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1.
PLoS One ; 15(8): e0237210, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790725

RESUMO

BACKGROUND: Chronic childhood malnutrition, or stunting, remains a persistent barrier to achieve optimal cognitive development, child growth and ability to reach full potential. Almost half of children under-five years of age are stunted in the province of Sindh, Pakistan. OBJECTIVE: The primary objective of this study was to test the hypothesis that the provision of lipid-based nutrient supplement-medium-quantity (LNS-MQ) known as Wawamum will result in a 10% reduction in risk of being stunted at the age of 24 months in the intervention group compared with the control group. DESIGN: A cluster randomized controlled trial was conducted in Thatta and Sujawal districts of Sindh province, Pakistan. A total of 870 (419 in intervention; 451 in control) children between 6-18 months old were enrolled in the study. The unit of randomization was union council and considered as a cluster. A total of 12 clusters, 6 in each study group were randomly assigned to intervention and control group. All children received standard government health services, while children in the intervention group also received 50 grams/day of Wawamum. RESULTS: Children who received Wawamum were found to have a significantly reduced risk of stunting (RR = 0.91, 95% CI; 0.88-0.94, p<0.001) and wasting (RR = 0.78, 95% CI; 0.67-0.92, p = 0.004) as compared to children who received the standard government health services. There was no evidence of a reduction in the risk of underweight (RR = 0.94, 95% CI; 0.85-1.04, p = 0.235) in the intervention group compared to the control group. Statistically significant reduction in anaemia in the intervention group was also found as compared to the control group (RR = 0.97, 95% CI; 0.94-0.99, p = 0.042). The subgroup analysis by age, showed intervention effect is significant in reduction of risk of stunting in younger children of aged 6-12 month (RR = 0.83, 95% CI; 0.81-0.86, p = <0.001) and their older peers aged 13-18 month- (RR = 0.90, 95% CI; 0.83-0.97, p = 0.008). The mean compliance of Wawamum was 60% among children. CONCLUSIONS: The study confirmed that the provision of Wawamum to children 6-23 months of age is effective in reducing the risk of stunting, wasting and anaemia. This approach should be scaled up among the most food insecure areas/households with a high prevalence of stunting to achieve positive outcomes for nutrition and health. This study was registered at clinicaltrials.gov as NCT02422953. Clinical Trial Registration Number: NCT02422953.


Assuntos
Anemia Ferropriva/prevenção & controle , Gorduras na Dieta/administração & dosagem , Suplementos Nutricionais , Fórmulas Infantis , Transtornos da Nutrição do Lactente/prevenção & controle , Síndrome de Emaciação/prevenção & controle , Anemia Ferropriva/dietoterapia , Gorduras na Dieta/uso terapêutico , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente/dietoterapia , Masculino , Paquistão , Síndrome de Emaciação/dietoterapia
2.
Cochrane Database Syst Rev ; 7: CD012241, 2020 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-32710657

RESUMO

BACKGROUND: Education of family members about infant weaning practices could affect nutrition, growth, and development of children in different settings across the world. OBJECTIVES: To compare effects of family nutrition educational interventions for infant weaning with conventional management on growth and neurodevelopment in childhood. SEARCH METHODS: We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5), MEDLINE via PubMed (1966 to 26 June 2018), Embase (1980 to 26 June 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 June 2018). We searched clinical trials databases, conference proceedings, and references of retrieved articles. We ran an updated search from 1 January 2018 to 12 December 2019 in the following databases: CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA: We included randomised controlled trials that examined effects of nutrition education for weaning practices delivered to families of infants born at term compared to conventional management (standard care in the population) up to one year of age. DATA COLLECTION AND ANALYSIS: Two review authors independently identified eligible trial reports from the literature search and performed data extraction and quality assessments for each included trial. We synthesised effect estimates using risk ratios (RRs), risk differences (RDs), and mean differences (MDs), with 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included 21 trials, recruiting 14,241 infants. Five of the trials were conducted in high-income countries and the remaining 16 were conducted in middle- and low-income countries. Meta-analysis showed that nutrition education targeted at improving weaning-related feeding practices probably increases both weight-for-age z scores (WAZ) (MD 0.15 standard deviations, 95% CI 0.07 to 0.22; 6 studies; 2551 infants; I² = 32%; moderate-certainty evidence) and height-for-age z scores (0.12 standard deviations, 95% CI 0.05 to 0.19; 7 studies; 3620 infants; I² = 49%; moderate-certainty evidence) by 12 months of age. Meta-analysis of outcomes at 18 months of age was heterogeneous and inconsistent in the magnitude of effects of nutrition education on WAZ and weight-for-height z score across studies. One trial that assessed effects of nutrition education on growth at six years reported an uncertain effect on change in height and body mass index z score. Two studies investigated effects of nutrition education on neurodevelopment at 12 to 24 months of age with conflicting results. No trials assessed effects of nutrition education on long-term neurodevelopmental outcomes. AUTHORS' CONCLUSIONS: Nutrition education for families of infants may reduce the risk of undernutrition in term-born infants (evidence of low to moderate certainty due to limitations in study design and substantial heterogeneity of included studies). Modest effects on growth during infancy may not be of clinical significance. However, it is unclear whether these small improvements in growth parameters in the first two years of life affect long-term childhood growth and development. Further studies are needed to resolve this question.


