1.  Title: Prevention of low birthweight. Author: Alam DS Source: Nestle Nutrition Workshop Series. Paediatric Programme. 2009;63:209-21; discussion 221-5, 259-68. Abstract: Globally an estimated 20 million infants are born with low birthweight (LBW), of those over 18 million are born in developing countries. These LBW infants are at a disproportionately higher risk of mortality, morbidity, poor growth, impaired psychomotor and cognitive development as immediate outcomes, and are also disadvantaged as adults due to their greater susceptibility to type 2 diabetes, hypertension and coronary heart disease. Maternal malnutrition prior to and during pregnancy manifested by low bodyweight, short stature, inadequate energy intake during pregnancy and coexisting micronutrient deficiency are considered major determinants in developing countries where the burden is too high. LBW is a multifactorial outcome and its prevention requires a lifecycle approach and interventions must be continued for several generations. So far, most interventions are targeted during pregnancy primarily due to the increased nutritional demand and aggravations of already existing inadequacy in most women. Several individually successful interventions during pregnancy include balanced protein energy supplementation, several single micro-nutrients or more recently a mix of multiple micronutrients. Nutrition education has been successful in increasing the dietary intake of pregnant women but has had no effect on LBW. The challenge is to identify a community-specific intervention package. Current evidence supports intervention during pregnancy with increased dietary intakes including promotions of foods rich in micronutrients and micronutrient supplementation, preferably with a multiple micronutrient mix. Simultaneously a culturally appropriate educational component is required to address misconceptions about diet during pregnancy and childbirth including support for healthy pregnancy with promotion of antenatal and perinatal care services. While further research is needed to identify more efficacious interventions, an urgent public health priority would be to select and implement an optimal mix of interventions to avert the immediate adverse consequences of LBW and to prevent the impending epidemic of type 2 diabetes, hypertension and coronary heart disease which are negatively associated with LBW. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | LOW BIRTH WEIGHT | PREVALENCE | INTERVENTIONS | INTRAUTERINE GROWTH RETARDATION | MATERNAL NUTRITION | FOOD SUPPLEMENTATION | VITAMINS AND MINERALS | DIET | Birth Weight | Body Weight | Physiology | Biology | Measurement | Research Methodology | Programs | Organization and Administration | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Diseases | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care Document Number: 341347 |
| 2. Title: Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa. Author: Chhagan MK; Van den Broeck J; Luabeya KK; Mpontshane N; Tucker KL; Bennish ML Source: European Journal of Clinical Nutrition. 2009 Jul;63(7):850-7. Abstract: BACKGROUND/OBJECTIVE: The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children. METHODS: We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6-24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting. RESULTS: We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children. CONCLUSIONS: Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | DOUBLE-BLIND STUDIES | INFANT | DIARRHEA, INFANTILE | INCIDENCE | HIV INFECTIONS | FOOD SUPPLEMENTATION | ZINC | VITAMIN A | VITAMINS AND MINERALS | ANTHROPOMETRY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diarrhea | Diseases | Measurement | Viral Diseases | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Metals | Physiology | Biology Document Number: 342462 |
| 3. Title: Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal. Author: Christian P; Khatry SK; Leclerq SC; Dali SM Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 13; Abstract: OBJECTIVE: To examine the effect of supplemental prenatal folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrients on maternal morbidity in rural Nepal. METHODS: A cluster-randomized double-masked controlled trial of pregnant women who received daily supplements from early pregnancy through 3 months post partum as per the treatment allocation. Women were interviewed at birth about labor and delivery complications and for 9 days post partum to obtain 24-hour histories of morbidity. RESULTS: A total of 3986 (97.3%) women completed an interview regarding labor and delivery; morbidity history was available for 3564 (87.0%) women. Folic acid-iron reduced the risk of postpartum hemorrhage (relative risk [RR] 0.59; 95% confidence interval [CI] 0.35-0.98). Risk of dysfunctional labor increased with multiple micronutrient supplementation (RR 1.28; 95% CI, 1.01-1.60), although preterm premature rupture of membrane decreased (RR 0.40; 95% CI, 0.21-0.79). Puerperal sepsis was lower in those receiving folic acid-iron, folic acid-iron-zinc, and multiple micronutrients compared with controls (P<0.05). CONCLUSION: Prenatal folic acid-iron supplementation reduced the risk of obstetric complications in this South Asian setting. Language: English Keywords: NEPAL | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | CHILDBIRTH | PREGNANCY COMPLICATIONS | MATERNAL NUTRITION | FOOD SUPPLEMENTATION | PUERPERAL DISORDERS | VITAMINS AND MINERALS | FOLIC ACID | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Physiology | Biology Document Number: 341459 |
| 4. Peer Reviewed Title: [Association between iron supplementation during pregnancy and prematurity, low birth weight, and very low birth weight] Associação entre o uso de sais de ferro durante a gestação e nascimento pré-termo, baixo peso ao nascer e muito baixo peso ao nascer. Author: Dal Pizzol TD; Giugliani ER; Mengue SS Source: Cadernos de Saude Publica. 2009 Jan;25(1):160-168. Abstract: The objective was to evaluate the association between prophylactic iron supplementation and prematurity and low birth weight. Pregnant women 20 years and older with 21 to 28 weeks of gestational age were enrolled consecutively in prenatal services in the Unified National Health System in six Brazilian State capitals between 1991 and 1995. Socio-demographic data and information on iron supplementation up until the 28th gestational week were obtained by means of an interview. Outcomes and other variables were collected from medical records. Anemia was present in 31.3% of the 3,865 women. Among anemic women (hemoglobin < 11.0g/dL), 29.8% were taking iron supplements, as compared to 16.7% among non-anemic women (hemoglobin > 11.0g/dL). After adjusting for potential confounders, iron was not associated with prematurity (OR = 0.88; 95%CI: 0.73-1.07), low birth weight (OR = 0.99; 95%CI: 0.75-1.31), or very low birth weight (OR = 0.58; 95%CI: 0.29-1.13). The results suggest that iron supplementation up to the 28th gestational week does not reduce the risk of prematurity, low birth weight, or very low birth weight. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | PREGNANCY | IRON | SERUM IRON LEVEL | VITAMINS AND MINERALS | LOW BIRTH WEIGHT | ANEMIA | TREATMENT | PREVENTION AND CONTROL | South America, Eastern | South America | Latin America | Americas | Developing Countries | Reproduction | Metals | Physiology | Biology | Hemic System | Birth Weight | Body Weight | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341872 |
