Association of a summary index of child feeding with diet quality and growth of 6-23 months children in urban Madagascar.

BACKGROUND/OBJECTIVES: The assessment of child feeding practices has received renewed attention through the development of an infant and child feeding index (ICFI). However, the advantages and shortcomings of such a summary index are still not well known. The aim of this study was to assess the usefulness of ICFI as an analytical tool (1) by studying its association with complementary food energy intake and mean micronutrient density adequacy (MMDA) and (2) by testing whether ICFI and its components are associated with length-for-age z-score (LAZ) of 6-23 months children in urban Madagascar. SUBJECTS/METHODS: ICFI was constructed using data from questionnaires on feeding practices and quantitative 24-h recalls (n=1589). Multivariate analysis was used to control for household wealth and other confounding factors. RESULTS: ICFI was positively correlated with complementary food energy intake (P<0.0001) and MMDA (P<0.0001). ICFI was associated with LAZ among 6-8 months children (P=0.02). For all ages combined, there was a tendency towards an association that did not reach statistical significance (P=0.08). Among feeding practices that formed ICFI, breastfeeding was associated with LAZ (P=0.03) but not in the expected direction with +0.16 z-score difference in favour of non-breast-fed children. When breastfeeding was removed and introduced separately into the multivariate model, the relationship between the modified ICFI and LAZ became significant (P=0.02). CONCLUSIONS: Findings suggest that the ICFI could be a useful analytical tool, which needs however to be constructed according to its final use and which should be adapted to each context.

Determinants of nutrition improvement in a large-scale urban project: a follow-up study of children participating in the Senegal Community Nutrition Project.

OBJECTIVE: To study individual determinants of differential benefit from the Senegal Community Nutrition Project (CNP) by monitoring improvement in children's weight-for-age index (WA) or underweight status (WA < -2 Z-scores) during participation. DESIGN: A follow-up study using the CNP child monitoring data. Linear general models compared variations in WA according to 14 factors describing the beneficiaries and CNP services. SETTING: Poor neighbourhoods of Diourbel, a large city in Senegal, West Africa. Over a 6-month period, the CNP provided underweight or nutritionally at-risk 6-35-month-old children with monthly growth monitoring and promotion and weekly food supplementation, provided that mothers attended weekly nutrition education sessions. SUBJECTS: All the children who participated in the first two years of the project (n=4084). RESULTS: Mean WA varied from -2.13 (standard deviation (SD) 0.82) to -1.58 (SD 0.81) Z-scores between recruitment and the end of the follow-up. The lower the child's initial WA, the greater was their increase in WA but the lower was the probability of recovery from underweight. Only 61% of underweight children recovered. Six months of CNP services may not be sufficient for catch-up growth of severely underweight children. The number of food supplement rations received was not a direct indicator of the probability of recovery. After adjustment for services received and initial WA, probability of recovery was lower in girls, in younger children, in twins and when mothers belonged to a specific ethnic group. CONCLUSIONS: Determinants of benefit from CNP differed from the risk factors for underweight. Identification of participants with a lower probability of recovery can help improve outcome. Moreover, an explanation for the lack of recovery could be that many underweight children are stunted but not necessarily wasted.

Red palm oil as a source of vitamin A for mothers and children: impact of a pilot project in Burkina Faso.

OBJECTIVE: To demonstrate the effectiveness of the commercial introduction of red palm oil (RPO) as a source of vitamin A (VA) for mothers and children in a non-consuming area, as a dietary diversification strategy. DESIGN: A pre-post intervention design (no control area) was used to assess changes in VA intake and status over a 24-month pilot project. SETTING AND SUBJECTS: The pilot project involved RPO promotion in 10 villages and an urban area in east-central Burkina Faso, targeting approximately 10 000 women and children aged <5 years. A random sample of 210 mother-child (12-36-months-old) pairs was selected in seven out of the 11 pilot sites for the evaluation. RESULTS: After 24 months, RPO was reportedly consumed by nearly 45% of mothers and children in the previous week. VA intake increased from 235+/-23 microg retinol activity equivalents (RAE) to 655+/-144 microg RAE in mothers (41 to 120% of safe intake level), and from 164+/-14 microg RAE to 514+/-77 microg RAE in children (36 to 97%). Rates of serum retinol <0.70 micromol l(-1) decreased from 61.8+/-8.0% to 28.2+/-11.0% in mothers, and from 84.5+/-6.4% to 66.9+/-11.2% in children. Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake. CONCLUSIONS: Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites. While it is promising as part of a national strategy, additional public health and food-based measures are needed to control VA malnutrition, which remained high in the RPO project area.

[Malnutrition and anemia in children hospitalized in Martinique]. / Malnutrition et anémie chez des enfants hospitalisés en Martinique.

In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a clinical and biological study was undertaken at Lamentin hospital in 100 hospitalized children aged 6 months to 6 years. Forty seven p. cent of children were underweight and 38 p. cent were anemic. Anemia and iron deficiency predominated in the under-24-month age group, whereas wasting was the dominate finding in older children. Under 2 years of age, risk factors for wasting and anemia were associated with method of breastfeeding. Over 2 years of age, low birthweight was the only risk factor of wasting identified. In Martinique, nutritional deficiency is common in children admitted to hospital and a high index of suspicion is indicated in the hospitalized population. Following the resolution of infections, supplemental iron therapy must be considered for a great number of children under 2 years of age.

[Utilization of gossypol-free cottonseed and its by-products as human food]. / Utilisation en alimentation humaine de la graine de coton sans gossypol et de ses dérivés.

Trials have principally turned on a glandless cottonseed flour, with 56 p. 100 of proteins. It is possible to blend it with millet or sorghum flour, and so to prepare the main meals of the local cooking. Trial of acceptability and long-dated consumption have shown that this flour is rather well appreciated especially in sauces. The growth of young children has been better thanks to the consumption of a cottonseed flour pap during six months. Trials to manufacture biscuits and noodles have been attempted. Kernels of cottonseed with 32 p. 100 of proteins and 33 p. 100 of lipids have been consumed with success. Four tons of kernels have been sold at the same price as sorghum in the area where the glandless cotton plant is under cultivation.