Assuntos
Família , Fenômenos Fisiológicos da Nutrição do Lactente , Desmame , Anemia Ferropriva/epidemiologia , Viés , Estatura , Peso Corporal , Desenvolvimento Infantil , Países Desenvolvidos , Países em Desenvolvimento , Humanos , Lactente , Morte do Lactente , Alimentos Infantis , Transtornos da Nutrição do Lactente/prevenção & controle , Recém-Nascido , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Nascimento a Termo
3.
BMC Public Health ; 20(1): 744, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32443977

RESUMO

Evidence of the impact of community-based nutrition programs is uncommon for two main reasons: the lack of untreated controls, and implementation does not account for the evaluation design. Suchana is a large-scale program to prevent malnutrition in children in Sylhet division, Bangladesh by improving the livelihoods and nutrition knowledge of poor and very poor households. Suchana is being implemented in 157 unions, the smallest administrative unit of government, in two districts of Sylhet. Suchana will deliver a package of interventions to poor people in about 40 randomly selected new unions annually over 4 years, until all are covered. All beneficiaries will receive the normal government nutrition services. For evaluation purposes the last 40 unions will act as a control for the first 40 intervention unions. The remaining unions will receive the program but will not take part in the evaluation. A baseline survey was conducted in both intervention and control unions; it will be repeated after 3 years to estimate the impact on the prevalence of stunted children and other indicators. This stepped wedge design has several advantages for both the implementation and evaluation of services, as well as some disadvantages. The units of delivery are randomized, which controls for other influences on outcomes; the program supports government service delivery systems, so it is replicable and scalable; and the program can be improved over time as lessons are learned. The main disadvantages are the difficulty of estimating the impact of each component of the program, and the geographical distribution of unions, which increases program delivery costs. Stepped implementation allows a cluster randomized trial to be achieved within a large-scale poverty alleviation program and phased-in and scaled-up over a period of time. This paper may encourage evaluators to consider how to estimate attributable impact by using stepped implementation, which allows the counterfactual group eventually to be treated.


Assuntos
Serviços de Saúde Comunitária , Promoção da Saúde , Transtornos da Nutrição do Lactente/prevenção & controle , Adolescente , Adulto , Bangladesh/epidemiologia , Doença Crônica , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
5.
Int J Equity Health ; 19(1): 14, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992299

RESUMO

INTRODUCTION: Adequate dietary diversity is vital for the survival, growth and development of infants and children. Inadequate dietary diversity is the major cause of micronutrient deficiency in Sub-saharan Africa, including Ethiopia, where only less than one-fourth of the children aged 6-23 months obtain adequate diversified diet. Thus country implemented a strategy known as the Sustainable Undernutrtion Reduction (SUR) programs to alleviate the problem. However, empirical evidences are scarce on the impact of the program on children aged 6-23 months. Therefore, this study aimed to compare the level of dietary diversity among children aged 6-23 months in districts covered and not covered by SURE program in West Gojjam zone. METHODS: A community based comparative cross-sectional study was conducted in three districts of West Gojjam zone, Ethiopia, from February 29 to April 20, 2019. A total of 832 mother and child pairs were selected by the simple random sampling technique. A pretested and structured interviewer-administered questionnaire was used to collect data. A binary logistic regression model was fitted to identify factors associated with dietary diversity. Crude odds and adjusted odds ratios with 95% confidence intervals (CI) were calculated to assess the strength of associations and significance of the identified factors for dietary diversity score. RESULT: The overall proportion of adequate dietary diversity among children aged 6-23 months was 29.9% (95% CI: 27.0-33.0), whereas in SURE covered and uncovered districts it was 33.4% (95%CI: 29.0-38.and 26.4%(95% CI: 22.0, 31.0), respectively. ANC (Antenatal care) (AOR = 1.7; 95% CI: 1.16, 2.55) and postnatal care services (AOR = 2.1; 95% CI: 1.38, 3.28), participating in food preparation programs (AOR = 1.9; 95% CI: 1.19, 2.96), GMP (AOR = 2.74,95%CI:1.80, 4.18), vitamin A supplementation (AOR = 2.10,95%CI:1.22, 3.61) and household visits by health extension workers (AOR = 2.0; 95% CI: 1.25, 3.21) were significantly associated with dietary diversity. CONCLUSION: The proportion of adequate dietary diversity was higher among children in the program than those out of the program. ANC visits, PNC follow-ups, women's participating in food preparation programs and household visits by health extension workers were significantly associated with dietary diversity. Therefore, and strengthening and scaling up the program to non covered districts and providing health and nutrition counseling on Infant and Young Child Feeding (IYCF) during ANC and PNC services are recommended for achieving the recommended dietary diversity.


