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1.
Mymensingh Med J ; 30(2): 387-394, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33830118

RESUMEN

Undernutrition in children under five years remains a significant health problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although Bangladesh has made rapid progress over the last decade in the field of health and nutrition, there has been very slow progress in improving the state of child nutrition. Studies aiming at determination of interrelationship between child undernutrition and maternal undernutrition are to be scientifically established if appropriate intervention policy is to be introduced. This study was undertaken to see whether this assumption has a statistically proven basis that maternal undernutrition influences child undernutrition. The objective of this cross sectional analytical study was to evaluate the association between child undernutrition and their maternal undernutrition in child-mother pair in a tertiary care hospital and was conducted from July 2017 to April 2018 in the department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study subjects were 196 children between the ages of six months to five years who were admitted in BSMMU and their accompanying mothers. Children who had any known chronic diseases or clinically obvious syndrome were excluded. Before enrollment, parents of all the patients were informed about the study & its objectives. Anthropometric measurements of children and mothers were done by standard procedure. Demographic profile and relevant maternal information were collected by interviewing the mothers. Among the undernourished children, 17.3% were found underweight, 7.1% stunted, 16.3% wasted. Combined underweight & wasted were 34.7%, underweight & stunted 9.2%, stunted & wasted 5.1%, underweight, stunted and wasted 10.2%. Maternal undernutrition was more common (95.7%) in undernourished children group. Undernutrition was significantly higher in mothers of children with undernutrition (OR=40.75, p<0.001). Children having a better nutrition were born from mothers who were well nourished, educated, had good childcare knowledge and higher family income. This emphasized the need to provide the guideline for appropriate measure to be taken to reduce child undernutrition.


Asunto(s)
Trastornos de la Nutrición del Niño , Desnutrición , Bangladesh/epidemiología , Niño , Trastornos de la Nutrición del Niño/epidemiología , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Desnutrición/epidemiología , Madres , Estado Nutricional , Prevalencia , Centros de Atención Terciaria
2.
Medicine (Baltimore) ; 100(5): e24419, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592890

RESUMEN

ABSTRACT: Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level - the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55-0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36-0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59-0.76).The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos del Crecimiento/epidemiología , Delgadez/epidemiología , Síndrome Debilitante/epidemiología , Antropometría , Preescolar , Estudios Transversales , Demografía , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Estado Nutricional , Prevalencia , Factores de Riesgo , Clase Social , Factores Socioeconómicos , Yemen/epidemiología
3.
Curr Opin Clin Nutr Metab Care ; 24(3): 271-275, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33631771

RESUMEN

PURPOSE OF REVIEW: Undernutrition, including micronutrient deficiencies, continues to plague children across the world, particularly in low and middle-income countries (LMICs). The situation has worsened alongside the SARS-CoV-2 pandemic because of major systemic disruptions to food supply, healthcare, and employment. Large-scale food fortification (LSFF) is a potential strategy for improving micronutrient intakes through the addition of vitamins and minerals to staple foods and improving the nutritional status of populations at large. RECENT FINDINGS: Current evidence unquestionably supports the use of LSFF to improve micronutrient status. Evidence syntheses have also demonstrated impact on some functional outcomes, including anemia, wasting, underweight, and neural tube defects, that underpin poor health and development. Importantly, many of these effects have also been reflected in effectiveness studies that examine LSFF in real-world situations as opposed to under-controlled environments. However, programmatic challenges must be addressed in LMICs in order for LSFF efforts to reach their full potential. SUMMARY: LSFF is an important strategy that has the potential to improve the health and nutrition of entire populations of vulnerable children. Now more than ever, existing programs should be strengthened and new programs implemented in areas with widespread undernutrition and micronutrient deficiencies.


Asunto(s)
Salud del Niño/tendencias , Trastornos de la Nutrición del Niño/terapia , Alimentos Fortificados/provisión & distribución , Micronutrientes/administración & dosificación , Niño , Trastornos de la Nutrición del Niño/epidemiología , Países en Desarrollo/estadística & datos numéricos , Femenino , Humanos , Masculino , Estado Nutricional , Pobreza/estadística & datos numéricos
4.
Artículo en Inglés | MEDLINE | ID: mdl-33477580

RESUMEN

Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from -1.77 to -1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package.


