This study aimed to construct indices of living standards in rural
Bangladesh that could be useful to study health outcomes or identify
target populations for poverty-alleviation programmes. The ...indices were
con-structed using principal component analysis of data on household
assets and house construction materials. Their robustness and use was
tested and found to be internally consistent and correlated with
maternal and infant health, nutritional and demographic indicators, and
infant mortality. Indices derived from 9 or 10 household asset
variables performed well; little was gained by adding more variables
but problems emerged if fewer variables were used. A ranking of the
most informative assets from this rural, South Asian context is
provided. Living standards consistently and significantly improved over
the six-year study period. It is concluded that simple household
socioeconomic data, collected under field conditions, can be used for
constructing reliable and useful indices of living standards in rural
South Asian communities that can assist in the assessment of health,
quality of life, and capabilities of households and their members.
Wheat flour is a possible food vehicle for vitamin A fortification.
This study assessed the efficacy of consumption of a vitamin A-fortified wheat-flour bun (pandesal) on the vitamin A status of ...school-age children.
This was a double-masked clinical trial conducted in 396 and 439 children aged 6-13 y attending 4 rural schools in the Philippines. The children were randomly assigned to a vitamin A-fortified (experimental) or nonfortified (control) group. A 60-g vitamin A-fortified pandesal (containing approximately 133 microg retinol equivalents) or a nonfortified pandesal was consumed by the children 5 d/wk for 30 wk. Vitamin A status, hemoglobin concentration, anthropometric status, morbidity, and dietary intake were assessed at baseline and 30 wk later. A modified relative dose response (MRDR) was assessed in a subsample of 20% of the children ( approximately 75/group) with the lowest initial serum retinol concentration at the 30-wk follow-up.
Baseline serum retinol significantly modified the effect of the intervention. The fortified group, whose initial serum retinol concentrations were below the median, had a 0.07 +/- 0.03-micromol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group (P: = 0.02). Improved vitamin A status was also evident in the MRDR subsample. End-of-study differences in the MRDR showed that vitamin A- fortified pandesal intake decreased the percentage of children with inadequate liver vitamin A stores by 50% (15.3% compared with 28.6%; P: = 0.05).
Daily consumption of vitamin A-fortified pandesal significantly improved the vitamin A status of Filipino school-age children with marginal-to-low initial serum retinol concentrations.
Iron deficiency anaemia is estimated to be the leading cause of years lived with disability among children. Young children's diets are often inadequate in iron and other micronutrients, and provision ...of essential vitamin and minerals has long been recommended. With the limited programmatic success of iron drop/syrup interventions, interest in micronutrient powders (MNP) has increased. MNP are a mixture of vitamins and minerals, enclosed in single‐dose sachets, which are stirred into a child's portion of food immediately before consumption. MNP are an efficacious intervention for reducing iron deficiency anaemia and filling important nutrient gaps in children 6–23 months of age. As of 2014, 50 countries have implemented MNP programmes including 9 at a national level. This paper provides an overview of a 3‐paper series, based on findings from the “Micronutrient Powders Consultation: Lessons Learned for Operational Guidance” held by the USAID‐funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. The objectives of the Consultation were to identify and summarize the most recent MNP programme experiences and lessons learned for operationalizing MNP for young children and prioritize an implementation research agenda. The Consultation was composed of 3 working groups that used the following methods: deliberations among 49 MNP programme implementers and experts, a review of published and grey literature, questionnaires, and key informant interviews, described in this overview. The following articles summarize findings in 3 broad programme areas: planning, implementation, and continual programme improvement. The papers also outline priorities for implementation research to inform improved operationalization of MNP.
Abstract only
BACKGROUND
The earthquake that hit Nepal in April, 2015, caused considerable structural damage and loss of life but little is known about the longer term impacts of the earthquake on ...nutritional status of preschool children and related risk factors. This analysis provides the first systematic national estimate of the nutritional situation in Nepal following the earthquake.
OBJECTIVE
Identify individual, household and community level factors associated with stunting in Nepali children 6–59 months of age.
