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: 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 |
| 5. Title: Effect of preventive supplementation on young children in Niger [letter] Author: Ghosh D Source: JAMA. 2009 Jun 3;301(21):2208-9; author reply 2209. Abstract: Ms Isanaka and colleagues conducted a cluster randomized trial to evaluate the effect of ready-to-use therapeutic foods on various measures of nutritional status, morbidity, and mortality in children in Niger. The cluster randomized trial design is a very useful one for this setting because of logistical constraints. However, such a design leads to analytic complications. There are 2 levels of correlation in the study that need to be accounted for in the analysis. The first is that the children were clustered within households. This is shown in Figure 1 of the article, which indicates 1671 children from 647 households in the intervention group and 1862 children from 760 households in the control group. This leads to use of mixed effects models in which correlation is accounted for at the village, household, and individual levels. However, the survival analyses are more problematic in this setting. The authors employed a marginal modeling approach, in which the population-averaged effect of treatment on the time to event was modeled, adjusting for other covariates. For this approach, the correlation at multiple levels is not accounted for in the estimation of the adjusted hazard ratios. It is instead adjusted for in the estimates of the variance of the adjusted hazard ratios, which are reflected in the estimated 95% confidence intervals presented in Tables 2 and 3. However, validity of this estimation procedure requires that the number of truly statistically independent sampling units be large. In this study, the sampling units are the villages, of which there are 12. Such a small number calls into doubt the validity of the standard errors used in computing the 95% confidence intervals in the adjusted hazard ratios in Tables 2 and 3. The issue of how to properly model survival data in a group-randomized trial setting is still very much an open question, although some recent proposals have been made. (full-text) Language: English Keywords: NIGER | CRITIQUE | CHILDREN | MALNUTRITION | FOOD SUPPLEMENTATION | PREVENTION AND CONTROL | IMPACT | PROGRAM EFFECTIVENESS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Communication | Program Evaluation | Programs | Organization and Administration Document Number: 341624 |
| 6. Peer Reviewed Title: Effect of preventive supplementation with ready-to-use therapeutic food on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger: a cluster randomized trial. Author: Isanaka S; Nombela N; Djibo A; Poupard M; Van Beckhoven D; Gaboulaud V; Guerin PJ; Grais RF Source: JAMA. 2009 Jan 21;301(3):277-85. Abstract: CONTEXT: Ready-to-use therapeutic foods (RUTFs) are an important component of effective outpatient treatment of severe wasting. However, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated. OBJECTIVE: To evaluate the effect of a 3-month distribution of RUTF on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. All children in the study villages aged 6 to 60 months were eligible for recruitment. INTERVENTION: Children with weight-for-height 80% or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF (92 g [500 kcal/d]) from August to October 2006. Children in the 6 nonintervention villages received no preventive supplementation. Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007. MAIN OUTCOME MEASURES: Changes in weight-for-height z score (WHZ) according to the World Health Organization Child Growth Standards and incidence of wasting (WHZ <-2) over 8 months of follow-up. RESULTS: The number of children with height and weight measurements in August, October, December, and February was 3166, 3110, 2936, and 3026, respectively. The WHZ difference between the intervention and nonintervention groups was -0.10 z (95% confidence interval [CI], -0.23 to 0.03) at baseline and 0.12 z (95% CI, 0.02 to 0.21) after 8 months of follow-up. The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z (95% CI, 0.13 to 0.30). The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year (140 events/841 child-years) and 0.03 events per child-year (29 events/943 child-years) in the intervention villages, compared with 0.26 events per child-year (233 events/895 child-years) and 0.07 events per child-year (71 events/1029 child-years) in the nonintervention villages. The intervention thus resulted in a 36% (95% CI, 17% to 50%; P < .001) reduction in the incidence of wasting and a 58% (95% CI, 43% to 68%; P < .001) reduction in the incidence of severe wasting. There was no reduction in mortality, with a mortality rate of 0.007 deaths per child-year (7 deaths/986 child-years) in the intervention villages and 0.016 deaths per child-year (18 deaths/1099 child-years) in the nonintervention villages (adjusted hazard ratio, 0.51; 95% CI, 0.25 to 1.05). CONCLUSION: Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00682708. Language: English Keywords: NIGER | RESEARCH REPORT | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | CHILDREN | FOOD SUPPLEMENTATION | CHILD MORTALITY | CHILD SURVIVAL | CHILD NUTRITION | PREVENTIVE HEALTH CARE | DISTRIBUTIONAL ACTIVITIES | BODY WEIGHT | GROWTH | MALNUTRITION | PREVALENCE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Survivorship | Length of Life | Nutrition | Program Activities | Programs | Organization and Administration | Physiology | Biology | Child Development | Nutrition Disorders | Diseases | Measurement Document Number: 330049 |
