RESUMO
BACKGROUND: Using formative research to guide the planning and implementation of home fortification programs is critical if they are to achieve the desired level of acceptance and coverage by the target beneficiaries. OBJECTIVE: To explore contextual factors that could influence acceptance, delivery, and use of micronutrient powders (MNP) in Aileu District, Timor-Leste. METHODS: Two focus group discussions were conducted with mothers of children 6 to 23 months of age, and 56 in-depth interviews were conducted with mothers (n = 18), fathers (n = 14), grandmothers (n = 14), health workers (n = 8), and Catholic catechists (n = 2). These were followed by a 14-day usability trial during which 45 mothers fed their children MNP daily and were interviewed about their experience. Participants were selected from three villages. RESULTS: The findings revealed limited exclusive breastfeeding and early introduction of complementary foods due to traditional beliefs and poor knowledge. MNP was generally liked by the respondents. Thirty of the 45 children in the trial consumed all of the 14 MNP sachets provided to them. The majority of mothers (n > or = 30) split and fed the daily dose of MNP at different times of the day. They gave several reasons for this practice, including changes in the color of food when a whole sachet of MNP was added. Only six mothers shared MNP-fortified food among siblings. The participants suggested contextual attributes that could influence their adoption of MNP including preferred name, packaging design, and delivery channel. They preferred orange-colored sachets with a picture of a "healthy" Timorese baby, the logo of the Ministry of Health, and instructions on how to use the product. CONCLUSIONS: The findings offer context-specific knowledge that could guide the success of the MNP program in this district and similar settings.
Assuntos
Alimentos Fortificados/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Micronutrientes/administração & dosagem , Avaliação de Programas e Projetos de Saúde/métodos , Projetos de Pesquisa , Adulto , Aleitamento Materno/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Feminino , Grupos Focais , Promoção da Saúde/estatística & dados numéricos , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Entrevistas como Assunto/métodos , Masculino , Pós , Timor-Leste , Adulto JovemRESUMO
<b>Background and Objective:</b> Infertility is still a phenomenon in the community, so consuming Moringa leaves (<i>Moringa oleifera</i> Lam.) is expected to increase fertility. This study aimed to determine the effect of Moringa leaf extract (<i>Moringa oleifera</i> Lam.) on the diameter of the primary and secondary follicles in female mice (<i>Mus musculus</i>). <b>Materials and Methods:</b> This study was an experiment using a Completely Randomized Design (CRD). The population of this study was 45 mice and samples were obtained by a simple random sampling technique from as many as 24 mice with the following criteria: Weight 20-25 g, 2-3 months old, female and in good health. Data analysis was performed through the ANOVA Test with a confidence level of α = 0.05 and further tested for the least significant difference (LSD). <b>Results:</b> Moringa leaf extract significantly positively affects the diameter of primary and secondary follicles in female mice (p<0.05). The average primary follicle diameter was P<sub>0</sub> (92.65 µm), P<sub>1</sub> (124.92 µm), P<sub>2 </sub>(150.72 µm), P<sub>3</sub> (175.68 µm) and the average secondary follicle diameter was control (157.17 µm), P<sub>1 </sub>(171.33 µm), P<sub>2</sub> (204.57 µm), P<sub>3</sub> (211.11 µm). Giving Moringa leaf extract (<i>Moringa oleifera</i> Lam.) significantly increases the diameter of mice's primary and secondary follicles due to the presence of vitamin E in Moringa leaf extract (<i>Moringa oleifera</i> Lam.). <b>Conclusion:</b> This can stimulate granulosa cells to secrete the hormone estrogen, causing an increase in the diameter of the primary and secondary follicles.
