the Rasch model was optimised by rescoring each item, producing a summated score from 0 to 16. Internal consistency was acceptable (Cronbach's alpha = 0.74) and test-retest reliability was excellent (ICC2,1 = 0.91). Each CAP-Knee item contributed uniquely to one discrete 'Central Mechanisms trait' factor. High CAP-Knee scores associated with worse overall knee pain intensity, and with each of sensory- and affective- McGill Pain Questionnaire scores. CONCLUSION CAP-Knee is a simple and valid self-report questionnaire, which measures a single 'Central Mechanisms' trait, and may help identify and target centrally-acting treatments aiming to reduce the burden of knee pain.
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Affiliation(s)
- K Akin-Akinyosoye
- Pain Centre Versus Arthritis, University of Nottingham, UK; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, UK.
| | - R J E James
- Pain Centre Versus Arthritis, University of Nottingham, UK; School of Psychology, University of Nottingham, UK.
| | - D F McWilliams
- Pain Centre Versus Arthritis, University of Nottingham, UK; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, UK.
| | - B Millar
- Pain Centre Versus Arthritis, University of Nottingham, UK; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, UK.
| | - R das Nair
- Pain Centre Versus Arthritis, University of Nottingham, UK; Institute of Mental Health, University of Nottingham, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK.
| | - E Ferguson
- Pain Centre Versus Arthritis, University of Nottingham, UK; School of Psychology, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, UK.
| | - D A Walsh
- Pain Centre Versus Arthritis, University of Nottingham, UK; Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, UK; Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, UK.
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Brouzes CMC, Darcel N, Tomé D, Bourdet-Sicard R, Youssef Shaaban S, Gamal El Gendy Y, Khalil H, Ferguson E, Lluch A. Local Foods Can Increase Adequacy of Nutrients Other than Iron in Young Urban Egyptian Women: Results from Diet Modeling Analyses. J Nutr 2021; 151:1581-1590. [PMID: 33693946 PMCID: PMC8169812 DOI: 10.1093/jn/nxab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nutrition transition and recent changes in lifestyle in Middle Eastern countries have resulted in the double burden of malnutrition. In Egypt, 88% of urban women are overweight or obese and 50% are iron deficient. Their energy, sugar, and sodium intakes are excessive, while intakes of iron, vitamin D, and folate are insufficient. OBJECTIVE This study aimed to formulate dietary advice based on locally consumed and affordable foods and determine the need for fortified products to meet the nutrient requirements of urban Egyptian women. METHODS Food intakes were assessed using a 4-d food diary collected from 130 urban Egyptian women aged 19-30 y. Food prices were collected from modern and traditional markets to calculate diet cost. Population-based linear and goal programming analyses (Optifood tool) were used to identify "limiting nutrients" and to assess whether locally consumed foods (i.e., consumed by >5% of women) could theoretically improve nutrient adequacy at an affordable cost (i.e., less than or equal to the mean diet cost), while meeting recommendations for SFAs, sugars, and sodium. The potential of hypothetical fortified foods for improving intakes of micronutrients was also assessed. RESULTS Iron was the most limiting nutrient. Daily consumption of fruits, vegetables, milk or yogurt, meat/fish/eggs, and tahini (sesame paste) were likely to improve nutrient adequacy for 11 out of 12 micronutrients modeled. Among fortified foods tested, iron-fortified rice, milk, water, bread, or yogurt increased the minimized iron content of the modeled diet from 40% to >60% of the iron recommendation. CONCLUSIONS A set of dietary advice based on locally consumed foods, if put into practice, can theoretically meet requirements for most nutrients, except for iron for which adequacy is harder to achieve without fortified products. The acceptability of the dietary changes modeled needs evaluation before promoting them to young Egyptian women.
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Affiliation(s)
- Chloé M C Brouzes
- Université Paris-Saclay, AgroParisTech, INR AE, UMR PNCA, 75005, Paris, France
| | - Nicolas Darcel
- Université Paris-Saclay, AgroParisTech, INR AE, UMR PNCA, 75005, Paris, France
| | - Daniel Tomé
- Université Paris-Saclay, AgroParisTech, INR AE, UMR PNCA, 75005, Paris, France
| | | | | | | | | | - Elaine Ferguson
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
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Titaley CR, Dibley MJ, Ariawan I, Mu'asyaroh A, Alam A, Damayanti R, Do TT, Ferguson E, Htet K, Li M, Sutrisna A, Fahmida U. Determinants of low breastfeeding self-efficacy amongst mothers of children aged less than six months: results from the BADUTA study in East Java, Indonesia. Int Breastfeed J 2021; 16:12. [PMID: 33468196 PMCID: PMC7816511 DOI: 10.1186/s13006-021-00357-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Despite the increasing rate of exclusive breastfeeding in Indonesia, there is still a need for supportive interventions. The breastfeeding self-efficacy of mothers is a key factor positively associated with optimum breastfeeding practices. Our analysis aims to assess the determinants of low breastfeeding self-efficacy amongst a sample of women with children aged under 6 months in Malang and Sidoarjo Districts, East Java, Indonesia. Methods We used information from 1210 mothers of children aged < 6 months recruited in the BADUTA study conducted in 2015–2016 in Malang and Sidoarjo Districts. The outcome variable in this analysis was mothers’ self-efficacy for breastfeeding using the 14 statements in the Breastfeeding Self-Efficacy-Short Form. We evaluated 17 potential predictors of breastfeeding self-efficacy, organized into six sub-groups of variables: (1) context/demographic; (2) household factors; (3) maternal characteristics; (4) child characteristics; (5) breastfeeding practices; and (6) antenatal and delivery care. Logistic regression analyses were employed to examine factors associated with mothers’ self-efficacy with breastfeeding. Results More than half of the women in this study had a low level of self-efficacy. One of the factors associated with low breastfeeding self-efficacy found in this study was mothers’ problems related to breastfeeding. Mothers who had problems with breastfeeding not related to illness (adjusted odds ratio [aOR] 3.27; 95% CI 2.45, 4.36) or problems related to both illness and non-illness conditions (aOR 3.57; 95% CI 1.37, 9.33) had higher odds of low breastfeeding self-efficacy than those who did not have any problems. Compared to mothers who completed university education, there was a significantly higher odds of low breastfeeding self-efficacy in mothers who completed primary school or lower (aOR 1.88; 95% CI 1.16, 3.05); completed junior high school (aOR 2.27; 95% CI 1.42, 3.63); and completed senior high school (aOR 1.94; 95% CI 1.29, 2.91). Other significant predictors of low breastfeeding self-efficacy were mothers not exposed to any breastfeeding interventions (aOR 1.87; 95% CI 1.09, 3.22); working outside the house (aOR 1.69; 95% CI 1.23, 2.32); not obtaining any advice on breastfeeding (aOR 1.40; 95% CI 1.08, 1.82); with low knowledge of breastfeeding (aOR 1.38; 95% CI 1.03, 1.84); and delivered by Caesarean section (aOR 1.34; 95% CI 1.05, 1.70). Conclusions Multipronged breastfeeding education programs and support are required to improve women’s self-efficacy with breastfeeding. Improved access to breastfeeding counselors, active support for mothers following cesarean delivery, and increased supporting facilities at workplaces are essential to improve self-efficacy with breastfeeding. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00357-5.
