Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018.

INTRODUCTION: Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases and one million deaths per year worldwide. However, there remains a lack of well-documented and biochemically assessed prevalence of IDA based on the representative population-based samples globally and regionally. In this study, we aimed to assess the National Nutrition Survey (NNS) 2018 to identify the prevalence and risk factors of IDA in Pakistani CU5 and WRA. METHODS: Secondary analysis was conducted on the NNS 2018, a cross-sectional survey, which collected data on dietary practices, malnutrition, and food insecurity. Anemia was defined as hemoglobin levels < 11.0 g/dL in children and 12.0 g/dL in women. IDA was defined as low hemoglobin and low ferritin (<12 ng/mL) levels, adjusted for inflammation using AGP and CRP biomarkers in CU5 and WRA. Univariate and multivariable logistic regressions were conducted using Stata statistical software (version 16). We also compared the IDA rates of NNS 2018 and 2011. RESULTS: A total of 17,814 CU5 and 22,114 WRA were included in the analysis. Of the CU5, 28.9% had IDA, while 18.4% of WRA reported to experience IDA. Among the CU5, IDA was most prevalent among male children aged 6-23 months living in rural areas and with the presence of diarrhea and fevers in the last 2 weeks. Children whose mothers had no education, were aged 20-34 years, and employed, had a higher prevalence of IDA. Married WRA, who are employed, living in rural areas, and with no education, had a higher prevalence of IDA. In the multivariable logistic regression, children aged 6-23 months (AOR = 1.19, 95% CI [1.08-1.33], p < 0.001) and with the presence of diarrhea in the last 2 weeks (AOR = 1.32, 95% CI [1.13-1.54], p < 0.001) or fever (AOR = 1.16, 95% CI [1.02-1.32], p = 0.02) had higher odds of IDA. At the household level, the odds of IDA among CU5 were higher in the poorest households (AOR = 1.27, 95% CI [1.08-1.50], p = 0.005), with ≥5 CU5 (AOR = 1.99, 95% CI [1.28-3.11], p = 0.002), and with no access to improved sanitation facilities (AOR = 1.17, 95% CI [1.02-1.34], p = 0.026). For WRA, the multivariable logistic regression found that the odds of IDA were higher among women with vitamin A deficiency (Severe: AOR = 1.26, 95% CI [1.05-1.52], p = 0.013; Mild: AOR = 1.36, 95% CI [1.23-1.51], p < 0.001), zinc deficiency (AOR = 1.42, 95% CI [1.28-1.57], p < 0.001), no education (AOR = 1.53, 95% CI [1.30-1.81], p < 0.001), and from severely food insecure households (AOR = 1.20, 95% CI [1.07-1.34], p = 0.001). The odds of IDA were lower among women whose body mass index was overweight (AOR = 0.77, 95% CI [0.69-0.86], p < 0.001) or obese (AOR = 0.71, 95% CI [0.62-0.81], p < 0.001). CONCLUSIONS: The child's age, presence of diarrhea or fever, place of residence, household size, wealth status, and access to sanitation facilities were significantly associated with IDA among CU5 in Pakistan. For WRA, education, body mass index, vitamin A and zinc status, household food security status, wealth status, and access to sanitation facilities were significantly associated with IDA. Large, well-established, government-funded programmes focused on micronutrient supplementation, food fortification, the diversification of food supplies, and the treatment and prevention of infectious and parasitic diseases are needed to prevent IDA and all forms of anemia among children and women in Pakistan.

In-vivo (Albino Mice) and in-vitro Assimilation and Toxicity of Zinc Oxide Nanoparticles in Food Materials.