Assuntos
Moringa oleifera , Moringa , Camundongos , Feminino , Animais , Extratos Vegetais/farmacologia , Folhas de PlantaRESUMO
Introduction: A total of 19% of forcibly displaced Myanmar Nationals (FDMNs) Bangladesh fall within the age range of under five years old, while an average of 1% exhibit severe malnutrition. Cox's Bazar is the closest host community for FDMNs, with similar traditional culture and religion and shared linguistic, ethnic, and cultural ties. Methods: A qualitative study was conducted to investigate the impact of socio-cultural factors on the healthcare-seeking behavior of caregivers of critically malnourished children in FDMN camps and neighboring host communities. Results: The utilization of informal healthcare by caregivers in both populations can be attributed to cultural attitudes, taboos, and peer pressure. The healthcare by practices in the FDMN camps and host towns were primarily affected by household responsibilities, familial assistance in accessing medical services, decisions made by husbands or mothers-in-law, and the availability and accessibility of healthcare facilities. Certain features were identified that prompt caregivers to seek formal treatment in both groups. The efficacy of the treatment was a primary consideration. In instances where conventional remedies and informal treatments proved ineffective in restoring the health of children, others who were invested in their well-being, such as family members and neighbors, advised caretakers to pursue professional medical care. Discussion: Enhanced caregiver awareness of severe wasting, enhanced healthcare accessibility, and increased community volunteer engagement have the potential to facilitate early identification of severely wasted children and mitigate delays in treatment.
RESUMO
Our specific aim was to characterize maternal knowledge of anemia and its relationship to maternal and child anemia and to behaviors related to anemia reduction. We examined the relationship between maternal knowledge of anemia and anemia in the mother and the youngest child, aged 6-59 months, in 7,913 families from urban slums and 37,874 families from rural areas of Indonesia. Knowledge of anemia was defined based upon the mother's ability to correctly name at least one symptom of anemia and at least one treatment or strategy for reducing anemia. Hemoglobin was measured in both the mother and the child. In urban and rural areas, respectively, 35.8 and 36.9% of mothers had knowledge of anemia, 28.7 and 25.1% of mothers were anemic (hemoglobin <12 g/dL), and 62.3 and 54.0% of children were anemic (hemoglobin <11 g/dL). Maternal knowledge of anemia was associated with child anemia in urban and rural areas, respectively (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.79, 1.02, P = 0.10; OR 0.93, 95% CI 0.87, 0.98, P = 0.01) in multivariate logistic regression models adjusting for potential confounders. There was no significant association between maternal knowledge of anemia and maternal anemia. Maternal knowledge of anemia was significantly associated with iron supplementation during pregnancy and child consumption of fortified milk. There was no association of maternal knowledge of anemia with child deworming. Maternal knowledge of anemia is associated with lower odds of anemia in children and with some health behaviors related to reducing anemia.
Assuntos
Anemia/epidemiologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Mães , Adulto , Anemia/prevenção & controle , Pré-Escolar , Estudos Transversais , Família , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Modelos Logísticos , Masculino , Idade Materna , Inquéritos Nutricionais , Vigilância da População , Áreas de Pobreza , Prevalência , Fatores de Risco , População Rural , Fatores Socioeconômicos , População Urbana , Adulto JovemRESUMO
OBJECTIVES: To describe risk factors for clustering of anemia among mothers and children in Indonesia. METHODS: An anemia cluster was defined as hemoglobin <12 g/dl in the mother and <11 g/dl in the youngest child, aged 6-59 months. RESULTS: Anemia clustering occurred in 4907 (18.3%) of 26 809 urban families and 12 756 (15.5%) of 82 291 rural families. Maternal overweight/obesity, older child age, consumption of fortified milk by the child, use of iodized salt, vitamin A supplementation, paternal smoking and greater expenditure on animal and plant source foods were associated with lower odds of anemia clustering. Older maternal age, maternal underweight, ≥2 children in the family and >4 individuals eating from the same kitchen were associated with greater odds of anemia clustering. CONCLUSION: Fortified milk, iodized salt, vitamin A supplementation and greater expenditure on plant and animal foods are among modifiable risk factors associated with lower risk of anemia clustering in Indonesia.
