evidence-based blog of Filippo Dibari

Archive for the ‘Under-nutrition’ Category

Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review

In Under-nutrition on September 6, 2018 at 5:48 am

from: the Journal of Global Health Science and Practice

by Jessica Bliss, Natasha Lelijveld, André Briend, Marko Kerac, Mark Manary, Marie McGrath, Zita Weise Prinzo, Susan Shepherd, Noël Marie Zagre, Sophie Woodhead, Saul Guerrero and Amy Mayberry

Limited studies suggest that with robust program inputs caregivers and CHWs can correctly use mid-upper arm circumference to detect severe acute malnutrition (SAM) and that properly trained and supported CHWs can treat uncomplicated SAM in communities.

(download)

Abstract

Background: A stubborn persistence of child severe acute malnutrition (SAM) and continued gaps in program coverage have made identifying methods for expanding detection, diagnosis, and treatment of SAM an urgent public health need. There is growing consensus that making mid-upper arm circumference (MUAC) use more widely accessible among caregivers and community health workers (CHWs) is an important next step in further decentralizing SAM care and increasing program coverage, including the ability of CHWs to treat uncomplicated SAM in community settings.

 

Methods: We conducted a systematic review to summarize published and operational evidence published since 2000 describing the use of MUAC for detection and diagnosis of SAM in children aged 6–59 months by caregivers and CHWs, and of management of uncomplicated SAM by CHWs, all outside of formal health care settings. We screened 1,072 records, selected 43 records for full-text screening, and identified 22 studies that met our eligibility criteria. We extracted data on a number of items, including study design, strengths, and weaknesses; intervention and control; and key findings and operational lessons. We then synthesized the qualitative findings to inform our conclusions. The issue of treating children classified as SAM based on low weight-for-height, rather than MUAC, at household level, is not addressed in this review.

 

Findings: We found evidence that caregivers are able to use MUAC to detect SAM in their children with minimal risk and many potential benefits to early case detection and coverage. We also found evidence that CHWs are able to correctly use MUAC for SAM detection and diagnosis and to provide a high quality of care in the treatment of uncomplicated SAM when training, supervision, and motivation are adequate. However, the number of published research studies was small, their geographic scope was narrow, and most described intensive, small-scale interventions; thus, findings are not currently generalizable to public-sector health care systems.

 

Conclusions: Scaling up the use of MUAC by caregivers and CHWs to detect SAM in household and community settings is a promising step toward improving the coverage of SAM detection, diagnosis, and treatment. Further research on scalability, applicability across a wider range of contexts, coverage impact, and cost is needed. The primary use of MUAC for SAM detection should also be explored where appropriate.

Internship Opportunities with the WFP – Ethiopia

In Over-nutrition, Under-nutrition on September 5, 2018 at 7:00 pm

Background

Ethiopia has made important development gains over the past two decades, reducing poverty and expanding investments in basic social services. However, food insecurity and under-nutrition still hinder economic growth. In 2015 it ranked 174 out of 188 in the UNDP Human Development Report. The country is also home to the second largest refugee population on the continent; it currently hosts 909,000 registered refugees from South Sudan, Somalia, Sudan, Eritrea and Kenya. 2016 was a challenging year for Ethiopia as it suffered from the worst El Niño impact in the last 50 years. The onset of El Niño combined with failed Belg (spring harvest) and Meher (main harvest) rains in 2015 left 10.2 million people in need of emergency food and nutrition assistance. While the Government and partners averted a major humanitarian catastrophe, the drought has left a negative legacy on many families, who lost livestock and other productive assets. The residual needs from the past year have been compounded by a new and devastating drought which hit Ethiopia and other parts of the Horn of Africa in early 2017. In  August 2017, the Government of Ethiopia released the Mid-Year Humanitarian Requirements Document which outlined the need to support 8.5 million people with emergency food, nutrition, health, water and education programmes. WFP supports the Ethiopian Government through a range of life-saving and resilience-building activities as well as providing assistance in refugee camps. We use food, cash, nutrition assistance and innovative approaches to improve nutrition, empower women, build local capacities and enhance preparedness to climate-related shocks.

