evidence-based blog of Filippo Dibari

Posts Tagged ‘undernutrition’

PostMDG: “Embedding nutrition in a post-2015 development framework”

In Under-nutrition on June 1, 2013 at 10:11 am

Haddad, L. and Corbett, H.
IDS Policy Briefing 33 – Publisher IDS

(Download this pubblication)

 

Putting an end to the current nutrition crisis by 2030 is possible, but only if nutrition is embedded within a post-2015 development framework.

Undernutrition continues to afflict 170 million children worldwide and is responsible for nearly 3 million child deaths each year. The life-long and wideranging effects of undernutrition cannot be overstated – brain damage, immune system malfunction, weaker schooling attainment, lower workforce productivity, greater poverty and a greater susceptibility to chronic disease later in life. A new development framework must seek to establish a much clearer and stronger set of nutrition targets and indicators than exist within the current Millennium Development Goals (MDGs).

 

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World largest child nutrition program: all is not well?

In Under-nutrition on February 24, 2013 at 7:41 am

by Mukta Singhvi, Sarvjeet Kaur, and Suman Kumari

Introduction

click here for to download this paper

A country truly concerned about its development would put its children’s health on a higher priority than the GDP. For, population of over a billion can add strength to a country, only, if it is healthy and productive.

In India about 42% of the children are under weight. It has been reported by that on in every three most malnourished children of the world live in India. It is cause worry because such a populace can become a liability in the coming years. The problem of malnutrition is a matter of shame. Despite impressive growth in our GDP, the level of under nutrition in the country is unacceptably high . India has not succeeded in reducing malnutrition fast enough, though the integrated child development services (ICDS) programme continues to be our most important tool to fight malnutrition.

The global community has designated halving the prevalence of under weigh children by 2015 as a key indicator of progress towards the millennium development goal (MDG) of eradicating extreme poverty and hunger. However, it appears that that economic growth alone, though impressive, will not reduce malnutrition sufficiently to meet the MDG. Nutrition target. India’s main early child development and nutrition intervention , the ICDS program has expanded steadily across the country during the last more than three and half decade of its existence. It is one of the World’s largest, most unique well designed and well placed programme to address many of the underlying cause of under nutrition in India. However, it faces a range of implementation difficulties that prevent it from fully realizing its potential.

This article is an attempt to critically examine the World largest programme and identifies the most important weakness in the implementation of ICDS and suggest a way out that can be taken to improve the impact of the programme.

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Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

In Under-nutrition on October 25, 2012 at 8:50 am

Tekeste AWondafrash MAzene GDeribe K.

Cost Eff Resour Alloc. 2012 Mar 19;10:4

 

Abstract

BACKGROUND:

This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition (SAM) in Sidama Zone, Ethiopia compared to facility based therapeutic feeding center (TFC).

METHODS:

A cost effectiveness analysis comparing costs and outcomes of two treatment programmes was conducted. The societal perspective, which considers costs to all sectors of the society, was employed. Outcomes and health service costs of CTC and TFC were obtained from Save the Children USA (SC/USA) CTC and TFC programme, government health services and UNICEF(in kind supplies) cost estimates of unit costs. Parental costs were estimated through interviewing 306 caretakers. Cost categories were compared and a single cost effectiveness ratio of costs to treat a child with SAM in each program (regardless of outcome) was computed and compared.

RESULTS:

A total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC. The institutional cost per child treated was $262.62 in TFC and $128.58 in CTC. Out of these institutional costs in TFC 46.6% was personnel cost. In contrast, majority (43.2%) of the institutional costs in CTC went to ready to use therapeutic food (RUTF). The opportunity cost per caretaker in the TFC was $21.01 whereas it was $5.87 in CTC. The result of this study shows that community based CTC was two times more cost effective than TFC.

CONCLUSION:

CTC was found to be relatively more cost effective than TFC in this setting. This indicates that CTC is a viable approach on just economic grounds in addition to other benefits such improved access, sustainability and appropriateness documented elsewhere. If costs of RUTF can be reduced such as through local production the CTC costs per child can be further reduced as RUTF constitutes the highest cost in these study settings.

 

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Predictors of stunting, wasting and underweight among Tanzanian children born to HIV-infected women

In Under-nutrition on October 24, 2012 at 7:52 am

McDonald CMKupka RManji KPOkuma JBosch RJAboud SKisenge RSpiegelman DFawzi WWDuggan CP.

Eur J Clin Nutr. 2012 Oct 3

Abstract

Background/Objectives: Children born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized.