Assuntos
Anemia/epidemiologia , Comportamentos Relacionados com a Saúde , Adulto , Fatores Etários , Pré-Escolar , Análise por Conglomerados , Características da Família , Comportamento Alimentar , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Modelos Logísticos , Masculino , Idade Materna , Mães/estatística & dados numéricos , Vigilância da População , Áreas de Pobreza , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricosRESUMO
Effective coverage of antenatal iron and folic acid (IFA) supplementation is important to prevent adverse maternal and newborn health outcomes. We interviewed 2572 women from two rural districts in Bangladesh who had a live birth in the preceding six months. We analysed the number of IFA tablets received and consumed during pregnancy and examined the factors influencing IFA consumption by multiple linear regression and user adherence-adjusted effective coverage of IFA (consuming ≥180 IFA tablets) by Poisson regression. Overall, about 80% of women consumed IFA supplements in any quantity. About 76% of women received antenatal care at least once, only 8% received ≥180 IFA tablets, and 6% had user adherence-adjusted coverage of antenatal IFA supplementation. Multivariable analysis showed a linear relationship between the number of antenatal care (ANC) visits and the number of IFA supplements consumed, which was modified by the timing of the first ANC visit. Women's education, free IFA, and advice on IFA were also associated with higher IFA consumption. Interventions targeting at least eight ANC contacts, starting early in pregnancy, providing advice on the importance of IFA, and providing IFA supplements in higher quantity at ANC contacts are likely to increase effective coverage of antenatal IFA supplementation.
Assuntos
Ácido Fólico , Ferro , Bangladesh , Suplementos Nutricionais , Feminino , Humanos , Recém-Nascido , Gravidez , Cuidado Pré-NatalRESUMO
Because the global financial crisis and high food prices affect food consumption, we characterized the relationship between stunting and nongrain food expenditure at the household level among children 0-59 mo old in Indonesia's rural and urban poor population. Expenditure and height-for-age data were obtained from a population-based sample of 446,473 children in rural and 143,807 in urban poor areas in Indonesia. Expenditure on food was grouped into categories: animal, plant, total nongrain, and grain. The prevalence of stunting in rural and urban poor areas was 33.8 and 31.2%, respectively. In rural areas, the odds ratios (OR) (5th vs. first quintile) for stunting were similar for proportion of household expenditure on animal (0.87; 95% CI = 0.85-0.90; P < 0.0001), plant (0.86; 95% CI = 0.84-0.88; P < 0.0001), and total nongrain (0.85; 95% CI = 0.83-0.87; P < 0.0001). In urban poor areas, the relationship between stunting and proportion of household expenditure on animal sources was stronger than in rural areas (OR 0.78; 95% CI = 0.74-0.81; P < 0.0001), whereas the relationship with nongrain was similar to rural areas (OR 0.88; 95% CI = 0.85-0.92; P < 0.0001) and no relationship was observed with plant sources (OR 0.97; 95% CI = 0.93-1.01; P = 0.13). For grain expenditure, OR for stunting in highest vs. lowest quintile was 1.21 (95% CI = 1.18-1.24; P < 0.0001) in rural and 1.09 (95%CI = 1.04-1.13; P < 0.0001) in urban poor areas. Thus, households that spent a greater proportion on nongrain foods, in particular animal source foods, had a lower prevalence of child stunting. This suggests potential increased risk of malnutrition associated with reductions of household expenditure due to the current global crises.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Alimentos/classificação , Alimentos/economia , Transtornos do Crescimento/economia , Transtornos do Crescimento/epidemiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Animais , Pré-Escolar , Laticínios , Características da Família , Frutas , Humanos , Indonésia/epidemiologia , Lactente , Recém-Nascido , Fatores de Risco , VerdurasRESUMO