| 5. Title: Micronutrient deficiencies in maternity and child health: a review of environmental and social context and implications for Malawi. Author: Dickinson N; Macpherson G; Hursthouse AS; Atkinson J Source: Environmental Geochemistry and Health. 2009 Apr;31(2):253-72. Abstract: It is well documented that micronutrient malnutrition is of increasing concern in the developing world, resulting in poor health and high rates of mortality and morbidity. During pregnancy, deficiency of iron and zinc can produce cognitive and growth impairment of the foetus, which may continue into infancy. Iron and zinc are essential micronutrients for both plant growth and human nutrition. Despite significant work in the areas of soil fertility, crop biofortification and dietary interventions, the problems of micronutrient deficiencies persist in Africa. There is a need to examine why communities have not embraced intervention strategies which may offer health benefits. Bottom-up, interdisciplinary approaches are required to effectively study the relationships between local communities and their environment, and to assess the impact their behaviour has on the cycling of micronutrients within the soil-plant-human system. From a detailed consideration of diverse influencing factors, a methodological model is suggested for studying the barriers to improving micronutrient uptake within rural communities. It combines environmental understanding with health and social factors, emphasising the need for and potential benefits of understanding and coherence in true interdisciplinary working. Language: English Keywords: MALAWI | CRITIQUE | RESEARCH PROPOSAL | METHODOLOGICAL STUDIES | INTERDISCIPLINARY STUDIES | STUDY DESIGN | RURAL POPULATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | INFANT | VITAMINS AND MINERALS | MATERNAL NUTRITION | INFANT NUTRITION | MALNUTRITION | SOIL DEGRADATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Youth | Age Factors | Physiology | Biology | Nutrition | Health | Nutrition Disorders | Diseases | Environmental Degradation | Environment Document Number: 341174 |
| 6. Peer Reviewed Title: Micronutrient supplementation affects maternal-infant feeding interactions and maternal distress in Bangladesh. Author: Frith AL; Naved RT; Ekstrom EC; Rasmussen KM; Frongillo EA Source: American Journal of Clinical Nutrition. 2009 Jul;90(1):141-8. Abstract: BACKGROUND: Good maternal-infant interaction is essential for optimal infant growth, health, and development. Although micronutrient malnutrition has been associated with poorer interaction, the effects of maternal micronutrient supplementation on interaction are unknown. OBJECTIVES: We examined differences in maternal-infant feeding interaction between 3 maternal pre- and postpartum micronutrient supplementation groups that differed in iron dose and inclusion of multiple micronutrients and determined whether any differences observed were mediated by maternal distress. DESIGN: A cohort of 180 pregnant women was selected from 3300 women in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk of gestation, women were randomly assigned to 1 of 3 groups to receive a daily supplement of micronutrients (14 wk gestation to 12 wk postpartum): 60 or 30 mg Fe each with 400 microg folic acid or multiple micronutrients (MuMS; 30 mg Fe, 400 microg folic acid, and other micronutrients). A maternal-infant feeding interaction was observed in the home when infants were 3.4-4.0 mo of age, and maternal distress was assessed. RESULTS: Compared with 30 mg Fe, 60 mg Fe decreased the quality of maternal-infant feeding interaction by approximately 10%. Compared with 30 mg Fe, MuMS did not improve interaction but reduced maternal early postpartum distress. Distress did not mediate the effects of micronutrient supplementation on interaction. CONCLUSION: For pregnant and postpartum women, micronutrient supplementation should be based on both nutritional variables (eg, iron status) and functional outcomes (eg, maternal-infant interaction and maternal distress). Language: English Keywords: BANGLADESH | RESEARCH REPORT | DOUBLE-BLIND STUDIES | PREGNANT WOMEN | VITAMINS AND MINERALS | FOOD SUPPLEMENTATION | BONDING | MATERNAL HEALTH | DEFICIENCY DISEASES | IRON | FOLIC ACID | ANXIETY DISORDERS | DEPRESSION | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Interpersonal Relations | Behavior | Nutrition Disorders | Diseases | Metals | Psychological Factors | Mental Disorders Document Number: 341995 |
| 7. Peer Reviewed Title: Patterns of soil-transmitted helminth infection and impact of four-monthly albendazole treatments in preschool children from semi-urban communities in Nigeria: a double-blind placebo-controlled randomised trial. Author: Kirwan P; Asaolu SO; Molloy SF; Abiona TC; Jackson AL; Holland CV Source: BMC Infectious Diseases. 2009;9:20. Abstract: BACKGROUND: Children aged between one and five years are particularly vulnerable to disease caused by soil-transmitted helminths (STH). Periodic deworming has been shown to improve growth, micronutrient status (iron and vitamin A), and motor and language development in preschool children and justifies the inclusion of this age group in deworming programmes. Our objectives were to describe the prevalence and intensity of STH infection and to investigate the effectiveness of repeated four-monthly albendazole treatments on STH infection in children aged one to four years. METHODS: The study was carried out in four semi-urban villages situated near Ile-Ife, Osun State, Nigeria. The study was a double-blind placebo-controlled randomised trial. Children aged one to four years were randomly assigned to receive either albendazole or placebo every four months for 12 months with a follow-up at 14 months. RESULTS: The results presented here revealed that 50% of the preschool children in these semi-urban communities were infected by one or more helminths, the most prevalent STH being Ascaris lumbricoides (47.6%). Our study demonstrated that repeated four-monthly anthelminthic treatments with albendazole were successful in reducing prevalence and intensity of A. lumbricoides infections. At the end of the follow-up period, 12% and 43% of the children were infected with A. lumbricoides and mean epg was 117 (S.E. 50) and 1740 (S.E. 291) in the treatment and placebo groups respectively compared to 45% and 45% of the children being infected with Ascaris and mean epg being 1095 (S.E. 237) and 1126 (S.E. 182) in the treatment and placebo group respectively at baseline. CONCLUSION: Results from this study show that the moderate prevalence and low intensity of STH infection in these preschool children necessitates systematic treatment of the children in child health programmes. Language: English Keywords: NIGERIA | RESEARCH REPORT | PREVALENCE | CHILDREN | CHILD NUTRITION | GASTROINTESTINAL EFFECTS | INFECTIONS | VITAMINS AND MINERALS | DEFICIENCY DISEASES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Physiology | Biology | Diseases | Nutrition Disorders Document Number: 330549 |
