Women's input into household decisions and their nutritional status in three resource-constrained settings

OBJECTIVE: To understand the role of women's input into household decisions as a possible factor contributing to women's undernutrition in settings where HIV/AIDS and drought have constrained household resources. DESIGN AND SETTING: Three cross-sectional surveys of non-pregnant women in partnerships without a birth in the last 3 months were analysed. Factors associated with chronic energy deficiency (CED), defined as body mass index of<18.5 kg m(-2), were assessed among 1920 women in Zimbabwe, 2870 women in Zambia and 6219 women in Malawi. RESULTS: Prevalence of CED was 4.2% in Zimbabwe, 13.5% in Zambia and 6.7% in Malawi. In Malawi, women with less input into decisions were more likely to have CED. After multivariable adjustment, each additional decision made by the partner increased the odds of CED in Malawi by 1.08 (95% confidence interval (CI) 1.02-1.15); each additional decision made by the woman decreased the odds of CED by 0.90 (95% CI 0.88-0.97). Malawian women with all the final say or with partners with no final say had significantly more CED than expected (odds ratio (OR)=2.88, 95% CI 1.42-5.83 and OR=1.64, 95% CI 1.06-2.52, respectively), and removing these points increased the magnitude and significance of the linear trends. In Zambia, the relationship was found for urban women only and no associations were found in Zimbabwe. CONCLUSIONS: Input into household decisions may be a key factor in the cycle of drought and CED. Women with both low input and CED may lose productive capacity, putting them at greater risk of food insecurity and potentially HIV/AIDS in high prevalence settings.     

Responding to the crisis in sub-Saharan Africa: the role of nutrition

In the chapter dealing with education and health, the report of the influential Commission for Africa prioritises basic health systems, HIV/AIDS, malaria and tuberculosis. In contrast, nutrition is given less than half a page and is reduced to parasite control and micronutrient support. Such neglect of nutrition is hard to understand in the context of increasing hunger and malnutrition across the continent. Sub-Saharan Africa is the only region in the world where the proportion of underweight children has stagnated and the absolute numbers have actually increased in the last decade. It has been pointed out that if current trends continue sub-Saharan Africa will achieve the Millennium Development Goal for child mortality around 2115 - one century after the target date. Quite clearly those concerned with nutrition need to more powerfully advocate the role of nutrition in lifting Africa out of the spiral of poverty. The present paper argues that to achieve this requires an understanding not just of the critical role of nutrition for health and development (both individual and national), but also of how recent global changes are interacting with changes in food production and supply, other determinants of maternal and child health, and the role and capacity of the state to tackle malnutrition in Africa. It concludes by suggesting some responses that nutritionists could now be making.     

Studies on the nutritional status of children aged 0-5 years in a drought-affected desert area of western Rajasthan, India

OBJECTIVE: The present study was undertaken to assess the impact of drought on the nutritional status of pre-school children aged 0-5 years from a rural population in a desert area facing drought conditions very frequently. DESIGN: The sampling design for assessment was the three-stage sampling technique. SETTING: The study was carried out in 24 villages belonging to six tehsils (sub-units of district) of Jodhpur District, a drought-affected desert district of western Rajasthan, during a drought in 2003. SUBJECTS: A total of 914 children were examined at household level, with nutritional status assessed by anthropometry, dietary intake and clinical signs of nutritional deficiency. RESULTS: The results revealed growth retardation. Stunting (malnutrition of long duration) was observed in 53% of children and underweight in 60%. Wasting, an indicator of short-duration malnutrition, was present in 28% of children. The extent of malnutrition was significantly higher in girls than boys (P<0.05). Vitamin A and B complex deficiencies were found in 0.7 and 3.0% of children, respectively. Prevalence of marasmus (protein-energy malnutrition, PEM) was 1.7% (2.3% in boys and 1.1% in girls). Overall deficits in mean energy and protein intakes were very high (76 and 54%, respectively). Comparison of the present drought results with earlier studies in desert normal and desert drought conditions showed higher prevalence of PEM and higher dietary energy and protein deficiencies. CONCLUSIONS: The prevalence of wasting was high, greater than the cut-off point of 15% stated by the World Health Organization to indicate that the severity of malnutrition is critical. PEM, vitamin A and B complex deficiencies and anaemia, along with dietary deficits of energy and protein, were observed to be higher than in non-desert areas. This may be due to the harsh environmental conditions in desert areas where drought occurs quite frequently and adversely affects the economy, largely by eroding the coping capacity and economic potential of the people as a result of heavy livestock losses and reduced harvests, leading to increased poverty and poor food intake of the inhabitants. Due to inadequate consumption of daily food the children were suffering from wasting and PEM. Efforts should be made to incorporate measures, such as ensuring the supply of adequate energy and protein to all age groups and especially pre-school children, into ongoing nutrition programmes in order to improve the food security of local inhabitants in this area.     