Assuntos
Dieta/estatística & dados numéricos , Transtornos da Nutrição do Lactente/prevenção & controle , Estudos Transversais , Etiópia , Humanos , Lactente , Avaliação de Programas e Projetos de Saúde
6.
Ecol Food Nutr ; 59(3): 243-262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31778086

RESUMO

The study aimed to quantify the immediate effects of dietary diversification, food safety, and hygiene interventions on child undernutrition in four rural villages in Kongwa district of central Tanzania. One hundred mothers with their children of less than 24 months old were recruited for this study. The difference-in-difference (DID) method was used to assess the effects of intensive intervention through a learning-by-doing process on the topic of aflatoxin free diversified food utilization and improved hygiene practices. Periodic anthropometric measurements were conducted on the 0th, 7th, 14th, and 21st days, and DID estimator showed the significant and positive average marginal effects of the intervention on Z-Scores being 0.459, 0.252, and 0.493 for wasting, stunting, and underweight, respectively. Notably, at the end of the study, the mean aflatoxin M1 level in urine samples decreased by 64% in the intervention group, while it decreased by 11% in the control group. The study provides quantitative evidence on intensive 21-day training for mothers incorporating integrated technologies yielded positive impacts on their children's nutritional outcomes.


Assuntos
Aflatoxinas/urina , Dieta/normas , Higiene/normas , Transtornos da Nutrição do Lactente/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Mães/educação , Feminino , Humanos , Lactente , Masculino , Micronutrientes/administração & dosagem , Estado Nutricional , População Rural , Tanzânia/epidemiologia
7.
Rev. esp. nutr. comunitaria ; 25(4): 0-0, oct.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191451

RESUMO

FUNDAMENTOS: En la etapa lactante los patrones de consumo alimentario (PCA) adecuados pueden mantener el correcto estado nutricional. La presente investigación buscó asociar el PCA durante la alimentación complementaria con el estado nutricional en lactantes. MÉTODOS:Se realizó un estudio transversal analítico (mayo-julio de 2017) con población lactante (n=35, femeninos 60% y masculinos 40%) de 4 a 12 meses de edad del municipio de Santo Domingo, Oaxaca. Se evaluó el estado nutricional con indicadores (Peso/Edad, Peso/Longitud y Longitud/Edad), así como se realizó valoración dietética aplicada a las madres o cuidadoras. RESULTADOS: El 68,57% de los lactantes presentaron un estado de nutrición normal. Se encontró una asociación significativa entre el adecuado estado de nutrición y el consumo de verduras, cereales sin grasa, alimentos de origen animal, leche, aceites sin proteína y con proteína. La asociación del estado de nutrición con el PCA no fue significativa (p=0,501). CONCLUSIONES: Se encontró una asociación significativa entre el adecuado estado de nutrición y el consumo de ciertos alimentos. El balance energético positivo de los lactantes es un factor que conduce a un sesgo de información, ya que el PCA inadecuado en esta etapa y la ingesta elevada de calorías incrementa el peso corporal


BACKGROUND: In the lactating stage, adequate dietary consumption patterns (PCA) can maintain the correct nutritional status. The present investigation seeks to associate the PCA during complementary feeding with the nutritional status in infants. METHODS: An analytical cross-sectional study was included (May-July 2017) with a lactating population (n=35, 60% female and 40% male) from 4 to 12 months of age born from the Santo Domingo, Oaxaca. The nutritional status was evaluated with indicators (Weight/Age, Weight/Length and Length/Age), as well as dietary assessment applied to mothers or caregivers. RESULTS: 68.57% of infants had a normal nutritional status. A significant association was found between the proper state of nutrition and the consumptionof vegetables, non-fat cereals, foods of animal origin, milk, oils without protein and with protein. The association of the nutritional status with the PCA was not significant (p = 0.501). CONCLUSIONS: A significant association was found between the proper state of nutrition and the consumption of certain foods. The positive energy balance of infants is a factor that leads to information bias, since inadequate PCA at this stage and high calorie intake increases body weight