| 8. Peer Reviewed Title: Effects of maternal multimicronutrient supplementation on the mental development of infants in rural western China: follow-up evaluation of a double-blind, randomized, controlled trial. Author: Li Q; Yan H; Zeng L; Cheng Y; Liang W; Dang S; Wang Q; Tsuji I Source: Pediatrics. 2009 Apr;123(4):e685-92. Abstract: OBJECTIVE: We investigated the benefits of maternal multimicronutrient supplementation during gestation on the mental and psychomotor development of infants. METHODS: In a double-blind, randomized, controlled trial, pregnant women (N = 5828) in 2 rural counties in western China were assigned randomly to receive multimicronutrient (5 minerals and 10 vitamins at levels approximating the recommended daily allowance), folic acid plus iron, or folic acid supplementation daily from approximately 14 weeks of gestation until delivery. We assessed a subset of the newborns (N = 1305) from the 3 supplementation groups by measuring their mental and psychomotor development with the Bayley Scales of Infant Development, at 3, 6, and 12 months of age. Multilevel analyses were used to compare the mental development and psychomotor development raw scores at 3, 6, and 12 months. RESULTS: Multimicronutrient supplementation was associated with mean increases in mental development raw scores for infants at 1 year of age of 1.00 and 1.22 points, compared with folic acid only and folic acid plus iron supplementation, respectively. However, supplementation did not increase significantly the psychomotor development raw scores up to 1 year of age. CONCLUSION: Compared with iron and folic acid supplementation, the administration of multimicronutrients to pregnant women improved the mental development of their children at 1 year of age. Language: English Keywords: CHINA | RESEARCH REPORT | CLINICAL TRIALS | FOLLOW-UP STUDIES | DOUBLE-BLIND STUDIES | MULTIVARIATE ANALYSIS | RURAL POPULATION | INFANT | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | VITAMINS AND MINERALS | FOOD SUPPLEMENTATION | CHILD DEVELOPMENT | INTELLIGENCE | ANTENATAL CARE | Asia, Eastern | Asia | Developing Countries | Clinical Research | Research Methodology | Studies | Data Analysis | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Economic Development | Economic Factors | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Personality | Psychological Factors | Behavior | Maternal Health Services | Maternal-Child Health Services Document Number: 331245 |
| 9. Peer Reviewed Title: RNA viruses in community-acquired childhood pneumonia in semi-urban Nepal; a cross-sectional study. Author: Mathisen M; Strand TA; Sharma BN; Chandyo RK; Valentiner-Branth P; Basnet S; Adhikari RK; Hvidsten D; Shrestha PS; Sommerfelt H Source: BMC Medicine. 2009;7:35. Abstract: BACKGROUND: Pneumonia is among the main causes of illness and death in children <5 years of age. There is a need to better describe the epidemiology of viral community-acquired pneumonia (CAP) in developing countries. METHODS: From July 2004 to June 2007, we examined nasopharyngeal aspirates (NPA) from 2,230 cases of pneumonia (World Health Organization criteria) in children 2 to 35 months old recruited in a randomized trial of zinc supplementation at a field clinic in Bhaktapur, Nepal. The specimens were examined for respiratory syncytial virus (RSV), influenza virus type A (InfA) and B (InfB), parainfluenza virus types 1, 2 and 3 (PIV1, PIV2, and PIV3), and human metapneumovirus (hMPV) using a multiplex reverse transcriptase polymerase chain reaction (PCR) assay. RESULTS: We identified 919 virus isolates in 887 (40.0%) of the 2,219 NPA specimens with a valid PCR result, of which 334 (15.1%) yielded RSV, 164 (7.4%) InfA, 129 (5.8%) PIV3, 98 (4.4%) PIV1, 93 (4.2%) hMPV, 84 (3.8%) InfB, and 17 (0.8%) PIV2. CAP occurred in an epidemic pattern with substantial temporal variation during the three years of study. The largest peaks of pneumonia occurrence coincided with peaks of RSV infection, which occurred in epidemics during the rainy season and in winter. The monthly number of RSV infections was positively correlated with relative humidity (rs = 0.40, P = 0.01), but not with temperature or rainfall. An hMPV epidemic occurred during one of the three winter seasons and the monthly number of hMPV cases was also associated with relative humidity (rs = 0.55, P = 0.0005). CONCLUSION: Respiratory RNA viruses were detected from NPA in 40% of CAP cases in our study. The most commonly isolated viruses were RSV, InfA, and PIV3. RSV infections contributed substantially to the observed CAP epidemics. The occurrence of viral CAP in this community seemed to reflect more or less overlapping micro-epidemics with several respiratory viruses, highlighting the challenges of developing and implementing effective public health control measures. Language: English Keywords: NEPAL | RESEARCH REPORT | RANDOMIZED RESPONSE TECHNIC | CHILDREN | MORBIDITY | DEATH RATE | PNEUMONIA | VITAMINS AND MINERALS | ZINC | RESPIRATORY INFECTIONS | TREATMENT | Developing Countries | Asia, Southern | Asia | Questionnaire Design | Survey Methodology | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Mortality | Population Dynamics | Pulmonary Effects | Physiology | Biology | Metals | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342879 |
| 10. Title: Maternal MTHFR polymorphisms and risk of spontaneous abortion. Author: Rodriguez-Guillen Mdel R; Torres-Sanchez L; Chen J; Galvan-Portillo M; Blanco-Munoz J; Anaya MA; Silva-Zolezzi I; Hernandez-Valero MA; Lopez-Carrillo L Source: Salud Publica de Mexico. 2009 Jan-Feb;51(1):19-25. Abstract: OBJECTIVE: To asses the association between intake of folate and B vitamins and the incidence of spontaneous abortion (SA) according to the maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677 C>T and 1298 A>C). MATERIAL AND METHODS: We conducted a nested case-control study within a perinatal cohort of women recruited in the state of Morelos, Mexico. Twenty-three women with SA were compared to 74 women whose pregnancy survived beyond week 20th. Intake of folate and B vitamins respectively, was estimated using a validated food frequency questionnaire. Maternal MTHFR polymorphisms were determined by PCR-RFLP and serum homocysteine levels by HPLC. RESULTS: Carriers of MTHFR 677TT and 1298AC genotypes respectively showed an increased risk of SA (OR 677TT vs. CC/CT=5.0; 95% CI: 1.2, 20.9 and OR 1298 AC vs. AA=5.5; 95% CI: 1.1, 26.6). CONCLUSIONS: Our results support the role of MTHFR polymorphisms as a risk factor for SA, regardless of dietary intake of B vitamins. Language: English Keywords: MEXICO | RESEARCH REPORT | COHORT ANALYSIS | INCIDENCE | PREGNANT WOMEN | ABORTION, SPONTANEOUS | VITAMINS AND MINERALS | MATERNAL NUTRITION | RISK FACTORS | North America | Americas | Developing Countries | Research Methodology | Measurement | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Physiology | Biology | Nutrition | Health Document Number: 330500 |
| 11. Title: DMPA's effect on bone mineral density: A particular concern for adolescents. Author: Schrager SB Source: Journal of Family Practice. 2009 May;58(5):E1-8. Abstract: Discuss the potential for decreased bone mineral density in using depot-medroxyprogesterone acetate (DMPA) with any woman who is thinking of it as a means of contraception. Recommend to women that they take 1300 mg of calcium and 400 IU of vitamin D when using DMPA. Consider prescribing estrogen replacement if DMPA is going to be used for more than 2 years. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | ADOLESCENTS | MEDROXYPROGESTERONE ACETATE | SKELETAL EFFECTS | VITAMINS AND MINERALS | RISK FACTORS | RECOMMENDATIONS | Developed Countries | North America | Americas | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Physiology | Biology | Health Document Number: 341628 |
