A review of the dietary diversity and micronutrient adequacy among the women of reproductive age in low- and middle-income countries.

The dietary quality of women of reproductive age (WRA) is particularly important during preconception, conception, and pregnancy for themselves and their offspring. Poorly diversified diets resulting in inadequate micronutrient consumption may have adverse effects on their health. This narrative review summarizes the findings of studies reporting on dietary diversity and micronutrient intake by WRA in low- and middle-income countries (LMICs). Studies on WRA aged 15-49 years in LMICs, with a sample size of more than 150, report dietary diversity and multiple micronutrient intake based on 24-h dietary recall/food weighed record/food frequency questionnaire, and published between January 2011 and June 2021 were included. The results were compared to the Food and Agriculture Organization (FAO) recommended cut-off for dietary diversity and the Indian Council of Medical Research (ICMR) recommended age- and sex-specific estimated average requirements (EARs) for micronutrient intake. This review includes 35 articles, of which 21 focused on dietary diversity and 14 on micronutrient intake. The results showed that WRA in LMICs had inadequate dietary diversity, with mean food group consumption of only 3.0-4.84, and around 42.3%-90% of women consumed inadequately diversified diets (<5 food groups). Additionally, most studies found that WRA did not consume adequate amounts of essential micronutrients, particularly calcium, iron, zinc, vitamin A, thiamin, riboflavin, folate, and vitamin B12. However, the intake of vitamin C, niacin, and vitamin B6 was above the required levels. In conclusion, this review highlights the common inadequacy of dietary diversity and multiple micronutrient intake among WRA in most LMICs. Effective measures involving improving dietary diversity, food fortification with micronutrients, and supplementation programs could help improve the dietary quality and intake of optimal micronutrients by women in LMICs.

Nutrient density of Bangladeshi foods and its application in planning diet for pregnant women.

Nutrient profiling is a method that classifies foods based on their nutrient content and identifies foods that are high in micronutrients both across and within food groups. This study aimed to identify foods that are rich sources of the seven micronutrients (iron, zinc, calcium, thiamine, riboflavin, vitamin A, and vitamin B12) of public health concern for the Bangladeshi population.. This study developed a metric termed "naturally nutrient-rich score 7 (NNR7)" specifically for third-trimester pregnant women to identify nutrient-dense foods. Further, it computed the nutrient adequacy score (NAS) of the top NNR7-scored foods for seven micronutrients to assess the extent (percent) to which foods can meet pregnant women's recommended dietary allowances (RDA). A linear programming technique was then used to construct a nutrient-adequate model diet for third-trimester pregnant women using the top ten NNR7-scored foods. According to the NNR7, food groups such as leafy vegetables, fish, meat, poultry and eggs, and vegetables are the richest sources of the problem micronutrients. Mutton liver (916.7%), soybean (39.3%), lamb liver (2160%) and duck liver (50.0%) were found to fulfill the highest percentage of the RDA of vitamin A, zinc, vitamin B12, and iron, respectively. In the formulated nutrient-adequate diets for pregnant women, rice, potato, brown wheat flour, and soya oil were universal to all three diets and Bengal gram, orange, Ganges River sprat, and duck liver were the most common ones. The study findings highlight the need for the consumption of foods such as leafy vegetables, fish, meat, poultry, eggs, pulses and vegetables to increase the intake of problematic micronutrients. Planning a nutrient-adequate diet for pregnant women using linear programming can be an alternative approach to optimize and shape food choices to meet their nutritional requirements.

Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression.

BACKGROUND: Cost-effectiveness analysis of HIV self-testing using patient-level data from a randomized clinical trial can inform HIV prevention funding decisions. Cost-effectiveness analysis using net-benefit regression addresses the sampling uncertainty in the trial data and the variability of policymakers' willingness to pay (WTP). METHODS: We used published data from a 12-month longitudinal randomized clinical trial that enrolled 2665 men who had sex with men randomly assigned to the self-testing arm (participants receiving self-test kits) and control arm (participants receiving standard-of-care), and the self-testing arm identified 48 additional new HIV cases. We used net-benefit regression to investigate the cost-effectiveness of an HIV self-testing intervention, which compared the incremental cost per new HIV diagnosis with policymakers' WTP thresholds. We addressed the uncertainties in estimating the incremental cost and the policymakers' WTP per new diagnosis through the incremental net-benefit (INB) regression and cost-effectiveness acceptability curve (CEAC) analyses. RESULTS: From the health care provider's perspective, the INB analysis showed a positive net benefit of HIV self-testing compared with standard-of-care when policymakers' WTP per new HIV diagnosis was $9365 (95% confidence interval: $5700 to $25,500) or higher. The CEAC showed that the probability of HIV self-testing being cost-effective compared with standard-of-care was 58% and >99% at a WTP of $10 000 and $50 000 per new HIV diagnosis, respectively. CONCLUSION: The INB and CEAC analyses suggest that HIV self-testing has the potential to be cost-effective for relatively low values of policymakers' WTP.