| 7. Title: A systematic review of randomized controlled trials of prenatal and postnatal vitamin A supplementation of HIV-infected women. Author: Kongnyuy EJ; Wiysonge CS; Shey MS Source: International Journal of Gynaecology and Obstetrics. 2009 Jan;104(1):5-8. Abstract: We searched the Cochrane Library, MEDLINE, EMBASE, AIDSearch, and Gateway to assess the effect of prenatal and/or postnatal vitamin A supplementation on the risk of mother-to-child transmission (MTCT) of HIV and other pregnancy outcomes. We included 5 trials totaling 7528 women (4 trials of prenatal and 1 trial of postnatal supplementation). Overall, there was no evidence of an effect of prenatal and/or postnatal vitamin A supplementation on the risk of MTCT of HIV (Relative Risk [RR] 1.06, 95% Confidence Interval [CI] 0.89-1.26). However, prenatal vitamin A supplementation significantly improved birth weight (weighted mean difference 89.78; 95% CI, 84.73-94.83), but there was no evidence of an effect on stillbirths (RR 0.99; 95% CI, 0.68-1.43), preterm births (RR 0.88; 95% CI, 0.65-1.19), death before 24 months among live births (RR 1.08; 95% CI, 0.91-1.29), and maternal death (RR 0.83; 95% CI, 0.59-1.17). The available evidence does not support vitamin A supplementation of HIV-infected pregnant and lactating women, despite improvement in birth weight. Language: English Keywords: AFRICA | RESEARCH REPORT | CLINICAL TRIALS | PREGNANT WOMEN | PERSONS LIVING WITH HIV/AIDS | VITAMIN A | FOOD SUPPLEMENTATION | MOTHER-TO-CHILD TRANSMISSION | RISK FACTORS | BIRTH WEIGHT | Developing Countries | Clinical Research | Research Methodology | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Vitamins and Minerals | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Transmission | Infections | Body Weight Document Number: 341390 |
| 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: Iron deficiency and child and maternal health. Author: Murray-Kolb LE; Beard JL Source: American Journal of Clinical Nutrition. 2009 Mar;89(3):946S-950S. Abstract: BACKGROUND: Iron deficiency is most commonly found in women of reproductive age and infants worldwide, but the influence of maternal iron deficiency on infant development is underexplored. OBJECTIVE: The objective was to examine the relation between maternal iron status and mother-child interactions in a randomized, double-blind, intervention trial conducted in South Africa. DESIGN: Women were recruited into the study from a health clinic at 6-8 wk postpartum and were classified as either iron-deficient anemic (IDA) or iron-sufficient after blood analysis. IDA mothers received iron supplements of 125 mg FeSO(4) (IDA-Fe; n = 34) or placebo (IDA-PL; n = 30) daily from 10 wk to 9 mo postpartum. The control group (n = 31) consisted of iron-sufficient mothers. Free-play mother-child interaction sessions were videotaped in the clinic at 10 wk (n = 80) and 9 mo (n = 66) postpartum and coded per the Emotional Availability Scales (4 maternal scales: sensitivity, structuring, nonintrusiveness, and nonhostility; 2 infant scales: responsiveness and involvement). RESULTS: At 10 wk, scores for maternal sensitivity and child responsiveness were significantly greater in the control group than in the IDA groups (P = 0.028 and 0.009, respectively). At 9 mo, the control and IDA-Fe groups no longer differed. These 2 groups scored significantly better on the maternal sensitivity, structuring, and nonhostility scales and on the child responsiveness scale than did the IDA-PL group (P = 0.007-0.032), whose iron status remained low. CONCLUSION: These data indicate that maternal iron deficiency negatively affects mother-child interactions and that iron supplementation protects against these negative effects. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | WOMEN IN DEVELOPMENT | INFANT | MOTHERS | CHILD DEVELOPMENT | SERUM IRON LEVEL | DEFICIENCY DISEASES | MATERNAL NUTRITION | FOOD SUPPLEMENTATION | ADMINISTRATION AND DOSAGE | BONDING | PARENTAL INVOLVEMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Studies | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Biology | Hemic System | Physiology | Nutrition Disorders | Diseases | Nutrition | Health | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Drugs | Treatment | Medical Procedures | Medicine | Interpersonal Relations | Behavior | Child Rearing Document Number: 330708 |
| 10. Title: Cost-effectiveness of misoprostol and prenatal iron supplementation as maternal mortality interventions in home births in rural India. Author: Sutherland T; Bishai DM Source: International Journal of Gynaecology and Obstetrics. 