| 12. Title: International child health: state of the art. Author: Torjesen K; Olness K Source: Current Problems in Pediatric and Adolescent Health Care. 2009 Sep;39(8):192-213. Abstract: Many published articles and policies describe what should be state of the art in global child health, and there are dozens of large initiatives aimed at implementing these policies. We have knowledge of what should work, yet struggle to effectively implement that knowledge and improve child health outcomes in resource-poor settings, even at the most basic level of ensuring sufficient food and clean water for the world's children. This article highlights many smaller programs that are operational in the field, demonstrating excellence in global child health efforts, and may approach state of the art in actual implementation. The examples include a grass roots primary health care program, a home-based neonatal care program, kangaroo mother care, ready-to-use therapeutic food (RUTF), a vitamin A program, point-of-use water purification, disasters and children, a pain management program, and a developmental disabilities program. This article also discusses the importance of strengthening human resources for health by, for example, training child health professionals in low resource countries. These programs show what can be done and could be replicated in other communities to improve child health, given a few committed individuals and modest resources. Ultimately, truly state of the art health care for children must be defined locally and championed by each state or nation. Nevertheless, there are overarching components and supports that are the responsibility of the global community, particularly those needed to assure that the basic human rights of children, including health, are met throughout the world. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | CHILDREN | CHILD HEALTH | PRIMARY HEALTH CARE | ANTENATAL CARE | HUMAN RIGHTS | VITAMIN A | VITAMINS AND MINERALS | FOOD SECURITY | MALNUTRITION | WATER SUPPLY | SANITATION | PAIN | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Health Services | Delivery of Health Care | Maternal Health Services | Maternal-Child Health Services | Political Factors | Sociocultural Factors | Physiology | Biology | Food Supply | Natural Resources | Environment | Nutrition Disorders | Diseases | Public Health | Signs and Symptoms Document Number: 342519 |
| 13. Title: Effect of vitamin supplementation on breast milk concentrations of retinol, carotenoids and tocopherols in HIV-infected Tanzanian women. Author: Webb AL; Aboud S; Furtado J; Murrin C; Campos H; Fawzi WW; Villamor E Source: European Journal of Clinical Nutrition. 2009 Mar;63(3):332-9. Abstract: BACKGROUND/OBJECTIVE: The effect of daily prenatal and postnatal vitamin supplementation on concentrations of breast milk nutrients is not well characterized in HIV-infected women. We examined the impact of vitamin supplementation during pregnancy and lactation on breast milk concentrations of retinol, carotenoids and tocopherols during the first year postpartum among 626 HIV-infected Tanzanian women. SUBJECTS/METHODS: We conducted a randomized, double-blind, placebo-controlled trial. Women were assigned to one of four daily oral supplements: vitamin A+beta-carotene (VA+BC); multivitamins (MV; B, C and E); MV+VA+BC or placebo. Concentrations of breast milk nutrients were determined by high-performance liquid chromatography at birth and every 3 months thereafter. RESULTS: Supplementation with VA+BC increased concentrations of retinol, beta-carotene and alpha-carotene at delivery by 4799, 1791 and 84 nmol l(-1), respectively, compared to no VA+BC (all P<0.0001). MV supplementation did not increase concentrations of alpha-tocopherol or delta-tocopherol at delivery but significantly decreased concentrations of breast milk gamma-tocopherol and retinol. Although concentrations of all nutrients decreased significantly by 3 months postpartum, retinol, alpha-carotene and beta-carotene concentrations were significantly higher among those receiving VA+BC at 3, 6 and 12 months compared to no VA+BC. alpha-Tocopherol was significantly higher, while gamma-tocopherol concentrations were significantly lower, among women receiving MV compared to no MV at 3, 6 and 12 months postpartum. CONCLUSIONS: Sustained supplementation of HIV-infected breastfeeding mothers with MV could be a safe and effective intervention to improve vitamin E concentrations in breast milk. VA+BC supplementation increases concentrations of breast milk retinol but it is not recommended in HIV-infected mothers due to the elevated risk of vertical transmission. Language: English Keywords: TANZANIA | RESEARCH REPORT | WOMEN | PERSONS LIVING WITH HIV/AIDS | PREGNANCY | VITAMINS AND MINERALS | BREASTFEEDING | VITAMIN A | HUMAN MILK | FOOD SUPPLEMENTATION | HIV | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Reproduction | Physiology | Biology | Infant Nutrition | Nutrition | Health | Lactation | Maternal Physiology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care Document Number: 341043 |
| 14. Title: [Use of spirulina supplement for nutritional management of HIV-infected patients: study in Bangui, Central African Republic] Interet de la Spiruline chez les personnes vivant avec le VIH a Bangui (RCA). Author: Yamani E; Kaba-Mebri J; Mouala C; Gresenguet G; Rey JL Source: Medecine Tropicale. 2009 Feb;69(1):66-70. Abstract: Treatment of HIV-infected persons including nutritional management is a major concern in Africa and in particular in the Central African Republic (CAR). This six-month randomized prospective longitudinal study was carried out at the Friends of Africa Center that was a facility for comprehensive management of persons infected and affected by HIV in Banqui, CAR. The purpose of the study was to assess the impact of spirulina supplement on clinical and laboratory findings in HIV-infected patients who were not indications for ARV treatment. A total of 160 patients were randomly assigned to two groups. Patients in group 1 (n=79) received 10 grams of spirulina per day on a regular basis while patients in group 2 (n = 81) received a placebo. In addition patients in both groups received dietary products supplied by the World Food Program (WFP). Follow-up of the 160 patients at three and six months showed that 16 patients had been lost from follow-up and 16 had died, with no difference in distribution between the two groups. A significant improvement in the main follow-up criteria, i.e., weight, arm girth, number of infectious episodes, CD4 count, and protidemia, was observed in both groups. No difference was found between the two groups except with regard to protidemia and creatinemia that were higher in the group receiving spirulina supplement. From a clinical standpoint results were less clear-cut since the Karnofsky score was better in the group receiving spirulina than in the group receiving the placebo at 3 months but not at 6 months and fewer patients presented pneumonia at six months. Further study over a longer period will be needed to determine if spirulina is useful and to evaluate if higher doses can have beneficial nutritional and immunitary effects without adverse effects, in particular renal problems. Language: French Keywords: AFRICA, CENTRAL | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | VITAMINS AND MINERALS | HIV INFECTIONS | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | NUTRITION | Africa, Sub Saharan | Africa | Developing Countries | Viral Diseases | Diseases | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning Document Number: 342434 |
| 15. Peer Reviewed Title: Political insanity. Mad leadership [editorial] Source: South African Medical Journal. 2008 Jul;98(7):489. Abstract: Language: English Keywords: SOUTH AFRICA | CRITIQUE | EVALUATION | GOVERNMENT AGENCIES | IMMIGRANTS | MEDICINAL PLANTS | AIDS PREVENTION | POLITICAL FACTORS | VITAMINS AND MINERALS | ANTIRETROVIRAL THERAPY | SOCIAL DISCRIMINATION | VIOLENCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Organizations | Sociocultural Factors | Migrants | Migration | Population Dynamics | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | AIDS | HIV Infections | Viral Diseases | Diseases | Physiology | Biology | HIV | Social Problems | Behavior Document Number: 328512 |