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Affiliation(s)
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Iwan Ariawan
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Anifatun Mu'asyaroh
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Rita Damayanti
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Tran Thanh Do
- National Institute of Nutrition, Hanoi, 116110, Vietnam
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Kyaw Htet
- Southeast Asian Ministers of Education Organization, Regional Center for Food and Nutrition, Pusat Kajian Gizi Regional Universitas Indonesia, Salemba Raya 6, Jakarta, 10430, Indonesia
| | - Mu Li
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Aang Sutrisna
- Global Alliance for Improved Nutrition (GAIN), Jakarta, Indonesia
| | - Umi Fahmida
- Southeast Asian Ministers of Education Organization, Regional Center for Food and Nutrition, Pusat Kajian Gizi Regional Universitas Indonesia, Salemba Raya 6, Jakarta, 10430, Indonesia
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21
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Dibley MJ, Alam A, Fahmida U, Ariawan I, Titaley CR, Htet MK, Damayanti R, Li M, Sutrisna A, Ferguson E. Evaluation of a Package of Behaviour Change Interventions (Baduta Program) to Improve Maternal and Child Nutrition in East Java, Indonesia: Protocol for an Impact Study. JMIR Res Protoc 2020; 9:e18521. [PMID: 32897234 PMCID: PMC7509610 DOI: 10.2196/18521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Over the past decade, the prevalence of stunting has been close to 37% in children aged <5 years in Indonesia. The Baduta program, a multicomponent package of interventions developed by the Global Alliance for Improved Nutrition, aims to improve maternal and infant nutrition in Indonesia. OBJECTIVE This study aims to assess the impact of the Baduta program, a package of health system strengthening and behavior change interventions, compared with the standard village health services on maternal and child nutrition. METHODS The impact evaluation uses a cluster randomized controlled trial design with 2 outcome assessments. The first uses cross-sectional surveys of mothers of children aged 0-23 months and pregnant women before and after the interventions. The second is a cohort study of pregnant women followed until their child is 18 months from a subset of clusters. We will also conduct a process evaluation guided by the program impact pathway to assess coverage, fidelity, and acceptance. The study will be conducted in the Malang and Sidoarjo districts of East Java, Indonesia. The unit of randomization is the subdistricts. As random allocation of interventions to only 6 subdistricts is feasible, we will use constrained randomization to ensure balance of baseline covariates. The first intervention will be health system strengthening, including the Baby-Friendly Hospital Initiative, and training on counseling for appropriate infant and young child feeding (IYCF). The second intervention will be nutrition behavior change that includes Emo-Demos; a national television (TV) advertising campaign; local screening TV spots; a free, text message service; and promotion of low-cost water filters and hygiene practices. The primary study outcome is child stunting (low length-for-age), and secondary outcomes include length-for-age Z scores, wasting (low weight-for-length), anemia, child morbidity, IYCF indicators, and maternal and child nutrient intakes. The sample size for each cross-sectional survey is 1400 mothers and their children aged <2 years and 200 pregnant women in each treatment group. The cohort evaluation requires a sample size of 340 mother-infant pairs in each treatment group. We will seek Gatekeeper consent and written informed consent from the participants. The intention-to-treat principle will guide our data analysis, and we will apply Consolidated Standards of Reporting Trials guidelines for clustered randomized trials in the analysis. RESULTS In February 2015, we conducted a baseline cross-sectional survey on 2435 women with children aged <2 years and 409 pregnant women. In February 2017, we conducted an end-line survey on 2740 mothers with children aged <2 years and 642 pregnant women. The cohort evaluation began in February 2015, with 729 pregnant women, and was completed in December 2016. CONCLUSIONS The results of the program evaluation will help guide policies to support effective packages of behavior change interventions to prevent child stunting in Indonesia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/18521.
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Affiliation(s)
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Australia
| | - Umi Fahmida
- SEAMEO RECFON-Pusat Kajian Gizi Regional, Universitas Indonesia, Jakarta, Indonesia
| | - Iwan Ariawan
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | | | - Min Kyaw Htet
- SEAMEO RECFON-Pusat Kajian Gizi Regional, Universitas Indonesia, Jakarta, Indonesia
| | - Rita Damayanti
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Jakarta, Indonesia
| | - Mu Li
- Sydney School of Public Health, The University of Sydney, Australia
| | - Aang Sutrisna
- Indonesia Office, Global Alliance for Improved Nutrition, Jakarta, Indonesia
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
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Akin-Akinyosoye K, Sarmanova A, Fernandes GS, Frowd N, Swaithes L, Stocks J, Valdes A, McWilliams DF, Zhang W, Doherty M, Ferguson E, Walsh DA. Baseline self-report 'central mechanisms' trait predicts persistent knee pain in the Knee Pain in the Community (KPIC) cohort. Osteoarthritis Cartilage 2020; 28:173-181. [PMID: 31830591 DOI: 10.1016/j.joca.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/13/2019] [Accepted: 11/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We investigated whether baseline scores for a self-report trait linked to central mechanisms predict 1 year pain outcomes in the Knee Pain in the Community cohort. METHOD 1471 participants reported knee pain at baseline and responded to a 1-year follow-up questionnaire, of whom 204 underwent pressure pain detection thresholds (PPTs) and radiographic assessment at baseline. Logistic and linear regression models estimated the relative risks (RRs) and associations (β) between self-report traits, PPTs and pain outcomes. Discriminative performance for each predictor was compared using receiver-operator characteristics (ROC) curves. RESULTS Baseline Central Mechanisms trait scores predicted pain persistence (Relative Risk, RR = 2.10, P = 0.001) and persistent pain severity (β = 0.47, P < 0.001), even after adjustment for age, sex, BMI, radiographic scores and symptom duration. Baseline joint-line PPTs also associated with pain persistence (RR range = 0.65 to 0.68, P < 0.02), but only in univariate models. Lower baseline medial joint-line PPT was associated with persistent pain severity (β = -0.29, P = 0.013) in a fully adjusted model. The Central Mechanisms trait model showed good discrimination of pain persistence cases from resolved pain cases (Area Under the Curve, AUC = 0.70). The discrimination power of other predictors (PPTs (AUC range = 0.51 to 0.59), radiographic OA (AUC = 0.62), age, sex and BMI (AUC range = 0.51 to 0.64), improved significantly (P < 0.05) when the central mechanisms trait was included in each logistic regression model (AUC range = 0.69 to 0.74). CONCLUSION A simple summary self-report Central Mechanisms trait score may indicate a contribution of central mechanisms to poor knee pain prognosis.