METHODS
The Policy and Science for Health, Agriculture, and Nutrition (PoSHAN) study under the Nutrition Innovation Lab operating in Nepal has established a national agriculture‐to‐nutrition surveillance system comprising a representative sample of ~5500 households in 63 wards across 21 districts, 7 in each of the 3 agro‐ecological zones of the country. Within each ward, all households with a child under 5 years of age or a newly married woman were eligible for inclusion. We present data from three annual rounds of data collection conducted at the same sites in the same season each year (2013, 2014, and 2016), with <50% of 2016 data yet available at submission. Household agricultural, SES, dietary, anthropometric, program and other risk factor and resource data were collected each year. Child anthropometry included height and weight, with status expressed as height‐for‐age (HAZ) and weight‐for‐height or length (WHZ or WLZ) z‐scores against the WHO growth reference.
RESULTS
Data is available for 5401 children surveyed in 2013, 5474 in 2014 and, to date, 2188 in 2016. Over the 3‐year period the national prevalence of stunting (<‐2HAZ) remained stable at 35.5%, 37.4%, and 34.6%, respectively. Wasting (<‐2 WHZ or WLZ) decreased from 17.7% to 16.3% to 12.9% in 2013, 2014 and 2016, respectively. The final analysis will isolate trends in agricultural productivity, household food security, dietary diversity and nutritional status by quake affected areas within zones.
CONCLUSION
Available data from one year after the earthquake suggests that the earthquake was not associated with an increase in national rates of malnutrition, and are consistent with a reduction in wasting malnutrition over the three period.
Support or Funding Information
Supported by USAID Feed the Future Innovation Lab for Nutrition
Abstract only
BACKGROUND
Despite marked improvement in child undernutrition, especially stunting, in Nepal over the past decade, stunting prevalence remains high at 41% thus generating an urgent need ...to understand factors associated with childhood stunting.
OBJECTIVE
Identify individual, household and community level factors associated with stunting in Nepali children 6–59 months of age.
METHODS
The Policy and Science for Health, Agriculture, and Nutrition (PoSHAN) Community Studies has established a national agriculture‐to‐nutrition surveillance system in a representative sample of ~5500 households in 63 wards across 21 districts, 7 in each of the 3 agro‐ecological zones of the country. This study presents cross‐ sectional data collected in 2013 among a sample of 4853 children to determine factors associated with under‐five stunting, indicated by a height‐for‐age (HAZ) < −2. Using mixed effects logistic regressions to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CI), we examined individual, household and community level risk factors associated with stunting, adjusting for the multi‐level clustering design.
RESULTS
The national prevalence of stunting among children < 5 years was 37.5%. Children living in less developed communities had a higher odds of stunting than those who lived in more developed communities AOR (95% CI): 2.38 (1.36, 4.14). Female household headship was associated with lower odds of stunting 0.78 (0.64, 0.95). The presence of 3 or more under‐five year old children in a household was associated with an increased risk of stunting risk 1.19 (1.44, 2.52) versus households with only one <5 year old. Monthly expenditure (below the 20
th
vs above the 80
th
%ile of household expenditure) was associated with an increased stunting risk 1.68 (1.27, 2.24). At the individual level, wasting of the child 1.52 (1.24, 1.86), high fever in the last 30 days 1.28 (1.03, 1.59), and maternal factors such as a lack of formal education 2.09 (1.48, 296) and short stature 2.52 (1.96, 3.25) were associated with an increased risk of stunting.
CONCLUSION
This study identifies risk factors at community, household and individual maternal and child levels associated with preschool child stunting that may assist in targeting programs to highest risk groups in the future.
Support or Funding Information
USAID, Feed the Future Lab for Nutrition
Severe anemia (hemoglobin < 70 g/L) in pregnancy may increase the risk of maternal and perinatal mortality.
We assessed response to standard treatment with high-dose iron-folic acid for 90 d and ...single-dose (500 mg) mebendazole among severely anemic pregnant women in periurban Karachi, Pakistan. In addition, we evaluated the efficacy of 2 enhanced treatment regimens.