16.  Title: Malnutrition and micronutrient deficiencies among Bhutanese refugee children - Nepal, 2007. Author: United States. Centers for Disease Control and Prevention [CDC] Source: MMWR. Morbidity and Mortality Weekly Report. 2008 Apr 11;57(14):370-373. Abstract: Acute and chronic malnutrition and micronutrient deficiencies have been found in refugee camp populations. In southeastern Nepal, despite consistent access by refugees to general rations, certain micronutrient deficiencies have posed a substantial health burden to the approximately 100,000 Bhutanese residing in seven refugee camps. Limited food diversity, frequent illness, and poor feeding practices have been cited as underlying causes of poor nutritional status in this population. Annual surveys to assess levels of acute malnutrition (i.e., wasting) and chronic malnutrition (i.e., stunting) have been conducted in these camps by the Association of Medical Doctors of Asia (AMDA) and United Nations High Commissioner for Refugees (UNHCR); however, the capacity to reliably evaluate micronutrient deficiencies has not existed locally in the camps. In January 2007, AMDA and CDC, at the request of UNHCR and the World Food Programme (WFP), conducted a nutritional survey of children aged 6-59 months, assessing 1) the prevalence of acute malnutrition, chronic malnutrition, underweight, anemia, and angular stomatitis (i.e., riboflavin deficiency); 2) the cumulative incidence of diarrhea and acute respiratory illness (ARI); and 3) the feeding practices of the children's mothers. This report describes the results of that survey, which indicated that, although acute malnutrition was found in only 4.2% of the children, chronic malnutrition was found in 26.9% and anemia in 43.3%. These findings underscore the importance of monitoring both malnutrition and micronutrient deficiencies and addressing the underlying causes of nutritional deficits. (excerpt) Language: English Keywords: NEPAL | RESEARCH REPORT | REFUGEES | CHILDREN | MALNUTRITION | VITAMINS AND MINERALS | DEFICIENCY DISEASES | AGE FACTORS | ANEMIA | DIARRHEA | Developing Countries | Asia, Southern | Asia | Migrants | Migration | Population Dynamics | Demographic Factors | Population | Youth | Population Characteristics | Nutrition Disorders | Diseases | Physiology | Biology Document Number: 325986 |
| 17. Peer Reviewed Title: Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Author: Adu-Afarwuah S; Lartey A; Brown KH; Zlotkin S; Briend A Source: American Journal of Clinical Nutrition. 2008 Apr;87(4):929-938. Abstract: Micronutrient deficiencies are common during infancy, and optimal approaches for their prevention need to be identified. The objective was to compare the efficacy and acceptability of Sprinkles (SP), crushable Nutritabs (NT), and fat-based Nutributter (NB; 108 kcal/d), which provide 6, 16, and 19 vitamins and minerals, respectively, when used for home fortification of complementary foods. Ghanaian infants were randomly assigned to receive SP (n = 105),NT (n = 105), or NB (n = 103) daily from 6 to 12 mo of age. We assessed dietary intake, morbidity, and compliance weekly. Hemoglobin and plasma ferritin, TfR, C-reactive protein, and zinc were measured at 6 and 12 mo. We used an exit interview to assess acceptability. A randomly selected control group of infants who received no intervention (NI; n = 96) were assessed at 12 mo. All supplements were well accepted, and the mean percentage of days that supplements were consumed (87%) did not differ between groups. At 12 mo, all 3 intervention groups had significantly higher ferritin and lower TfR concentrations than did the NI control group. Mean (plus or minus SD) hemoglobin was significantly higher in NT (112 plus or minus 14 g/L) and NB (114 plus or minus 14 g/L) but not in SP (110 plus or minus 14 g/L) infants than in NI infants (106 plus or minus 14 g/L). The prevalence of iron deficiency anemia was 31% in the NI control group compared with 10% in the intervention groups combined (P less than 0.0001). All 3 options for home fortification of complementary foods are effective for reducing the prevalence of iron deficiency in such populations. (author's) Language: English Keywords: GHANA | RESEARCH REPORT | INFANT | VITAMINS AND MINERALS | IRON | DEFICIENCY DISEASES | INTERVENTIONS | PREVENTION AND CONTROL | TREATMENT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Metals | Nutrition Disorders | Diseases | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 325933 |
| 18. Peer Reviewed Title: What works? Interventions for maternal and child undernutrition and survival. Author: Bhutta ZA; Ahmed T; Black RE; Cousens S; Dewey K Source: Lancet. 2008 Feb 2;371(9610):417-440. Abstract: We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment. (author's) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | CLINICAL RESEARCH | PREGNANT WOMEN | INFANT | MOTHERS | WOMEN IN DEVELOPMENT | MATERNAL-CHILD HEALTH SERVICES | MATERNAL NUTRITION | INFANT NUTRITION | MALNUTRITION | VITAMINS AND MINERALS | FOOD SUPPLEMENTATION | CHILD SURVIVAL | BREASTFEEDING | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Economic Development | Economic Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Nutrition | Nutrition Disorders | Diseases | Physiology | Biology | Nutrition Programs | Survivorship | Length of Life | Mortality | Population Dynamics Document Number: 324320 |
| 19. Title: The effect of maternal micronutrient supplementation on early neonatal morbidity in rural Nepal: a randomised, controlled, community trial. Author: Christian P; Darmstadt GL; Wu L; Khatry SK; Leclerq SC Source: Archives of Disease in Childhood. 2008 Aug;93(8):660-4. Abstract: OBJECTIVE: Micronutrient deficiencies during pregnancy may be linked to poor newborn health and poor host defences against infection. We assessed newborn morbidity to determine the effect of four combinations of antenatal micronutrient supplements. DESIGN: Cluster-randomised, double-masked, controlled trial. SETTING: Rural community in Nepal. INTERVENTIONS: Women received daily supplements from early pregnancy through to 3 months postpartum of vitamin A alone (control) or vitamin A with folic acid, folic acid plus iron, folic acid plus iron plus zinc or a multiple micronutrient supplement containing these and 11 other nutrients. MAIN OUTCOME MEASURES: Infants were visited in their home at birth (n = 3927) and for each of 9 days thereafter to elicit a 24-h history of nine infant morbidity symptoms, measure infant respiratory rate and axial temperature, and assess the infant for chest indrawing. At 6 weeks of age, infants were visited again in their homes to elicit a 30-day and 7-day history of 10 morbidity symptoms using parental recall. RESULTS: Maternal micronutrient supplementation had no effect on 10-day morbidity or morbidity 30-day and 7-day morbidity assessed at 6 weeks of age all relative risks were close to 1. Symptoms of birth asphyxia increased by about 60% (p<0.05) in infants of women who received the multiple micronutrient supplement compared with the control. Symptoms of combinations of sepsis, preterm and birth asphyxia were associated with 8- to 14-fold increased odds of 6-month infant mortality. CONCLUSIONS: None of the combinations of antenatal micronutrient supplements tested improved symptoms of neonatal morbidity in the first 10 days of life or at 6 weeks of age. Further research is needed to elucidate the association and mechanism of increased risk of birth asphyxia following maternal multiple micronutrient supplementation. Trial registration numbers: NCT00115271. Language: English Keywords: NEPAL | RESEARCH REPORT | CONTROL GROUPS | RURAL POPULATION | PREGNANT WOMEN | INFANT | VITAMINS AND MINERALS | ANTENATAL CARE | PREGNANCY OUTCOMES | CHILD HEALTH | SIGNS AND SYMPTOMS | Developing Countries | Asia, Southern | Asia | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Physiology | Biology | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Diseases Document Number: 328438 |
