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Brander RL, Puett C, Becquey E, Leroy JL, Ruel MT, Sessou FE, Huybregts L. The cost and cost-effectiveness of an integrated wasting prevention and screening intervention package in Burkina Faso and Mali. J Nutr 2024:S0022-3166(24)00179-2. [PMID: 38599389 DOI: 10.1016/j.tjnut.2024.04.010] [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: 12/29/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Little is known about costs and cost-effectiveness of interventions that integrate wasting prevention into screening for child wasting. OBJECTIVE This study's objective was to estimate the cost and cost-effectiveness of an intervention that integrated behavior change communication (BCC) and small-quantity lipid-based nutrient supplements (SQ-LNS) into platforms for wasting screening in Burkina Faso (a facility-based platform, where BCC was enhanced compared to standard care) and Mali (a community-based platform, with standard BCC). METHODS Activity-based costing was used to estimate the cost per child-contact for the intervention and the comparison group, which did not receive the intervention. Costs were ascertained from accounting records, interviews, surveys, and observations. The number of child-contacts were calculated using population size estimates and average attendance rates for each service. Costs per disability-adjusted life year (DALY) averted were estimated using a Markov model populated with data from the parent trials on impact on wasting incidence and treatment coverage. RESULTS In the intervention group in Burkina Faso, the cost per child-contact of facility-based screening was $0.85, of enhanced BCC was $4.28, and of SQ-LNS was $8.86. In Mali, the cost per child-contact of community-based screening was $0.57, of standard BCC was $0.72, and of SQ-LNS was $4.14. Although no SQ-LNS costs were incurred in the comparison groups (hence lower total costs), costs per child-contact for screening and BCC were higher because coverage of these services was lower. The intervention package cost $1,073 per DALY averted in Burkina Faso and $747 in Mali. CONCLUSIONS Integration of wasting prevention into screening for child wasting led to higher total costs but lower unit costs than standard screening due to increased coverage. Greater cost-effectiveness could be achieved if BCC were strengthened and led to improved caregiver health and nutrition practices and if screening triggered appropriate use of services and higher treatment coverage.
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Affiliation(s)
- Rebecca L Brander
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA.
| | - Chloe Puett
- Department of Family, Population & Preventive Medicine, Program in Public Health, Health Sciences Center, Stony Brook University, Stony Brook, New York, USA
| | - Elodie Becquey
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Jef L Leroy
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Marie T Ruel
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Fidele Eric Sessou
- UNICEF Innocenti Global Office of Research and Foresight, Florence, Italy
| | - Lieven Huybregts
- Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns by fine stratum of gestational age and birthweight for 230 679 live births in nine low- and middle-income countries, 2000-2017. BJOG 2024. [PMID: 38228570 DOI: 10.1111/1471-0528.17743] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017. DESIGN Descriptive multi-country secondary data analysis. SETTING Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Liveborn infants from 15 population-based cohorts. METHODS Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42+0 , 39+0 -41+6 (reference category), 37+0 -38+6 , 34+0 -36+6 ,34+0 -36+6 ,32+0 -33+6 , 30+0 -31+6 , 28+0 -29+6 and less than 28 weeks. MAIN OUTCOME MEASURES Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births). RESULTS We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 370 -386 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality. CONCLUSIONS In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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3
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Bastos-Moreira Y, Ouédraogo L, De Boevre M, Argaw A, de Kok B, Hanley-Cook GT, Deng L, Ouédraogo M, Compaoré A, Tesfamariam K, Ganaba R, Huybregts L, Toe LC, Lachat C, Kolsteren P, De Saeger S, Dailey-Chwalibóg T. A Multi-Omics and Human Biomonitoring Approach to Assessing the Effectiveness of Fortified Balanced Energy-Protein Supplementation on Maternal and Newborn Health in Burkina Faso: A Study Protocol. Nutrients 2023; 15:4056. [PMID: 37764838 PMCID: PMC10535470 DOI: 10.3390/nu15184056] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Fortified balanced energy-protein (BEP) supplementation is a promising intervention for improving maternal health, birth outcomes and infant growth in low- and middle-income countries. This nested biospecimen sub-study aimed to evaluate the physiological effect of multi-micronutrient-fortified BEP supplementation on pregnant and lactating women and their infants. Pregnant women (15-40 years) received either fortified BEP and iron-folic acid (IFA) (intervention) or IFA only (control) throughout pregnancy. The same women were concurrently randomized to receive either a fortified BEP supplement during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention) or the postnatal standard of care, which comprised IFA alone for 6 weeks postpartum (i.e., control). Biological specimens were collected at different timepoints. Multi-omics profiles will be characterized to assess the mediating effect of BEP supplementation on the different trial arms and its effect on maternal health, as well as birth and infant growth outcomes. The mediating effect of the exposome in the relationship between BEP supplementation and maternal health, birth outcomes and infant growth were characterized via biomonitoring markers of air pollution, mycotoxins and environmental contaminants. The results will provide holistic insight into the granular physiological effects of prenatal and postnatal BEP supplementation.
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Affiliation(s)
- Yuri Bastos-Moreira
- Center of Excellence in Mycotoxicology and Public Health, MYTOXSOUTH Coordination Unit, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium; (M.D.B.); (S.D.S.)
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Lionel Ouédraogo
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
- Centre Muraz, Bobo-Dioulasso 01 BP 390, Burkina Faso
| | - Marthe De Boevre
- Center of Excellence in Mycotoxicology and Public Health, MYTOXSOUTH Coordination Unit, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium; (M.D.B.); (S.D.S.)
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Giles T. Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Lishi Deng
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Moctar Ouédraogo
- Agence de Formation de Recherche et d’Expertise en Santé pour l’Afrique (AFRICSanté), Bobo-Dioulasso 01 BP 298, Burkina Faso; (M.O.); (A.C.); (R.G.)
| | - Anderson Compaoré
- Agence de Formation de Recherche et d’Expertise en Santé pour l’Afrique (AFRICSanté), Bobo-Dioulasso 01 BP 298, Burkina Faso; (M.O.); (A.C.); (R.G.)
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Rasmané Ganaba
- Agence de Formation de Recherche et d’Expertise en Santé pour l’Afrique (AFRICSanté), Bobo-Dioulasso 01 BP 298, Burkina Faso; (M.O.); (A.C.); (R.G.)
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
- Nutrition, Diets, and Health Unit, Department of Food and Nutrition Policy, International Food Policy Research Institute (IFPRI), Washington, DC 20005, USA
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
- Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso 01 BP 545, Burkina Faso
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
| | - Sarah De Saeger
- Center of Excellence in Mycotoxicology and Public Health, MYTOXSOUTH Coordination Unit, Faculty of Pharmaceutical Sciences, Ghent University, 9000 Ghent, Belgium; (M.D.B.); (S.D.S.)
- Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng 2028, South Africa
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium; (L.O.); (A.A.); (B.d.K.); (G.T.H.-C.); (L.D.); (K.T.); (L.H.); (L.C.T.); (C.L.); (P.K.)
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Erchick DJ, Subedi S, Verhulst A, Guillot M, Adair LS, Barros AJD, Chasekwa B, Christian P, da Silva BGC, Silveira MF, Hallal PC, Humphrey JH, Huybregts L, Kariuki S, Khatry SK, Lachat C, Matijasevich A, McElroy PD, Menezes AMB, Mullany LC, Perez TLL, Phillips-Howard PA, Roberfroid D, Santos IS, ter Kuile FO, Ravilla TD, Tielsch JM, Wu LSF, Katz J. Quality of vital event data for infant mortality estimation in prospective, population-based studies: an analysis of secondary data from Asia, Africa, and Latin America. Popul Health Metr 2023; 21:10. [PMID: 37507749 PMCID: PMC10375772 DOI: 10.1186/s12963-023-00309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Infant and neonatal mortality estimates are typically derived from retrospective birth histories collected through surveys in countries with unreliable civil registration and vital statistics systems. Yet such data are subject to biases, including under-reporting of deaths and age misreporting, which impact mortality estimates. Prospective population-based cohort studies are an underutilized data source for mortality estimation that may offer strengths that avoid biases. METHODS We conducted a secondary analysis of data from the Child Health Epidemiology Reference Group, including 11 population-based pregnancy or birth cohort studies, to evaluate the appropriateness of vital event data for mortality estimation. Analyses were descriptive, summarizing study designs, populations, protocols, and internal checks to assess their impact on data quality. We calculated infant and neonatal morality rates and compared patterns with Demographic and Health Survey (DHS) data. RESULTS Studies yielded 71,760 pregnant women and 85,095 live births. Specific field protocols, especially pregnancy enrollment, limited exclusion criteria, and frequent follow-up visits after delivery, led to higher birth outcome ascertainment and fewer missing deaths. Most studies had low follow-up loss in pregnancy and the first month with little evidence of date heaping. Among studies in Asia and Latin America, neonatal mortality rates (NMR) were similar to DHS, while several studies in Sub-Saharan Africa had lower NMRs than DHS. Infant mortality varied by study and region between sources. CONCLUSIONS Prospective, population-based cohort studies following rigorous protocols can yield high-quality vital event data to improve characterization of detailed mortality patterns of infants in low- and middle-income countries, especially in the early neonatal period where mortality risk is highest and changes rapidly.
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Affiliation(s)
- Daniel J. Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Seema Subedi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Andrea Verhulst
- Population Studies Center, University of Pennsylvania, Philadelphia, PA USA
| | - Michel Guillot
- Population Studies Center, University of Pennsylvania, Philadelphia, PA USA
- Department of Sociology, University of Pennsylvania, Philadelphia, PA USA
| | - Linda S. Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Aluísio J. D. Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | | | | | - Pedro C. Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Jean H. Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC USA
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Simon Kariuki
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | | | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | - Peter D. McElroy
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ana Maria B. Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luke C. Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Tita Lorna L. Perez
- USC-Office of Population Studies Foundation, University of San Carlos, Cebu City, Philippines
| | | | | | - Iná S. Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | | | - James M. Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC USA
| | - Lee S. F. Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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5
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Argaw A, de Kok B, Toe LC, Hanley-Cook G, Dailey-Chwalibóg T, Ouédraogo M, Compaoré A, Vanslambrouck K, Ganaba R, Kolsteren P, Lachat C, Huybregts L. Correction: Fortified balanced energy-protein supplementation during pregnancy and lactation and infant growth in rural Burkina Faso: A 2 × 2 factorial individually randomized controlled trial. PLoS Med 2023; 20:e1004267. [PMID: 37459579 PMCID: PMC10351922 DOI: 10.1371/journal.pmed.1004267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1004186.].
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Argaw A, Toe LC, Hanley-Cook G, Dailey-Chwalibóg T, de Kok B, Ouédraogo L, Compaoré A, Ouédraogo M, Sawadogo A, Ganaba R, Vanslambrouck K, Kolsteren P, Lachat C, Huybregts L. Effect of prenatal micronutrient-fortified balanced energy-protein supplementation on maternal and newborn body composition: A sub-study from the MISAME-III randomized controlled efficacy trial in rural Burkina Faso. PLoS Med 2023; 20:e1004242. [PMID: 37486952 PMCID: PMC10406330 DOI: 10.1371/journal.pmed.1004242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/07/2023] [Accepted: 05/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Micronutrient-fortified balanced energy-protein (BEP) supplements are promising interventions to prevent intrauterine growth retardation in low- and middle-income countries. On the other hand, one concern with blanket prenatal supplementation programs using energy-dense supplements is that they could lead to more maternal and/or infant overweight. However, evidence is lacking on the potential effect of BEP on maternal and offspring body composition. This study evaluates the effects of micronutrient-fortified BEP supplementation during pregnancy on body composition of mothers and their newborns in rural Burkina Faso. METHODS AND FINDINGS The MISAME-III study is an open label individually randomized controlled trial where pregnant women (n = 1,897) of gestational age <21 weeks received either a combination of micronutrient-fortified BEP and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control). The prenatal phase of the MISAME-III study was conducted between the first enrollment in October 2019 and the last delivery in August 2021. In a sub-study nested under the MISAME-III trial, we evaluated anthropometry and body composition in newborns who were born starting from 17 November 2020 (n: control = 368 and intervention = 352) and their mothers (n: control = 185 and intervention = 186). Primary study outcomes were newborn and maternal fat-free mass (FFMI) and fat-mass (FMI) indices. We used the deuterium dilution method to determine FFMI and FMI and %FFM and %FM of total body weight within 1 month postpartum. Our main analysis followed a modified intention-to-treat approach by analyzing all subjects with body composition data available. Univariable and multivariable linear regression models were fitted to compare the intervention and control arms, with adjusted models included baseline maternal age, height, arm fat index, hemoglobin concentration and primiparity, household size, wealth and food security indices, and newborn age (days). At study enrollment, the mean ± SD maternal age was 24.8 ± 6.13 years and body mass index (BMI) was 22.1 ± 3.02 kg/m2 with 7.05% of the mothers were underweight and 11.5% were overweight. Prenatal micronutrient-fortified BEP supplementation resulted in a significantly higher FFMI in mothers (MD (mean difference): 0.45; 95% CI (confidence interval): 0.05, 0.84; P = 0.026) and newborns (MD: 0.28; 95% CI: 0.06, 0.50; P = 0.012), whereas no statistically significant effects were found on FMI. The effect of micronutrient-fortified BEP on maternal FFMI was greater among mothers from food secure households and among those with a better nutritional status (BMI ≥21.0 kg/m2 or mid-upper arm circumference (MUAC) ≥23 cm). Key limitations of the study are the relatively high degree of missing data (approximately 18%), the lack of baseline maternal body composition values, and the lack of follow-up body composition measurements to evaluate any long-term effects. CONCLUSIONS Micronutrient-fortified BEP supplementation during pregnancy can increase maternal and newborn FFMI, without significant effects on FMI. TRIAL REGISTRATION ClinicalTrials.gov with identifier NCT03533712.