Underweight, overweight and obesity among South African adolescents: results of the 2002 National Youth Risk Behaviour Survey

OBJECTIVE: The present paper reports the prevalence of underweight, overweight and obesity by gender, ethnicity and grade, among participants in a 2002 national survey among South African school-going youth that included height and weight measurements. DESIGN: A stratified two-stage sample was used. Nationally representative rates of underweight, overweight and obesity were calculated using weighted survey data and compared using chi2 analysis. SETTING: In all, 9224 grade 8 to grade 11 students, present at school in selected classes within selected South African government-funded schools in all nine provinces, participated in this study. Most of the students were between 13 and 19 years of age. RESULTS: Higher rates of underweight were observed for males than females as well as for black and 'coloured' than white students. Within each gender group, black and 'coloured' students had significantly higher rates of underweight than their white counterparts. Higher percentages of females than males were overweight and obese, overall and among black students. Furthermore, white male students had significantly higher rates of overweight than their black and 'coloured' counterparts. Among females, black and white students had significantly higher rates than 'coloured' students. Students in higher grades showed significantly lower rates of underweight and higher rates of overweight. DISCUSSION: These data confirm that South Africa, a developing nation in socio-economic transition, is experiencing both undernutrition and overnutrition. However, these problems are disproportionately distributed by gender, socio-economics and ethnicity. Continued surveillance of nutritional status may be one important component of a national strategy to prevent and control malnutrition.     

Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002

OBJECTIVE: To investigate the effects on maternal micronutrient status and infant growth of the increased maize prices that resulted from the southern African drought of 2001-2002. DESIGN: Longitudinal cohort study. SETTING: A maternal and child health clinic in Lusaka, Zambia. SUBJECTS: Maternal and infant health and nutrition data and maternal plasma were being collected for a study of breast-feeding and postpartum health. Samples and data were analysed according to whether they were collected before (June to December 2001), during (January 2002 to April 2003) or after (May 2003 to January 2004) the period of increased maize price. Season and maternal HIV status were controlled for in analyses. RESULTS: Maize price increases were associated with decreased maternal plasma vitamin A during pregnancy (P = 0.028) and vitamin E postpartum (P = 0.042), with the lowest values among samples collected after May 2003 (vitamin A: 0.96 micromol l(-1), 95% confidence interval (CI) 0.84-1.09, n = 38; vitamin E: 30.8 micromol mmol(-1) triglycerides, 95% CI 27.2-34.8, n = 64) compared with before January 2002 (vitamin A: 1.03 micromol l(-1), 95% CI 0.93-1.12, n = 104; vitamin E: 38.9 micromol mmol(-1) triglycerides, 95% CI 34.5-43.8, n = 47). There were no significant effects of sampling date on maternal weight, haemoglobin or acute-phase proteins and only marginal effects on infant weight. Infant length at 6 and 16 weeks of age decreased progressively throughout the study (P-values for time of data collection were 0.51 at birth, 0.051 at 6 weeks and 0.026 at 16 weeks). CONCLUSIONS: The results show modest effects of the maize price increases on maternal micronutrient status. The most serious consequence of the price increases is likely to be the increased stunting among infants whose mothers experienced high maize prices while pregnant. During periods of food shortages it might be advisable to provide micronutrient supplements even to those who are less food-insecure.     