Assuntos
Humanos , Masculino , Feminino , Lactente , Nutrição do Lactente , Alimentos Infantis/classificação , Necessidades Nutricionais/fisiologia , Recomendações Nutricionais/tendências , Transtornos da Nutrição do Lactente/prevenção & controle , México/epidemiologia , Alimentos Fortificados/análise , Tamanho da Porção de Referência/estatística & dados numéricos , Avaliação Nutricional , Estado Nutricional/fisiologia , Transtornos da Nutrição do Lactente/epidemiologia
8.
Ann Nutr Metab ; 75(2): 99-102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31743897

RESUMO

Growth from conception through age 2 years, the "First 1,000 days," is important for long-term health of the growing fetus and child and is influenced by several factors including breastfeeding and complementary feeding. Low- and middle-income countries face a complicated array of factors that influence healthy growth, ranging from high food insecurity, poor sanitation, limited prenatal or neonatal care, and high levels of poverty that exacerbate the "vicious cycle" associated with intergenerational promotion of growth retardation. It is now well recognized that the period prior to conception, both maternal and paternal health and diet, play an important role in fetal development, giving rise to the concept of the "First 1,000 Days+". Breastfeeding and complementary feeding practices can be improved through a combination of interventions such as baby-friendly hospitals, regulations for marketing of foods and beverages to children, adequate counseling and support, and sound social and behavior change communication, but continued research is warranted to make such programs more universal and fully effective. Thus, improving the overall understanding of factors that influence growth, such as improved breastfeeding and age-appropriate and adequate complementary feeding, is critical to reducing the global prevalence of the double burden of malnutrition.


Assuntos
Transtornos da Nutrição Infantil/etiologia , Transtornos da Nutrição do Lactente/etiologia , Hipernutrição/etiologia , Determinantes Sociais da Saúde , Aleitamento Materno , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Países em Desenvolvimento , Comportamento Alimentar , Feminino , Retardo do Crescimento Fetal/etiologia , Retardo do Crescimento Fetal/fisiopatologia , Transtornos da Nutrição Fetal/etiologia , Transtornos da Nutrição Fetal/prevenção & controle , Saúde Global , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Alimentos Infantis , Transtornos da Nutrição do Lactente/epidemiologia , Transtornos da Nutrição do Lactente/prevenção & controle , Recém-Nascido , Masculino , Desnutrição/fisiopatologia , Fenômenos Fisiológicos da Nutrição Materna , Hipernutrição/epidemiologia , Hipernutrição/prevenção & controle , Herança Paterna , Pobreza , Lesões Pré-Concepcionais/etiologia , Lesões Pré-Concepcionais/prevenção & controle , Gravidez , Complicações na Gravidez/fisiopatologia , Prevalência
9.
PLoS Med ; 16(8): e1002877, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31454347

RESUMO

BACKGROUND: Community management of acute malnutrition (CMAM) is a highly efficacious approach for treating acute malnutrition (AM) in children who would otherwise be at significantly increased risk of mortality. In program settings, however, CMAM's effectiveness is limited because of low screening coverage of AM, in part because of the lack of perceived benefits for caregivers. In Burkina Faso, monthly screening for AM of children <2 years of age is conducted during well-baby consultations (consultation du nourrisson sain [CNS]) at health centers. We hypothesized that the integration of a preventive package including age-appropriate behavior change communication (BCC) on nutrition, health, and hygiene practices and a monthly supply of small-quantity lipid-based nutrient supplements (SQ-LNSs) to the monthly screening would increase AM screening and treatment coverage and decrease the incidence and prevalence of AM. METHODS AND FINDINGS: We used a cluster-randomized controlled trial and allocated 16 health centers to the intervention group and 16 to a comparison group. Both groups had access to standard CMAM and CNS services; caregivers in the intervention group also received age-appropriate monthly BCC and SQ-LNS for children >6 months of age. We used two study designs: (1) a repeated cross-sectional study of children 0-17 months old (n = 2,318 and 2,317 at baseline and endline 2 years later) to assess impacts on AM screening coverage, treatment coverage, and prevalence; (2) a longitudinal study of 2,113 children enrolled soon after birth and followed up monthly for 18 months to assess impacts on AM screening coverage, treatment coverage, and incidence. Data were analyzed as intent to treat. Level of significance for primary outcomes was α = 0.016 after adjustment for multiple testing. Children's average age was 8.8 ± 4.9 months in the intervention group and 8.9 ± 5.0 months in the comparison group at baseline and, respectively, 0.66 ± 0.32 and 0.67 ± 0.33 months at enrollment in the longitudinal study. Relative to the comparison group, the intervention group had significantly higher monthly AM screening coverage (cross-sectional study: +18 percentage points [pp], 95% CI 10-26, P < 0.001; longitudinal study: +23 pp, 95% CI 17-29, P < 0.001). There were no impacts on either AM treatment coverage (cross-sectional study: +8.0 pp, 95% CI 0.09-16, P = 0.047; longitudinal study: +7.7 pp, 95% CI -1.2 to 17, P = 0.090), AM incidence (longitudinal study: incidence rate ratio = 0.98, 95% CI 0.75-1.3, P = 0.88), or AM prevalence (cross-sectional study: -0.46 pp, 95% CI -4.4 to 3.5, P = 0.82). A study limitation is the referral of AM cases (for ethical reasons) by study enumerators as part of the monthly measurement in the longitudinal study that may have attenuated the detectable impact on AM treatment coverage. CONCLUSIONS: Adding a preventive package to CMAM delivered at health facilities in Burkina Faso increased participation in monthly AM screening, thus overcoming a major impediment to CMAM effectiveness. The lack of impact on AM treatment coverage and on AM prevalence and incidence calls for research to address the remaining barriers to uptake of preventive and treatment services at the health center and to identify and test complementary approaches to bring integrated preventive and CMAM services closer to the community while ensuring high-quality implementation and service delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT02245152.