| 20. Peer Reviewed Title: [Effectiveness of weekly iron supplementation on hemoglobin concentration, nutritional status and development of infants of public daycare centers in Recife, Pernambuco State, Brazil] Efetividade da suplementacao semanal com ferro sobre a concentracao de Author: Eickmann SH; Brito CM; Lira PI; Lima MC Source: Cadernos de Saude Publica. 2008;24 Suppl 2:S303-11. Abstract: This study analyzed the effectiveness of weekly iron supplementation on hemoglobin concentration, nutritional status, and mental and motor development of infants at four public daycare centers in Recife, Pernambuco State, Brazil. This was a before-after intervention study conducted with weekly iron supplementation for six months in a sample of 76 infants in the 4 to 24 month age group, from February to December 2005. Mental and motor development was assessed through the Bayley Scale of Infant Development II. After supplementation, a significant increase was observed in hemoglobin concentration in the group of infants with initial hemoglobin level < or = 9.5g/dL (p = 0.001). There was also a significant increase in the mean weight-for-length z-score, but the opposite was found for length-for-age. No difference was observed in the developmental indices. We conclude that weekly iron supplementation was effective for increasing hemoglobin concentration in infants with lower initial levels, but no impact on infant development was observed. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | CONTRACEPTIVE USE-EFFECTIVENESS | NUTRITION INDEXES | INFANT | INFANT HEALTH | IRON | VITAMINS AND MINERALS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Contraceptive Effectiveness | Contraception | Family Planning | Nutrition | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Health | Metals | Physiology | Biology Document Number: 330118 |
| 21. Title: Aetiological factors and perception of anaemia in Tunisian women of reproductive age. Author: El Ati J; Lefevre P; Beji C; Ben Rayana C; Gaigi S; Delpeuch F Source: Public Health Nutrition. 2008 Jul;11(7):729-36. Abstract: OBJECTIVES: To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia. DESIGN: Two cross-sectional surveys and sixteen focus group discussions. SETTING: The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW). SUBJECTS: Two representative samples of 687 (GT) and 729 (SW) women of reproductive age; 108 women were included in focus group discussions. RESULTS: Among anaemic women, 63.4% in the GT region and 80.2% in the SW displayed iron deficiency (ID). Genetic haemoglobinopathies accounted for 10.0% and 3.6% of the cases of anaemia in the two regions, respectively. After adjustment for confounders, the major factors for iron-deficiency anaemia were low dietary Fe intake (OR = 5.0, 95% CI 3.0, 8.4), drinking tea after eating (OR = 3.4, 95% CI 2.0, 5.7) and pica (OR = 2.1, 95% CI 1.1, 3.9). Most of the women related anaemia to the following causes: malnutrition, lack of hygiene, and their heavy workload and responsibilities in the household. Many women connected anaemia with hypotension. Few established a relationship between ID and anaemia. They had confidence in their doctor for treatment, but many complained they were not given sufficient information. Low dietary Fe intake, inappropriate food practices and inadequate perceptions contribute to the aetiology of anaemia in women. CONCLUSIONS: These results point out to the need for a strategy combining food fortification, Fe supplementation for pregnant women, nutritional education for the general public and at-risk specific target groups, and training of health professionals. Language: English Keywords: TUNISIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | FOCUS GROUPS | WOMEN | PERCEPTION | ATTITUDES | ANEMIA | NUTRITION DISORDERS | VITAMINS AND MINERALS | REPRODUCTIVE AGE | Developing Countries | Africa, North | Africa | Research Methodology | Data Collection | Demographic Factors | Population | Psychological Factors | Behavior | Diseases | Physiology | Biology | Reproduction Document Number: 328818 |
| 22. Peer Reviewed Title: Dihydrofolate reductase I164L mutations in Plasmodium falciparum isolates: Clinical outcome of 14 Kenyan adults infected with parasites harbouring the I164L mutation. Author: Hamel MJ; Poe A; Bloland P; McCollum A; Zhou Z Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Apr;102(4):338-345. Abstract: Recently, Plasmodium falciparum bearing dihydrofolate reductase (DHFR) I164L was isolated from Africa. Quadruple mutations containing I164L confer high-level resistance to antifolate antimalarials. We prospectively measured the effect of co-trimoxazole (CTX) prophylaxis on P. falciparum antifolate resistance development among HIV-infected persons. HIV-positive patients with CD4 cell count less than 350 cells/microl (n = 692) received CTX; HIV-positive patients with CD4 cell count greater than or equal to 350 cells/microl (n = 336) and HIV-negative patients (n = 132) received multivitamins. Malaria microscopy-positive samples (n = 413) and selected microscopy-negative/PCR-positive samples (n = 76) were analysed for DHFR mutations at baseline and during six months follow up. We identified I164L in 14 patients. Seven were malaria microscopy-positive: two failed sulfadoxine-pyrimethamine (SP). Among seven microscopynegative/ PCR-positive patients, none developed patent infections with I164L. I164L wasnot associated with high-level SP resistance or poor outcome among adults living where malaria is highly endemic. Surveillance to monitor spread of I164L is critical, especially among children and pregnant women, who are potentially a source for I164L amplification. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | ADULTS | PERSONS LIVING WITH HIV/AIDS | PARASITES | MALARIA | ANTIMALARIAL DRUGS | DRUG RESISTANCE | VITAMINS AND MINERALS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Biology | Parasitic Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology Document Number: 325272 |
| 23. Title: Micronutrient supplementation in pregnancy in developing countries [editorial] Author: Hiremath G Source: BMJ. 2008;337:a1942. Abstract: Micronutritional interventions clearly have a major role in improving women's health, pregnancy, birth outcomes, and child survival. Future endeavours must focus on carefully designed nutritional research that could help elucidate the mechanisms by which micronutrients exert beneficial effects and increase our understanding of the interactions between micronutrients that influence their bioavailability. Prospective high quality community trials should look at the influence of maternal nutritional status on pregnancy and perinatal outcomes. They should also focus on identifying the optimal micronutritional approach (supplementation with single or multiple micronutrients) in representative populations and inform local policies. In due course, the effectiveness of these approaches should be tested at the community level. Ultimately, long term efforts should involve a multidimensional approach to bring about a global improvement in women's health, precipitate social changes, and bridge cultural gaps. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | SUMMARY REPORT | PREGNANT WOMEN | MATERNAL NUTRITION | VITAMINS AND MINERALS | IRON | FOLIC ACID | WOMEN'S HEALTH | MATERNAL HEALTH | INTERVENTIONS | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Physiology | Biology | Metals | Programs | Organization and Administration Document Number: 330122 |