2009 Mar;104(3):189-93. Abstract: OBJECTIVE: To determine the cost-effectiveness of prenatal iron supplementation and misoprostol use as interventions to prevent maternal mortality in home births in rural India. METHODS: A cost-effectiveness analysis depicted three hypothetical cohorts of 10,000 pregnant women delivering at home in rural India: one with no intervention, one receiving standard prenatal iron supplements, and 1 receiving 600 microg of misoprostol in the third stage of labor. RESULTS: Misoprostol used to prevent postpartum hemorrhage resulted in a 38% (95% CI, 5%-73%) decrease in maternal deaths, while prenatal iron supplementation resulted in a 5% (95% CI, 0%-47%) decrease. Misoprostol cost a median US $1401 (IQR US $1008-$1848) prenatal iron supplementation cost a median US $2241 (IQR No Lives Saved-$3882) per life saved compared with the standard care outcome. CONCLUSION: Misoprostol is a cost-effective maternal mortality intervention for home births. Iron supplementation may be worthwhile to improve women's health, but it is uncertain whether it can prevent mortality after hemorrhage. Language: English Keywords: INDIA | RURAL AREAS | RESEARCH REPORT | STATISTICAL STUDIES | PREGNANT WOMEN | MATERNAL MORTALITY | INTERVENTIONS | MISOPROSTOL | IRON | FOOD SUPPLEMENTATION | COST EFFECTIVENESS | ANEMIA | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Studies | Research Methodology | Population Characteristics | Demographic Factors | Mortality | Population Dynamics | Programs | Organization and Administration | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Metals | Vitamins and Minerals | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Evaluation Indexes | Quantitative Evaluation | Evaluation | Diseases Document Number: 341385 |
| 11. Peer Reviewed Title: Integration of immunization services with other health interventions in the developing world: what works and why? Systematic literature review. Author: Wallace A; Dietz V; Cairns KL Source: Tropical Medicine and International Health. 2009 Jan;14(1):11-9. Abstract: OBJECTIVE: To assess benefits, challenges and characteristics of integrating child and maternal health services with immunization programmes. METHODS: Literature review using journal databases and grey literature. Papers meeting the inclusion criteria were rated for the quality of methodology and relevant information was systematically abstracted. RESULTS: Integrated services were vitamin A supplementation, bednet distribution, deworming tablet distribution, Intermittent Preventive Therapy for infants and referrals for family planning services. Two key characteristics of success were compatibility between interventions and presence of a strong immunization service prior to integration. Overburdened staff, unequal resource allocation and logistical difficulties were mentioned as risks of integration, whereas rapid uptake of the linked intervention and less competition for resources were listed as two key benefits of integration. CONCLUSION: The theoretical strengths of integrating other health services with immunization services remain to be rigorously proved in practice. When additional interventions are carefully selected for compatibility and when they receive adequate support, coverage of these interventions may improve, provided immunization coverage is already high. Evidence for the effectiveness of integration in increasing efficiency of resource use was insufficient and most benefits and challenges were not statistically quantified. More substantive information about the costs of integrated vs. vertical programmes and full documentation of the impacts of integration on immunization services should be published. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | CHILDREN | INTEGRATED PROGRAMS | IMMUNIZATION | MATERNAL-CHILD HEALTH SERVICES | VITAMIN A | FOOD SUPPLEMENTATION | BED NETS | DISTRIBUTIONAL ACTIVITIES | PARASITE CONTROL | PREVENTIVE HEALTH CARE | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Vitamins and Minerals | Physiology | Biology | Nutrition Programs | Public Health | Program Activities Document Number: 330264 |
| 12. 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 |
| 13. Title: Additional zinc delivered in a liquid supplement, but not in a fortified porridge, increased fat-free mass accrual among young Peruvian children with mild-to-moderate stunting. Author: Arsenault JE; de Romana DL; Penny MH; Van Loan MD; Brown KH Source: Journal of Nutrition. 2008 Jan;138:108-114. Abstract: The exact mechanism whereby zinc influences growth is unknown, although it has been postulated that zinc may stimulate appetite and energy intake or enhance fat-free mass (FFM) accrual directly. We compared energy intake, reported appetite, and body composition of 6- to 8-mo-old Peruvian children with initial length-for-age Z-score (LAZ) < -0.5 SD who were randomly assigned to receive daily for 6 mo: 1) 3 mg/d zinc in a liquid supplement; 2) 3 mg/d zinc in a fortified porridge; or 3) no extra zinc in either the supplement or porridge. There were no group-wise differences in changes in dietary energy intakes or body composition or in the prevalence of reported poor appetite. However, among children with an initial LAZ less than the median (-1.1 SD), those who received zinc as a liquid supplement had a 0.41 kg greater increase in FFM than those who did not receive zinc (P < 0.05). We concluded that daily provision of 3 mg of supplemental zinc did not affect energy intake or reported appetite. Among children with initial mild-to-moderate stunting, those who received the zinc supplement had a greater increase in FFM than those who did not receive additional zinc. It is possible that the growth-restricted children were more likely to be zinc deficient and that FFM accrual may be an early growth response to supplemental zinc. Zinc supplements may be more efficacious than the same dose of zinc provided in fortified food; therefore, further research is needed on the optimal level of zinc fortification that will result in improved health outcomes in populations with high rates of zinc deficiency. (author's) Language: English Keywords: PERU | RESEARCH REPORT | COMPARATIVE STUDIES | CLINICAL RESEARCH | CHILDREN | ZINC | FOOD SUPPLEMENTATION | BODY WEIGHT | GROWTH | ADMINISTRATION AND DOSAGE | South America, Western | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Metals | Vitamins and Minerals | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Child Development | Drugs | Treatment | Medical Procedures | Medicine Document Number: 323233 |