 

Opportunity – WFP Ethiopia Country Office seeks (1) graduate (BSc), and post-graduate (MSc) students looking for field-based dissertation topics, (2) BSc and MSc students already graduated within a year, looking for opportunity hands-on work experience, and (3) researchers looking for settings where to develop operational research topics. Background: Nutrition/Public Health/Epidemiology, Food Technology, Communication, Social Sciences, Logistics, Engineering, Economy and any other field related to food and nutrition.

 

More information

  • What? The interns will be integrated into WFP existing and/or about-to-start programmes. The potential areas include (1) integrated nutrition and food security surveillance, (2) treatment of moderate acute malnutrition, (3) development of social behavioural change communication to reduce stunting and wasting, (4) interlinkages between HIV and malnutrition, (5) food fortification, (6) nutrition advocacy, strategic evidence-based policy- and decision-making, (7) social protection in food insecure households.
  • When? Candidate can apply anytime during the year.
  • Where? According to the Terms of Reference (ToR) and the deliverables of the internship, the candidate will be placed either at WFP Country Office (Addis Abeba) and/or at the provincial Sub-Offices.
  • Supervised by who? Administratively the interns will be supervised by a WFP line manager. The ToR and the deliverables will be agreed by and with the candidate, eventually with the tutor of the institution of origin and WFP.
  • For how long? The duration of the internship will depend on the nature of the ToR and its deliverables.
  • Which kind of support? WFP has limited resources for support to internship programmes. Therefore, candidates are encouraged to rely on their own means of support for living, and international / national travel costs. WFP can cover at least the intern health insurance. Additional WFP support can be put under consideration in case of strong candidatures.
  • I am interested. How to apply? For an initial contact, get in touch with both Filippo Dibari (filippo.dibari@wfp.org) and Pauline Akabwai (pauline.akabwai@wfp.org). Note that the email subject should be reading exactlyinternship at WFP’). Be ready to submit curriculum vitae (one page max), provide specific evidence of your skills, undertake a written test and an interview, share reference contact details.

 

For further reading – Ethiopia nutrition profile – source: Global Nutrition Report 2017 (link  or under request) and WFP Ethiopia Country Profile (Link)

Impact of anthropogenic CO2 emissions on global human nutrition

In Under-nutrition on August 29, 2018 at 4:40 am

by Matthew R. Smith & Samuel S. Myers

Nature Climate Change volume 8pages 834–839 (2018) – link

Abstract

Atmospheric CO2 is on pace to surpass 550 ppm in the next 30–80 years. Many food crops grown under 550 ppm have protein, iron and zinc contents that are reduced by 3–17% compared with current conditions.

We analysed the impact of elevated CO2 concentrations on the sufficiency of dietary intake of iron, zinc and protein for the populations of 151 countries using a model of per-capita food availability stratified by age and sex, assuming constant diets and excluding other climate impacts on food production.

We estimate that elevated COcould cause an additional 175 million people to be zinc deficient and an additional 122 million people to be protein deficient (assuming 2050 population and CO2 projections).

For iron, 1.4 billion women of childbearing age and children under 5 are in countries with greater than 20% anaemia prevalence and would lose >4% of dietary iron.

Regions at highest riskSouth and Southeast Asia, Africa, and the Middle East—require extra precautions to sustain an already tenuous advance towards improved public health.

New book: Mass starvation – the history and future of famine

In Under-nutrition on August 23, 2018 at 9:32 pm

In Mass Starvation, world-renowned expert on humanitarian crisis and response, and WPF Executive Director, Alex de Waal, provides an authoritative history of modern famines: their causes, dimensions and why they ended. He analyses starvation as a crime, and breaks new ground in examining forced starvation as an instrument of genocide and war. Refuting the enduring but erroneous view that attributes famine to overpopulation and natural disaster, he shows how political decision or political failing is an essential element in every famine, while the spread of democracy and human rights, and the ending of wars, were major factors in the near-ending of this devastating phenomenon.

Hard-hitting and deeply informed, Mass Starvation (Polity Books, 2017) explains why man-made famine and the political decisions that could end it for good must once again become a top priority for the international community.