Paternal smoking is associated with increased risk of child malnutrition among poor urban families in Indonesia

OBJECTIVE: Paternal smoking is highly prevalent in Asia, and tobacco may account for a large proportion of household expenditures among poor families. We sought to characterise the relationship between paternal smoking, child malnutrition and food expenditures. DESIGN: Data on smoking, household expenditures and child malnutrition were examined in a stratified multistage cluster sample of households in the Indonesia nutrition surveillance system. Main outcome measures were child wasting (weight-for-height Z-score < - 2), underweight (weight-for-age Z-score < - 2) and stunting (height-for-age Z-score < - 2), and severe wasting, underweight and stunting (defined by respective Z-scores < - 3). SETTING: In total, 175,583 households from urban slum areas in Indonesia. SUBJECTS: Children 0-59 months of age. RESULTS: The prevalence of paternal smoking was 73.8%. After adjusting for child gender and age, maternal age and education, and weekly per capita household expenditures, paternal smoking was associated with child stunting (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.08-1.14, P < 0.0001), severe wasting (OR = 1.17, 95% CI 1.03-1.33, P = 0.018) and severe stunting (OR = 1.09, 95% CI 1.04-1.15, P < 0.001). In households where the father was a smoker, tobacco accounted for 22% of weekly per capita household expenditures, with less money spent on food compared with households in which the father was a non-smoker. CONCLUSIONS: Among poor families in urban slum areas of Indonesia, paternal smoking diverts household money from food to tobacco and exacerbates child malnutrition.     

Effects of conservation agriculture techniques on infiltration and soil water content in Zambia and Zimbabwe

The adoption of conservation agriculture (CA), based on minimal soil movement, permanent soil cover with crop residues or growing plants and crop rotation has advanced rapidly in the Americas and Australia over the last three decades. One of the immediate benefits of CA in dryland agriculture is improved rainfall-use efficiency through increased water infiltration and decreased evaporation from the soil surface, with associated decreases in runoff and soil erosion. This paper focuses on the effect of CA techniques on soil moisture relations in two researcher-managed trials in Zambia and Zimbabwe. In 2005/2006 and 2006/2007, we found significantly higher water infiltration on both sites on CA fields compared to conventionally ploughed fields. At Henderson Research Station, Zimbabwe, on a sandy soil, a direct seeded CA treatments had a 49% and 45% greater infiltration rate than the conventionally tilled plots after a simulated rainfall in both seasons. At Monze Farmer Training Centre, Zambia, on a finer-textured soil, the same treatment had 57% and 87% greater infiltration rate than the conventionally tilled control treatment in both seasons. Treatments that included reduced tillage and surface residue retention had less water runoff and erosion on runoff plots at Henderson Research Station, Zimbabwe. On average, soil moisture was higher throughout the season in most CA treatments than in the conventionally tilled plots. However, the full potential of CA in mitigating drought was not evident as there was no significant drought period in either season. Results suggest that CA has the potential to increase the productivity of rainfall water and therefore reduce the risk of crop failure, as was apparent at the Monze Farmer Training Centre, Zambia, in 2005/2006 when a period of moisture stress at tassling affected CA treatments less than the conventionally tilled treatment.     

Excluding infants under 6 months of age from surveys: impact on prevalence of pre-school undernutrition

OBJECTIVE: Infants aged 0-5 months are not systematically included in assessments of child nutritional status and are generally excluded from surveys conducted in emergencies. We estimated the impact of excluding 0-5-month-old infants on the prevalence of stunting, wasting and underweight among children under 5 years (U5) and under 3 years (U3) of age. DESIGN: Comparison of the prevalence of stunting, wasting and underweight in U5 and U3 with or without inclusion of the age group 0-5 months. SETTING: Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 76 developing countries and countries in transition. SUBJECTS: Children under 3 or under 5 years of age included in the surveys.Results Excluding 0-5-month-old infants resulted in an overestimation of the prevalence of stunting, wasting and underweight in U5 of 3.0, 0.3 and 2.6 percentage points, respectively, and of 4.8, 1.0 and 5.2 percentage points, respectively, in U3. The overestimation for wasting was negligible. The regions showing the highest overestimations for stunting and underweight were Asia and sub-Saharan Africa. Overall, countries with high prevalences of stunting and underweight showed especially large overestimations. The prevalence of underweight in infants aged 0-5 months was correlated with the prevalence of low maternal body mass index. CONCLUSION: All surveys, even in situations of nutrition emergency, should include 0-5-month-old infants. Strictly comparable age ranges are essential in nutrition surveys for monitoring trends and evaluating programme impact. Greater awareness of prenatal and early child undernutrition is needed among policy-makers.     

