1
|
Delgas F, Bitsch L, König LM, Beitze DE, Scherbaum V, Podszun MC. Dietary supplement use among lactating mothers following different dietary patterns - an online survey. Matern Health Neonatol Perinatol 2024; 10:3. [PMID: 38297389 PMCID: PMC10832081 DOI: 10.1186/s40748-023-00171-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Breastfeeding is important for the healthy growth and development of newborns, and the nutrient composition of human milk can be affected by maternal nutrition and supplementation. In Germany, iodine supplementation is recommended for all lactating mothers, and docosahexaenoic acid (DHA) supplementation is recommended for mothers with inadequate or no fish intake. Vitamin B12 supplementation is required for strict vegans during lactation, and other nutrient supplementation may be necessary depending on the individual's nutritional status. To address the lack of data on dietary supplements used by lactating mothers following a vegetarian or vegan diet, an online survey was conducted in Germany, with a focus on iodine, DHA, and vitamin B12. METHODS Study participants were asked to report whether they followed specific dietary patterns (omnivorous [OM], vegetarian [VT], vegan [VN]) as well as their use of dietary supplements. Relationships between diets and supplement use were analyzed using chi-square tests. RESULTS 2054 lactating women were included (1240 OM, 410 VT, and 404 VN) in this analysis. Within OM, VT and VN, at least one dietary supplement was taken by 67.3%, 84.9% and 98.0% respectively (p < 0.001). Overall, 53.2% OM, 66.8% VT, 88.4% VN reported taking at least one supplement containing iodine (p < 0.001). 54.6% OM, 61.7% VT and 58.2% VN reported supplements containing vitamin B12, while 34.1% OM, 40.2% VT and 38.6% VN mentioned supplements containing DHA (p < 0.05). CONCLUSION More than half of the participants reported the use of supplements during lactation with the highest proportion in vegans. However, over one third of the mothers did not report supplementing with iodine, regardless of their dietary pattern and most participants also did not report DHA supplements. It is worrisome that a high number of vegans did not report vitamin B12 supplementation, but this could be partly due to issues with reporting. It is crucial to provide further education to breastfeeding mothers about the importance of taking micronutrient supplements, especially for those following a vegetarian or vegan diet. This will help ensure that mothers and their breastfed infants receive optimal nutrition for a healthy development.
Collapse
Affiliation(s)
- Franziska Delgas
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr.12, 70599, Stuttgart, Germany.
| | - Lisa Bitsch
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr.12, 70599, Stuttgart, Germany
| | - Laura Maria König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Bayreuth, Germany
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Maren C Podszun
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr.12, 70599, Stuttgart, Germany.
| |
Collapse
|
2
|
Beitze DE, Kavira Malengera C, Barhwamire Kabesha T, Frank J, Scherbaum V. Disparities in health and nutrition between semi-urban and rural mothers and birth outcomes of their newborns in Bukavu, DR Congo: a baseline assessment. Prim Health Care Res Dev 2023; 24:e61. [PMID: 37870120 PMCID: PMC10594532 DOI: 10.1017/s1463423623000518] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/24/2023] Open
Abstract
AIM This research aimed to evaluate health and nutritional practices of mothers during pregnancy and birth outcomes of their newborns in Bukavu, Democratic Republic of the Congo (DRC), comparing semi-urban and rural areas. BACKGROUND Health and nutrition during pregnancy are crucial for adequate development of the fetus. Health care plays an important role but is often poor in rural areas of developing countries. METHODS A baseline survey of a nutritional follow-up study was conducted in two semi-urban and one rural hospital in the vicinity of Bukavu, DRC. In total, 471 mother-child pairs were recruited after delivery. Data collection included socio-demographic parameters, nutrition and health measures during pregnancy, and anthropometric parameters. Semi-urban and rural study locations were compared and predictors of birth weight evaluated. FINDINGS Semi-urban and rural mothers differed significantly in nutrition and health practices during pregnancy, as well as birth outcomes. In the rural area, there was a higher rate of newborns with low birth weight (10.7%) and lower rates of antimalarial medication (80.8%), deworming (24.6%), consumption of nutritional supplements (81.5%), and being informed about nutrition by medical staff (32.8%) during pregnancy as well as practicing family planning (3.1%) than in the semi-urban areas (2.7%, 88.6%, 88.3%; 89.3%, 46.5%, and 17.1%, respectively). Birth weight was positively predicted by increasing maternal MUAC, age, and gestational age and negatively by rural location, being primipara, being a farmer, and female newborn sex. CONCLUSION The findings highlight the importance of strengthening antenatal care activities especially in rural areas in order to ameliorate both maternal and infantile health and ensure appropriate development.
Collapse
Affiliation(s)
| | - Céline Kavira Malengera
- School of Public Health, Faculty of Medicine, Université de Goma, Goma, DR Congo
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Département de Nutrition, Centre de Recherche en Sciences Naturelles/Lwiro, D.S. Bukavu, DR Congo
| | - Theophile Barhwamire Kabesha
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR Congo
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
3
|
Abou-Rizk J, Jeremias T, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study. Nutrients 2022; 14:nu14214459. [PMID: 36364722 PMCID: PMC9654662 DOI: 10.3390/nu14214459] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
Collapse
Affiliation(s)
- Joana Abou-Rizk
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
- Correspondence: or
| | - Theresa Jeremias
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC 27707, USA or
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Jan Frank
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| |
Collapse
|
4
|
Woldetensay YK, Belachew T, Ghosh S, Kantelhardt EJ, Biesalski HK, Scherbaum V. The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study. Int Breastfeed J 2021; 16:27. [PMID: 33743775 PMCID: PMC7980325 DOI: 10.1186/s13006-021-00375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index. METHODS This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors. RESULTS Reports of higher postnatal depressive symptoms (ß = - 1.03, P = 0.001) and IPV (ß = - 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index. CONCLUSIONS Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.
Collapse
Affiliation(s)
- Yitbarek Kidane Woldetensay
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Tefera Belachew
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Shibani Ghosh
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, USA
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Hans Konrad Biesalski
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
5
|
Abera SF, Kantelhardt EJ, Bezabih AM, Tsadik M, Lauvai J, Ejeta G, Wienke A, Frank J, Scherbaum V. What factors are associated with maternal undernutrition in eastern zone of Tigray, Ethiopia? Evidence for nutritional well-being of lactating mothers. BMC Public Health 2020; 20:1214. [PMID: 32770979 PMCID: PMC7414570 DOI: 10.1186/s12889-020-09313-0] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background Maternal undernutrition is a pervasive health problem among Ethiopian mothers. This study aims at identifying the level of maternal undernutrition and its associated factors in Kilte Awaleo-Health and Demographic Surveillance Site (KA-HDSS), Tigray region, Ethiopia. Methods Nutritional status of 2260 lactating mothers was evaluated using the mid-upper-arm circumference (MUAC). Data from the vital events and verbal autopsy databases were linked to the survey and baseline recensus data to investigate the association of adult mortality from chronic causes of death (CoD) on maternal undernutrition. We employed a generalized log-binomial model to estimate the independent effects of the fitted covariates. Results The overall prevalence of maternal undernutrition based on MUAC < 23 cm was 38% (95% CI: 36.1, 40.1%). Recent occurrence of household morbidity (adjusted prevalence ratio (adjPR) = 1.49; 95%CI: 1.22, 1.81) was associated with increased risk of maternal undernutrition. In addition, there was a 28% higher risk (adjPR = 1.28; 95%CI: 0.98, 1.67) of maternal undernutrition for those mothers who lived in households with history of adult mortality from chronic diseases. Especially, its association with severe maternal undernutrition was strong (adjusted OR = 3.27; 95%CI: 1.48, 7.22). In contrast, good maternal health-seeking practice (adjPR = 0.86; 95%CI: 0.77, 0.96) and production of diverse food crops (adjPR = 0.72; 95%CI: 0.64, 0.81) were associated with a lower risk of maternal undernutrition. Relative to mothers with low scores of housing and environmental factors index (HAEFI), those with medium and higher scores of HAEFI had 0.81 (adjPR = 0.81; 95%CI: 0.69, 0.95) and 0.82 (adjPR = 0.82; 95%CI: 0.72, 0.95) times lower risk of maternal undernutrition, respectively. Conclusions Efforts to ameliorate maternal undernutrition need to consider the influence of the rising epidemiology of adult mortality from chronic diseases. Our data clearly indicate the need for channeling the integrated intervention power of nutrition-sensitive development programs with that of nutrition-specific sectoral services.