| 14. Peer Reviewed Title: The impact of Mexico's conditional cash transfer programme, Oportunidades, on birthweight. Author: Barber SL; Gertler PJ Source: Tropical Medicine and International Health. 2008 Nov;13(11):1405-14. Abstract: OBJECTIVES: To evaluate the impact of Oportunidades, a large-scale, conditional cash transfer programme in Mexico, on birthweight. The programme provides cash transfers to low-income, rural households in Mexico, conditional on accepting nutritional supplements health education, and health care. METHODS: The primary analyses used retrospective reports from 840 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Pregnant women in participating households received nutrition supplements and health care, and accepted cash transfers. Using multivariate and instrumental variable analyses, we estimated the impact of the programme on birthweight in grams and low birthweight (<2500 g), receipt of any pre-natal care, and number of pre-natal visits. RESULTS: Oportunidades beneficiary status was associated with 127.3 g higher birthweight among participating women and a 4.6 percentage point reduction in low birthweight. CONCLUSION: The Oportunidades conditional cash transfer programme improved birthweight outcomes. This finding is relevant to countries implementing conditional cash transfer programmes. Language: English Keywords: MEXICO | RESEARCH REPORT | MULTIVARIATE ANALYSIS | RETROSPECTIVE STUDIES | LOW INCOME POPULATION | RURAL POPULATION | HOUSEHOLDS | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | INCENTIVES | BIRTH WEIGHT | FOOD SUPPLEMENTATION | LOW BIRTH WEIGHT | North America | Americas | Developing Countries | Data Analysis | Research Methodology | Studies | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | Economic Development | Policy | Political Factors | Body Weight | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 330042 |
| 15. Peer Reviewed Title: Effect of 50,000 IU vitamin A given with BCG vaccine on mortality in infants in Guinea-Bissau: Randomised placebo controlled trial. Author: Benn CS; Diness BR; Roth A; Nante E; Fisker AB Source: BMJ. British Medical Journal. 2008 Jun 21;336(7658):1416-1420. Abstract: The objective of this study was to investigate the effect of high dose vitamin A supplementation given with BCG vaccine at birth in an African setting with high infant mortality. The study design was a randomised placebo controlled trial in Bandim Health Project's demographic surveillance system in Guinea-Bissau, covering approximately 90 000 inhabitants. Participants were 4345 infants due to receive BCG. Infants were randomised to 50 000 IU vitamin A or placebo and followed until age 12 months. The main outcome measure was mortality rate ratios. 174 children died during follow-up (mortality= 47/1000person-years). Vitamin A supplementation was not significantly associated with mortality; the mortality rate ratio was 1.07 (95% confidence interval 0.79 to 1.44). The effect was 1.00 (0.65 to 1.56) during the first four months and 1.13 (0.75 to 1.68) from 4 to 12 months of age. The mortality rate ratio in boyswas0.84 (0.55 to 1.27) compared with 1.39 (0.90 to 2.14) in girls (P for interaction=0.10). An explorative analysis revealed a strong interaction between vitamin A and season of administration. Vitamin A supplementation given with BCG vaccine at birth had no significant benefit in this African setting. Although little doubt exists that vitamin A supplementation reduces mortality in older children, a global recommendation of supplementation for all newborn infants may not contribute to better survival. (author's) Language: English Keywords: GUINEA-BISSAU | RESEARCH REPORT | CLINICAL TRIALS | INFANT | INFANT NUTRITION | INFANT MORTALITY | INFANT NUTRITION DISORDERS | VITAMIN A | VACCINES | FOOD SUPPLEMENTATION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Mortality | Population Dynamics | Nutrition Disorders | Diseases | Vitamins and Minerals | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Nutrition Programs | Primary Health Care Document Number: 327079 |