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Affiliation(s)
- Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | | | | | | | | | | | - Katrien Vanslambrouck
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
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7
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Erchick DJ, Hazel EA, Katz J, Lee ACC, Diaz M, Wu LSF, Yoshida S, Bahl R, Grandi C, Labrique AB, Rashid M, Ahmed S, Roy AD, Haque R, Shaikh S, Baqui AH, Saha SK, Khanam R, Rahman S, Shapiro R, Zash R, Silveira MF, Buffarini R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zeng L, Zhu Z, He J, Qiu X, Gebreyesus SH, Tesfamariam K, Bekele D, Chan G, Baye E, Workneh F, Asante KP, Kaali EB, Adu-Afarwuah S, Dewey KG, Gyaase S, Wylie BJ, Kirkwood BR, Manu A, Thulasiraj RD, Tielsch J, Chowdhury R, Taneja S, Babu GR, Shriyan P, Ashorn P, Maleta K, Ashorn U, Mangani C, Acevedo-Gallegos S, Rodriguez-Sibaja MJ, Khatry SK, LeClerq SC, Mullany LC, Jehan F, Ilyas M, Rogerson SJ, Unger HW, Ghosh R, Musange S, Ramokolo V, Zembe-Mkabile W, Lazzerini M, Rishard M, Wang D, Fawzi WW, Minja DTR, Schmiegelow C, Masanja H, Smith E, Lusingu JPA, Msemo OA, Kabole FM, Slim SN, Keentupthai P, Mongkolchati A, Kajubi R, Kakuru A, Waiswa P, Walker D, Hamer DH, Semrau KEA, Chaponda EB, Chico RM, Banda B, Musokotwane K, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021. BJOG 2023. [PMID: 37156239 DOI: 10.1111/1471-0528.17510] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN Descriptive multi-country secondary data analysis. SETTING Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION Liveborn infants. METHODS Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.
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Affiliation(s)
- D J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - E A Hazel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Diaz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - L S F Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - R Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - C Grandi
- Argentine Society of Paediatrics, Ciudad Autónoma de Buenos Aires, Argentina
| | - A B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M Rashid
- IntraHealth International, Dhaka, Bangladesh
| | - S Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - A D Roy
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - R Haque
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - S Shaikh
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - A H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - R Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S Rahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - R Shapiro
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - R Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - M F Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - R Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - P Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - C Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - L Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - D Roberfroid
- Medicine Department, Faculty of Medicine, University of Namur, Namur, Belgium
| | - L Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Z Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - J He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - X Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou, China
| | - S H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - K Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - D Bekele
- Department of Obstetrics and Gynecology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - G Chan
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - E Baye
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - F Workneh
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - K P Asante
- Kintampo Health Research Centre, Research and Development Division, Kintampo, Ghana
| | - E B Kaali
- Kintampo Health Research Centre, Research and Development Division, Kintampo, Ghana
| | - S Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - K G Dewey
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California, USA
| | - S Gyaase
- Department of Statistics, Kintampo Health Research Centre, Kintampo, Ghana
| | - B J Wylie
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - B R Kirkwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A Manu
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- University of Ghana School of Public Health, Accra, Ghana
| | | | - J Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - R Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, Delhi, India
| | - S Taneja
- Centre for Health Research and Development, Society for Applied Studies, Delhi, India
| | - G R Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - P Shriyan
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, India
| | - P Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - K Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - U Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - C Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - S Acevedo-Gallegos
- National Institute of Perinatology, Maternal-Fetal Medicine Department, Mexico City, Mexico
| | - M J Rodriguez-Sibaja
- National Institute of Perinatology, Maternal-Fetal Medicine Department, Mexico City, Mexico
| | - S K Khatry
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - S C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project - Sarlahi (NNIPS), Kathmandu, Nepal
| | - L C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - F Jehan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - M Ilyas
- The Aga Khan University, Karachi, Pakistan
| | - S J Rogerson
- Department of Infectious Diseases, University of Melbourne, Doherty Institute, Melbourne, Victoria, Australia
| | - H W Unger
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - R Ghosh
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - S Musange
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - V Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - W Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Johannesburg, South Africa
| | - M Lazzerini
- Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
| | - M Rishard
- University Obstetrics Unit, De Soysa Hospital for Women, Colombo, Sri Lanka
- Department of Obstetrics & Gynaecology, University of Colombo, Colombo, Sri Lanka
| | - D Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - W W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - D T R Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - C Schmiegelow
- Centre for Medical Parasitology, Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Masanja
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - E Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, DC, USA
| | - J P A Lusingu
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - O A Msemo
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - F M Kabole
- Ministry of Health Zanzibar, Zanzibar, Tanzania
| | - S N Slim
- Ministry of Health Zanzibar, Zanzibar, Tanzania
| | - P Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - A Mongkolchati
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
| | - R Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - A Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - P Waiswa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - D Walker
- Institute for Global Health Sciences and Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - D H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - K E A Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E B Chaponda
- Department of Biological Sciences, School of Natural Sciences, University of Zambia, Lusaka, Zambia
| | - R M Chico
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - B Banda
- Research Unit for Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - K Musokotwane
- Health Specialist PMTCT and Pediatric AIDS, UNICEF, Lusaka, Zambia
| | - A Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - B Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - J Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. BJOG 2023. [PMID: 37156238 DOI: 10.1111/1471-0528.17518] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs). DESIGN Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. SETTING Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Live birth neonates. METHODS We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. MAIN OUTCOME MEASURES Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. RESULTS There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. CONCLUSIONS Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- South African Research Chair in Social Policy at College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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9
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Cani P, Clarys P, Clinquart A, De Henauw S, Delzenne N, Deriemaeker P, Douny C, Guelinckx I, Huybrechts I, Huybregts L, Kolsteren P, Lachat C, Laquiere I, Larondelle Y, Leroy J, Manghuin-Rogister G, Matthys C, Mullie P, Neve J, Scippo ML, Sioen I, Remaut AM, Van Camp J, Vandevijvere S, Vansant M. Correction: Establishing a Belgian Nutrition Society (BNS): Filling the Void. Arch Public Health 2023. [PMCID: PMC9841667 DOI: 10.1186/s13690-022-01018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jef Leroy
- BNS founding members, Brussels, Belgium
| | | | | | | | - Jean Neve
- BNS founding members, Brussels, Belgium
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10
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Hanley-Cook G, Toe LC, Tesfamariam K, de Kok B, Argaw A, Compaoré A, Ouédraogo M, Dailey-Chwalibóg T, Kolsteren P, Lachat C, Huybregts L. Fortified Balanced Energy-Protein Supplementation, Maternal Anemia, and Gestational Weight Gain: A Randomized Controlled Efficacy Trial among Pregnant Women in Rural Burkina Faso. J Nutr 2022; 152:2277-2286. [PMID: 35906874 PMCID: PMC9535447 DOI: 10.1093/jn/nxac171] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Limited research indicates that balanced energy-protein (BEP) supplements reduce the incidence of inadequate GWG. OBJECTIVES We assessed the efficacy of a micronutrient-fortified BEP supplement on the secondary outcomes of anemia, GWG, GWG rate, and GWG in relation to the Institute of Medicine (IOM)'s recommendations, as compared with an iron-folic acid (IFA) tablet. METHODS We conducted a randomized controlled trial in Burkina Faso, among pregnant women (15-40 y old) enrolled at <21 weeks of gestation. Women received either BEP and IFA (intervention) or IFA (control). Hemoglobin (g/dL) concentrations were measured at baseline and the third antenatal care visit (ANC), whereas maternal weight was measured at baseline and all subsequent ∼7-weekly ANCs. GWG (kg) was calculated as a woman's last weight measurement (at ∼36 weeks of gestation) minus weight at enrollment, whereas GWG rate (kg/wk) was GWG divided by the time between the first and last weight measurements. GWG adequacy (%) was computed as GWG divided by the IOM's recommendation. Binary outcomes included severely inadequate, inadequate, and excessive GWG. Statistical analyses followed the intention-to-treat principle. Linear regression and probability models were fitted for the continuous and binary outcomes, respectively, adjusting for baseline measurements. RESULTS Women in the BEP group tended to have higher, but nonsignificantly different, GWG (0.28 kg; 95% CI: -0.05, 0.58 kg; P = 0.099). Furthermore, there were no significant differences in prenatal anemia prevalence, GWG rate, GWG adequacy, or incidence of inadequate or excessive GWG. Findings were robust to model adjustments and complete case and per protocol analyses. CONCLUSIONS This trial does not provide evidence that fortified BEP supplementation reduces maternal anemia or increases GWG, as compared with IFA. In conjunction with the small, but positive, effects of maternal BEP supplementation on birth outcomes, our findings warrant the investigation of additional biochemical and postnatal outcomes.This trial was registered at clinicaltrials.gov as NCT03533712.
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Affiliation(s)
- Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia C Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.,Nutrition and Metabolic Diseases Unit, Health Sciences Research Institute (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Anderson Compaoré
- AFRICSanté (Health Research and Expertise Training Agency for Africa), Bobo-Dioulasso, Burkina Faso
| | - Moctar Ouédraogo
- AFRICSanté (Health Research and Expertise Training Agency for Africa), Bobo-Dioulasso, Burkina Faso
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA
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11
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Dewey KG, Arnold CD, Wessells KR, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannottie LL, Jannat K, Lartey A, Port AL, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 116:1314-1333. [PMID: 36045000 DOI: 10.1093/ajcn/nqac232] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. OBJECTIVE We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3). METHODS We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation. CONCLUSIONS Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, 9000Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.,Helen Keller International, New York, NY, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | | | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, NSW, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Agnes Le Port
- Montpellier Interdisciplinary center on Sustainable Agri-food systems (MoISA), French National Research Institute for Sustainable Development (IRD), Montpellier, France
| | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Kenneth Maleta
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh.,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Minyanga Nkhoma
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Harriet Okronipa
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Ann M Weber
- School of Public Health, Division of Epidemiology, University of Nevada, Reno, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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12
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Leroy JL, Frongillo EA, Kase BE, Alonso S, Chen M, Dohoo I, Huybregts L, Kadiyala S, Saville NM. Strengthening causal inference from randomised controlled trials of complex interventions. BMJ Glob Health 2022; 7:bmjgh-2022-008597. [PMID: 35688484 PMCID: PMC9189821 DOI: 10.1136/bmjgh-2022-008597] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/14/2022] [Indexed: 11/06/2022] Open
Abstract
Researchers conducting randomised controlled trials (RCTs) of complex interventions face design and analytical challenges that are not fully addressed in existing guidelines. Further guidance is needed to help ensure that these trials of complex interventions are conducted to the highest scientific standards while maximising the evidence that can be extracted from each trial. The key challenge is how to manage the multiplicity of outcomes required for the trial while minimising false positive and false negative findings. To address this challenge, we formulate three principles to conduct RCTs: (1) outcomes chosen should be driven by the intent and programme theory of the intervention and should thus be linked to testable hypotheses; (2) outcomes should be adequately powered and (3) researchers must be explicit and fully transparent about all outcomes and hypotheses before the trial is started and when the results are reported. Multiplicity in trials of complex interventions should be managed through careful planning and interpretation rather than through post hoc analytical adjustment. For trials of complex interventions, the distinction between primary and secondary outcomes as defined in current guidelines does not adequately protect against false positive and negative findings. Primary outcomes should be defined as outcomes that are relevant based on the intervention intent and programme theory, declared (ie, registered), and adequately powered. The possibility of confirmatory causal inference is limited to these outcomes. All other outcomes (either undeclared and/or inadequately powered) are secondary and inference relative to these outcomes will be exploratory.
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Affiliation(s)
- Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Bezawit E Kase
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Silvia Alonso
- Animal and Human Health Porgram, International Livestock Research Institute, Nairobi, Kenya
| | - Mario Chen
- Biostatistics and Data Sciences, FHI 360, Durham, North Carolina, USA
| | - Ian Dohoo
- Health Management, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | | | - Naomi M Saville
- Institute for Global Health, University College London, London, UK
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13
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Hanley-Cook GT, Argaw A, de Kok B, Toe LC, Dailey-Chwalibóg T, Ouédraogo M, Kolsteren P, Huybregts L, Lachat C. Seasonality and Day-to-Day Variability of Dietary Diversity: Longitudinal Study of Pregnant Women Enrolled in a Randomized Controlled Efficacy Trial in Rural Burkina Faso. J Nutr 2022; 152:2145-2154. [PMID: 35524695 PMCID: PMC9445846 DOI: 10.1093/jn/nxac104] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Panel data indicate that nonpregnant women's dietary diversity fluctuates across climatic seasons in low- and middle-income countries. The natural day-to-day variability in food group consumption during gestation is unknown. OBJECTIVES A longitudinal study was conducted among pregnant women enrolled in the Micronutriments pour la Santé de la Mère et de l'Enfant study 3 randomized controlled efficacy trial [i.e., daily fortified balanced energy-protein supplement and an iron-folic acid (IFA) tablet compared with an IFA tablet only] to investigate the number of 24-hour recalls required to estimate usual prenatal food group (FG) diversity and the seasonality of pregnant women's dietary diversity in Houndé, Burkina Faso. METHODS FG consumption was assessed twice weekly by qualitative, list-based, 24-hour recalls among 1757 pregnant women (892 control, 865 intervention). The number of days needed to estimate a woman's usual prenatal 10-point FG diversity score was calculated using the within-subject coefficient of variation. Regression models, including truncated Fourier series, were fitted to assess seasonal variations in the FG diversity score and the probability of reaching Minimum Dietary Diversity for Women (MDD-W; i.e., ≥5 FGs). RESULTS The monthly mean FG scores (<5 FGs) and MDD-W prevalence (<45%) were low. Five list-based recalls allowed observed FG diversity to lie within 15% of the true mean in 90% of the estimations (mean ± SD, 40.4 ± 20.7 recalls per woman). Both the FG diversity score and prevalence achieving MDD-W showed responsiveness to seasonal variations, with peaks at the end of the dry season (i.e., April or May) and troughs in the rainy season (i.e., August). CONCLUSIONS Five list-based recalls are sufficient to estimate usual FG diversity during gestation, although intra-annual seasonal patterns did modestly affect the FG diversity score and MDD-W prevalence. Thus, timing of repeated dietary surveys is critical to ensure nonbiased inferences of change and trends in Burkina Faso. This trial was registered at clinicaltrials.gov as NCT03533712.
