Salt iodization for the elimination of iodine deficiency

French version available in IDRC Digital Library: Iodation du sel pour l'élimination de la carence en iod

Monitoring universal salt iodization programmes

French version available in IDRC Digital Library: Contrôles des programmes universels d'iodation du se

Effect of multiple micronutrient supplementation on survival of HIV-infected children in Uganda: a randomized, controlled trial

<p>Abstract</p> <p>Background</p> <p>Micronutrient deficiencies compromise the survival of HIV-infected children in low-income countries. We assessed the effect of multiple micronutrient supplementation on the mortality of HIV-infected children in Uganda.</p> <p>Methods</p> <p>In a randomized, controlled trial, 847 children aged one to five years and attending HIV clinics in Uganda were stratified by antiretroviral therapy (ART, n = 85 versus no ART, n = 762). The children were randomized to six months of either: twice the recommended dietary allowance of 14 micronutrients as the intervention arm (vitamins A, B₁, B₂, niacin, B₆, B₁₂, C, D and E, folate, zinc, copper, iodine and selenium); or the standard recommended dietary allowance of six multivitamins (vitamins A, D_2,B₁, B₂, C and niacin) as a comparative "standard-of-care" arm. Mortality was analyzed at 12 months of follow up using Kaplan Meier curves and the log rank test.</p> <p>Results</p> <p>Mortality at 12 months was 25 out of 426 (5.9%) children in the intervention arm and 28 out of 421 (6.7%) in the comparative arms: risk ratio 0.9 (95% CI 0.5 - 1.5). Two out of 85 (2.4%) children in the ART stratum died compared with 51 out of 762 (6.7%) in the non-ART stratum. Of those who died in the non-ART stratum, 25 of 383 (6.5%) were in the intervention arm and 26 of 379 (6.9%) in the comparative arm; risk ratio 1.0 (95% CI 0.6 - 1.6). There was no significant difference in survival at 12 months (p = 0.64, log rank test). In addition, there was no significant difference in mean weight-for-height at 12 months; 0.70 ± 1.43 (95% CI 0.52 - 0.88) for the intervention versus 0.59 ± 1.15 (95% CI 0.45 - 0.75) in the comparative arm. The mean CD4 cell count; 1024 ± 592 (95% CI 942 - 1107) versus 1060 ± 553 (95% CI 985 - 1136) was also similar between the two groups.</p> <p>Conclusions</p> <p>Twice the recommended dietary allowance of 14 micronutrients compared with a standard recommended dietary allowance of six multivitamins for six months was well tolerated, but it did not significantly alter mortality, growth or CD4 counts. Future intervention studies should carefully consider: (1) the composition and dosing of the supplements; and (2) the power needed to detect a difference between arms.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier: NCT00122941</p

Micronutrient status and intervention programs in Malaysia

Approximately 70% of the world's malnourished children live in Asia, giving that region the highest concentration of childhood malnutrition worldwide. Prevalence of stunting and underweight are high especially in south Asia where one in every two preschool children is stunted. Iron-deficiency anemia affects 40%-50% of preschool and primary schoolchildren. Nearly half of all vitamin A deficiency and xerophthalmia in the world occurs in south and southeast Asia. Iodine deficiency disorders have resulted in high goiter rates in India, Pakistan, and parts of Indonesia. Compared with other developing countries in Asia, the nutrition situation in Malaysia is considerably better, owing to rapid economic and socioeconomic development that has occurred since Malaysia gained its independence in 1957. Prevalence of undernutrition and micronutrient deficiency is markedly lower in Malaysian children. Nonetheless, undernutrition in the form of underweight, stunting, and anemia can be found in poor communities throughout the country. A prevalence of 25% underweight and 35% stunting is reported among young children from poor rural households. Anemia and subclinical forms of vitamin A deficiency were reported in children under 5 years old. Typical of a country in nutrition transition, Malaysia faces the dual burden of malnutrition in children, with the persistence of undernutrition problems especially among the poor and the emerging overweight problem especially in urban areas. Since 1996, nutrition programs of the government sector are coordinated under the National Plan of Action for Nutrition. These activities and other nutrition intervention efforts by other agencies are discussed in this paper

High participation in the Posyandu nutrition program improved children nutritional status

The objective of this research was to analyze nutritional status and food consumption of children participating in the Posyandu nutrition program. A total sample of 300 children under five years had been drawn. Sample was divided into two categories namely high participation and low participation in the Posyandu nutrition program. The sample was selected from two sub districts of Cianjur District, West Java. The districts were areas with a high proportion of poor people and many of them take the benefits of Posyandu nutrition program conducted by the government. The participation of children (under five years old) in visiting Posyandus was relatively good, namely, 92.4% (for the high participation group). However, for the low participation group, the number of participating children was relatively low (28.3%). The average consumption of energy for children under five years old was still below the recommended dietary allowance < 80% of RDA, whereas the protein consumption was already above the RDA. The prevalence of underweight, stunting, and wasting among children were respectively 30.0%, 43.7%, and 12.3%. The activities at Posyandus had a positive impact on the nutritional status of children under five years olds, measured in terms of weight for age (W/A) and weight for height (W/H). The more frequent the visit to Posyandus, the better the nutritional statuses would be

