Relationship between paternal involvement and child malnutrition in a rural area of Vietnam

BACKGROUND: Malnutrition is a public health problem in Vietnam. Child health and the status of women have been targets for various health programs in the country. In general, reports in the literature suggest that care is positively correlated with positive nutritional status of children. In the household, the father is considered a resource for care. However, the role of paternal care in health programs has not received the attention it deserves. OBJECTIVE: To identify associations between the involvement of fathers in child care and housework and the nutritional status of children under 3 years of age. METHODS: This cross-sectional study was based on a random sample of 547 children under 3 years of age from intact families and their biological parents. The main outcome variable was child nutrition. Predictor variables represented two domains of father's involvement. Multivariable general linear modeling and multivariable logistic regression modeling were performed with the use of a combination of stepwise and hierarchical approaches in data analysis. RESULTS: The overall prevalence of underweight among children was 19.1%, and the prevalence of stunting was 14.4%. Children whose fathers did not bring them to a medical facility for immunization were about 1.7 times more likely to be underweight and stunted than those whose fathers did bring them for immunization after child's age, household economic status, and mother's education were controlled for. Father's involvement in housework was not found to be related to the prevalence of malnutrition. CONCLUSIONS: Paternal involvement in child immunization should be encouraged by health-care providers who manage immunization programs.     

Lessons from successful micronutrient programs. Part II: program implementation

National programs for vitamin A supplementation and iodization of the salt supply were launched and sustained with high (but not universal) coverage in most of the countries studied. Iron programs (requiring daily or weekly supplementation, in contrast to vitamin A), which were distributed mainly through antenatal care, had lower coverage and acceptance. Constraints to supplementation were supply, awareness of health staff and communities, and (for vitamin A) insecurity with phasing out of the national immunization days, which have been a major vehicle for distribution. Administration to women postpartum becomes even more important and needs greater coverage. Iodized salt programs have expanded well, with good interagency collaboration and local management, supported by legislation (which may need strengthening); constraints remain in terms of too many salt producers, inadequate quality, import issues, and prices. More integrated, multifaceted programs are needed, with priority to developing and implementing fortification--especially in finding effective ways to iron-fortify rice. Data are lacking, with fewer surveys once programs start, constraining monitoring and program control and adaptation. Nonetheless, interventions appear to have gone to scale remarkably successfully.     

Effects of a food supplementation program on the nutritional status of pregnant women in Bangladesh

BACKGROUND: The Government of Bangladesh implemented a comprehensive nutrition intervention in 1997 to reduce the rates of malnutrition among women and children. The pilot program, the Bangladesh Integrated Nutrition Program (BINP), adopted a multisectoral approach targeting women and children through food supplementation, home gardening, and health and nutrition education. OBJECTIVE: This paper estimates the effectiveness of BINP's food supplementation and nutrition education on the nutritional status of pregnant women. Methods. Three effectiveness measures were considered: target efficiency, improvements in the nutritional status of beneficiaries, and the persistence of nutritional effects. To isolate the effects of the intervention, the nutritional status of participants and nonparticipants was compared after controlling for various demographic and socioeconomic characteristics. Data were collected in 2000 from a random sample of 3262 households in a BINP intervention area. RESULTS: Thirty-nine percent of pregnant women were correctly targeted by the program's food supplementation activities. The nutrition program reduced the prevalence of thinness among participant pregnant women by about 3 percentage points per month of enrollment. The prevalence of thinness among program graduates was 62%, which was much higher than that of the matched (nonparticipant) group (35%). This finding is perplexing but it may simply imply that those who enrolled at the initial phase of the project were severely underweight and they fell back to their original status within a short period of time. CONCLUSIONS: The nutrition program was intended to improve the nutritional status of women in the longer run through the provision of nutrition education during the food supplementation phase. The prevalence of thinness or severe underweight in women who exited the program after completion of the enrollment period was found to be much higher than in women of similar age and socioeconomic status in the community. This apparent lack of persistence of program benefits requires careful re-evaluation of alternative mechanisms for improving the long-term nutritional status of women.     