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Affiliation(s)
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,Institut de Recherche en Sciences de la Santé (IRSS), Unité Nutrition et Maladies Métaboliques, Bobo-Dioulasso, Burkina Faso
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | | | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium,Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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14
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Akseer N, Keats EC, Thurairajah P, Cousens S, Bétran AP, Oaks BM, Osrin D, Piwoz E, Gomo E, Ahmed F, Friis H, Belizán J, Dewey K, West K, Huybregts L, Zeng L, Dibley MJ, Zagre N, Christian P, Kolsteren PW, Kaestel P, Black RE, El Arifeen S, Ashorn U, Fawzi W, Bhutta ZA. Characteristics and birth outcomes of pregnant adolescents compared to older women: An analysis of individual level data from 140,000 mothers from 20 RCTs. EClinicalMedicine 2022; 45:101309. [PMID: 35243274 PMCID: PMC8885463 DOI: 10.1016/j.eclinm.2022.101309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10-19 years) compared to older mothers in low and middle-income countries. METHODS This study was conducted between March 16, 2018 and May 25, 2021. Data were obtained from 20 randomised controlled trials of micronutrient supplementation in pregnancy. Stratified analyses were conducted by age (10-14 years, 15-17 years, 18-19 years, 20-29 years, 30-39 years, 40+ years) and geographical region (Africa, Asia). Crude and confounder-adjusted means, prevalence and relative risks of pregnancy, nutrition and birth outcomes were estimated using multivariable linear and log-binomial regression models with 95% confidence intervals. FINDINGS Adolescent mothers comprised 31.6% of our data. Preterm birth, small-for-gestational age (SGA), low birthweight (LBW) and newborn mortality followed a U-shaped trend in which prevalence was highest among the youngest mothers (10-14 years) and then reduced gradually, but increased again for older mothers (40+ years). When compared to mothers aged 20-29 years, there was a 23% increased risk of preterm birth, a 60% increased risk of perinatal mortality, a 63% increased risk of neonatal mortality, a 28% increased risk of LBW, and a 22% increased risk of SGA among mothers 10-14 years. Mothers 40+ years experienced a 22% increased risk of preterm birth and a 103% increased risk of stillbirth when compared to the 20-29 year group. INTERPRETATION The youngest and oldest mothers suffer most from adverse pregnancy and birth outcomes. Policy and programming agendas should consider both biological and socioeconomic/environmental factors when targeting these populations. FUNDING Bill and Melinda Gates Foundation (Grant No: OP1137750).
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Emily Catherine Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Pravheen Thurairajah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - David Osrin
- Institute for Global Health, University College London, United Kingdom
| | - Ellen Piwoz
- The Bill and Melinda Gates Foundation, United States
| | | | | | | | | | | | - Keith West
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Lingxia Zeng
- School of Public Health, Xi'an Jiaotong University Health Science Centre, China
| | | | - Noel Zagre
- UNICEF Regional Office for West and Central Africa, Senegal
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | | | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Wafaie Fawzi
- Harvard T.H. Chan School of Public Health, United States
| | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
- Corresponding author at: Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.
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15
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de Kok B, Argaw A, Hanley-Cook G, Toe LC, Ouédraogo M, Dailey-Chwalibóg T, Diop L, Becquey E, Kolsteren P, Lachat C, Huybregts L. Fortified Balanced Energy-Protein Supplements Increase Nutrient Adequacy without Displacing Food Intake in Pregnant Women in Rural Burkina Faso. J Nutr 2021; 151:3831-3840. [PMID: 34494113 PMCID: PMC8643591 DOI: 10.1093/jn/nxab289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/01/2021] [Accepted: 08/06/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In many low- and middle-income countries, the prevalence of energy and nutrient deficiencies is high among pregnant women. Balanced energy-protein (BEP) supplements are a promising strategy to cover nutritional requirements during pregnancy and improve birth outcomes. However, the displacement of nutrient-dense foods by BEP might attenuate the efficacy of supplementation. OBJECTIVE This cross-sectional study of participants in a randomized controlled trial evaluated the difference in energy and macro- and micronutrient intakes, food groups, and nutrient adequacy between a control and intervention group receiving either a daily iron-folic acid (IFA) tablet or IFA and BEP supplement during pregnancy, respectively. METHODS We collected a single multiple-pass 24-h recall from 470 pregnant women from the MIcronutriments pour la SAnté de la Mère et de l'Enfant (MISAME) III study that investigates the efficacy of BEP supplementation on birth outcomes and infant growth. Dietary intake (median and IQR) and nutrient adequacy were assessed using individual recipes and preparation methods of mixed dishes for each participant. Linear regression models were fitted to compare energy and nutrient intakes. RESULTS Dietary energy, and macro- and micronutrient intakes were significantly higher among women in the intervention group when including BEP [2329 kcal/d (1855, 3008 kcal/d) compared with 1942 kcal/d (1575, 2405 kcal/d) in the control group (all P < 0.001)]. The difference in median energy intake (448 kcal/d; 95% CI: 291, 605 kcal/d) was approximately equivalent to a daily dose of the BEP supplement (393 kcal). Nutrient adequacy ratios for both groups were low for all micronutrients (between 0.02 and 0.66), when excluding BEP (except iron and folic acid, due to standard supplemental doses) from analysis. However, nutrient intakes increased to the Estimated Average Requirement for pregnant women when including BEP supplements. CONCLUSIONS BEP supplementation increases energy and macro- and micronutrient intakes among pregnant women and fills nutrient gaps without displacing food intake. This trial was registered at clinicaltrials.gov as NCT03533712 (https://clinicaltrials.gov/ct2/show/NCT03533712).
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Affiliation(s)
- Brenda de Kok
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Giles Hanley-Cook
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Institut de Recherche en Sciences de la Santé (IRSS), Unité Nutrition et Maladies Métaboliques, Bobo‐Dioulasso, Burkina Faso
| | | | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Loty Diop
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
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16
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Dewey KG, Wessells KR, Arnold CD, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Bendabenda J, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannotti LL, Jannat K, Lartey A, Le Port A, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:15S-42S. [PMID: 34590672 PMCID: PMC8560308 DOI: 10.1093/ajcn/nqab278] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < -2) by 18%, acute malnutrition (WLZ < -2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < -2) by 13%, and small head size (head circumference-for-age z score < -2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation. CONCLUSIONS The positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Jaden Bendabenda
- Department of Nutrition and Food Safety, WHO, Geneva, Switzerland
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA,Helen Keller International, New York, NY, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Minyanga Nkhoma
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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17
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Wessells KR, Arnold CD, Stewart CP, Prado EL, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn P, Ashorn U, Becquey E, Brown KH, Byrd KA, Campbell RK, Christian P, Fernald L, Fan YM, Galasso E, Hess SY, Huybregts L, Jorgensen JM, Kiprotich M, Kortekangas E, Lartey A, Le Port A, Leroy JL, Lin A, Maleta K, Matias SL, Mbuya M, Mridha MK, Mutasa K, Naser AM, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Rahman M, Schulze K, Smith LE, Weber AM, Zongrone A, Dewey KG. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:68S-94S. [PMID: 34590114 PMCID: PMC8560313 DOI: 10.1093/ajcn/nqab276] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Small-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers. RESULTS SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics. CONCLUSIONS SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.
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Affiliation(s)
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA,Helen Keller International, New York, NY, USA
| | | | - Rebecca K Campbell
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yue-Mei Fan
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Josh M Jorgensen
- Nutrition Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Emma Kortekangas
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Audrie Lin
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Abu M Naser
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh,Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Mahbubur Rahman
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Kerry Schulze
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Smith
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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18
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Prado EL, Arnold CD, Wessells KR, Stewart CP, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn U, Ashorn P, Becquey E, Brown KH, Chandna J, Christian P, Dentz HN, Dulience SJL, Fernald LC, Galasso E, Hallamaa L, Hess SY, Huybregts L, Iannotti LL, Jimenez EY, Kohl P, Lartey A, Le Port A, Luby SP, Maleta K, Matchado A, Matias SL, Mridha MK, Ntozini R, Null C, Ocansey ME, Parvez SM, Phuka J, Pickering AJ, Prendergast AJ, Shamim AA, Siddiqui Z, Tofail F, Weber AM, Wu L, Dewey KG. Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. Am J Clin Nutr 2021; 114:43S-67S. [PMID: 34590116 PMCID: PMC8560311 DOI: 10.1093/ajcn/nqab277] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. OBJECTIVES We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). RESULTS In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). CONCLUSIONS Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.
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Affiliation(s)
| | - Charles D Arnold
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA,Helen Keller International, New York, NY, USA
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly N Dentz
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Elizabeth Y Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Patricia Kohl
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Sarker M Parvez
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - John Phuka
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Abu A Shamim
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Zakia Siddiqui
- Healthy Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Lee S F Wu
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
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Bai Y, Huybregts L, Iannotti L, Chapnick M, Jones A, Headey D, Masters W. The Economics of Feeding Infants: Least-Cost Nutrient Adequate Diets From 6 to 23 Months of Age Using Breastmilk and Locally Available Foods in 31 Low-Income Countries. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab045_005] [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
Meeting infant needs requires complementing breastmilk with the gradual introduction of solid foods after 6 months. Existing studies have limited evidence on the availability and cost of complementary foods needed during the 6–23 month window when millions of children experience irreversible harm from inadequate diets.
Methods
Using food prices from the World Bank on 374 items potentially used for infant foods and available for sale in 31 low-income countries, food composition data, and dietary reference intakes (DRIs), we compute least-cost diets for children between 6–23 months. We further used data for food yield and nutrient retention factors and introduced volume constraints. DRIs differ for children aged 6–8 months, 9–11 months, and 12–23 months. We used lower and upper
bounds on 25 different nutrients plus fiber and sodium. Our primary specification (Scenario I) considers only total protein and fats, while a more restrictive Scenario II also considers 11 essential amino acids and fatty acids.
Results
The cost of complementary foods to replace breastmilk is $1–2/day at 6–8 months when small quantities of high-cost ingredients are needed, then declines to below $/1day at 9–11 months when lower-cost foods can be used before rising above $1/day again as children grow. Increased breastfeeding substitutes for complementary foods to a limited degree, as shown by the small decline in cost as breastmilk intake rises, and there is a clear threshold beyond which sufficiently nutrient-dense ingredients are very expensive or entirely unavailable. Average intake recommendation levels of breastmilk measured in low-income countries are close to that which makes complementary feeding least expensive, except in Scenario II for the youngest children.
Conclusions
We find that sufficient nutrients from complementary foods for infants from 6 to 23 months are not affordable for many households in these countries, implying a need for targeted assistance, especially in settings where household incomes are below the global poverty line of $1.90/person/day.
Funding Sources
This study was funded by the Bill & Melinda Gates Foundation through the project Advancing Research on Nutrition and Agriculture (AReNA), Phase II (Investment ID: OPP1177007), jointly with the project Food Prices for Nutrition (INV-016158) funded by the Bill & Melinda Gates Foundation and UKAid.
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Affiliation(s)
| | | | | | - Melissa Chapnick
- Washington University in St. Louis, Emory Rollins School of Public Health
| | | | | | - William Masters
- Tufts University Friedman School of Nutrition Science and Policy
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Vanslambrouck K, de Kok B, Toe LC, De Cock N, Ouedraogo M, Dailey-Chwalibóg T, Hanley-Cook G, Ganaba R, Lachat C, Huybregts L, Kolsteren P. Effect of balanced energy-protein supplementation during pregnancy and lactation on birth outcomes and infant growth in rural Burkina Faso: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e038393. [PMID: 33762226 PMCID: PMC7993280 DOI: 10.1136/bmjopen-2020-038393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/11/2020] [Revised: 01/06/2021] [Accepted: 01/23/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Adequate nutrition during pregnancy is crucial to both mother and child. Maternal malnutrition can be the cause of stillbirth or lead to poor birth outcomes such as preterm delivery and small-for-gestational-age newborns. There is a probable positive effect of providing pregnant women a balanced energy-protein (BEP) food supplement, but more evidence is needed. The MIcronutriments pour la SAnté de la Mère et de l'Enfant (MISAME) III project aims to improve birth outcomes and infant growth by testing a BEP supplement during pregnancy and lactation in rural Burkina Faso. This paper describes the study protocol. METHODS AND ANALYSIS MISAME-III is a four-arm individually randomised efficacy trial implemented in six rural health centre catchments areas in the district of Houndé. Eligible pregnant women, aged between 15 and 40 years old and living in the study areas, will be enrolled. Women will be randomly assigned to one of the four study groups: (1) prenatal intervention only, (2) postnatal intervention only, (3) prenatal and postnatal intervention or (4) no prenatal or postnatal intervention. The intervention group will receive the BEP supplement and iron/folic acid (IFA) tablets, while the control group will only receive the IFA tablets following the national health protocol. Consumption will be supervised by trained village women on a daily basis by means of home visits. The primary outcomes are small-for-gestational age at birth and length-for-age z-score at 6 months of age. Secondary outcomes will be measured at birth and during the first 6 months of the infants' life. Women will be enrolled from October 2019 until the total sample size is reached. ETHICS AND DISSEMINATION MISAME-III has been reviewed and approved by the University Hospital of Ghent and the ethics committee of Centre Muraz, Burkina Faso. Informed consent will be obtained. Results will be published in relevant journals and shared with other researchers and public health institutions. TRIAL REGISTRATION NUMBER NCT03533712.