The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months.

Subjects/Methods: Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant’s birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight.

Results: A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted.

Conclusions: Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women.

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Two charities challenge company’s patent on Plumpy’Nut

In Under-nutrition on October 18, 2012 at 2:56 pm

by Clare Dyer

from the British Medical Journal (BMJ) 2010;340:c2510

“The US patent for a peanut based food product that has transformed the treatment of acute malnutrition in Africa has come under challenge by two US not for profit organisations that say they could produce similar products more cheaply.

“The California based Mama Cares Foundation and Breedlove Foods in Texas have filed a joint suit in the US District Court in the District of Columbia to try to overturn the patent held by the French company Nutriset.

“Nutriset’s Plumpy’Nut, a blend of peanut butter, powdered milk, vegetable oil, and sugar fortified with vitamins and minerals, is said by some experts to have revolutionised aid agencies’ response to malnutrition and become the standard “ready to use therapeutic food” (RUTF).

“It achieved dramatic results in Niger in 2005. Because it doesn’t need to be mixed with water, children who would previously have to be taken to hospital can be treated much more cheaply at home.

“Nutriset and its partners around the world provide the bulk of the world’s supply, but Mike Mellace, executive director of Mama Cares, said it was poised to ship its rival Re:vive product to Africa, Honduras, South East Asia, and other regions.

“The patent lawyer Robert Chiaviello is giving his services free of charge to the two organisations. Mr Mellace said that their main claim was that the patent should not have been granted because Plumpy’Nut was not novel or unique.

“If you grab a jar of Nutella and compare it to the ingredients statement on Plumpy’Nut you’ll find that it’s virtually identical. All that they’ve done is change the mixture round and have a higher vitamin and mineral mix to get to the proper WHO specifications, which anybody could do.”

“He said that Mama Cares, a non-profit offshoot of his family snack business, had managed to reduce its costs to $0.4 (£0.27; €0.78) a unit; Plumpy’Nut costs 0.55 a unit. “If you simply took the same aid dollars you could treat 30% more children because the product is cheaper.”

“Nutriset has recently started manufacturing Plumpy’Nut in the United States, in partnership with a non-profit body called Edesia. Its network of partner manufacturers also produce Plumpy’Nut locally in Niger, Ethiopia, Malawi, the Democratic Republic of the Congo, the Dominican Republic, India, Madagascar, and Mozambique.

“The company, which has registered patents in the European Union, the US, Canada, and 32 other countries, has sent legal letters to other producers of nut based RUTFs. It was criticised in an open letter last November by the international humanitarian organisation Médecins Sans Frontières for sending a letter asserting its intellectual property rights to the Indian and Norwegian manufacturer Compact.

“Adeline Lescanne, deputy general manager of Nutriset, said: “Some may pretend they are able to produce the equivalent of Plumpy’Nut at a cheaper price, but we fear that those solutions may not be [long lasting]. What should be the goal: to have companies manufacturing an RUTF in the North or to have them helping to develop local nutrition capacities, working with local health authorities, transferring competences to the South?

“It’s interesting to see the plaintiffs working on new products. Our patent on Plumpy’Nut gave them motivation to seek something else. What is really needed are increased efforts to prevent malnutrition. There are lots of things to do in the prevention field.”

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Lipid-based, ready-to-use foods to fight undernutrition: the state of the art (UCDAVIS)

In Under-nutrition on October 16, 2012 at 8:10 am

Lipid-Based Nutrient Supplements: How Can They Combat Child Malnutrition?

Kathryn G. Dewey, Mary Arimond

PLOS Medicine  September 18, 2012

This paper (download entirely) is particularly relevant for anybody interested in the current knowledge achievements and gaps about management of undernutrition with lipid-based, ready-to-use foods.

The same paper offers also an updated list of references on this topic.

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Development, acceptability, and nutritional characteristics of a low-cost, shelf-stable supplementary food product for vulnerable groups in Kenya

In Uncategorized, Under-nutrition on October 15, 2012 at 8:14 am

 Kunyanga, Catherine; Imungi, Jasper; Okoth, Michael; Vadivel, Vellingiri; Biesalski, Hans Konrad

Food & Nutrition Bulletin, Volume 33, Number 1, March 2012 , pp. 43-52(10)

Abstract:

Background. Food-based approaches have been advocated as the best strategies to curb hunger and malnutrition in developing countries. The use of low-cost, locally available, nutritious foods in the development of supplementary foods has been recommended.