Asunto(s)
Trastornos de la Nutrición del Niño , Mejoramiento de la Calidad , Niño , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/prevención & control , Guatemala/epidemiología , Humanos , Lactante , Población Rural
5.
BMC Infect Dis ; 21(1): 18, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407207

RESUMEN

BACKGROUND: Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique. METHODS: The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR). RESULTS: Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed. CONCLUSIONS: The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Diarrea/epidemiología , Desnutrición/epidemiología , Infecciones por Rotavirus/epidemiología , Rotavirus/inmunología , Animales , Lactancia Materna , Preescolar , Comorbilidad , Estudios Transversales , Diarrea/virología , Composición Familiar , Heces/virología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Mozambique/epidemiología , Prevalencia , Factores de Riesgo , Infecciones por Rotavirus/prevención & control , Infecciones por Rotavirus/virología , Vacunas contra Rotavirus/uso terapéutico
8.
Rev. cuba. salud pública ; 46(4): e2111, oct.-dic. 2020. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1156632

RESUMEN

Introducción: Las adolescentes no presentan plenitud biológica ni cognitivo-emocional, y menos capacidad de autonomía social para asumir con éxito una responsabilidad de pareja y de maternidad. Objetivo: Determinar si la edad materna temprana es un factor de riesgo de desnutrición, durante el primer año de vida. Métodos: Se realizó un estudio cuantitativo observacional, longitudinal de cohorte en madres adolescentes (10 a 19 años) y madres adultas (20 a 30 años) con sus respectivos niños, en el Hospital Regional de Ayacucho Miguel A. Mariscal Llerena. Los niños fueron medidos en peso y talla durante los 12 primeros meses de vida, la prevalencia de niños desnutridos, en riesgo y normal fueron evaluados mediante los indicadores Z de peso/edad, peso/talla y talla/edad. Resultados: Las tendencias mensuales del porcentaje de niños desnutridos y en riesgo, fueron mayores en hijos de madres adolescentes. Esto se acentúa a partir de los 7 meses de edad y es más evidente en el indicador Z de talla/edad. No existe diferencia en la prevalencia mensual en los indicadores de peso/edad y peso/talla. Sin embargo, con el indicador talla/edad el porcentaje de desnutrición es significativamente mayor en hijos de madres adolescentes a partir de los 9 meses de edad. El inicio de la desnutrición es más temprano en hijos de madres adolescentes (9,41 meses) que en hijos de madres no adolescentes (10,31 meses). Conclusiones: Las características socioculturales de las madres adolescentes inciden en la desnutrición de sus hijos, lo cual ratifica la importancia y necesidad de atender su condición de adolescente antes, durante y después del embarazo(AU)


Introduction: Adolescent girls have no biological or cognitive-emotional fullness, and they have less capacity for social autonomy to successfully assume a partner and maternity responsibility. Objective: Determine whether if early maternal age is a risk factor for malnutrition, during the first year of life. Methods: An observational quantitative study was carried out, longitudinal cohort in adolescent mothers (10 to 19 years) and adult mothers (20 to 30 years) with their respective children, at Miguel A. Mariscal Llerena Regional Hospital of Ayacucho. Children were measured by weight and size during the first 12 months of life, the prevalence of malnourished, at-risk and normal children were evaluated using Z indicators of weight/age, weight/size and size/age. Results: Monthly trends in the percentage of malnourished and at-risk children were higher in children of adolescent mothers. This is accentuated from 7 months of age and is more evident in the Z indicator of size/age. There is no difference in monthly prevalence in weight/age and weight/size indicators. However, with the size/age indicator the percentage of malnutrition is significantly higher in children of adolescent mothers from 9 months of age. The onset of malnutrition is earlier in children of adolescent mothers (9.41 months) than in children of non-adolescent mothers (10.31 months). Conclusions: The sociocultural characteristics of adolescent mothers affect the malnutrition of their children, which confirms the importance and need to address their teenage status before, during and after pregnancy(AU)


Asunto(s)
Humanos , Femenino , Embarazo , Adolescente , Trastornos de la Nutrición del Niño/epidemiología , Factores de Riesgo , Edad Materna , Estudios Longitudinales , Estudios de Evaluación como Asunto , Estudio Observacional
10.
Afr J Prim Health Care Fam Med ; 12(1): e1-e7, 2020 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-33354983