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Affiliation(s)
- Katrien Vanslambrouck
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
- Institut de Recherche en Sciences de la Sante, Bobo-Dioulasso, Burkina Faso
| | - Nathalie De Cock
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | | | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | | | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Gent, Belgium
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21
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Diop L, Becquey E, Turowska Z, Huybregts L, Marie T R, Gelli A. Standard Minimum Dietary Diversity Indicators for Women or Infants and Young Children Are Good Predictors of Adequate Micronutrient Intakes in 24-59-Month-Old Children and Their Nonpregnant Nonbreastfeeding Mothers in Rural Burkina Faso. J Nutr 2021; 151:412-422. [PMID: 36898797 PMCID: PMC7850098 DOI: 10.1093/jn/nxaa360] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 06/18/2020] [Revised: 08/28/2020] [Accepted: 10/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Simple proxy indicators are needed to assess and monitor micronutrient intake adequacy of vulnerable populations. Standard dichotomous indicators exist for nonpregnant women of reproductive age and 6-23-mo-old children in low-income countries, but not for 24-59-mo-old children or pregnant or breastfeeding women. OBJECTIVES This study aimed to evaluate the performance of 2 standard food group scores (FGSs) and related dichotomous indicators to predict micronutrient adequacy of the diet of rural Burkinabe 24-59-mo-old children and women of reproductive age by physiological status. METHODS A 24-h recall survey was conducted at dry season among 1066 pairs of children and caregivers. Micronutrient adequacy was evaluated by the mean probability of adequacy (MPA) of intake over 11 micronutrients. Proxy indicators were FGS-10 [10 food groups based on the FAO/FHI360 minimum dietary diversity for women (MDD-W) guidelines] and related MDD-W (FGS-10 ≥5); and FGS-7 [7 groups based on the WHO infant and young child (IYC) feeding MDD guidelines] and related MDD-IYC (FGS-7 ≥4). RESULTS FGS-10 and FGS-7 were similar across children and women (∼3 groups). FGS-10 performed better than FGS-7 to predict MPA in children (Spearman rank correlation = 0.59 compared with 0.50) and women of all 3 physiological statuses (Spearman rank correlation = 0.53-0.55 compared with 0.42-0.52). MDD-W and MDD-IYC performed well in predicting MPA >0.75 in children and MPA >0.6 in nonpregnant nonbreastfeeding (NPNB) women, but a 4-group cutoff for FGS-10 allowed a better balance between sensitivity, specificity, and proportion of correct classification. MPA levels for pregnant and breastfeeding women were too low to assess best cutoff points. CONCLUSIONS MDD-IYC or an adapted MDD-W (FGS-10 ≥4 instead of FGS-10 ≥5) can be extended to 24-59-mo-old children and NPNB women in similar-diet settings. The inadequacy of micronutrient intakes in pregnant and breastfeeding women warrants urgent action. Micronutrient adequacy predictors should be validated in populations where a higher proportion of these women do meet dietary requirements. J Nutr 2021;151:412-422.
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Affiliation(s)
- Loty Diop
- International Food Policy Research Institute (IFPRI), Washington, DC, USA.
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | | | - Lieven Huybregts
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Ruel Marie T
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
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22
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Barba FM, Huybregts L, Leroy JL. Incidence Correction Factors for Moderate and Severe Acute Child Malnutrition From 2 Longitudinal Cohorts in Mali and Burkina Faso. Am J Epidemiol 2020; 189:1623-1627. [PMID: 32666072 PMCID: PMC7705604 DOI: 10.1093/aje/kwaa139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Abstract
Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies, which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor $K$, obtained from the few available cohorts that measured AM. We estimated $K$ factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from 2 cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition-PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using complete (weight-for-length z score, mid-upper arm circumference (MUAC), and edema) and partial (MUAC, edema) definitions of SAM and MAM. $K$ estimates for SAM were 9.4 and 5.7 in Burkina Faso and in Mali, respectively; K estimates for MAM were 4.7 in Burkina Faso and 5.1 in Mali. The MUAC and edema-based definition of AM did not lead to different $K$ estimates. Our results suggest that $K$ can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.
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Affiliation(s)
| | - Lieven Huybregts
- Correspondence to Dr. Lieven Huybregts, Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC (e-mail: )
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23
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Argaw A, Bouckaert KP, Wondafrash M, Kolsteren P, Lachat C, De Meulenaer B, Hanley-Cook G, Huybregts L. Effect of fish-oil supplementation on breastmilk long-chain polyunsaturated fatty acid concentration: a randomized controlled trial in rural Ethiopia. Eur J Clin Nutr 2020; 75:809-816. [PMID: 33159163 DOI: 10.1038/s41430-020-00798-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND For infants and young children in low-income settings, human milk (HM) is the main source of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPs), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). However, the n-3 LCPs concentrations of HM show wide variability, largely depending on the maternal intake of marine foods. This may put children living far from coastal areas at risk of inadequate intake. We evaluated the efficacy of fish-oil (FO) supplementation of lactating mothers on HM n-3 LCPs concentrations in a rural setting from Ethiopia. METHODS Mothers (n = 360) with children 6-12 months old were randomized to receive either intervention FO capsules (215 mg DHA + 285 mg EPA) or control corn-oil capsules (without n-3 LCPs). In a random subsample of 154 participants, we analyzed LCPs in HM and child capillary blood using gas chromatography. RESULTS Compared to the control, FO supplementation increased HM concentrations of DHA by 39.0% (95% CI: 20.6, 57.5%; P < 0.001) and EPA by 36.2% (95% CI: 16.0, 56.4%; P < 0.001), whereas the arachidonic acid (AA)/(DHA + EPA) ratio decreased by 53.5% (95% CI: -70.2, -36.7%; P < 0.001). We also found statistically significant association between the changes in (DHA + EPA)/AA ratio in HM and child capillary blood (P < 0.001). However, HM DHA concentrations remained lower than international norms after FO supplementation. CONCLUSIONS FO supplementation improves n-3 LCPs content of HM. Future studies should evaluate different doses of n-3 LCPs and consider potential effect modifiers such as genetic polymorphism and diet. This trial was registered at clinicaltrials.gov as NCT01817634.
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Affiliation(s)
- Alemayehu Argaw
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia. .,Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
| | - Kimberley P Bouckaert
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Mekitie Wondafrash
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Bruno De Meulenaer
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
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Ngure F, Gelli A, Becquey E, Ganaba R, Headey D, Huybregts L, Pedehombga A, Sanou A, Traore A, Zongo F, Zongrone A. Exposure to Livestock Feces and Water Quality, Sanitation, and Hygiene (WASH) Conditions among Caregivers and Young Children: Formative Research in Rural Burkina Faso. Am J Trop Med Hyg 2020; 100:998-1004. [PMID: 30693864 PMCID: PMC6447103 DOI: 10.4269/ajtmh.18-0333] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Livestock farming is common in low-income settings as a source of income and animal-sourced food. However, there is growing evidence of the harmful health effects of proximity of animals to infants and young children, especially through exposure to zoonotic pathogens. Poultry ownership is almost universal in rural Burkina Faso. Poultry feces are a significant risk factor for enteric diseases that are associated with child undernutrition. To investigate the extent of exposure to livestock feces among young children and caregivers, we conducted direct observations of 20 caregiver-child dyads for a total of 80 hours (4 hours per dyad) and recorded water quality, sanitation, and hygiene (WASH)-related behaviors. We also undertook in-depth interviews with these caregivers and focus group discussions with separate groups of men and women who were poultry farmers. Poultry and other livestock feces were visible in all 20 and 19 households, respectively, in both kitchen areas and in the household courtyards where children frequently sit or crawl. Direct soil ingestion by young children was observed in almost half of the households (45%). Poor handwashing practices were also common among caregivers and children. Although latrines were available in almost all households, child feces disposal practices were inadequate. This body of research suggests an urgent need to adapt conventional WASH and livestock interventions to reduce the exposure of infants and young children to livestock feces.
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Affiliation(s)
- Francis Ngure
- Independent Research Consultant, International Food Policy Research Institute (IFPRI), Washington, District of Colombia and Cornell University, Ithaca, New York
| | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, District of Columbia
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Washington, District of Columbia
| | - Rasmané Ganaba
- Agence de Formation, de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSante), Bobo-Dioulasso, Burkina Faso
| | - Derek Headey
- International Food Policy Research Institute (IFPRI), Washington, District of Columbia
| | - Lieven Huybregts
- International Food Policy Research Institute (IFPRI), Washington, District of Columbia
| | - Abdoulaye Pedehombga
- Agence de Formation, de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSante), Bobo-Dioulasso, Burkina Faso
| | - Armande Sanou
- Agence de Formation, de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSante), Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Traore
- Agence de Formation, de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSante), Bobo-Dioulasso, Burkina Faso
| | - Florence Zongo
- Agence de Formation, de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSante), Bobo-Dioulasso, Burkina Faso
| | - Amanda Zongrone
- International Food Policy Research Institute (IFPRI), Washington, District of Columbia
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25
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Stewart CP, Wessells KR, Arnold CD, Huybregts L, Ashorn P, Becquey E, Humphrey JH, Dewey KG. Lipid-based nutrient supplements and all-cause mortality in children 6-24 months of age: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2020; 111:207-218. [PMID: 31697329 DOI: 10.1093/ajcn/nqz262] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Undernutrition is associated with an elevated risk of mortality among children in low- and middle-income countries. Small-quantity lipid-based nutrient supplements (LNS) have been evaluated as a method to prevent undernutrition and improve infant development, but the effects on mortality are unknown. OBJECTIVE Our objective was to evaluate the effect of LNS on all-cause mortality among children 6-24 mo old. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials of LNS designed to prevent undernutrition, with or without other interventions. Literature was searched in May 2019 and trials were included if they enrolled children between 6 and 24 mo old and the period of supplementation lasted ≥6 mo. We extracted data from participant flow diagrams and contacted study investigators to request data. We conducted a meta-analysis to produce summary RR estimates. RESULTS We identified 18 trials conducted in 11 countries that enrolled 41,280 children and reported 586 deaths. The risk of mortality was lower in the LNS arms than in the non-LNS comparison arms (RR: 0.73; 95% CI: 0.59, 0.89; 13 trials). Estimates were similar when trials with maternal LNS intervention arms were added or when alternative formulations of LNS were excluded. The results appeared stronger in trials in which LNS were compared with passive control arms. Excluding these contrasts and only comparing multicomponent arms with LNS groups and comparison groups that contained all the same components without LNS attenuated the effect estimate (RR: 0.82; 95% CI: 0.61, 1.10). CONCLUSIONS LNS provided for the prevention of undernutrition may reduce the risk of mortality, but more trials with appropriate comparison groups allowing isolation of the effect of LNS alone are needed.This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42019128718.
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Affiliation(s)
- Christine P Stewart
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Lieven Huybregts
- International Food Policy Research Institute, Washington, DC, USA
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elodie Becquey
- International Food Policy Research Institute, Washington, DC, USA
| | - Jean H Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
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26
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Argaw A, Hanley-Cook G, De Cock N, Kolsteren P, Huybregts L, Lachat C. Drivers of Under-Five Stunting Trend in 14 Low- and Middle-Income Countries since the Turn of the Millennium: A Multilevel Pooled Analysis of 50 Demographic and Health Surveys. Nutrients 2019; 11:E2485. [PMID: 31623183 PMCID: PMC6835629 DOI: 10.3390/nu11102485] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/05/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Understanding the drivers contributing to the decreasing trend in stunting is paramount to meeting the World Health Assembly's global target of 40% stunting reduction by 2025. METHODS We pooled data from 50 Demographic and Health Surveys since 2000 in 14 countries to examine the relationships between the stunting trend and potential factors at distal, intermediate, and proximal levels. A multilevel pooled trend analysis was used to estimate the association between the change in potential drivers at a country level and stunting probability for an individual child while adjusting for time trends and child-level covariates. A four-level mixed-effects linear probability regression model was fitted, accounting for the clustering of data by sampling clusters, survey-rounds, and countries. RESULTS Stunting followed a decreasing trend in all countries at an average annual rate of 1.04 percentage points. Among the distal factors assessed, a decrease in the Gini coefficient, an improvement in women's decision-making, and an increase in urbanization were significantly associated with a lower probability of stunting within a country. Improvements in households' access to improved sanitation facilities and drinking water sources, and children's access to basic vaccinations were the important intermediate service-related drivers, whereas improvements in early initiation of breastfeeding and a decrease in the prevalence of low birthweight were the important proximal drivers. CONCLUSIONS The results reinforce the need for a combination of nutrition-sensitive and -specific interventions to tackle the problem of stunting. The identified drivers help to guide global efforts to further accelerate stunting reduction and monitor progress against chronic childhood undernutrition.
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Affiliation(s)
- Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium.
- Department of Population and Family Health, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium.
| | - Nathalie De Cock
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium.
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium.
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20005-3915, USA.
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium.
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27
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Gelli A, Headey D, Becquey E, Ganaba R, Huybregts L, Pedehombga A, Santacroce M, Verhoef H. Poultry husbandry, water, sanitation, and hygiene practices, and child anthropometry in rural Burkina Faso. Matern Child Nutr 2019; 15:e12818. [PMID: 30912287 PMCID: PMC6850613 DOI: 10.1111/mcn.12818] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Poultry production in low income countries provides households with nutrient-rich meat and egg products, as well as cash income. However, traditional production systems present potential health and nutrition risks because poultry scavenging around household compounds may increase children's exposure to livestock-related pathogens. Data from a cross-sectional survey were analysed to examine associations between poultry, water, sanitation, and hygiene practices, and anthropometric indicators in children (6-59 months; n = 3,230) in Burkina Faso. Multilevel regression was used to account for the hierarchical nature of the data. The prevalence of stunting and wasting in children 6-24 months was 19% and 17%, respectively, compared with a prevalence of 26% and 6%, respectively, in children 25-60 months. Over 90% of households owned poultry, and chicken faeces were visible in 70% of compounds. Caregivers reported that 3% of children consumed eggs during a 24-hr recall. The presence of poultry faeces was associated with poultry flock size, poultry-husbandry and household hygiene practices. Having an improved water source and a child visibly clean was associated with higher height-for-age z scores (HAZ). The presence of chicken faeces was associated with lower weight-for-height z scores, and no associations were found with HAZ. Low levels of poultry flock size and poultry consumption in Burkina Faso suggest there is scope to expand production and improve diets in children, including increasing chicken and egg consumption. However, to minimize potential child health risks associated with expanding informal poultry production, research is required to understand the mechanisms through which cohabitation with poultry adversely affects child health and design interventions to minimize these risks.