 Objective. To develop low-cost food supplements using different traditionally processed local foods, consisting of cereals, legumes, nuts, fish, and vegetables, to meet the nutrient requirements for vulnerable groups in Kenya.

 Methods. Four food supplements were developed and evaluated by taste panel procedures. The product containing amaranth grain, pigeon pea, sweet potato, groundnuts, and brown sugar was found to be the most acceptable supplement. Evaluation of nutritional composition, shelf-life, and cost analysis of the acceptable supplement was carried out to assess if it could satisfactorily provide more than 50% of the Recommended Dietary Allowances (RDAs) of the basic nutrients for vulnerable groups.

 Results. The acceptable supplement contained 453.2 kcal energy, 12.7 g crude protein, 54.3 g soluble carbohydrates, 20.8 g crude fat, and 10.1 g crude fiber per 110 g. The micronutrient contents were 93.0 mg calcium, 172.4 mg magnesium, 2.7 mg zinc, 5.7 mg iron, 0.8 mg vitamin B1, 0.2 mg vitamin B2, 7.9 mg niacin, 100 μg folic acid, and 140 μg retinol equivalent per 110 g. The supplement also contained 21% total essential amino acid in addition to appreciable levels of palmitic, stearic, oleic, linoleic, and α-linolenic fatty acids. The shelf-life study showed that it could be stored in different packaging materials (polythene bags, gunny bags, and kraft paper) at 26°C without deleterious effects on its chemical composition for up to 4 months. Cost analysis of the supplement indicated that the product could be competitively sold at US$0.812/kg (KES 65.50/kg).

 Conclusions. Locally available indigenous foods can be used in the formulation of acceptable, low-cost, shelf-stable, nutritious supplementary foods for vulnerable groups.

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WHO: Supplementary foods for the management of moderate acute malnutrition

In Under-nutrition on October 12, 2012 at 12:34 pm

Original title: Supplementary foods  for the management of moderate acute malnutrition in infants and children 6–59 months of age (Technical note)

by WHO (2012)

(download here a brief version of the document)

This document proposes the nutrient composition of supplementary foods to manage moderate acute malnutrition (MAM) in children under 5 years of age.

Experimental data were used to inform the estimates, taking into consideration the effect of different levels of nutrients and their bio-availability.

The document also lists the principles of nutritional management of children with MAM and reports the assumptions considered to set up the proposed recommendations, suggesting  which uses the latter can be applied for and topics for further research in this area.

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Maize porridge enriched with a micronutrient powder containing low-dose iron as NaFeEDTA, but not amaranth grain flour, reduces anemia and iron deficiency in Kenyan preschool children.

In Under-nutrition on October 6, 2012 at 6:06 am

Macharia-Mutie CW, Moretti D, Van den Briel N, Omusundi AM, Mwangi AM, Kok FJ, Zimmermann MB, Brouwer ID

J Nutrition 142: 1756-1763, 2012

Abstract 

Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder (MNP) containing low doses of highly bioavailable iron to control iron deficiency anemia (IDA) in children.

We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children. In a 16-wk intervention trial, children (n = 279; 12-59 mo) were randomly assigned to: unrefined maize porridge (control; 4.1 mg of iron/meal; phytate:iron molar ratio 5:1); unrefined maize (30%) and amaranth grain (70%) porridge (amaranth group; 23 mg of iron/meal; phytate:iron molar ratio 3:1); or unrefined maize porridge with MNP (MNP group; 6.6 mg iron/meal; phytate:iron molar ratio 2.6:1; 2.5 mg iron as NaFeEDTA).

Primary outcomes were anemia and iron status with treatment effects estimated relative to control. At baseline, 38% were anemic and 30% iron deficient.

Consumption of MNP reduced the prevalence of anemia [-46% (95% CI: -67, -12)], iron deficiency [-70% (95% CI: -89, -16)], and IDA [-75% (95% CI: -92, -20)]. The soluble transferrin receptor [-10% (95% CI: -16, -4)] concentration was lower, whereas the hemoglobin (Hb) [2.7 g/L (95% CI: 0.4, 5.1)] and plasma ferritin [40% (95% CI: 10, 95)] concentrations increased in the MNP group. There was no significant change in Hb or iron status in the amaranth group.

Consumption of maize porridge fortified with low-dose, highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children. In contrast, fortification with amaranth grain did not improve iron status despite a large increase in iron intake, likely due to high ratio of phytic acid:iron in the meal.

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.

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