RESUMEN

BACKGROUND: Malnutrition is a significant risk factor for ill health among children under 5 years of age and the consequences are significant. AIM: The aim of this study was to determine the prevalence and factors associated with malnutrition among under-5-year-old hospitalised children. SETTING: This study was set at Sebokeng, Kopanong and Heidelberg hospitals, Sedibeng district, South Africa. METHODS: This was a cross-sectional study comprising 306 hospitalised under-5-year-old children. Information on socio-demography, feeding practices, immunisation and clinical problems was obtained from caregivers and medical records. Anthropometric measurements were also performed. RESULTS: Most participants were male (59.8%), had normal birth weights (80.0%), come from a household with a monthly income R2000 (about 150 US dollars) (50.3%), up-to-date immunisation (97.4%), breastfed for 6 months (57.4%) and were fed 3-4 meals/day (66.7%) and, at most, one snack/day (63.4%). Acute malnutrition accounted for 9.5% (n = 29) of admissions. Among these, 82.8% (n = 24) had severe acute malnutrition. On test of association, monthly household income (p = 0.01), mother's and father's employment status (p = 0.01; p = 0.01), breastfeeding history (p = 0.01) and having diarrhoea in index admission (p = 0.01) were significantly associated with malnutrition admission. In multivariate regression analyses, not being breastfed (odds ratio [OR] = 3.9; 95% confidence interval [CI]: 1.23-12.29; p = 0.02) and diarrhoea at index admission were independently associated with malnutrition (OR = 23.3; 95% CI: 6.85-79.43; p = 0.01). CONCLUSION: A significant proportion of participants had malnutrition and were subjected to suboptimal feeding practices. Healthcare providers in primary care need to entrench dietary education and anthropometric screening in all clinic visits for children 5 years old, particularly when they present with diarrhoea or are not being breastfed.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Diarrea , Conducta Alimentaria , Hospitalización , Desnutrición/epidemiología , Antropometría , Lactancia Materna , Salud del Niño , Trastornos de la Nutrición del Niño/etiología , Preescolar , Estudios Transversales , Escolaridad , Femenino , Hospitales Públicos , Humanos , Renta , Lactante , Masculino , Desnutrición/etiología , Comidas , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Desnutrición Aguda Severa/epidemiología , Desnutrición Aguda Severa/etiología , Sudáfrica/epidemiología
11.
Rev Saude Publica ; 54: 111, 2020.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33175027

RESUMEN

OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Lactante/epidemiología , Estado Nutricional , Brasil/epidemiología , Trastornos de la Nutrición del Niño/diagnóstico , Preescolar , Colombia/epidemiología , Estudios Transversales , Femenino , Humanos , Lactante , Trastornos de la Nutrición del Lactante/diagnóstico , Recién Nacido , Masculino , Desnutrición/epidemiología , Prevalencia , Factores Socioeconómicos
12.
BMC Public Health ; 20(1): 1559, 2020 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-33066763

RESUMEN

BACKGROUND: Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. METHODS: A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. RESULTS: The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight. CONCLUSIONS: Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. TRIAL REGISTRATION: Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Áreas de Pobreza , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Preescolar , Estudios Transversales , Femenino , Humanos , India/epidemiología , Lactante , Masculino , Madres/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Factores Socioeconómicos
13.
PLoS Med ; 17(9): e1003285, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32931496

RESUMEN

BACKGROUND: Biannual azithromycin distribution has been shown to reduce child mortality as well as increase antimicrobial resistance. Targeting distributions to vulnerable subgroups such as malnourished children is one approach to reaching those at the highest risk of mortality while limiting selection for resistance. The objective of this analysis was to assess whether the effect of azithromycin on mortality differs by nutritional status. METHODS AND FINDINGS: A large simple trial randomized communities in Niger to receive biannual distributions of azithromycin or placebo to children 1-59 months old over a 2-year timeframe. In exploratory subgroup analyses, the effect of azithromycin distribution on child mortality was assessed for underweight subgroups using weight-for-age Z-score (WAZ) thresholds of -2 and -3. Modification of the effect of azithromycin on mortality by underweight status was examined on the additive and multiplicative scale. Between December 2014 and August 2017, 27,222 children 1-11 months of age from 593 communities had weight measured at their first study visit. Overall, the average age among included children was 4.7 months (interquartile range [IQR] 3-6), 49.5% were female, 23% had a WAZ < -2, and 10% had a WAZ < -3. This analysis included 523 deaths in communities assigned to azithromycin and 661 deaths in communities assigned to placebo. The mortality rate was lower in communities assigned to azithromycin than placebo overall, with larger reductions among children with lower WAZ: -12.6 deaths per 1,000 person-years (95% CI -18.5 to -6.9, P < 0.001) overall, -17.0 (95% CI -28.0 to -7.0, P = 0.001) among children with WAZ < -2, and -25.6 (95% CI -42.6 to -9.6, P = 0.003) among children with WAZ < -3. No statistically significant evidence of effect modification was demonstrated by WAZ subgroup on either the additive or multiplicative scale (WAZ < -2, additive: 95% CI -6.4 to 16.8, P = 0.34; WAZ < -2, multiplicative: 95% CI 0.8 to 1.4, P = 0.50, WAZ < -3, additive: 95% CI -2.2 to 31.1, P = 0.14; WAZ < -3, multiplicative: 95% CI 0.9 to 1.7, P = 0.26). The estimated number of deaths averted with azithromycin was 388 (95% CI 214 to 574) overall, 116 (95% CI 48 to 192) among children with WAZ < -2, and 76 (95% CI 27 to 127) among children with WAZ < -3. Limitations include the availability of a single weight measurement on only the youngest children and the lack of power to detect small effect sizes with this rare outcome. Despite the trial's large size, formal tests for effect modification did not reach statistical significance at the 95% confidence level. CONCLUSIONS: Although mortality rates were higher in the underweight subgroups, this study was unable to demonstrate that nutritional status modified the effect of biannual azithromycin distribution on mortality. Even if the effect were greater among underweight children, a nontargeted intervention would result in the greatest absolute number of deaths averted. TRIAL REGISTRATION: The MORDOR trial is registered at clinicaltrials.gov NCT02047981.