Assuntos
Serviços de Saúde da Criança , Transtornos da Nutrição do Lactente/prevenção & controle , Burkina Faso/epidemiologia , Estudos Transversais , Humanos , Incidência , Lactente , Transtornos da Nutrição do Lactente/diagnóstico , Transtornos da Nutrição do Lactente/epidemiologia , Recém-Nascido , Estudos Longitudinais , Masculino , Programas de Rastreamento
10.
PLoS Med ; 16(8): e1002892, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31454356

RESUMO

BACKGROUND: Community-based management of acute malnutrition (CMAM) has been widely adopted to treat childhood acute malnutrition (AM), but its effectiveness in program settings is often limited by implementation constraints, low screening coverage, and poor treatment uptake and adherence. This study addresses the problem of low screening coverage by testing the impact of distributing small-quantity lipid-based nutrient supplements (SQ-LNSs) at monthly screenings held by community health volunteers (CHVs). Screening sessions included behavior change communication (BCC) on nutrition, health, and hygiene practices (both study arms) and SQ-LNSs (one study arm). Impact was assessed on AM screening and treatment coverage and on AM incidence and prevalence. METHODS AND FINDINGS: A two-arm cluster-randomized controlled trial in 48 health center catchment areas in the Bla and San health districts in Mali was conducted from February 2015 to April 2017. In both arms, CHVs led monthly AM screenings in children 6-23 months of age and provided BCC to caregivers. The intervention arm also received a monthly supply of SQ-LNSs to stimulate caregivers' participation and supplement children's diet. We used two study designs: i) a repeated cross-sectional study (n = approximately 2,300) with baseline and endline surveys to examine impacts on AM screening and treatment coverage and prevalence (primary study outcomes) and ii) a longitudinal study of children enrolled at 6 months of age (n = 1,132) and followed monthly for 18 months to assess impact on AM screening and treatment coverage and incidence (primary study outcomes). All analyses were done by intent to treat. The intervention significantly increased AM screening coverage (cross-sectional study: +40 percentage points [pp], 95% confidence interval [CI]: 32, 49, p < 0.001; longitudinal study: +28 pp, 95% CI: 23, 33, p < 0.001). No impact on treatment coverage or AM prevalence was found. Children in the intervention arm, however, were 29% (95% CI: 8, 46; p = 0.017) less likely to develop a first AM episode (incidence) and, compared to children in comparison arm, their overall risk of AM (longitudinal prevalence) was 30% (95% CI: 12, 44; p = 0.002) lower. The intervention lowered CMAM enrollment by 10 pp (95% CI: 1.9, 18; p = 0.016), an unintended negative impact likely due to CHVs handing out preventive SQ-LNSs to caregivers of AM children instead of referring them to the CMAM program. Study limitations were i) the referral of AM cases by our research team (for ethical reasons) during monthly measurements in the longitudinal study might have interfered with usual CMAM activities and ii) the outcomes presented by child age also reflect seasonal variations because of the closed cohort design. CONCLUSIONS: Incorporating SQ-LNSs into monthly community-level AM screenings and BCC sessions was highly effective at improving screening coverage and reducing AM incidence, but it did not improve AM prevalence or treatment coverage. Future evaluation and implementation research on CMAM should carefully assess and tackle the remaining barriers that prevent AM cases from being correctly diagnosed, referred, and adequately treated. TRIAL REGISTRATION: ClinicalTrials.gov NCT02323815.