We screened pregnant women (n = 6288) for severe anemia and provided them all with the standard treatment. To test the efficacy of 2 additional treatments, women were randomly assigned to standard treatment alone (control) or with 100 mg mebendazole twice daily for 3 d or 90 d of daily multivitamins or both using a 2 x 2 factorial design.
Prevalence of severe anemia was high (10.5%) during pregnancy. Prevalence of geohelminths and malaria was low. Treatment response was defined as hemoglobin > 100 g/L at the 90-d or > or = 25 g/L at the 60-d follow-up visit. The standard-of-care treatment resulted in a response rate of 49% at follow-up, although an adherence of > or = 85% elicited a higher response (67%). The effect of the additional treatments was weak. Although response was higher in the enhanced groups than for the standard treatment at the final assessment, the differences were not statistically significant. However, hemoglobin concentration increased significantly in all groups and was higher in the enhanced mebendazole group compared with the standard group (P < 0.05).
Iron deficiency was high in this population, and the standard-of-care treatment resulted in a treatment response of 50%, although better treatment adherence showed a higher response. Multivitamins and the enhanced mebendazole regimen had a modest benefit over and above the standard treatment.
Abstract only
BACKGROUND
Despite growing attention to the importance of reducing neonatal mortality, little is known about the prevalence, types, severity, causes or case fatality of infant bleeding ...in rural South Asia. Vitamin K deficiency is a presumptive cause but this remains unknown.
OBJECTIVE
The objectives of this study were to document the prevalence, severity, mortality case fatality rates and risk factors for infantile bleeding in rural Bangladesh.
METHODS
This study was conducted within the JiVitA‐1 trial in northwest Bangladesh which tested effects of antenatal vitamin A or beta‐carotene supplementation on infant and maternal mortality. 59,756 pregnancies were detected through community surveillance from Aug 2001 to Oct 2006, resulting in 41,956 live births. Bleeding symptoms of bruising, and bleeding from the umbilicus and nose, were identified by parental recall at 3 and 6 months. Additionally, a verbal autopsy, administered to consenting parents of all deceased infants, included recall of the same bleeding symptoms. Mortality per 1000 live born infants and case fatality rate (CFR) per 1000 symptomatic cases were based on deaths within 7 days of incident symptoms. Risk ratios were estimated using log‐binomial regression for associations between different covariates and risk of bleeding and bleeding‐related mortality. Associations were examined between maternal PIVKA‐II levels in the 3
rd
trimester and 3 months postpartum from a subset of 62 cases and 216 controls, matched on gestational age at birth, using restricted cubic splines fit to conditional logistic regression models.
RESULTS
Incidence per 1000 95% CI of a 1
st
episode of any bleeding through 6 mo of age was 53.06 50.64, 55.47, early bleeding (<48 hours of birth) was 11.15 10.02, 12.28, classical bleeding (2–7 days) was 20.95 19.38, 22.52, late bleeding was 22.62 20.96, 24.29. The CFR for any bleeding event under 6 mo was 216.5 197.2, 235.7 per 1,000 cases. Nasal bleeding had a particularly high CFR of 605.3 550.32, 660.2. Significant risk factors for bleeding included maternal age, parity, accident in the 3
rd
trimester, gestational age at delivery, obstructed labor, and breech birth. No statistically significant linear or non‐linear associations were found between bleeding and maternal PIVKA‐II levels during the 3
rd
trimester or 3 mo post‐partum, times that may not reflect newborn vitamin K status.
CONCLUSION
Bleeding in early infancy is highly prevalent and fatal in rural Bangladesh. While several risk factors were identified, vitamin K deficiency remains a presumptive cause due widespread lack of supplementation at birth. In low resource settings where infant bleeding is observed, trials of oral VK supplementation may be warranted to evaluate its impact in reducing bleeding and infant mortality.
Support or Funding Information
Supported by the Bill & Melinda Gates Foundation (GH614)
Background: Household food insecurity (HFI) can lead to a poor diet and malnutrition. Yet, little is known about the extent to which maternal diet covaries with food insecurity during pregnancy and ...lactation.