| 24. Title: Low serum vitamin B12 is associated with recurrent pregnancy loss in Syrian women. Author: Hubner U; Alwan A; Jouma M; Tabbaa M; Schorr H; Herrmann W Source: Clinical Chemistry and Laboratory Medicine. 2008;46(9):1265-9. Abstract: BACKGROUND: Hyperhomocysteinemia and B-vitamin deficiency are associated with recurrent abortion. Recent studies have not investigated functional markers of vitamin B12 deficiency, such as methylmalonic acid. METHODS: A total of 43 consecutive Syrian women with unexplained recurrent abortion and 32 pregnant controls were enrolled in the study. Serum folate, vitamin B12, methylmalonic acid and plasma homocysteine were determined. RESULTS: Vitamin B12 was significantly decreased in patients with recurrent abortion compared to controls (mean concentrations 197 vs. 300 pg/mL, p=0.004). The lowest mean serum vitamin B12 (172 pg/mL) was observed in primary aborters. Homocysteine was elevated in aborters in comparison to controls (8.3 vs. 7.1 micromol/L, p=0.093). Folate and methylmalonic acid did not differ significantly between the study groups. A highly significant correlation between homocysteine and methylmalonic acid and vitamin B12 was observed only in patients but not in controls (p<0.001 and p=0.002, respectively). In the logistic regression model, only serum vitamin B12 emerged with a significant odds ratio. CONCLUSIONS: The results confirm low serum vitamin B12 in recurrent abortion patients. However, methylmalonic acid did not support that functional vitamin B12 plays a role in this group. This unexpected result might be due to a decrease of the metabolically inert vitamin B12 fraction (holohaptocorrin) or confounding factors. Further studies are necessary to investigate the role of vitamin B12 deficiency in recurrent abortion. Language: English Keywords: SYRIA | RESEARCH REPORT | WOMEN | PREGNANT WOMEN | FETAL DEATH | VITAMINS AND MINERALS | ABORTION, SPONTANEOUS | Middle East | Developing Countries | Demographic Factors | Population | Population Characteristics | Mortality | Population Dynamics | Physiology | Biology | Pregnancy Complications | Diseases Document Number: 329297 |
| 25. Peer Reviewed Title: Effect of pregnancy on totalantioxidant capacity in Nigerian women. Author: Idogun ES; Odiegwu ME; Momoh SM; Okonofua FE Source: Pakistan Journal of Medical Sciences. 2008 Apr-Jun;24 Pt 1(2):292-295. Abstract: The objective was to assess the total antioxidant capacity during the 3rd trimester of normal pregnancy with the aim of establishing the status of total antioxidant capacity (TAC) in pregnant Nigerians. The subjects consisted of 20 pregnant Nigerian women and 20 non-pregnant women. The cases were age matched with the controls. Total antioxidant capacity was assayed in both the cases and controls using standard methods of total antioxidant capacity assay. The total antioxidant capacity was lower in the pregnant women 0.84mmol/L compared with the controls 1.00mmol/L, P = 0.007 't' test. We observed low total antioxidant capacity in Nigerian women with normal pregnancy. This preliminary report, calls for further investigations. (author's) Language: English Keywords: NIGERIA | RESEARCH REPORT | CASE CONTROL STUDIES | PREGNANT WOMEN | LABORATORY EXAMINATIONS AND DIAGNOSES | PREGNANCY, THIRD TRIMESTER | VITAMINS AND MINERALS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Physiology | Biology Document Number: 327272 |
| 26. Peer Reviewed Title: Micronutrients and anaemia. Author: Jamil KM; Rahman AS; Bardhan PK; Khan AI; Chowdhury F; Sarker SA; Khan AM; Ahmed T Source: Journal of Health, Population, and Nutrition. 2008 Sep;26(3):340-355. Abstract: Micronutrient deficiencies and anaemia remain as major health concerns for children in Bangladesh. Among the micronutrient interventions, supplementation with vitamin A to children aged less than five years has been the most successful, especially after distribution of vitamin A was combined with National Immunization Days. Although salt sold in Bangladesh is intended to contain iodine, much of the salt does not contain iodine, and iodine deficiency continues to be common. Anaemia similarly is common among all population groups and has shown no sign of improvement even when iron-supplementation programmes have been attempted. It appears that many other causes contribute to anaemia in addition to iron deficiency. Zinc deficiency is a key micronutrient deficiency and is covered in a separate paper because of its importance among new child-health interventions. Language: English Keywords: BANGLADESH | RESEARCH REPORT | INTERVENTIONS | CHILDREN | VITAMINS AND MINERALS | ANEMIA | SERUM IRON LEVEL | DEFICIENCY DISEASES | VITAMIN A | MALNUTRITION | CHILD NUTRITION | Developing Countries | Asia, Southern | Asia | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Diseases | Hemic System | Nutrition Disorders | Nutrition | Health Document Number: 328661 |
| 27. Peer Reviewed Title: Micronutrient supplementation has limited effects on intestinal infectious disease and mortality in a Zambian population of mixed HIV status: a cluster randomized trial. Author: Kelly P; Katubulushi M; Todd J; Banda R; Yambayamba V; Fwoloshi M; Zulu I; Kafwembe E; Yavwa F; Sanderson IR; Tomkins A Source: American Journal of Clinical Nutrition. 2008 Oct;88(4):1010-7. Abstract: BACKGROUND: Diarrheal disease remains a major contributor to morbidity and mortality in Africa, but host defense against intestinal infection is poorly understood and may depend on nutritional status. OBJECTIVE: To test the hypothesis that defense against intestinal infection depends on micronutrient status, we undertook a randomized controlled trial of multiple micronutrient supplementation in a population where there is borderline micronutrient deficiency. DESIGN: All consenting adults (> or =18 y) living in a carefully defined sector of Misisi, Lusaka, Zambia, were included in a cluster-randomized (by household), double-blind, placebo-controlled trial with a midpoint crossover. There were no exclusion criteria. Participants were given a daily tablet containing 15 micronutrients at just above the recommended nutrient intake or placebo. The primary endpoint was the incidence of diarrhea; secondary endpoints were severe episodes of diarrhea, respiratory infection, nutritional status, CD4 count, and mortality. RESULTS: Five hundred participants were recruited and followed up for 3.3 y (10,846 person-months). The primary endpoint, incidence of diarrhea (1.4 episodes/y per person), did not differ with treatment allocation. However, severe episodes of diarrhea were reduced in the supplementation group (odds ratio: 0.50; 95% CI: 0.26, 0.92; P = 0.017). Mortality was reduced in HIV-positive participants from 12 with placebo to 4 with supplementation (P = 0.029 by log-rank test), but this was not due to changes in CD4 count or nutritional status. CONCLUSION: Micronutrient supplementation with this formulation resulted in only modest reductions in severe diarrhea and reduced mortality in HIV-positive participants. The trial was registered as ISRCTN31173864. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | EPIDEMIOLOGIC METHODS | PERSONS LIVING WITH HIV/AIDS | ADULTS | VITAMINS AND MINERALS | FOOD SUPPLEMENTATION | GASTROINTESTINAL EFFECTS | DEATH RATE | DIARRHEA | COMPLICATIONS | DEFICIENCY DISEASES | PREVALENCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Age Factors | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Nutrition Disorders | Measurement Document Number: 329081 |