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Affiliation(s)
- K Akin-Akinyosoye
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - A Sarmanova
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - G S Fernandes
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK; Centre for Sports, Exercise, and Osteoarthritis Versus Arthritis, UK.
| | - N Frowd
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - L Swaithes
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - J Stocks
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - A Valdes
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - D F McWilliams
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - W Zhang
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - M Doherty
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - E Ferguson
- Pain Centre Versus Arthritis, UK; School of Psychology, University of Nottingham, UK.
| | - D A Walsh
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
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Rothwell M, Starmer G, Grenfell K, Harrison R, Reeves B, Ferguson E. 706 Rheumatic Heart Disease: Implementation of Innovative Cardiac Care Models under the Auspices of the Queensland Action Plan. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pradeilles R, Allen E, Gazdar H, Bux Mallah H, Budhani A, Mehmood R, Mazhar S, Mysorewala A, Aslam S, Dangour AD, Ferguson E. Maternal BMI mediates the impact of crop-related agricultural work during pregnancy on infant length in rural Pakistan: a mediation analysis of cross-sectional data. BMC Pregnancy Childbirth 2019; 19:504. [PMID: 31847831 PMCID: PMC6918638 DOI: 10.1186/s12884-019-2638-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 11/26/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stunted growth in early infancy is a public health problem in low-and-middle income countries. Evidence suggests heavy agricultural work during pregnancy is inversely associated with maternal body mass index (BMI) and infant birth weight in low- and middle-income countries; but pathways linking agricultural work to length-for-age Z-scores (LAZ) in early infancy have not been examined. This study aimed to investigate the relationship between agricultural work during pregnancy, post-natal maternal BMI and LAZ among young infants in rural Pakistan; and explored whether maternal BMI mediated the relationship between agricultural work and infant LAZ. METHODS A cross-sectional survey was conducted from December 2015 to January 2016 in rural Sindh, Pakistan. Mother-infant dyads were recruited via systematic random cluster sampling at 2-12 weeks' post-partum (n = 1161). Anthropometric measurements (maternal and infant height/length and weight) and questionnaire data were collected. Multivariable linear regression and structural-equation based mediation analyses were used to examine associations of agricultural work during pregnancy with maternal BMI and infant LAZ. RESULTS During pregnancy, women reported engaging in livestock-related work (57.0%), crop-related work (42.7%), and cotton harvesting (28.4%). All three forms of agricultural work were negatively associated with maternal BMI (β = - 0.67 [- 1.06; - 0.28], β = - 0.97 [- 1.51; - 0.48]; and β = - 0.87 [- 1.33; - 0.45], respectively). Maternal engagement in cotton harvesting alone was negatively associated with infant LAZ after controlling for confounding factors. The total negative effect of cotton harvesting on infant LAZ was - 0.35 [- 0.53; - 0.16]. The indirect effect of maternal BMI on infant LAZ was - 0.06 [- 0.08; - 0.03], revealing that 16% (- 0.06/- 0.35) of the relationship between cotton harvesting and infant LAZ, after adjustment, was mediated via maternal BMI. CONCLUSION These results underscore a need to reduce labour-intensive agricultural workload demands during pregnancy, especially in cotton harvesting, to reduce risks of negative maternal energy balance and poor growth outcomes in early infancy.
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Affiliation(s)
- Rebecca Pradeilles
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Haris Gazdar
- Collective for Social Science Research, Karachi, Pakistan
| | | | - Azmat Budhani
- Collective for Social Science Research, Karachi, Pakistan
| | - Rashid Mehmood
- Collective for Social Science Research, Karachi, Pakistan
| | - Sidra Mazhar
- Collective for Social Science Research, Karachi, Pakistan
| | | | - Saba Aslam
- Collective for Social Science Research, Karachi, Pakistan
| | - Alan D. Dangour
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elaine Ferguson
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Johnson VA, Cramer YS, Rosenkranz SL, Becker S, Klingman KL, Kallungal B, Coakley E, Acosta EP, Calandra G, Saag MS, Bedimo R, Owens S, Ferguson E, Kessels L, Shugarts D, Parrillo V, Upton K, White V, Goldman M, Zwickl W, del Rio C, Turkia A, Zadzilk A, Darren Hazelwood J, Lu D. Antiretroviral Activity of AMD11070 (An Orally Administered CXCR4 Entry Inhibitor): Results of NIH/NIAID AIDS Clinical Trials Group Protocol A5210. AIDS Res Hum Retroviruses 2019; 35:691-697. [PMID: 31099252 DOI: 10.1089/aid.2018.0256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AMD11070 binds to the chemokine receptor CXCR4, with anti-HIV-1 activity in vitro and in vivo. We conducted a phase IB/IIA proof-of-concept dose-escalating, open-label study to determine safety and antiviral activity of AMD11070 administered over 10 days to HIV-1-infected participants who harbored CXCR4-tropic virus. Primary endpoints were ≥1 log10 rlu (relative luminescence units) reduction in CXCR4-tropic virus during 10 days of AMD11070 treatment or in the 7 days following treatment discontinuation, rlu changes over 10 days of treatment, and safety. Plasma pharmacokinetic parameters, HIV-1 RNA, and safety labs were obtained over 90 days of study. The study was stopped early due to emerging AMD11070 animal toxicity data. Six HIV-infected participants with plasma HIV-1 RNA ≥5,000 copies/mL on no antiretroviral therapy for 14 days before entry were treated. AMD11070 was well-tolerated when administered at 200 mg orally every 12 h for 10 days. All enrolled participants had dual/mixed (D/M) viruses. Reductions of almost 1 log10 rlu or more in CXCR4 virus were seen in three of six participants after 10 days of treatment. No participants had ≥1 log10 decline in plasma HIV-1 RNA from baseline at day 10. No clear relationship between pharmacokinetic parameters and response to therapy (X4 log rlu reduction) was observed. AMD11070 demonstrated in vivo activity as measured by reductions in CXCR4 rlu signal. Despite the finding of discordant rlu and plasma HIV RNA responses in these participants with D/M viruses, exploration of other HIV-1 CXCR4 antagonist therapies is possible.
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Affiliation(s)
- Victoria A. Johnson
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- Department of Pharmacology and Toxicology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Yoninah S. Cramer
- Statistical and Data Management Center, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Susan L. Rosenkranz
- Statistical and Data Management Center, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Eoin Coakley
- Monogram Biosciences, Inc., South San Francisco, California
| | - Edward P. Acosta
- Department of Pharmacology and Toxicology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Michael S. Saag
- Department of Pharmacology and Toxicology, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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Samuel A, Osendarp SJM, Ferguson E, Borgonjen K, Alvarado BM, Neufeld LM, Adish A, Kebede A, Brouwer ID. Identifying Dietary Strategies to Improve Nutrient Adequacy among Ethiopian Infants and Young Children Using Linear Modelling. Nutrients 2019; 11:E1416. [PMID: 31238506 PMCID: PMC6627485 DOI: 10.3390/nu11061416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
Nutrient adequacy of young children's diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6-8, 9-11 and 12-23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6-12 months of age and every other day for 12-23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.