Purpose: Recent advances in nanotechnology have given rise to the potential utilization of nanoparticles as food, nano-medicine/biomedicines. Patient: The study aimed to investigate the effects of nano-zinc oxide (nano-zinc) on the bio-assimilation of mineral (Zn) in mice, aged 3-6 weeks. Methods: ZnO nanoparticles were added to the basal diet as a supplement at amounts of 0.07, 0.14 and 0.21 mg/kg. The synthesized material was characterized by Fourier transform infrared spectrophotometer, particle size, scanning electron microscope, Thermogravimetric Analysis Thermal, X-ray diffraction spectrophotometer and Zeta potential. Results: In-vitro bioavailability of synthesized group ZnO (120 nm) was 43%, whereas for standard group ZnO (50 nm) was reported as 55%. In-vivo bioavailability of zinc oxide illustrated the maximum absorption level compared with the control. In-vivo toxicity was characterized as damage done to the liver and spleen tissues with a high dose of 0.21 mg/kg, while smaller doses indicated no toxic effects. Conclusion: The study provided important insights on the toxicological effects of ZnO nanoparticles, depending on dose rate and bio-assimilation, as well as particles, under various conditions (in-vitro and in-vivo). These findings will motivate further detailed research on nano-based medicine for alleviating malnutrition conditions.

Soybean herbage yield, nutritional value and profitability under integrated manures management.

Organic manures are more preferred and environmentally friendly than chemical fertilizers for minimally contaminating soil, water and environmental resources, but the determination of right source of organic manures continues to remain an unexplored aspect. Considering the important issue, a multi-year field trial was carried out to determine the response of forage soybean to four sources of nutrients such as chemical fertilizers (IF), poultry litter (PL), bovine's farm yard slurry (BFYS) and sewage sludge (SS) and their seven binary combinations (PL+BFYS, PL+SS, PL+IF, BFYS+SS, BFYS+IF, SS+IF and PL+BFYS+SS). Supplementation of organic manures with mineral fertilizers remained superior to their sole application, particularly BFYS + IF was found significantly (p≤0.05) superior for yielding the highest fresh biomass (23.9, 26.4 and 25.7 t ha-1) with improved nutritional quality. The same combination of integrated fertilizer management also recorded higher sustainability as per sustainable forage yield index along with the highest net income and the benefit-cost ratio. PL and SS applied in conjunction with IF performed better than sole or binary application of organic manures. Therefore, BFYS + IF may be recommended for adoption to produce comparable forage yield and nutritional quality of soybean along with reducing dependency on chemical fertilizers.

Jambul (Syzygium cumini) Pulp Extract Enhances Viability, Motility, and In Vitro Fertilizability of Cryopreserved Bovine Semen.

To study the ameliorative capacity of Syzygium cumini fruit Pulp Extract (SPE) on cryopreserved bovine semen, three ejaculates each of three fertile bulls (total nine samples) were collected. Each sample was mixed with semen dilution medium in 1:2 ratios, centrifuged, and 50% of the supernatant was discarded. The remaining sample was mixed with semen cryopreservation extender (SCE) in 1:4 ratios. Three aliquots (0.3 mL) of each extended semen sample were further diluted with (1) 0.7 mL SCE (SCE group), (2) 0.7 mL SCE containing SPE equivalent to 7 ppm total antioxidants (SPE7 group), and (3) 0.7 mL SCE equivalent to 14 ppm antioxidants (SPE14 group). For each aliquot, semen quality was analyzed in situ as well as after cryopreservation. Results show significant improvement in sperm membrane integrity, motility, and fertilizability in SPE7 (63.5% ± 2.04%, 56.22% ± 1.7%, 51.1%, respectively) and SPE14 (68% ± 1.12%, 63.67% ± 1.06%, 57.7%, respectively) than the SCE group (62.33% ± 1.22%, 54.9% ± 1.34%, 48.8%, respectively). Similarly, significant improvement in the mean percent number of progressively motile sperm at the expense of the mean percent twitching, shaking, and whirling spermatozoa, both before and after cryopreservation, were observed in SPE7 (72 ± 1.06, 61.2 ± 1.2) and SPE14 (78.89 ± 1.12, 67 ± 1.32) groups to that of the SCE (59.6 ± 0.97, 52.3 ± 3.5). In addition, the mean percent of progressively motile spermatozoa showing 20 µm/s or above velocity, before and after cryopreservation, were significantly higher in SPE7 (58.9 ± 4.7, 43.6 ± 1.5) and SPE14 (66.9 ± 0.8, 51.3 ± 0.8) groups than that of the SCE (42.3 ± 3.1, 30 ± 2.4). These findings indicate that SPE can significantly improve various quality parameters of the cryopreserved bovine semen.