Iron deficiency anemia is not a rare problem among women of reproductive ages in Ethiopia: a community based cross sectional study

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, the existence of iron deficiency anemia is controversial despite the fact that Ethiopia is one of the least developed in Africa with a high burden of nutrient deficiencies.</p> <p>Methods</p> <p>The first large nutrition study of a representative sample of women in Ethiopia was conducted from June to July 2005 and a systematically selected sub-sample of 970 of these subjects, 15 to 49 years old, were used in this analysis of nutritional anemia. Hemoglobin was measured from capillary blood using a portable HemoCue photometer. For serum ferritin, venous blood from antecubital veins was measured by an automated Elecsys 1020 using commercial kits. Diets were assessed via simplified food frequency questionnaire. The association of anemia to demographic and health variables was tested by chi-square and a stepwise backward logistic regression model was applied to test the significant associations observed in chi square tests.</p> <p>Results</p> <p>Mean hemoglobin ± SD was 11.5 ± 2.1 g/dL with a 29.4% prevalence of anemia. Mean serum ferritin was 58 ± 41.1 ug/L with a 32.1% prevalence of iron deficiency. The overall prevalence rate of iron deficiency anemia was 18.0%. Prevalence of anemia, iron deficiency, and iron deficiency anemia was highest among those 31-49 years old (p < 0.05). Intake of vegetables less than once a day and meat less than once a week was common and was associated with increased anemia (p = 0.001). Although the prevalence of anemia was slightly higher among women with parasitic infestation the difference was not significant (p = 0.9). Nonetheless, anemia was significantly higher in women with history of illness and the association was retained even when the variable was adjusted for its confounding effect in the logistic regression models (AOR = 0.3; 95%CI = 0.17 to 0.5) signifying that the most probable causes of anemia is nutrition related and to some extent chronic illnesses.</p> <p>Conclusion</p> <p>Moderate nutritional anemia in the form of iron deficiency anemia is a problem in Ethiopia and therefore, the need for improved supplementation to vulnerable groups is warranted to achieve the United Nation's Millennium Development Goals. Chronic illnesses are another important cause of anemia.</p

Ethical and Sociocultural Considerations of Biofortified Crops: Ensuring Value and Sustainability for Public Health

This chapter highlights ethical considerations related to biofortified crops and provides insights on how planned and implemented biofortification interventions can take into account sociocultural aspects to improve public health. A literature review of ethical and sociocultural issues was performed, as well as an analysis of biofortification using a public health ethics framework. The research suggests that biofortification has clear public health goals and has promise toward meeting those goals. Where there is a need for more research is to better understand the impacts of biofortification programs on issues of self-determination, liberties, and food justice, the burdens and nonmaleficence to society can be minimized. This can be done through early involvement of the community in research and programmatic strategies. Distributive justice issues, such as ensuring fair access to seeds and foods for farmers and consumers, ought to be considered

Micronutrient malnutrition and biofortification: recent advances and future perspectives

Micronutrients malnutrition is of great public health importance in several parts of the world, especially the developing and underdeveloped countries. It has been estimated that about 2 billion people, about one third of the world’s population, are deficient in one or more mineral elements. Although required in traces, these mineral elements are involved in many vital metabolic functions. Micronutrient deficiencies in humans can be remedied through food diversification, mineral supplementation, food fortification, and biofortification. Biofortification is the strategy of increasing the content of bioavailable nutrients in the edible parts of staple food crops for better human nutrition. Staple crops such as maize, rice, and wheat provide most of the calories for low-income families around the globe. However, staple crop-based diets fall far short in providing the required amounts of micronutrients and heavy reliance on staple food is the root cause of micronutrient malnutrition. Biofortification includes the enhanced uptake of such minerals from soils, their transport to edible plant parts, and improving the bioavailability of these minerals. International initiatives have recently released several plant cultivars with increased bioavailable micronutrient concentrations in their edible parts. The use of these biofortified cultivars is expected to mitigate micronutrient malnourishment in large populations especially in Africa. Crop breeding, genetic manipulation, and application of mineral fertilizers are the bases of biofortification strategies and have enormous potential to address micronutrient malnourishment. In this chapter, crop biofortification for zinc, iron, vitamin A, and iodine has been discussed. Biofortification is a proven strategy to combat micronutrient deficiency in large populations, particularly for those living in developing countries. However, to make it more effective, efficient, and acceptable for people, better planning, implementation, monitoring, and evaluation of biofortification programs are needed to produce cost-effective and socially acceptable biofortified food crops. Food safety, quality assurance, and legal framework also need to be considered while developing any biofortification strategy