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Affiliation(s)
- Aregash Samuel
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
- Nutrition International (NI), Ottawa, ON K2P2K3, Canada.
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK.
| | - Karin Borgonjen
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Brenda M Alvarado
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Lynnette M Neufeld
- Global Alliance for Improved Nutrition (GAIN), 1202 Geneva, Switzerland.
| | - Abdulaziz Adish
- Nutrition International (NI), Nifas Silk Lafto Sub City, Kebele 04, Addis Ababa, Ethiopia.
| | - Amha Kebede
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
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27
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De Beurs D, Fried EI, Wetherall K, Cleare S, O' Connor DB, Ferguson E, O'Carroll RE, O' Connor RC. Exploring the psychology of suicidal ideation: A theory driven network analysis. Behav Res Ther 2019; 120:103419. [PMID: 31238299 DOI: 10.1016/j.brat.2019.103419] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 05/05/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022]
Abstract
Two leading theories within the field of suicide prevention are the interpersonal psychological theory of suicidal behaviour (IPT) and the integrated motivational-volitional (IMV) model. The IPT posits that suicidal thoughts emerge from high levels of perceived burdensomeness and thwarted belongingness. The IMV model is a multivariate framework that conceptualizes defeat and entrapment as key drivers of suicide ideation. We applied network analysis to cross-sectional data collected as part of the Scottish Wellbeing Study, in which a nationally representative sample of 3508 young adults (18-34 years) completed a battery of psychological measures. Network analysis can help us to understand how the different theoretical components interact and how they relate to suicide ideation. Within a network that included only the core factors from both models, internal entrapment and perceived burdensomeness were most strongly related to suicide ideation. The core constructs defeat, external entrapment and thwarted belonginess were mainly related to other factors than suicide ideation. Within the network of all available psychological factors, 12 of the 20 factors were uniquely related to suicide ideation, with perceived burdensomeness, internal entrapment, depressive symptoms and history of suicide ideation explaining the most variance. None of the factors was isolated, and we identified four larger clusters: mental wellbeing, interpersonal needs, personality, and suicide-related factors. Overall, the results suggest that relationships between suicide ideation and psychological risk factors are complex, with some factors contributing direct risk, and others having indirect impact.
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Affiliation(s)
- D De Beurs
- Netherlands Institute for Health Services Research, Otterstraat, 118-124, Utrecht, the Netherlands.
| | - E I Fried
- Leiden University, Clinical Psychology, Netherlands
| | - K Wetherall
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | - S Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | | | - E Ferguson
- School of Psychology, University of Nottingham, UK
| | - R E O'Carroll
- Division of Psychology, School of Natural Sciences, University of Stirling, UK
| | - R C O' Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
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Brouzes C, Tomé D, Darcel N, Ferguson E, Lluch A. How to Improve Dietary Practices of 19–30yo Egyptian Women Living in Urban Areas? An Optifood Analysis (OR25-04-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz051.or25-04-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The double burden of malnutrition is rising in several Arab countries due to rapid changes in dietary patterns and lifestyle. Egyptian women have one of the highest BMI worldwide, and nearly one quarter of them suffer from anemia. The objective was to identify changes needed in dietary practices and product offer, which could help to rebalance nutrient intakes for women living in urban Egypt.
Methods
Food intakes were obtained from a 4-days dietary record in 127 women (19–30 yo) and food prices were collected in modern and in traditional trades. Modeling analyses (Optifood software) were used to identify problem nutrients and design affordable food-based recommendations (FBRs): we assessed whether locally and consumed foods could theoretically be combined to ensure nutrient adequacy, at a fixed cost, without exceeding recommendations in energy and SFAs, total sugars and sodium. Fortified foods were included in additional modeling analyses to test their potential to improve intakes of the most problematic micronutrient to cover.
Results
Preliminary results from modeling analyses indicated that iron is the most problematic recommendation to cover from a combination of local and consumed foods. Daily consumption of fruits, vegetables, grains, milk or yoghurt, and tahini associated with smart food choices in the meat-fish-eggs category would result in a low percentage of women at risk for 11 out of 12 micronutrients modeled. Among the fortified foods tested, iron fortified bread, rice, milk and yoghurt would be promising vectors to improve iron intakes.
Conclusions
Local foods can ensure nutrient adequacy of most nutrients. However, strategies are needed to promote acceptable FBRs to rebalance the diet of Egyptian women. Iron fortified products could help to improve iron intakes for this population at risk of anemia.
Funding Sources
Danone Research.
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Htet MK, Fahmida U, Do T, Ferguson E, Dibley M. Tablet Based Multiple-pass Dietary Recall Application to Collect Dietary Intake of Under-two Children in the Prospective Cohort Study in Indonesia (P16-054-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz050.p16-054-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The purpose of the paper is to describe the process of developing electronic data collection which can accommodate the principle of multiple-pass 24-hour dietary recall (24HR) in cohort study.
Methods
The study was part of Baduta project which evaluated the effectiveness of integrated nutrition-sensitive and nutrition-specific intervention to reduce stunting and anemia among undertwo-year-old children and mothers in East Java, Indonesia. CommCare platform was used for electronic data collection. Among 680 cohort children, dietary data were collected using electronic data collection while paper-based 24HR was conducted among 2000 undertwo-year-old children in cross-sectional survey.
Results
Approximately 76%, 86% and 90% for 6–8mo, 9–11mo and 12–23mo were classified as acceptable energy reporters (within 95% CI of Energy Intake to Total Energy Expenditure (EI: TEE) ratio. These proportions were lower for the paper-based interview ie 45%, 57% and 61%, respectively. The energy and nutrient intakes were comparable between paper-based and tablet-based dietary data.
Conclusions
We have shown that dietary data collection using tablet-based application was feasible and reliable in longitudinal cohort study. This will open up opportunity for integrating electronic-based dietary data collection in nation-wide survey and follow-up study in developing countries.
Funding Sources
Global Alliance for Improved Nutrition.
Supporting Tables, Images and/or Graphs
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Affiliation(s)
| | - Umi Fahmida
- South East Asian Ministers of Education Organization - Regional Center for Food and Nutrition
| | - Tran Do
- National Institute of Nutrition
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Pries A, Rehman A, Filteau S, Sharma N, Upadhyay A, Ferguson E. High Consumption of Unhealthy Snack Foods/beverages Is Associated with Lower Length-for-age Z-scores Among Children 12–23 Months in Kathmandu Valley, Nepal (P11-092-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz048.p11-092-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Consumption of unhealthy snack foods and beverages (USFB) among young children in low- and middle-income countries (LMIC) is rising, however, little is known about their effect on nutritional outcomes during the complementary feeding period. This study aimed to assess the association of high versus low USFB consumption on the iron status and growth of 12–23 month old children living in Kathmandu Valley, Nepal.