| 28. Peer Reviewed Title: Newborn vitamin A supplementation reduced infant mortality in rural Bangladesh. Author: Klemm RD; Labrique AB; Christian P; Rashid M; Shamim AA Source: Pediatrics. 2008 Jul 1;122(1):e242-e250. Abstract: OBJECTIVES. We assessed the effect of supplementing newborns with 50 000 IU of vitamin A on all-cause infant mortality through 24 weeks of age. PATIENTS AND METHODS. This was a community-based, double-masked, cluster-randomized, placebo-controlled trial conducted in 19 unions in rural northwest Bangladesh. The study was nested into and balanced across treatment arms of an ongoing placebo-controlled, weekly maternal vitamin A or beta-carotene supplementation trial. Study-defined sectors (N = 596) were evenly randomized for newborns of participating mothers to receive a single, oral supplement of vitamin A (50 000 IU) or placebo as droplets of oil squeezed from a gelatinous capsule. Mothers provided informed consent for newborn participation at approx. 28 weeks' gestation. After birth, typically at home (where >90% of births occurred), infants were supplemented and their vital status was followed through 24 weeks of age. The main outcome measure was mortality through 24 weeks of age. RESULTS. We obtained maternal consent to dose 17 116 live-born infants (99.8% of all eligible) among whom 15 937 (93.1%) were visited to be supplemented <30 days after birth and for whom vital status at 24 weeks of age was known. Dosed infants (n = 15 902 [99.8%]) received their study supplement at a median age of 7 hours. Relative to control subjects, the risk of death in vitamin A-supplemented infants was 0.85, reflecting a 15% reduction in all-cause mortality. Protective relative risks were indistinguishable by infant gender, gestational age, birth weight, age at dosing, maternal age, parity, or across the 3 treatment arms of the maternal supplementation trial. CONCLUSIONS. Newborn vitamin A dosing improved infant survival through the first 6 months of life in Bangladesh. These results corroborate previous findings from studies in Indonesia and India and provide additional evidence that vitamin A supplementation shortly after birth can reduce infant mortality in South Asia. Language: English Keywords: BANGLADESH | RESEARCH REPORT | RURAL AREAS | COMMUNITY-BASED DISTRIBUTION | INFANT | CHILD SURVIVAL | VITAMIN A | VITAMINS AND MINERALS | ADMINISTRATION AND DOSAGE | TREATMENT | INFANT MORTALITY | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Survivorship | Length of Life | Mortality | Population Dynamics | Physiology | Biology | Drugs | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 327919 |
| 29. Peer Reviewed Title: Randomized, double-blind, placebo-controlled trial of selenium supplements among HIV-infected pregnant women in Tanzania: effects on maternal and child outcomes. Author: Kupka R; Mugusi F; Aboud S; Msamanga GI; Finkelstein JL Source: American Journal of Clinical Nutrition. 2008 Jun;87(6):1802-1808. Abstract: In observational studies, adequate selenium status has been associated with better pregnancy outcomes and slowed HIV disease progression. We investigated the effects of daily selenium supplements on CD4 cell counts, viral load, pregnancy outcomes, and maternal and infant mortality among 913 HIV-infected pregnant women. In this randomized, double-blind, placebo-controlled trial, eligible women between 12 and 27 wk of gestation were given daily selenium (200 microg as selenomethionine) or placebo as supplements from recruitment until 6 mo after delivery. All women received prenatal iron, folic acid, and multivitamin supplements irrespective of experimental assignment. The selenium regimen had no significant effect on maternal CD4 cell counts or viral load. Selenium was marginally associated with a reduced risk of low birth weight [relative risk (RR) = 0.71; 95% CI: 0.49, 1.05; P = 0.09] and increased risk of fetal death (RR = 1.58; 95% CI = 0.95, 2.63; P = 0.08), but had no effect on risk of prematurity or small-for-gestational age birth. The regimen had no significant effect on maternal mortality (RR= 1.02; 95% CI = 0.51, 2.04; P = 0.96). There was no significant effect on neonatal or overall child mortality, but selenium reduced the risk of child mortality after 6 wk (RR = 0.43; 95% CI = 0.19, 0.99; P = 0.048). Among HIV-infected women from Dar es Salaam, Tanzania, selenium supplements given during and after pregnancy did not improve HIV disease progression or pregnancy outcomes, but may improve child survival. This trial was registered at clinicaltrials.gov as NCT00197561. (author's) Language: English Keywords: TANZANIA | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | INFANT | VITAMINS AND MINERALS | HIV INFECTIONS | PREGNANCY OUTCOMES | MATERNAL NUTRITION | INFANT MORTALITY | LOW BIRTH WEIGHT | MATERNAL MORTALITY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Studies | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Physiology | Biology | Pregnancy | Reproduction | Nutrition | Health | Mortality | Population Dynamics | Birth Weight | Body Weight Document Number: 308640 |
| 30. Peer Reviewed Title: Adequacy of prenatal care as a major determinant of folic acid, iron, and vitamin intake during pregnancy. Author: Lunet N; Rodrigues T; Correia S; Barros H Source: Cadernos de Saude Publica. 2008 May;24(5):1151-1157. Abstract: This study aimed to quantify the association between adequacy of prenatal care and prevalence of folic acid, iron, and multivitamin intake during pregnancy. Data were obtained on socio-demographics, prenatal care, pregnancy complications, and use of vitamin/mineral supplements for 836 women, using a postpartum interview. Associations with the use of vitamin/mineral supplements were quantified with risk ratios (RR), computed by generalized binomial regression. A high proportion of women reported the use of folic acid (81.9%), iron (55.4%), and multivitamins (76.2%) as supplements during pregnancy. Use of supplements was independently associated with adequacy of prenatal care (adequate vs. inadequate: folic acid, RR = 2.28; 95%CI: 1.58-3.29; iron, RR = 1.99; 95%CI: 1.57-2.52, multivitamins, RR = 1.97; 95%CI: 1.54-2.51). Higher schooling was also associated with increased use of folic acid (RR = 1.42; 95%CI: 1.18-1.70), but not multivitamins (RR = 0.87; 95%CI: 0.77-0.98). Use of folic acid was less prevalent in single women (RR = 0.67; 95%CI: 0.48-0.95) and during unplanned pregnancies (RR = 0.81; 95%CI: 0.71-0.92). Adequacy of prenatal care is a major determinant of vitamin/ mineral intake during pregnancy. (author's) Language: English Keywords: PORTUGAL | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREGNANT WOMEN | ANTENATAL CARE | VITAMINS AND MINERALS | FOLIC ACID | IRON | FOOD SUPPLEMENTATION | PREVALENCE | EDUCATION | Developed Countries | Europe, Southwestern | Europe | Research Methodology | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Physiology | Biology | Metals | Nutrition Programs | Measurement Document Number: 326501 |
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