Collapse
Affiliation(s)
- Semaw Ferede Abera
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany. .,Food Security Center, University of Hohenheim, Stuttgart, Germany. .,School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany.,Department of Gynaecology, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mache Tsadik
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,Kilte Awlaelo - Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Judith Lauvai
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Gebisa Ejeta
- Department of Agronomy, Purdue University, West Lafayette, IN, USA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
6
|
Stiller CK, Golembiewski SKE, Golembiewski M, Mondal S, Biesalski HK, Scherbaum V. Maternal nutritional status and child feeding practices: a retrospective study in Santal communities, Birbhum District, West Bengal, India. Int Breastfeed J 2020; 15:50. [PMID: 32471456 PMCID: PMC7257594 DOI: 10.1186/s13006-020-00262-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background In West Bengal, according to the National Family Health Survey (NFHS-4) 2015-16, undernutrition and anemia are particularly common among scheduled tribe women and children. The purpose of this research is to assess the nutritional status of Adivasi mothers and child feeding patterns, relevant for clinical practice and the design of future preventive actions. These baseline characteristics were obtained in the scope of a feeding trial aimed at improving the hemoglobin concentration of the index child (6–39 months). Methods In February 2015, the baseline survey was conducted in 21 tribal villages. In total, 288 mothers and 307 children were recruited for their hemoglobin levels (HemoCue Hb201+), as well as anthropometric indices height/length, weight and MUAC. By questionnaire-based interview aspects on child feeding practices, childcare, family scheduling, and prenatal care were elucidated. Results The majority of mothers belong to the Santal tribe (93.8%). Nearly half of mothers suffered from underweight including severe forms (BMI < 18.5: 49.4%), and the majority of mothers were anemic (Hb < 12 g/dl: 86.2%). Similarly, undernutrition was highly prevalent among the index children. Ever breastfeeding was almost universal in the study area (99.6%), with all infants aged < 12 months at the time of the interview still being breastfed. The majority of children were breastfed within the first hour after birth (75.7%), still every third child (32.2%) was deprived of colostrum. Merely 32.9% of infants were exclusively breastfed for 6 months (180 days) according to the recommendations of the WHO/UNICEF. When relating to the proposed complementary feeding (CF) indicator then 89.6% of children have received CF (mainly family foods/biscuits/plain rice) during the first 6 to 8 months, and 46.8% of children aged 6 to 23 months fulfilled the minimum acceptable diet (2 to 3 meals per day and ≥ 4 food groups per day), corresponding to 58.1% among children aged 12 to 23 months versa 25% among infants aged 6 to 11 months. Conclusion The maternal nutritional status was poor and showed interrelations with the nutritional status of the index child. Inadequate feeding and caring practices were common. In particular the younger age group (< 12 months) was found at risk of being offered inadequate CF, which needs to be tackled by future programs. Trial registration The trial was retrospectively registered at the German Clinical Trials Register on the 1st July 2019 (DRKS00017388).
Collapse
Affiliation(s)
- Caroline Katharina Stiller
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstr. 30, 70599, Stuttgart, Germany. .,Shining Eyes -medical aid for children and socioeconomic village development in India e.V., Flein, Germany.
| | - Silvia Konstanze Ellen Golembiewski
- Shining Eyes -medical aid for children and socioeconomic village development in India e.V., Flein, Germany. .,Institute of Household and Consumer Economics (530A), University of Hohenheim, Stuttgart, Germany.
| | - Monika Golembiewski
- Shining Eyes -medical aid for children and socioeconomic village development in India e.V., Flein, Germany
| | - Srikanta Mondal
- Bolpur Manab Jamin, South Jambuni, Birbhum District, Bolpur, West Bengal, India
| | - Hans Konrad Biesalski
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstr. 30, 70599, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Garbenstr. 30, 70599, Stuttgart, Germany
| |
Collapse
|
7
|
Abera SF, Kantelhardt EJ, Bezabih AM, Gebru AA, Ejeta G, Lauvai J, Wienke A, Scherbaum V. Nutrition-specific and sensitive drivers of poor child nutrition in Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, Northern Ethiopia: implications for public health nutrition in resource-poor settings. Glob Health Action 2019; 12:1556572. [PMID: 31154991 PMCID: PMC6338276 DOI: 10.1080/16549716.2018.1556572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/21/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Child undernutrition is a prevalent health problem and poses various short and long-term consequences. Objective: This study seeks to investigate the burden of child undernutrition and its drivers in Kilte Awlaelo-Health and Demographic Surveillance Site, Tigray, northern Ethiopia. Methods: In 2015, cross-sectional data were collected from 1,525 children aged 6-23 months. Maternal and child nutritional status was assessed using the mid upper arm circumference. Child's dietary diversity score was calculated using 24-hours dietary recall method. Log-binomial regression and partial proportional odds model were fitted to examine the drivers of poor child nutrition and child dietary diversity (CDD), respectively. Results: The burden of undernutrition and inadequate CDD was 13.7% (95% CI: 12.1-15.5%) and 81.3% (95%CI: 79.2-83.1%), respectively. Maternal undernutrition (adjusted prevalence ratio, adjPR = 1.47; 95%CI: 1.14-1.89), low CDD (adjPR = 1.90; 95%CI: 1.22-2.97), and morbidity (adjPR = 1.83; 95%CI: 1.15-2.92) were the nutrition-specific drivers of child undernutrition. The nutrition-sensitive drivers were poverty (compared to the poorest, adjPR poor = 0.65 [95%CI:0.45-0.93], adjPR medium = 0.64 [95%CI: 0.44-0.93], adjPR wealthy = 0.46 [95%CI: 0.30-0.70], and adjPR wealthiest = 0.53 [95%CI: 0.34-0.82]), larger family size (adjPR = 1.10; 95%CI: 1.02-1.18), household head's employment insecurity (adjPR = 2.10; 95%CI: 1.43-3.09), and residing in highlands (adjPR = 1.93; 95%CI: 1.36-2.75). The data show that higher CDD was positively associated with wealth (OR wealthy = 3.06 [95%CI: 1.88-4.99], OR wealthiest = 2.57 [95%CI: 1.53-4.31]), but it was inversely associated with lack of diverse food crops production in highlands (OR = 0.23; 95%CI: 0.10-0.57]). Conclusions: Our findings suggest that the burden of poor child nutrition is very high in the study area. Multi-sectoral collaboration and cross-disciplinary interventions between agriculture, nutrition and health sectors are recommended to address child undernutrition in resource poor and food insecure rural communities of similar settings.
Collapse
Affiliation(s)
- Semaw Ferede Abera
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany
- Department of Gynaecology, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Afewrok Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Alemseged Aregay Gebru
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebisa Ejeta
- Department of Agronomy, Purdue University, West Lafayette, IN, USA
| | - Judith Lauvai
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University, Halle, Germany
| | - Veronika Scherbaum
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
8
|
Woldetensay YK, Belachew T, Biesalski HK, Ghosh S, Lacruz ME, Scherbaum V, Kantelhardt EJ. The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study. BMC Pregnancy Childbirth 2018; 18:374. [PMID: 30219050 PMCID: PMC6139168 DOI: 10.1186/s12884-018-2009-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression during pregnancy has far-reaching adverse consequences on mothers, children and the whole family. The magnitude and determinants of prenatal depressive symptoms in low-resource countries are not well established. This study aims to describe the prevalence of prenatal depressive symptoms and whether it is associated with maternal nutrition, intimate partner violence and social support among pregnant women in rural Ethiopia. METHODS This study is based on the baseline data from a large prospective, community-based, birth cohort study conducted in the South Western part of Ethiopia from March 2014 to March 2016. A total of 4680 pregnant women were recruited between 12 and 32 weeks of gestation. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9) scale and a cut off of ≥8 was taken to define prenatal depressive symptoms. Data collection was conducted electronically on handheld tablets and submitted to a secured server via an internet connection. Bivariate and multivariate logistic regression analyses were computed using IBM SPSS version 20 software. RESULT The community based prevalence of depressive symptoms during pregnancy was 10.8% (95%Confidence Interval (CI): 9.92-11.70). Adjusting for confounding variables, moderate household food insecurity (OR 1.74; 95% CI: 1.31-2.32), severe household food insecurity (OR 7.90; 95% CI: 5.87-10.62), anaemia (OR = 1.30; 95% CI: 1.04-1.61) and intimate partner violence (OR 3.08; 95% CI: 2.23-4.25) were significantly associated with prenatal depressive symptoms. On the other hand, good social support from friends, families and husband reduced the risk of prenatal depressive symptoms by 39% (OR 0.61; 95% CI: 0.50-0.76). CONCLUSION Prenatal depressive symptomatology is rather common during pregnancy in rural Ethiopia. In this community based study, household food insecurity, anaemia and intimate partner violence were significantly associated with prenatal depressive symptoms. Good maternal social support from friends, families and spouse was rather protective. The study highlights the need for targeted screening for depression and intimate partner violence during pregnancy. Policies aimed at reducing household food insecurity, maternal anaemia and intimate partner violence during pregnancy may possibly reduce depression.
Collapse
Affiliation(s)
- Yitbarek Kidane Woldetensay
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Stuttgart, Germany. .,Food Security Center, University of Hohenheim, Stuttgart, Germany. .,Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia.
| | - Tefera Belachew
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Shibani Ghosh
- Tufts University, Freidman School of Nutrition Science and Policy, Boston, USA
| | - Maria Elena Lacruz
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Veronika Scherbaum
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Stuttgart, Germany.,Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Faculty of Medicine, Martin-Luther University, Halle, Germany.,Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| |
Collapse
|
9
|
Woldetensay YK, Belachew T, Tesfaye M, Spielman K, Biesalski HK, Kantelhardt EJ, Scherbaum V. Validation of the Patient Health Questionnaire (PHQ-9) as a screening tool for depression in pregnant women: Afaan Oromo version. PLoS One 2018; 13:e0191782. [PMID: 29408928 PMCID: PMC5800570 DOI: 10.1371/journal.pone.0191782] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 01/04/2018] [Indexed: 12/03/2022] Open
Abstract
Background Semantic, technical, content, criterion and conceptual equivalence must be examined in order to validate a psychological rating scale in a new cultural setting. Few validation studies have been conducted in sub-Saharan Africa for scales seeking to detect depression in pregnant women. The aim of this study is to validate the 9-item Patient Health Questionnaire (PHQ-9) as a screening instrument for depression among Afaan Oromo speaking pregnant Ethiopian women. Methods A random sample of 246 pregnant women were recruited in Seka Chekorsa District, Ethiopia during their first, second or third trimester. One week later, 29 participants were selected to answer the questionnaire for a second time to evaluate test retest reliability. The Mini International Neuropsychiatric Interview (MINI-Plus) scale was used as a gold standard to evaluate validity. PHQ-9 was compared with MINI-Plus and sensitivity, specificity, accuracy, positive likelihood ratio, negative likelihood ratio and Receiver Operating Characteristic Curves (ROC) for PHQ-9 were calculated. Rasch analysis was also carried out using Winsteps version 3.81.0. Results The reliability coefficient, Cronbach's alpha, for the PHQ-9 total score was 0.84. Both the agreement and consistency Intra-class Correlation coefficients (ICC) for the one-week test-retest reliability were 0.98. The cut-off point of a summed score of eight resulted in a sensitivity of 80.8% and a specificity of 79.5%. The calculated area under the curve (AUC) for the PHQ-9 score versus the MINI-Plus was excellent, 0.88 (SE = 0.04; CI = 0.81–0.95). The PHQ-9 meets the criteria established by Linacre for rating scale effectiveness. Conclusions The PHQ-9 proved to be a reliable and valid instrument that may be used to screen major depressive disorders among Afaan Oromo speaking Ethiopian pregnant women.
Collapse
Affiliation(s)
- Yitbarek Kidane Woldetensay
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Tefera Belachew
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Markos Tesfaye
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Kathryn Spielman
- Tufts University, Freidman School of Nutrition Science and policy, Boston, United States of America
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Veronika Scherbaum
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
10
|
Abera SF, Gebru AA, Biesalski HK, Ejeta G, Wienke A, Scherbaum V, Kantelhardt EJ. Social determinants of adult mortality from non-communicable diseases in northern Ethiopia, 2009-2015: Evidence from health and demographic surveillance site. PLoS One 2017; 12:e0188968. [PMID: 29236741 PMCID: PMC5728486 DOI: 10.1371/journal.pone.0188968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 11/16/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION In developing countries, mortality and disability from non-communicable diseases (NCDs) is rising considerably. The effect of social determinants of NCDs-attributed mortality, from the context of developing countries, is poorly understood. This study examines the burden and socio-economic determinants of adult mortality attributed to NCDs in eastern Tigray, Ethiopia. METHODS We followed 45,982 adults implementing a community based dynamic cohort design recording mortality events from September 2009 to April 2015. A physician review based Verbal autopsy was used to identify the most probable causes of death. Multivariable Cox proportional hazards regression was performed to identify social determinants of NCD mortality. RESULTS Across the 193,758.7 person-years, we recorded 1,091 adult deaths. Compared to communicable diseases, NCDs accounted for a slightly higher proportion of adult deaths; 33% vs 34.5% respectively. The incidence density rate (IDR) of NCD attributed mortality was 194.1 deaths (IDR = 194.1; 95% CI = 175.4, 214.7) per 100,000 person-years. One hundred fifty-seven (41.8%), 68 (18.1%) and 34 (9%) of the 376 NCD deaths were due to cardiovascular disease, cancer and renal failure, respectively. In the multivariable analysis, age per 5-year increase (HR = 1.35; 95% CI: 1.30, 1.41), and extended family and non-family household members (HR = 2.86; 95% CI: 2.05, 3.98) compared to household heads were associated with a significantly increased hazard of NCD mortality. Although the difference was not statistically significant, compared to poor adults, those who were wealthy had a 15% (HR = 0.85; 95% CI: 0.65, 1.11) lower hazard of mortality from NCDs. On the other hand, literate adults (HR = 0.35; 95% CI: 0.13, 0.9) had a significantly decreased hazard of NCD attributed mortality compared to those adults who were unable to read and write. The effect of literacy was modified by age and its effect reduced by 18% for every 5-year increase of age among literate adults. CONCLUSION In summary, the study indicates that double mortality burden from both NCDs and communicable diseases was evident in northern rural Ethiopia. Public health intervention measures that prioritise disadvantaged NCD patients such as those who are unable to read and write, the elders, the extended family and non-family household co-residents could significantly reduce NCD mortality among the adult population.
Collapse
Affiliation(s)
- Semaw Ferede Abera
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, Mekelle, Ethiopia
| | - Alemseged Aregay Gebru
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Kilte Awlaelo- Health and Demographic Surveillance Site, Mekelle, Ethiopia
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Gebisa Ejeta
- Department of Agronomy, Purdue University, West Lafayette, Indiana, United States of America
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Veronika Scherbaum
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Department of Gynaecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
| |
Collapse
|
11
|
Keno T, Ahrens C, Lauvai J, Kurabachew H, Biesalski HK, Scherbaum V. Iodine status in pregnant women and school children of the Aira district in Ethiopia. NFS Journal 2017. [DOI: 10.1016/j.nfs.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Abstract
Breastfeeding has an important role in the prevention of different forms of childhood malnutrition, including wasting, stunting, over- and underweight and micronutrient deficiencies. This chapter reviews research that demonstrates how improved breastfeeding rates have the potential to improve childhood nutrition, with associated impacts on infectious and noninfectious disease prevention. The unique composition of breastmilk, the importance of breastfeeding in infectious disease prevention, the iron status of breastfed infants, and breastfeeding's protective effect on overweight and obesity are discussed based on currently available research. Early and tailored dietary counseling is needed to improve maternal diets, which can affect the nutritional status of breastmilk. Promotion and support of breastfeeding are important to prevent childhood morbidity and mortality. A review of the literature reveals key factors shown to be effective in improving breastfeeding rates, especially including legislation to control the marketing of breastmilk substitutes. In conclusion, breastfeeding is shown to be the best natural resource to improve childhood nutrition throughout the world.
Collapse
|
13
|
Gao H, Wang Q, Hormann E, Stuetz W, Stiller C, Biesalski HK, Scherbaum V. Breastfeeding practices on postnatal wards in urban and rural areas of the Deyang region, Sichuan province of China. Int Breastfeed J 2016; 11:11. [PMID: 27182280 PMCID: PMC4867090 DOI: 10.1186/s13006-016-0070-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 05/02/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the efforts that have been made to promote breastfeeding in China since the 1990s, there is still a very low prevalence of exclusive breastfeeding. The objective of this study was to assess the current situation of infant feeding practices during the postpartum hospital stay in urban and rural areas of the Deyang region. METHODS Cross-sectional sampling was used in two urban hospitals and five rural clinics in the Deyang region of southwestern China. Interviews with mothers after delivery (urban n = 102, rural n = 99) were conducted before discharge and five focus group discussions were held. RESULTS The prevalence of Caesarean section was high in both urban and rural areas (63.9 % urban vs. 68.4 % rural). After birth, nearly all mothers (98.0 % urban vs. 99.0 % rural) initiated breastfeeding. One week after delivery, the prevalence of exclusive breastfeeding was 8.0 % (9.8 % urban vs. 6.1 % rural), almost exclusive breastfeeding 34.5 % (29.4 % urban vs. 39.8 % rural), mixed feeding 56.0 % (58.8 % urban vs. 53.1 % rural), and exclusive formula feeding 1.5 % (2.0 % urban vs. 1.0 % rural). Breastfeeding initiation (≤ two days after birth) was positively associated (Odds Ratio [OR] 1.97, 95 % Confidence Interval [CI] 1.11, 3.50) with exclusive and almost exclusive breastfeeding, whereas birth length under 50 cm (OR 0.48, 95 % CI 0.26, 0.87), mother's education > 12 years (OR 0.46, 95 % CI 0.24, 0.88) and mother's lack of knowledge about the importance of colostrum (OR 0.35, 95 % CI 0.14, 0.86) were negatively associated with almost exclusive breastfeeding. CONCLUSION Although disparities between urban and rural areas exist, the situation of infant feeding is inadequate in both settings. The high prevalence of Caesarean section, the mothers' poor knowledge of the physiology of breast milk production, the mothers' lack of breastfeeding confidence, the widespread advertising of breast milk substitutes, and the changing perception of the function of breasts, may influence the unfavorable breastfeeding behavior observed in the study area.
Collapse
Affiliation(s)
- Haoyue Gao
- />Institute of Social Science in Agriculture (430b), University of Hohenheim, Museumsfluegel, Stuttgart, 70599 Germany
| | - Qi Wang
- />Medical Society of Deyang City, Sichuan, Public Health Bureau of Deyang, Lushan Nan Road No. 299, Jingyang District, Deyang, 618000 China
| | - Elizabeth Hormann
- />Europäisches Institut für Stillen und Laktation, Wittberg 14, Kramsach, 6233 Austria
| | - Wolfgang Stuetz
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
| | - Caroline Stiller
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
| | - Hans Konrad Biesalski
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
- />Food Security Center (793), University of Hohenheim, Wollgrasweg 43, Stuttgart, 70599 Germany
| | - Veronika Scherbaum
- />Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart, 70599 Germany
- />Food Security Center (793), University of Hohenheim, Wollgrasweg 43, Stuttgart, 70599 Germany
| |
Collapse
|
14
|
Bellows AC, Lemke S, Jenderedjian A, Scherbaum V. Violence as an Under-Recognized Barrier to Women’s Realization of Their Right to Adequate Food and Nutrition. Violence Against Women 2015; 21:1194-217. [DOI: 10.1177/1077801215591631] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article addresses under-acknowledged barriers of structural violence and discrimination that interfere with women’s capacity to realize their human rights generally, and their right to adequate food and nutrition in particular. Case studies from Georgia and South Africa illustrate the need for a human rights–based approach to food and nutrition security that prioritizes non-discrimination, public participation, and self-determination. These principles are frustrated by different types of structural violence that, if not seriously addressed, pose multiple barriers to women’s economic, public, and social engagement.
Collapse
Affiliation(s)
| | - Stefanie Lemke
- Coventry University, Center for Agroecology, Water, and Resilience, UK, and University of Hohenheim, Institute for Social Sciences in Agriculture (430b), Stuttgart, Germany
| | - Anna Jenderedjian
- University of Hohenheim, Institute for Social Sciences in Agriculture (430b), Stuttgart, Germany
| | - Veronika Scherbaum
- University of Hohenheim, Institute of Biological Chemistry and Nutrition (140a), and Food Security Center (FSC), Stuttgart, Germany
| |
Collapse
|
15
|
Scherbaum V, Purwestri RC, Stuetz W, Inayati DA, Suryantan J, Bloem MA, Biesalski HK. Locally produced cereal/nut/legume-based biscuits versus peanut/milk-based spread for treatment of moderately to mildly wasted children in daily programmes on Nias Island, Indonesia: an issue of acceptance and compliance? Asia Pac J Clin Nutr 2015; 24:152-61. [PMID: 25740754 DOI: 10.6133/apjcn.2015.24.1.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment effects of fortified ready-to-use foods for moderately to mildly wasted children are largely unknown. METHODS Two nutritionally comparable forms of locally produced ready-to-use foods for daily feeding programmes of moderately to mildly wasted children (weight-for-height Z-score/WHZ>=-3 to <-1.5SD) were assessed on Nias, Indonesia. The frequencies of reaching target WHZ>=-1.5SD, compliance to the ready-touse food programme, and weight gain until recovery or programme closure among children treated with peanut/ milk-based spreads (n=29) were compared among children receiving cereal/nut/legume-based biscuits (n=44) and a second group treated with cereal/nut/legume-based biscuits whose mothers received intensive nutrition education (n=38). RESULTS Children in the cereal/nut/legume-based biscuits groups were younger (31 and 33 vs 39 months, p=0.004) and more likely to be moderately wasted (45 and 39 vs 21% with WHZ<-2, p=0.114) at admission, but had a higher rate in recovery (84 and 79 vs 62%, p=0.086) and showed more frequently a high compliance (>80%) to the ready-to-use (86 and 84 vs 45%, p<0.001) than those children in the peanut/milk-based spreads programme. Multivariable logistic regression revealed high compliance followed by weight gain and a lower degree of wasting at admission as independent and significant predictors of reaching target WHZ>=-1.5SD (all p<0.01). Weight gain was positively associated with the consumption of the biscuits (vs peanut//milk-based spreads: r=0.188, p=0.051) and was highest in the cereal/nut/legume-based biscuits plus intensive education compared with the cereal/nut/legume-based biscuits and peanut/milk-based spreads groups. CONCLUSIONS Locally produced ready-to-use foods as biscuits or spreads were similarly effective for rehabilitation of moderately to mildly wasted children.
Collapse
Affiliation(s)
- Veronika Scherbaum
- Institute for Social Sciences in Agriculture, Department of Gender and Nutrition (430), University of Hohenheim, Schloss, Museumsfluegel, 70593 Stuttgart, Germany. .,Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | - Ratna Chrismiari Purwestri
- Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.,Faculty of Medicine, Nutrition Department, University of Brawijaya, Malang, Indonesia
| | - Wolfgang Stuetz
- Institute of Nutrition, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Dyah Ayu Inayati
- Institute for Social Sciences in Agriculture, Department of Gender and Nutrition (430), University of Hohenheim, Schloss, Museumsfluegel, 70593 Stuttgart, Germany
| | | | | | - Hans Konrad Biesalski
- Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
16
|
Abstract
The economic value of breastfeeding to the society at large is under researched and its importance as a preventive public health strategy is underestimated. What little research there is indicates that considerable savings would accrue from following the WHO/UNICEF advice to breastfeed exclusively for six months and continue breastfeeding along with complementary foods for two years or more. Despite relatively high breastfeeding initiation in Germany, neither exclusive breastfeeding nor breastfeeding duration come close to international recommendations. Breastfeeding is mostly regarded as a woman’s personal choice and the government has been slow to engage in breastfeeding promotion, support and research. Some structures in Germany do offer support for breastfeeding women – including the growing number of Baby Friendly Hospital Initiative (BFHI) certified hospitals and a comprehensive maternity leave policy. However, the costs of breastfeeding are mostly borne by the mothers and those for breastfeeding training mostly by the individual health care workers or hospital, while the health insurance companies and society-at-large are profiting from the financial savings from exclusive and long-term breastfeeding. Factors which might improve breastfeeding rates and duration in this country include broad expansion of and financial support for both BFHI hospitals as well as training for the health care personnel who support the mother-infant dyad during the breastfeeding period.
Collapse
Affiliation(s)
| | - Elizabeth Hormann
- European Institute for Breastfeeding and Lactation (ret.), Neusser Str. 866, Cologne, 50737 Germany
| | - Veronika Scherbaum
- Institute for Social Science in Agriculture, Gender and Nutrition, University of Hohenheim, 430b, Schloß, Museumsflügel, Stuttgart, 70593 Germany
| |
Collapse
|
17
|
Gao H, Stiller CK, Scherbaum V, Biesalski HK, Wang Q, Hormann E, Bellows AC. Dietary intake and food habits of pregnant women residing in urban and rural areas of Deyang City, Sichuan Province, China. Nutrients 2013; 5:2933-54. [PMID: 23912325 PMCID: PMC3775236 DOI: 10.3390/nu5082933] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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: 03/22/2013] [Revised: 05/31/2013] [Accepted: 07/01/2013] [Indexed: 11/17/2022] Open
Abstract
Micronutrient deficiencies and imbalanced dietary intake tend to occur during the reproductive period among women in China. In accordance with traditional Chinese culture, pregnant women are commonly advised to follow a specific set of dietary precautions. The purpose of this study was to assess dietary intake data and identify risk factors for nutritional inadequacy in pregnant women from urban and rural areas of Deyang region, Sichuan province of China. Cross-sectional sampling was applied in two urban hospitals and five rural clinics (randomly selected) in Deyang region. Between July and October 2010, a total of 203 pregnant women in the third trimester, aged 19-42 years, were recruited on the basis of informed consent during antenatal clinic sessions. Semi-structured interviews on background information and 24-h dietary recalls were conducted. On the basis of self-reported height and pre-pregnancy weight, 68.7% of the women had a pre-pregnancy body mass index (BMI) within the normal range (18.5 ≤ BMI < 25), 26.3% were found to be underweight with a BMI <18.5 (20.8% in urban vs. 35.6% in rural areas), while only 5.1% were overweight with a BMI ≥30. In view of acceptable macronutrient distribution ranges (AMDRs) the women's overall dietary energy originated excessively from fat (39%), was low in carbohydrates (49.6%), and reached the lower limits for protein (12.1%). Compared to rural areas, women living in urban areas had significantly higher reference nutrient intake (RNI) fulfillment levels for energy (106.1% vs. 93.4%), fat (146.6% vs. 119.7%), protein (86.9% vs. 71.6%), vitamin A (94.3% vs. 65.2%), Zn (70.9% vs. 61.8%), Fe (56.3% vs. 48%), Ca (55.1% vs. 41%) and riboflavin (74.7% vs. 60%). The likelihood of pregnant women following traditional food recommendations, such as avoiding rabbit meat, beef and lamb, was higher in rural (80%) than in urban (65.1%) areas. In conclusion, culturally sensitive nutrition education sessions are necessary for both urban and rural women. The prevalence of underweight before conception and an insufficient supply of important micronutrients were more pronounced in rural areas. Therefore, attention must be given to the nutritional status, especially of rural women before, or at the latest, during pregnancy.
Collapse
Affiliation(s)
- Haoyue Gao
- Institute of Social Sciences in Agriculture, Gender and Nutrition (430b), University of Hohenheim, Garbenstraße 30, Stuttgart 70599, Germany; E-Mails: (H.G.); (C.K.S.)
| | - Caroline K. Stiller
- Institute of Social Sciences in Agriculture, Gender and Nutrition (430b), University of Hohenheim, Garbenstraße 30, Stuttgart 70599, Germany; E-Mails: (H.G.); (C.K.S.)
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart 70599, Germany; E-Mail:
| | - Veronika Scherbaum
- Institute of Social Sciences in Agriculture, Gender and Nutrition (430b), University of Hohenheim, Garbenstraße 30, Stuttgart 70599, Germany; E-Mails: (H.G.); (C.K.S.)
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart 70599, Germany; E-Mail:
| | - Hans Konrad Biesalski
- Institute of Biological Chemistry and Nutrition (140a), University of Hohenheim, Garbenstraße 30, Stuttgart 70599, Germany; E-Mail:
| | - Qi Wang
- Medical Society of Deyang City, Sichuan, Public Health Bureau of Deyang, Lushan Nan Road No.299, Jingyang District of Deyang City, Deyang 618000, China; E-Mail:
| | - Elizabeth Hormann
- Europäisches Institut für Stillen und Laktation, Wittberg 14, Kramsach 6233, Austria; E-Mail:
| | - Anne C. Bellows
- Department of Public Health, Food Studies, and Nutrition, David B Falk College, Syracuse University, Syracuse, NY 13244, USA; E-Mail:
| |
Collapse
|
18
|
Purwestri RC, Scherbaum V, Inayati DA, Wirawan NN, Suryantan J, Bloem MA, Pangaribuan RV, Stuetz W, Hoffmann V, Qaim M, Biesalski HK, Bellows AC. Impact of Daily versus Weekly Supply of Locally Produced Ready-to-Use Food on Growth of Moderately Wasted Children on Nias Island, Indonesia. ISRN Nutr 2013; 2013:412145. [PMID: 24959543 PMCID: PMC4045281 DOI: 10.5402/2013/412145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/08/2013] [Indexed: 11/23/2022]
Abstract
This study reports the outcomes of daily (semi-urban areas) and weekly (remote rural regions) programs for moderately wasted children supplemented with locally produced ready-to-use foods in the form of fortified cereal/nut/legume-based biscuits on Nias Island, Indonesia (RUF-Nias biscuit). Thirty-four children in daily and twenty children in weekly programs aged ≥6 to <60 months with weight-for-height z-score (WHZ) ≥ -3 to < -2 SD were recruited (October 2007-June 2008) on Nias and admitted into existing nutrition centers in the Church World Service project area. Individual discharge criterion was WHZ ≥ -1.5 SD. Weight gain of the children in daily and weekly programs was 3.9 ± 3.8 and 2.0 ± 2.0 g/kg/day, respectively. A higher proportion of children in daily than weekly programs reached target WHZ (76% vs. 35%, P = 0.004). Weight gain at program discharge/closure was highly predicted (R (2) = 0.228, P < 0.001) by compliance to RUF biscuits: high vs. low compliance resulted in a 1.33 (95% CI 0.16 to 1.53) g/kg/day higher weight gain. Compliance and admission in daily programs were significant factors in reducing the risk of not reaching the discharge criterion. However, mothers complained more frequently about time constraints in the daily relative to weekly programs.
Collapse
Affiliation(s)
- Ratna Chrismiari Purwestri
- Department of Gender and Nutrition, Institute of Social Sciences in Agriculture, University of Hohenheim and Center of Gender and Nutrition, Schloss, Museumfluegel, 70593 Stuttgart, Germany ; Institute for Biological Chemistry and Nutrition, University of Hohenheim, 70593 Stuttgart, Germany ; Study Program Nutrition, Faculty of Medicine, University of Brawijaya, Malang 65145, Indonesia
| | - Veronika Scherbaum
- Department of Gender and Nutrition, Institute of Social Sciences in Agriculture, University of Hohenheim and Center of Gender and Nutrition, Schloss, Museumfluegel, 70593 Stuttgart, Germany ; Institute for Biological Chemistry and Nutrition, University of Hohenheim, 70593 Stuttgart, Germany
| | - Dyah Ayu Inayati
- Department of Gender and Nutrition, Institute of Social Sciences in Agriculture, University of Hohenheim and Center of Gender and Nutrition, Schloss, Museumfluegel, 70593 Stuttgart, Germany
| | - Nia Novita Wirawan
- Study Program Nutrition, Faculty of Medicine, University of Brawijaya, Malang 65145, Indonesia
| | | | | | - Rosnani Verba Pangaribuan
- SEAMEO TROPMED Regional Centre for Community Nutrition, University of Indonesia, Jakarta 10430, Indonesia
| | - Wolfgang Stuetz
- Institute of Nutrition, Friedrich-Schiller-University of Jena, 07743 Jena, Germany
| | - Volker Hoffmann
- Department of Gender and Nutrition, Institute of Social Sciences in Agriculture, University of Hohenheim and Center of Gender and Nutrition, Schloss, Museumfluegel, 70593 Stuttgart, Germany
| | - Matin Qaim
- Department of Agricultural Economics and Rural Development, University of Goettingen, 37073 Goettingen, Germany
| | - Hans Konrad Biesalski
- Institute for Biological Chemistry and Nutrition, University of Hohenheim, 70593 Stuttgart, Germany
| | - Anne Camilla Bellows
- Department of Gender and Nutrition, Institute of Social Sciences in Agriculture, University of Hohenheim and Center of Gender and Nutrition, Schloss, Museumfluegel, 70593 Stuttgart, Germany ; Department of Public Health, Food Studies, and Nutrition, David B. Falk College, Syracuse University, NY 13244, USA
| |
Collapse
|
19
|
Purwestri RC, Scherbaum V, Inayati DA, Wirawan NN, Suryantan J, Bloem MA, Pangaribuan RV, Hoffmann V, Biesalski HK, Qaim M, Bellows AC. Cost analysis of community-based daily and weekly programs for treatment of moderate and mild wasting among children on Nias Island, Indonesia. Food Nutr Bull 2012; 33:207-16. [PMID: 23156124 DOI: 10.1177/156482651203300306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ready-to-use food in the form of biscuits (RUF-Nias biscuit) was locally produced for rehabilitation of moderately and mildly wasted (weight-for-height z-score > or = -3 to < -1.5 SD) children on Nias Island, Indonesia. Daily programs were performed in semiurban settings, and weekly programs took place in rural areas. OBJECTIVE To analyze the cost of daily and weekly distribution and supervision of RUF-Nias biscuit programs. METHODS The costs of the daily and weekly programs were derived from the financial report and interviews with program implementers and participating households. Costs were calculated on the basis of total rehabilitation costs per child per day required to achieve a target weight-for-height z-score > or = -1.5 SD in daily and weekly programs. RESULTS Institutional costs to the implementing organization were similar for both programs (approximately US $4 per child per day). The daily programs resulted in a significantly higher proportion of recovered children (78.6% vs. 65.4%) and higher weight gain (3.7 vs. 2.2 g/kg/day) than the weekly programs. About 6% to 7% of the total cost of the programs was accounted for by locally produced RUF-Nias biscuits. The social cost borne by the community for the weekly programs was about half that for the daily programs. CONCLUSIONS The daily programs achieved better results for the implementing organization than the weekly programs; however, the weekly programs were preferred by the community because of the lower time constraints and the lower opportunity cost of time. The willingness of community and household members to invest their time in more intensive activities in the daily programs led to better program outcomes.
Collapse
Affiliation(s)
- Ratna Chrismiari Purwestri
- Institute for Social Sciences in Agriculture, Center of Gender and Nutrition, University of Hohenheim, Stuttgart, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Inayati DA, Scherbaum V, Purwestri RC, Wirawan NN, Suryantan J, Hartono S, Bloem MA, Pangaribuan RV, Biesalski HK, Hoffmann V, Bellows AC. Improved nutrition knowledge and practice through intensive nutrition education: a study among caregivers of mildly wasted children on Nias Island, Indonesia. Food Nutr Bull 2012; 33:117-27. [PMID: 22908693 DOI: 10.1177/156482651203300205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inappropriate nutrition knowledge and feeding practices of caregivers are among several important causes of persistent malnutrition problems in young children. Thus, it is essential to provide caregivers with the necessary knowledge to help them modify their feeding practices. OBJECTIVE To examine the effectiveness of two different nutrition education methods, weekly intensive nutrition education (INE) and monthly nonintensive nutrition education (NNE), designed for caregivers of mildly wasted children (weight-for-height z-score ≥ -1.5 to < -1) aged ≥ 6 to < 60 months on Nias Island, Indonesia. METHODS To assess the impact of the two different nutrition education approaches on nutrition knowledge and practice of caregivers with their children, respondents were assigned to receive either weekly INE (n=114) or monthly NNE (n=96). The knowledge and practice levels of the mothers in each group were assessed and compared using a pretested validated questionnaire at admission and after the intervention period. RESULTS At admission, the knowledge and practice levels of caregivers in both groups were not statistically significantly different. After participating in the nutrition education program, the percentage of correct answers on nutrition knowledge and practice in the INE group was significantly higher than that in the NNE group. Significant improvement in knowledge and practice scores was observed in the INE group after the intervention (p < 0.001), whereas only a significant improvement in knowledge was found in the NNE group (p < .05). CONCLUSIONS In comparison with NNE, the INE approach was significantly better in bringing about a positive change in knowledge and practice of caregivers of mildly wasted children in the study area.
Collapse
|
21
|
Inayati DA, Scherbaum V, Purwestri RC, Hormann E, Wirawan NN, Suryantan J, Hartono S, Bloem MA, Pangaribuan RV, Biesalski HK, Hoffmann V, Bellows AC. Infant feeding practices among mildly wasted children: a retrospective study on Nias Island, Indonesia. Int Breastfeed J 2012; 7:3. [PMID: 22436662 PMCID: PMC3349617 DOI: 10.1186/1746-4358-7-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 03/21/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This study investigated the infant feeding practices of participating mothers who were recruited into a research project aimed at improving the nutritional status of mildly wasted children (< -1.0 to ≥ -1.5 Weight-for-Height Z-scores) aged ≥ 6 to < 60 months on Nias Island, Indonesia. METHODS Cross-sectional, questionnaire-based interview of mothers of the index children (n = 215) who were admitted to the community program for mildly wasted children in the study area. Four focus groups and twenty in-depth interviews were conducted to explore further information on infant feeding practices in the study area. RESULTS Retrospective results indicated that 6% of the mothers never breastfed. Fifty two percent of mothers initiated breastfeeding within six hours of birth, but 17% discarded colostrum. Exclusive breastfeeding until 6 months of age was practiced by 12%. Seventy-four percent of the mothers offered supplementary liquids besides breast milk within the first 7 days of life, and 14% of infants received these supplementary liquids from 7 days onwards until 6 months of age. Moreover, 79% of the infants were given complementary foods (solid, semi-solid, or soft foods) before 6 months of age. About 9% of the children were breastfed at least two years. Less than one in five of the mildly wasted children (19%) were breastfed on admission to the community program. Qualitative assessments found that inappropriate infant feeding practices were strongly influenced by traditional beliefs of the mothers and paternal grandmothers in the study areas. CONCLUSION Generally, suboptimal infant feeding was widely practiced among mothers of mildly wasted children in the study area on Nias Island, Indonesia. To promote breastfeeding practices among mothers on Nias Island, appropriate nutrition training for community workers and health-nutrition officers is needed to improve relevant counseling skills. In addition, encouraging public nutrition education that promotes breastfeeding, taking into account social-cultural factors such as the influence of paternal grandmothers on infant feeding practice, is needed.
Collapse
Affiliation(s)
- Dyah Ayu Inayati
- Institute for Social Sciences in Agriculture, Center Gender and Nutrition (430b), University Hohenheim, Fruwirthstrasse 14-16, 70593 Stuttgart, Germany
| | - Veronika Scherbaum
- Institute for Social Sciences in Agriculture, Center Gender and Nutrition (430b), University Hohenheim, Fruwirthstrasse 14-16, 70593 Stuttgart, Germany
- Institute for Biological Chemistry and Nutrition, University Hohenheim, Stuttgart, Germany
| | - Ratna Chrismiari Purwestri
- Institute for Social Sciences in Agriculture, Center Gender and Nutrition (430b), University Hohenheim, Fruwirthstrasse 14-16, 70593 Stuttgart, Germany
- Institute for Biological Chemistry and Nutrition, University Hohenheim, Stuttgart, Germany
| | - Elizabeth Hormann
- The European Institute for Breastfeeding and Lactation, Kramsach, Austria
| | - Nia Novita Wirawan
- Faculty of Medicine, Study Program Nutrition, University of Brawijaya, Malang, Indonesia
| | | | | | | | | | - Hans Konrad Biesalski
- Institute for Biological Chemistry and Nutrition, University Hohenheim, Stuttgart, Germany
| | - Volker Hoffmann
- Institute for Social Sciences in Agriculture, Center Gender and Nutrition (430b), University Hohenheim, Fruwirthstrasse 14-16, 70593 Stuttgart, Germany
| | - Anne Camilla Bellows
- Institute for Social Sciences in Agriculture, Center Gender and Nutrition (430b), University Hohenheim, Fruwirthstrasse 14-16, 70593 Stuttgart, Germany
| |
Collapse
|
22
|
Purwestri RC, Scherbaum V, Inayati DA, Wirawan NN, Suryantan J, Bloem MA, Pangaribuan RV, Stuetz W, Hoffmann V, Qaim M, Biesalski HK, Bellows AC. Supplementary feeding with locally-produced Ready-to-Use Food (RUF) for mildly wasted children on Nias Island, Indonesia: comparison of daily and weekly program outcomes. Asia Pac J Clin Nutr 2012; 21:374-379. [PMID: 22705426] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal and 8-10% protein per 100 g) were tested among mildly wasted children from October 2007 to June 2008, and were labelled as RUF-Nias biscuits. This study reports on a comparison of supplementary feeding program outcomes of mildly wasted children with weight-for-height z-score (WHZ) >=-2 to <-1.5 SD aged >=6 to <60 months old given locally produced RUF-Nias biscuits within daily (in semi-urban areas) and weekly (in rural remote regions) distribution and supervision program settings. In the Church World Service project area, all eligible children were recruited continuously from monthly community-based screening programs and admitted into existing nutrition centers managed by the community on Nias Island, Indonesia. Individual discharge criterion of the programs was WHZ >=-1.5 SD. Of the index children admitted in daily programs (n=51), 80.4% reached target WHZ, which was higher than in weekly programs (72.9%; n=48) by a similar length of stay of about 6 weeks. Weight gain of the children in daily programs was higher (3.1±3.6 g/kg body weight/day) than in weekly programs (2.0±2.1 g/kg body weight/day), and they achieved significantly higher WHZ at discharge. However, the majority of caretakers preferred weekly programs due to lower time constraints. Locally produced RUF in the form of biscuits for treatment of mild wasting among children demonstrated promising results both in daily and weekly community-based intervention programs.
Collapse
Affiliation(s)
- Ratna C Purwestri
- Institute for Social Sciences in Agriculture, Center of Gender and Nutrition, University of Hohenheim, Schloss, Museumsfluegel, Stuttgart, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Inayati DA, Scherbaum V, Purwestri RC, Wirawan NN, Suryantan J, Hartono S, Bloem MA, Pangaribuan RV, Biesalski HK, Hoffmann V, Bellows AC. Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia. Asia Pac J Clin Nutr 2012; 21:361-373. [PMID: 22705425] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder (MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (>=-1.5 to <-1.0 WHZ) children aged >=6 to <60 months in the Church World Service (CWS) project areas were assigned by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission, during the study, and at individual discharge. Children's weight gain (g/kg body weight/day) was highest in INE+MNP group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention groups (INE+MNP, NNE+MNP), supplements significantly increased Hb value (g/L) of respective children (10.0±10.0; p<0.001 and 3.0±8.0; p<0.05 respectively). Proportion of children who reached discharge criterion was highest among the INE+MNP (70.6%; n=36), followed by INE (64.1%; n=41), NNE+MNP (26.0%; n=13), and NNE (20.0%; n=10) groups (p<0.001). Shortest length of stay until recovery was observed among children in the INE+MNP group (29.9 days), followed by INE (40.0 days), NNE+MNP (80.6 days), and NNE (86.2 days) respectively (p<0.001). Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children.
Collapse
Affiliation(s)
- Dyah A Inayati
- Institute for Social Sciences in Agriculture, Center of Gender and Nutrition, University of Hohenheim, Schloss, Museumsfluegel, Stuttgart-Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Trox J, Vadivel V, Vetter W, Stuetz W, Kammerer DR, Carle R, Scherbaum V, Gola U, Nohr D, Biesalski HK. Catechin and epicatechin in testa and their association with bioactive compounds in kernels of cashew nut (Anacardium occidentale L.). Food Chem 2011. [DOI: 10.1016/j.foodchem.2011.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
25
|
|
26
|
Trox J, Vadivel V, Vetter W, Stuetz W, Scherbaum V, Gola U, Nohr D, Biesalski HK. Bioactive compounds in cashew nut (Anacardium occidentale L.) kernels: effect of different shelling methods. J Agric Food Chem 2010; 58:5341-5346. [PMID: 20387832 DOI: 10.1021/jf904580k] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In the present study, the effects of various conventional shelling methods (oil-bath roasting, direct steam roasting, drying, and open pan roasting) as well as a novel "Flores" hand-cracking method on the levels of bioactive compounds of cashew nut kernels were investigated. The raw cashew nut kernels were found to possess appreciable levels of certain bioactive compounds such as beta-carotene (9.57 microg/100 g of DM), lutein (30.29 microg/100 g of DM), zeaxanthin (0.56 microg/100 g of DM), alpha-tocopherol (0.29 mg/100 g of DM), gamma-tocopherol (1.10 mg/100 g of DM), thiamin (1.08 mg/100 g of DM), stearic acid (4.96 g/100 g of DM), oleic acid (21.87 g/100 g of DM), and linoleic acid (5.55 g/100 g of DM). All of the conventional shelling methods including oil-bath roasting, steam roasting, drying, and open pan roasting revealed a significant reduction, whereas the Flores hand-cracking method exhibited similar levels of carotenoids, thiamin, and unsaturated fatty acids in cashew nuts when compared to raw unprocessed samples.
Collapse
Affiliation(s)
- Jennifer Trox
- Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Getahun Z, Scherbaum V, Taffese Y, Teshome B, Biesalski HK. Breastfeeding in Tigray and Gonder, Ethiopia, with special reference to exclusive/almost exclusive breastfeeding beyond six months. Breastfeed Rev 2004; 12:8-16. [PMID: 17891858] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This study assesses the initiation and duration of exclusive/almost exclusive breastfeeding (Ex/AEx-BF) versus partial breastfeeding (P-BF) and its relationship to infant growth and maternal body mass index (BMI) in Ethiopian infants up to 12 months of age (Tigray n = 471; Gonder n =596). Initiation of breastfeeding within 1 hr after birth was 1.7 times more common in Tigray. In Gonder 19% of the mothers started breastfeeding on the third day of delivery and consequently, a significant higher proportion of newborns were offered prelacteal feeds (P<0.001). At six months, 52.2% and 61.5% of mothers in Tigray and Gonder respectively practised Ex/AEx-BF. Perceived lack of breastmilk was a major factor for offering complementary foods before six months. More than 25% of infants in both regions were Ex/AEx-BF up to the eighth month and 16.4% and 15.7% of infants in Tigray and Gonder were still Ex/AEx-BF at the end of the first year. Growth faltered before six months of age but less frequently in Ex/AEx-BF compared to P-BF infants. Malnutrition became obvious after eight months in both groups. Malnourished mothers (BMI < 18.5) offering mixed feeding to their malnourished children (<-2 z-score) below six months of age was higher in both regions compared to the Ex/AEx-BF group (in Gonder 25% vs 5.9%; in Tigray 42.9% vs 33.3%). Nutrition education to raise awareness of mothers regarding initiation of exclusive breastfeeding directly after birth, the value of colostrum and avoidance of pre-postlacteal feeds, needs to be implemented. A new health package to be implemented could be a proper vehicle to reach the rural population, which doesn't have access to health services. The relationship between infant growth, mode of feeding and mothers nutritional status should be further investigated, particularly in populations with a high prevalence of maternal and infant nutrition and where long term breastfeeding is practiced.
Collapse
Affiliation(s)
- Zewditu Getahun
- Institute of Biological Chemistry and Nutrition, Garbenstrasse 30, University Hohenheim, Germany
| | | | | | | | | |
Collapse
|
28
|
Pangaribuan R, Scherbaum V, Erhardt JG, Sastroamidjojo S, Biesalski HK. Socioeconomic and familial characteristics influence caretakers' adherence to the periodic vitamin A capsule supplementation program in Central Java, Indonesia. J Trop Pediatr 2004; 50:143-8. [PMID: 15233189 DOI: 10.1093/tropej/50.3.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The adherence of program participants to periodic vitamin A capsule (VAC) supplementation among children aged 1-5 years (n = 677) in Central Java, Indonesia was assessed. Fourteen villages from five sub-districts and one ward from one sub-district in Central Java were included in the study to represent rural and suburban areas. All questions about demographic factors, socioeconomic conditions, current dietary practice and healthcare-seeking attitudes for common childhood illnesses, previous breastfeeding experience, their knowledge about vitamin A and adherence to the VAC program after capsule distribution (two periods in 2000) were asked. Caretakers with limited knowledge about the health benefits of vitamin A, households with more than one preschool child, and households with older children (> 36 months) were associated with a decreased likelihood of regular participation in the program with odds ratios of 0.38, 0.55, and 0.26, respectively (p < 0.01). The percentage of caretakers who utilized community health centers, village health posts or midwives' practices in rural areas, was significantly higher (86.6 per cent, p < 0.001) than in suburban areas (62.8 per cent). Living in a rural location was associated with an increased adherence to participate in the program regularly with an odds ratio of 2.02 (p < 0.01). In conclusion, nutritional education and periodic social marketing should be re-emphasized and other potential delivery channels, such as private healthcare practices, could also contribute to an increase adherence of supplementation program.
Collapse
Affiliation(s)
- Rosnani Pangaribuan
- SEAMEO-TROPMED Regional Center for Community Nutrition, University of Indonesia, Jakarta, Indonesia.
| | | | | | | | | |
Collapse
|
29
|
Pangaribuan R, Erhardt JG, Scherbaum V, Biesalski HK. Vitamin A capsule distribution to control vitamin A deficiency in Indonesia: effect of supplementation in pre-school children and compliance with the programme. Public Health Nutr 2003; 6:209-16. [PMID: 12675964 DOI: 10.1079/phn2002418] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of a widespread vitamin A supplementation programme and to describe indicators of compliance with the programme in Indonesia. DESIGN Prospective cohort study. Children's anthropometric data were gathered at baseline (June 2000) and 4 months later (2 months after supplementation in August 2000). Serum retinol, haemoglobin, ferritin, alpha1-acid glycoprotein and C-reactive protein were measured at baseline and at follow-up. Caregivers of the children were interviewed using a questionnaire. SETTING Semi-urban and rural areas of Semarang district, Central Java, Indonesia. SUBJECTS Children aged 1-5 years. RESULTS After the supplementation, the proportion of children with a low concentration of retinol decreased in recipients from 18.8 to 14.5%. However, in non-recipients, the prevalence of vitamin A deficiency increased from 31.9 to 37.5%, this prevalence being significantly higher than in recipients. A significant decrease occurred in the proportion of recipients with low ferritin (26.5 to 16.2%) and haemoglobin (25.7 to 15.3%), whereas the proportions did not show a significant change after supplementation for non-recipients. Modest linear growth was detected in recipients after supplementation but there was no effect on ponderal growth. The coverage rate of the supplementation in the study areas was 60%. There was an association between compliance of the caregivers and their knowledge about the potential benefit of vitamin A supplementation, the place where sick children were taken and age of the children. CONCLUSIONS The vitamin A supplementation programme marginally decreased the proportion of vitamin A deficiency and had a marginal effect on the nutritional status of recipients. More than one micronutrient intervention is needed to increase the effectiveness of the supplementation programme. To increase compliance and coverage in the supplementation programme, nutrition communication and private healthcare practices need to be included in the programme.
Collapse
Affiliation(s)
- Rosnani Pangaribuan
- Institute of Biological Chemistry and Nutrition (140), University of Hohenheim, Fruwirthstrasse 12, D-70599
| | | | | | | |
Collapse
|
30
|
Golder AM, Erhardt JG, Scherbaum V, Saeed M, Biesalski HK, Fürst P. Dietary intake and nutritional status of women and pre-school children in the Republic of the Maldives. Public Health Nutr 2001; 4:773-80. [PMID: 11415484 DOI: 10.1079/phn2000101] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Malnutrition and poor nutritional status among children are common problems in the Republic of Maldives, a small island nation in the Indian Ocean. The aim of this study was to determine possible macro- and micronutrient deficiencies in the traditional Maldivian diet. DESIGN In five atolls, 333 women with children aged between 1 and 4 years who were no longer breast-fed were interviewed, using a 24-hour recall. Additionally, the weights and heights of both the women and children were measured, and blood samples from 15 women were collected for measurements of vitamins A and E, beta-carotene, homocysteine, cholesterol and haemoglobin. RESULTS Of the women, 22% had a body mass index (BMI) below 18.5. Of the children, 41% were stunted, 14% were wasted and 51% were underweight. The women's and children's diets were sufficient in protein (14%) and carbohydrates (67%) but deficient in fat, which contributed only 19% to the total energy intake. Consumption of dietary substances that depend on vegetable and fruit intake (e.g. beta-carotene, vitamin C, dietary fibre and folic acid) was low. The low intake of beta-carotene was underlined by low plasma concentration. The estimated iron intake was low, although blood haemoglobin levels were normal. CONCLUSIONS Marginal nutritional status and marginal malnutrition are due to low fat intake and selected micronutrient deficiency. Higher intakes of locally available vegetables and fruits and fat (especially for children) on a regular basis might reverse the deficits documented on the atolls.
Collapse
Affiliation(s)
- A M Golder
- Institute of Biological Chemistry and Nutrition, University of Hohenheim, Garbenstrasse 30, D-70599 Stuttgart, Germany
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
Current guidelines for the management of severe malnutrition are mainly based on new concepts regarding the causes of malnutrition and on advances in our knowledge of the physiological roles of micronutrients. In contrast to the early 'protein dogma', there is a growing body of evidence that severely malnourished children are unable to tolerate large amounts of dietary protein during the initial phase of treatment. Similarly, great caution must be exercised to avoid excessive supply of iron and sodium in the diet, while keeping energy intake at maintenance levels during early treatment. Because severely malnourished children require special micronutrients, a mineral-vitamin mix is added to the milk-based formula diets, which are specially designed for the initial treatment and the rehabilitation phase. To further improve nutritional rehabilitation and reduce cases of relapse, 'ready-to-use therapeutic food' and 'ready-to-eat nutritious supplements' with relatively low protein (10% protein calories) and high fat content (54-59% lipidic calories) have been developed. Although current dietary recommendations do not differentiate between oedematous and nonoedematous forms of malnutrition or between adults and children, there are indications that further clarification is still needed for applying dietary measures for specific target groups.
Collapse
Affiliation(s)
- V Scherbaum
- Institute for Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.
| | | |
Collapse
|