Variations in the Major Nutrient Composition of Dominant High-Yield Varieties (HYVs) in Parboiled and Polished Rice of Bangladesh.

Rice (Oryza sativa L.) is the principal staple food, a fundamental component of food security, a significant source of energy and major nutrients, and a key player in the overall nutritional status in Bangladesh. Parboiling is a common rice-processing treatment in Bangladesh. Recently, polishing has also become a common practice among millers seeking to attract consumers. Polishing may influence the nutrient composition of rice. The present study aimed to investigate the impact of parboiling and polishing on the nutritional content of the five High Yield Varieties (HYVs) of rice (BR11, BRRI dhan28, BRRI dhan29, BRRI dhan49, and BRRI dhan84) and their percent contributions to the Recommended Dietary Allowances (RDA) of vitamins and minerals. All of the rice samples were analyzed for proximate parameters, vitamins (B1, B2, B3, B6, and folate), and minerals (Ca, Mg, Fe, Zn, Na, K, P). Moisture, ash, fat, and total dietary fiber (TDF) were determined gravimetrically, according to the AOAC Official Methods; protein was measured by the Kjeldahl method; B-group vitamins were measured using Ultra Pressure Liquid Chromatography; and mineral content was determined by ICP-OES. The energy, protein, fat, and total dietary fiber (TDF) content of the samples ranged between 342-357 kcal/100 g, 6.79-10.74 g/100 g, 0.31-1.69 g/100 g, and 2.59-3.92 g/100 g respectively. Thiamin, riboflavin, niacin, pyridoxin, and folate content ranged from 0.11-0.25 mg/100 g, 0.01-0.05 mg/100 g, 2.82-6.42 mg/100 g, 0.12-0.30 g/100 g, and 5.40-23.95 g/100 g respectively. In a comparison of parboiling and polishing, macronutrients and vitamin retention were higher in parboiled unpolished rice than in polished unparboiled rice. The minerals (mg/100 g) Ca, Mg, Fe, Zn, Na, K, and P were in the ranges 32.82-44.72, 30.69-58.34, 0.51-0.70,1.83-2.79, 5.00-5.36, 106.49-112.73, and 162.23-298.03. Minerals of BRRI dhan84 were unaffected by polishing and parboiling. BRRI dhan84 contributed a higher percentage of RDA of all B vitamins and minerals. Therefore, to reduce nutrient loss in rice, industries and consumers should be encouraged to avoid polishing or limit polishing to 10% DOM and to consume unpolished rice, either parboiled or unparboiled.

Validity of Food insecurity experience scale (FIES) for use in rural Bangladesh and prevalence and determinants of household food insecurity: An analysis of data from Bangladesh integrated household survey (BIHS) 2018-2019.

"Access" dimension of Food insecurity (FI) is directly measured by the Food Insecurity Experience Scale (FIES). The current study assessed the appropriateness of the FIES for measuring FI in rural Bangladesh, followed by an assessment of FI prevalence and its correlates utilizing Bangladesh Integrated Household Survey (BIHS) data. The internal validity of the FIES and the prevalence of FI were investigated using the Rasch modeling approach. We utilized equating procedure to calibrate the study's result to the global FIES reference scale and determined FI prevalence rates that were comparable across countries. The external validity of the FIES was evaluated by examining its association with other FI measures using Spearman's rho correlation analysis. With an overall Rasch reliability of 0.84, the FIES met the Rasch model assumptions of conditional independence and equal discrimination, and as well as the fit statistics standards for all eight items. Infit statistics were within the allowed limit for all FIES items indicating good internal validity. However, we noted a high outfit (>2) for the "unable to eat healthy and nutritious food" item indicating the presence of some unusual response patterns. Our analysis found no significant (>0.4) correlation between FIES items. We also found a significant correlation between FIES and other FI proxies, e.g., the Household hunger scale (HHS), Food consumption score (FCS), and Household dietary diversity score (HDDS). Overall, the prevalence of moderate or severe FI was 18.92% in rural Bangladesh. Geographic areas, access to electricity, household ownership, access to sanitation, livestock ownership, family size, education level, and monthly per capita food expenditure significantly explained the variation in FI. Our analyses suggest that the FIES is internally and externally valid for FI measurement in rural Bangladesh. However, FIES questions may need to be reordered to more accurately evaluate lower levels of FI, and the item "unable to eat healthy and nutritious food" may need cognitive testing.