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Affiliation(s)
- Aulo Gelli
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | - Derek Headey
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | | | - Lieven Huybregts
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | | | - Marco Santacroce
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | - Hans Verhoef
- London School of Hygiene & Tropical Medicine (LSHTM)LondonUK
- MRC Unit The Gambia at LSHTMBanjulGambia
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
- Cell Biology and Immunology GroupWageningen UniversityWageningenThe Netherlands
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28
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Becquey E, Huybregts L, Zongrone A, Le Port A, Leroy JL, Rawat R, Touré M, Ruel MT. Impact on child acute malnutrition of integrating a preventive nutrition package into facility-based screening for acute malnutrition during well-baby consultation: A cluster-randomized controlled trial in Burkina Faso. PLoS Med 2019; 16:e1002877. [PMID: 31454347 PMCID: PMC6711504 DOI: 10.1371/journal.pmed.1002877] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Community management of acute malnutrition (CMAM) is a highly efficacious approach for treating acute malnutrition (AM) in children who would otherwise be at significantly increased risk of mortality. In program settings, however, CMAM's effectiveness is limited because of low screening coverage of AM, in part because of the lack of perceived benefits for caregivers. In Burkina Faso, monthly screening for AM of children <2 years of age is conducted during well-baby consultations (consultation du nourrisson sain [CNS]) at health centers. We hypothesized that the integration of a preventive package including age-appropriate behavior change communication (BCC) on nutrition, health, and hygiene practices and a monthly supply of small-quantity lipid-based nutrient supplements (SQ-LNSs) to the monthly screening would increase AM screening and treatment coverage and decrease the incidence and prevalence of AM. METHODS AND FINDINGS We used a cluster-randomized controlled trial and allocated 16 health centers to the intervention group and 16 to a comparison group. Both groups had access to standard CMAM and CNS services; caregivers in the intervention group also received age-appropriate monthly BCC and SQ-LNS for children >6 months of age. We used two study designs: (1) a repeated cross-sectional study of children 0-17 months old (n = 2,318 and 2,317 at baseline and endline 2 years later) to assess impacts on AM screening coverage, treatment coverage, and prevalence; (2) a longitudinal study of 2,113 children enrolled soon after birth and followed up monthly for 18 months to assess impacts on AM screening coverage, treatment coverage, and incidence. Data were analyzed as intent to treat. Level of significance for primary outcomes was α = 0.016 after adjustment for multiple testing. Children's average age was 8.8 ± 4.9 months in the intervention group and 8.9 ± 5.0 months in the comparison group at baseline and, respectively, 0.66 ± 0.32 and 0.67 ± 0.33 months at enrollment in the longitudinal study. Relative to the comparison group, the intervention group had significantly higher monthly AM screening coverage (cross-sectional study: +18 percentage points [pp], 95% CI 10-26, P < 0.001; longitudinal study: +23 pp, 95% CI 17-29, P < 0.001). There were no impacts on either AM treatment coverage (cross-sectional study: +8.0 pp, 95% CI 0.09-16, P = 0.047; longitudinal study: +7.7 pp, 95% CI -1.2 to 17, P = 0.090), AM incidence (longitudinal study: incidence rate ratio = 0.98, 95% CI 0.75-1.3, P = 0.88), or AM prevalence (cross-sectional study: -0.46 pp, 95% CI -4.4 to 3.5, P = 0.82). A study limitation is the referral of AM cases (for ethical reasons) by study enumerators as part of the monthly measurement in the longitudinal study that may have attenuated the detectable impact on AM treatment coverage. CONCLUSIONS Adding a preventive package to CMAM delivered at health facilities in Burkina Faso increased participation in monthly AM screening, thus overcoming a major impediment to CMAM effectiveness. The lack of impact on AM treatment coverage and on AM prevalence and incidence calls for research to address the remaining barriers to uptake of preventive and treatment services at the health center and to identify and test complementary approaches to bring integrated preventive and CMAM services closer to the community while ensuring high-quality implementation and service delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT02245152.
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Affiliation(s)
- Elodie Becquey
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
- * E-mail:
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Amanda Zongrone
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Agnes Le Port
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Jef L. Leroy
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Rahul Rawat
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Mariama Touré
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
| | - Marie T. Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States of America
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29
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Argaw A, Huybregts L, Wondafrash M, Kolsteren P, Belachew T, Worku BN, Abessa TG, Bouckaert KP. Neither n-3 Long-Chain PUFA Supplementation of Mothers through Lactation nor of Offspring in a Complementary Food Affects Child Overall or Social-Emotional Development: A 2 × 2 Factorial Randomized Controlled Trial in Rural Ethiopia. J Nutr 2019; 149:505-512. [PMID: 30544211 DOI: 10.1093/jn/nxy202] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/25/2018] [Accepted: 08/01/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The n-3 (ω-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n-3 LC-PUFA supplementation on child development in low-income countries. OBJECTIVE We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6-24 mo in rural Ethiopia. METHODS We conducted a double-blind randomized controlled trial of n-3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil-enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6-12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention × time interaction). RESULTS The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention × time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (β: -0.03 SDs/mo; 95% CI: -0.04, -0.01 SD/mo; P < 0.01). CONCLUSIONS n-3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6-24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention. This trial was registered at clinicaltrials.gov as NCT01817634.
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Affiliation(s)
- Alemayehu Argaw
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC
| | - Mekitie Wondafrash
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Berhanu N Worku
- Department of Psychology, Jimma University, Jimma, Ethiopia.,Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Teklu G Abessa
- Special Needs and Inclusive Education, College of Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.,Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Kimberley P Bouckaert
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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30
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Ortiz J, Jacxsens L, Astudillo G, Ballesteros A, Donoso S, Huybregts L, De Meulenaer B. Multiple mycotoxin exposure of infants and young children via breastfeeding and complementary/weaning foods consumption in Ecuadorian highlands. Food Chem Toxicol 2018; 118:541-548. [PMID: 29883782 DOI: 10.1016/j.fct.2018.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 12/30/2017] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 12/24/2022]
Abstract
The dietary exposure to mycotoxins in Ecuadorian children aged 0-23 months (320 rural and 603 urban) was evaluated based on the intake of breast milk and staple cereals used as complementary/weaning foods. A probabilistic distribution approach by first order Monte Carlo simulation was adopted to assess the locally occurring mycotoxins (aflatoxins M1 and B1 in breast milk, ochratoxin A and deoxynivalenol in wheat noodles and oat flakes, and HT-2 toxin in polished rice). Overall, exposure was modest but higher for rural children due to their monotonous diet. Aflatoxin exposure by breast milk intake were of health concern in both areas (Margin of Exposure and Combined Margin of Exposure Index<10,000). Mycotoxin exposure by staple cereals intake was considered tolerable across feeding stages for individual mycotoxin-cereal combination (Hazard Quotient<1) and combined exposure (Hazard Index<1). The major exposure was to HT-2 toxin by rice intake at complementary feeding (15% rural and 4% urban above TDI) and at weaning stage (26% rural and 6% urban above TDI). Since the usual Ecuadorian diet is based on the same staple cereals, risk management actions could lead to a better protection of young children and also ensure higher safety of the recommended breastfeeding practices by protecting nursing mothers.
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Affiliation(s)
- Johana Ortiz
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium; Department of Biosciences, Food Nutrition and Health Research Unit, Faculty of Chemical Sciences, Cuenca University, Av. 12 de Abril s/n Cdla. Universitaria, P.O. Box 01.01.168, Cuenca, Ecuador.
| | - Liesbeth Jacxsens
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| | - Gabriela Astudillo
- Department of Biosciences, Food Nutrition and Health Research Unit, Faculty of Chemical Sciences, Cuenca University, Av. 12 de Abril s/n Cdla. Universitaria, P.O. Box 01.01.168, Cuenca, Ecuador
| | - Adriana Ballesteros
- Department of Biosciences, Food Nutrition and Health Research Unit, Faculty of Chemical Sciences, Cuenca University, Av. 12 de Abril s/n Cdla. Universitaria, P.O. Box 01.01.168, Cuenca, Ecuador
| | - Silvana Donoso
- Department of Biosciences, Food Nutrition and Health Research Unit, Faculty of Chemical Sciences, Cuenca University, Av. 12 de Abril s/n Cdla. Universitaria, P.O. Box 01.01.168, Cuenca, Ecuador
| | - Lieven Huybregts
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium; Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Bruno De Meulenaer
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
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31
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Nguyen PH, Huybregts L, Sanghvi TG, Tran LM, Frongillo EA, Menon P, Ruel MT. Dietary Diversity Predicts the Adequacy of Micronutrient Intake in Pregnant Adolescent Girls and Women in Bangladesh, but Use of the 5-Group Cutoff Poorly Identifies Individuals with Inadequate Intake. J Nutr 2018; 148:790-797. [PMID: 30053285 PMCID: PMC7413035 DOI: 10.1093/jn/nxy045] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background The Minimum Dietary Diversity for Women (MDD-W) indicator based on a 10-food group women dietary diversity score (WDDS-10) has been validated to assess dietary quality in nonpregnant women. Little is known about its applicability in pregnant women, and specifically pregnant adolescent girls with higher nutrient requirements. Objectives This study aimed to 1) compare the adequacy of micronutrient intakes between pregnant adolescent girls and women, 2) examine the performance of WDDS-10 in predicting the mean probability of adequacy (MPA) of 11 micronutrients, and 3) assess how well the MDD-W cutoff of 5 groups performed in pregnant adolescent girls and women. Methods We used data from a 2015 household survey in Bangladesh (n = 600). Nutrient intakes were estimated with a multiple-pass 24-h recall and WDDS-10 was assessed through the use of a list-based method. Multiple linear regression models adjusted for geographical clustering assessed the association between WDDS-10 and MPA. Sensitivity and specificity analysis assessed the accuracy of MDD-W in correctly classifying individuals into high (MPA >0.6) or low MPA. Results Dietary intakes of pregnant adolescent girls and women were similar in energy intake, WDDS-10 (5.1 ± 1.4), MPA (0.40 ± 0.12), and micronutrient intakes. Probabilities of adequacy were ∼0.30 for riboflavin, vitamin B-12, calcium, and zinc; 0.12-0.15 for folate; 0.16-0.19 for vitamin A; and extremely low for iron at 0.01. The WDDS-10 was significantly associated with MPA in both groups and predicted MPA equally well at population level (SD of residuals 0.11 for both). Use of the 5-food groups cutoff for MDD-W to classify individuals' diets into MPA >0.6, however, resulted in a low correct classification (∼40%). A cutoff of 6 food groups markedly improved correct classification. Conclusions The WDDS-10 predicted MPA equally well for pregnant adolescent girls and women at population level. The MDD-W indicator performed poorly in classifying individuals with MPA >0.6.
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Affiliation(s)
| | | | | | | | | | - Purnima Menon
- International Food Policy Research Institute, Washington, DC
| | - Marie T Ruel
- International Food Policy Research Institute, Washington, DC
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32
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Argaw A, Wondafrash M, Bouckaert KP, Kolsteren P, Lachat C, Belachew T, De Meulenaer B, Huybregts L. Effects of n-3 long-chain PUFA supplementation to lactating mothers and their breastfed children on child growth and morbidity: a 2 × 2 factorial randomized controlled trial in rural Ethiopia. Am J Clin Nutr 2018; 107:454-464. [PMID: 29566189 DOI: 10.1093/ajcn/nqx057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/01/2017] [Indexed: 11/14/2022] Open
Abstract
Background Recurrent infections and inflammation contribute to growth faltering in low-income countries. n-3 (ω-3) Long-chain polyunsaturated fatty-acids (LC-PUFAs) may improve immune maturation, resistance to infections, and growth in young children who are at risk. Objective We evaluated the independent and combined effects of fish oil (500 mg n-3 LC-PUFAs/d) supplementation to lactating mothers and their breastfed children, aged 6-24 mo, on child morbidity, systemic inflammation, and growth in southwest Ethiopia. Design A 4-arm double-blind randomized controlled trial was conducted by enrolling 360 mother-infant pairs with infants 6-12 mo old. Study arms were both the lactating mother and child receiving fish oil intervention (MCI), only the lactating mother receiving fish oil intervention and child receiving placebo control (MI), only the child receiving intervention and mother receiving placebo control (CI), and both mother and child receiving a placebo supplement or control (C). The primary study outcome was linear growth using monthly changes in length-for-age z score. Anthropometric measurements were taken monthly, and hemoglobin, C-reactive protein, and blood LC-PUFAs were measured at baseline and after 6 and 12 mo of follow-up. Weekly morbidity surveillance was conducted throughout the study. Results Fish-oil supplementation significantly increased blood n-3 LC-PUFA concentration (P < 0.01) and decreased the arachidonic acid:(docosahexaenoic acid + eicosapentaenoic acid) ratio (P < 0.001) in all intervention arms. No significant intervention effect was found on linear growth, morbidity, or systemic inflammation. Compared to the control group, a small positive effect on monthly changes in weight-for-length z scores was found in the CI arm (effect size: 0.022/mo; 95% CI: 0.005, 0.039/mo; P = 0.012) and the MCI arm (effect size: 0.018/mo; 95% CI: 0.001, 0.034/mo; P = 0.041). Conclusions n-3 LC-PUFA supplementation of lactating mothers and children did not affect child linear growth and morbidity in a low-income setting. n-3 LC-PUFA supplementation given directly to children modestly increased relative weight gain. This trial was registered at clinicaltrials.gov as NCT01817634.
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Affiliation(s)
- Alemayehu Argaw
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Mekitie Wondafrash
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Kimberley P Bouckaert
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bruno De Meulenaer
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC
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33
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Ochoa-Avilés A, Verstraeten R, Huybregts L, Andrade S, Van Camp J, Donoso S, Ramírez PL, Lachat C, Maes L, Kolsteren P. A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial. Nutr J 2017; 16:79. [PMID: 29228946 PMCID: PMC5725778 DOI: 10.1186/s12937-017-0299-5] [Citation(s) in RCA: 21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 11/23/2017] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND In Ecuador, adolescents' food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent's inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents. METHODS A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage. RESULTS Data from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66 g; 95% CI: -9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one. CONCLUSIONS The trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale. TRIAL REGISTRATION ClinicalTrial.gov-NCT01004367 .
