Anthropometry, Morbidity and Mortality in Rural Sarawak.

This thesis is concerned with the use of anthropometric measurements and indices as tools to assess current adult nutritional status. The practical characteristics, distribution and determinants of the anthropometric variables and also their relationships to morbidity and mortality were examined in a rural population in Sarawak, East Malaysia. The study made use of baseline anthropometric data obtained on 1047 adults in 1990. 94% of the survivors since 1990 were re-measured and re-interviewed in 1996. Verbal autopsies were applied to the closest relatives of the non-survivors since 1990. The body mass index (kg/m2) and mid-upper arm circumference better fulfilled the characteristics required for an ideal index of nutritional status m adults than any other anthropometric measurements or indices. Both the body mass index and mid-upper arm circumference were highly correlated with body energy stores and were relatively independent of height and shape. Negative associations of the body mass index and mid-upper arm circumference with mortality- were observed when overweight (>=25kg/m2) individuals were excluded from the analyses. Age altered the strength of these associations. Low mid-upper arm circumference and body mass index were associated with increased risks of self-reporting episodes of fever and epigastric or respiratory problems not associated with hypertension in a cross-sectional analysis of the non-obcse (<=30kg/m2) population. Amongst the non-obese section of the population who reported being healthy at the baseline, low mid-upper arm circumference was also associated with increased risks of self-reporting subsequent episodes of fever and epigastric or respiratory problems not associated with hypertension. Logistic regression found that the body mass index cut-off point of 18.5kg/m2 was associated with increased risks of mortality when overweight individuals were excluded and early mortality was discounted. Amongst the non-obese section of the population who reported being healthy at the baseline, the body mass index cut-off point of 18.5kg/m2 was associated with increased risks of self-reporting subsequent episodes of fever and epigastric or respiratory problems not associated with hypertension. Thus this study provides support for the hypothesis that the body mass index may be useful in the diagnosis of chronic energy deficiency. However, the results suggest that a scheme which assesses current nutritional status in adults using anthropometric indices should consider employing distinct cut-offs for older adults

Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal

AbstractObjectiveTo investigate the prevalence of anaemia (haemoglobin 8.3 μg ml−1) and vitamin A deficiency (serum retinol < 0.7 μmoll−1) in adolescent refugees.DesignCross-sectional surveys.SettingKakuma refugee camp in Kenya and seven refugee camps in Nepal.SubjectsAdolescent refugee residents in these camps.ResultsAnaemia was present in 46% (95% confidence interval (CI): 42–51) of adolescents in Kenya and in 24% (95% CI: 20–28) of adolescents in Nepal. The sensitivity of palmar pallor in detecting anaemia was 21%. In addition, 43% (95% CI: 36–50) and 53% (95% CI: 46–61) of adolescents in Kenya and Nepal, respectively, had iron deficiency. In both surveys, anaemia occurred more commonly among adolescents with iron deficiency. Vitamin A deficiency was found in 15% (95% CI: 10–20) of adolescents in Kenya and 30% (95% CI: 24–37) of adolescents in Nepal. Night blindness was not more common in adolescents with vitamin A deficiency than in those without vitamin A deficiency. In Kenya, one of the seven adolescents with Bitot's spots had vitamin A deficiency.ConclusionsAnaemia, iron deficiency and vitamin A deficiency are common among adolescents in refugee populations. Such adolescents need to increase intakes of these nutrients; however, the lack of routine access makes programmes targeting adolescents difficult. Adolescent refugees should be considered for assessment along with other at-risk groups in displaced populations

doi:10.1093/heapol/czi004 Health Policy and Planning 20(1), HEALTH POLICY AND PLANNING; 20(1): 35–40

Objective: To compare levels of childhood malnutrition in areas where the Bangladesh Integrated Nutrition Project had been operational for over 5 years with matched non-project areas, with the purpose of evaluating whether the project had achieved its objective of reducing the prevalence of underweight among children,24 months. Methods: The study involved an ex-post cross-sectional survey in six thanas (a locality with a population of approximately 200 000–450 000 people) in Bangladesh. Participants were 6820 households (4554 in the project areas and 2266 in the non-project areas) including 7183 children aged 6–59 months selected using a two-stage stratified cluster sampling frame. Main outcome measures were moderate and severe underweight, wasting and stunting reported using z scores, and indicators of mothers ’ reported nutritional knowledge and practice. Results: 2388 children aged 6–23 months and 6815 children aged 6–59 months had clean anthropometric data. No significant difference was found between the socio-economic variables of households in the project and non-project areas. No significant difference was found in the prevalence of either severe or moderate underweight (weight-for-age) in children aged 6–23 months in the project and non-project areas: 183 (11.4%, 95 % confidence interval 9.9–13.2%) children in project areas and 9