| 16. Peer Reviewed Title: Malnutrition and morbidity among children not reached by the national vitamin A capsule programme in urban slum areas of Indonesia. Author: Berger SG; de Pee S; Bloem MW; Halati S; Semba RD Source: Public Health. 2008 Apr;122(4):371-378. Abstract: The objective was to determine whether vitamin A capsule programmes fail to reach children who are at higher risk of malnutrition and morbidity. Although it has been suggested that there are health disparities between children who are reached or not reached by these programmes, little quantitative work has been undertaken to characterize this relationship. As part of a national surveillance system, nutritional status and other factors were compared in 138,956 children, aged 12-59 months, who had and had not received vitamin A supplementation in urban slum areas in Indonesia. In total, 63.1% of children had received a vitamin A capsule within the previous 6 months. Among children who had and had not received vitamin A supplementation, respectively, the proportion with weight-for-age and height-forage Z scores less than -3 were 7.8% vs 8.6% (P less than 0.0001) and 9.4% vs 10.7% (P less than 0.0001), and with a history of diarrhoea in the previous week was 8.1% vs 10.7% (P less than 0.0001). In families where a child had or had not received vitamin A supplementation, the proportion with a history of infant death less than 12 months was 5.2% vs 7.2% (P less than 0.0001) and child death less than 5 years was 6.7% vs 9.2%, respectively (P less than 0.0001). Children who had not received vitamin A supplementation were also significantly more likely to be anaemic and have diarrhoea or fever on the survey day compared with children who had received supplementation. In the urban slums of Indonesia, children who do not receive vitamin A supplementation tend to be slightly more malnourished and ill, and are more likely to come from families with higher child mortality than children who receive vitamin A. Higher rates of child mortality in non-participating households suggest that reaching preschoolers could yield a disproportionate survival benefit. Importantly, children who are not reached by the vitamin A programme are also unlikely to be reached by vaccination and other services, emphasizing the need to identify and extend efforts to reach non-participants. (author's) Language: English Keywords: INDONESIA | SLUMS | RESEARCH REPORT | NUTRITION SURVEYS | CHILDREN | MALNUTRITION | MORBIDITY | VITAMIN A | ANEMIA | DIARRHEA | IMMUNIZATION | FOOD SUPPLEMENTATION | Developing Countries | Asia, Southeastern | Asia | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Nutrition | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Nutrition Disorders | Diseases | Vitamins and Minerals | Physiology | Biology | Primary Health Care | Health Services | Delivery of Health Care | Nutrition Programs Document Number: 325094 |
| 17. Peer Reviewed Title: Effectiveness of zinc supplementation plus oral rehydration salts compared with oral rehydration salts alone as a treatment for acute diarrhea in a primary care setting: a cluster randomized trial. Author: Bhandari N; Mazumder S; Taneja S; Dube B; Agarwal RC; Mahalanabis D; Fontaine O; Black RE; Bhan MK Source: Pediatrics. 2008 May;121(5):e1279-85. Abstract: OBJECTIVE: The purpose of this work was to evaluate whether education about zinc supplements and provision of zinc supplements to caregivers is effective in the treatment of acute diarrhea and whether this strategy adversely affects the use of oral rehydration salts. PATIENTS AND METHODS: Six clusters of 30,000 people each in Haryana, India, were randomly assigned to intervention and control sites. Government and private providers and village health workers were trained to prescribe zinc and oral rehydration salts for use in diarrheal episodes in 1-month-old to 5-year-old children in intervention communities; in the control sites, oral rehydration salts alone was promoted. In 2 cross-sectional surveys commencing 3 months (survey 2) and 6 months (survey 3) after the start of the intervention, care-seeking behavior, drug therapy, and oral rehydration salts use during diarrhea, diarrheal and respiratory morbidity, and hospitalization rates were measured. RESULTS: In the 2 surveys, zinc was used in 36.5% (n = 1571) and 59.8% (n = 1649) and oral rehydration salts in 34.8% (n = 1571) and 59.2% (n = 1649) of diarrheal episodes occurring in the 4 weeks preceding interviews in the intervention areas. In control areas, oral rehydration salts were used in 7.8% (n = 2209) and 9.8% (n = 2609) of episodes. In the intervention communities, care seeking for diarrhea reduced by 34% (survey 3), as did the prescription of drugs of unknown identity (survey 3) and antibiotics (survey 3) for diarrhea. The 24-hour prevalences of diarrhea and acute lower respiratory infections were lower in the intervention communities (survey 3). All-cause, diarrhea, and pneumonia hospitalizations in the preceding 3 months were reduced in the intervention compared with control areas (survey 3). CONCLUSIONS: Diarrhea is more effectively treated when caregivers receive education on zinc supplementation and have ready access to supplies of oral rehydration salts and zinc, and this approach does not adversely affect the use of oral rehydration salts; in fact, it greatly increases use of the same. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | CROSS SECTIONAL ANALYSIS | CHILDREN | HEALTH PERSONNEL | COMMUNITY WORKERS | ORAL REHYDRATION | ZINC | TRAINING PROGRAMS | FOOD SUPPLEMENTATION | DIARRHEA | ANTIBIOTICS | UTILIZATION OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | Metals | Vitamins and Minerals | Physiology | Biology | Education | Nutrition Programs | Primary Health Care | Diseases | Drugs Document Number: 328041 |
