evidence-based blog of Filippo Dibari

Posts Tagged ‘Asia’

Stunting: latest evidence (open source)

In Under-nutrition on May 19, 2016 at 8:42 pm

Stop stunting: improving child feeding, women’s nutrition and household sanitation in South Asia.

Víctor M. Aguayo and Purnima Menon



Childhood stunting: a global perspective.

Mercedes de Onis and Francesco Branca



Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: evidence, challenges and opportunities.

Kathryn G. Dewey



Feeding practices for infants and young children during and after common illness. Evidence from South Asia.

Kajali Paintal and Víctor M. Aguayo



Improving women’s nutrition imperative for rapid reduction of childhood stunting in South Asia: coupling of nutrition specific interventions with nutrition sensitive measures essential.

Sheila C. Vir



Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications.

Oliver Cumming and Sandy Cairncross



Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries.

Mduduzi N. N. Mbuya and Jean H. Humphrey



Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra’s comprehensive nutrition survey.

Víctor M. Aguayo, Rajilakshmi Nair, Nina Badgaiyan and Vandana Krishna



Achieving behaviour change at scale: Alive & Thrive’s infant and young child feeding programme in Bangladesh.

Tina Sanghvi, Raisul Haque, Sumitro Roy, Kaosar Afsana, Renata Seidel, Sanjeeda Islam, Ann Jimerson and Jean Baker



Evidence-based evolution of an integrated nutrition-focused agriculture approach to address the underlying determinants of stunting.

Nancy J. Haselow, Ame Stormer and Alissa Pries



Estimating the cost of delivering direct nutrition interventions at scale: national and subnational level insights from India.

Purnima Menon, Christine M. McDonald and Suman Chakrabarti



The costs of stunting in South Asia and the benefits of public investments in nutrition.

Meera Shekar, Julia Dayton Eberwein and Jakub Kakietek



Understanding the null-to-small association between increased macroeconomic growth and reducing child undernutrition in India: role of development expenditures and poverty alleviation.

William Joe, Ramaprasad Rajaram and S. V. Subramanian



Drivers of nutritional change in four South Asian countries: a dynamic observational analysis.

Derek Headey, John Hoddinott and Seollee Park



Rethinking policy perspectives on childhood stunting: time to formulate a structural and multifactorial strategy.

S V Subramanian, Iván Mejía-Guevara and Aditi Krishna


Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study

In Over-nutrition on September 24, 2012 at 3:47 pm

by Mohsen Nematy, Maryam Alinezhad-Namaghi, Masoud mahdavi Rashed, Mostafa Mozhdehifard, Seyedeh Sania Sajjadi, Saeed Akhlaghi, Maryam Sabery, Seyed Amir R Mohajeri, Neda Shalaey, Mohsen Moohebati and Abdolreza Norouzy

Nutrition Journal 2012, 11:69 – Published: 10 September 2012

(download the provisional entire paper)

Abstract (provisional)


Previous research has shown that Ramadan fasting has beneficial effects on cardiovascular risk factors, however there are controversies. In the present study, the effect of Ramadan fasting on cardiovascular risk factors has been investigated.


This is a prospective observational study that was carried out in a group of patients with at least one cardiovascular risk factor (including history of documented previous history of either coronary artery disease (CAD), metabolic syndrome or cerebro-vascular disease in past 10 y). Eighty two volunteers including 38 male and 44 female, aged 29–70 y, mean 54.0 [PLUS-MINUS SIGN] 10 y, with a previous history of either coronary artery disease, metabolic syndrome or cerebro-vascular disease were recruited. Subjects attended the metabolic unit after at least 10 h fasting, before and after Ramadan who were been fasting for at least 10 days. A fasting blood sample was obtained, blood pressure was measured and body mass index (BMI) was calculated. Lipids profile, fasting blood sugar (FBS) and insulin, homocysteine (hcy), high-sensitivity C-reactive protein (hs-CRP) and complete blood count (CBC) were analyzed on all blood samples.


A significant improvement in 10 years coronary heart disease risk (based on Framingham risk score) was found (13.0 [PLUS-MINUS SIGN] 8 before Ramadan and 10.8 [PLUS-MINUS SIGN]7 after Ramadan, P <0.001, t test).There was a significant higher HDL-c, WBC, RBC and platelet count (PLT), and lower plasma cholesterol, triglycerides, LDL-c, VLDL-c, systolic blood pressure, body mass index and waist circumference after Ramadan (P <0.05, t test). The changes in FBS, insulin,Homeostasis Model Assessment Insulin Resistance (HOMA-IR), hcy, hs-CRP and diastolic blood pressure before and after Ramadan were not significant (P >0.05, t test).


This study shows a significant improvement in 10 years coronary heart disease risk score and other cardiovascular risk factors such as lipids profile, systolic blood pressure, weight, BMI and waist circumference in subjects with a previous history of cardiovascular disease.

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Maternal Multiple Micronutrient Supplements and Child Cognition: A Randomized Trial in Indonesia

In Under-nutrition on September 1, 2012 at 7:20 am

Elizabeth L. PradoKatherine J. AlcockHusni MuadzMichael T. UllmanAnuraj H. Shankar, for the SUMMIT Study Group

Pediatrics. August 20, 2012


OBJECTIVES: We investigated the relative benefit of maternal multiple micronutrient (MMN) supplementation during pregnancy and until 3 months postpartum compared with iron/folic acid supplementation on child development at preschool age (42 months).

METHODS: We assessed 487 children of mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial, a cluster-randomized trial in Indonesia, on tests adapted and validated in the local context measuring motor, language, visual attention/spatial, executive, and socioemotional abilities. Analysis was according to intention to treat.

RESULTS: In children of undernourished mothers (mid-upper arm circumference <23.5 cm), a significant benefit of MMNs was observed on motor ability (B = 0.39 [95% confidence interval (CI): 0.08–0.70]; P = .015) and visual attention/spatial ability (B = 0.37 [95% CI: 0.11–0.62]; P = .004). In children of anemic mothers (hemoglobin concentration <110 g/L), a significant benefit of MMNs on visual attention/spatial ability (B = 0.24 [95% CI: 0.02–0.46]; P = .030) was also observed. No robust effects of maternal MMN supplementation were found in any developmental domain over all children.

CONCLUSIONS: When pregnant women are undernourished or anemic, provision of MMN supplements can improve the motor and cognitive abilities of their children up to 3.5 years later, particularly for both motor function and visual attention/spatial ability. Maternal MMN but not iron/folic acid supplementation protected children from the detrimental effects of maternal undernutrition on child motor and cognitive development.

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Efficacy of a high-dose in addition to daily low-dose vitamin A in children suffering from severe acute malnutrition with other illnesses

In Under-nutrition on August 29, 2012 at 11:49 am

by Sattar SAhmed TRasul CHSaha DSalam MAHossain MI

PLoS One. 2012;7(3):e33112. Epub 2012 Mar 27

(download the entire paper)



Efficacy of high-dose vitamin A (VA) in children suffering from severe acute malnutrition (SAM) has recently been questioned. This study compared the efficacy of a single high-dose (200,000 IU) in addition to daily low-dose (5000 IU) VA in the management of children suffering from SAM with diarrhea and/or acute lower respiratory tract infection (ALRI).


In a randomized, double-blind, controlled clinical trial in icddr,b, Bangladesh during 2005-07, children aged 6-59 months with weight-for-height <-3 Z-score and/or bipedal edema (SAM) received either a high-dose VA or placebo on admission day. Both the groups received 5,000 IU/day VA in a multivitamins drop for 15 days and other standard treatment which is similar to WHO guidelines.


A total 260 children (130 in each group) were enrolled. All had diarrhea, 54% had concomitant ALRI, 50% had edema, 48.5% were girl with a mean±SD age of 16±10 months. None had clinical signs of VA deficiency. Mean±SD baseline serum retinol was 13.15±9.28 µg/dl, retinol binding protein was 1.27±0.95 mg/dl, and pre-albumin was 7.97±3.96 mg/dl. Median (inter quartile range) of C-reactive protein was 7.8 (2.1, 22.2) mg/L. Children of the two groups did not differ in any baseline characteristic. Over the 15 days treatment period resolution of diarrhea, ALRI, edema, anthropometric changes, and biochemical indicators of VA were similar between the groups. The high-dose VA supplementation in children with SAM did not show any adverse event.


Efficacy of daily low-dose VA compared to an additional single high-dose was not observed to be better in the management of children suffering from SAM with other acute illnesses. A single high-dose VA may be given especially where the children with SAM may leave the hospital/treatment center early.

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Public Nutrition in poor settings: the latest publications in peer-reviewed journals

In Under-nutrition on August 28, 2012 at 4:43 pm

This week is particularly full of interesting papers about nutrition-related topics relevant for low-income countries. I could not decide the criteria to make a selection. Therefore I list them all here beneath. Enjoy the reading.

Evaluation of the Rural Primary Health Care project on undernutrition equity among children in rural Western China.
L Pei, D Wang, L Ren, and H Yan
Health Policy Plan. 2012. 

The importance of maternal undernutrition for maternal, neonatal, and child health outcomes: an editorial. [Editorial].
JB Mason, LS Saldanha, and R Martorell
Food Nutr Bull. 2012; 33: S3.

Policies and program implementation experience to improve maternal nutrition in Ethiopia.
LS Saldanha, L Buback, JM White, A Mulugeta, SG Mariam, AC Roba, H Abebe, and JB Mason
Food Nutr Bull. 2012; 33: S27. 

Opportunities for improving maternal nutrition and birth outcomes: synthesis of country experiences.
JB Mason, LS Saldanha, U Ramakrishnan, A Lowe, EA Noznesky, AW Girard, DA McFarland, and R Martorell
Food Nutr Bull. 2012; 33: S104. 

A situation analysis of public health interventions, barriers, and opportunities for improving maternal nutrition in Bihar, India.
EA Noznesky, U Ramakrishnan, and R Martorell
Food Nutr Bull. 2012; 33: S93. 

Public health interventions, barriers, and opportunities for improving maternal nutrition in India.
U Ramakrishnan, A Lowe, S Vir, S Kumar, R Mohanraj, A Chaturvedi, EA Noznesky, R Martorell, and JB Mason
Food Nutr Bull. 2012; 33: S71. 

Public health interventions, barriers, and opportunities for improving maternal nutrition in Northeast Nigeria.
AW Girard, C Dzingina, O Akogun, JB Mason, and DA McFarland
Food Nutr Bull. 2012; 33: S51. [MEDLINE Citation]

and also:

Determinants of Cognitive Development of Low SES Children in Chile: A Post-transitional Country with Rising Childhood Obesity Rates.
M Galvan, R Uauy, C Corvalan, G Lopez-Rodriguez, and J Kain
Matern Child Health J, Aug 2012

Maternal Multiple Micronutrient Supplements and Child Cognition: A Randomized Trial in Indonesia
Elizabeth L. Prado, Katherine J. Alcock, Husni Muadz, Michael T. Ullman, Anuraj H. Shankar for the SUMMIT Study Group
Pediatrics, Aug 2012; 10.1542/peds.2012-0412.

Growth and complementary feeding in the Americas.
CK Lutter
Nutr Metab Cardiovasc Dis, Aug 2012

Intergenerational effects of maternal birth season on offspring size in rural Gambia
Ian J. Rickard, Alexandre Courtiol, Andrew M. Prentice, Anthony J. C. Fulford, Tim H. Clutton-Brock, and Virpi Lummaa
Proc R Soc B, Aug 2012; 10.1098/rspb.2012.1363.

Worldwide implementation of the WHO Child Growth Standards 

Mercedes de Onisa1 c1, Adelheid Onyangoa1, Elaine Borghia1, Amani Siyama1, Monika Blössnera1 and Chessa Luttera2 for the WHO Multicentre Growth Reference Study Group

Public Health Nutrition / Volume 15 / Issue 09 / September 2012 , pp 1603-1610

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Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh

In Under-nutrition on August 9, 2012 at 12:45 pm

Nahar BHossain MIHamadani JDAhmed TGrantham-McGregor SPersson LA.

BMC Public Health. 2012 Aug 7;12(1):622. [Epub ahead of print]




Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS) on the quality of the home environment and mothers’ child-rearing practices in a community-based trial with severely malnourished Bangladeshi children.


Severely underweight children (n = 507), 6-24 months of age, were randomly assigned to five groups: PS; food supplementation (FS); PS + FS; clinic-control (CC); and, hospital-control (CH). PS included fortnightly follow-up visits for six months at community clinics where a play leader demonstrated play activities and gave education on child development and child rearing practices. FS comprised cereal-based supplements (150-300 kcal/day) for three months. All groups received medical care, micronutrient supplements and growth monitoring. Mothers were given the Home Observation for Measurement of the Environment (HOME) inventory and a questionnaire on parenting at baseline and after six months to assess the outcome.


322 children completed the study. After six months of intervention the PS + FS and PS groups benefitted in the total HOME score (depending on the comparison group, effect sizes varied from 0.66 to 0.33 SD) The PS + FS and PS groups also benefitted in two HOME subscales: maternal involvement (effect sizes: 0.8 to 0.55 SD) and play materials, (effect sizes: 0.46 to 0.6 SD), and child-rearing practices scores (effect size: 1.5 to 1.1 SD). The PS + FS group benefitted 4.0 points in total HOME score compared with CH, 4.8 points compared with CC and 4.5 points compared with FS (p < 0.001 for all). The PS group benefitted 2.4 points compared with CH (p = 0.035), 3.3 points compared with CC (p = 0.004), and 2.9 points compared with FS (p = 0.006). Child-rearing practice scores of the PS + FS group improved 7.7, 6.4 and 6.6 points and the PS group improved 8.5, 7.2 and 7.4 points more than CH, CC and FS, respectively (p < 0.001 for all).


Child-rearing practices of mothers of severely malnourished children and the quality of their home environment can be improved through community-based psychosocial stimulation with or without food supplementation. This may be of importance to promote child development.

The effect of a vaccination program on child anthropometry: evidence from India’s Universal Immunization Program.

In Under-nutrition on June 3, 2012 at 8:08 am

by TD Anekwe and S Kumar

J Public Health, May 18, 2012

BACKGROUND: Childhood vaccination may protect children’s nutritional status and lead to improved child growth in developing countries. This study evaluates the effect of India’s childhood vaccination program Universal Immunization Program (UIP) on the growth of children under 4 years of age.

METHODS: Regression models were estimated to examine the effect of UIP on vaccination status and children’s anthropometric outcomes. Regression models were also estimated to test whether UIP’s effect was uniform across various subpopulations of Indian children.

RESULTS: UIP increased height-for-age among Indian children who were <4 years of age in 1992-1993, resulting in a 17-22% reduction in the height-for-age-deficit of the average child. The program appears to have had no effect on other anthropometric indicators or vaccination status. UIP also led to differential changes in anthropometry and vaccination status, based on differences in maternal education and scheduled-caste status.

CONCLUSIONS: UIP led to improved child growth. This suggests that vaccination programs-in addition to being a major intervention for reducing child mortality-might be considered a tool for mitigating undernutrition in developing countries. This study also adds to the growing evidence that childhood vaccination programs are high-return investments because they produce long-term health benefits for children.

Nutrition of children and women in Bangladesh: trends and directions for the future

In Under-nutrition on May 25, 2012 at 10:56 am

by Ahmed T, Mahfuz M, Ireen S, Ahmed AM, Rahman S, Islam MM, Alam N, Hossain MI, Rahman SM, Ali MM, Choudhury FP, Cravioto A.

J Health Popul Nutr. 2012 Mar;30(1):1-11.

(free download)


“Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations’ Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized.”

Acceptability of Lipid-Based Nutrient Supplements and Micronutrient Powders among Pregnant and Lactating Women and Infants and Young Children in Bangladesh and Their Perceptions about Malnutrition and Nutrient Supplements (2012)

In Under-nutrition on May 25, 2012 at 9:17 am

FANTA-2 and partners University of California-Davis; the International Centre for Diarrhoeal Disease Research, Bangladesh; and the World Mission Prayer League (LAMB Hospital) conducted an assessment of the acceptability of lipid-based nutrient supplements (LNS) and micronutrient powders (MNP) among pregnant and lactating women and infants and young children in Bangladesh. Two different flavored LNS products, and one MNP (for infants and young children only) were tested for each group through a 2-day test feeding trial and a 2-week take-home trial. Focus groups were held with participants and community health program staff and volunteers to discuss their preferences for the LNS and MNP and to get feedback about their perceptions of malnutrition and nutrient supplements. Results showed that all tested supplements were acceptable in terms of both the amount of the test meal consumed and the rankings of overall acceptability. The home-use trials and focus group discussion data confirmed acceptability and indicated that sharing of supplements with others was uncommon.”

 Download the document.

Malnutrition, Child Health, and Water Quality: Is There a Role for Private Sector Participation in South Asia?

In Under-nutrition on May 25, 2012 at 8:52 am

by Katrina Kosec

CESifo Economic Studies (2012) 58 (2): 450-470.


This article discusses the potential of private sector participation (PSP) to improve the urban water supply in South Asia. I first provide background on the literature linking a safe and adequate water supply with malnutrition, morbidity, and mortality. To better understand the selection mechanism underlying the decision to undergo PSP, I then analyze factors associated with the award of private water contracts worldwide. I next present empirical evidence that PSP in water is associated with a lower incidence of diarrheal disease and higher rates of access to piped water among young children in urban Africa. Finally, I conclude by reviewing the South Asian context and its limited experiences with PSP in water, raising questions for future research.

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