Maternal Pregnancy Intention and Antenatal Care Seeking Behaviors in Bangladesh: Evidence From Bangladesh Demographic and Health Survey, 2018.

Objective: This study aimed to examine the association between pregnancy intention and antenatal care (ANC)-seeking behaviors among women in Bangladesh. Methods: ANC-related data of 5,012 women, from the 2018 Bangladesh Demographic and Health Survey (BDHS), who had a live birth within 3 years preceding the survey were analyzed in the study. Multivariate logistic regression models were used to assess the association of pregnancy intention with ANC utilization. Results: Approximately one-fifth (20.9%) of the women had unintended pregnancy. Among all the women, 40.4% received their first ANC visit within the first three months of pregnancies, 47% had at least four ANC visits, 26.1% received all the components of ANC services, and 22.2% received an adequate dosage of supplementary iron-folic acid tablets/syrup. Women with unintended pregnancy were less likely to receive their first ANC visit within the first 3 months, four or more ANC visits, and all ANC services than those with intended pregnancy. Conclusion: Unintended pregnancy was inversely associated with the proper utilization of ANC among women in Bangladesh. Appropriate measures to reduce unintended pregnancy might foster the utilization of optimum antenatal care.

Complementary feeding practices and their determinants among children aged 6-23 months in rural Bangladesh: evidence from Bangladesh Integrated Household Survey (BIHS) 2018-2019 evaluated against WHO/UNICEF guideline -2021.

BACKGROUND: Appropriate Complementary feeding (CF) practices play a crucial role in determining child nutrition, growth, and development. This study seeks to examine CF practices and their predictors among children aged 6 to 23 months in rural Bangladesh according to the most recently updated WHO/UNICEF guidelines for CF. METHODS: A total of 665 children aged 6 to 23 months from the Bangladesh Integrated Household Survey (BIHS) 2018-2019 dataset were analyzed. The WHO/UNICEF guidelines for CF were followed to evaluate each of the nine CF practice indicators. We also examined the effect of the child, maternal, household, and community-level factors on different CF components using multiple logistic regression analyses. RESULTS: Approximately two-thirds of the children initiated complementary feeding on time (63.5%) but had zero vegetable or fruit consumption (63.2%). More than half (52.4%) and the majority (86.5%) of children had minimum meal frequency and minimum milk feeding frequency, respectively. On the other hand, the proportion of minimum dietary diversity was quite low (18.3%), as reflected in the alarming prevalence (16.3%) of minimum acceptable diet. Egg and/or flesh food, sweet beverage, and unhealthy food consumption were 23.3%, 2.5%, and 12.2%, respectively. Child age, mothers' education level, antenatal care visit, household food security, monthly household income, and place of residence were found to be associated with CF practices. CONCLUSION: When compared to results obtained using the previous guideline, the new one has resulted in a lower prevalence of Introduction of solid, semi-solid, or soft foods (ISSF), Minimum dietary diversity (MDD), Minimum meal frequency (MMF), and Minimum acceptable diet (MAD). It is crucial to convey the new knowledge for better child feeding and nutrition as the country prepares to apply the new guideline.

Dietary diversity and micronutrients adequacy among the women of reproductive age at St. Martin's island in Bangladesh.

