Chile Crece Contigo: Implementation, results, and scaling-up lessons.

BACKGROUND: Chile Crece Contigo (ChCC) is defined as a comprehensive, intersectoral, and multicomponent policy that aims to help all children reach their full potential for development, regardless of their socio-economic status. METHODS: This case study was developed on the basis of grey literature review and key informants' interviews. RESULTS: ChCC behaves as a complex adaptive system that combines universal and targeted benefits for the more vulnerable starting since gestation and until the children are 4 years old. Three key ministries are involved in ChCC management: health, education, and social development. Studies show adequate programme implementation and positive effects of ChCC on child development. In addition, it was found that the more families use ChCC benefits and the longer the subsystem has been operating in the commune, the greater the positive effects. CONCLUSIONS: Strong political support based on principles of equity and child rights combined with strong evidence and funding commitment from government has been central to emergence, scaling up, and sustainability of ChCC. Further sustainability of ChCC will rely on firmly establishing a well-trained and compensated cadre of early child development professionals and paraprofessionals as well as an improved management and evaluation decentralized system.

Food stamps are associated with food security and dietary intake of inner-city preschoolers from Hartford, Connecticut.

The goal of the present study was to examine the association of the Food Stamp Program with the food security and dietary intake of low-income children from Hartford, CT, who were enrolled in the Supplemental Food Program for Women, Infants, and Children (WIC). We compared the food and nutrition situation of low-income preschoolers who received food stamps (FS, n = 59) with that of those who did not receive food stamps (NFS, n = 40). Children were an average age of 2.7 +/- 0.6 y, and 95% were receiving WIC benefits at the time of the study. Groups were comparable in demographic characteristics, but the socioeconomic status of the FS group was lower than that of the NFS group (P < 0.05). Food security was assessed with the Radimer/Cornell hunger scale, and dietary intake was assessed with a single 24-h recall and a 14-item food frequency questionnaire. Multivariate analyses within the FS group indicated that a monthly duration of food stamps of <4 wk was a predictor of household food security (odds ratio 0.10, 95% confidence interval 0.02-0.56). Food stamp use was associated with above-median energy-adjusted intakes of vitamin B-6 (3.13, 1.16-8.45), folate (2.92, 1.09-7.81) and iron (3.72, 1.31-10.54). The NFS children were more likely to consume <8 mg iron/d (3.73, 1.09-12.80). These results suggest that the Food Stamp Program is associated with food security and preschoolers' micronutrient intake.

Folic acid supplementation for the prevention of neural tube defects. Should it be a priority for developing countries?

PIP: Folic acid supplementation during pregnancy has been widely advocated for the prevention of neural tube defects in developing countries. The author of this letter, however, argues that such a strategy is unwarranted and a misuse of scarce resources. Folic acid deficiency is not the primary cause of neural tube defects and the incidence of this defect is similar in developed and developing countries. It has been estimated that folic acid fortification of cereal-based products--an exceedingly difficult, expensive intervention--would prevent only about 1000 neural tube defect cases per year. Moreover, additional folic acid can prevent neural tube defects only if consumed during the periconceptional period. Although women at risk of neural tube defect recurrence are advised to take 4 mg of folic acid per day when they plan to become pregnant, the recommendation for the vast majority of women in developing countries is increased consumption of beans, oranges, and green leafy vegetables.^ieng

Periconceptional folic acid and neural tube defects: public health issues.

This review examines evidence linking periconceptional folic acid intake to neural tube defects (NTDs) and related public health issues in the United States and developing countries. Sources of information were identified through on-line searches (Medline, UCAT-University of Connecticut) and by contacting researchers in the field. The distribution of NTDs varies across regions. Recurrent NTDs can be prevented with high-dosage folic acid supplementation during periconception, but it is not clear if such a protective effect can be achieved with lower dosages or in low-NTD-risk populations. Overall, it appears that women with a previous NTD pregnancy should receive folic acid supplementation during periconception under medical guidance. Dietary counseling regarding foods rich in folate should be given to all women of childbearing age. However, primary prevention of NTDs through widespread food fortification with folic acid seems unwarranted in both the United States and developing countries due to the low prevalence of NTDs relative to other problems and a potentially unfavorable benefit/risk ratio.