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. Peer Reviewed Title: A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. Author: Cantrell RA; Sinkala M; Megazinni K; Lawson-Marriott S; Washington S; Chi BH; Tambatamba-Chapula B; Levy J; Stringer EM; Mulenga L; Stringer JS Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Oct 1;49(2):190-5. Abstract: BACKGROUND: The provision of food supplementation to food-insecure patients initiating antiretroviral therapy (ART) may improve adherence to medications. METHODS: A home-based adherence support program at 8 government clinics assessed patients for food insecurity. Four clinics provided food supplementation, and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio), CD4, and weight gain outcomes among food-insecure patients enrolled at the food clinics with those enrolled at the control clinics. RESULTS: Between May 1, 2004, and March 31, 2005, 636 food- insecure adults were enrolled. Food supplementation was associated with better adherence to therapy. Two hundred fifty-eight of 366 (70%) patients in the food group achieved a medication possession ratio of 95% or greater versus 79 of 166 (48%) among controls (relative risk = 1.5; 95% confidence interval: 1.2 to 1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline World Health Organization stage, and baseline hemoglobin. We did not observe a significant effect of food supplementation on weight gain or CD4 cell response. CONCLUSIONS: This analysis suggests that providing food to food-insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to ART patients is urgently needed to inform international policy. Language: English Keywords: ZAMBIA | RESEARCH REPORT | PILOT PROJECTS | ADULTS | FOOD SUPPLEMENTATION | FOOD SECURITY | HIV INFECTIONS | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Food Supply | Natural Resources | Environment | Viral Diseases | Diseases | Behavior | HIV Document Number: 329042 |
| 20. Peer Reviewed Title: Effectiveness of weekly supplementation of iron to control anaemia among adolescent girls of Nashik, Maharashtra, India. Author: Deshmukh PR; Garg BS; Bharambe MS Source: Journal of Health, Population and Nutrition. 2008 Mar;26(1):74-78. Abstract: A national nutritional anaemia-control programme in India, focusing on supplementation of iron to pregnant women after the first trimester of pregnancy, failed to make an impact. It is prudent to recommend the correction of iron stores before the woman becomes pregnant. 'Efficacy' of weekly supplementation of iron has been proved to improve iron stores in adolescence in many studies abroad and in India. The objective was to study the 'effectiveness' of a weekly iron-supplementation regimen among urban-slum, rural, and tribal girls of Nashik district, Maharashtra, India. A baseline and the mid-term assessments were done using the cluster-sampling techniques. In each stratum, 30 clusters were identified. Twelve and 10 adolescent girls from each cluster were identified in the baseline and mid-term surveys respectively. The haemoglobin estimation was done using the HemoCue system. Data were analyzed using the Epi Info software (version 6.04). The overall prevalence of anaemia came down significantly to 54.3% from 65.3%. The decline was statistically significant (p less than 0.001) in tribal girls (48.6% from 68.9%) and among rural girls (51.6% from 62.8%). But the decline was not statistically significant among urban slum girls. Similarly, a significant rise in the mean haemoglobin levels was seen among tribal and rural girls. However, it did not increase significantly among urban slum girls. The programme had performed poorly in urban-slum areas, as the mean number of tablets consumed in urban-slum areas was only 5.6 plus or minus 3.3, as against 6.7 plus or minus 2.6 tablets in tribal girls and 7.2 plus or minus 2.2 tablets in rural girls. Considering the biological and operational feasibility and the effectiveness of the intervention, weekly supplementation of iron to adolescent girls should be universally started to correct the iron stores of a woman before she becomes pregnant. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | ADOLESCENTS, FEMALE | ANEMIA | PREVENTION AND CONTROL | IRON | FOOD SUPPLEMENTATION | Developing Countries | Asia, Southern | Asia | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Metals | Vitamins and Minerals | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 327031 |
| 21. Title: The cognitive link between geography and development: Iodine deficiency and schooling attainment in Tanzania. Author: Field EM; Robles O; Torero M Source: Cambridge, Massachusetts, National Bureau of Economic Research, 2008 Mar. 63 p. (NBER Working Paper No. 13838) Abstract: An estimated 20 million children born each year are at risk of brain damage from in utero iodine deficiency, the only micronutrient deficiency known to have significant, non-reversible effects on cognitive development. Cognitive damage from iodine deficiency disorders (IDD) has potentially important implications for economic growth through its effect on human capital attainment. To gauge the magnitude of this influence, we evaluate the impact of reductions in fetal IDD on child schooling attainment that resulted from an intensive distribution of iodized oil capsules (IOC) in Tanzania. We look for evidence of improvements in cognitive ability attributable to the intervention by assessing whether children who benefited from IOC in utero exhibit higher rates of grade progression at ages 10 to 14 relative to siblings and older and younger children in the district who did not. Our findings suggest that reducing fetal IDD has significant benefits for child cognition: Protection from IDD in utero is associated with 0.36 years of additional schooling. Furthermore, the effect appears