evidence-based blog of Filippo Dibari

Posts Tagged ‘nutrition intervention’

Maternal and Child Nutrition: Promoting Healthy Growth and Preventing Childhood Stunting

In Under-nutrition on September 14, 2014 at 6:06 am

Maternal and Child Nutrition Journal – Special Issue: Promoting Healthy Growth and Preventing Childhood Stunting

September 2013 – Volume 9, Issue Supplement S2 Pages 1–149

  • Editorial

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Promoting healthy growth and preventing childhood stunting: a global challenge (pages 1–5)

Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12092

  • Original Article

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The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions (pages 6–26)

Mercedes de Onis, Kathryn G. Dewey, Elaine Borghi, Adelheid W. Onyango, Monika Blössner, Bernadette Daelmans, Ellen Piwoz and Francesco Branca

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12075

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Contextualising complementary feeding in a broader framework for stunting prevention (pages 27–45)

Christine P. Stewart, Lora Iannotti, Kathryn G. Dewey, Kim F. Michaelsen and Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12088

  • Review Article

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Multi-sectoral interventions for healthy growth (pages 46–57)

Ma del Carmen Casanovas, Chessa K. Lutter, Nune Mangasaryan, Robert Mwadime, Nemat Hajeebhoy, Ana Maria Aguilar, Ciro Kopp, Luis Rico, Gonzalo Ibiett, Doris Andia and Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12082

  • Original Articles

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Parental height and child growth from birth to 2 years in the WHO Multicentre Growth Reference Study (pages 58–68)

Cutberto Garza, Elaine Borghi, Adelheid W. Onyango, Mercedes de Onis and WHO Multicentre Growth Reference Study Group

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12085

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The economic rationale for investing in stunting reduction (pages 69–82)

John Hoddinott, Harold Alderman, Jere R. Behrman, Lawrence Haddad and Susan Horton

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12080

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The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction (pages 83–100)

David Pelletier, Rukhsana Haider, Nemat Hajeebhoy, Nune Mangasaryan, Robert Mwadime and Satyajit Sarkar

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12081

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Key principles to improve programmes and interventions in complementary feeding (pages 101–115)

Chessa K Lutter, Lora Iannotti, Hilary Creed-Kanashiro, Agnes Guyon, Bernadette Daelmans, Rebecca Robert and Rukhsana Haider

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12087

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Designing appropriate complementary feeding recommendations: tools for programmatic action (pages 116–130)

Bernadette Daelmans, Elaine Ferguson, Chessa K. Lutter, Neha Singh, Helena Pachón, Hilary Creed-Kanashiro, Monica Woldt, Nuné Mangasaryan, Edith Cheung, Roger Mir, Rossina Pareja and André Briend

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12083

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Introducing infant and young child feeding indicators into national nutrition surveillance systems: lessons from Vietnam (pages 131–149)

Nemat Hajeebhoy, Phuong Hong Nguyen, Do Thanh Tran and Mercedes de Onis

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12086

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London: HUNGER TALKS (Fri, 19th Oct 2012) – open to public

In Under-nutrition on October 1, 2012 at 8:42 am

From the Conference Brochure:

Action Against Hunger and Birkbeck University are pleased to welcome you to HUNGER TALKS, a one day event that we hope will become a regular feature in the nutrition calendar.

“The aim of HUNGER TALKS is to bring together leading voices from the frontlines of the fight against hunger.

“In this first instalment, HUNGER TALKS will look at hunger from a broad perspective; not only from a Nutrition or Food Security & Livelihoods perspective, but by exploring ways in which these two come together.

“This year’s HUNGER TALKS will focus on what it means to integrate Nutrition and Food Security & Livelihoods in the 21st century, where the opportunities lie and where the challenges may lie.

“To do so, we have invited a panel of fi very experienced and innovative speakers:

Saul Guerrero – Chair man

Abigail Perry – DFID

Stephen Spratt – Research Fellow, IDS

Mark Davies – Programme Manager Social Protection, IDS

Filippo Dibari – Valid International/UCL (Institute of Global Health)

Leena Camadoo – TWIN

Click here  for the bio of the speakers, the programme details and the location.

The participation is OPEN to anybody interested.

Nutrition Barometer – Measuring What Matters

In Under-nutrition on September 26, 2012 at 5:43 pm

from 2000 days web site:

“Recently, Save the Children and World Vision joined forces to launch a ground-breaking Nutrition Barometer that examines the progress being made to improve nutrition in the 36 countries that are home to 90% of the world’s malnourished children.

