Assessing the potential for food-based strategies to reduce Vitamin A and iron deficiencies

This paper reviews current knowledge and experience with food-based approaches to reduce vitamin A and iron deficiencies. It presents a review of recently published literature, highlights some of the lessons learned, and identifies knowledge gaps and research priorities. Plant breeding strategies are also discussed because of their potential to increase the content of vitamin A and iron in the diet as well as their bioavailability. populations. The same question as that posed in previous reviews decades ago remains at the end of the present review: what really can be achieved with food-based interventions to control vitamin A and iron deficiency? Food based approaches could be an essential part of the long-termglobal strategy to alleviate micronutrient deficiencies but their real potential is still to be explored.Minerals in human nutrition. ,Nutrition. ,Plant breeding. ,

Does urban agriculture help prevent malnutrition?

Previous research has suggested that urban agriculture has a positive impact on the household food security and nutritional status of low-socioeconomic status groups in cities in Sub-Saharan Africa, but a formal test of the link between semisubsistence urban food production and nutritional status has not accompanied these claims. This paper seeks to redress this gap in the growing literature on urban agriculture through an analysis of the determinants of the nutritional status of children under five in Kampala, Uganda, where roughly one-third of all households in the sample engage in some form of urban agriculture. When controlling for other individual child, maternal, and household characteristics, these data indicate that urban agriculture has a positive, significant association with higher nutritional status of children, particularly height-for-age. Several pathways by which this relationship is manifested are suggested, and the implications of these results for urban food and nutrition policy and urban management are briefly discussed.Food policies. ,Urban agriculture. ,Food security Household. ,Children Nutrition. ,Nutritional status ,

Cultivating nutrition

"Over the past decade, donor-funded policies and programs designed to address undernutrition in the Global South have shifted away from agriculture-based strategies toward nutrient supplementation and food fortification programs. Given the potential benefits resulting from agriculture-based nutrition interventions, this study uses Q methodology to explore the views of a range of stakeholders from both developed and developing countries on the value of—and constraints related to—gender-sensitive, nutrition-oriented agricultural projects. The three distinct viewpoints that emerge from this exercise all support the use of agricultural strategies to improve nutrition and underline the importance of gender-sensitive approaches. The viewpoints differ, however, on the relative importance of nutrition education, the strategic use of nutrient supplementation and food fortification, and the degree to which agriculture-based approaches have an impact on nutrition. The findings indicate that there is common ground among a range of stakeholders—donors, researchers, policymakers, and program practitioners—on the benefits of agriculture and gender-sensitive strategies to improve nutrition. These areas of agreement can serve as a foundation for forging an effective integrative strategy to improve nutrition that includes gender-sensitive agricultural approaches." Authors' AbstractNutrition ,malnutrition ,Agriculture ,stakeholders ,Gender ,

Cultivating nutrition

"Over the past decade, donor-funded policies and programs designed to address undernutrition in the Global South have shifted away from agriculture-based strategies toward nutrient supplementation and food fortification programs. Given the potential benefits resulting from agriculture-based nutrition interventions, this study uses Q methodology to explore the views of a range of stakeholders from both developed and developing countries on the value of—and constraints related to—gender-sensitive, nutrition-oriented agricultural projects. The three distinct viewpoints that emerge from this exercise all support the use of agricultural strategies to improve nutrition and underline the importance of gender-sensitive approaches. The viewpoints differ, however, on the relative importance of nutrition education, the strategic use of nutrient supplementation and food fortification, and the degree to which agriculture-based approaches have an impact on nutrition. The findings indicate that there is common ground among a range of stakeholders—donors, researchers, policymakers, and program practitioners—on the benefits of agriculture and gender-sensitive strategies to improve nutrition. These areas of agreement can serve as a foundation for forging an effective integrative strategy to improve nutrition that includes gender-sensitive agricultural approaches." Authors' AbstractNutrition ,malnutrition ,Agriculture ,stakeholders ,Gender ,

Does geographic targeting of nutrition interventions make sense in cities?

Although most developing country cities are characterized by pockets of substandard housing and inadequate service provision, it is not known to what degree low incomes and malnutrition are confined to specific neighborhoods. This analysis uses representative household surveys of Abidjan and Accra to quantify small-area clustering in service provision, demographic characteristics, consumption, and nutrition. Both cities showed significant clustering in housing conditions but not in nutrition, while income was clustered in Abidjan, but less so in Accra. This suggests that neighborhood targeting of poverty-alleviation or nutrition interventions in these and similar cities could lead to undercoverage of the truly needy.Food consumption. ,Human Nutrition. ,Urban poor Africa. ,Malnutrition Africa. ,Africa. ,