Methods
A cross-sectional survey was conducted from February – April 2017 among a representative sample of 12–23 month old children and their caregivers (n = 745). Dietary (interactive 4-pass 24 hour recalls) and anthropometric measurements and capillary blood samples were collected to estimate dietary intakes of energy and nutrients, Z-scores for length-for-age (LAZ) and weight-for-length (WLZ), and indices of iron status. Percentages of dietary energy intakes (%TEI) from USFB (defined using the United Kingdom's Food Standard Agency's nutrient profiling model) were calculated. LAZ, WLZ, hemoglobin (Hb), serum ferritin (SF), and transferrin receptor (TR) concentrations of children classified into the lowest versus the highest terciles of %TEI from USFB were compared using multivariable linear regression analyses after adjustment for covariates that influence nutrition.
Results
Ninety-one % of all children had consumed a USFB in the previous day. On average, 46.9% TEI came from USFB among the highest tercile consumers, compared to 5.2% TEI among the lowest. Nineteen % of children (n = 138) were stunted (LAZ < –2), 5.2% (n = 38) were wasted (WLZ < -2), while only four children were overweight/obese (WHZ > 2). Thirty-eight % of children (n = 257) were anemic and 28.7% (n = 193) had iron deficiency anemia. In the adjusted model, mean LAZ was nearly 0.3SD lower among high USFB consumers than low consumers (P = 0.003). No associations were found with WLZ or biochemical concentrations.
Conclusions
In this LMIC context, urban 1–2 year old children who were high USFB consumers were significantly shorter compared to those who were low USFB consumers. To safeguard child nutrition in LMIC, policies and programs many need to address the increasing access and use of inexpensive, nutrient-poor USFB.
Funding Sources
Bill & Melinda Gates Foundation.
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Hjertholm KG, Holmboe-Ottesen G, Iversen PO, Mdala I, Munthali A, Maleta K, Shi Z, Ferguson E, Kamudoni P. Seasonality in associations between dietary diversity scores and nutrient adequacy ratios among pregnant women in rural Malawi - a cross-sectional study. Food Nutr Res 2019; 63:2712. [PMID: 30837821 PMCID: PMC6397333 DOI: 10.29219/fnr.v63.2712] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/20/2022] Open
Abstract
Background Dietary diversity scores (DDS) are simple indicators often used as proxies for nutrient adequacy. A 10-food group indicator is proposed by the Food and Agriculture Organization of the United Nations as a global standard for measuring dietary diversity among women in low-resource settings. However, its validity as a proxy for nutrient adequacy across different agricultural seasons for pregnant women has not been determined. Objective We studied associations between DDS and nutrient adequacy ratios (NAR) across two different agricultural seasons (pre- and post-harvest seasons) for pregnant women in rural Malawi and assessed whether a 1-day DDS or a 3-day DDS would be the best indicator of nutrient adequacy. Design Dietary intakes of 330 pregnant women were assessed between gestational weeks 28 and 35. Intakes of energy, macronutrients, and 11 micronutrients were estimated using three repeated interactive 24-h diet recalls, and DDS were also calculated from these days. Correlation coefficients (r) between DDS, NAR, and mean adequacy ratio (MAR) of the 11 micronutrients were determined. Results After energy adjustments, we found significant correlations between DDS and MAR with both DDS indicators in the preharvest season (r = 0.22–0.23; p < 0.001) but not in the post-harvest season (p > 0.05). For individual energy-adjusted NARs, correlations were not consistently significant across the two seasons and the two DDS indicators. Conclusions Our results suggest that DDS could be used to predict overall nutrient adequacy during the preharvest season. As similar correlations were found using both the 1- and 3-day indicators, we recommend using a 1-day DDS, for simplicity. However, as the indicators are sensitive to seasonality they should be used with care in this study setting.
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Affiliation(s)
- Katrine G Hjertholm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Ibrahimu Mdala
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Alister Munthali
- School of Public Health and Medicine, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- School of Public Health and Medicine, University of Malawi, Zomba, Malawi
| | - Zumin Shi
- Discipline of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Penjani Kamudoni
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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32
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Moug SJ, Henderson N, Tiernan J, Bisset CN, Ferguson E, Harji D, Maxwell-Armstrong C, MacDermid E, Acheson AG, Steele RJC, Fearnhead NS. The colorectal surgeon's personality may influence the rectal anastomotic decision. Colorectal Dis 2018; 20:970-980. [PMID: 29904991 DOI: 10.1111/codi.14293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
AIM Colorectal surgeons regularly make the decision to anastomose, defunction or form an end colostomy when performing rectal surgery. This study aimed to define personality traits of colorectal surgeons and explore any influence of such traits on the decision to perform a rectal anastomosis. METHOD Fifty attendees of The Association of Coloproctology of Great Britain and Ireland 2016 Conference participated. After written consent, all underwent personality testing: alexithymia (inability to understand emotions), type of thinking process (intuitive versus rational) and personality traits (extraversion, agreeableness, openness, emotional stability, conscientiousness). Questions were answered regarding anastomotic decisions in various clinical scenarios and results analysed to reveal any influence of the surgeon's personality on anastomotic decision. RESULTS Participants were: male (86%), consultants (84%) and based in England (68%). Alexithymia was low (4%) with 81% displaying intuitive thinking (reflex, fast). Participants scored higher in emotional stability (ability to remain calm) and conscientiousness (organized, methodical) compared with population norms. Personality traits influenced the next anastomotic decision if: surgeons had recently received criticism at a departmental audit meeting; were operating with an anaesthetist that was not their regular one; or there had been no anastomotic leaks in their patients for over 1 year. CONCLUSION Colorectal surgeons have speciality relevant personalities that potentially influence the important decision to anastomose and could explain the variation in surgical practice across the UK. Future work should explore these findings in other countries and any link of personality traits to patient-related outcomes.