Effect of Varying Levels of Chromium Propionate on Growth Performance and Blood Biochemistry of Broilers.

The objective of this work was to evaluate the effects of varying levels of chromium propionate on blood biochemistry and growth performance of broilers (1-35 days). Five diets were formulated by using chromium propionate with inclusion levels of 0, 200, 400, 800 and 1600 ppb. A total of 300 broilers were divided into 5 groups with 6 replicates of 10 birds in each under completely randomized design. The starter feed intake remained unaffected (p > 0.05) whereas finisher and overall feed intake was different (p < 0.05) among different experimental groups. Feed conversion ratio and weight gain in starter, finisher and overall improved significantly (p < 0.05) with the increasing levels of chromium propionate. Blood glucose was decreased (p < 0.05) with increasing dietary chromium level. Chromium supplementation did not affect antibodies titers against NDV and AIV-H9. Neither live, hilal, after skin removal, eviscerated, chest weight and legs with shanks weight nor liver and heart weights were affected (p > 0.05) while gizzard weight reduced significantly (p < 0.05) due to supplementation of chromium. On the basis of results, it may be concluded that chromium propionate supplementation improved weight gain and FCR and reduced blood glucose. However, better performance and weight gain may be achieved if chromium propionate is added at the rate of 400 ppb in broiler diets.

A mixed methods study to assess the effectiveness of food-based interventions to prevent stunting among children under-five years in Districts Thatta and Sujawal, Sindh Province, Pakistan: study protocol.

BACKGROUND: Maternal and child malnutrition is widely prevalent in low and middle income countries. In Pakistan, widespread food insecurity and malnutrition are the main contributors to poor health, low survival rates and the loss of human capital development. The nutritional status trends among children exhibit a continuous deteriorating with rates of malnutrition exceeding the WHO critical threshold. With the high prevalence of maternal and child malnutrition, it is important to identify effective preventative approaches, especially for reducing stunting in children under-five years of age. The primary aim of this study is to assess the effectiveness of food-based interventions to prevent stunting in children under-five years. METHODS: A mixed methods study design will be conducted to evaluate the effectiveness of food-based interventions to prevent stunting among children under-five years in districts Thatta and Sujawal, Sindh Province, Pakistan. The study will include cross sectional surveys, a community-based cluster randomized controlled trial and a process evaluation. The study participants will be pregnant women, lactating mothers and children under-five years. The cross-sectional surveys will be conducted with 7360 study participants at baseline and endline. For the randomized control trial, 5000 participants will be recruited and followed monthly for compliance of food-based supplements, dietary diversity, pregnancy outcomes, and maternal and child morbidity and mortality. Anthropometric measurements and hemoglobin levels will be measured at baseline, quarterly and at endline. The interventions will consist of locally produced lipid-based nutrient supplement (Wawamum) for children 6-23 months, micronutrient powders for children 24-59 months, and wheat soya blends for pregnant and lactating mothers. Government lady health workers will deliver interventions to participants. The effectiveness of the project will be measured in terms of the impact of the proposed interventions on stunting, nutritional status, micronutrient deficiencies, and other key indicators of the participants. The process evaluation will assess the acceptability, feasibility and potential barriers of project implementation through focus group discussions, key informant interviews and household surveys. Data analysis will be conducted using STATA version 12. DISCUSSION: There is considerable evidence on the effectiveness of food-based interventions in managing stunting in developing countries. However, these studies do not account for the local environmental factors and widespread nutrient deficiencies in Pakistan. These studies are often conducted in controlled environments, where the results cannot be generalized to programs operating under field conditions. The findings of this study will provide sufficient evidence to develop policies and programs aimed to prevent stunting in children 6-59 months and to improve maternal and child health and growth outcomes in poor resource settings. TRIAL REGISTRATION: NCT02422953 . Registered on April 15, 2015.