to be substantially larger for girls, consistent with new evidence from laboratory studies indicating greater cognitive sensitivity of the female fetus to maternal thyroid deprivation. There is no indication that IOC improved rates of illness or school absence due to illness, suggesting that IOC improves schooling through its effect on cognition rather than its effect on health. However, there is weak evidence that the program also reduced child but not fetal or infant mortality, which may bias downward the estimated effect on education. Cross-country regression estimates corroborate the results from Tanzania, indicating a strong negative influence of total goiter rate and strong positive influence of salt iodization on female school participation. Together, these findings provide micro-level evidence of the direct influence of ecological conditions on economic development and suggest a potentially important role of variation in rates of learning disability in explaining cross-country growth patterns and gender differences in schooling attainment. (author's) Language: English Keywords: TANZANIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CHILDREN | FETUS | GEOGRAPHIC FACTORS | EDUCATIONAL STATUS | GOITER | PREVALENCE | DEFICIENCY DISEASES | PROTEIN BOUND IODINE ALTERATIONS | SEX FACTORS | FOOD SUPPLEMENTATION | MATERNAL NUTRITION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Thyroid Effects | Endocrine Effects | Endocrine System | Physiology | Biology | Measurement | Nutrition Disorders | Diseases | Hematological Effects | Hemic System | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Nutrition Document Number: 325671 |
| 22. Peer Reviewed Title: Does age affect the response to zinc therapy for diarrhoea in Bangladeshi infants? Author: Fischer Walker CL; Black RE; Baqui AH Source: Journal of Health, Population and Nutrition. 2008 Mar;26(1):105-109. Abstract: The benefit of zinc for the treatment of diarrhoea in a cluster-randomized trial of children, aged 3-59 months, living in rural Bangladesh was previously reported. Here, the benefits of zinc stratified by age-3-5 months, 6-11 months, and 12-59 months-are reported. Although the sample sizes in the stratified groups were too small to detect statistical significance in the 3-5-month and 6-11-month age-groups, the trends suggest that there may be a benefit of zinc for the treatment of diarrhoea on the duration of diarrhoea and on subsequent morbidity and mortality. Additional research is needed to better understand the effect of zinc for the treatment of diarrhoea among infants aged less than six months. (author's) Language: English Keywords: BANGLADESH | RESEARCH REPORT | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | INFANT | AGE FACTORS | DIARRHEA, INFANTILE | ZINC | TREATMENT | TIME FACTORS | FOOD SUPPLEMENTATION | Developing Countries | Asia, Southern | Asia | Clinical Research | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Diarrhea | Diseases | Metals | Vitamins and Minerals | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Nutrition Programs | Primary Health Care Document Number: 308654 |
| 23. Peer Reviewed Title: Maternal zinc supplementation and growth in Peruvian infants. Author: Iannotti LL; Zavaleta N; Leon Z; Shankar AH; Caulfield LE Source: American Journal of Clinical Nutrition. 2008 Jul;88(1):154-160. Abstract: Little is known about how maternal zinc intake influences growth in utero and in postnatal life in humans. The author's aimed to assess the effect of maternal zinc supplementation during pregnancy on infant growth through age 1 y. A double-blind, randomized controlled trial of prenatal zinc supplementation was conducted from 1995 to 1997 in Lima, Peru. Women (n = 1295) were enrolled at 15.6 +/- 4.6 wk gestation and assigned to receive daily supplements with zinc (15 mg Zn + 60 mg Fe + 250 microg folic acid) or without zinc (60 Fe + 250 microg folic acid) through pregnancy to 1 mo after delivery. At birth, 546 infants were followed for 12 mo to assess growth. Anthropometric measures of body size and composition were collected monthly, and morbidity and dietary intake surveillance was carried out weekly. No differences in maternal socioeconomic characteristics by treatment group or follow-up period were found. Infants born to mothers prenatally supplemented with zinc had significantly (P < 0.05) larger average growth measures beginning in month 4 and continuing through month 12. In longitudinal regression modeling, prenatal zinc was associated with greater weight (by 0.58 +/- 0.12 kg; P < 0.001), calf circumference (by 1.01 +/- 0.21 cm; P < 0.001), chest circumference (by 0.60 +/- 0.20 cm; P = 0.002), and calf muscle area (by 35.78 +/- 14.75 mm(2); P = 0.01) after adjustment for a range of covariates. No effect was observed for linear growth. Maternal zinc supplementation in this population was associated with offspring growth, which is suggestive of lean tissue mass accretion. (author's) Language: English Keywords: PERU | DOUBLE-BLIND STUDIES | ZINC | FOOD SUPPLEMENTATION | PREGNANT WOMEN | INFANT NUTRITION | MATERNAL NUTRITION | MUSCULAR EFFECTS | ANTENATAL CARE | South America, Western | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Metals | Vitamins and Minerals | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Nutrition | Maternal Health Services | Maternal-Child Health Services Document Number: 327663 |