In Bangladesh, poor rural families often deal with high food costs by purchasing primarily rice. Our objective was to characterize the relationship between household expenditure on rice and nonrice foods with maternal and child malnutrition. Food expenditure data and anthropometry were obtained in a population-based sample of 304,856 households in the Bangladesh Nutrition Surveillance Project, 2000-2005. Food expenditures were categorized as rice and nonrice foods and expressed as quintiles of proportional food expenditure. Of children aged 6-11, 12-23, and 24-59 mo, the prevalence of stunting was 33.5, 56.3, and 53.1%, respectively. The prevalence of maternal underweight (BMI < 18.5 kg/m(2)) was 37.3%. Among children aged 6-11, 12-23, and 24-59 mo, rice expenditures were associated with stunting [odds ratio (OR) 1.11, 95% CI 1.02-1.20, P = 0.01; OR 1.09, 95% CI 1.04-1.13, P < 0.0001; OR 1.13, 95% CI 1.08-1.18, P < 0.0001), respectively, among families in the highest compared with the lowest quintile, adjusting for potential confounders, and nonrice food expenditures were associated with stunting (OR 0.87, 95% CI 0.80-0.95, P = 0.002; OR 0.86, 95% CI 0.83-0.90, P < 0.0001; OR 0.89, 95% CI 0.85-0.94, P < 0.0001) among families in the highest compared with the lowest quintile, adjusting for potential confounders. In the highest compared with the lowest quintile, rice expenditures (OR 1.12, 95% CI 1.08-1.15, P < 0.0001) and nonrice food expenditures (OR 0.93, 95% CI 0.90-0.96, P < 0.0001) were associated with maternal underweight. Households that spent a greater proportion on nonrice foods and less on rice had a lower prevalence of maternal and child malnutrition.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Alimentos/economia , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Oryza/economia , Adulto , Bangladesh/epidemiologia , Criança , Características da Família , Feminino , Humanos , Lactente , Desnutrição/epidemiologia , Razão de Chances , Vigilância da PopulaçãoRESUMO
In Bangladesh, rice prices are known to be positively associated with the prevalence of child underweight and inversely associated with household nongrain food expenditures, an indicator of dietary quality. The collection of reliable data on household expenditures is relatively time consuming and requires extensive training. Simple dietary diversity scores are increasingly used as measures of food security and as proxies for nutrient adequacy. This study examines associations between a simple dietary diversity score and commonly used indicators of socioeconomic status in Bangladesh. Data representative of rural Bangladesh was collected from 188,835 households over 18 rounds of bi-monthly data collection from 2003-2005. A simple household dietary diversity score was developed by summing the number of days each household consumed an item from each of 7 food groups over a 7-d period. The dietary diversity score was associated with per capita nongrain food expenditures (r = 0.415), total food expenditures (r = 0.327), and total household expenditures (r = 0.332) using Spearman correlations (all P < 0.0001). The frequency of meat and egg consumption showed greater variation across quintiles of total monthly expenditure than other items contributing to the dietary diversity score. After controlling for other measures of socioeconomic status in multiple linear regression models, the dietary diversity score was significantly associated with monthly per capita food and total expenditures. Low dietary diversity during the period prior to major food price increases indicates potential risk for worsening of micronutrient deficiencies and child malnutrition in Bangladesh.
Assuntos
Dieta , Alimentos/economia , Desnutrição/epidemiologia , Bangladesh/epidemiologia , Criança , Transtornos da Nutrição Infantil , Inquéritos sobre Dietas , Características da Família , Humanos , Estado NutricionalRESUMO
BACKGROUND: Child stunting is associated with poor child development and increased mortality. Our aim was to determine the effect of length of maternal and paternal education on stunting in children under the age of 5 years. METHODS: Data for indicators of child growth and of parental education and socioeconomic status were gathered from 590,570 families in Indonesia and 395,122 families in Bangladesh as part of major nutritional surveillance programmes. FINDINGS: The prevalence of stunting in families in Indonesia was 33.2%, while that in Bangladesh was 50.7%. In Indonesia, greater maternal formal education led to a decrease of between 4.4% and 5% in the odds of child stunting (odds ratio per year 0.950, 95% CI 0.946-0.954 in rural settings; 0.956, 0.950-0.961 in urban settings); greater paternal formal education led to a decrease of 3% in the odds of child stunting (0.970, 0.967-0.974). In Bangladesh, greater maternal formal education led to a 4.6% decrease in the odds of child stunting (0.954, 0.951-0.957), while greater paternal formal education led to a decrease of between 2.9% and 5.4% in the odds of child stunting (0.971, 0.969-0.974 in rural settings; 0.946, 0.941-0.951 in urban settings). In Indonesia, high levels of maternal and paternal education were both associated with protective caregiving behaviours, including vitamin A capsule receipt, complete childhood immunisations, better sanitation, and use of iodised salt (all p<0.0001). INTERPRETATION: Both maternal and paternal education are strong determinants of child stunting in families in Indonesia and Bangladesh.