“The Nutrition Barometer measures the political and financial commitments made by governments to tackle malnutrition, and looks at progress in transforming these commitments into real improvements for mothers and children.

“Of the countries profiled, Guatemala, Malawi and Peru –all SUN countries– are making the greatest strides against malnutrition, while the Democratic Republic of Congo, India and Yemen show the weakest performance, with frail commitments and poor outcomes for children.

“The Nutrition Barometer stresses the need to hold governments accountable for sustaining nutrition investments over the long-term in order to reverse the “unacceptably high levels” of chronic malnutrition and child mortality.”

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Development of a crossover-randomized trial method to determine the acceptability and safety of novel ready-to-use therapeutic foods (ahead of print)

In Under-nutrition on September 19, 2012 at 5:07 pm

by Dibari F, Bahwere P, Huerga H, Irena AH, Owino V, Collins S, Seal A.

Nutrition (article in press).

Abstract

Objective: To develop a method for determining the acceptability and safety of ready-to-use therapeutic foods (RUTF) before clinical trialing. Acceptability was defined using a combination of three consumption, nine safety, and six preference criteria. These were used to compare a soy/maize/sorghum RUTF (SMS-RUTFh), designed for the rehabilitation of human immunodeficiency virus/tuberculosis (HIV/TB) wasted adults, with a peanut-butter/milk-powder paste (P-RUTF; brand: Plumpy’nut) designed for pediatric treatment.

Methods: A cross-over, randomized, controlled trial was conducted in Kenya. Ten days of repeated measures of product intake by 41 HIV/TB patients, >18 y old, body mass index (BMI) 18-24 kg/m^2, 250 g were offered daily under direct observation as a replacement lunch meal. Consumption, comorbidity, and preferences were recorded.

Results: The study arms had similar age, sex, marital status, initial BMI, and middle upper-arm circumference. No carryover effect or serious adverse events were found. SMS-RUTFh energy intake was not statistically different from the control, when adjusted for BMI on day 1, and the presence of throat sores. General preference, taste, and sweetness scores were higher for SMS-RUTFh compared to the control (P < 0.05). Most consumption, safety, and preference criteria for SMS-RUTFh were satisfied except for the average number of days of nausea (0.16 versus 0.09 d) and vomiting (0.04 versus 0.02 d), which occurred with a higher frequency (P < 0.05).

Conclusion: SMS-RUTFh appears to be acceptable and can be safely clinically trialed, if close monitoring of vomiting and nausea is included. The method reported here is a useful and feasible approach for testing the acceptability of ready-to-use foods in low income countries.

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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

Abstract

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)

Abstract

BACKGROUND:

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).

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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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An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia

In Under-nutrition on August 28, 2012 at 8:52 pm

by Bridget Fenn, Assaye T Bulti, Themba Nduna, Arabella Duffield and Fiona Watson

Public Health Nutrition / Volume 15 / Issue 09 / September 2012 , pp 1746-1754

Abstract

Objective To determine which interventions can reduce linear growth retardation (stunting) in children aged 6–36 months over a 5-year period in a food-insecure population in Ethiopia.

Design We used data collected through an operations research project run by Save the Children UK: the Child Caring Practices (CCP) project. Eleven neighbouring villages were purposefully selected to receive one of four interventions: (i) health; (iii) nutrition education; (iii) water, sanitation and hygiene (WASH); or (iv) integrated comprising all interventions. A comparison group of three villages did not receive any interventions. Cross-sectional surveys were conducted at baseline (2004) and for impact evaluation (2009) using the same quantitative and qualitative tools. The primary outcome was stunted growth in children aged 6–36 months measured as height (or length)-for-age Z-scores (mean and prevalence). Secondary outcomes were knowledge of health seeking, infant and young child feeding and preventive practices.

Setting Amhara, Ethiopia.

Subjects Children aged 6–36 months.

Results The WASH intervention group was the only group to show a significant increase in mean height-for-age Z-score (+0·33, P = 0·02), with a 12·1 % decrease in the prevalence of stunting, compared with the baseline group. This group also showed significant improvements in mothers’ knowledge of causes of diarrhoea and hygiene practices. The other intervention groups saw non-significant impacts for childhood stunting but improvements in knowledge relating to specific intervention education messages given.

Conclusions The study suggests that an improvement in hygiene practices had a significant impact on stunting levels. However, there may be alternative explanations for this and further evidence is required.

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An effectiveness trial showed lipid-based nutrient supplementation but not corn–soya blend offered a modest benefit in weight gain among 6- to 18-month-old underweight children in rural Malawi

In Under-nutrition on August 28, 2012 at 8:44 pm

by Chrissie M Thakwalakwa, Per Ashorn, Mpumulo Jawati, John C Phuka, Yin Bun Cheung and Kenneth M Maleta

Public Health Nutrition / Volume 15 / Issue 09 / September 2012 , pp 1755-1762

Abstract

 Objective To determine if supplementation with corn–soya blend (CSB) or lipid-based nutrient supplement (LNS) improved the weight gain of moderately underweight infants and children when provided through the national health service.

Design A randomised, controlled, assessor-blinded clinical trial. Infants and children were randomised to receive for 12 weeks an average daily ration of 71 g CSB or 43 g LNS, providing 1188 kJ and 920 kJ, respectively, or no supplement (control). Main outcome was weight gain. Secondary outcomes included changes in anthropometric indices and incidence of serious adverse events. Intention-to-treat analyses were used.

Setting Kukalanga, Koche, Katema and Jalasi health centres in Mangochi District, rural Malawi.

Subjects Underweight (weight-for-age Z-score <−2) infants and children aged 6–15 months (n 299).

Results Mean weight gain was 630 g, 680 g and 750 g in control, CSB and LNS groups, respectively (P = 0·21). When adjusted for baseline age, children receiving LNS gained on average 90 g more weight (P = 0·185) and their weight-for-length Z-score increased 0·22 more (P = 0·049) compared with those receiving no supplementation. No statistically significant differences were observed between the CSB and control groups in mean weight and length gain.

Conclusions LNS supplementation provided during the lean season via through the national health service was associated with a modest increase in weight. However, the effect size was lower than that previously reported under more controlled research settings.

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Literature Review and Institutional Analysis: Toward an Integrated Approach for Addressing Malnutrition in Zambia (IFPRI)

In Under-nutrition on August 28, 2012 at 8:09 pm

by Jody Harris and Scott Drimie

IFPRI Discussion Paper 01200 – August 2012

 

Abstract

Due to the predominance of direct, specific interventions in nutrition for development, the health sector tends to own nutrition, with interventions customarily implemented through health programs. That the agriculture sector should also be a vehicle for improved nutrition is intuitive, but this sector often delivers neither good nutrition nor food security to the most vulnerable in the population. The complex and multisectoral nature of malnutrition may explain why it has not been effectively addressed, even though we know many of the solutions; intersectoral action is critical to addressing this complexity, but to date there is no consensus on how intersectoral solutions are best implemented or institutionalized. This review brings together experiences from across Sub-Saharan Africa in order to draw out recommendations for improved intersectoral implementation going forward, and assesses how these findings apply specifically to the Zambian context.

The experiences reviewed suggest three broad barriers to intersectoral collaboration for nutrition: low political commitment and mobilization; sector-bound organizational structures and weak coordinating bodies; and lack of human resources and capacity. Key lessons for improved intersectoral implementation include the role of advocacy in framing the problem in context and highlighting mutual gains for different sectors, to create the political will and working space for nutrition action; the importance of organizational arrangements, including convening or coordinating bodies with multisectoral credibility to facilitate mobilizing and resourcing power; and the importance of building not only technical but also strategic capacity to manage multisectoral relationships for improved nutrition outcomes. Ultimately, these solutions will have to be tailored to country contexts.

Zambia is an ideal candidate for a country that could make a significant impact on its malnutrition problem. With the emergence of the Scaling Up Nutrition (SUN) movement in the country, nutrition has received some high-level political attention, and the multi-sectoral nature of nutrition is recognized in overarching development policies and strategies. However, political attention has not moved into concrete action, and nutrition strategies, policies, and plans are essentially wish lists noting best practice, confined mainly to the health sector, created with substantial input from external actors, and without the backing of political commitment, budgetary or human resources, or capacity; implementation of these grand ideas is severely lacking. Several vital but attainable processes would improve intersectoral coordination for nutrition in Zambia and enable its potentially strong policy to be implemented across sectors. These include strategic lobbying for real political and social commitment to nutrition in sectors outside of health; strengthening the National Food and Nutrition Commission both in terms of its power to convene the different actors and the strategic capacity of its leadership; and improved technical training outside of core nutrition competencies in nutrition workers in general. These recommendations are interlinked; one cannot happen without the other, and all are necessary but not sufficient to improve the nutrition situation in Zambia. Movement should start in all areas at once, and the high-level momentum created by the SUN movement is an opportunity, providing the potential for cross-sectoral dialogue and increased resources, that should not be missed.

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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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