Predictors of poor anthropometric status among children under 2 years of age in rural Uganda

OBJECTIVE: To assess predictors of poor anthropometric status among infants and young children.DESIGN: Cross-sectional survey.SETTING: The rural subsistence agricultural district of Hoima, western Uganda.SUBJECTS: Seven hundred and twenty children aged 0-23 months with their mothers/carers.METHODS: Participants were recruited in September 2002, using a two-stage cluster sampling methodology. A structured questionnaire was administered to mothers in their home settings. Information on health, household socio-economic status, child feeding practices and anthropometric measurement was gathered. Conditional logistic regression analysis was applied taking into account the hierarchical relationships between potential determinants of poor anthropometric status.RESULTS: The mean Z-score for weight-for-height was -0.2 (95% confidence interval (CI) -0.1, -0.7), for height-for-age was -1.1 (95% CI -1.2, -0.9) and for weight-for-age was -0.7 (95% CI -0.8, -0.6). Wasting was independently associated only with a history of fever in the 2 weeks prior to the survey (odds ratio (OR)=4.4, 95% CI 1.5, 13), while underweight was associated with a history of fever (OR=2.4, 95% CI 1.3, 4.4) and cough (OR=3.0, 95% CI 1.3, 6.8). Stunting was positively associated with a wider range of factors, including: history of a fever episode (OR=1.7, 95% CI 1.0, 2.9), lack of a latrine in the household (OR=2.7, 95% CI 1.5, 4.9), failure to de-worm children 12 months or older (OR=1.7, 95% CI 1.1, 2.8), and being born to a non-formally educated mother compared with mothers educated above primary school (OR=2.1, 95% CI 1.1, 4.0).CONCLUSIONS: In analyses guided by the hierarchical interrelationships of potential determinants of malnutrition, wasting and underweight turned out to be independently predicted by morbidity (proximal) factors. Stunting, however, was predicted by socio-economic (distal), environmental and health-care (intermediate) factors in addition to morbidity. Strategies aimed at improving the growth of infants and young children in rural communities should address morbidity due to common childhood illness coupled with environmental and socio-economically oriented measures.     

Dietary intake and body mass index in HIV-positive and HIV-negative drug abusers of Hispanic ethnicity

OBJECTIVE: Malnutrition in drug abusers has been attributed to poor diet. However, previous studies are conflicting. Many studies have not considered possible concurrent HIV disease. The purpose of this study was to determine the relationship between drug abuse and dietary intake in Hispanic Americans with and without HIV infection. DESIGN: Dietary intake was measured using 3-day food records and 24-hour dietary recalls in three groups: HIV-positive drug abusers, HIV-negative drug abusers and HIV-positive persons who do not use drugs ('non-drug abusers'). SETTING: The baseline data from a prospective cohort study of the role of drug abuse in HIV/AIDS weight loss and malnutrition conducted in Boston, Massachusetts, USA. SUBJECTS: The first 284 participants to enroll in the study. RESULTS: HIV-positive drug abusers had a body mass index (BMI) that was significantly lower than that of HIV-positive non-drug abusers. Reported energy, fat and fibre intakes did not differ between groups. All groups had median reported intakes of vitamin A, vitamin B6, vitamin B12, selenium and zinc that were in excess of the dietary reference values (DRI). Intakes of alpha-tocopherol were below the DRI, but did not differ from intakes of the general US population. However, increasing levels of drug abuse were associated with lower reported intakes of vitamin B6, vitamin B12, selenium and zinc. CONCLUSIONS: Overall, this study does not support the notion that dietary intake can explain the lower BMI of HIV-positive drug abusers. Further studies examining non-dietary determinants of nutritional status in drug abusers are warranted.     