Prevalence and Predictors of Iron Deficiency Anemia in Children under Five Years of Age in Pakistan, A Secondary Analysis of National Nutrition Survey Data 2011-2012.

BACKGROUND: Iron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey. METHODS: Secondary analysis was performed on the National Nutrition Survey in Pakistan 2011-2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. IDA was defined as having both haemoglobin levels of <110 g/L and ferritin levels of < 12 µg/L. Data analysis was performed by applying univariate and multivariate techniques using logistic regression through SPSS. FINDINGS: A total of 7138 children aged between 6-59 months were included in the analysis. The prevalence of IDA was 33.2%. In multivariate regression analysis adjusted odds ratios (AOR) were calculated. Age < 24 months (AOR 1.40, 95% CI 1.18-1.55 p <0.05), stunting (AOR 1.42 CI 1.23-1.63 p<0.05), presence of clinical anemia (AOR 5.69 CI 4.93-6.56 p<0.05), having a mother with IDA (AOR 1.72 CI 1.47-2.01 p<0.05) and household food insecurity (AOR 1.20 CI 1.10-1.40 P<0.05) were associated with IDA. Living in a rural area (AOR 0.77 CI 0.65-0.90 p<0.05) and being a female child (AOR 0.87 CI 0.76-0.98 p<0.05) were associated with reduced odds of IDA. CONCLUSION: The prevalence of IDA amongst Pakistani children represents a moderate burden that disproportionately affects the youngest, growth retarded children, affected children are more likely to have mothers with IDA and live in areas where food security is lacking. National efforts to alleviate the burden of IDA should involve both short term vertical programs such as iron supplementation and long term horizontal programs including wheat flour fortification.

Antibacterial activity of Elaeagnus umbellata (Thunb.) a medicinal plant from Pakistan.

OBJECTIVE: To evaluate the biological activity of Elaeagnus umbellata extracts on standard microorganism strains as well as multi-drug resistant bacteria isolated from hospitals. METHODS: We carried out this study at the Plant Pathology Laboratory of the University College of Agriculture, Rawalakot Pakistan during the period between September-November 2004. Flowers, leaves, and berries of the plant were extracted in different solvents and tested for their antibacterial activity by disc diffusion method on selected organisms like methicillin resistant Staphylococcus aureus (S. aureus), multi-drug resistant Pseudomonas aeruginosa (P. aeruginosa), and enterohemorrhagic Escherichia coli (E. coli). RESULTS: The ether extract of flower was found to be highly effective against E. coli, P. aeruginosa, S. aureus, and Bacillus subtilis (B. subtilis). The alcohol extract of these leaves also demonstrated strong activity against gram positive and negative bacteria. The aqueous extract from the berry strongly inhibited the growth of E. coli and S. aureus whereas, it exhibited a very small zone of inhibition against B. subtilis. Multi-drug resistant P. aeruginosa was found completely resistant to aqueous extract. The acetone extract of the berry showed good activity against P. aeruginosa. CONCLUSION: The present study reports the antibacterial activity of Elaeagnus umbellata. Most of the extracts displayed broad-spectrum activity, since gram positive bacteria including S. aureus, B. subtilis and gram-negative bacteria including E. coli and P. aeruginosa were inhibited. These preliminary findings may provide the basis for traditional use of this plant in the treatment of infectious diseases.