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Artículo en Inglés | MEDLINE | ID: mdl-28315890


As momentum for investment in early childhood nutrition grows, so does the evidence base for the effectiveness of interventions to improve complementary feeding in low- and middle-income countries (LMIC), where the risk of early growth faltering is high. The aim of this chapter is to review the current state of the evidence for the impact of two categories of interventions (nutrition education alone and provision of food or nutrient supplements with or without education) on linear and ponderal growth of children aged 6-23 months in LMIC. Pooled-effect sizes from three recent systematic reviews consistently suggest a modest but significant effect of both types of complementary feeding interventions on weight and length gain. However, interpretation of these pooled estimates is limited by the variability in intervention design and inconsistency in reporting of growth outcomes across the relatively small number of rigorous controlled trials currently available in the literature.

Desarrollo Infantil , Fenómenos Fisiológicos Nutricionales del Lactante , Países en Desarrollo , Suplementos Dietéticos , Medicina Basada en la Evidencia , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Metaanálisis como Asunto , Micronutrientes/administración & dosificación , Madres/educación , Estado Nutricional , Ensayos Clínicos Controlados Aleatorios como Asunto
Matern Child Nutr ; 11(4): 815-28, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24118777


The Haitian National Nutrition Policy identifies the promotion of optimal complementary feeding (CF) practices as a priority action to prevent childhood malnutrition. We analysed data from the nationally representative 2005-2006 Haiti Demographic Health Survey using the World Health Organization 2008 infant and young child feeding indicators to describe feeding practices among children aged 6-23 months and thus inform policy and programme planning. Multivariate regression analyses were used to identify the determinants of CF practices and to examine their association with child growth outcomes. Overall, 87.3% of 6-8-month-olds received soft, solid or semi-solid foods in the previous 24 h. Minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD) were achieved in 29.2%, 45.3% and 17.1% of children aged 6-23 months, respectively. Non-breastfed children were more likely to achieve MDD than breastfed children of the same age (37.3% vs. 25.8%; P < 0.001). The proportion of children achieving MMF varied significantly by age (P < 0.001). Children with overweight mothers were more likely to achieve MDD, MMF and MAD [odds ratio (OR) 2.08, P = 0.012; OR 1.81, P = 0.02; and OR 2.4, P = 0.01, respectively] than children of normal weight mothers. Odds of achieving MDD and MMF increased with household wealth. Among mothers with secondary or more education, achieving MDD or MAD was significantly associated with lower mean weight-for-age z-score and height-for-age z-score (P-value <0.05 for infants and young child feeding indicator × maternal education interaction). CF practices were mostly inadequate and contributed to growth faltering among Haitian children 6-23 months old.

Desarrollo Infantil , Fenómenos Fisiológicos Nutricionales del Lactante , Índice de Masa Corporal , Peso Corporal , Lactancia Materna , Estudios Transversales , Demografía , Conducta Alimentaria , Femenino , Haití , Encuestas Epidemiológicas , Humanos , Lactante , Alimentos Infantiles , Masculino , Desnutrición/prevención & control , Análisis Multivariante , Ingesta Diaria Recomendada , Factores Socioeconómicos , Organización Mundial de la Salud
Matern Child Nutr ; 10(1): 1-17, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23945347


As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country-specific analyses of the indicators' associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross-country patterns of associations of each of these indicators with child stunting, wasting, height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub-Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05). These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed. The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.

Antropometría , Lactancia Materna , Fenómenos Fisiológicos Nutricionales Infantiles , Conducta Alimentaria , Niño , Preescolar , Calidad de los Alimentos , Humanos , Lactante , Alimentos Infantiles , Factores Socioeconómicos , Organización Mundial de la Salud
Food Nutr Bull ; 34(4): 462-79, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24605696