The humanitarian emergency in Burundi: evaluation of the operational strategy for management of nutritional crisis

OBJECTIVE: To evaluate the impact and appropriateness of programmes for the management and treatment of severe malnutrition in emergency situations. DESIGN: A central unified database was set up with all data and statistics provided by nutritional centres (NC) active in Burundi. SETTING: The paper describes the case of Burundi as an example of the response of the humanitarian community to nutritional crisis. SUBJECTS: Since 1999, more than one million (1,054,210) severely malnourished patients were treated in NC established in Burundi. RESULTS: Peaks of beneficiaries were registered in 2000 and 2001; the admission rate started to decrease in 2002. In 2004, twenty therapeutic feeding centres (TFC) and 224 supplementary feeding centres (SFC) were active for the treatment of 127,420 beneficiaries. Nutritional programmes were present in every province with a coverage rate of 55%. The most convincing impact of the nutritional programme in Burundi was the reduction of mortality rate in children under 5 years of age; an impact on the prevalence of acute malnutrition could not be demonstrated. Children under 5 years old accounted for 62% of beneficiaries in TFC and 76% in SFC. TFC performance indicators fulfilled the minimum standards in disaster response; the performance of SFC was not so optimal with a low recovery rate (69% v. >80%) and a high non-respondent rate (16% v. <5%). With the combination of coverage and cure rate, the programme met 44% of the assessed needs in 2004. CONCLUSIONS: In Burundi the stabilisation of security conditions permitted a combination of humanitarian responses ranging from emergency activities to strengthening of community-based initiatives that could correct the coverage and impact limitations.     

Community-based assessment of infant feeding practices within a programme for prevention of mother-to-child HIV transmission in rural Zimbabwe

OBJECTIVE: To describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe. DESIGN: A cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004. SETTING: The study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe. SUBJECTS: The interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women. RESULTS: Overall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10(-5)). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages. CONCLUSION: The HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.     

Malnutrition and high childhood mortality among the Onge tribe of the Andaman and Nicobar Islands

OBJECTIVES: A study was conducted among the Onge tribe of the Andaman and Nicobar Islands with the objectives of identifying demographic factors responsible for the decline in their population and assessing their nutritional status, which is an important determinant of child survival. STUDY DESIGN AND SUBJECTS: The study included estimation of indices of fertility and child mortality, and assessment of nutritional status. All individuals of the Onge community settled on Little Andaman Island were included. RESULTS: The mean total marital fertility rate was estimated to be 5.15 live births per woman and the general fertility rate was 200 live births per 1000 married-woman-years. Although the gross reproduction rate was estimated to be 2.2 female children per married woman, the net reproduction rate was only 0.9 surviving female child per married woman. The mean infant mortality rate during the past 30 years was 192.7 per 1000 live births, and the child survival rate was found to be only 53.2%. A mild to moderate degree of malnutrition was found in 85% of children of pre-school age and severe malnutrition in 10%. The Onges had low intakes of iron, vitamin A and vitamin C. All the screened Onges were found to be infested with one or more intestinal parasites. CONCLUSIONS: High childhood mortality appears to be the predominant demographic factor responsible for the decline in the Onge population. The high prevalence of undernutrition and micronutrient deficiency disorders could be important factors contributing to the high childhood mortality.     

Effectiveness of a community-based intervention to improve nutrition in young children in Senegal: a difference in difference analysis

There are few studies of community growth promotion as a means of addressing malnutrition that are based on longitudinal analysis of large-scale programmes with adequate controls to construct a counterfactual. The current study uses a difference in difference comparison of cohorts to assess the impact on the proportion of underweight children who lived in villages receiving services provided by the Senegal Nutrition Enhancement Project between 2004 and 2006. The project, designed to extend nutrition and growth promotion intervention into rural areas through non-governmental organisation service providers, significantly lowered the risk of a child having a weight more than 2 sd below international norms. The odds ratio of being underweight for children in programme villages after introduction of the intervention was 0.83 (95% CI 0.686, 1.000), after controlling for regional trends and village and household characteristics. Most measured aspects of health care and health seeking behaviour improved in the treatment relative to the control.     