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Affiliation(s)
- Angélica Ochoa-Avilés
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador.
| | - Roosmarijn Verstraeten
- Independent researcher, Ghent, Belgium.,Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, 2033 K St, NW, Washington, DC, USA
| | - Susana Andrade
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador
| | - John Van Camp
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
| | - Silvana Donoso
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador
| | - Patricia Liliana Ramírez
- Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador
| | - Carl Lachat
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium
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Tollosa DN, Van Camp J, Huybrechts I, Huybregts L, Van Loco J, De Smet S, Sterck E, Rabâi C, Van Hecke T, Vanhaecke L, Vossen E, Peeters M, Lachat C. Validity and Reproducibility of a Food Frequency Questionnaire for Dietary Factors Related to Colorectal Cancer. Nutrients 2017; 9:E1257. [PMID: 29149033 PMCID: PMC5707729 DOI: 10.3390/nu9111257] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 09/29/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022] Open
Abstract
Dietary factors play a major role in the development of colorectal cancer. This study evaluated the reproducibility and validity of a 109-food item Food Frequency Questionnaire (FFQ) to measure the consumption of foods and nutrients related to the development of colorectal cancer in a population aged ≥50 years in Flanders, Belgium. A semi-quantitative FFQ was administered two times in a period of two weeks to evaluate reproducibility (FFQ1 and FFQ2). The validity of the FFQ was assessed by comparing FFQ1 against the 3-day diary method (3 DD). A total of 162 respondents (mean age 57.5 years) provided data for the FFQ, of whom 156 also participated in the validity assessment. Mean differences in the intake of foods and nutrients between FFQ1 and FFQ2 were, overall, small and statistically insignificant. However, a higher estimation was observed by FFQ1 as compared to the 3-DD method for the majority of food groups and nutrient intake in the validity assessment. A systematic mean difference (g/day) was observed for eight food groups in the Bland-Altman agreement test; the largest was for fruit intake. Regarding the nutrients, a systematic mean difference was observed in calcium, fat, and vitamin D intake. Overall, the reproducibility of the FFQ was good, and its validity could be satisfactory for estimating absolute food and nutrient intakes and ranking individuals according to high and low intake categories.
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Affiliation(s)
- Daniel Nigusse Tollosa
- Department of Food Safety and Food Quality, Ghent University, Coupure Link 653, 9000 Ghent, Belgium.
- Department of Public Health, College of Health Sciences, Mekelle University, Mekelle 1871, Ethiopia.
| | - John Van Camp
- Department of Food Safety and Food Quality, Ghent University, Coupure Link 653, 9000 Ghent, Belgium.
| | - Inge Huybrechts
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France.
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, 2033 K Street NW, Washington, DC 20006, USA.
| | - Joris Van Loco
- Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium.
| | - Stefaan De Smet
- Laboratory of Animal Nutrition and Animal Product Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Ellen Sterck
- Department of Food Safety and Food Quality, Ghent University, Coupure Link 653, 9000 Ghent, Belgium.
| | - Céline Rabâi
- Department of Food Safety and Food Quality, Ghent University, Coupure Link 653, 9000 Ghent, Belgium.
| | - Thomas Van Hecke
- Laboratory of Animal Nutrition and Animal Product Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Lynn Vanhaecke
- Laboratory of Chemical Analysis, Department of Veterinary Public Health and Food Safety, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - Els Vossen
- Laboratory of Animal Nutrition and Animal Product Quality, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Coupure Link 653, 9000 Ghent, Belgium.
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35
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Gelli A, Becquey E, Ganaba R, Headey D, Hidrobo M, Huybregts L, Verhoef H, Kenfack R, Zongouri S, Guedenet H. Improving diets and nutrition through an integrated poultry value chain and nutrition intervention (SELEVER) in Burkina Faso: study protocol for a randomized trial. Trials 2017; 18:412. [PMID: 28874177 PMCID: PMC5586047 DOI: 10.1186/s13063-017-2156-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 01/05/2017] [Accepted: 08/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background The SELEVER study is designed to evaluate the impact of an integrated agriculture–nutrition package of interventions (including poultry value chain development, women’s empowerment activities, and a behavior change communications strategy to promote improved diets and feeding, care, and hygiene practices) on the diets, health, and nutritional status of women and children in Burkina Faso. This paper presents the rationale and study design. Methods The impact evaluation involves a cluster randomized controlled trial design that will be implemented in 120 rural communities/villages within 60 communes supported by SELEVER in the Boucle de Mouhoun, Centre-Ouest, and Haut-Bassins regions of Burkina Faso. Communities will be randomly assigned to one of three treatment arms, including: (1) SELEVER intervention group; (2) SELEVER with an intensive WASH component; and (3) control group without intervention. Primary outcomes include the mean probability of adequacy of diets for women and children (aged 2–4 years at baseline), infant and young child feeding practices of caregivers of children aged 0–2 years, and household poultry production and sales. Intermediate outcomes along the agriculture and nutrition pathways will also be measured, including child nutrition status and development. The evaluation will follow a mixed-methods approach, including a panel of child-, household-, community-, and market-level surveys, and data collection points during post-harvest and lean seasons, as well as one year after implementation completion to examine sustainability. Discussion To our knowledge, this study is the first to rigorously examine from a food systems perspective, the simultaneous impact of scaling-up nutrition-specific and nutrition-sensitive interventions through a livestock value-chain and community-intervention platform, across nutrition, health, and agriculture domains. The findings of this evaluation will provide evidence to support the design of market-based nutrition-sensitive interventions. Trial registration ISRCTN registry, ISRCTN16686478. Registered on 2 December 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2156-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aulo Gelli
- International Food Policy Research Institute (IFPRI), 2033 K Street NW, Washington, DC, 20006, USA.
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), 2033 K Street NW, Washington, DC, 20006, USA
| | | | - Derek Headey
- International Food Policy Research Institute (IFPRI), 2033 K Street NW, Washington, DC, 20006, USA
| | - Melissa Hidrobo
- International Food Policy Research Institute (IFPRI), 2033 K Street NW, Washington, DC, 20006, USA
| | - Lieven Huybregts
- International Food Policy Research Institute (IFPRI), 2033 K Street NW, Washington, DC, 20006, USA
| | - Hans Verhoef
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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Lee AC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, Sania A, Rosen HE, Schmiegelow C, Adair LS, Baqui AH, Barros FC, Bhutta ZA, Caulfield LE, Christian P, Clarke SE, Fawzi W, Gonzalez R, Humphrey J, Huybregts L, Kariuki S, Kolsteren P, Lusingu J, Manandhar D, Mongkolchati A, Mullany LC, Ndyomugyenyi R, Nien JK, Roberfroid D, Saville N, Terlouw DJ, Tielsch JM, Victora CG, Velaphi SC, Watson-Jones D, Willey BA, Ezzati M, Lawn JE, Black RE, Katz J. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21 st standard: analysis of CHERG datasets. BMJ 2017; 358:j3677. [PMID: 28819030 PMCID: PMC5558898 DOI: 10.1136/bmj.j3677] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated.Setting CHERG birth cohorts from 14 population based sites in low and middle income countries.Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%.Results In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (<2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the highest (34%); about 26% of neonatal deaths were attributable to infants born small for gestational age. Reduction of the prevalence of small for gestational age from 19.3% to 10.0% in these countries could reduce neonatal deaths by 9.2% (254 600 neonatal deaths; 164 800 to 449 700).Conclusions In low and middle income countries, about one in five infants are born small for gestational age, and one in four neonatal deaths are among such infants. Increased efforts are required to improve the quality of care for and survival of these high risk infants in low and middle income countries.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Naoko Kozuki
- International Rescue Committee, 1730 M Street NW, Suite 505, Washington, DC 20036, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Simon Cousens
- Facuty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Maternal, Adolescent, Reproductive, and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Gretchen A Stevens
- Department of Information, Evidence and Research, World Health Organization (WHO), Geneva, Switzerland, CH-1211
| | - Hannah Blencowe
- Facuty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Maternal, Adolescent, Reproductive, and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Mariangela F Silveira
- Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 30 piso, Centro, CEP 96020-220, Pelotas, RS, Brazil
| | - Ayesha Sania
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032
| | - Heather E Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen K, Denmark
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 137 E. Franklin, Chapel Hill, NC 27516, USA
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Fernando C Barros
- Programa de Pós-graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Félix da Cunha, 412, CEP 96010-000, Centro, Pelotas, RS, Brazil
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G A04, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Stadium Road PO Box 3500, Karachi 74800, India
| | - Laura E Caulfield
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W2041, Baltimore, MD 21205 USA
| | - Parul Christian
- Women's Nutrition, Bill and Melinda Gates Foundation, Seattle, WA 98102, USA
| | - Siân E Clarke
- Faculty of Infectious Disease and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Malaria Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- Department of Nutrition, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Rogelio Gonzalez
- Pontificia Universidad Católica de Chile, School of Medicine, Avenida Libertador General Bernardo O'Higgins #340, Santiago, Chile
- Clínica Santa María, Avenida Santa María 0410 Providencia, Santiago, Chile
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W2041, Baltimore, MD 21205 USA
- Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Road, Meyrick Park, Harare, Zimbabwe
| | - Lieven Huybregts
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653 - 9000 Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, 2033 K St, NW Washington, DC 20006-1002, USA
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, PO Box 1578-40100, Kisumu, Kenya
- Centers for Disease Control and Prevention Kenya, Off Kisumu-Busia Highway, PO Box 1578-40100, Kisumu, Kenya
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653 - 9000 Ghent, Belgium
| | - John Lusingu
- National Institute for Medical Research, PO Box 5004, Tanga, Tanzania
- University of Copenhagen, Denmark
| | - Dharma Manandhar
- Mother and Infant Research Activities (MIRA), YB Bhawan, Thapathali, Kathmandu 921, Nepal
| | - Aroonsri Mongkolchati
- ASEAN Institute for Health Development, Mahidol University, 999 Phuttamonthon 4 Rd, Salaya, Nakhon Pathom 73170, Thailand
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Richard Ndyomugyenyi
- Vector Control Division, Ministry of Health, Uganda, Plot 6 Lourdel Rd, Nakasero, Kampala, Uganda
| | - Jyh Kae Nien
- Fetal Maternal Medicine Unit, Clinica Davila, Avenida Recoleta 464, Santiago, Chile
- Faculty of Medicine, Universidad de Los Andes, Avda San Carlos De Apoquindo 2200, Santiago, Chile
| | - Dominique Roberfroid
- Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, Brussels, Belgium
| | - Naomi Saville
- Mother and Infant Research Activities (MIRA), YB Bhawan, Thapathali, Kathmandu 921, Nepal
- Institute for Global Health, University College London Institute of Child Health, London WC1N 1EH, UK
| | - Dianne J Terlouw
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, PO Box 30096, Chichiri, Blantyre 3, Malawi
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, NW, Suite 400, Washington, DC 20052, USA
| | - Cesar G Victora
- Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 30 piso, Centro, CEP 96020-220, Pelotas, RS, Brazil
| | - Sithembiso C Velaphi
- Department of Paediatrics, Chris Hani Baragwaneth Hospital, Faculty of Health Sciences, University of Witwatersrand, Soweto, Johannesburg, South Africa
| | - Deborah Watson-Jones
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Mwanza Intervention Trial Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Barbara A Willey
- Facuty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Maternal, Adolescent, Reproductive, and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, London W2 1PG, UK
| | - Joy E Lawn
- Facuty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Maternal, Adolescent, Reproductive, and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
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Tonguet-Papucci A, Houngbe F, Huybregts L, Ait-Aissa M, Altare C, Kolsteren P, Huneau JF. Unconditional Seasonal Cash Transfer Increases Intake of High-Nutritional-Value Foods in Young Burkinabe Children: Results of 24-Hour Dietary Recall Surveys within the Moderate Acute Malnutrition Out (MAM’Out) Randomized Controlled Trial. J Nutr 2017; 147:1418-1425. [DOI: 10.3945/jn.116.244517] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/31/2017] [Accepted: 04/27/2017] [Indexed: 11/14/2022] Open
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Houngbe F, Tonguet-Papucci A, Altare C, Ait-Aissa M, Huneau JF, Huybregts L, Kolsteren P. Unconditional Cash Transfers Do Not Prevent Children’s Undernutrition in the Moderate Acute Malnutrition Out (MAM’Out) Cluster-Randomized Controlled Trial in Rural Burkina Faso. J Nutr 2017; 147:1410-1417. [DOI: 10.3945/jn.117.247858] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/21/2017] [Accepted: 04/18/2017] [Indexed: 11/14/2022] Open
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Wondafrash M, Huybregts L, Lachat C, Bouckaert KP, Kolsteren P. Feeding practices and growth among young children during two seasons in rural Ethiopia. BMC Nutr 2017; 3:39. [PMID: 32153819 PMCID: PMC7050872 DOI: 10.1186/s40795-017-0158-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 08/17/2016] [Accepted: 04/21/2017] [Indexed: 11/26/2022] Open
Abstract
Background The use of indices of infant and young child feeding practices to predict growth has generated inconsistent results, possibly through age and seasonal confounding. The aim of this study was to evaluate the association of a dietary diversity score (DDS) and infant and child feeding index (ICFI) with growth among young children in a repeated cross-sectional and a follow-up study in two distinct seasons in rural southwest Ethiopia. Methods We used a repeated cross-sectional design comparing child feeding practices to nutritional status in 6–12 month old children during harvest (HS; n = 320) and pre-harvest season (PHS; n = 312). In addition, 6–12 month old children from the HS were reassessed 6 months later during PHS. In addition to child anthropometry, child feeding practices were collected using 24-h and 7-day dietary recalls. Results The mean (±SD) length-for-age z-score (LAZ) of the 6–12 month old children was −0.77 (±1.4) and −1.0 (±1.3) in HS and PHS, respectively, while the mean (±SD) of the follow-up children in PHS was −1.0 (±1.3). The median DDS (IQR) was 2.0 (1.0, 3.0.), 2.0 (2.0, 3.0) and 3.0 (2.0, 4.0) for the children in HS, PHS and the follow-up children in PHS, respectively. The DDS in HS was positively associated with LAZ at follow-up (β = 0.16; 95% CI: 0.01, 0.30; P = 0.03) after controlling for confounding factors. ICFI and DDS were not associated with mean LAZ, weight-for-height z-score and weight-for-age z-score within season. However, the odds of being stunted when having a DDS ≤ 2 was 2.3 times (95% CI: 1.10, 4.78; P = 0.03) higher compared to a DDS > 2 child in HS and 1.7 times (95% CI: 1.04, 2.71; P = 0.04) higher for the pooled sample of 6–12 months old children in HS and PHS. Conclusions The DDS was found to be an indicator for child stunting during the Ethiopian harvest season. The DDS can be an appropriate tool to evaluate the association of child feeding practices with child growth irrespective of season. Inclusion of other dimensions in the construction of ICFI should be considered in future analysis as we found no association with growth. Electronic supplementary material The online version of this article (doi:10.1186/s40795-017-0158-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mekitie Wondafrash
- 1Department of Population and Family Health, College of Health Sciences, Jimma University, P.O. Box 343, Jimma, Ethiopia.,2Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium
| | - Lieven Huybregts
- 2Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.,3Poverty, Health and Nutrition Division, International Food Policy Research Institute, 2033 K Street NW, 20006 Washington DC, USA
| | - Carl Lachat
- 2Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.,4Unit of Nutrition and Child Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Kimberley P Bouckaert
- 2Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.,4Unit of Nutrition and Child Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Patrick Kolsteren
- 2Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.,4Unit of Nutrition and Child Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Huybregts L, Becquey E, Zongrone A, Le Port A, Khassanova R, Coulibaly L, Leroy JL, Rawat R, Ruel MT. The impact of integrated prevention and treatment on child malnutrition and health: the PROMIS project, a randomized control trial in Burkina Faso and Mali. BMC Public Health 2017; 17:237. [PMID: 28274214 PMCID: PMC5343313 DOI: 10.1186/s12889-017-4146-6] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/23/2017] [Indexed: 01/09/2023] Open
Abstract
Background Evidence suggests that both preventive and curative nutrition interventions are needed to tackle child acute malnutrition (AM) in developing countries. In addition to reducing the incidence of AM, providing preventive interventions may also help increase attendance (and coverage) of AM screening, a major constraint in the community-based management of child acute malnutrition (CMAM) model. There is a paucity of evidence-based strategies to deliver integrated preventive and curative interventions effectively and affordably at scale. The aim of the Innovative Approaches for the Prevention of Childhood Malnutrition (PROMIS) study is to assess the feasibility, quality of implementation, effectiveness and cost-effectiveness of an integrated child malnutrition prevention and treatment intervention package implemented through a community-based platform in Mali and a facility-based platform in Burkina Faso. Methods/Design The PROMIS intervention entails a comprehensive preventive package offered on a monthly basis to caregivers of children, while children are screened for acute malnutrition (AM). The package consists of behavior change communication on essential nutrition and hygiene actions, and monthly preventive doses of small quantity lipid-based nutrient supplements (SQ-LNS) for children aged 6 to 23.9 months. Positive AM cases are referred to treatment services offered by first-line health services according to the CMAM model. The PROMIS intervention will be evaluated using a mixed methods approach. The impact study encompasses two types of study design: i) repeated cross-sectional surveys conducted at baseline and at endline after 24 months of program implementation and ii) a longitudinal study with a monthly follow-up for 18 months. Primary study impact measures include the incidence and endpoint prevalence of AM, AM screening coverage and treatment compliance. A process evaluation will assess the feasibility and quality of implementation of the intervention guided by country specific program impact pathways (PIPs). Cost-effectiveness analysis will assess the economic feasibility of the intervention. Discussion The PROMIS study assesses the effectiveness of an innovative model to integrate prevention and treatment interventions for greater and more sustainable impacts on the incidence and prevalence of AM using a rigorous, theory-based randomized control trial approach. This type of programmatic research is urgently needed to help program implementers, policy makers, and investors prioritize, select and scale-up the best program models to prevent and treat AM and achieve the World Health Assembly goal of reducing childhood wasting to less than 5% globally by the year 2025. Trial registration Clinicaltrials.gov NCT02323815 (registered on December 18, 2014) and NCT02245152 (registered on September 16, 2014) Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4146-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lieven Huybregts
- International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA.