Minimum dietary diversity for women, an important dimension of diet quality, has been widely used as a proxy indicator for micronutrient adequacy. In low- and middle-income countries (LMICs), women of reproductive age (WRA) particularly are at high risk of inadequate micronutrient intake resulting from poor diversified diets. Therefore, the present study aimed to assess dietary diversity and micronutrients adequacy in the diets of WRA of St. Martin's island, along with their socio-economic determinants. A cross-sectional study was conducted on a representative sample of 201 WRA living at St. Martin's island. Utilizing the Estimated Average Requirement (EAR) cut-point approach, the adequacy of micronutrient intake was evaluated from observed 24-h recall dietary data. The recent guideline of FAO was employed to evaluate Minimum Dietary Diversity for Women (MDD-W). Binary logistic regression and multiple linear regression analyses were performed to identify socio-economic determinants of MDD-W and micronutrients adequacy. The mean (SD) dietary diversity score was 4.25 (1.17) and about 40.3% of the participants met the MDD-W cut-off. Starchy staples (100%), meat/poultry/fish (87%), and other vegetables (79%) were consumed more frequently, while, the least reported food groups were dairy (2%), nuts and seeds (11%), and vitamin A-rich fruits and vegetables (11%). Except for Niacin, intake of all micronutrients was inadequate, with an inadequacy prevalence of 36-100%. Educational level, and decision-making role of women were significantly related to their dietary diversity. On the other hand, age, decision-making role, and MDD-W were important determinants of micronutrient adequacy. In conclusion, the WRA of St. Martin's island consumed neither a sufficient amount of micronutrients nor an adequate diversity of foods. In addition, several socio-economic components are linked with dietary diversity and micronutrient adequacy. Therefore, attention is needed to decide on the best strategies to improve the quality of diet and dietary diversity for WRA in this setting.

Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States.

OBJECTIVE: Depression is prevalent among persons with HIV (PWH) and is associated with poorer adherence and lack of viral load suppression (VLS). When treated for depression, PWH are more likely to stay in HIV care and adhere to medications; however, for many PWH, depression is not adequately diagnosed or treated. We adapted Progression and Transmission of HIV (PATH 3.0), a U.S. agent-based dynamic stochastic simulation model, by incorporating a continuum of depression care and estimating the impact on VLS of an enhanced depression diagnosis and care scenario (EDC). METHODS: We compared EDC - whereby every PWH is assessed for depression, gets treatment if diagnosed, and of those, half achieve remission - to a status quo scenario (SQ) on VLS. Based on published findings, assumptions for SQ were: 34.7% depressed, 45% diagnosed, 55.3% treated and 33% of treated achieving remission. Compared to PWH without depression, we assumed the probability of being non-virally suppressed increased by 1.57 times for PWH with depression (PWH-D), and by 0.95 times for PWH with remitted depression. RESULTS: There was an average increase of 14.6% (11.5-18.5) in the proportion of PWH-D who achieved VLS in EDC compared to SQ. Among all PWH, there was a 4.7% (3.4-6.0) increase in the proportion who achieved VLS in EDC compared to SQ. CONCLUSIONS: Fully diagnosing and adequately treating depression would improve health and quality of life for a substantial proportion of PWH-D and result in a nearly 5% increase in expected rates of VLS in the United States, supporting national prevention goals.

Assessment of nutrient adequacy and associated factors among lactating women of rural Bangladesh using observed intake: Findings from Bangladesh Integrated Household Survey 2018-2019.

Lactating women of low- and middle-income countries are prone to develop deficiencies in essential nutrients due to various demographic and socioeconomic components. This study aimed to estimate the adequacy of dietary intake and the determinants of diet quality of lactating women in rural Bangladesh. One-day dietary recall (24-Hour recall) data of 973 lactating women were obtained from the Bangladesh Integrated Household Survey (BIHS) 2018-2019. Nutrient adequacy was determined using the Estimated Average Requirement (EAR) cut-point approach. The molar ratios of phytate to zinc, calcium, and iron were calculated. Mean Adequacy Ratio (MAR) was calculated to measure diet quality, and multiple linear regression analysis was performed to assess the sociodemographic determinants of MAR. While the intakes of protein and carbohydrate were equal to/above the Acceptable Macronutrient Distribution Range (AMDR) among most of the subjects, intakes of total energy and fat were below the reference intakes for 74.4% and 98.3%, respectively. Nutrient adequacy remained unmet for riboflavin, calcium, vitamin A, and folate among most (87.2%-97.6%) of the study population, and the mean (SD) MAR was 0.72 (0.12). Cereals were the major contributor of energy and B vitamins, while protein and iron mainly came from plant-based sources. The molar ratio of phytate to iron was greater than the critical limit among most respondents. Maternal Body Mass Index (BMI) (beta = 0.003, p = .014) and education level (beta = 0.017, p = .038) were associated with their diet quality. The diet of most lactating women in rural Bangladesh indicates the inadequacy of several micronutrients. This can lead to a worsening of the double burden of malnutrition in women. Lactating women should be given special consideration when designing food and nutrition programs for reproductive women in rural Bangladesh.

Effect of Mother's Nutritional Knowledge and Hygiene Practices on School-Going Adolescents Living in Dhaka City of Bangladesh.