Objective: Longitudinal associations between HFI and maternal dietary diversity from early pregnancy to 3 mo postpartum were examined in rural Bangladesh.
Methods: We repeatedly assessed dietary intake by using a 7-d food-frequency questionnaire in the first and third trimesters of pregnancy and at 3 mo postpartum among 14,600 women enrolled into an antenatal micronutrient supplementation trial. Maternal dietary diversity score (DDS) was constructed as the sum of 10 food groups reportedly consumed at each assessment. Households were classified at 6 mo postpartum as being food secure or having mild, moderate, or severe HFI on the basis of a 9-item standard scale. Generalized estimating equations were used to estimate the longitudinal relation between HFI status and DDS and the likelihood of individual food-group consumption, adjusting for confounders at the maternal and household levels.
Results: The DDS decreased with progressively worse HFI, an association best explained by a derived household wealth index. Compared with women from food-secure households, women of mild, moderate, and severe HFI were less likely, in a dose-response fashion, to have consumed dairy products adjusted ORs (95% CIs): 0.73 (0.69, 0.78), 0.62 (0.58, 0.66), and 0.52 (0.48, 0.55), respectively, eggs 0.81 (0.76, 0.85), 0.73 (0.68, 0.77), and 0.61 (0.57, 0.65), meat 0.83 (0.79, 0.88), 0.73 (0.69, 0.78), and 0.60 (0.56, 0.64), fish 0.87 (0.80, 0.94), 0.76 (0.70, 0.83), and 0.59 (0.54, 0.65), legumes and nuts 0.88 (0.83, 0.93), 0.81 (0.76, 0.87), and 0.79 (0.74, 0.85), and yellow and orange fruit and vegetables 0.85 (0.80, 0.91), 0.78 (0.73, 0.84), and 0.72 (0.67, 0.78). Neither intakes of dark-green leafy vegetables nor of vegetable oil were associated with HFI status.
Conclusion: Antenatal and postnatal maternal dietary diversity, especially intakes of animal-source foods, fruit, and vegetables, declined with worsening food insecurity in rural Bangladesh.
Vitamin A deficiency remains a nutritional concern in sub-Saharan Africa. Conventionally bred maize hybrids with high provitamin A carotenoid concentrations may have the potential to improve vitamin ...A status in maize-consuming populations. We evaluated the efficacy of regular provitamin A carotenoid-biofortified "orange" maizemeal (~15 μg β-carotene/g) consumption in improving vitamin A status and reducing vitamin A deficiency in children. This was a cluster-randomized controlled trial in the rural farming district of Mkushi, Zambia. All 4- to 8-y-old children in an ~400-km2 area were identified and grouped by proximity into clusters of ~15-25 children. We randomly assigned clusters to 1) orange maizemeal (n = 25), 2) white maizemeal (n = 25), or 3) a parallel, nonintervention group (n = 14). Children in intervention clusters (n = 1024) received 200 g maizemeal for 6 d/wk over 6 mo; the maizemeal was prepared according to standardized recipes and served in cluster-level kitchens. Staff recorded attendance and leftovers. We collected venous blood before and after the intervention to measure serum retinol, β-carotene, C-reactive protein, and a1-acid glycoprotein. Intervention groups were comparable at baseline, and vitamin A status was better than anticipated (12.1% deficient on the basis of serum retinol <0.7 μmol/L). Although attendance at meals did not differ (85%), median daily maize intake was higher in white (154 g/d) than in orange (142 g/d) maizemeal clusters. At follow-up, mean serum β-carotene was 0.14 μmol/L (95% CI: 0.09, 0.20 μmol/L) higher in orange maizemeal clusters (P < 0.001), but mean serum retinol (1.00 ± 0.33 μmol/L overall) and deficiency prevalence (17.1% overall) did not differ between arms. In this marginally nourished population, regular biofortified maizemeal consumption increased serum β-carotene concentrations but did not improve serum retinol.
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