Aceptabilidad y uso en el hogar de un alimento complementario listo para consumir en el área rural de Guatemala

Con el objetivo de apoyar el plan del Gobierno de Guatemala para reducir las tasas de desnutrición crónica, el Instituto de Nutrición de Centro América y Panamá (INCAP) desarrolló un Alimento Complementario Listo para Consumir (ACLC), el cual está hecho con una base de pasta de maní, leche y micronutrientes para aportar un rango entre el 50 y el 60% de las recomendaciones diarias en micronutrientes, según el INCAP para niños de 6-24 meses de edad. El objetivo de este estudio fue evaluar la aceptabilidad y uso del ACLC en niños de 6 a 24 meses de edad (estratificados en grupos de 6-12, 13-18 y >18 meses de edad) y sus madres, en una comunidad rural maya q’eqchi’ con alta vulnerabilidad a la desnutrición crónica infantil, ubicada al norte de Guatemala. 46 fueron evaluadas por medio de pruebas sensoriales y grupos focales. 43 niños fueron evaluados a través del consumo del alimento, durante un período de ocho semanas. La aceptabilidad global del alimento por parte de la madre (“le gusta”) fue de un 89.8%. La aceptabilidad en 43 niños, evaluada en la séptima semana de intervención (S7), mostró una mediana de consumo de 31.9 + 1.7 g por día (93.8% del producto disponible, cuyo peso promedio fue de 34.0 g por paquete), lo cual fue comparable en los tres grupos etarios estudiados. En conclusión, el ACLC tuvo una aceptabilidad y uso adecuados en la población estudiada, lo que respalda continuar el desarrollo y uso de esta formulación, como una alternativa en la implementación de programas preventivos de la desnutrición crónica infantil en Guatemala

Maternal and perinatal outcomes of women with vaginal birth after cesarean section compared to repeat cesarean birth in select South Asian and Latin American settings of the global network for women\u27s and children\u27s health research

Objective: Our objective was to analyze a prospective population-based registry including five sites in four low- and middle-income countries to observe characteristics associated with vaginal birth after cesarean versus repeat cesarean birth, as well as maternal and newborn outcomes associated with the mode of birth among women with a history of prior cesarean.Hypothesis: Maternal and perinatal outcomes among vaginal birth after cesarean section will be similar to those among recurrent cesarean birth.Methods: A prospective population-based study, including home and facility births among women enrolled from 2017 to 2020, was performed in communities in Guatemala, India (Belagavi and Nagpur), Pakistan, and Bangladesh. Women were enrolled during pregnancy, and delivery outcome data were collected within 42 days after birth.Results: We analyzed 8267 women with a history of prior cesarean birth; 1389 (16.8%) experienced vaginal birth after cesarean, and 6878 (83.2%) delivered by a repeat cesarean birth. Having a repeat cesarean birth was negatively associated with a need for curettage (ARR 0.12 [0.06, 0.25]) but was positively associated with having a blood transfusion (ARR 3.74 [2.48, 5.63]). Having a repeat cesarean birth was negatively associated with stillbirth (ARR 0.24 [0.15, 0.49]) and, breast-feeding within an hour of birth (ARR 0.39 [0.30, 0.50]), but positively associated with use of antibiotics (ARR 1.51 [1.20, 1.91]).Conclusions: In select South Asian and Latin American low- and middle-income sites, women with a history of prior cesarean birth were 5 times more likely to deliver by cesarean birth in the hospital setting. Those who delivered vaginally had less complicated pregnancy and labor courses compared to those who delivered by repeat cesarean birth, but they had an increased risk of stillbirth. More large scale studies are needed in Low Income Country settings to give stronger recommendations.Trial registration: NCT01073475, Registered February 21, 2010, https://clinicaltrials.gov/ct2/show/record/NCT01073475

Determinación de la ganancia de peso, calidad proteíca y digestibilidad de ocho dietas a base de dos leguminosas, maní (Arachis hypogaea L.) y ajonjolí (Sesamum indicum L.) en ratas Wistar.