The constraints to good child care practices in Accra

Life in urban areas presents special challenges for maternal child care practices. Data from a representative survey of households with children less than 3 years of age in Accra were used to test a number of hypothesized constraints to child care, including various maternal (education, employment, marital status, age, health, ethnic group, migration status) and household-level factors (income, calorie availability, quality of housing and asset ownership, availability of services, household size, and crowding). An age-specific child care index was created using recall data on maternal child feeding practices and use of preventive health services. A hygiene index was created from spot check observations of proxies of hygiene behaviors. Multivariate analyses showed that maternal schooling was the most consistent constraint to both the care and the hygiene index. None of the household-level characteristics were associated with the care index, but better housing quality and access to garbage collection services were associated with better hygiene. Female head of household and larger family size were associated with poorer hygiene. The programmatic implications of these findings for nutrition education and behavior change interventions in Accra are discussed. The focus is on using the information to target the right practices to be modified as well as the main constraints to their adoption.FCND ,Child care. ,Ghana. ,Maternal and infant welfare Developing countries. ,Urban health. ,

Good care practices can mitigate the negative effects of poverty and low maternal schooling on children's nutritional status

This study uses data from a representative survey of households with preschoolers in Accra, Ghana to (1) examine the importance of care practices for children's height-for-age z-scores (HAZ); and (2) identify subgroups of children for whom good maternal care practices may be particularly important. Good caregiving practices related to child feeding and use of preventive health services were a strong determinant of children's HAZ, specially among children from the two lower income terciles and children whose mothers had less than secondary schooling. In this population, good care practices could compensate for the negative effects of poverty and low maternal schooling on children's HAZ. Thus, effective targeting of specific education messages to improve child feeding practices and use of preventive health care could have a major impact on reducing childhood malnutrition in Accra.Health services. ,Child care. ,Child Feeding. ,Poverty. ,

Cost analysis of centralized viral load testing for antiretroviral therapy monitoring in Nicaragua, a low-HIV prevalence, low-resource setting

<p>Abstract</p> <p>Background</p> <p>HIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low-HIV prevalence, low-resource country.</p> <p>Methods</p> <p>A detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.</p> <p>Results</p> <p>The total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to$97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to$20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to$14.93.</p> <p>Conclusions</p> <p>The quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited-resource countries with low HIV prevalence.</p

Health gains and fi nancial risk protection aff orded by public fi nancing of selected interventions in Ethiopia: an extended cost-eff ectiveness analysis

Background The way in which a government chooses to fi nance a health intervention can aff ect the uptake of health interventions and consequently the extent of health gains. In addition to health gains, some policies such as public fi nance can insure against catastrophic health expenditures. We aimed to evaluate the health and fi nancial risk protection benefi ts of selected interventions that could be publicly fi nanced by the government of Ethiopia. Methods We used extended cost-eff ectiveness analysis to assess the health gains (deaths averted) and fi nancial risk protection aff orded (cases of poverty averted) by a bundle of nine (among many other) interventions that the Government of Ethiopia aims to make universally available. These nine interventions were measles vaccination, rotavirus vaccination, pneumococcal conjugate vaccination, diarrhoea treatment, malaria treatment, pneumonia treatment, caesarean section surgery, hypertension treatment, and tuberculosis treatment. Findings Our analysis shows that, per dollar spent by the Ethiopian Government, the interventions that avert the most deaths are measles vaccination (367 deaths averted per $100 000 spent), pneumococcal conjugate vaccination (170 deaths averted per$100 000 spent), and caesarean section surgery (141 deaths averted per $100 000 spent). The interventions that avert the most cases of poverty are caesarean section surgery (98 cases averted per$100 000 spent), tuberculosis treatment (96 cases averted per $100 000 spent), and hypertension treatment (84 cases averted per$100 000 spent). Interpretation Our approach incorporates fi nancial risk protection into the economic evaluation of health interventions and therefore provides information about the effi ciency of attainment of both major objectives of a health system: improved health and fi nancial risk protection. One intervention might rank higher on one or both metrics than another, which shows how intervention choice—the selection of a pathway to universal health coverage—might involve weighing up of sometimes competing objectives. This understanding can help policy makers to select interventions to target specifi c policy goals (ie, improved health or fi nancial risk protection). It is especially relevant for the design and sequencing of universal health coverage to meet the needs of poor populations

Kinetics and Determining Factors of the Virologic Response to Antiretrovirals during Pregnancy

HIV-infected pregnant women with undetectable plasma HIV RNA concentrations at delivery pose a minimal risk of vertical transmission. We studied the kinetics and the determinants of the virologic response to antiretroviral therapy in 117 consecutive pregnancies. Patients who initiated therapy during pregnancy had a VL decrease of 2 and 2.5 log10 after 4 and 24 weeks, respectively. Therapeutic drug monitoring (TDM) of the protease inhibitors administered in doses recommended for nonpregnant adults resulted in below-target concentrations in 29%, 35%, and 44% of 1st, 2nd, and 3rd trimester measurements, respectively, but low drug concentrations did not correlate with virologic failure. Demographic characteristics, antiretroviral experience prior to pregnancy, baseline VL, or use of specific antiretrovirals did not affect the virologic response. Adherence to ≥95% of prescribed doses and utilization of psychosocial services were associated with undetectable plasma HIV RNA at delivery. In conclusion, the virologic responses of pregnant and nonpregnant adults share similar charactersitics