Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
2.
Food Nutr Bull ; 37(3): 375-386, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27150298

RESUMO

BACKGROUND: Vitamin A supplementation (VAS) among children 6 to 59 months of age reduces vitamin A deficiency (VAD)-related mortality. Child health days (CHDs) only reach an estimated 16.7% of children at exactly 6 months, leaving uncovered children at risk of VAD-related mortality; similarly, VAS provided at 9 months of age with measles-containing vaccine leaves infants unprotected for 3 months. OBJECTIVE: Using data from sub-Saharan Africa, we estimated the mortality benefits and safety of providing VAS at age 6 months, compared to delivery through CHDs and at 9 months. METHODS: We modeled VAS-preventable mortality benefits at 6 months as a function of published VAS effect sizes, intervention coverage, and proportion of infant deaths occurring between 6 and 11 months. To evaluate safety, we modeled the effect of different VAS coverage scenarios on maximum hepatic vitamin A concentrations (HVACs). RESULTS: VAS linked to a 6-month visit could reduce infant mortality by an additional 1.95 (95% confidence interval [CI]: 1.38-2.52) and 1.63 (95% CI: 1.15-2.11) percentage points compared to VAS through CHDs and at 9 months, respectively. The HVAC models indicate that VAS at 6 months is safe even in the presence of a second VAS dose 1 month later and other food-based vitamin A control strategies. CONCLUSION: Advancing the first VAS dose to 6 months should be considered in settings where VAS is currently given first at 9 months. A 6-month VAS dose should also be considered in settings where VAS is delivered through CHDs. VAS delivery at 6 months could also serve as a platform to deliver other high-impact interventions.

5.
Matern Child Health J ; 19(9): 1985-92, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25665894

RESUMO

Since 2004, twice-yearly mass vitamin A supplementation (VAS) has equitably reached over 85% of children 6-59 months old in Sierra Leone. However infants who turn 6 months after the event may wait until they are 11 months old to receive their first dose. The effectiveness of integrating VAS at 6 months into the Expanded Program of Immunization (EPI) in a revised child health card was studied. Health facilities matched according to staff cadre and work load were assigned to provide either a 'mini package' of VAS and infant and young child feeding (IYCF), a 'full package' of VAS, IYCF and family planning (FP), or 'child health card' only. 400 neonates were enrolled into each group, caregivers given the new child health card and followed until they were 12 months old. More infants in the full: 74.5% and mini: 71.7% group received VAS between 6 and 7 months of age compared with the new CH card only group: 60.2% (p = 0.002, p < 0.001 respectively). FP commodities were provided to 44.5% of caregivers in the full compared with <2.5% in the mini and new child health card only groups (p < 0.0001). Integration of VAS within the EPI schedule achieved >60% coverage for infants between 6 and 7 months of age. Provision of FP and/or IYCF further improved coverage. Funding was provided by the Canadian Department of Foreign Affairs, Trade and Development who had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.


Assuntos
Suplementos Nutricionais , Programas de Imunização/métodos , Vitamina A/uso terapêutico , Comportamento Alimentar , Feminino , Humanos , Imunização/métodos , Lactente , Recém-Nascido de Baixo Peso , Masculino , Avaliação de Programas e Projetos de Saúde , Serra Leoa , Fatores Socioeconômicos
6.
Proc Nutr Soc ; 72(4): 381-5, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24025656

RESUMO

The scaling up nutrition (SUN) policy framework requires extensive public­private partnership (PPP). Malnutrition is multi-dimensional and should engage multi-sectoral platforms. The SUN policy however did not fully embrace the dynamics of harnessing PPP. The objectives of the present paper are to highlight the reasons for the apprehension around PPP and illustrate how effective coordination of PPP in West Africa has contributed to implementing large-scale food fortification with micronutrients as a complementary nutrition intervention. The experience of Helen Keller International (HKI) in scaling up food fortification was emphasised with understanding of the factors contributing to indifference by the international community to private sector contribution to SUN. The roles of different stakeholders in a PPP are elucidated and the process linked to who, why and how to engage. The private sector provides direct nutrition services while the public sector creates the enabling environment for the private sector to thrive on social values. Through this approach fortified vegetable oil and wheat flour are now reaching over 70% of the population in West Africa. As a neutral broker HKI coordinated and facilitated dialogue among the different stakeholders. The core competencies of each stakeholder were harnessed and each partner was held accountable. It concludes that multi-sectoral relationship must be transparent, equitable and based on shared mutual interests. The rules and values of PPP offer opportunities for SUN.