Background: Adolescence which is a critical stage for growth and development is influenced by various issues along with maternal nutritional knowledge, control over their earnings, freedom of movement, and participation in household decision-making over child's health care. Objective: This study focused on assessing mothers' nutritional knowledge and hygiene practices and their effect on dietary diversity as well as the nutritional status of school-going adolescents of Dhaka city. Methods: A community-based cross-sectional study was conducted at 44 schools in Dhaka city. A total of 710 school-going adolescents aged 10-17 years were randomly selected and their mothers were interviewed for assessing their knowledge on nutrition and hygiene practices. One-way ANOVA and multivariate linear regression were used to examine the association between dietary diversity and the nutritional status of the adolescents with their mother's nutritional knowledge and hygiene practices. Results: About one-third (35.8%) of the mothers maintained hygiene and sanitation satisfactorily. Although 53.1% of them had satisfactory general knowledge about a healthy diet, only 6.5% showed good knowledge of the nutritional value of food. The prevalence of stunting, thin, and overweight was 8, 4.6, and 5.8%, respectively. Fair hygiene practices were positively associated (P = 0.048) with height for age z-score. Maternal knowledge on the nutritional value of food was positively associated (P = 0.027) with the dietary diversity of the adolescents. Conclusion: Adequate nutritional knowledge and hygiene practices of the mothers have positive effects on children's dietary diversity and nutritional status. Providing nutrition education to mothers would ensure better nutritional status and improved dietary practices for their children.

Malnutrition among under-five children in St. Martin's Island, Bangladesh: A cross-sectional study on prevalence and associated factors.

Objectives: Early childhood nutrition is critical for physical and mental development, and any hindrance (malnutrition) at this stage adversely affects adulthood which makes them more susceptible to a variety of communicable and non-communicable diseases. St. Martin's Island was the focus of this study, which examined the prevalence and risk factors for malnutrition among under-five children. Methods: In this cross-sectional study, 256 children aged under five were assessed for anthropometry, and multiple logistic regression models were fitted to identify potential predictors of malnutrition. For analysis, SPSS and WHO Anthro software were used. Results: The prevalence of stunting, wasting, underweight, and overweight were 34.4%, 17.6%, 18.9%, and 6.9% respectively among children under-five years of age in St. Martin's Island. An increase in child's age decreases their risk of being stunted (AOR = 0.97, p = 0.006). Males were more likely than females to be wasted (AOR = 2.03, p = 0.001). Both stunting (AOR = 2.42, p = 0.004) and wasting (AOR = 2.82, p = 0.015) rate were higher among the poorer section as compared to the richest. On the contrary, underweight was low among the poorest section (AOR = 0.37, p = 0.024). Other socio-economic factors, for example, household food insecurity, and parental occupation affect these forms of malnutrition significantly. Conclusion: Prevalence of all forms of malnutrition except underweight was higher as compared to the national perspective in St. Martin's Island among the under-five children. Community-based approaches by the local government in collaboration with various non-government organizations should be taken to reduce and prevent malnutrition among children.

Child-sensitive water, sanitation, and hygiene composite score and its association with child nutritional outcomes in St. Martin's Island, Bangladesh.

Objectives: This study aimed to outline water, sanitation, and hygiene (WASH) practices for children under 5 years of age among the households of St. Martin's Island as well as examine the role of water, sanitation, and hygiene on child nutritional outcomes. Methods: A total of 256 children under 5 years of age were anthropometrically measured, and multiple linear regression was performed to understand the relationship between combined water, sanitation, and hygiene score and child nutritional outcomes: height-for-age, weight-for-age, weight-for-height z-scores. Results: The majority of the sampled households had improved drinking water facilities. Over one-third of the participants (36.5%) did not have access to better sanitation, and 12.4% reported defecating in open places. Just over one-third of those surveyed reported washing their hands with soap or detergents after defecation, with more than 22% of people not having access to a handwashing station on their premises. Stunting, wasting, and underweight were found to be prevalent in 34.4%, 17.6%, and 18.9% of the sampled children, respectively. Height-for-age (0.08 SDs) and weight-for-age (0.014 SDs) were greater on average in children from households with improved water, sanitation, and hygiene conditions, but weight-for-height did not significantly differ from those from WASH-unimproved households. Conclusion: Certain aspects of WASH, particularly, sanitation facilities and hygiene practices were not up to the mark in St. Martin's Island, and consistent with findings from other studies, our study findings underlined the potential benefits of improved water, sanitation, and hygiene practices in addressing child undernutrition.