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Affiliation(s)
- S J Moug
- Royal Alexandra Hospital, Paisley, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - J Tiernan
- Cleveland Clinic, Cleveland, Ohio, USA
| | | | - E Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK
| | - D Harji
- Health Education North East, Newcastle Upon Tyne, UK
| | - C Maxwell-Armstrong
- Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - E MacDermid
- New South Wales Health, North Sydney, Australia
| | - A G Acheson
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | | | - N S Fearnhead
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | -
- Cleveland Clinic, Cleveland, Ohio, USA
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Pradeilles R, Norris T, Ferguson E, Gazdar H, Mazhar S, Bux Mallah H, Budhani A, Mehmood R, Aslam S, Dangour AD, Allen E. Factors associated with catch-up growth in early infancy in rural Pakistan: A longitudinal analysis of the women's work and nutrition study. Matern Child Nutr 2018; 15:e12733. [PMID: 30345717 PMCID: PMC6587826 DOI: 10.1111/mcn.12733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022]
Abstract
The adverse health impacts of early infant stunting can be partially ameliorated by early catch‐up growth. Few studies have examined predictors of and barriers to catch‐up growth to identify intervention points for improving linear growth during infancy. This study aimed to estimate the prevalence of, and factors associated with, catch‐up growth among infants in Pakistan. A longitudinal study of mother–infant dyads (n = 1,161) was conducted in rural Sindh province, with enrolment between December 2015 and February 2016 (infants aged 0.5–3 months), and follow‐up (n = 1035) between November 2016 and January 2017 (infants aged 9–15 months). The outcome was catch‐up growth (change in conditional length‐for‐age z‐scores >0.67 between baseline and endline). Associated factors were examined using multivariable logistic regression analyses. The prevalence of stunting was 45.3% at baseline and 60.7% at follow‐up. 22.8% of infants exhibited catch‐up growth over this period. Factors positively associated with catch‐up growth included maternal height (odds ratio (OR) = 1.08 [1.05–1.11]), household wealth (OR = 3.61 [1.90–6.84]), maternal (OR = 2.43 [1.30–4.56]) or paternal (OR = 1.46 [1.05–2.03]) education, and households with two or more adult females (OR = 1.91 [1.26–2.88]). Factors negatively associated with catch‐up growth were two (OR = 0.64 [0.45–0.89]) or three or more (OR = 0.44 [0.29–0.66]) preschool children in the household and the infant being currently breastfed (OR = 0.59 [0.41–0.88]). Catch‐up growth was exhibited among approximately a quarter of infants despite living in challenging environments associated with extremely high rates of early infant stunting. Several modifiable factors were identified that might represent suitable programme intervention points to off‐set early infant stunting in rural Pakistan.
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Affiliation(s)
- Rebecca Pradeilles
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Norris
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Elaine Ferguson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Haris Gazdar
- Collective for Social Science Research, Karachi, Pakistan
| | - Sidra Mazhar
- Collective for Social Science Research, Karachi, Pakistan
| | | | - Azmat Budhani
- Collective for Social Science Research, Karachi, Pakistan
| | - Rashid Mehmood
- Collective for Social Science Research, Karachi, Pakistan
| | - Saba Aslam
- Collective for Social Science Research, Karachi, Pakistan
| | - Alan D Dangour
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Allen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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34
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Cunningham K, Ferguson E, Ruel M, Uauy R, Kadiyala S, Menon P, Ploubidis G. Water, sanitation, and hygiene practices mediate the association between women's empowerment and child length-for-age z-scores in Nepal. Matern Child Nutr 2018; 15:e12638. [PMID: 30047247 DOI: 10.1111/mcn.12638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/19/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022]
Abstract
In Nepal, more than one-third of children are stunted. Prior studies have shown that women's empowerment in agriculture is associated with child (<2 years) length-for-age z-scores (LAZ) in Nepal. This study tests whether child dietary diversity (DD) and household water, sanitation, and hygiene (WASH) facilities and practices mediate the associations between women's empowerment and LAZ. With a cross-sectional dataset of 4,080 households from 240 rural communities across 16 districts of Nepal, we used ordinary least squares regression models to first estimate the associations between women's empowerment and LAZ for children 6 to 24 months (n = 1,402; our previous published analysis included all children <24 months of age), using the Women's Empowerment in Agriculture Index's Five Domains of Empowerment subindex. We used standardized structural equation models to test whether child DD and/or household WASH mediated the association between women's empowerment and child LAZ. Overall, women's empowerment was positively associated with child LAZ (β = 0.24, P = 0.03), as found in our previous analyses. In the mediation analysis, women's empowerment was positively associated with WASH (β = 0.78, P < 0.001), and in turn child LAZ (β = 0.09, P < 0.001). Women's empowerment was not associated with DD, but DD was associated with LAZ (β = 0.06, P = 0.05). Empowered women had better WASH practices than nonempowered women, which translated into higher child LAZ. Child DD was not a mediating factor in the association between women's empowerment and child LAZ. More research is needed to explore other pathways by which women's empowerment may affect child nutrition outcomes.
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Affiliation(s)
| | - Elaine Ferguson
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Marie Ruel
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA
| | - Ricardo Uauy
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Food Nutrition and Food Technology, Santiago, Chile
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Purnima Menon
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, D.C., USA.,Poverty Health and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - George Ploubidis
- Department of Quantitative Social Science, Centre for Longitudinal Studies; Institute of Education, London, UK
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35
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Ferguson E, Lawrence C. It is only fair: blood donors are more sensitive to violations of fairness norms than nondonors - converging psychometric and ultimatum game evidence. Vox Sang 2018; 113:242-250. [DOI: 10.1111/vox.12636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/09/2017] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- E. Ferguson
- School of Psychology; University of Nottingham; Nottingham UK
| | - C. Lawrence
- School of Psychology; University of Nottingham; Nottingham UK
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Liu NLBH, Kaler J, Ferguson E, O'Kane H, Green LE. Sheep farmers' attitudes to farm inspections and the role of sanctions and rewards as motivation to reduce the prevalence of lameness. Anim Welf 2018. [DOI: 10.7120/09627286.27.1.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Deptford A, Allieri T, Childs R, Damu C, Ferguson E, Hilton J, Parham P, Perry A, Rees A, Seddon J, Hall A. Cost of the Diet: a method and software to calculate the lowest cost of meeting recommended intakes of energy and nutrients from local foods. BMC Nutr 2017; 3:26. [PMID: 32153808 PMCID: PMC7050783 DOI: 10.1186/s40795-017-0136-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/11/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND When food is available, the main obstacle to access is usually economic: people may not be able to afford a nutritious diet, even if they know what foods to eat. The Cost of the Diet method and software was developed to apply linear programming to better understand the extent to which poverty may affect people's ability to meet their nutritional specifications. This paper describes the principles of the method; the mathematics underlying the linear programming; the parameters and assumptions on which the calculations are based; and then illustrates the output of the software using examples taken from assessments. RESULTS The software contains five databases: the energy and nutrient content of foods; the energy and nutrient specifications of individuals; predefined groups of individuals in typical households; the portion sizes of foods; and currency conversion factors. Data are collected during a market survey to calculate the average cost of foods per 100 g while focus group discussions are used to assess local dietary habits and preferences. These data are presented to a linear programming solver within the software which selects the least expensive combination of local foods for four standard diets that meet specifications for: energy only; energy and macronutrients; energy, macronutrients and micronutrients; and energy, macronutrients and micronutrients but with constraints on the amounts per meal that are consistent with typical dietary habits. Most parameters in the software can be modified by users to examine the potential impact of a wide range of theoretical interventions. The output summarises for each diet the costs, quantity and proportion of energy and nutrient specifications provided by all the foods selected for a given individual or household by day, week, season and year. When the cost is expressed as a percentage of income, the affordability of the diet can be estimated. CONCLUSIONS The Cost of the Diet method and software could be used to inform programme design and behaviour change communication in the fields of nutrition, food security, livelihoods and social protection as well as to influence policies and advocacy debates on the financial cost of meeting energy and nutrient specifications.
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Affiliation(s)
- Amy Deptford
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Tommy Allieri
- Imperial College, School of Public Health, Norfolk Place, London, W2 1PG UK
| | - Rachel Childs
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Claudia Damu
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jennie Hilton
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Paul Parham
- Department of Public Health and Policy, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3GL UK
| | - Abigail Perry
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Alex Rees
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - James Seddon
- Stainton House, 101 Church Street, Staines, Middlesex, TW18 4XS UK
| | - Andrew Hall
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
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Abstract
Safety culture is a vital concept in human healthcare because of its influence on staff behaviours in relation to patient safety. Understanding safety culture is essential to ensure the acceptance and sustainability of changes, such as the introduction of safe surgery checklists. While widely studied and assessed in human medicine, there is no tool for its assessment in veterinary medicine. This paper therefore presents initial data on such an assessment: the Nottingham Veterinary Safety Culture Survey (NVSCS). 350 pilot surveys were distributed to practising vets and nurses. The survey was also available online. 229 surveys were returned (65 per cent response rate) and 183 completed online, resulting in 412 surveys for analysis. Four domains were identified: (1) organisational safety systems and behaviours, (2) staff perceptions of management, (3) risk perceptions and (4) teamwork and communication. Initial indications of the reliability and the validity of the final survey are presented. Although early in development, the resulting 29-item NVSCS is presented as a tool for measuring safety culture in veterinary practices with implications for benchmarking, safety culture assessment and teamwork training.
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Affiliation(s)
- C Oxtoby
- School of Veterinary Medicine and Science, Nottingham University, Sutton Bonnington Campus, Leicestershire LE125RD, UK.,36 The Street Shipton Moyne, Tetbury, Gloucestershire GL88PN, UK
| | - L Mossop
- School of Veterinary Medicine and Science, Nottingham University, Nottingham, UK
| | - K White
- School of Veterinary Medicine and Science, Nottingham University, Nottingham, UK
| | - E Ferguson
- Department of Psychology, Nottingham University, University Park Nottingham, Nottingham NG7 2RD, UK
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Hjertholm KG, Iversen PO, Holmboe-Ottesen G, Mdala I, Munthali A, Maleta K, Shi Z, Ferguson E, Kamudoni P. Maternal dietary intake during pregnancy and its association to birth size in rural Malawi: A cross-sectional study. Matern Child Nutr 2017; 14. [PMID: 28217860 DOI: 10.1111/mcn.12433] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/20/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Abstract
In low-resource settings, such as rural Malawi, pregnant women are prone to energy and micronutrient deficiencies with the consequence of delivering low-birth weight infants with higher risks of morbidity and mortality. This study aimed to examine the association between maternal dietary intakes during pregnancy and infant birth size. Dietary intakes of 203 pregnant women were assessed between 28 and 35 weeks of gestation and their infants' (n = 132) birth size measured. Intakes of energy, macronutrients, and 11 micronutrients were estimated using a 3-day interactive 24-hr diet recall. Semiquantitative data on food intakes for four additional days were also collected to assess food patterns. Using multilevel linear regression modeling, maternal intakes of carbohydrate were negatively associated with neonate length (β: -0.1; 95% CI: -0.2, 0.0 cm/E%) and abdominal circumference (β: -0.1, 95% CI: -0.2, 0.0 cm/E%), whereas intakes of fat were positively associated with neonate length (β: 0.1; 95% CI: 0.0, 0.2 cm/E%) and abdominal circumference (β: 0.1; 95% CI: 0.0, 0.2 cm/E%). Vitamin C intakes were positively associated with birth weight (β: 1.4; 95% CI: 0.5, 2.3 g/mg). The frequency of milk intake was positively associated with birth weight (β: 75.3; 95% CI: 13.6, 137.0 g/day). These findings offer practical suggestions for food-based interventions in the study area to promote inclusion of fat, vitamin C-rich foods, and milk in pregnancy.
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Affiliation(s)
- Katrine G Hjertholm
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gerd Holmboe-Ottesen
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Alister Munthali
- School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Zumin Shi
- Discipline of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Penjani Kamudoni
- Department of Community Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Wyatt LA, Moreton BJ, Mapp PI, Wilson D, Hill R, Ferguson E, Scammell BE, Walsh DA. Histopathological subgroups in knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:14-22. [PMID: 27720884 DOI: 10.1016/j.joca.2016.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 09/01/2016] [Accepted: 09/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a heterogeneous, multi-tissue disease. We hypothesised that different histopathological features characterise different stages during knee OA progression, and that discrete subgroups can be defined based on validated measures of OA histopathological features. DESIGN Medial tibial plateaux and synovium were from 343 post-mortem (PM) and 143 OA arthroplasty donations. A 'chondropathy/osteophyte' group (n = 217) was classified as PM cases with osteophytes or macroscopic medial tibiofemoral chondropathy lesions ≥grade 3 to represent pre-surgical (early) OA. 'Non-arthritic' controls (n = 48) were identified from the remaining PM cases. Mankin histopathological scores were subjected to Rasch analysis and supplemented with histopathological scores for subchondral bone marrow replacement and synovitis. Item weightings were derived by principle components analysis (PCA). Histopathological subgroups were sought using latent class analysis (LCA). RESULTS Chondropathy, synovitis and osteochondral pathology were each associated with OA at arthroplasty, but each was also identified in some 'non-arthritic' controls. Tidemark breaching in the chondropathy/osteophyte group was greater than in non-arthritic controls. Three histopathological subgroups were identified, characterised as 'mild OA', or 'severe OA' with mild or moderate/severe synovitis. CONCLUSIONS Presence and severity of synovitis helps define distinct histopathological OA subgroups. The absence of a discrete 'normal' subgroup indicates a pathological continuum between normality and OA status. Identifying specific pathological processes and their clinical correlates in OA subgroups has potential to accelerate the development of more effective therapies.