(from WPF web page)

 

 

Acceptability and Utilization of Three Nutritional Supplements during Pregnancy: Findings from a Longitudinal, Mixed-Methods Study in Niger

In Under-nutrition on August 23, 2018 at 9:21 pm

by Adrienne Clermont , Stephen R. Kodish , Amadou Matar Seck , Aichatou Salifou, Joseph Rosen, Rebecca F. Grais and Sheila Isanaka.

Nutrients 2018, 10(8), 1073; https://doi.org/10.3390/nu10081073

(download)

Abstract

Nutritional status in pregnancy is a key determinant of birth outcomes. In low-income countries, maternal diets are often limited, and daily nutrient supplements are recommended to fill nutrient gaps.

As a result, it is important to understand the factors influencing acceptability and utilization of nutrient supplements in these settings. Qualitative data (individual interviews and focus group discussions with pregnant women, household members, and study staff) and quantitative data (unannounced household spot checks) were collected in 24 villages in the Maradi region of south-central Niger.

Each village was randomly assigned to one of three study arms, with pregnant women receiving either iron and folic acid (IFA) supplements, multiple micronutrient (MMN) supplements, or medium-quantity lipid-based nutrient supplements (MQ-LNS) for daily consumption during pregnancy. Data were collected longitudinally to capture changes in perspective as women progressed through their pregnancy. Participants accepted all three supplement types, and perceived a wide range of health benefits attributed to supplement consumption.

However, several important barriers to appropriate consumption were reported, and rumors about the supplements leading to childbirth complications also decreased utilization. The household spot checks suggested that IFA had the highest level of correct consumption. Overall, despite a stated high level of acceptance and enthusiasm for the supplements among participants and their household members, certain fears, side effects, and organoleptic factors led to decreased utilization.

The effectiveness of future programs to improve maternal nutritional status through supplementation may be improved by understanding perceived barriers and facilitating factors among participants and tailoring communication efforts appropriately.

Position of the American Dietetic Association: vegetarian diets

In Over-nutrition, Under-nutrition on August 11, 2018 at 7:12 am

Craig WJ1, Mangels AR; American Dietetic Association.

(download pdf)

Abstract

It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods.

This article reviews the current data related to key nutrients for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. A vegetarian diet can meet current recommendations for all of these nutrients. In some cases, supplements or fortified foods can provide useful amounts of important nutrients. An evidence- based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes.

The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians.

Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals.

The variability of dietary practices among vegetarians makes individual assessment of dietary adequacy essential. In addition to assessing dietary adequacy, food and nutrition professionals can also play key roles in educating vegetarians about sources of specific nutrients, food purchase and preparation, and dietary modifications to meet their needs.

Global Event: ACCELERATING THE END OF HUNGER AND MALNUTRITION

In Over-nutrition, Under-nutrition on August 10, 2018 at 5:25 am

source: conference web page

An IFPRI-FAO global event
November 28-30, 2018
Bangkok, Thailand
Improving food security and nutrition is critical to meeting the Sustainable  Development Goals (SDGs), but the world is not on track to end hunger and malnutrition by 2030.
How can we accelerate progress in transforming our agri-food systems to meet the needs of the hungry and malnourished?
To answer this question, the International Food Policy Research Institute (IFPRI) and the Food and Agriculture Organization of the United Nations (FAO) are organizing a global event on Accelerating the End of Hunger and Malnutrition on November 28-30, 2018 in Bangkok, Thailand
The event will share evidence and lessons learned from around the world on food system transformation for reducing hunger and malnutrition; explore innovations to build further momentum and accelerate progress; and identify opportunities for scaling up successful actions.
For more information, please go to the conference website.

Are you a Nutritionist with HIV Programming experience and fluent in En/Fr?

In Under-nutrition on July 25, 2018 at 5:22 pm

Image result for wfp logoComplete vacancy Announcement available here

QUALIFICATIONS & EXPERIENCE REQUIRED:

Education:  Advanced academic studies in nutrition, public health or related field. The ideal candidate will hold an advanced university degree with a focus on one of the following: International Health & Nutrition, Public Health & Nutrition Policy and Management, Family Health & Nutrition. 
Experience:  Minimum five years of experience in design, implementation and monitoring of nutrition activities, preferably in the context of reaching vulnerable populations in developing countries. 

Sound technical knowledge of the nutritional needs of vulnerable populations, with a specific focus on people living with HIV/AIDS. 

Experience in formulating technical proposals, particularly as related to mobilizing funds to research and pilot nutrition and public health interventions. 

Experience in nutrition survey methodologies, nutrition assessment and relevant statistical data analysis. 

Prior experience with WFP’s work in the field of nutrition and Maternal and Child Health would be an advantage. 

Experience in supporting Social and Behavior Change Communication strategies is desirable. 

Knowledge & Skills:  Strong technical skill and knowledge of nutrition and public health programming in developing countries. 

Strong managerial skills. 

Knowledge of sound research methods and monitoring and evaluation standards. Familiarity with quantitative and qualitative health/nutrition survey techniques is an added value. 

Ability to foster and manage collaborative approaches involving diverse stakeholders. 

Understanding of strategies and program priorities around global nutrition and HIV/AIDS initiatives. 

Excellent analytical and writing skills.

Advanced computer skills with at least intermediate proficiency in Windows based word processing, spreadsheet and nutrition/public health software (i.e. WHO 2006, ANTHRO, EPIinfo, STATA, SPSS, EndNote);

Demonstrated capacity to work with counterparts within and outside of WFP.

General knowledge of United Nations system policies, rules, regulations and procedures governing administration is highly desirable.

 

 
Languages:  Fluency in French and English required. 

2018 Global food policy report

In Over-nutrition, Under-nutrition on July 13, 2018 at 9:50 pm

from IFPRI web-page

Free Book on global – Pages: 150
IFPRI’s flagship report reviews the major food policy issues, developments, and decisions of 2017, and highlights challenges and opportunities for 2018 at the global and regional levels. This year’s report looks at the impacts of greater global integration—including the movement of goods, investment, people, and knowledge—and the threat of current antiglobalization pressures. Drawing on recent research, IFPRI researchers and other distinguished food policy experts consider a range of timely topics:

 

■ How can the global food system deliver food security for all in the face of the radical changes taking place today?

■ What is the role of trade in improving food security, nutrition, and sustainability?

■ How can international investment best contribute to local food security and better food systems in developing countries?

■ Do voluntary and involuntary migration increase or decrease food security in source countries and host countries?

■ What opportunities does greater data availability open up for improving agriculture and food security?

■ How does reform of developed-country farm support policies affect global food security?

■ How can global governance structures better address problems of food security and nutrition?

■ What major trends and events affected food security and nutrition across the globe in 2017?

The 2018 Global Food Policy Report also presents data tables and visualizations for several key food policy indicators, including country-level data on hunger, agricultural spending and research investment, and projections for future agricultural production and consumption.  In addition to illustrative figures, tables, and a timeline of food policy events in 2017, the report includes the results of a global opinion poll on globalization and the current state of food policy.

Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials

In Over-nutrition, Under-nutrition on July 11, 2018 at 7:58 am

source: NY times web page

A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly.Based on decades of research, the resolution says that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes.Then the United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations.
American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

When that failed, they turned to threats, according to diplomats and government officials who took part in the discussions. Ecuador, which had planned to introduce the measure, was the first to find itself in the cross hairs.The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.

The showdown over the issue was recounted by more than a dozen participants from several countries, many of whom requested anonymity because they feared retaliation from the United States.

Health advocates scrambled to find another sponsor for the resolution, but at least a dozen countries, most of them poor nations in Africa and Latin America, backed off, citing fears of retaliation, according to officials from Uruguay, Mexico and the United States.

“We were astonished, appalled and also saddened,” said Patti Rundall, the policy director of the British advocacy group Baby Milk Action, who has attended meetings of the assembly, the decision-making body of the World Health Organization, since the late 1980s.

“What happened was tantamount to blackmail, with the U.S. holding the world hostage and trying to overturn nearly 40 years of consensus on the best way to protect infant and young child health,” she said.In the end, the Americans’ efforts were mostly unsuccessful. It was the Russians who ultimately stepped in to introduce the measure — and the Americans did not threaten them.

During the deliberations, some American delegates even suggested the United States might cut its contribution to the W.H.O., several negotiators said. Washington is the single largest contributor to the health organization, providing $845 million, or roughly 15 percent of its budget, last year.