Assuntos
Suplementos Nutricionais , Transtornos da Nutrição do Lactente/prevenção & controle , Doença Aguda , Adulto , Serviços de Saúde Comunitária , Estudos Transversais , Características da Família , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Estudos Longitudinais , Masculino , Mali , Programas de Rastreamento
12.
Nutrients ; 11(6)2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31238506

RESUMO

Nutrient adequacy of young children's diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6-8, 9-11 and 12-23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6-12 months of age and every other day for 12-23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.


Assuntos
Dieta , Transtornos da Nutrição do Lactente/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/prevenção & controle , Estado Nutricional , Valor Nutritivo , Fatores Etários , Estudos Transversais , Inquéritos sobre Dietas , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Transtornos da Nutrição do Lactente/fisiopatologia , Masculino , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Programação Linear , Recomendações Nutricionais , Fatores de Risco
13.
S Afr Med J ; 109(5): 328-332, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31131800

RESUMO

BACKGROUND: Early-life exposure to excess sugar affects eating behaviour and creates a predisposition to non-communicable diseases (NCDs). While reducing sugar consumption has been high on the public health agenda, little is known about the sugar content of baby foods. OBJECTIVES: To describe and analyse the sugar content of baby foods in South Africa (SA). METHODS: A cross-sectional study was conducted to analyse the sugar content of baby foods. The study sample included commercially available baby foods targeted at children aged <12 months, sold in supermarkets and by other major retailers in SA. Primary data were obtained from the packaging, and sugar content was compared with recommended intake guidelines. Bivariate analyses were conducted to determine whether there were any associations between the sugar content, added sugar and the characteristics of foods. RESULTS: Over 70% of products were sweet in taste, with one in four containing added sugars. Sugar content was high in 78% of the foods sampled. Over 80% of cereals and pureed desserts contained added sugar. Fewer than 10% of pureed composite meal and pureed fruit and vege-table categories contained added sugar. Most products adhered to SA labelling standards, but none had front-of-pack nutritional information. CONCLUSIONS: The SA baby food market is characterised by products with a high sugar content, promoting an environment that encourages development of sweet-taste preferences and in the long term contributing to the rising burden of NCDs. There is an urgent need for mandatory regulation of sugar in baby foods.


Assuntos
Alimentos Infantis/análise , Transtornos da Nutrição do Lactente/prevenção & controle , Estado Nutricional , Valor Nutritivo , Açúcares/análise , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Masculino , Recomendações Nutricionais , Estudos Retrospectivos , África do Sul
14.
Nutr J ; 18(1): 22, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940147

RESUMO

BACKGROUND: Evidences indicate that the risk of linear growth faltering is higher among children born from young mothers. Although such findings have been documented in various studies, they mainly originate from cross-sectional data and demographic and health surveys which are not designed to capture the growth trajectories of the same group of children. This study aimed to assess the association between young maternal age and linear growth of infants using data from a birth cohort study in Ethiopia. METHODS: A total of 1423 mother-infant pairs, from a birth cohort study in rural Ethiopia were included in this study. They were followed for five time points, with three months interval until the infants were 12 months old. However, the analysis was based on 1378 subjects with at least one additional follow-up measurement to the baseline. A team of data collectors including nurses collected questionnaire based data and anthropometric measurements from the dyads. We fitted linear mixed-effects model with random intercept and random slope to determine associations of young maternal age and linear growth of infants over the follow-up period after adjusting for potential confounders. RESULTS: Overall, 27.2% of the mothers were adolescents (15-19 years) and the mean ± SD age of the mothers was 20 ± 2 years. Infant Length for Age Z score (LAZ) at birth was negatively associated with maternal age of 15-19 years (ß = - 0.24, P = 0.032). However, young maternal age had no significant association with linear growth of the infants over the follow-up time (P = 0.105). Linear growth of infants was associated positively with improved maternal education and iron-folate intake during pregnancy and negatively with infant illness (P < 0.05). CONCLUSION: Young maternal age had a significant negative association with LAZ score of infants at birth while its association over time was not influential on their linear growth. The fact that wide spread socio economic and environmental inequalities exist among mothers of all ages may have contributed to the non-significant association between young maternal age and linear growth faltering of infants. This leaves an opportunity to develop comprehensive interventions targeting for the infants to attain optimal catch-up growth.