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Escolaridade , Transtornos do Crescimento/epidemiologia , Crescimento , Bangladesh/epidemiologia , Estatura , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/etiologia , Humanos , Indonésia/epidemiologia , Lactente , Modelos Logísticos , Masculino , Inquéritos Nutricionais , Pais , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: Food insecurity is common in developing countries and is related to the physical well-being of families. Household food insecurity is intended to reflect a household's access, availability, and utilization of food, but its relationship with child mortality has not been well characterized. OBJECTIVE: To examine the relationship of a modified household food insecurity score with a history of neonatal, infant, and under-five child mortality. METHODS: In a cross-sectional study of 26,339 rural households in the Indonesian Nutrition Surveillance System, 2000-03, household food insecurity was measured with the use of a modified nine-item food security questionnaire. A simple food insecurity score of O to 9 was calculated based on responses and related to mortality history in the family. RESULTS: The proportion of households with neonatal, infant, and under-five child mortality was 4.6%, 8.8%, and 10.6%, respectively. In households with and without neonatal, infant, and under-five child mortality, the mean (+/- SD) food insecurity scores were 2.19 +/- 1.89 vs. 1.72 +/- 1.65, 2.29 +/- 1.94 vs. 1.69 +/- 1.63, and 2.29 +/- 1.93 vs. 1.68 +/- 1.62 (all p < .0001), respectively. The food insecurity score was related to mortality among neonates (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02 to 1.09; p = .003), infants (OR, 1.06; 95% CI, 1.03 to 1.09; p < .0001), and children under five (OR, 1.07; 95% CI, 1.04 to 1.10; p < .0001) after adjustment for potential confounders. CONCLUSIONS: Higher household food insecurity score is associated with greater neonatal, infant, and under-five child mortality among rural families in Indonesia. Greater household food insecurity may signify a higher risk of infant and young child mortality.
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Mortalidade da Criança , Abastecimento de Alimentos/estatística & dados numéricos , Mortalidade Infantil , Adulto , Pré-Escolar , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Indonésia/epidemiologia , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multivariada , Saúde da População Rural , Fatores SocioeconômicosRESUMO
BACKGROUND: Salt iodization is the main strategy for reducing iodine deficiency disorders worldwide. Characteristics of families not using iodized salt need to be known to expand coverage. OBJECTIVE: The objective was to determine whether families who do not use iodized salt have a higher prevalence of child malnutrition and mortality and to identify factors associated with not using iodized salt. DESIGN: Use of adequately iodized salt (>or =30 ppm), measured by rapid test kits, was assessed between January 1999 and September 2003 in 145 522 and 445 546 families in urban slums and rural areas, respectively, in Indonesia. RESULTS: Adequately iodized salt was used by 66.6% and 67.2% of families from urban slums and rural areas, respectively. Among families who used adequately iodized salt, mortality in neonates, infants, and children aged <5 y was 3.3% compared with 4.2%, 5.5% compared with 7.1%, and 6.9% compared with 9.1%, respectively (P < 0.0001 for all), in urban slums; among families who did not use adequately iodized salt, the respective values were 4.2% compared with 6.3%, 7.1% compared with 11.2%, and 8.5% compared with 13.3% (P < 0.0001 for all) in rural areas. Families not using adequately iodized salt were more likely to have children who were stunted, underweight, and wasted. In multivariate analyses that controlled for potential confounders, low maternal education was the strongest factor associated with not using adequately iodized salt. CONCLUSION: In Indonesia, nonuse of adequately iodized salt is associated with a higher prevalence of child malnutrition and mortality in neonates, infants, and children aged <5 y. Stronger efforts are needed to expand salt iodization in Indonesia.