Asunto(s)
Azitromicina/uso terapéutico , Trastornos de la Nutrición del Niño/tratamiento farmacológico , Trastornos de la Nutrición del Niño/mortalidad , Antibacterianos/uso terapéutico , Peso Corporal , Mortalidad del Niño/tendencias , Preescolar , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Malaria/tratamiento farmacológico , Masculino , Administración Masiva de Medicamentos/métodos , Administración Masiva de Medicamentos/mortalidad , Niger/epidemiología , Estado Nutricional , Delgadez
14.
PLoS One ; 15(9): e0239036, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32946500

RESUMEN

Malnutrition is a huge problem in Burundi. In order to improve the health system response, the Ministry of Health piloted the introduction of malnutrition prevention and care indicators within its performance-based financing (PBF) scheme. Paying for units of services and for qualitative indicators is expected to enhance provision and quality of these nutrition services. The objective of this study is to assess the impacts of this intervention, on both child acute malnutrition recovery rates at health centre level and prevalence of chronic and acute malnutrition among children at community level. This study follows a cluster-randomized controlled evaluation design: 90 health centres (HC) were randomly selected for the study, 45 of them were randomly assigned to the intervention and received payment related to their performance in malnutrition activities, while the other 45 constituted the control group and got a simple budget allocation. Data were collected from baseline and follow-up surveys of the 90 health centres and 6,480 households with children aged 6 to 23 months. From the respectively 1,067 and 1,402 moderate and severe acute malnutrition transcribed files and registers, findings suggest that the intervention had a positive impact on moderate acute malnutrition recovery rates (OR: 5.59, p = 0.039 -at the endline, 78% in the control group and 97% in the intervention group) but not on uncomplicated severe acute malnutrition recovery rate (OR: 1.16, p = 0.751 -at the endline, 93% in the control group and 92% in the intervention group). The intervention also had a significant increasing impact on the number of children treated for acute malnutrition. Analyses from the anthropometric data collected among 12,679 children aged 6-23 months suggest improvements at health centre level did not translate into better results at community level: prevalence of both acute and chronic malnutrition remained high, precisely at the endline, acute and chronic malnutrition prevalence were resp. 8.80% and 49.90% in the control group and 8.70% and 52.0% in the intervention group, the differences being non-significant. PBF can contribute to a better management of malnutrition at HC level; yet, to address the huge problem of child malnutrition in Burundi, additional strategies are urgently required.


Asunto(s)
Trastornos de la Nutrición del Niño/prevención & control , Estado Nutricional/fisiología , Reembolso de Incentivo/economía , Pesos y Medidas Corporales/métodos , Burundi/epidemiología , Preescolar , Composición Familiar , Femenino , Humanos , Lactante , Masculino , Desnutrición/prevención & control , Prevalencia , Reembolso de Incentivo/tendencias , Desnutrición Aguda Severa/prevención & control , Encuestas y Cuestionarios
16.
Am J Trop Med Hyg ; 103(4): 1397-1404, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32783799

RESUMEN

Recurrent enteric infections and micronutrient deficiencies, including deficiencies in the tryptophan-kynurenine-niacin pathway, have been associated with environmental enteric dysfunction, potentially contributing to poor child growth and development. We are conducting a randomized, placebo-controlled, 2 × 2 factorial interventional trial in a rural population in Haydom, Tanzania, to determine the effect of 1) antimicrobials (azithromycin and nitazoxanide) and/or 2) nicotinamide, a niacin vitamer, on attained length at 18 months. Mother/infant dyads were enrolled within 14 days of the infant's birth from September 2017 to September 2018, with the follow-up to be completed in February 2020. Here, we describe the baseline characteristics of the study cohort, risk factors for low enrollment weight, and neonatal adverse events (AEs). Risk factors for a low enrollment weight included being a firstborn child (-0.54 difference in weight-for-age z-score [WAZ] versus other children, 95% CI: -0.71, -0.37), lower socioeconomic status (-0.28, 95% CI: -0.43, -0.12 difference in WAZ), and birth during the preharvest season (November to March) (-0.22, 95% CI: -0.33, -0.11 difference in WAZ). The most common neonatal serious AEs were respiratory tract infections and neonatal sepsis (2.2 and 1.4 events per 100 child-months, respectively). The study cohort represents a high-risk population for whom interventions to improve child growth and development are urgently needed. Further analyses are needed to understand the persistent impacts of seasonal malnutrition and the interactions between seasonality, socioeconomic status, and the study interventions.


Asunto(s)
Salud del Niño/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto , Azitromicina/uso terapéutico , Peso Corporal , Trastornos de la Nutrición del Niño , Preescolar , Estudios de Cohortes , Intervención Médica Temprana , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Madres , Sepsis Neonatal/tratamiento farmacológico , Sepsis Neonatal/epidemiología , Niacinamida/uso terapéutico , Pobreza , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Población Rural , Estaciones del Año , Tanzanía/epidemiología , Tiazoles/uso terapéutico , Adulto Joven
17.
PLoS Negl Trop Dis ; 14(8): e0008435, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32817617

RESUMEN

Noma is an orofacial gangrene affecting primarily children living in extreme poverty in remote parts of subtropical and tropical countries. Mortality and disability are high, and survivors often have physical and functional deformities resulting in stigma and isolation. Many healthcare professionals and primary healthcare workers where noma risk factors exist have no knowledge about noma and its implications. Public health measures to improve nutrition, immunizations, sanitation, and access to healthcare and measures to eliminate extreme poverty can lead to the eradication of noma. Research allocation has been insufficient to study the epidemiology, treatment, and prevention of noma. In a recent editorial by Hotez and colleagues in PLOS Neglected Tropical Diseases (NTDs), "What constitutes an NTD?" Noma is not included. The exclusion of noma from NTDs constitutes this preventable childhood disease as a neglected neglected disease. The purpose of this article is the inclusion of noma with the PLOS NTDs. Increased awareness and attention to noma can lead to the eradication of this disease affecting the world's most vulnerable.


Asunto(s)
Trastornos de la Nutrición del Niño/complicaciones , Enfermedades Desatendidas , Noma , Niño , Humanos , Pobreza , Factores de Riesgo
18.
Proc Natl Acad Sci U S A ; 117(34): 20511-20519, 2020 08 25.
Artículo en Inglés | MEDLINE | ID: mdl-32788353

RESUMEN

Examining linkages among multiple sustainable development outcomes is key for understanding sustainability transitions. Yet rigorous evidence on social and environmental outcomes of sustainable development policies remains scarce. We conduct a national-level analysis of Brazil's flagship social protection program, Zero Hunger (ZH), which aims to reduce food insecurity and poverty. Using data from rural municipalities across Brazil and quasi-experimental causal inference techniques, we assess relationships between social protection investment and outcomes related to sustainable development goals (SDGs): "no poverty" (SDG 1), "zero hunger" (SDG 2), and "health and well being" (SDG 3). We also assess potential perverse outcomes arising from agricultural development impacting "climate action" (SDG 13) and "life on land" (SDG 15) via clearance of natural vegetation. Despite increasing daily per capita protein and kilocalorie production, summed ZH investment did not alleviate child malnutrition or infant mortality and negligibly influenced multidimensional poverty. Higher investment increased natural vegetation cover in some biomes but increased losses in the Cerrado and especially the Pampa. Effects varied substantially across subprograms. Conditional cash transfer (Bolsa Familia [BF]) was mainly associated with nonbeneficial impacts but increased protein production and improved educational participation in some states. The National Program to Strengthen Family Farming (PRONAF) was typically associated with increased food production (protein and calories), multidimensional poverty alleviation, and changes in natural vegetation. Our results inform policy development by highlighting successful elements of Brazil's ZH program, variable outcomes across divergent food security dimensions, and synergies and trade-offs between sustainable development goals, including environmental protection.


Asunto(s)
Abastecimiento de Alimentos , Política Pública , Desarrollo Sostenible , Brasil , Trastornos de la Nutrición del Niño/prevención & control , Preescolar , Humanos , Lactante , Mortalidad Infantil , Pobreza , Bosque Lluvioso
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