Food for nutrition: mainstreaming nutrition in WFP

Most preventable deaths among hungry people take place outside of emergency contexts. In countries not involved in conflicts or natural disasters malnutrition is directly implicated in the deaths of millions of children and mothers each year. Thus, WFP's great efforts focused on saving lives in emergencies should be mirrored by efforts aimed at tackling malnutrition, and hence saving lives, beyond emergencies as well. While food sufficiency is not the same as good nutrition, food is nevertheless an important part of the nutrition equation. New scientific evidence confirms that it is possible to have positive nutritional impacts with food aid. Consistent with Strategic Priority No. 3, WFP seeks to use food resources to achieve nutritional impacts in three complementary ways: a) enhancing the effectiveness and impact of targeted mother and child health and nutrition interventions (MCHN) that combine food and appropriate nonfood inputs; b) enhancing the nutritional value of WFP food (for instance, through micronutrient fortification); and c) enhancing the nutritional impact of other WFP (non-MCHN) interventions. These approaches represent a mainstreaming of nutrition across WFP's activities. Adoption of evidence-based programming, joint interventions with partners, and new project designs offer the promise of greater WFP effectiveness and impact in the coming years.     

Effect of iron supplementation during pregnancy on birthweight: evidence from Zimbabwe

BACKGROUND: Iron deficiency in pregnant women has been shown to reduce the oxygen supply to the fetus, cause intrauterine growth retardation, and increase the risk of premature delivery and reduced birthweight. Yet the effects of iron supplementation programs on pregnancy outcomes are not well documented for developing countries. OBJECTIVE: To examine the relation between iron supplementation of mothers during pregnancy and children's birthweight using data from a national population-based survey in Zimbabwe. METHODS: The analysis uses information on 3559 births during the five years preceding the 1999 Zimbabwe Demographic and Health Survey. The effect of iron supplementation during pregnancy on birthweight was estimated by multiple regression, controlling for potential confounding effects of prenatal care, child's sex and birth order, mother's education and nutritional status (measured by body-mass index), household living standard, smoke exposure, and other variables. RESULTS: Babies born to mothers who received iron supplementation during pregnancy were 103 g heavier (95% confidence interval, 42-164; p = .001), on average, than babies born to mothers who did not receive iron supplementation during pregnancy. The difference was 64 g (95% confidence interval, 2-125; p = .043) for children whose birthweights were taken from health cards and 163 g (95% confidence interval, 44-281; p = .008) for children whose birthweights were reported by their mothers. CONCLUSIONS: Iron supplementation during pregnancy is associated with significantly higher birthweight, independent of other pregnancy care factors, mother's nutritional status, smoke exposure, and a number of demographic and socioeconomic factors. Prenatal iron supplementation programs can improve pregnancy outcomes and promote child survival in developing countries.     

Nutrition services in Canadian neonatal follow-up programs.

The benefits of nutrition assessment and support of the high-risk infant are well established. The premature infant remains vulnerable for poor growth and developmental disabilities, thus requiring consistent monitoring, intervention, and follow-up care. The purpose of this study was to determine the registered dietitian's role in neonatal/perinatal follow-up programs. A survey was sent to the 26 follow-up programs in Canada. The questionnaire response rate was 81%. Registered dietitians were involved in 67% of these programs. Of these dietitians, 43% were assigned to neonatal/perinatal follow-up programs while 57% were involved only by consult. The average time that assigned registered dietitians devoted to programs was 0.35 full-time equivalents. Over 80% of the dietitians did ongoing development, evaluation, and modification of nutrition care plans; 71% screened new patients for nutritional risk, and 100% instructed patient families and developed teaching materials. The study findings will assist program planners who wish to establish a dietitian position in a neonatal/ perinatal follow-up program. For registered dietitians already working in such programs, the results may provide some guidance on role definition and expansion.     