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Mortalidade da Criança , Transtornos da Nutrição Infantil/epidemiologia , Mortalidade Infantil , Iodo/administração & dosagem , Cloreto de Sódio na Dieta/administração & dosagem , Magreza/epidemiologia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Escolaridade , Pai , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Mães , Análise Multivariada , Estado Nutricional , Vigilância da População , Áreas de Pobreza , Prevalência , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricosRESUMO
The specific aims of this study were to examine the relationships between household food expenditures and under-5 child mortality among families in rural Indonesia. Data collected between 2000 and 2003 in the Indonesia Nutrition and Health Surveillance System, a population-based surveillance system conducted in 7 rural provinces, were utilized for the analysis. Food expenditures were divided into 4 major categories: plant foods (fruits and vegetables), animal foods, other nongrain foods, and grain foods (primarily rice) and expressed as quintiles of proportional food expenditure. Of 292,894 households, 32,777 (11.2%) households reported a history of under-5 child mortality. Plant food expenditures were associated with reduced odds of under-5 child mortality [odds ratio (OR), 0.70; 95% CI, 0.67-0.73; P < 0.0001) among families in the highest quintile compared with the lowest quintile, adjusting for potential confounders. Grain food expenditures were associated with increased odds of under-5 child mortality (OR, 1.25; 95% CI, 1.20-1.30; P < 0.0001) among families in the highest quintile compared with the lowest quintile, adjusting for potential confounders. Animal food expenditures were not consistently and significantly associated with under-5 child mortality across quintiles of expenditures. These findings suggest that lower under-5 child mortality is found in households that spend a greater proportion of income on plant foods and less on grain foods in rural Indonesia.
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Mortalidade da Criança/tendências , Frutas/economia , Carne/economia , Leite/economia , Verduras/economia , Animais , Bovinos , Galinhas , Criança , Peixes , Humanos , Indonésia , Razão de Chances , Risco , Fatores de Risco , População RuralRESUMO
We examined the relationship between paternal smoking and child mortality. Among 361,021 rural and urban families in Indonesia, paternal smoking was associated with increased infant mortality (rural, odds ratio [OR] = 1.30; 95% confidence interval [CI] = 1.24, 1.35; urban, OR = 1.10; 95% CI = 1.01, 1.20), and under-5 child mortality (rural, OR = 1.32; 95% CI = 1.26, 1.37; urban, OR = 1.14; 95% CI = 1.05, 1.23). Paternal smoking diverts money from basic necessities to cigarettes and adversely affects child health; tobacco control should therefore be considered among strategies to improve child survival.
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Mortalidade da Criança , Pai/estatística & dados numéricos , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Criança , Transtornos da Nutrição Infantil/etiologia , Transtornos da Nutrição Infantil/mortalidade , Proteção da Criança/estatística & dados numéricos , Países em Desenvolvimento , Escolaridade , Pai/educação , Feminino , Necessidades e Demandas de Serviços de Saúde , Habitação/estatística & dados numéricos , Humanos , Indonésia/epidemiologia , Masculino , Idade Materna , Análise Multivariada , Vigilância da População , Prevalência , Características de Residência , Doenças Respiratórias/etiologia , Doenças Respiratórias/mortalidade , Saúde da População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Indústria do Tabaco , Poluição por Fumaça de Tabaco/prevenção & controle , Saúde da População Urbana/estatística & dados numéricosRESUMO
OBJECTIVES: To characterize diarrhea and fever as risk factors for anemia among children in developing countries. METHODS: We characterized risk factors for anemia in a sample of 32873 children, aged 6-59 months, from poor families in urban slum areas of Indonesia from 2000 to 2003. RESULTS: The prevalence of anemia was 58.7%. In separate multivariate models, after adjusting for age, sex, stunting, maternal age and education, and weekly per capita household expenditure, current diarrhea (OR 1.20, 95% CI 1.07-1.35, p=0.002), current fever (OR 1.44, 95% CI 1.18-1.75, p<0.0001), and a history of diarrhea in the previous seven days (OR 1.12, 95% CI 1.03-1.23, p=0.024) were associated with an increased risk of anemia. CONCLUSIONS: Diarrhea and fever are important risk factors for anemia among young children living in urban slum communities in Indonesia.