Assuntos
Alimentos Fortificados , Micronutrientes/administração & dosagem , Política Nutricional , Parcerias Público-Privadas , África Ocidental , Humanos , Estado Nutricional
7.
Food Nutr Bull ; 34(2): 199-214, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23964393

RESUMO

BACKGROUND: Zinc supplementation of young children in lower-income countries reduces morbidity from diarrhea and pneumonia and all-cause mortality, but the most cost-effective approach for distributing zinc supplements is unknown. OBJECTIVE: To examine the potential impact of four possible strategies for delivering zinc supplements on disease prevention and deaths averted among children 6 to 59 months of age in sub-Saharan Africa. METHODS: We analyzed different zinc supplementation strategies to assess their likely impact on morbidity and mortality of preschool children in sub-Saharan Africa and to estimate their possible costs. RESULTS: Preventive zinc supplementation reduces diarrhea incidence by 27% among children 12 to 59 months of age, pneumonia incidence by 21% among children 6 to 59 months of age, and all-cause mortality by 18% among children 12 to 59 months of age. The likely average total program costs of zinc supplementation programs were estimated from the outlays of existing service delivery platforms, such as child health days, community-based nutrition programs, and clinic-based treatment of diarrhea, assuming different levels of coverage and target age ranges of children. CONCLUSIONS: We found that the average total costs per life saved ranged from approximately US$462 to US$3,111, and the most cost-effective interventions were weekly or intermittent preventive zinc supplementation, because of the possibility of high coverage and fewer supplements required. Empirical data from zinc supplementation programs will be needed to confirm these estimates.


Assuntos
Mortalidade da Criança , Suplementos Nutricionais/economia , Zinco/administração & dosagem , Zinco/deficiência , África Subsaariana/epidemiologia , Pré-Escolar , Análise Custo-Benefício , Custos e Análise de Custo , Diarreia/etiologia , Diarreia/mortalidade , Diarreia/prevenção & controle , Humanos , Lactente , Desnutrição/tratamento farmacológico , Morbidade , Pneumonia/etiologia , Pneumonia/mortalidade , Pneumonia/prevenção & controle
8.
Food Nutr Bull ; 34(1): 21-38, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23767278

RESUMO

BACKGROUND: Food fortification has been increasingly recognized as a promising approach to prevent micronutrient deficiencies. The Fortification Rapid Assessment Tool (FRAT) was developed to assist public health program managers to acquire the information needed to implement an effective mass food fortification program. Multiple countries have conducted FRAT surveys, but information on results and experiences with the FRAT tool has been available only at the national level. OBJECTIVE: To summarize the findings of the FRAT surveys previously conducted in sub-Saharan Africa. METHODS: Surveys from 12 sub-Saharan African countries (Burkina Faso, Cameroon, Congo, Guinea, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Uganda) were identified. Information on consumption patterns for wheat flour, vegetable oil, sugar, and bouillon cubes was reviewed and summarized. RESULTS: Most surveys found that a moderate to high proportion of women reported consuming wheat flour (48% to 93%), vegetable oil (44% to 98%), sugar (55% to 99%), and bouillon cubes (79% to 99%) in the past 7 days, although consumption was more common and more frequent in urban areas than in rural areas. Similarly, the reported amounts consumed during the previous 24 hours were generally higher in urban settings. CONCLUSIONS: The FRAT instrument has been successfully used in multiple countries, and the results obtained have helped in planning national food fortification programs. However, the recommended sampling scheme may need to be reconsidered, and the guidelines should be revised to clarify important aspects of fieldworker training, implementation, data analysis and interpretation, and reporting of the results.


Assuntos
Inquéritos sobre Dietas/métodos , Alimentos Fortificados , Adolescente , Adulto , África Subsaariana , Pré-Escolar , Inquéritos sobre Dietas/normas , Inquéritos sobre Dietas/tendências , Sacarose Alimentar , Feminino , Farinha , Humanos , Lactente , Micronutrientes/deficiência , Pessoa de Meia-Idade , Óleos de Plantas , Triticum , Adulto Jovem
9.
Food Nutr Bull ; 30(1 Suppl): S12-40, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19472600