国外学生营养餐的发展对我国的启示

学生营养状况体现了国家的综合实力水平。国外学生营养餐开始较早,已经形成了基本成熟规范的运作模式,而我国尚处于学生营养餐发展的初始阶段。本文对国外学生营养餐的发展历史进行了回顾和介绍,通过对多个国家经典案例的分析,归纳和总结了国外在实施推广学生营养餐过程中的经验教训,旨在为我国开展学生营养餐计划提供参考和借鉴。     

Lessons from successful micronutrient programs. Part III: program impact

Micronutrient-deficiency control programs have been greatly extended at the national level in the last 10 to 15 years. However, rigorous evaluations of these are scarce, so that conclusions on impact are tentative and based mainly on indirect evidence. The coverage of vitamin A capsule distribution programs has exceeded 70% in most study countries. In countries implementing national iodized salt programs, the coverage reaches 60% to 90% of households with adequately iodized salt. Of the three micronutrients, coverage of iron tablet supplementation is the least well documented due to inadequate program monitoring systems and population survey data. Supplementation of preschool children 6 to 59 months of age with vitamin A capsules has plausibly contributed to the reduction in clinical vitamin A deficiency and its near-elimination in many countries. The impact of vitamin A capsule supplementation on children's biochemical vitamin A status (serum retinol) in national programs may be less. National data on salt iodization show a consistent relation to reduced prevalence of iodine-deficiency disorder symptoms (goiter); the rates of cretinism and other results of iodine deficiency are almost certainly falling too. The evaluation of the impact of salt iodization programs on biochemical iodine status is limited by a lack of data. Although trials have demonstrated the efficacy of iron supplementation in reducing the prevalence of anemia, the interpretation of national-level data is not so clear. Given the substantial financial and technical commitment required to implement national micronutrient-deficiency control programs, it is vital that investment enable the evaluation of the impact of these programs. It is becoming increasingly important to collect data on subclinical deficiency (e.g., biochemical data) to assess program impact.     

Intensifying efforts to reduce child malnutrition in India: an evaluation of the Dular program in Jharkhand, India

BACKGROUND: The Dular strategy is a unique nutrition initiative initiated by UNICEF India in collaboration with the states of Bihar and Jharkhand. Designed to complement the government's Integrated Child Development Services (ICDS) and build upon its infrastructure, one of the major goals of the Dular program is to capitalize and develop community resources at the grassroots level. The emphasis of the Dular program is on establishing a community-based tracking system of the health status of women and of children 0 to 36 months of age by neighborhood-based local resource persons (LRPs). The main objectives of the Dular program include increased prenatal attendance, improvement in breastfeeding and colostrum delivery, improved nutritional practices, and decreased malnutrition. OBJECTIVES AND METHOD: An impact evaluation of 744 women and children in Jharkhand examined antenatal and birthing practices, colostrum delivery, delivery of breastmilk as first food, reported use of iodized salt, measured iodized salt status, immunization and weight-for-age z-scores (WAZ) of children 0 to 36 months of age, controlling for various measures of socioeconomic status. RESULTS: Differences were found between Dular and non-Dular villages in all major outcomes. Particularly noteworthy is that young children in Dular areas had a 45% lower prevalence of severe malnutrition and were four times more likely to receive colostrum than those in non-Dular villages. CONCLUSIONS: Our evaluation results indicate that programmatic overlays to the ICDS program, which focus primary attention on children 0 to 36 months of age and on women, have the potential to transform into a cost-effective instrument for reducing child malnutrition in India, with implications for women and children in India.     

Integrating nutrition security with treatment of people living with HIV: lessons from Kenya

BACKGROUND: The increased caloric requirements of HIV-positive individuals, undesirable side effects of treatment that may be worsened by malnutrition (but alleviated by nutritional support), and associated declines in adherence and possible increased drug resistance are all justifications for developing better interventions to strengthen the nutrition security of individuals receiving antiretroviral treatment. OBJECTIVE: To highlight key benefits and challenges relating to interventions aimed at strengthening the nutrition security of people living with HIV who are receiving antiretroviral treatment. METHODS: Qualitative research was undertaken on a short-term nutrition intervention linked to the provision of free antiretroviral treatment for people living with HIV in western Kenya in late 2005 and early 2006. RESULTS: Patients enrolled in the food program while on treatment regimens self-reported greater adherence to their medication, fewer side effects, and a greater ability to satisfy increased appetite. Most clients self-reported weight gain, recovery of physical strength, and the resumption of labor activities while enrolled in dual (food supplementation and treatment) programs. Such improvements were seen to catalyze increased support from family and community. CONCLUSIONS: These findings provide further empirical support to calls for a more holistic and comprehensive response to the coexistence of AIDS epidemics with chronic nutrition insecurity. Future work is needed to clarify ways of bridging the gap between short-term nutritional support to individuals and longer-term livelihood security programming for communities affected by AIDS. Such interdisciplinary research will need to be matched by intersectoral action on the part of the agriculture and health sectors in such environments.     