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Anemia/complicações , Diarreia/complicações , Febre/complicações , Anemia/diagnóstico , Anemia/epidemiologia , Pré-Escolar , Diarreia/epidemiologia , Feminino , Febre/epidemiologia , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Razão de Chances , Áreas de Pobreza , Prevalência , Fatores de Risco , População UrbanaRESUMO
OBJECTIVE: To assess the effectiveness of micronutrient powder (MNP) supplementation in reducing anemia levels in children aged 6 mo to 6 y in India. METHODS: Sixty sachets of MNP (Sprinkles Plus) were administered flexibly over a 4 mo period to 17,124 children at anganwadi centers or at home through Integrated Child Development Services (ICDS). Compliance was monitored using compliance cards and an assessment of mother's recall at post-intervention survey. Hemoglobin was measured in separate random samples of 1,786 children before and 1,782 children after MNP supplementation. RESULTS: Mean compliance rate was estimated at 56.4 % (based on mother's recall) and 91.7 % (based on compliance cards) for children who received MNP at home. Mean compliance was 96.9 % (based on compliance cards) for children who received MNP at anganwadis. A significant reduction in anemia (50 % to 33 % in boys; p-value <.000; 47.4 % to 34.2 % in girls) was seen following MNP supplementation. CONCLUSIONS: Integration of a flexibly administered MNP supplementation into the ICDS is effective in reducing and treating anemia in children 6 mo to 6 y age.
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Anemia Ferropriva/terapia , Suplementos Nutricionais , Criança , Serviços de Saúde da Criança , Pré-Escolar , Humanos , Índia , Lactente , Cooperação do PacienteRESUMO
BACKGROUND: Many developing countries now face the double burden of malnutrition, defined as the coexistence of a stunted child and overweight mother within the same household. OBJECTIVE: This study sought to estimate the prevalence of the double burden of malnutrition and to identify associated maternal, child, and household characteristics in rural Indonesia and Bangladesh. DESIGN: A total of 247,126 rural households that participated in the Indonesia Nutrition Surveillance System (2000-2003) and 168,317 rural households in the Bangladesh Nutritional Surveillance Project (2003-2006) were included in the analysis. Maternal and child double burden (MCDB) and its association with individual and household characteristics were determined by using logistic regression models. RESULTS: MCDB was observed in 11% and 4% of the households in rural Indonesia and Bangladesh, respectively. Maternal short stature [Indonesia (OR: 2.32; 95% CI: 2.25, 2.40); Bangladesh (OR: 2.11; 95% CI: 1.96, 2.26)], and older age were strong predictors of MCDB. Child characteristics such as older age and being female were associated with an increased odds of MCDB, whereas currently being breastfed was protective against MCDB [Indonesia (OR: 0.84; 95% CI: 0.81, 0.84); Bangladesh (OR: 0.55; 95% CI: 0.52, 0.58)]. A large family size and higher weekly per capita household expenditure predicted MCDB [Indonesia (OR: 1.34; 95% CI: 1.28, 1.40); Bangladesh (OR: 1.94; 95% CI: 1.77, 2.12)]. CONCLUSIONS: Double burden is not exclusive to urban areas. Future policies and interventions should address under- and overweight simultaneously in both rural and urban developing country settings.
Assuntos
Efeitos Psicossociais da Doença , Desnutrição/epidemiologia , Hipernutrição/epidemiologia , Saúde da População Rural , Adulto , Bangladesh/epidemiologia , Índice de Massa Corporal , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento , Características da Família , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Modelos Logísticos , Masculino , Mães , Vigilância da População , Prevalência , Fatores de Risco , Saúde da População UrbanaRESUMO
In developing countries, poor families in urban slums often do not receive municipal services including water. The objectives of our study were to characterize families who purchased drinking water and to examine the relation between purchasing drinking water and child morbidity and mortality in urban slums of Indonesia, using data collected between 1999 and 2003. Of 143,126 families, 46.8% purchased inexpensive drinking water from street vendors, 47.4% did not purchase water, i.e., had running or spring/well water within household, and 5.8% purchased more expensive water in the previous 7 days. Families that purchased inexpensive drinking water had less educated parents, a more crowded household, a father who smoked, and lower socioeconomic level compared with the other families. Among children of families that purchased inexpensive drinking water, did not purchase drinking water, or purchased more expensive water, the prevalence was, respectively, for diarrhea in last 7 days (11.2%, 8.1%, 7.7%), underweight (28.9%, 24.1%, 24.1%), stunting (35.6%, 30.5%, 30.5%), wasting (12.0%, 10.5%, 10.9%), family history of infant mortality (8.0%, 5.6%, 5.1%), and of under-five child mortality (10.4%, 7.1%, 6.4%) (all P<0.0001). Use of inexpensive drinking water was associated with under-five child mortality (Odds Ratio [O.R.] 1.32, 95% Confidence Interval [C.I.] 1.20-1.45, P<0.0001) and diarrhea (O.R. 1.43, 95% C.I. 1.29-1.60, P<0.0001) in multivariate logistic regression models, adjusting for potential confounders. Purchase of inexpensive drinking water was common and associated with greater child malnutrition, diarrhea, and infant and under-five child mortality in the family. Greater efforts must be made to ensure access to safe drinking water, a basic human right and target of the Millennium Development Goals, in urban slums.