Perceptions of weight and associated factors of adolescents in Jiangsu Province, China

OBJECTIVE: To describe perceptions of weight of adolescents and associated factors. DESIGN: Cross-sectional survey in 2002. SETTING: Eight public middle schools in two distinct socio-economic areas of Jiangsu Province, China. SUBJECTS: Eight hundred and twenty-four adolescents (aged 12-14 years) and 628 of their parents. METHODS: Self-administered questionnaires for students and their parents were used to collect the data. Height and weight of the students were measured. RESULTS: One-third of the girls perceived themselves as overweight, while only 8.9% were actually overweight or obese according to the World Health Organization definition. On the other hand, 15.0% of the girls considered themselves underweight, while 5.6% were underweight according to the definition. Among the boys, one-fifth of those defined as overweight perceived their weight as normal. Furthermore, 23.9% perceived themselves as underweight when in fact only 4.9% were classified as underweight according to the definition. About one-quarter of the students dieted in the past year. Adolescents who perceived themselves to be overweight dieted and skipped breakfast more often. They also had lower intake frequencies of animal foods, Western foods and milk/yoghurt. No disparity was observed in the intake frequency of fruits and vegetables between the groups of different weight perception. Parents' weight norms seemed to favour overweight in both genders, but especially among boys. CONCLUSIONS: Both overweight and underweight concerns were common among girls, while a higher body weight was favoured by normal-weight boys and their parents. Distorted weight perceptions in adolescents, as well as dieting, are problems that need appropriate intervention.     

基于生长模拟模型的冬小麦生理过程水份胁迫影响因子效应的定量研究

A deep understanding of crop-water eco-physiological relations is the basis for quantifying plant physiological responses to soil water stress. Pot experiments were conducted to investigate the winter wheat crop-water relations under both drought and waterlogging conditions in two sequential growing seasons from 2000 to 2002, and then the data were used to develop and validate models simulating the responses of winter wheat growth to drought and waterlogging stress. Thee xperiment consisted of four treatments, waterlogging (keep 1 to 2 cm water layer depth above soil surface), control (70%-80% field capacity), light drought (40%-50% field capacity) and severe drought (30%-40% field capacity) with six replicates at five stages in the 2000-2001 growth season. Three soil water content treatments (waterlogging, control and drought) with two replicates were designed in the 2001-2002 growth season. Waterlogging and control treatments are the same as in the 2000-2001 growth season. For the drought treatment, no water was supplied and the soil moisture decreased from field capacity to wilting point. Leaf net photosynthetic rate, transpiration rate, predawn leaf water potential, soil water potential, soil water content and dry matter weight of individual organs were measured. Based on crop-water eco-physiological relations, drought and waterlogging stress factors for winter wheat growth simulation model were put forward. Drought stress factors integrated soil water availability, the sensitivity of different development stages and the difference between physiological processes (such as photosynthesis, transpiration and partitioning). The quantification of waterlogging stress factor considered different crop species, soil water status, waterlogging days and sensitivity at different growth stages. Data sets from the pot experiments revealed favorable performance reliability for the simulation sub-models with the drought and waterlogging stress factors.     

Mini Nutritional Assessment of rural elderly people in Bangladesh: the impact of demographic, socio-economic and health factors

OBJECTIVE: In stating the Millennium Development Goals, the United Nations aims to halve malnutrition around the world by 2015. Nutritional status of the elderly population in low-income countries is seldom focused upon. The present study aimed to evaluate the magnitude of malnutrition among an elderly population in rural Bangladesh. DESIGN AND SETTING: Data collection for a multidimensional cross-sectional study of community-based elderly people aged 60 years and over was conducted in a rural area in Bangladesh. SUBJECTS: Of 850 randomly selected elderly individuals, 625 participated in home interviews. Complete nutritional information was available for 457 individuals (mean age 69+/-8 years, 55% female). Nutritional status was assessed using an adapted form of the Mini Nutritional Assessment (MNA) including body mass index (BMI). Age, sex, education, household expenditure on food and self-reported health problems were investigated as potential predictors of nutritional status. RESULTS: BMI<18.5 kg m(-2), indicating chronic energy deficiency, was found in 50% of the population. MNA revealed a prevalence of 26% for protein-energy malnutrition and 62% for risk of malnutrition. Health problems rather than age had a negative impact on nutritional status. Level of education and food expenditure were directly associated with nutritional status. CONCLUSION: In order to reduce world hunger by half in the coming decade, it is important to recognise that a substantial proportion of the elderly population, particularly in low-income countries, is undernourished.     

Vitamin A deficiency and child mortality in Mozambique

BACKGROUND: In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average. OBJECTIVES: To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations. METHODS: The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD=1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births). RESULTS: In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30,000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group. DISCUSSION: Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers' training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.     

WHO 2006 child growth standards: implications for the prevalence of stunting and underweight-for-age in a birth cohort of Gabonese children in comparison to the Centers for Disease Control and Prevention 2000 growth charts and the National Center for Health Statistics 1978 growth references

OBJECTIVES: To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references. DESIGN AND SETTING: Prospective birth cohort in Lambaréné, Gabon. SUBJECTS: Two hundred and eighty-nine children from birth to 15 months of age. METHODS: Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below -2 SD of the corresponding reference median (Z score < or = -2) were classified as stunted or underweight-for-age, respectively. RESULTS: With the new WHO 2006 standards a higher proportion (4.0%) of 3-month-old infants were underweight compared with the CDC (1.0%) or the NCHS (0.7%) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20%) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months. CONCLUSIONS: The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.     

Are opportunities for vitamin A supplementation being utilised at primary health-care clinics in the Western Cape Province of South Africa?

OBJECTIVES: To determine missed opportunities and problems relating to implementation of the Vitamin A Supplementation Programme in urban and rural regions of the Western Cape Province of South Africa.MethodA cross-sectional survey was conducted at primary health-care (PHC) clinics in Cape Metropole, an urban region, and West Coast Winelands, a rural region, of the Western Cape. A purposive sample of clinics where more than 30 children were seen per day was drawn from 10 of the 11 districts in the Cape Metropole region and the two districts of the West Coast Winelands region. The number of children selected from each district was weighted in terms of population size for the two regions. At each clinic visited, the first five to 10 children seen on a day, and meeting the inclusion criteria for vitamin A supplementation (VAS) based on the vitamin A provincial policy guidelines, were selected. These included children with low birth weight (LBW), growth faltering, underweight and severe undernutrition, recurrent diarrhoea and lower respiratory tract infection (LRTI), tuberculosis, measles, HIV/AIDS and eye signs of vitamin A deficiency. Clinic records were reviewed following consultation with the PHC nurse to identify if the child required vitamin A, exit interviews were conducted with mothers/caregivers, and Road to Health Charts (RTHCs) were reviewed. At the end of the study, PHC managers were interviewed to determine if problems could be identified with the Programme. RESULTS: Forty-three of 123 (35%) and 13 of 40 (33%) of the fixed PHC clinics in the Cape Metropole and West Coast Winelands regions were visited, and a total of 300 children (234 from Cape Metropole, 66 from West Coast Winelands) with a mean (standard deviation) age of 24.3 (16.3) months and who met the inclusion criteria for VAS were selected. Of the total sample of children, 198 (66%) had multiple (i.e. more than one) indication and 102 (34%) had a single indication for VAS. There were a total of 617 indications for VAS in the two regions; 238 (39%) for growth faltering, 119 (19%) for underweight, 98 (16%) for LBW, 70 (11%) for LRTI, 51 (8%) for diarrhoea, 21 (3%) for HIV/AIDS and 20 (3%) for tuberculosis. A total of 102 (34%) of the children in the two regions received vitamin A supplements (Cape Metropole 29%; West Coast Winelands 52%). A record was made on the RTHC of 79 (77%) of the children who received VAS (Cape Metropole 76%; West Coast Winelands 79%). Twenty-four per cent of the mothers knew why their child had been given vitamin A (Cape Metropole 29%; West Coast Winelands 12%). Eleven per cent of the mothers had previously heard about the Vitamin A Supplementation Programme (Cape Metropole 12%; West Coast Winelands 6%). More than 81% of PHC managers indicated that health staff had been trained to implement the Vitamin A Supplementation Programme. The main problems identified by health staff in the two regions were lack of vitamin A capsules, inadequate training and difficulties in implementing the Programme. CONCLUSIONS: Opportunities to administer vitamin A were underutilised in both regions. Recommendations such as improving mothers' awareness of the benefits of vitamin A and training of PHC nurses were made to the provincial Department of Health and are being implemented to improve the effectiveness of the Programme.