| | - Elodie Becquey
- International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA
| | - Amanda Zongrone
- International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA
| | - Agnes Le Port
- International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA
| | - Regina Khassanova
- Helen Keller International Burkina Faso country office, Ouagadougou, Burkina Faso
| | | | - Jef L Leroy
- International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA
| | - Rahul Rawat
- International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA
| | - Marie T Ruel
- International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA
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De Cock N, Van Camp J, Kolsteren P, Lachat C, Huybregts L, Maes L, Deforche B, Verstraeten R, Vangeel J, Beullens K, Eggermont S, Van Lippevelde W. Development and validation of a quantitative snack and beverage food frequency questionnaire for adolescents. J Hum Nutr Diet 2016; 30:141-150. [DOI: 10.1111/jhn.12411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. De Cock
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - J. Van Camp
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - P. Kolsteren
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - C. Lachat
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
| | - L. Huybregts
- Department of Food Safety and Food Quality; Ghent University; Ghent Belgium
- Poverty; Health and Nutrition Division International Food Policy Research Institute; Washington DC USA
| | - L. Maes
- Department of Public Health; Ghent University; Ghent Belgium
| | - B. Deforche
- Department of Public Health; Ghent University; Ghent Belgium
- Physical Activity; Nutrition and Health Research Unit; Faculty of Physical Education and Physical Therapy; Vrije Universiteit Brussel; Brussels Belgium
| | | | - J. Vangeel
- Leuven School for Mass Communication Research; KU Leuven; Leuven Belgium
| | - K. Beullens
- Leuven School for Mass Communication Research; KU Leuven; Leuven Belgium
- Research Foundation Flanders (FWO); Brussel Belgium
| | - S. Eggermont
- Leuven School for Mass Communication Research; KU Leuven; Leuven Belgium
| | - W. Van Lippevelde
- Physical Activity; Nutrition and Health Research Unit; Faculty of Physical Education and Physical Therapy; Vrije Universiteit Brussel; Brussels Belgium
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De Cock N, Van Lippevelde W, Goossens L, De Clercq B, Vangeel J, Lachat C, Beullens K, Huybregts L, Vervoort L, Eggermont S, Maes L, Braet C, Deforche B, Kolsteren P, Van Camp J. Sensitivity to reward and adolescents' unhealthy snacking and drinking behavior: the role of hedonic eating styles and availability. Int J Behav Nutr Phys Act 2016; 13:17. [PMID: 26861539 PMCID: PMC4748632 DOI: 10.1186/s12966-016-0341-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 09/08/2015] [Accepted: 02/02/2016] [Indexed: 12/11/2022] Open
Abstract
Background Although previous research found a positive association between sensitivity to reward (SR) and adolescents’ unhealthy snacking and drinking behavior, mechanisms explaining these associations remain to be explored. The present study will therefore examine whether the associations between SR and unhealthy snack and/or sugar-sweetened beverage (SSB) intake are mediated by external and/or emotional eating and if this mediation is moderated by availability at home or at school. Methods Cross-sectional data on snacking, availability of snacks at home and at school, SR (BAS drive scale) and external and emotional eating (Dutch eating behavior questionnaire) of Flemish adolescents (n = 1104, mean age = 14.7 ± 0.8 years; 51 % boys; 18.0 % overweight) in 20 schools spread across Flanders were collected. Moderated mediation analyses were conducted using generalized structural equation modeling in three steps: (1) direct association between SR and unhealthy snack or SSB intake, (2) mediation of either external or emotional eating and (3) interaction of home or school availability and emotional or external eating. Results Partial mediation of external eating (a*b = 0.69, p < 0.05) and of emotional eating (a*b = 0.92, p < 0.01) in the relation between SR and intake of unhealthy snacks was found (step 2). The relation between SR and SSB intake was not mediated by external or emotional eating (step 2). No moderation effects of home or school availability were found (step 3). Conclusion Our findings indicate that the association between SR and the consumption of unhealthy snacks is partially explained by external and emotional eating in a population-based sample of adolescents irrespective of the home or school availability of these foods.
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Affiliation(s)
- Nathalie De Cock
- Department of Food safety and Food quality, Ghent University, Coupure Links 653, Ghent, Belgium.
| | - Wendy Van Lippevelde
- Department of Public Health, Ghent University, De Pintelaan 185A, Ghent, Belgium.
| | - Lien Goossens
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, Ghent, Belgium.
| | - Bart De Clercq
- Department of Public Health, Ghent University, De Pintelaan 185A, Ghent, Belgium.
| | - Jolien Vangeel
- Leuven School for Mass Communication Research, KU Leuven, Parkstraat 45 -box 3603, Leuven, Belgium.
| | - Carl Lachat
- Department of Food safety and Food quality, Ghent University, Coupure Links 653, Ghent, Belgium.
| | - Kathleen Beullens
- Leuven School for Mass Communication Research, KU Leuven, Parkstraat 45 -box 3603, Leuven, Belgium. .,Research Foundation-Flanders (FWO), Egmontstraat 5, Brussels, Belgium.
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division International Food Policy Research Institute, 2033 K Street, 20006, Washington, DC, USA.
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, Ghent, Belgium.
| | - Steven Eggermont
- Leuven School for Mass Communication Research, KU Leuven, Parkstraat 45 -box 3603, Leuven, Belgium.
| | - Lea Maes
- Department of Public Health, Ghent University, De Pintelaan 185A, Ghent, Belgium.
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, Ghent, Belgium.
| | - Benedicte Deforche
- Department of Public Health, Ghent University, De Pintelaan 185A, Ghent, Belgium. .,Department of Human Biometry and Biomechanics, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Patrick Kolsteren
- Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium.
| | - John Van Camp
- Department of Food safety and Food quality, Ghent University, Coupure Links 653, Ghent, Belgium.
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Katz J, Lee ACC, Vogel JP, Silveira MF, Sania A, Stevens GA, Cousens S, Caulfield LE, Christian P, Huybregts L, Roberfroid D, Schmiegelow C, Adair LS, Barros FC, Cowan M, Fawzi W, Kolsteren P, Merialdi M, Mongkolchati A, Saville N, Victora CG, Bhutta ZA, Blencowe H, Ezzati M, Lawn JE, Black RE. Short Maternal Stature Increases Risk of Small-for-Gestational-Age and Preterm Births in Low- and Middle-Income Countries: Individual Participant Data Meta-Analysis and Population Attributable Fraction. J Nutr 2015; 145:2542-50. [PMID: 26423738 PMCID: PMC6457093 DOI: 10.3945/jn.115.216374] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [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: 05/11/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Small-for-gestational-age (SGA) and preterm births are associated with adverse health consequences, including neonatal and infant mortality, childhood undernutrition, and adulthood chronic disease. OBJECTIVES The specific aims of this study were to estimate the association between short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature. METHODS We conducted an individual participant data meta-analysis with the use of data sets from 12 population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each of these studies, we individually calculated RRs between height exposure categories of < 145 cm, 145 to < 150 cm, and 150 to < 155 cm (reference: ≥ 155 cm) and outcomes of SGA, preterm birth, and their combination categories. SGA was defined with the use of both the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) birth weight standard and the 1991 US birth weight reference. The associations were then meta-analyzed. RESULTS All short stature categories were statistically significantly associated with term SGA, preterm appropriate-for-gestational-age (AGA), and preterm SGA births (reference: term AGA). When using the INTERGROWTH-21st standard to define SGA, women < 145 cm had the highest adjusted risk ratios (aRRs) (term SGA-aRR: 2.03; 95% CI: 1.76, 2.35; preterm AGA-aRR: 1.45; 95% CI: 1.26, 1.66; preterm SGA-aRR: 2.13; 95% CI: 1.42, 3.21). Similar associations were seen for SGA defined by the US reference. Annually, 5.5 million term SGA (18.6% of the global total), 550,800 preterm AGA (5.0% of the global total), and 458,000 preterm SGA (16.5% of the global total) births may be associated with maternal short stature. CONCLUSIONS Approximately 6.5 million SGA and/or preterm births in LMIC may be associated with short maternal stature annually. A reduction in this burden requires primary prevention of SGA, improvement in postnatal growth through early childhood, and possibly further intervention in late childhood and adolescence. It is vital for researchers to broaden the evidence base for addressing chronic malnutrition through multiple life stages, and for program implementers to explore effective, sustainable ways of reaching the most vulnerable populations.