Assuntos
Estatura , Desenvolvimento Infantil/fisiologia , Crescimento/fisiologia , Idade Materna , Gravidez na Adolescência/fisiologia , Adolescente , Estudos de Coortes , Estudos Transversais , Escolaridade , Etiópia , Feminino , Seguimentos , Humanos , Transtornos da Nutrição do Lactente/prevenção & controle , Recém-Nascido , Masculino , Gravidez , Adulto Jovem
15.
Matern Child Nutr ; 15(3): e12780, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30690869

RESUMO

In Cambodia, existing food products for treating or preventing undernutrition have met with limited success. Therefore, in 2014, alternative ready-to-use foods were developed. This trial aimed to assess the acceptability of the novel ready-to-use supplementary food (RUSF) as a snack or mixed with borbor (white rice porridge), compared with corn-soy blend plus plus (CSB++) and borbor fortified with micronutrient powder (MNP). The nonblinded, randomised 4 × 4 crossover trial recruited 95 children aged 9-23 months from communities in peri-urban Phnom Penh. Small quantities (100 g for porridges, 42 g for snack) of each food were offered for three consecutive days at testing sites (homes of health volunteers). Main outcomes were children's consumption, caregivers' assessment of children's preferences, and caregivers' ranking of the foods. Median percentage consumed of the test food servings ranged from 21 to 50% (p = 0.003). The odds of children consuming over 50% were greatest for borbor fortified with MNP versus RUSF snack (unadjusted OR = 6.79, CI = 2.80-16.47, p < 0.001). However, the median energy children received when consuming the RUSF with borbor (57 kcals) or as a snack (48 kcals) was greater than with CSB++ (15 kcals) or borbor fortified with MNP (18 kcals; p < 0.001). Therefore, although children ate less RUSF, it provided approximately three times more kilocalories. Caregivers reported that their children had the highest preference for borbor fortified with MNP. Caregivers themselves ranked the novel RUSF snack highest. Thus, the innovative RUSF was considered sufficiently acceptable to proceed to an effectiveness trial.


Assuntos
Fast Foods , Preferências Alimentares/fisiologia , Alimentos Fortificados , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Camboja , Cuidadores , Estudos Cross-Over , Ingestão de Energia/fisiologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/dietoterapia , Transtornos da Nutrição do Lactente/prevenção & controle , Micronutrientes
16.
S Afr Med J ; 109(11b): 83-88, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-32252874

RESUMO

Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016 - 2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990 - 2015), to achieving optimal health through the 'Survive, thrive and transform' global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.


Assuntos
Saúde da Criança , Política de Saúde , Saúde do Lactente , Fármacos Anti-HIV/uso terapêutico , Aleitamento Materno , Mortalidade da Criança , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Poluição Ambiental/prevenção & controle , Poluição Ambiental/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Lactente , Fórmulas Infantis , Mortalidade Infantil , Transtornos da Nutrição do Lactente/epidemiologia , Transtornos da Nutrição do Lactente/mortalidade , Transtornos da Nutrição do Lactente/prevenção & controle , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Saúde Materna , Morbidade , Gravidez , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/mortalidade , África do Sul/epidemiologia , Desenvolvimento Sustentável , Tuberculose/epidemiologia , Tuberculose/mortalidade , Doenças Preveníveis por Vacina/epidemiologia , Doenças Preveníveis por Vacina/mortalidade , Vacinas/uso terapêutico
17.
Public Health Nutr ; 22(1): 3-14, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30520406

RESUMO

OBJECTIVE: The prevention of malnutrition in children under two approach (PM2A), women's empowerment and agricultural interventions have not been widely evaluated in relation to child diet and nutrition outcomes. The present study evaluated the effectiveness of PM2A, women's empowerment groups (WEG), farmer field schools (FFS) and farmer-to-farmer training (F2F). DESIGN: Community-matched quasi-experimental design; outcome measures included children's dietary diversity, stunting and underweight. SETTING: Communities in South Kivu, Democratic Republic of the Congo.ParticipantsA total of 1312 children from 1113 households. RESULTS: Achievement of minimum dietary diversity ranged from 22·9 to 39·7 % and was significantly greater in the PM2A and FFS groups (P<0·05 for both comparisons). Fewer than 7·6 and 5·8 % of children in any group met minimum meal frequency and acceptable diet targets; only the PM2A group differed significantly from controls (P<0·05 for both comparisons). The endline stunting prevalence ranged from 54·7 % (PM2A) to 69·1 % (F2F) and underweight prevalence from 22·3 % (FFS) to 34·4 % (F2F). No significant differences were found between intervention groups and controls for nutrition measures; however, lower prevalences of stunting (PM2A, -4 %) and underweight (PM2A and FFS, -7 %) suggest potential impact on nutrition outcomes. CONCLUSIONS: Children in the PM2A and FFS groups had better child diet measures and nutrition outcomes with the best results among PM2A beneficiaries. Interventions that address multiple aspects nutrition education, health, ration provision and income generation may be more effective in improving child diet and nutrition in resource-poor settings than stand-alone approaches.