BACKGROUND: The Haitian National Nutrition Policy prioritizes prevention and treatment of anemia among mothers and young children, but there are few available data to support planning for scale-up of anemia interventions. OBJECTIVE: To describe the prevalence and predictors of anemia among Haitian women (15 to 49 years) and children (6 to 59 months) and to draw implications for national nutrition programming. METHODS: Descriptive and univariate analyses and multivariate logistic regression models were performed using data from the nationally representative Haitian Demographic Health Survey 2005/06. RESULTS: The prevalence of mild (hemoglobin 11.0 to 11.9 g/dL), moderate (hemoglobin 8.0 to 10.9 g/dL), and severe (hemoglobin < 8.0 g/dL) anemia was 19.2%, 21.7%, and 4.4%, respectively, among women aged 15 to 49 years and 22.9%, 33.9%. and 2.2% among children aged 6 to 59 months. Unexpectedly anemia was more prevalent in urban women (54.4 %) and children (65.1%) than in rural women (43.1%, p < .001) and children (55.7%, p = .004). In multivariate regression models, factors associated with anemia among urban women (birth spacing, p = .027; overweight BMI, p < .001; education level, p = .022) were different from those in rural women (wealth quintile, p < .05; employment, p = .003). Anemia in urban and rural children aged 6 to 59 months increased with child age (p < .05) and maternal anemia status (p = .004; p < .001). Female sex (p = .007) and maternal overweight (p = .009) were associated with reduced risk of anemia in rural children only. CONCLUSIONS: Anemia among Haitian young children and women of childbearing age is a severe public health problem. The findings suggest the need for context-specific rural and urban strategies, reinforcement of anemia prevention in health services reaching women of childbearing age, and targeted interventions for young children.

Anemia/epidemiología , Adolescente , Adulto , Anemia/diagnóstico , Anemia/prevención & control , Intervalo entre Nacimientos/estadística & datos numéricos , Índice de Masa Corporal , Preescolar , Escolaridad , Femenino , Haití/epidemiología , Hemoglobinas/análisis , Humanos , Lactante , Masculino , Persona de Mediana Edad , Política Nutricional , Población Rural , Población Urbana , Adulto Joven
J Nutr ; 142(4): 774-80, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22378328


The integration of nutrition support for infants of HIV-infected mothers is a recognized need; however, the evidence for effective programmatic solutions is weak. The objective of our study was to implement and evaluate a new infant feeding support intervention for HIV-exposed, uninfected, non-breast-fed infants 6-12 mo of age attending the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) pediatric clinic in Port-au-Prince, Haiti. The 24-wk intervention included a lipid-based nutrient supplement, education, promotion of existing clinical services, and social support. We compared growth outcomes among intervention participants (n = 73) at start (wk 0) and end (wk 24) of intervention to a historical control group of HIV-exposed infants seen at the GHESKIO in the year prior to the intervention who would have met the intervention entrance criteria (n = 294). The intervention and historical control groups did not differ significantly at age 6 mo (wk 0). At age 12 mo (wk 24), the intervention group had a lower prevalence of underweight and stunting than the historical control group (weight-for-age Z-score < -2 SD: 6.8 vs. 20.8%, P = 0.007; length-for-age Z-score < -2 SD: 9.6 vs. 21.2%, P = 0.029). Wasting tended to be lower in the intervention group than the historical control (weight-for-length Z-score < -2 SD: 2.9 vs. 8.9%, P = 0.11). Implementation of the intervention was associated with reduced risk of growth faltering in HIV-exposed uninfected children from 6 to 12 mo of age. This is a promising intervention model that can be adapted and scaled-up to other HIV care contexts.

Desarrollo Infantil , Suplementos Dietéticos , Trastornos del Crecimiento/prevención & control , Seropositividad para VIH , Delgadez/prevención & control , Síndrome Debilitante/prevención & control , Instituciones de Atención Ambulatoria , Estatura , Peso Corporal , Estudios Transversales , Suplementos Dietéticos/análisis , Femenino , Servicios de Alimentación , Alimentos Fortificados/análisis , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Seropositividad para VIH/fisiopatología , Haití/epidemiología , Humanos , Lactante , Masculino , Prevalencia , Riesgo , Delgadez/epidemiología , Delgadez/etiología , Salud Urbana , Síndrome Debilitante/epidemiología , Síndrome Debilitante/etiología