RESUMO

Zinc supplementation trials carried out among children have produced variable results, depending on the specific outcomes considered and the initial characteristics of the children who were enrolled. We completed a series of meta-analyses to examine the impact of preventive zinc supplementation on morbidity; mortality; physical growth; biochemical indicators of zinc, iron, and copper status; and indicators of behavioral development, along with possible modifying effects of the intervention results. Zinc supplementation reduced the incidence of diarrhea by approximately 20%, but the impact was limited to studies that enrolled children with a mean initial age greater than 12 months. Among the subset of studies that enrolled children with mean initial age greater than 12 months, the relative risk of diarrhea was reduced by 27%. Zinc supplementation reduced the incidence of acute lower respiratory tract infections by approximately 15%. Zinc supplementation yielded inconsistent impacts on malaria incidence, and too few trials are currently available to allow definitive conclusions to be drawn. Zinc supplementation had a marginal 6% impact on overall child mortality, but there was an 18% reduction in deaths among zinc-supplemented children older than 12 months of age. Zinc supplementation increased linear growth and weight gain by a small, but highly significant, amount. The interventions yielded a consistent, moderately large increase in mean serum zinc concentrations, and they had no significant adverse effects on indicators of iron and copper status. There were no significant effects on children's behavioral development, although the number of available studies is relatively small. The available evidence supports the need for intervention programs to enhance zinc status to reduce child morbidity and mortality and to enhance child growth. Possible strategies for delivering preventive zinc supplements are discussed.


Assuntos
Mortalidade da Criança , Diarreia/prevenção & controle , Crescimento/efeitos dos fármacos , Malária/prevenção & controle , Infecções Respiratórias/prevenção & controle , Oligoelementos/uso terapêutico , Zinco/uso terapêutico , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Deficiências Nutricionais/mortalidade , Deficiências Nutricionais/prevenção & controle , Suplementos Nutricionais , Feminino , Humanos , Lactente , Masculino , Estado Nutricional/efeitos dos fármacos , Oligoelementos/sangue , Zinco/sangue , Zinco/deficiência
10.
Food Nutr Bull ; 30(1 Suppl): S179-84, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19472607

RESUMO

This paper summarizes the results of the foregoing reviews of the impact of different intervention strategies designed to enhance zinc nutrition, including supplementation, fortification, and dietary diversification or modification. Current evidence indicates a beneficial impact of such interventions on zinc status and zinc-related functional outcomes. Preventive zinc supplementation reduces the incidence of diarrhea and acute lower respiratory tract infection among young children, decreases mortality of children over 12 months of age, and increases growth velocity. Therapeutic zinc supplementation during episodes of diarrhea reduces the duration and severity of illness. Zinc fortification increases zinc intake and total absorbed zinc, and recent studies are beginning to confirm a positive impact of zinc fortification on indicators of population zinc status. To assist with the development of zinc intervention programs, more information is needed on the prevalence of zinc deficiency in different countries, and rigorous evaluations of the effectiveness of large-scale zinc intervention programs should be planned. Recommended steps for scaling up zinc intervention programs, with or without other micronutrients, are described. In summary, there is now clear evidence of the benefit of selected interventions to reduce the risk of zinc deficiency, and a global commitment is urgently needed to conduct systematic assessments of population zinc status and to develop interventions to control zinc deficiency in the context of existing public health and nutrition programs.


Assuntos
Suplementos Nutricionais , Saúde Pública , Oligoelementos/uso terapêutico , Zinco/uso terapêutico , Dieta , Alimentos Fortificados , Humanos , Oligoelementos/administração & dosagem , Oligoelementos/deficiência , Zinco/administração & dosagem , Zinco/deficiência
11.
J Trop Pediatr ; 53(3): 190-6, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17463012

RESUMO

BACKGROUND: Vitamin A deficiency (VAD) is a major contributor to child mortality in sub-Saharan Africa. Sustained control of VAD is essential to meet the Millennium Development Goal (MDG) for reduction of child mortality in Guinea. Since, twice yearly vitamin A supplementation (VAS), either coupled with National Immunization Days or stand-alone has been adopted as a key strategy to combat VAD in 6-59 months old children. OBJECTIVES: The objectives of this survey were to describe national VAS coverage rates and related factors affecting VAS coverage among 6-59 months old Guinean children. METHODS: In July 2003, a VAS coverage survey was implemented in Guinea. A cross-sectional random cluster survey was conducted to select Guinean children (n = 1950, 390 mother-child pairs per zone) aged 6-59 months. The country was divided into four agro-ecological zones with 30 clusters chosen per zone. Within each cluster, a random selection of 13 households with at least one child was carried out with random selection of one child per household. Data on characteristics of children, receipt of VAS, caregivers' socio-economic characteristics, vitamin A knowledge and practices of caregivers were collected by questionnaire. RESULTS: The national coverage rate of 68% is much lower than the official coverage rate of 93%. Middle Guinea, the region most affected by VAD, had the lowest coverage rate (58%). CONCLUSION: In order to increase overall VAS coverage and reduce regional disparities, it is suggested that mass VAS be organized on a regional level, prioritizing rural regions (Middle and Upper Guinea) and the city of Conakry.