Assuntos
Agricultura/educação , Dieta/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Transtornos da Nutrição do Lactente/prevenção & controle , Magreza/epidemiologia , Mulheres/educação , República Democrática do Congo/epidemiologia , Inquéritos sobre Dietas , Empoderamento , Feminino , Transtornos do Crescimento/etiologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/complicações , Recém-Nascido , Masculino , Avaliação de Programas e Projetos de Saúde , Magreza/etiologia , Mulheres/psicologia
18.
BMC Pediatr ; 18(1): 394, 2018 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-30579346

RESUMO

BACKGROUND: Malnutrition has been responsible directly or indirectly for 10.9 million deaths worldwide annually among children under five. Childhood malnutrition is highly related to poor nutritional quality diet in developing countries where there is limited access to animal based foods. Most foods consumed by young children are cereal based which contain high amounts of anti-nutritional factors. Fermentation is thought to significantly lower the content of anti-nutrients in cereal grains. This study therefore, aimed to determine complementary feeding practices and effect of spontaneous fermentation on anti-nutritional factors and mineral contents of selected cereals. METHODS: Cross sectional survey was conducted in Ebinat district to determine complementary feeding practices among 324 lactating mothers. Laboratory analysis was carried out for teff and wheat cereal grains to determine the effect of spontaneous fermentation on anti-nutrients as well as mineral contents. RESULTS: Prevalence of appropriate complementary feeding practice was 1.5%. Fermentation of the sampled cereals for 12 h significantly (p < 0.05) reduced total phytate and total tannin. The reduction continued and most of the reduction of phytate and tannin contents occurred during the 72 h of fermentation for both cereal samples. However, the reduction for some fermentation times was not statistically significant. A significant (p < 0.05) variation was also noticed in the total amounts of calcium, iron and zinc in both sampled cereals within the 72 h of fermentation. CONCLUSION: Prevalence of appropriate complementary feeding practice was very low. There were significant reductions of phytate and tannin contents with concomitant increments of minerals after fermentation of cereals. Phytate: mineral ratios were significantly decreased after fermentation for all the parameters examined. It is recommended to ferment cereals while preparing complementary foods for children so as to enhance their micronutrient uptake.


Assuntos
Grão Comestível/química , Grão Comestível/metabolismo , Fermentação , Fenômenos Fisiológicos da Nutrição do Lactente , Valor Nutritivo , Disponibilidade Biológica , Aleitamento Materno , Estudos Transversais , Etiópia , Feminino , Humanos , Lactente , Transtornos da Nutrição do Lactente/prevenção & controle , Recém-Nascido , Micronutrientes/metabolismo , Minerais/metabolismo , Ácido Fítico/análise , Taninos/análise , Fatores de Tempo
20.
BMC Health Serv Res ; 18(1): 530, 2018 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-29986733

RESUMO

BACKGROUND: Nutrition has been integrated within the health services in Bangladesh as it is an important issue for health and development. High penetration of mobile phones in the community and favourable policy and political commitment of the Government of Bangladesh has created possibilities of using Information Communication Technology such as mobile phones for nutrition programs. In this paper the implementation of nutrition services with a specific focus on infant and young child feeding was explored and the potential for using mobile phones to improve the quality and coverage of nutrition services was assessed. METHODS: A qualitative study was conducted in Mirzapur and Chakaria sub-districts, Bangladesh from February-April 2014. We conducted 24 in-depth interviews (mothers of young children), 8 focus group discussions (fathers and grandmothers); and 13 key informant interviews (community health workers or CHWs). We also observed 4 facilities and followed 2 CHWs during their work day. The data was analyzed manually using pre-existing themes. RESULTS: In this community, mothers demonstrated gaps in knowledge about IYCF. They depended on their social network and media for IYCF information. Although CHWs were trusted in the community, mothers and their family members did not consider them a good source of nutrition information as they did not talk about nutrition. In terms of ICTs, mobile phones were the most available and used by both CHWs and mothers. CHWs showed willingness to incorporate nutrition counselling through mobile phone as this can enhance their productivity, reduce travel time and improve service quality. Mothers were willing to receive voice calls from CHWs as long as the decision makers in the households were informed. CONCLUSIONS: Our study indicated that there are gaps in IYCF related service delivery and there is a potential for using mobile phones to both strengthen the quality of service delivery as well as reaching out to the mothers in the community. It is important however, to consider the community readiness to accept the technology during the design and delivery of the intervention.


Assuntos
Telefone Celular , Assistência à Saúde/normas , Transtornos da Nutrição do Lactente/prevenção & controle , Bangladesh , Criança , Pré-Escolar , Comunicação , Agentes Comunitários de Saúde/estatística & dados numéricos , Aconselhamento , Assistência à Saúde/métodos , Feminino , Humanos , Lactente , Masculino , Mães , Estado Nutricional , Pesquisa Qualitativa , Saúde da População Rural
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