El maní y ajonjolí, son dos fuentes importantes de macronutrientes y micronutrientes. El objetivodel estudio fue evaluar la ganancia de peso, calidad proteica y digestibilidad en ocho dietascompuestas a base de dos leguminosas, en ratas Wistar durante cuatro semanas. Las dietas seclasificaron en dieta control; dieta A (leche descremada), dieta B (libre de nitrógeno), dietas C, D,E, F (conformadas por 100%, 75%, 50%, 25% de maní complementadas con leche descremada),y dietas G, H, I, J (conformadas por 100%, 75%, 50%, 25% de ajonjolí, complementadas conleche descremada). Se encontraron diferencias significativas en la ganancia de peso en relación ala dieta control, principalmente en los grupos de ratas que consumieron la dieta D, maní 75% conun valor medio después de las cuatros semanas de 226.00 g (SD=55.29)(p<.05), dieta H, ajonjolí75%, con un valor medio de 218.16 g (SD=56.28)(p<.05), y dieta I, ajonjolí 50%, con un valormedio de 216.83 g (SD=45.86)(p<.05). Las dietas formuladas con leche y leguminosas fueronde alta digestibilidad (96% - 100%), con un índice de eficiencia proteica de 2.73, muy similar alencontrado en la dieta control. Estas formulaciones basadas en leguminosas podrían tener potencialuso en la nutrición humana.Palabras claves: semillas, proteína, nutrición, macronutrientes, micronutriente

Meat Consumption is Associated with Less Stunting among Toddlers in Four Diverse Low-Income Settings

Early growth faltering is common but is difficult to reverse after the first 2 years of life

Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the global network\u27s EmONC trial)

Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women\u27s and Children\u27s Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. Discussion: In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries

Evaluation of meat as a first complementary food for breastfed infants: impact on iron intake: Nutrition Reviews©, Vol. 66, No. S1

The rationale for promoting the availability of local, affordable, non-fortified food sources of bioavailable iron in developing countries is considered in this review. Intake of iron from the regular consumption of meat from the age of 6 months is evaluated with respect to physiological requirements. Two major randomized controlled trials evaluating meat as a first and regular complementary food are described in this article. These trials are presently in progress in poor communities in Guatemala, Pakistan, Zambia, Democratic Republic of the Congo, and China

Junk food use and neurodevelopmental and growth outcomes in infants in low-resource settings

Introduction Feeding infants a sub-optimal diet deprives them of critical nutrients for their physical and cognitive development. The objective of this study is to describe the intake of foods of low nutritional value (junk foods) and identify the association with growth and developmental outcomes in infants up to 18 months in low-resource settings. Methods This is a secondary analysis of data from an iron-rich complementary foods (meat versus fortified cereal) randomized clinical trial on nutrition conducted in low-resource settings in four low- and middle-income countries (Democratic Republic of the Congo, Guatemala, Pakistan, and Zambia). Mothers in both study arms received nutritional messages on the importance of exclusive breastfeeding up to 6 months with continued breastfeeding up to at least 12 months. This study was designed to identify the socio-demographic predictors of feeding infants’ complementary foods of low nutritional value (junk foods) and to assess the associations between prevalence of junk food use with neurodevelopment (assessed with the Bayley Scales of Infant Development II) and growth at 18 months. Results 1,231 infants were enrolled, and 1,062 (86%) completed the study. Junk food feeding was more common in Guatemala, Pakistan, and Zambia than in the Democratic Republic of Congo. 7% of the infants were fed junk foods at 6 months which increased to 70% at 12 months. Non-exclusive breastfeeding at 6 months, higher maternal body mass index, more years of maternal and paternal education, and higher socioeconomic status were associated with feeding junk food. Prevalence of junk foods use was not associated with adverse neurodevelopmental or growth outcomes. Conclusion The frequency of consumption of junk food was high in these low-resource settings but was not associated with adverse neurodevelopment or growth over the study period

Randomized controlled trial of meat compared with multimicronutrient-fortified cereal in infants and toddlers with high stunting rates in diverse settings

Background: Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested

Classifying perinatal mortality using verbal autopsy: is there a role for nonphysicians?

<p>Abstract</p> <p>Background</p> <p>Because of a physician shortage in many low-income countries, the use of nonphysicians to classify perinatal mortality (stillbirth and early neonatal death) using verbal autopsy could be useful.</p> <p>Objective</p> <p>To determine the extent to which underlying perinatal causes of deaths assigned by nonphysicians in Guatemala, Pakistan, Zambia, and the Democratic Republic of the Congo using a verbal autopsy method are concordant with underlying perinatal cause of death assigned by physician panels.</p> <p>Methods</p> <p>Using a train-the-trainer model, 13 physicians and 40 nonphysicians were trained to determine cause of death using a standardized verbal autopsy training program. Subsequently, panels of two physicians and individual nonphysicians from this trained cohort independently reviewed verbal autopsy data from a sample of 118 early neonatal deaths and 134 stillbirths. With the cause of death assigned by the physician panel as the reference standard, sensitivity, specificity, positive and negative predictive values, and cause-specific mortality fractions were calculated to assess nonphysicians' coding responses. Robustness criteria to assess how well nonphysicians performed were used.</p> <p>Results</p> <p>Causes of early neonatal death and stillbirth assigned by nonphysicians were concordant with physician-assigned causes 47% and 57% of the time, respectively. Tetanus filled robustness criteria for early neonatal death, and cord prolapse filled robustness criteria for stillbirth.</p> <p>Conclusions</p> <p>There are significant differences in underlying cause of death as determined by physicians and nonphysicians even when they receive similar training in cause of death determination. Currently, it does not appear that nonphysicians can be used reliably to assign underlying cause of perinatal death using verbal autopsy.</p

Building a Predictive Model of Low Birth Weight in Low- and Middle-Income Countries: A Prospective Cohort Study

BACKGROUND: Low birth weight (LBW, \u3c 2500 g) infants are at significant risk for death and disability. Improving outcomes for LBW infants requires access to advanced neonatal care, which is a limited resource in low- and middle-income countries (LMICs). Predictive modeling might be useful in LMICs to identify mothers at high-risk of delivering a LBW infant to facilitate referral to centers capable of treating these infants. METHODS: We developed predictive models for LBW using the NICHD Global Network for Women\u27s and Children\u27s Health Research Maternal and Newborn Health Registry. This registry enrolled pregnant women from research sites in the Democratic Republic of the Congo, Zambia, Kenya, Guatemala, India (2 sites: Belagavi, Nagpur), Pakistan, and Bangladesh between January 2017 - December 2020. We tested five predictive models: decision tree, random forest, logistic regression, K-nearest neighbor and support vector machine. RESULTS: We report a rate of LBW of 13.8% among the eight Global Network sites from 2017-2020, with a range of 3.8% (Kenya) and approximately 20% (in each Asian site). Of the five models tested, the logistic regression model performed best with an area under the curve of 0.72, an accuracy of 61% and a recall of 72%. All of the top performing models identified clinical site, maternal weight, hypertensive disorders, severe antepartum hemorrhage and antenatal care as key variables in predicting LBW. CONCLUSIONS: Predictive modeling can identify women at high risk for delivering a LBW infant with good sensitivity using clinical variables available prior to delivery in LMICs. Such modeling is the first step in the development of a clinical decision support tool to assist providers in decision-making regarding referral of these women prior to delivery. Consistent referral of women at high-risk for delivering a LBW infant could have extensive public health consequences in LMICs by directing limited resources for advanced neonatal care to the infants at highest risk