The confrontation was the latest example of the Trump administration siding with corporate interests on numerous public health and environmental issues.

In talks to renegotiate the North American Free Trade Agreement, the Americans have been pushing for language that would limit the ability of Canada, Mexico and the United States to put warning labels on junk food and sugary beverages, according to a draft of the proposal reviewed by The New York Times.

During the same Geneva meeting where the breast-feeding resolution was debated, the United States succeeded in removing statements supporting soda taxes from a document that advises countries grappling with soaring rates of obesity.

The Americans also sought, unsuccessfully, to thwart a W.H.O. effort aimed at helping poor countries obtain access to lifesaving medicines. Washington, supporting the pharmaceutical industry, has long resisted calls to modify patent laws as a way of increasing drug availability in the developing world, but health advocates say the Trump administration has ratcheted up its opposition to such efforts.

The delegation’s actions in Geneva are in keeping with the tactics of an administration that has been upending alliances and long-established practices across a range of multilateral organizations, from the Paris climate accord to the Iran nuclear deal to Nafta.

Ilona Kickbusch, director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, said there was a growing fear that the Trump administration could cause lasting damage to international health institutions like the W.H.O. that have been vital in containing epidemics like Ebola and the rising death toll from diabetes and cardiovascular disease in the developing world.

“It’s making everyone very nervous, because if you can’t agree on health multilateralism, what kind of multilateralism can you agree on?” Ms. Kickbusch asked.
Image

The opening of the World Health Assembly in May. After American officials pressured Ecuador, it was Russia that introduced a resolution in support of breast-feeding.CreditPeter Klaunzer/EPA, via Shutterstock
A Russian delegate said the decision to introduce the breast-feeding resolution was a matter of principle.“We’re not trying to be a hero here, but we feel that it is wrong when a big country tries to push around some very small countries, especially on an issue that is really important for the rest of the world,” said the delegate, who asked not to be identified because he was not authorized to speak to the media.He said the United States did not directly pressure Moscow to back away from the measure. Nevertheless, the American delegation sought to wear down the other participants through procedural maneuvers in a series of meetings that stretched on for two days, an unexpectedly long period.In the end, the United States was largely unsuccessful. The final resolution preserved most of the original wording, though American negotiators did get language removed that called on the W.H.O. to provide technical support to member states seeking to halt “inappropriate promotion of foods for infants and young children.”

The United States also insisted that the words “evidence-based” accompany references to long-established initiatives that promote breast-feeding, which critics described as a ploy that could be used to undermine programs that provide parents with feeding advice and support.

Elisabeth Sterken, director of the Infant Feeding Action Coalition in Canada, said four decades of research have established the importance of breast milk, which provides essential nutrients as well as hormones and antibodies that protect newborns against infectious disease.

A 2016 study in The Lancet found that universal breast-feeding would prevent 800,000 child deaths a year across the globe and yield $300 billion in  savings from reduced health care costs and improved economic outcomes for those reared on breast milk.

Scientists are loath to carry out double-blind studies that would provide one group with breast milk and another with breast milk substitutes. “This kind of ‘evidence-based’ research would be ethically and morally unacceptable,” Ms. Sterken said.

Abbott Laboratories, the Chicago-based company that is one of the biggest players in the $70 billion baby food market, declined to comment.

Nestlé, the Switzerland-based food giant with significant operations in the United States, sought to distance itself from the threats against Ecuador and said the company would continue to support the international code on the marketing of breast milk substitutes, which calls on governments to regulate the inappropriate promotion of such products and to encourage breast-feeding.

In addition to the trade threats, Todd C. Chapman, the United States ambassador to Ecuador, suggested in meetings with officials in Quito, the Ecuadorean capital, that the Trump administration might also retaliate by withdrawing the military assistance it has been providing in northern Ecuador, a region wracked by violence spilling across the border from Colombia, according to an Ecuadorean government official who took part in the meeting.

The United States Embassy in Quito declined to make Mr. Chapman available for an interview.

“We were shocked because we didn’t understand how such a small matter like breast-feeding could provoke such a dramatic response,” said the Ecuadorean official, who asked not to be identified because she was afraid of losing her job.

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