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Affiliation(s)
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
| | - Anne C C Lee
- Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA
| | - Joshua P Vogel
- School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia; UN Development Programme/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research
| | - Mariangela F Silveira
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - Laura E Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lieven Huybregts
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium; Poverty, Nutrition and Health Division, International Food Policy Research Institute, Washington, DC
| | - Dominique Roberfroid
- Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Linda S Adair
- University of North Carolina School of Public Health, Chapel Hill, NC
| | - Fernando C Barros
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Melanie Cowan
- Prevention of Noncommunicable Diseases Department, WHO, Geneva, Switzerland
| | - Wafaie Fawzi
- Department of Global Health and Population, Department of Nutrition, and Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium; Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Mario Merialdi
- UN Development Programme/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, BD, Franklin Lakes, NJ
| | - Aroonsri Mongkolchati
- ASEAN Institute for Health Development, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Naomi Saville
- Institute for Global Health, Institute of Child Health, University College London, London, United Kingdom; Mother and Infant Research Activities, Kathmandu, Nepal
| | - Cesar G Victora
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Hannah Blencowe
- Maternal Reproductive and Child Health Center, and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Majid Ezzati
- Medical Research Council - Public Health England (MRC-PHE) Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Joy E Lawn
- Maternal Reproductive and Child Health Center, and Saving Newborn Lives/Save the Children USA, Washington, DC; and Research and Evidence Division, UK Aid, London, United Kingdom
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Roberfroid D, Huybregts L, Lachat C, Vrijens F, Kolsteren P, Guesdon B. Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference: contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh. Nutr J 2015; 14:86. [PMID: 26303859 PMCID: PMC4547414 DOI: 10.1186/s12937-015-0074-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The two anthropometric indicators of acute malnutrition in children under 5 years, i.e. a Mid-Upper Arm Circumference < 125 mm (MUAC125) or a Weight-for-Height Z-score<-2 (WHZ-2), correlate poorly. We aimed at assessing the contribution of age, sex, stunting (Height-for-Age HAZ<-2), and low sitting-standing height ratio Z-score (SSRZ in the 1st tertile of the study population, called hereafter 'longer legs') to this diagnosis discrepancy. METHODS Data from 16 cross-sectional nutritional surveys carried out by Action Against Hunger International in South Sudan, the Philippines, Chad, and Bangladesh fed multilevel, multivariate regression models, with either WHZ-2 or MUAC125 as the dependent variable and age, sex, stunting, and 'longer legs' as the independent ones. We also compared how the performance of MUAC125 and WHZ-2 to detect slim children, i.e. children with a low Weight-for-Age (WAZ<-2) but no linear growth retardation (HAZ≥-2), was modified by the contributors. RESULTS Overall 23.1% of the 14,409 children were identified as acutely malnourished by either WHZ-2 or MUAC125, but only 28.5% of those (949/3,328) were identified by both indicators. Being stunted (+17.8%; 95 % CI: 14.8%; 22.8%), being a female (+16.5%; 95 % CI: 13.5%; 19.5%) and being younger than 24 months (+33.6%; 95 % CI: 30.4%; 36.7%) were factors strongly associated with being detected as malnourished by MUAC125 and not by WHZ-2, whereas having 'longer legs' moderately increased the diagnosis by WHZ-2 (+4.2%; 95 % CI: 0.7%; 7.6%). The sensitivity to detect slim children by MUAC125 was 31.0% (95 % CI: 26.8%; 35.2%) whereas it was 70.6% (95 % CI: 65.4%; 75.9%) for WHZ-2. The sensitivity of MUAC125 was particularly affected by age (57.4% vs. 18.1% in children aged < 24 months vs. ≥ 24 months). Specificity was high for both indicators. CONCLUSIONS MUAC125 should not be used as a stand-alone criterion of acute malnutrition given its strong association with age, sex and stunting, and its low sensitivity to detect slim children. Having 'longer legs' moderately increases the diagnosis of acute malnutrition by WHZ-2. Prospective studies are urgently needed to elucidate the clinical and physiological outcomes of the various anthropometric indicators of malnutrition.
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Affiliation(s)
- Dominique Roberfroid
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. .,Belgian Health Care Knowledge Center, Brussels, Belgium.
| | - Lieven Huybregts
- International Food Policy Research Institute, Washington, DC, USA.
| | - Carl Lachat
- Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
| | - France Vrijens
- Belgian Health Care Knowledge Center, Brussels, Belgium.
| | - Patrick Kolsteren
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. .,Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
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45
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Tonguet-Papucci A, Huybregts L, Ait Aissa M, Huneau JF, Kolsteren P. The MAM'Out project: a randomized controlled trial to assess multiannual and seasonal cash transfers for the prevention of acute malnutrition in children under 36 months in Burkina Faso. BMC Public Health 2015; 15:762. [PMID: 26253152 PMCID: PMC4529713 DOI: 10.1186/s12889-015-2060-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, as part of safety net approach, have potential to prevent under-nutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to a lack of evidence regarding their nutritional benefits. METHODS/DESIGN The MAM'Out research project aims at evaluating a seasonal and multiannual cash transfer program to prevent acute malnutrition in children under 36 months, in terms of effectiveness and cost-effectiveness in the Tapoa province (Eastern region of Burkina Faso, Africa). The program is targeted to economically vulnerable households with children less than 1 year old at the time of inclusion. Cash is distributed to mothers and the transfers are unconditional, leading to beneficiaries' self-determination on the use of cash. The study is designed as a two-arm cluster randomized intervention trial, based on the randomization of rural villages. One group receives cash transfers via mobile phones and one is a control group. The main outcomes are the cumulative incidence of acute malnutrition and the cost-effectiveness. Child anthropometry (height, weight and MUAC) is followed, as well as indicators related to dietary diversity, food security, health center utilization, families' expenses, women empowerment and morbidities. 24 h-food recalls are also carried out. Individual interviews and focus group discussions allow collecting qualitative data. Finally, based on a theory framework built a priori, the pathways used by the cash to have an effect on the prevention of under-nutrition will be assessed. DISCUSSION The design chosen will lead to a robust assessment of the effectiveness of the proposed intervention. Several challenges appeared while implementing the study and discrepancies with the research protocol, mainly due to unforeseen events, can be highlighted, such as delay in project implementation, switch to e-data collection and implementation of a supervision process. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT01866124, registered May 7, 2013.
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Affiliation(s)
- Audrey Tonguet-Papucci
- Research and Analyses Department, Action Contre la Faim, Paris, France.
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium.
- AgroParisTech, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
- NRA, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
| | - Lieven Huybregts
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium.
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA.
| | - Myriam Ait Aissa
- Research and Analyses Department, Action Contre la Faim, Paris, France.
| | - Jean-François Huneau
- AgroParisTech, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
- NRA, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior, Paris, France.
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium.
- Child Health and Nutrition Unit, Institute of Tropical Medicine, Antwerp, Belgium.
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46
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De Cock N, Van Lippevelde W, Vervoort L, Vangeel J, Maes L, Eggermont S, Braet C, Lachat C, Huybregts L, Goossens L, Beullens K, Kolsteren P, Van Camp J. Sensitivity to reward is associated with snack and sugar-sweetened beverage consumption in adolescents. Eur J Nutr 2015; 55:1623-32. [DOI: 10.1007/s00394-015-0981-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/29/2015] [Indexed: 11/28/2022]
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47
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Kozuki N, Katz J, Christian P, Lee ACC, Liu L, Silveira MF, Barros F, Tielsch JM, Schmiegelow C, Sania A, Roberfroid D, Ndyomugyenyi R, Mullany LC, Mongkolchati A, Huybregts L, Humphrey J, Fawzi W, Baqui AH, Adair L, Oddo VM, Black RE. Comparison of US Birth Weight References and the International Fetal and Newborn Growth Consortium for the 21st Century Standard. JAMA Pediatr 2015; 169:e151438. [PMID: 26147059 DOI: 10.1001/jamapediatrics.2015.1438] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE This study introduces how the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) international birth weight standards alter our previous understanding and interpretations of fetal growth restriction as represented by small for gestational age (SGA) status. OBJECTIVES To compare the birth weight distributions of the INTERGROWTH-21st international standard to commonly used US references and examine the differences in the prevalence and neonatal mortality risk of SGA status (below the 10th percentile of a population reference). DESIGN, SETTING, AND PARTICIPANTS We analyzed data from 16 prospective cohorts of newborns on gestational age, birth weight, and systematic mortality follow-up through 28 days from 10 low- and middle-income countries. The studies included were conducted between 1983 and 2008. The analysis was conducted in 2014. Infants were categorized as SGA using the 1991 US birth weight reference, the 1999-2000 US birth weight reference, and the new INTERGROWTH-21st standard. For each study, we compared the SGA prevalence and the risk ratio between SGA status and neonatal mortality, calculated using Poisson regression with robust error variance. MAIN OUTCOMES AND MEASURES We examine neonatal mortality (death within the first 28 days after birth) as the main outcome measure. RESULTS The pooled SGA prevalence was 23.7% (95% CI, 16.5%-31.0%) using the INTERGROWTH-21st standard compared with 36.0% (95% CI, 27.0%-45.0%) with the US 2000 reference. The relative decrease in prevalence was larger among infants born at 33 to less than 37 weeks' gestation compared with term infants. The pooled neonatal mortality risk did not differ significantly; the adjusted risk ratios were 2.13 (95% CI, 1.78-2.54; P < .001) for the INTERGROWTH-21st standard and 2.12 (95% CI, 1.81-2.48; P < .001) for the US 2000 reference. CONCLUSIONS AND RELEVANCE To our knowledge, INTERGROWTH-21st is the first international newborn standard for size for gestational age for healthy fetal growth. We observed a greater-than-one-quarter reduction in SGA prevalence and no significant change in the associated neonatal mortality risk, resulting in a decrease in the percentage of neonatal death attributable to SGA. Our study sheds light on how previously published studies on SGA status may be reinterpreted with the introduction of this new birth weight standard.
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Affiliation(s)
- Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Li Liu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland3Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mariangela F Silveira
- Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Fernando Barros
- Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - James M Tielsch
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Ayesha Sania
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts
| | - Dominique Roberfroid
- Nutrition and Child Health Unit, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Lieven Huybregts
- Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium12Poverty, Nutrition and Health Division, International Food Policy Research Institute, Washington, DC
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland13ZVITAMBO, Borrowdale, Harare, Zimbabwe
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts14Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts15Department of Epidemiology, Harvard School of Public Health, Boston, Massa
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda Adair
- University of North Carolina School of Public Health, Chapel Hill
| | - Vanessa M Oddo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Andrade S, Lachat C, Ochoa-Aviles A, Verstraeten R, Huybregts L, Roberfroid D, Andrade D, Camp JV, Rojas R, Donoso S, Cardon G, Kolsteren P. A school-based intervention improves physical fitness in Ecuadorian adolescents: a cluster-randomized controlled trial. Int J Behav Nutr Phys Act 2014; 11:153. [PMID: 25490946 PMCID: PMC4272792 DOI: 10.1186/s12966-014-0153-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 11/28/2014] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Effective lifestyle interventions are needed to prevent noncommunicable diseases in low- and middle-income countries. We analyzed the effects of a school-based health promotion intervention on physical fitness after 28 months and explored if the effect varied with important school characteristics. We also assessed effects on screen time, physical activity and BMI. METHODS AND RESULTS We performed a cluster-randomized pair matched trial in schools in urban Ecuador. The intervention included an individual and environmental component tailored to the local context and resources. Primary outcomes were physical fitness (EUROFIT battery), screen time (questionnaires) and physical activity (accelerometers). Change in BMI was a secondary outcome. A total of 1440 grade 8 and 9 adolescents (intervention: n = 700, 48.6%) and 20 schools (intervention: n = 10, 50%) participated. Data of 1083 adolescents (intervention: n = 550, 50.8%) from 20 schools were analyzed. CONCLUSIONS A school-based intervention with an individual and environment component can improve physical fitness and can minimize the decline in physical activity levels from childhood into adolescence in urban Ecuador. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01004367.
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Nikièma L, Huybregts L, Kolsteren P, Lanou H, Tiendrebeogo S, Bouckaert K, Kouanda S, Sondo B, Roberfroid D. Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso. Am J Clin Nutr 2014; 100:241-9. [PMID: 24808482 DOI: 10.3945/ajcn.113.072538] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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
BACKGROUND Management of moderate acute malnutrition (MAM) is, currently, focused on food supplementation approaches. However, the sustainability of these strategies remains weak in low- and middle-income countries. In food-secure settings, an educational/behavioral intervention could be an alternative for improving MAM management. OBJECTIVE This study compared the effectiveness of weekly context-appropriate child-centered counseling (CCC), with an improved corn-soy blend [corn-soy blend with added micronutrients (CSB++)] or a locally produced ready-to-use supplementary food (RUSF), in treating MAM through first-line rural health services. DESIGN We used a cluster randomized controlled trial design with 3 arms, involving 18 rural health centers (6 by arm) and children aged 6-24 mo with uncomplicated MAM. In the first arm (CCC), trained health workers provided weekly personalized counseling to caretakers. In the 2 other arms, children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF. Both food supplements provided ∼250 kcal/d. RESULTS The recovery rate after 3 mo of treatment was significantly lower with CCC (57.8%) than with CSB++ (74.5%) and RUSF (74.2%) (P < 0001). Mothers' attendance at health facilities was also substantially lower in the CCC arm (P < 0001); this arm had a high defaulter rate (P < 0.003). When the analysis was adjusted for attendance, we did not find a significant difference between the 3 arms, with incidence rate ratios of 1.14 (95% CI: 0.99, 1.31) and 1.13 (95% CI: 0.98, 1.30) for the CSB++ and RUSF arms, respectively, compared with the CCC arm. CONCLUSION Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC, we hypothesize that appropriate and specific nutrition counseling centered on children's needs, through primary health facilities, might be an alternative strategy for MAM treatment in rural food-secure areas, provided that attendance at counseling sessions by the caregiver is ensured. This trial was registered at clinicaltrials.gov as NCT01115647.
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Affiliation(s)
- Laetitia Nikièma
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Lieven Huybregts
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Patrick Kolsteren
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Hermann Lanou
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Simon Tiendrebeogo
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Kimberley Bouckaert
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Séni Kouanda
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Blaise Sondo
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
| | - Dominique Roberfroid
- From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK)
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Lanou H, Huybregts L, Roberfroid D, Nikièma L, Kouanda S, Van Camp J, Kolsteren P. Prenatal nutrient supplementation and postnatal growth in a developing nation: an RCT. Pediatrics 2014; 133:e1001-8. [PMID: 24590752 DOI: 10.1542/peds.2013-2850] [Citation(s) in RCA: 29] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prenatal lipid-based nutrient supplements (LNS) have been shown to improve birth anthropometry. However, little is known about the effects of such supplements on infant health. We hypothesized that prenatal LNS compared with multiple micronutrient supplement for pregnant and lactating women would improve survival, growth, and morbidity during infancy. METHODS Infants' weight, length, head, chest, and mid-upper arm circumferences were measured during monthly home visits from birth to 12 months of age in the Micronutriments et Santé de la Mère et de l'Enfant--2 trial. Differences in stunting and wasting episodes between study arms were assessed by Cox regression for recurrent event models. Morbidity signs during the 2 weeks before the visits and death cases were also assessed by multilevel analysis accounting for repeated individual measurements. RESULTS Infant length-for-age growth (-0.033 z score/month; 95% confidence interval: -0.601 to -0.006; P = .018) for the LNS group was inferior to that of the control group. We did not find evidence of significant difference in mortality or morbidity between groups. CONCLUSIONS The previously reported positive effect of prenatal LNS on birth length was not sustained during the postnatal phase. Prenatal LNS does not appear to make a long-lasting difference in child linear growth.
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Affiliation(s)
- Hermann Lanou
- Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso
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