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Affiliation(s)
- L A Wyatt
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
| | - B J Moreton
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - P I Mapp
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - D Wilson
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - R Hill
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - E Ferguson
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; School of Psychology, University of Nottingham, Nottingham, UK
| | - B E Scammell
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - D A Walsh
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
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Briend A, Ferguson E, Darmon N. Local Food Price Analysis by Linear Programming: A New Approach to Assess the Economic Value of Fortified Food Supplements. Food Nutr Bull 2016. [DOI: 10.1177/156482650102200210] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- André Briend
- Institut de Recherche pour le Développement and is currently working at the Institut des Sciences et Techniques de la Nutrition et de l'Alimentation in Paris, France
| | - Elaine Ferguson
- Department of Human Nutrition, University of Otago, in Dunedin, New Zealand
| | - Nicole Darmon
- Institut National de la Santé et de la Recherche Médicale and is currently working at the Institut des Sciences et Techniques de la Nutrition et de l'Alimentation in Paris
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Gibson RS, Hotz C, Temple L, Yeudall F, Mtitimuni B, Ferguson E. Dietary Strategies to Combat Deficiencies of Iron, Zinc, and Vitamin A in Developing Countries: Development, Implementation, Monitoring, and Evaluation. Food Nutr Bull 2016. [DOI: 10.1177/156482650002100218] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many developing countries, staple diets are plant-based and consumption of animal products is low. As a result, the intake and bioavailability of iron, zinc, and vitamin A are often poor. Deficiencies of these micronutrients can be prevented by using dietary diversification and modification, a strategy involving changes in food production practices, food selection patterns, and traditional household methods for preparing and processing indigenous foods. Strategies at the food production level include the use of fertilizers, plant breeding, and genetic engineering to enhance the content and bioavailability of micronutrients in plant-based staples and increase the yield of indigenous edible wild plants. Household strategies involve small-livestock production, aquaculture, gardening projects, and changes in certain food preparation and processing practices designed to alter the content of absorption modifiers in the diet, such as soaking, germination, fermentation, and enrichment. This review also describes how these household strategies can best be incorporated into existing food consumption patterns, and how their impact on the nutrient adequacy of the diets can be assessed. the steps necessary to test the acceptability of the modified recipes, to identify potential barriers to their adoption, and to implement them in the community are discussed, using an example from rural Malawi. Finally, methods of monitoring the progress and evaluating the impact of the dietary strategies in short- and long-term studies are included.
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Affiliation(s)
- R. S. Gibson
- Department of Human Nutrition, University of Otago, in Dunedin, New Zealand
| | - C. Hotz
- Department of Human Nutrition, University of Otago, in Dunedin, New Zealand
| | - L. Temple
- Department of Human Nutrition, University of Otago, in Dunedin, New Zealand
| | - F. Yeudall
- Department of Human Nutrition, University of Otago, in Dunedin, New Zealand
| | - B. Mtitimuni
- Bunda College of Agriculture, University of Malawi, Malawi
| | - E. Ferguson
- Department of Human Nutrition, University of Otago, in Dunedin, New Zealand
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Cornelsen L, Alarcon P, Häsler B, Amendah DD, Ferguson E, Fèvre EM, Grace D, Dominguez-Salas P, Rushton J. Cross-sectional study of drivers of animal-source food consumption in low-income urban areas of Nairobi, Kenya. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0109-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ferguson E, Chege P, Kimiywe J, Wiesmann D, Hotz C. Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children. Matern Child Nutr 2016; 11 Suppl 3:6-20. [PMID: 26778799 PMCID: PMC5066654 DOI: 10.1111/mcn.12243] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 01/24/2023]
Abstract
Poor quality infant and young child (IYC) diets contribute to chronic under‐nutrition. To design effective IYC nutrition interventions, an understanding of the extent to which realistic food‐based strategies can improve dietary adequacy is required. We collected 24‐h dietary recalls from children 6–23 months of age (n = 401) in two rural agro‐ecological zones of Kenya to assess the nutrient adequacy of their diets. Linear programming analysis (LPA) was used to identify realistic food‐based recommendations (FBRs) and to determine the extent to which they could ensure intake adequacy for 12 nutrients. Mean nutrient densities of the IYC diets were below the desired level for four to nine of the 10 nutrients analysed, depending on the age group. Mean dietary diversity scores ranged from 2.1 ± 1.0 among children 6–8 months old in Kitui County to 3.7 ± 1.1 food groups among children 12–23 months old in Vihiga County. LPA confirmed that dietary adequacy for iron, zinc and calcium will be difficult to ensure using only local foods as consumed. FBRs for breastfed children that promote the daily consumption of cows'/goats' milk (added to porridges), fortified cereals, green leafy vegetables, legumes, and meat, fish or eggs, 3–5 times per week can ensure dietary adequacy for nine and seven of 12 nutrients for children 6–11 and 12–23 months old, respectively. For these rural Kenyan children, even though dietary adequacy could be improved via realistic changes in habitual food consumption practices, alternative interventions are needed to ensure dietary adequacy at the population level.
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Affiliation(s)
- Elaine Ferguson
- London School of Hygiene and Tropical Medicine, Department of Population Health, London, UK
| | - Peter Chege
- Kenyatta University, Department of Food, Nutrition and Dietetics, Nairobi, Kenya
| | - Judith Kimiywe
- Kenyatta University, Department of Food, Nutrition and Dietetics, Nairobi, Kenya
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Zhao K, Ferguson E, Smillie L. Good manners rather than compassion predict fair allocations of wealth to a powerless partner: Personality–situation effects in economic bargaining games. Personality and Individual Differences 2016. [DOI: 10.1016/j.paid.2016.05.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Villemarette CP, Lyons E, Chung B, Ferguson E, LeMieux FM. 0955 The effect of three levels of unmilled rice on growth performance and digestive tract development in broilers and ducks. J Anim Sci 2016. [DOI: 10.2527/jam2016-0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dominguez-Salas P, Alarcón P, Häsler B, Dohoo IR, Colverson K, Kimani-Murage EW, Alonso S, Ferguson E, Fèvre EM, Rushton J, Grace D. Nutritional characterisation of low-income households of Nairobi: socioeconomic, livestock and gender considerations and predictors of malnutrition from a cross-sectional survey. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0086-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- E. Ferguson
- Personality, Social Psychology and Health (PSPH) Group; School of Psychology; University of Nottingham; Nottingham UK
| | - C. Lawrence
- Personality, Social Psychology and Health (PSPH) Group; School of Psychology; University of Nottingham; Nottingham UK
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Oxtoby C, Ferguson E, White K, Mossop L. We need to talk about error: causes and types of error in veterinary practice. Vet Rec 2015; 177:438. [DOI: 10.1136/vr.103331] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 11/04/2022]
Affiliation(s)
- C. Oxtoby
- School of Veterinary Medicine and Science, Nottingham University; Sutton Bonnington Campus Leicestershire LE125RD UK
| | - E. Ferguson
- School of Psychology, Nottingham University; University Park Nottingham NG7 2RD UK
| | - K. White
- School of Veterinary Medicine and Science, Nottingham University; Sutton Bonnington Campus Leicestershire LE125RD UK
| | - L. Mossop
- School of Veterinary Medicine and Science, Nottingham University; Sutton Bonnington Campus Leicestershire LE125RD UK
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