Assuntos
Suplementos Nutricionais/provisão & distribuição , Deficiência de Vitamina A/tratamento farmacológico , Vitamina A/administração & dosagem , Vitamina A/provisão & distribuição , Pré-Escolar , Estudos Transversais , Feminino , Guiné/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Masculino
12.
Public Health Nutr ; 10(11): 1241-6, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17381941

RESUMO

OBJECTIVES: To assess vitamin A supplementation (VAS) coverage of children aged 6-59 months and the factors that favour or limit this coverage during the National Nutrition Weeks in Mali. DESIGN: Cross-sectional study. Interviews about demographic factors and children's adherence to the vitamin A capsule distribution programme were conducted. Professionals' knowledge of vitamin A and various aspects related to the supplementation strategy were assessed. SETTING: Five regions out of the eight regions in the country, in addition to Bamako District. Three rural communes were selected in three regions to represent rural areas. SUBJECTS: Parents or caregivers of children under 5 years of age, health agents who participated in the weeks, and community and administrative leaders. RESULTS: At least 80% of the children received the supplement. More 'traditional' communication channels (town criers, friends and family members) appeared to be more effective in reaching the target groups than modern methods, i.e. radio and television. Mothers' possession of a radio (Pearson chi2 = 5.03; P = 0.025) and fathers' education (Pearson chi2 = 19.02; P < 0.001), possession of a radio (Pearson chi2 = 8.93; P = 0.003) and listening to it (Pearson chi2 = 7.62; P = 0.006) all appeared to be statistically and significantly associated with children's coverage. In multivariate logistic regression analysis, only the study site (urban/rural) (P = 0.004), 'traditional channels' (P = 0.02) and fathers' education (P = 0.04) were significantly associated with children's coverage. Knowledge about VAS was high among community and administrative leaders, and health professionals. The planning and implementation of activities at the district level were found to be good in general. CONCLUSION: National Nutrition Weeks provide a successful example of a periodic VAS strategy with high coverage among children aged 6-59 months in Mali. Campaigns aimed at informing and sensitising populations during the Nutrition Weeks should also target children's fathers.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Suplementos Nutricionais , Educação em Saúde , Deficiência de Vitamina A/prevenção & controle , Vitamina A/administração & dosagem , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Promoção da Saúde , Humanos , Lactente , Masculino , Mali/epidemiologia , Fatores Socioeconômicos , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/etiologia
13.
Food Nutr Bull ; 26(1): 26-31, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15810796

RESUMO

In 1997, the reduction of child mortality became a policy priority for the Government of Niger because Niger's child mortality rate was the highest in the world. The Ministry of Public Health, Helen Keller International (HKI), and UNICEF spearheaded a coalition-building process linking vitamin A deficiency (VAD) control to national child survival goals. An evidence-based advocacy strategy was developed around the child survival benefits of adequate and sustained VAD control with one unambiguous message: "VAD control can avert over 25,000 child deaths per year." As a result, in 1997 Niger became one of the first countries in Africa to effectively integrate vitamin A supplementation into National Immunization Days (NIDs) for polio eradication. The challenge was then to provide children with a second annual dose of vitamin A. This led in 1999 to the first ever National Micronutrient Days (NMDs) in Africa. NMDs are mobilization campaigns in which caregivers are actively encouraged to take their children for the delivery of vitamin A supplements. Since 1999, the combination of NIDs and NMDs has ensured that over 80% of children 6 to 59 months of age receive two vitamin A doses annually. The success of NIDs/NMDs has relied on five pillars: leadership and ownership by the Ministry of Public Health; district-level planning and implementation; effective training and flexible delivery mechanisms; effective social information, communication, and mobilization; and responsiveness and flexibility of Ministry of Public Health and development partners. This successful approach has been widely disseminated, notably through the West African Nutrition Focal Points Network.