Assuntos
Mortalidade da Criança , Morbidade , Pobreza , População Urbana/estatística & dados numéricos , Abastecimento de Água/normas , Criança , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Diarreia/economia , Diarreia/epidemiologia , Humanos , Indonésia/epidemiologia , Modelos Logísticos , Razão de Chances , Prevalência , Fatores Socioeconômicos , Abastecimento de Água/economiaRESUMO
Clinical vitamin A deficiency is characterized by night blindness and greater morbidity and mortality. The aim of this study was to examine the relationships between household food expenditures and night blindness among nonpregnant women of childbearing age among families in the slums of Jakarta, Indonesia. In a cross-sectional study of 42 974 households in the Indonesian Nutrition Surveillance System, 1998 to 2003, night blindness was assessed in nonpregnant women. Food expenditures were divided into 5 major categories as follows: plant-based foods (fruits and vegetables), animal-based foods, eggs, other nongrain foods, and grain foods (primarily rice), calculated as percentage of total weekly per capita food expenditure, and expressed in quintiles. The proportion of households with night blindness in nonpregnant women was 0.72%. Plant-based food, animal-based food, and eggs were associated with reduced odds of night blindness (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.33-0.67; P < .0001, and OR, 0.47; 95% CI, 0.29-0.76; P = .002; OR, 0.62; 95% CI, 0.44-0.85; P = .004), respectively, among families in the highest compared with the lowest quintile, adjusting for potential confounders. Grain food expenditures were associated with increased odds of night blindness among nonpregnant women (OR, 2.80; 95% CI, 1.86-4.22; P < .0001) among families in the highest compared with the lowest quintile, adjusting for potential confounders. This study suggests that nonpregnant women are at greater risk of clinical vitamin A deficiency where families spend more on rice and less on animal and plant-based foods, a situation that is more typical when food prices are high.
Assuntos
Dieta/economia , Alimentos/economia , Cegueira Noturna/epidemiologia , Deficiência de Vitamina A/epidemiologia , Adulto , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Análise Multivariada , Cegueira Noturna/economia , Cegueira Noturna/etiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/economia , Adulto JovemRESUMO
The high incidence of anemia of infection among children in developing countries is not well characterized. We investigated the relationship between diarrhea, fever and other risk factors for anemia in young children in the community. The relationship between risk factors for anemia was examined in a cross-sectional study of 85 229 children, aged 6-59 months, from impoverished families in rural areas of Indonesia. The prevalence of anemia was 56.1% among the study subjects. Those considered anemic were more likely to be younger, male, stunted, underweight, wasted, to have low maternal and paternal education and to have current diarrhea or history of diarrhea in the previous 7 days compared with children without anemia (all P < 0.0001). In separate multivariate models adjusted for age, sex, stunting, maternal age and education, and weekly per capita household expenditure, current diarrhea (OR 1.15, 95% CI 1.07-1.325, P < 0.0001) and a history of diarrhea in the previous 7 days (OR 1.16, 95% CI 1.09-1.25, P < 0.0001) were associated with an increased risk of anemia. In similar models, current fever had a borderline association with anemia (OR 1.14, 95% CI 0.98-1.32, P = 0.09). We conclude that diarrhea is a contributing factor of anemia among young children living in rural areas in Indonesia.