| 24. Peer Reviewed Title: Decreased susceptibility to Plasmodium falciparum infection in pregnant women with iron deficiency. Author: Kabyemela ER; Fried M; Kurtis JD; Mutabingwa TK; Duffy PE Source: Journal of Infectious Diseases. 2008 Jul 15;198:163-166. Abstract: Iron plus folate supplementation increases mortality and morbidity among children in areas of malaria endemicity in Africa, but the effects of supplementation on pregnant women in malaria-endemic areas remain unclear. In northeastern Tanzania, where malaria and iron deficiency are common, we found that placental malaria was less prevalent (8.5% vs. 47.3% of women; P<.0001) and less severe (median parasite density, 4.2% vs. 6.3% of placental red blood cells; P = .04) among women with iron deficiency than among women with sufficient iron stores, especially during the first pregnancy. Multivariate analysis revealed that iron deficiency (P<.0001) and multigravidity (P = .002) significantly decreased the risk of placental malaria. Interventional trials of iron and folate supplementation during pregnancy in malaria-endemic regions in Africa are urgently needed to ascertain the benefits and risks of this intervention. (author's) Language: English Keywords: TANZANIA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | ANEMIA | SERUM IRON LEVEL | MALARIA | IRON | PREVALENCE | FOLIC ACID | FOOD SUPPLEMENTATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Diseases | Hemic System | Physiology | Biology | Parasitic Diseases | Metals | Vitamins and Minerals | Measurement | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 327787 |
| 25. Peer Reviewed Title: Effect of folic acid in women with and without insulin resistance who have hyperhomocysteinemic polycystic ovary syndrome. Author: Kazerooni T; Asadi N; Dehbashi S; Zolghadri J Source: International Journal of Gynecology and Obstetrics. 2008 May;101(2):156-160. Abstract: The objective was to study the effect of folic acid on homocysteine (Hcy) levels in women with insulin resistance and polycystic ovary syndrome (PCOS) in a prospective clinical trial. Of 210 women with PCOS, 70 were hyperhomocysteinemic; and of these, 32 were insulin resistant and 38 were not. The 70 women were treated with folic acid for 3 months. Baseline and serum levels of Hcy and insulin were measured in both groups. In both groups Hcy concentrations were significantly decreased following folic acid supplementation. The mean plus or minus SD levels before and after treatment were 14.03 plus or minus 1.5 micromol/L and 12.53 plus or minus 1.72 micromol/L in group 1 (P less than 0.001), and they were 12.07 plus or minus 0.87 micromol/L and 8.83 plus or minus 0.78 micromol/L in group 2 (P less than 0.001). The Hcy levels of hyperhomocysteinemic women with PCOS were reduced after 3 months of folic acid supplementation, and the rate of reduction was higher among women without insulin resistance. No change was found in fasting insulin levels. (author's) Language: English Keywords: IRAN | RESEARCH REPORT | CLINICAL TRIALS | CLIENTS | OVARIAN CYSTS | DIABETES | FOLIC ACID | FOOD SUPPLEMENTATION | GLUCOSE TOLERANCE TEST | ENDOCRINE EFFECTS | Developing Countries | Middle East | Clinical Research | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Vitamins and Minerals | Physiology | Biology | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Endocrine System Document Number: 325979 |
| 26. 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 |
| 27. Title: An energy-dense complementary food is associated with a modest increase in weight gain when compared with a fortified porridge in Malawian children aged 6 - 18 months. Author: Lin CA; Manary MJ; Maleta K; Briend A; Ashorn P Source: Journal of Nutrition. 2008 Mar;138:593-598. Abstract: Poor complementary feeding practices are associated with stunting and growth faltering throughout the developing world. The objective was to compare the effect of using peanut-/soy-based fortified spread (FS) and corn porridge fortified with fish powder (FP) as complementary foods on growth in rural Malawian children. A total of 240 children were enrolled at the age of 6 mo and randomized to receive FS or FP. Both complementary foods provided 836 kJ/d from 6 to 9 mo of age and 1254 kJ/d from 9 to 18 mo of age. Children were followed monthly for anthropometry and fortnightly for the symptoms of fever, cough, or diarrhea until they were 18 mo old. Zn and Se status were assessed at 6 and 12 mo. The primary outcomes were the rates of weight and length gain from 6-12 mo and from 12-18 mo. Children who received FS gained 110 g more (95% CI 220 to 10) from 6-12 mo of age than children receiving FP. Weight gain did not differ between children receiving FS and FP between 12 and 18 mo of age, nor did statural growth from 6 to 12 mo or 12 to 18 mo. A total of 23% of all children were Zn deficient at 6 mo of age and this increased to 37% at 12 mo of age. Neither FS nor FP was associated with significantly improved Zn status. FS was associated with better weight gain from 6-12 mo of age and may be useful in conjunction with additional interventions to improve infant growth in the developing world. (author's) Language: English Keywords: MALAWI | RESEARCH REPORT | COMPARATIVE STUDIES | CLINICAL RESEARCH | INFANT | SUPPLEMENTARY FEEDING | FOOD SUPPLEMENTATION | BODY WEIGHT | ANTHROPOMETRY | FEVER | DIARRHEA | GROWTH | SERUM ZINC LEVEL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | |