Relative validity and reproducibility of an FFQ to determine nutrient intakes of New Zealand toddlers aged 12-24 months.

OBJECTIVE: The study objective was to determine the relative validity and reproducibility of a modified FFQ for ranking the nutrient intakes of New Zealand toddlers aged 12-24 months. DESIGN: Cross-sectional study. SETTING: Dunedin, New Zealand. SUBJECTS: One hundred and fifty-two participants completed a ninety-five-item FFQ twice, and five days of weighed diet recording (WDR), over one month. Validity and reproducibility were assessed for crude data and for data that were weighted for total fruit and vegetable intake (FV-adjusted). RESULTS: De-attenuated correlations between FV-adjusted FFQ data and WDR data ranged from 0.45 (Zn) to 0.77 (Ca). The percentage classified to the correct WDR quartile by the FV-adjusted FFQ data ranged from 34.6% (total fat, Zn) to 50.3% (Fe). Average gross misclassification was 3%. Bland-Altman statistics showed crude data had a range of 128-178% agreement with the WDR and mean FV-adjusted intakes had 112-160% agreement. FV-adjusted intra-class correlations, assessing reproducibility, ranged from 0.65 (vitamin C) to 0.75 (Ca). CONCLUSIONS: The Eating Assessment in Toddlers (EAT) FFQ showed acceptable to good relative validity, and good reproducibility, for ranking participants' nutrient intake and is able to identify toddlers at extremes of the nutrient intake distribution. It will be a useful tool for investigating toddlers' nutrient intakes in studies that require a method of dietary assessment with low respondent burden.

Socio-cultural determinants of infant malnutrition in Cameroon.

This study seeks to explore and explain the socio-cultural factors responsible for the incidence of infant malnutrition in Cameroon with particular emphasis on northern Cameroon where it is most accentuated. It combines quantitative data drawn from the 1991, 1998, 2004 and 2011 Cameroon Demographic and Health Surveys, as well as a literature review of publications by the WHO and UNICEF. This is further complemented with qualitative data from various regions of Cameroon, partly from a national ethnographic study on the ethno-medical causes of infertility in Cameroon conducted between 1999 and 2000. Whereas socio-cultural factors related to child feeding and maternal health (breast-feeding, food taboos and representations of the colostrum as dangerous for infants) are widespread throughout Cameroon, poverty-related factors (lack of education for mothers, natural disaster, unprecedented influx of refugees, inaccessibility and inequity in the distribution of health care services) are pervasive in northern Cameroon. This conjunction of factors accounts for the higher incidence of infant malnutrition and mortality in northern Cameroon. The study suggests the need for women's empowerment and for health care personnel in transcultural situations to understand local cultural beliefs, practices and sentiments before initiating change efforts in infant feeding practices and maternal health. Biomedical services should be tailored to the social and cultural needs of the target population--particularly women--since beliefs and practices underpin therapeutic recourse. Whereas infant diarrhoea might be believed to be the result of sexual contact, in reality, it is caused by unhygienic conditions. Similarly, weaning foods aimed at transmitting ethnic identity might not meet a child's age-specific food needs and might instead give rise to malnutrition.

Assessment of the nutritional status of 6-36-month-old infants in Xinjiang and analysis of the influencing factors.

The health of infants is not only related to family happiness, but also to the future and development of the country. Therefore, it is still a very important public health problem to pay attention to the nutritional health level of infants. This article explores the nutritional health levels of infants and reveals the related risk factors. Stratified and multi-stage cluster sampling was used to select 3949 infants and young children in Xinjiang for the study. Survey staff conducted face-to-face questionnaire surveys to investigate their demographic characteristics, complementary food feeding, and related risk factors affecting their nutritional status. Study results showed that compared with the Han nationality, the Uygur and other nationalities were independent risk factors for malnutrition, as odds ratio (OR) values were 2.456 and 1.747, respectively (P < 0.05). When the feeders were not maternal, and their educational background was junior high school or below, OR values were 2.122 and 1.810, respectively (P < 0.05). The scores for non-breastfeeding and feeding behaviors were independent risk factors, and OR values were 1.983 and 2.709, respectively (P < 0.05). When infant minimum dietary diversity, minimum meal frequency, and minimum acceptable diet were unqualified, these indices were independent risk factors, and OR values were 2.281, 2.315, and 1.865, respectively (P < 0.05). The healthy growth of Han infants is better than that of other ethnic groups, which may be related to varying living environments, customs, social/economic development levels, educational levels, and other factors. In the future, the focus of our work should be to cooperate with the superior health organization to strengthen and improve the nutritional health level of infants.

Malnutrition among children younger than 5 years-old in conflict zones of Chiapas, Mexico.

We performed a cross-sectional, community-based survey, supplemented by interviews with community leaders in Chiapas, Mexico, to examine the prevalence and predictors of child malnutrition in regions affected by the Zapatista conflict. The prevalence rates of stunting, wasting, and underweight were 54.1%, 2.9%, and 20.3%, respectively, in 2666 children aged younger than 5 years. Stunting was associated with indigenous ethnicity, poverty, region of residence, and intracommunity division. The results indicate that malnutrition is a serious public health problem in the studied regions.

[Nutritional status and social determinants of child height in the Guarita Indigenous Territory, Southern Brazil]. / Estado nutricional e fatores associados à estatura de crianças da Terra Indígena Guarita, Sul do Brasil.

The nutritional status of under-five children and the association between social conditions and child stature were examined using data from the program to control malnutrition and mortality in the Guarita Indigenous Territory, southern Brazil, 2001-2002. Anthropometric indices were calculated in z-scores of the CDC 2000 reference. At entrance into the program, 34.7% of the children presented stunting, 12.9% low weight for age, 4.2% wasting, and 8.7% overweight. Stunting was most prevalent among boys and children older than one year. Multivariate linear regression showed that, on average, children were shorter when the drinking water was collected directly in the environment (p = 0.046), there was no refrigerator for food preservation (p = 0.021), maternal age was less than 16 years at the birth of the oldest child among the under-fives (p = 0.019), and the mother was illiterate (p = 0.083). Sewage facilities only had an effect on the unadjusted model. There was no evidence that the number of under-five children had an effect on stature. Social inclusion policies and health and social provision which takes these factors into account are potentially relevant for improving health and nutrition in this population.

Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial.

BACKGROUND: Childhood stunting usually begins in utero and continues after birth; therefore, its reduction must involve actions across different stages of early life. OBJECTIVE: We evaluated the efficacy of small-quantity, lipid-based nutrient supplements (SQ-LNSs) provided during pregnancy, lactation, and infancy on attained size by 18 mo of age. DESIGN: In this partially double-blind, individually randomized trial, 1320 women at ≤20 wk of gestation received standard iron and folic acid (IFA group), multiple micronutrients (MMN group), or SQ-LNS (LNS group) daily until delivery, and then placebo, MMNs, or SQ-LNS, respectively, for 6 mo postpartum; infants in the LNS group received SQ-LNS formulated for infants from 6 to 18 mo of age (endline). The primary outcome was child length by 18 mo of age. RESULTS: At endline, data were available for 85% of 1228 infants enrolled; overall mean length and length-for-age z score (LAZ) were 79.3 cm and -0.83, respectively, and 12% of the children were stunted (LAZ <-2). In analysis based on the intended treatment, mean ± SD length and LAZ for the LNS group (79.7 ± 2.9 cm and -0.69 ± 1.01, respectively) were significantly greater than for the IFA (79.1 ± 2.9 cm and -0.87 ± 0.99) and MMN (79.1 ± 2.9 cm and -0.91 ± 1.01) groups (P = 0.006 and P = 0.009, respectively). Differences were also significant for weight and weight-for-age z score but not head or midupper arm circumference, and the prevalence of stunting in the LNS group was 8.9%, compared with 13.7% in the IFA group and 12.9% in the MMN group (P = 0.12). In analysis based on actual supplement provided at enrollment, stunting prevalences were 8.9% compared with 15.1% and 11.5%, respectively (P = 0.045). CONCLUSION: Provision of SQ-LNSs to women from pregnancy to 6 mo postpartum and to their infants from 6 to 18 mo of age may increase the child's attained length by age 18 mo in similar settings. This trial was registered at clinicaltrials.gov as NCT00970866.

Gender perceptions predict sex differences in growth patterns of indigenous Guatemalan infants and young children.

BACKGROUND: Nearly one-half of Guatemalan children experience growth faltering, more so in indigenous than in nonindigenous children. OBJECTIVES: On the basis of ethnographic interviews in Totonicapán, Guatemala, which revealed differences in maternal perceptions about food needs in infant girls and boys, we predicted a cumulative sex difference in favor of girls that occurred at ∼6 mo of age and diminished markedly thereafter. We examined whether the predicted differences in age-sex patterns were observed in the village, replicated the examination nationally for indigenous children, and examined whether the pattern in nonindigenous children was different. DESIGN: Ethnographic interviews (n = 24) in an indigenous village were conducted. Anthropometric measurements of the village children aged 0-35 mo (n = 119) were obtained. National-level growth patterns were analyzed for indigenous (n = 969) and nonindigenous (n = 1374) children aged 0-35 mo with the use of Demographic and Health Survey (DHS) data. RESULTS: Mothers reported that, compared with female infants, male infants were hungrier, were not as satisfied with breastfeeding alone, and required earlier complementary feeding. An anthropometric analysis confirmed the prediction of healthier growth in indigenous girls than in indigenous boys throughout the first year of life, which resulted in a 2.98-cm height-for-age difference (HAD) between sexes in the village and a 1.61-cm HAD (P < 0.001) in the DHS data between 6 and 17 mo of age in favor of girls. In both data sets, the growth sex differences diminished in the second year of life (P < 0.05). No such pattern was seen in nonindigenous children. CONCLUSIONS: We propose that the differences in the HAD that first favor girls and then favor boys in the indigenous growth patterns are due to feeding patterns on the basis of gendered cultural perceptions. Circumstances that result in differential sex growth patterns need to be elucidated, in particular the favorable growth in girls in the first year of life.

Assessing unmet need for services for pediatric undernutrition. HSPH MPH Student Research Team.

Evaluation and treatment of undernourished children in Massachusetts has been provided since 1984 by the seven outpatient Growth and Nutrition (GN) Clinics administered by the Massachusetts Department of Public Health (MDPH). This study explored the potential unmet need for nutritional services among low-income, multiethnic children ages birth to 36 months presenting to an inner-city pediatric emergency department (ED). During March 1992, staff obtained weight and stature on all children under 36 months of age brought to the ED. A structured interview questionnaire obtained data on demographic characteristics, birth history, and participation in means-tested federal benefit programs and MDPH GN Clinics. Among 252 children with complete anthropometric data, 22 (8.9%) had at least one anthropometric index (weight-for-age, height-for-age, weight-for-height) below the fifth percentile. Birthweights < 2500 g were reported by 18.5% of caregivers; 58% of children with height-for-age less than the fifth percentile and 63% of those with weight-for-age less than the fifth percentile were low birthweight (LBW) (Fisher's exact test, P < .002 and P < .006, respectively). Thirteen percent of families had no health insurance, and 77.1% received Medicaid. Among 22 children with anthropometry less than the fifth percentile, one half to three quarters participated in federally funded programs including Special Supplemental Food Program for Women, Infants, and Children (WIC), Aid to Families With Dependent Children (AFDC), and Food Stamps, but only 11% had been referred to the GN Clinics. These findings suggest that federal means-tested benefit programs and MDPH GN Clinic services were underused by groups at nutritional risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Maternal sensitivity in a developing society: the context of urban poverty and infant chronic undernutrition.

This study focuses on young children's chronic undernutrition and its association with maternal sensitivity, sociodemographic variables, children's play, and problem-solving measures. Data were obtained with home observations and laboratory procedures on 85 mothers and infants (M age = 18 months) in a low-income urban population in Santiago, Chile. Maternal sensitivity was correlated with maternal education, maternal weight, and marital satisfaction. Observed in a variety of maternal roles, maternal sensitivity was also significantly associated with children's nutritional status, attachment security, and mastery behavior. These findings demonstrate the relevance of the maternal sensitivity construct outside industrialized societies and underline the need for intervention strategies to extend beyond nutritional supplementation to address deficits of maternal care associated with specific caregiver's roles.

Nutritional problems in children aged 1-24 months: comparison of hill-tribe and Thai children.

A cross-sectional survey was conducted in Maecham district, Chiang Mai. The objective was to determine the magnitude of nutritional problems in children aged 1-24 months, both of hill-tribe and Thai communities, where breast-feeding is highly prevalent. Three hundred and fifty nine children were recruited, 252 were hill-tribe (Karen and Lahu), and 107 were Thai children. Anthropometric measurements were taken and mothers were interviewed. In a group of hill-tribe children, the prevalence of malnutrition (Z score of weight for age < -2) was 25.0 compared with 12.1 per cent for Thai children (p <0.01). The prevalence was highest in children aged between 12-24 months. This corresponded to the time children were weaned. The prevalence of stunting (Z score of height for age < -2) in hill-tribe and Thai children was 25.4 and 12.1 per cent respectively (p <0.01). There was no significant difference of wasting (Z score of weight for height < -2) between hill-tribe and Thai children, 9.1 and 8.4 per cent respectively. The mean (SD) Z scores of weight for age, weight for height, and height for age for both groups declined significantly as the age increased (p <0.001). In conclusion, this study revealed the nutritional problems of young hill-tribe children were more severe than those of Thai children. The factors that could be related with this, were socioeconomic status, as also genetics, as well as cultural beliefs concerning child raising. Such ethnic minorities therefore should be considered as special cases in programs of health and nutrition promotion.

Role of calcium deficiency in development of nutritional rickets in Indian children: a case control study.

CONTEXT: Nutritional rickets is usually attributed to vitamin D deficiency. Studies from some tropical countries have postulated low dietary intake of calcium as the cause of nutritional rickets. Both vitamin D and dietary calcium deficiency are highly prevalent in India. Information on their relative contribution in the development of rickets in Indian children is limited. OBJECTIVE: The aim was to study the role of calcium and vitamin D deficiency in causation of nutritional rickets in young Indian children. DESIGN AND METHODS: In a case-control study, 67 children with nutritional rickets and 68 age- and sex-matched healthy controls were compared for demographic factors, nutritional status, sun exposure (UV score), dietary calcium and phytate intake (for subjects not breast-fed at presentation), and biochemical parameters [serum calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25OHD), and PTH]. RESULTS: Mean intake of calcium (204±129 vs. 453±234 mg/d; P<0.001) and proportion of calcium from dairy sources (41.7 vs. 88.6%; P<0.001) were significantly lower in cases vs. controls. The dietary intake of phytate was also significantly higher in cases (P=0.01). Median serum 25OHD level (interquartile range) in both cases and controls was in the range of deficiency [13.7 (10; 17.9) and 19.4 (12.3; 24.6) ng/ml, respectively]. There was no significant difference in the serum 25OHD level (P=0.08) or sun exposure as measured by UV score (P=0.39) among the cases and controls. In cases with rickets, significant negative correlations were seen between dietary calcium intake and radiological score (r=-0.28; P=0.03) and PTH (r=-0.26; P=0.02). No correlation was found between serum 25OHD level and radiological score or biochemical parameters of rickets. CONCLUSIONS: Rickets develops when low dietary calcium intake coexists with a low or borderline vitamin D nutrition status.

The concept of "critical nutrient density" in complementary feeding: the demands on the "family foods" for the nutrient adequacy of young Guatemalan children with continued breastfeeding.

BACKGROUND: The WHO recommends the introduction of nutritionally adequate, safe, and appropriate complementary foods at 6 mo of age, with continued breastfeeding up to 2 y and beyond. Suggested strategies to support continued breastfeeding often postulate optimal use of customary "family foods" and adequate amounts of indigenous foodstuffs and local foods. OBJECTIVE: The objective was to determine the nutrient adequacy of the diet of Guatemalan children aged 6-24 mo receiving continued breastfeeding and "family foods" rather than specially formulated "baby foods" as complementary foods. DESIGN: "Critical nutrient densities" for complementary foods were determined by using specific energy and protein requirements, assuming children to be in the 50th or 15th weight percentile of the 2006 WHO standards. Nutrient requirements for the total diet were determined by using the recommended nutrient intakes. Breast milk was assumed to provide 75% of total energy between 7 and 9 mo, 50% between 10 and 12 mo, and 40% between 13 and 24 mo. Gaps between computed critical nutrient densities and the best-scenario Guatemalan adult's diet, as a proxy for family foods, were examined. RESULTS: Energy complementation with these diets provided adequate nutrient density for protein, thiamine, riboflavin, and vitamins B-6, B-12, and C but not vitamin A, niacin, and folate in some groups. Major gaps for calcium, iron, and zinc were ubiquitous. CONCLUSIONS: The critical nutrient density concept is useful to evaluate the nutrient adequacy of the young child's diet. Multiple micronutrients are likely to be limited in the diets of Guatemalan young children with continued breastfeeding and family foods.

Extrauterine growth restriction: universal problem among premature infants / Restrição de crescimento extrauterino: problema universal entre os prematuros

ABSTRACT Objective: To analyze the growth rate of premature infants in the first weeks of life and factors associated with extrauterine growth restriction. Methods: This is a cross-sectional study of 254 premature infants in a neonatal intensive care unit conducted from January 1, 2008 to December 31, 2010. Infants who died or had malformations incompatible with life were excluded. Median weight curves according to gestational age were constructed for the first four weeks of life. The Fenton growth chart calculations provided the weight Z-scores. Extrauterine growth restriction was defined as corrected weight-for-age Z-score ≤-2. Perinatal, morbidity, and health care variables were analyzed. The Poisson regression model yielded the prevalenceratios . Associations between extrauterine growth restriction and the perinatal, morbidity, and care variables were investigated. Poisson regression controlled possible confounding factors. Results: The frequency of extrauterine growth restriction was 24.0%. Most (85.0%) small-for-gestational-age infants developed extrauterine growth restriction; 55.3% of extrauterine growth restriction cases involved small-for-gestational-age infants. Premature infants with gestational age >32 weeks did not recover the median birth weight until the third week of life and had a higher frequency of small-for-gestational-age. The Z-scores of non-small-for-gestational-age infants decreased more after birth than those of small-for-gestational-age infants. extrauterine growth restriction was associated with small-for-gestational-age (PR=6.14; 95%CI=3.33-11.33;p <0.001) and time without enteral diet (PR=1.08; 95%CI=1.04-1.13; p =0.010). Conclusion: Extrauterine growth restriction occurs in premature infants of all gestational age. The participation of small-for-gestational-age and nutritional practices in its genesis is noteworthy. We suggest prospective studies of all premature infants. The implementation of best care practices, individualized for small-for-gestational-age infants, to improve nutrient supply can minimize the problem.

RESUMO Objetivo: Analisar o crescimento de prematuros nas primeiras semanas de vida e fatores associados à restrição de crescimento extrauterino. Métodos: Estudo transversal realizado entre 01/01/2008 e 31/12/2010 com 254 prematuros em unidade de terapia intensiva. Excluíram-se óbitos e malformações incompatíveis com a vida. Construíram-se curvas de medianas de peso para as quatro primeiras semanas de vida de acordo com a idade gestacional. Calcularam-se escores-Z do peso pela planilha Fenton growth chart calculations. Definiu-se restrição de crescimento extrauterino pelos escores-Z do peso ≤-2 para a idade corrigida na alta hospitalar. Analisaram-se associações entre variáveis perinatais, assistenciais e morbidades com a restrição de crescimento extrauterino. Utilizou-se a regressão de Poisson para controlar os possíveis fatores de confundimento. Resultados: A frequência de restrição de crescimento extrauterino foi de 24%. Dos pequenos para a idade gestacional, 85% evoluíram com restrição de crescimento extrauterino. Prematuros com idade gestacional >32 semanas não recuperaram medianas de peso ao nascer até a terceira semana de vida, e, dentre eles, estava a maior frequência de pequenos para a idade gestacional. Os não pequenos para a idade gestacional apresentaram maior queda do escore-Z de peso do nascimento à alta quando comparados aos pequenos para a idade gestacional. Associaram-se à restrição de crescimento extrauterino nascer pequeno para a idade gestacional (RP=6,14; IC95%=3,33-11,33; p<0,001) e tempo sem dieta enteral (RP=1,08; IC95%=1,04-1,13; p=0,010). Conclusão: A restrição de crescimento extrauterino ocorre entre prematuros de todas as idades gestacionais, ressaltando--se a participação do nascimento pequeno para a idade gestacional e das práticas nutricionais na sua gênese. Sugerem-se estudos prospectivos que envolvam todos os prematuros. A implementação de boas práticas assistenciais que visem melhorar a oferta nutricional e individualizada para os pequenos para a idade gestacional pode minimizar o problema .

Undernutrition in British Haredi infants within the Gateshead Millennium cohort study.

OBJECTIVE: During a study of weight faltering it was observed that infants from a minority Haredi (ultra-Orthodox Jewish) religious group showed very different growth patterns from the rest of the cohort. The authors thus set out to explore the characteristics of the community that may explain these differences. SETTING AND SUBJECTS: Gateshead Millennium Study cohort, UK. DESIGN: Prospective population-based cohort study of 961 term infants (of whom 33 were from the Haredi community) recruited shortly after birth and followed by postal questionnaires and measurement at age 13 months. RESULTS: At birth Haredi children had similar weights to the rest of the cohort, but by the age of a year the Haredi babies were significantly lighter (mean difference -1.06; p<0.001) and shorter even after allowing for parental heights (length z score mean difference -0.5; p=0.02). They were much more likely to have had weight faltering at some point: Haredi 48%, remainder 11%; RR=4.36; p<0.001. The Haredi families were much larger (54% had 5-12 siblings) were breast fed for longer (67% >4 months vs 15% of remainder; p<0.01) and started solids later (mean difference (CI) 7.5 (5.3 to 9.8) weeks; p<0.001) and these factors largely explained the differences in weight gain. CONCLUSIONS: The extreme growth patterns seen in these children seem to relate to large family size and delayed and inadequate introduction of complementary solids, which are known risk factors for malnutrition in less affluent societies.

[Nutritional profile and factors associated with malnutrition in Kaingáng children on the Mangueirinha Indigenous Reserve, Paraná State, Brazil]. / Perfil nutricional e fatores associados à ocorrência de desnutrição entre crianças indígenas Kaingáng da Terra Indígena de Mangueirinha, Paraná, Brasil.

The goal of this study was to evaluate the nutritional status of indigenous children and to investigate factors associated with nutritional deficits. Weight and height measurements were obtained for 141 Kaingáng children from 0 to 5 years of age living on the Mangueirinha Indigenous Reserve in Paraná State, Brazil. Data on maternal and infant conditions and socioeconomic characteristics were also gathered through face-to-face interviews. Based on World Health Organization criteria (2006), 24.8% of the children presented low height-for-age (HA), 9.2% low weight-for-age (WA), 2.1% low weight-for-height (WH), and 2.1% low weight according to body mass index for age (BMIA). Based on NCHS criteria (1977), 19.9% of the children presented low HA, 9.2% low WA, and 1.4% low WH. 6.4% were overweight according to BMIA. Low birth weight and non-masonry housing construction were associated statistically with nutritional deficits. The Kaingáng children are subject to poor living conditions, associated with deficits in their nutritional profile.

Adiposity and height of adult Hmong refugees: relationship with war-related early malnutrition and later migration.

This study investigated whether historical proxies for poor nutrition early in life were associated with differences in body composition and height among adult Hmong refugees. Life history and anthropometric data were collected from a sample of 279 Hmong aged 18-51 years who were born in Laos or Thailand and resettled in French Guiana or the United States following the Second Indochina War. Overall, 30.5% were born in a war zone in Laos, while 38.8% were displaced as infants; these individuals were presumed to have experienced malnutrition in the perinatal and infant periods, respectively. Resettlement in urban areas in the US was utilized as a proxy for greater exposure to excessive energy balance, compared with Hmong who resettled in rural areas in French Guiana. In multiple linear regression models, being displaced in infancy was negatively associated with height after controlling for confounders, while being born in a war zone was associated with higher adiposity and centralized body fat distribution. Resettlement in the US was associated with a higher centralization of subcutaneous fat, but not overall adiposity. These findings may be of interest to the study of the developmental origins of obesity, in a population that has undergone early malnutrition followed by migration and rapid nutritional transition.

Malnutrition improvement for infants under 18 months old of Dai minority in Luxi, China.

BACKGROUND: Child malnutrition and thiamine deficiency remain a matter of public concern in Dai children under 5 years old in Southwest areas of China. The aim of the present study was to understand the status and correlates of malnutrition and thiamine deficiency in Dai children under 18 months old in Yunnan, China, and to explore an effective intervention for improving their nutritional status and decreasing the prevalence of malnutrition and thiamine deficiency in Dai children. METHODS: Well-trained investigators completed a baseline evaluation survey, including questionnaire survey by maternal interviews, child physical measurements, lab examination of thiamine, and group discussions in a cross-sectional study. An intervention plan was constructed by a group consisting of the city governor, government officers, maternal and child health workers, community leaders, and villagers etc. A comprehensive community-based intervention was carried out for 352 children born after July 2001 and their mothers or caregivers in half of the baseline survey villages by the end of 2003. The intervention included participatory intervention, community nutrition education, child growth monitoring and distributing thiamine to new mothers just before or after delivery. RESULTS: The baseline evaluation survey in 2000 indicated that the prevalence of moderate and severe protein-energy malnutrition was 19.5% for underweight, 16.4% for stunting, and 6.7% for wasting, respectively. With increasing age, the prevalence increased, peaking at 12-15 months. The prevalence of underweight in girls was higher than in boys. A total of 10.5% of children suffered from thiamine deficiency, and 5.7% of the children were insufficient in thiamine supply. Low Kaup target (<25%) was significantly associated with lack of guidance by doctors, lack of nutrition knowledge, lack of knowledge of causes of malnutrition and local culture food taboos. The status of child nutrition has been improved significantly since the intervention measure implementation. The change of prevalence of underweight children aged 6-17 months prior to and after the intervention was significant: 20.5% before and 13.7% after the intervention in infants aged 6-11 months, and 39.0% before and 26.4% after the intervention in young children aged 12-17 months. Prevalence of girls was higher than that of boys. Some women began to eat vegetables and pork from the market, which were forbidden by the culture food taboos. There is no case report of child thiamine deficiency in project villages. CONCLUSION: The prevalence of moderate and severe protein-energy malnutrition is high in Dai infants and young children. However, based on the local situation, participatory community-based comprehensive nutrition intervention effectively reduces the prevalence of child malnutrition and thiamine deficiency. It is highlighted that population nutritional intervention can produce better results with participation at a community level.

Disadvantaged black and coloured infants in two urban communities in the Western Cape, South Africa differ in micronutrient status.

OBJECTIVES: To determine the nutritional and health status of urban infants in two disadvantaged communities in the Western Cape, South Africa with special reference to micronutrient status. The results of this study will serve to plan an intervention study in these communities in the same age group. DESIGN: Cross-sectional study. SETTING: Two disadvantaged urban black and 'coloured' communities in the Western Cape, South Africa. SUBJECTS: Sixty infants aged 6-12 months from each community. OUTCOME MEASURES: Dietary intake, anthropometric measurements, micronutrient status and psychomotor development. RESULTS: Stunting and underweight were more prevalent in coloured infants (18% and 7%, respectively) than in black infants (8% and 2%, respectively). Anaemia (haemoglobin (Hb) < 11 g dl(-1) was prevalent in 64% of coloured and 83% of black infants. Iron-deficiency anaemia (Hb < 11 g dl(-1) and ferritin < 10 ng ml(-1) was found in 32% of coloured infants and in 46% of black infants. Zinc deficiency was prevalent in 35% and 33% of the coloured and black infants, respectively. Marginal vitamin A deficiency (serum retinol < 20 microg dl(-1) was observed in 23% of black infants compared with 2% of coloured infants. Of black infants, 43% and of coloured infants 6% were deficient in two or more micronutrients. Six per cent of coloured infants had C-reactive protein concentrations above 5 mg l(-1) compared with 38% of the black infants. The dietary intake of micronutrients was in general lower in black infants than in coloured infants. The overall psychomotor development, assessed by the Denver Developmental Screening Test, was different between the two groups. The coloured infants scored higher in three out of the four categories as well as in their overall score. CONCLUSIONS: This study shows that information on stunting and wasting only in urban disadvantaged infants is not sufficient to make recommendations about specific community intervention programmes. Information on the micronutrient status, independent of wasting and stunting, is necessary to design nutrition programmes for different communities. The study also showed a substantially higher prevalence of micronutrient deficiencies among black infants.

Tackling infant malnutrition in The Gambia.

Malnutrition is common among young children in developing countries. Often it is caused by poor infant weaning practices. Karen Hoare describes a community-based infant weaning programme in The Gambia which adapted local foods to improve nutritional content. The project also resulted in the development of a simple but effective demonstration kit.

PIP: The Gambia in 1988 had an infant mortality rate of 16-17% with an estimated 25% of under five year old children malnourished as defined by the World Health Organization. The author describes a community-based infant weaning program introduced in 1990 to the West Kiang district town of Keneba as part of a wider health education initiative. Weaning foods, as traditionally prepared, tend to be low in energy and protein and high in bacterial content. Weaning food demonstrations were therefore introduced to develop health education acceptable to the recipients, to improve the nutritional status of infants, to make use of local foods, and to dispel food taboos. The program used village women as teachers in their home compounds, invited women with babies aged 4-9 months to attend the demonstrations, adapted traditional Gambian dishes to increase their protein and energy content and make them palatable to the infant, and used the demonstrations as a forum for health education. The project also resulted in the development of a simple, effective demonstration kit. The fortnightly demonstrations were popular and well-attended. The neighboring village of Kantong Kunda also became involved and started its own demonstrations. Dietary assessment forms revealed that milk and eggs were being used in infants' foods. Potentially conducted by any health worker, literate or illiterate, in any developing country, the demonstrations are a low-cost, low-technology way of reducing the prevalence of childhood malnutrition around the world.