Macrolevel approaches to improve the availability of complementary foods

Large numbers of infants and young children suffer from the short- and long-term health effects of poor breastfeeding and complementary feeding practices. Strategies to improve the availability of and access to low-cost fortified complementary foods can play an important corresponding role to that of behavior change in improving nutritional status of young children. However, the nutritional quality of complementary foods used in publicly funded programs is not always optimal, and such programs are costly and reach only a tiny fraction of those who could benefit. To broadly reach the target population, such foods need to be commercially available at affordable prices and promoted in a way that generates demand for their purchase. A sensible long-term policy for the promotion of low-cost fortified complementary foods calls for attention to their nutritional formulations and cost, the economics of production, and the legislative, regulatory, and competitive framework in which marketing occurs. This paper provides information on how to improve the nutritional formulations of fortified complementary foods and outlines the necessary conditions for a market approach to their production and promotion.     

An overview of microbial food safety programs in beef, pork, and poultry from farm to processing in Canada

Canada's vision for the agri-food industry in the 21st century is the establishment of a national food safety system employing hazard analysis and critical control point (HACCP) principles and microbiological verification tools, with traceability throughout the gate-to-plate continuum. Voluntary on-farm food safety (OFFS) programs, based in part on HACCP principles, provide producers with guidelines for good production practices focused on general hygiene and biosecurity. OFFS programs in beef cattle, swine, and poultry are currently being evaluated through a national recognition program of the Canadian Food Inspection Agency. Mandatory HACCP programs in federal meat facilities include microbial testing for generic Escherichia coli to verify effectiveness of the processor's dressing procedure, specific testing of ground meat for E. coli O157:H7, with zero tolerance for this organism in the tested lot, and Salmonella testing of raw products. Health Canada's policy on Listeria monocytogenes divides ready-to-eat products into three risk categories, with products previously implicated as the source of an outbreak receiving the highest priority for inspection and compliance. A national mandatory identification program to track livestock from the herd of origin to carcass inspection has been established. Can-Trace, a data standard for all food commodities, has been designed to facilitate tracking foods from the point of origin to the consumer. Although much work has already been done, a coherent national food safety strategy and concerted efforts by all stakeholders are needed to realize this vision. Cooperation of many government agencies with shared responsibility for food safety and public health will be essential.     

Utilization of positive deviance analysis in evaluating community-based nutrition programs: an application to the Dular program in Bihar, India

BACKGROUND: Positive deviance is increasingly employed in international development activities to permit the utilization of proven local solutions. Including positive deviance methods in evaluation analysis, particularly in places like Bihar, India, where the rates of child underweight hover at 55%, can help identify project activities and household characteristics that affect key outcomes. These can, in turn, inform decision-making regarding the intensification of particularly promising activities. OBJECTIVES: To apply positive deviance analysis to the Dular program in Bihar, a community-based nutrition program that seeks to improve the impact of India's Integrated Child Development Services on young children. METHODS: In order to assure that desired program outcomes were not dependent on higher economic status, the analysis isolated a subset of program beneficiaries--the poorest children with the best nutritional outcomes--and examined the behavioral and project factors that may have brought about positive results in this subgroup. The data for this analysis were drawn from a 2005 program evaluation with a sample of 1,560 children. RESULTS: The analysis found that positive deviant children with normal nutritional status in the poorest 50% of Dular households were introduced to complementary food almost 2 months earlier (7.18 vs. 9.02 months of age) than severely malnourished children, were more than twice as likely to use soap for handwashing after defecation (25.0% vs. 11.8%), and were more than seven times as likely to have literate mothers (25.0% vs. 3.5%). CONCLUSIONS: The analysis suggests that programmatic efforts relating to these activities have been particularly effective and may well deserve increased investment.     

Risk factors for moderate to severe anemia among children in Benin and Mali: insights from a multilevel analysis

BACKGROUND: Anemia currently affects 2 billion people throughout the world. Although the immediate causes of anemia among children are known (including malnutrition and infections), the importance of contextual determinants and their relationships with individual effects have rarely been explored. OBJECTIVE: To identify anemia risk factors at the individual, household, and community levels among Beninese and Malian children, using simple and multilevel regression methods. METHODS: An analysis was undertaken of nationally representative data collected in 2001 in Benin (n = 2,284) and Mali (n = 2,826) by the Demographic and Health Surveys. Sixteen potential risk factors for anemia were considered at the individual, household, and community levels. Comparative analyses were carried out using simple and multilevel logistic regression models. RESULTS: Simple and multilevel logistic regression analyses yielded broadly similar results. Risk factors for moderate to severe anemia included incomplete immunization, stunted growth, recent infection, absence of bednet, low household living standard, rural residency (Mali), low maternal education, and low community development index (Benin). In addition, multilevel analysis indicated a clustering level of anemia in communities (intraclass correlation) of 14% and 19% in Benin and Mali, respectively. CONCLUSIONS: Risk factors for child anemia appeared at all three levels (individual, household and community). Community-level clustering seemed to be low. Therefore, interventions to address anemia need not be village- or region-specific. Identifying a successful and replicable program is now a priority in child survival endeavors. It is likely that such a program would include a focus on improving immunization coverage, increased bednet usage, and reduced protein-energy malnutrition.     

Women's empowerment and domestic violence: the role of sociocultural determinants in maternal and child undernutrition in tribal and rural communities in South India

BACKGROUND: Moderate malnutrition continues to affect 46% of children under five years of age and 47% of rural women in India. Women's lack of empowerment is believed to be an important factor in the persistent prevalence of malnutrition. In India, women's empowerment often varies by community, with tribes sometimes being the most progressive. OBJECTIVE: To explore the relationship between women's empowerment, maternal nutritional status, and the nutritional status of their children aged 6 to 24 months in rural and tribal communities. METHODS: This study in rural Karnataka, India, included tribal and rural subjects and used both qualitative and quantitative methods of data collection. Structured interviews with mothers were performed and anthropometric measurements were obtained for 820 mother-child pairs. The data were analyzed by multivariate and logistic regression. RESULTS: Some degree of malnutrition was seen in 83.5% of children and 72.4% of mothers in the sample. Biological variables explained most of the variance in nutritional status, followed by health-care seeking and women's empowerment variables; socioeconomic variables explained the least amount of variance. Women's empowerment variables were significantly associated with child nutrition and explained 5.6% of the variance in the sample. Maternal experience of psychological abuse and sexual coercion increased the risk of malnutrition in mothers and children. Domestic violence was experienced by 34% of mothers in the sample. CONCLUSIONS: In addition to the known investments needed to reduce malnutrition, improving women's nutrition, promoting gender equality, empowering women, and ending violence against women could further reduce the prevalence of malnutrition in this segment of the Indian population.     

Dietary and physical activity patterns of 8- to 10-year-old urban schoolchildren in Manila,Philippines

This report is the second part of a study on the nutrition of urban schoolchildren in the city of Manila; the first part was on nutritional status. The primary purpose of the study was to gather data that will assist authorities in planning and implementing nutrition education programs focused on the growing problem of obesity and overweight in children. The study included 1,208 children 8 to 10 years of age, who were randomly selected from all public and private schools in the city of Manila. Data on the children's dietary and physical activity patterns, together with information on nutrition-related knowledge, attitudes, and preferences of the children and their parents, were gathered by interviews and self-administered questionnaires. There were distinct differences in dietary and physical activity patterns between the two groups of children. Children from private schools, who are generally of higher socioeconomic status than those from public schools, tended to consume more total food, more animal foods, fats, and oils, and more beverages, resulting in higher intakes of calories, protein, iron, and vitamin A than public schoolchildren. Moreover, children from private schools were apparently less physically active, were more likely to be driven to school instead of walking, and were more likely to prefer television and computer games over outdoor games. These differences agree with an earlier report on the nutritional status of the children as determined by anthropometry, which showed a higher proportion of overnutrition and a lower proportion of undernutrition among private schoolchildren than among public schoolchildren. Although the emphasis in public schools should be on prevention and control of undernutrition in children, private schools should begin to look at the emerging problem of overnutrition and the role of physical activity programs in the health of children. The information on the knowledge, attitudes, and preferences of the children and their parents showed that parents or guardians, teachers, and television influence the nutritional practices of schoolchildren. These groups should therefore be the major targets for nutrition education programs meant to improve the nutrition and health of schoolchildren.     

Community assessment of availability, consumption, and cultural acceptability of food sources of (pro)vitamin A: toward the development of a dietary intervention among preschool children in rural Burkina Faso

BACKGROUND: Vitamin A deficiency remains a public health problem in Burkina Faso and elsewhere in the developing world. Dietary diversification is a promising strategy that needs to be explored to strengthen the country's ongoing supplementation program. OBJECTIVE: The purpose of this study was to identify locally available and acceptable (pro)vitamin A-rich foods to be included in a dietary intervention addressing vitamin A deficiency in children aged six months to three years. METHODS: A food ethnographic study combining recall methods, observation, and focused group discussion was conducted in the dry and rainy seasons. Thirty-five mother-child pairs were randomly selected and included in the study. RESULTS: The dietary pattern of children was characterized by low diversity with extremely low energy and vitamin A intake in both seasons. The study identified the availability of numerous (pro)vitamin A-rich foods, but these foods are either not consumed or consumed by few in low amounts and/or in low frequencies. The main constraining factors identified are related to financial accessibility (for liver), seasonal availability (for egg, milk, mango, papaya, and green leafy vegetables), and beliefs related to consumption and preparation (for green leafy vegetables). However, the study also revealed that the study population associated all identified (pro)vitamin A-rich foods with positive attributes such as health, strength, and vitamin richness, which might offer an entry point for designing and implementing dietary interventions. CONCLUSIONS: Based on the findings of this formative research, intervention strategies with mango and liver are proposed to improve the vitamin A intake and status of children in the rural areas of Burkina Faso.     

Fatal gaps in seed security strategy

Seed security initiatives are proliferating in both developmental and crisis contexts but the field as a whole is weak in critical thinking. Two gaps in particular are explored in this paper: the need to set explicit seed security goals and the need to ensure balance among the security elements of availability, access and quality. Differences in the planning and implementing of seed security initiatives are examined in some detail for programs that variously aim for: food production, nutritional enhancement, system resilience, and income generation. Results show that one seed security program is not like another and that features such as partner choice, product design, delivery and awareness-raising strategy need to be tailored to meet the overarching goals. The paper closes with five key policy and programming recommendations.     

Delivery of oral doses of vitamin a to prevent vitamin a deficiency and nutritional blindness

Abstract

Approximately 8 to 10 million new cases of xerophthalmia due to vitamin A deficiency occur each year, with as many as ½ to 1 million children developing potentially blinding corneal disease. While vitamin A deficiency is the leading cause of blindness among children in developing countries, even milder states of deficiency carry an increased risk of morbidity and mortality, making its prevention a major public health priority. Three basic preventive strategies exist: (1) dietary modification through a variety of horticultural and nutrition education techniques to increase the routine availability and consumption of food sources of vitamin A, (2) fortification of a centrally processed, locally available and consumed food “vehicle” with vitamin A, and (3) periodic administration of a large dose of vitamin A to specific target groups in the community. This paper provides a critical review of the effectiveness of and challenges to management in implementing periodic, large‐dose vitamin A delivery. Current evidence indicates that programs that are well supervised and sustain at least 65% coverage of their “at risk” populations can expect to have a measurable impact on the occurrence of xerophthahnia among children in the community.     

Nutrition & specialized care

We live in a time of specialized medical care. Now, patients can find myriad healthcare centers that offer state-of-the-art treatment for their particular ailments & disabilities. As therapy regimens have become more sophisticated, so has the role food & nutrition programs play in patient care. Featured on the following pages are five programs that are tailored to patients living with chemical dependencies, eating disorders, cardiovascular disease, cancer & mental illness. In each, directors & dietitians are working actively with other healthcare professionals to provide the kind of nutritional support patients need to regain their health or, in some cases, even to survive.