Assuntos
Mortalidade Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Política Pública , Deficiência de Vitamina A/tratamento farmacológico , Vitamina A/administração & dosagem , Pré-Escolar , Suplementos Nutricionais , Feminino , Alimentos Fortificados , Humanos , Lactente , Masculino , Níger/epidemiologia , Saúde Pública , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/mortalidade
14.
Public Health Nutr ; 8(1): 33-7, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15705243

RESUMO

BACKGROUND: In Mali, an estimated 73% of pregnant women are anaemic largely due to iron deficiency. National policy recommends women to take iron and folic acid supplements daily from first prenatal contact until 3 months postpartum. However, many pregnant women in Mali could benefit from multiple micronutrient supplements. OBJECTIVE: To assess pregnant women's acceptability of and adherence to a daily multiple micronutrient supplementation scheme compared with the current daily iron and folic acid supplementation scheme. DESIGN: Seventy pregnant women were allocated to either the daily multiple micronutrient or daily iron and folic acid supplementation scheme. Women started receiving supplements at the end of the first trimester of pregnancy until delivery and throughout the first 3 months postpartum. RESULTS: No significant differences were observed between comparison groups with respect to women's perceptions about supplement size, colour, taste or flavour. Adherence to the multiple micronutrient supplementation scheme was better (257.5+/-20.9 tablets; average adherence 95.4%) than that to the iron and folic acid supplementation scheme (238.5+/-32.7 tablets; average adherence 92.2%; P=0.008) although both were very good, as were women's perceptions about the benefits of micronutrient supplements to their health and that of their newborns. CONCLUSION: Malian women adhere to prenatal/postpartum micronutrient supplementation - no matter what supplement is chosen - when access to supplements is guaranteed and when they are provided with minimum, consistent and easily understandable information and counselling, indicating that these are key elements to ensure effective programmes. These findings, together with those of the global research agenda on the efficacy of multiple micronutrient supplements for pregnant women, will inform policy development in Mali for the effective control of iron deficiency and iron-deficiency anaemia in pregnant women.


Assuntos
Anemia Ferropriva/prevenção & controle , Deficiência de Ácido Fólico/prevenção & controle , Lactação/fisiologia , Micronutrientes/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Anemia Ferropriva/tratamento farmacológico , Suplementos Nutricionais , Feminino , Ácido Fólico/administração & dosagem , Deficiência de Ácido Fólico/tratamento farmacológico , Humanos , Ferro/administração & dosagem , Deficiências de Ferro , Lactação/efeitos dos fármacos , Mali , Micronutrientes/administração & dosagem , Cooperação do Paciente , Período Pós-Parto , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal
15.
Food Nutr Bull ; 26(4): 348-55, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16465981

RESUMO

BACKGROUND: Children with vitamin A deficiency have higher risk of morbidity and mortality than vitamin A-sufficient children. Estimates on the potential child survival benefits of vitamin A deficiency control are needed for policy and program advocacy. OBJECTIVE: To determine the current prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa in order to estimate the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region. METHODS: Estimates of the prevalence of vitamin A deficiency generated in 1998, data from 11 nationally representative vitamin A deficiency surveys conducted in sub-Saharan Africa between 1997 and 2003, and the measured effects of vitamin A deficiency on child mortality were combined to estimate the prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa and the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region. RESULTS: Our analysis shows that in the absence of effective and sustained policies and programs for the control of vitamin A deficiency, an estimated 42.4% of children 0 to 59 months of age in sub-Saharan Africa (43.2 million children) are at risk for vitamin A deficiency. Such effective and sustained policy and program action for the control of vitamin A deficiency can bring about a potential 25% reduction in mortality in children 0 to 59 months with respect to 1995 mortality levels (i.e., before the onset of large-scale vitamin A supplementation programs in sub-Saharan Africa). CONCLUSIONS: Effective and sustained control of vitamin A deficiency has the potential to be among the most cost-effective and high-impact child-survival interventions in sub-Saharan Africa. A stronger political commitment and a more appropriate level of investment in the effective control of vitamin A deficiency could make a large contribution toward the attainment of the Millennium Development Goal for the reduction of child mortality rates by two-thirds between 1990 and 2015. Among the many challenges that Africa will need to face in the coming years, vitamin A deficiency is one that can be overcome. The need is urgent, and the solutions are known, effective, and affordable.


Assuntos
Causas de Morte , Mortalidade da Criança , Fenômenos Fisiológicos da Nutrição Infantil , Deficiência de Vitamina A/mortalidade , Deficiência de Vitamina A/prevenção & controle , África Subsaariana/epidemiologia , Serviços de Saúde da Criança , Pré-Escolar , Análise Custo-Benefício , Suplementos Nutricionais , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Política Nutricional , Análise de Sobrevida , Deficiência de Vitamina A/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA