Addressing the double burden of malnutrition in Egypt: do conditional cash transfers have a role?

Many developing countries are undergoing rapid socio-economic changes that impact on health and its social distribution. These changes can occur so rapidly that there is a resulting co-existence of diseases of affluence and diseases of poverty. Priority setting for nutritional programs has focused on the alleviation of undernutrition in low income settings. However, evidence shows that in many Low-and-Middle Income Countries the prevalence of obesity among women is increasing and can coexist with childhood stunting. This dual burden of poor nutrition contributes to worsening health inequity between the poor and the rich. Global and national policy makers are looking for novel programs to replace social protection mechanisms deemed inefficient. Conditional Cash Transfer (CCT) programs have emerged as an increasingly popular poverty alleviation strategy with some positive results. However, there is evidence they may have a negative impact if the complexity of transition settings is not taken into account. In this paper, we review the nutritional situation in Egypt and compare two CCT programs (Mexico and Colombia) in an attempt to identify features that would address both child undernutrition and adult overnutrition. We conclude with suggestions for design of an Egyptian CCT program that would help maximise benefit to its beneficiaries

Households with a stunted child and obese mother: trends and child feeding practices in a middle-income country, 1992-2008.

Middle-income countries in the intermediate stages of the nutrition transition are facing a complex picture of nutrition-related diseases with child stunting and maternal obesity coexisting within single households (SCOB). A debate exists as to whether SCOB is a true phenomenon or a statistical artefact. In this study, we examine time trends and determinants of SCOB in Egypt and test the hypothesis that increased child sugary snack consumption, and reduced fruit/vegetable consumption (markers of poor dietary diversity) are associated with SCOB. Data on 25,065 mothers and their children from the Egyptian Demographic and Health Surveys from 1992, 1995, 2005 and 2008 are used to examine trends in child stunting, maternal obesity and child-mother household type [normal/non-obese, stunted/non-obese, normal/obese, stunted/obese (SCOB)]. The association of child sugary snack and fruit/vegetable consumption with household type is also examined using multinomial logistic regression adjusting for maternal age, maternal education, child age, breastfeeding, household wealth and urban/rural residence. The prevalence of SCOB increased between the periods 1992/95 and 2005/08 despite reductions in stunting levels. This increase paralleled a rise in maternal obesity. Child sugary snack consumption was associated with higher odds (51 %) of belonging to a SCOB household compared with normal/non-obese households, while fruit/vegetable consumption was associated with lower odds (24 %). The results suggest the existence of a link between the rise in maternal obesity and an increase in SCOB, and an association between child sugary snack consumption and SCOB. Addressing SCOB may require a household-rather than individual-based approach to nutrition

Fluctuations and Movement Patterns of Race Chicken Egg Prices in Bengkulu Province

Chicken eggs are a staple food with a high enough animal protein content, but the price is quite affordable for all levels of society. This causes the consumption of chicken eggs to be relatively high compared to other animal protein sources, but currently, the amount of production and consumption by the public is not comparable; besides that, the price offered is constantly fluctuating. This study aims to determine price fluctuations and price movement patterns of broiler chicken eggs in Bengkulu Province. The data used is secondary data. The research method uses quantitative descriptive analysis. The research results show that. The risk of fluctuations in the price of broiler eggs in Bengkulu Province has a slightly higher risk for prices at the producer level when compared to prices at the consumer level. The development pattern of broiler egg prices in Bengkulu Province generally shows a positive direction. Fluctuations in the price of broiler eggs occur in specific periods. These fluctuations occur because they coincide with religious holidays such as Ramadan, Eid al-Fitr, Christmas and New Year, the influence of the Russia-Ukraine war, and economic problems due to the Covid-19 pandemic.Telur ayam merupakan salah satu makanan pokok yang memiliki kandungan protein hewani yang cukup tinggi namun harganya cukup terjangkau oleh semua lapisan masyarakat. Hal ini menyebabkan konsumsi telur ayam cukup tinggi dibandingkan sumber protein hewani lainnya, namun saat ini jumlah produksi dan konsumsi masyarakat tidak sebanding, selain itu harga yang ditawarkan selalu berfluktuasi. Penelitian ini bertujuan untuk mengetahui fluktuasi harga dan pola pergerakan harga telur ayam broiler di Provinsi Bengkulu. Data yang digunakan adalah data sekunder. Metode penelitian menggunakan analisis deskriptif kuantitatif. Hasil penelitian menunjukkan bahwa. Risiko fluktuasi harga telur ayam ras di Provinsi Bengkulu memiliki risiko harga yang sedikit lebih tinggi di tingkat produsen jika dibandingkan dengan harga di tingkat konsumen. Pola perkembangan harga telur ayam ras di Provinsi Bengkulu secara umum menunjukkan arah yang positif. Fluktuasi harga telur ayam pedaging terjadi pada periode tertentu. Fluktuasi tersebut terjadi karena bertepatan dengan hari besar keagamaan seperti bulan Ramadan, Idul Fitri, Natal dan Tahun Baru, serta pengaruh perang Rusia-Ukraina, serta masalah ekonomi akibat pandemi Covid-19.&nbsp

Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey

Background: The use of self-reported measures of chronic disease may substantially underestimate prevalence in low-income and middle-income country settings, especially in groups with lower socioeconomic status (SES). We sought to determine whether socioeconomic inequalities in the prevalence of non-communicable chronic diseases (NCDs) differ if estimated by using symptom-based or criterion-based measures compared with self-reported physician diagnoses. Methods: Using population-representative data sets of the WHO Study of Global Ageing and Adult Health (SAGE), 2007–2010 (n=42 464), we calculated wealth-related and education-related concentration indices of self-reported diagnoses and symptom-based measures of angina, hypertension, asthma/chronic lung disease, visual impairment and depression in three ‘low-income and lower middle-income countries’—China, Ghana and India—and three ‘upper-middle-income countries’—Mexico, Russia and South Africa. Results: SES gradients in NCD prevalence tended to be positive for self-reported diagnoses compared with symptom-based/criterion-based measures. In China, Ghana and India, SES gradients were positive for hypertension, angina, visual impairment and depression when using self-reported diagnoses, but were attenuated or became negative when using symptom-based/criterion-based measures. In Mexico, Russia and South Africa, this distinction was not observed consistently. For example, concentration index of self-reported versus symptom-based angina were: in China: 0.07 vs −0.11, Ghana: 0.04 vs −0.21, India: 0.02 vs −0.16, Mexico: 0.19 vs −0.22, Russia: −0.01 vs −0.02 and South Africa: 0.37 vs 0.02. Conclusions: Socioeconomic inequalities in NCD prevalence tend to be artefactually positive when using self-report compared with symptom-based or criterion-based diagnostic criteria, with greater bias occurring in low-income countries. Using standardised, symptom-based measures would provide more valid estimates of NCD inequalities

Frailty in Rheumatic Diseases

Frailty is a syndrome characterized by the decline in the physiologic reserve and function of several systems, leading to increased vulnerability and adverse health outcomes. While common in the elderly, recent studies have underlined the higher prevalence of frailty in chronic diseases, independent of age. The pathophysiological mechanisms that contribute to frailty have not been completely understood, although significant progresses have recently been made. In this context, chronic inflammation is likely to play a pivotal role, both directly and indirectly through other systems, such as the musculoskeletal, endocrine, and neurological systems. Rheumatic diseases are characterized by chronic inflammation and accumulation of deficits during time. Therefore, studies have recently started to explore the link between frailty and rheumatic diseases, and in this review, we report what has been described so far. Frailty is dynamic and potentially reversible with 8.3%\u201317.9% of older adults spontaneously improving their frailty status over time. Muscle strength is likely the most significant influencing factor which could be improved with training thus pointing at the need to maintain physical activity. Not surprisingly, frailty is more prevalent in patients affected by rheumatic diseases than in healthy controls, regardless of age and is associated with high disease activity to affect the clinical outcomes, largely due to chronic inflammation. More importantly, the treatment of the underlying condition may prevent frailty. Scales to assess frailty in patients affected by rheumatic diseases have been proposed, but larger casuistries are needed to validate disease-specific indexes, which could allow more accurate prognostic estimates than demographic and disease-related variables alone. Frail patients can be more vulnerable and more difficult to treat, due to the risk of side effects, therefore frailty should be taken into account in clinical decisions. Clinical trials addressing frailty could identify patients who are less likely to tolerate potentially toxic medications and might benefit from more conservative regimens. In conclusion, the implementation of the concept of frailty in rheumatology will allow a better understanding of the patient global health, a finest risk stratification and a more individualized management strategy

Anaemia among school children aged 6-11 years old in Gaza Strip, Palestine

The objective of the study was to determine the prevalence of anaemia among children aged 6-11 old years due to causes other than parasitic infections. The present study was a cross-sectional study that included 1446 school children of both sexes, distributed in three localities (Khanyounis, Gaza and Beit-lahia) of Gaza strip. The cut-off point for anaemia was determined according to the mean of haemoglobin for all studied school age children, which was (12 g/dl) in accordance to WHO criteria. The observed mean level of Hb was 12 g/dl; standard deviation was 0.915 while the normal value is ranged between 8.9-15.2. Anaemia was found slightly higher in girls (36.3%) than boys (34%). The results showed that anaemia constitute a health problem in Gaza with a prevalence of 35.3%. No variation in the prevalence of anaemia among the three studies areas. It is concluded that anaemia still constitutes a health problem among schoolchildren with a present prevalence among school–age children of 35.3%. It is expected that the prevalence of anaemia may be higher than that reported by this study due to Israeli siege to Gaza Strip

Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy.

The Coronavirus-associated disease, that was first identified in 2019 in China (CoViD-19), is a pandemic caused by a bat-derived beta-coronavirus, named SARS-CoV2. It shares homology with SARS and MERS-CoV, responsible for past outbreaks in China and in Middle East. SARS-CoV2 spread from China where the first infections were described in December 2019 and is responsible for the respiratory symptoms that can lead to acute respiratory distress syndrome. A cytokine storm has been shown in patients who develop fatal complications, as observed in past coronavirus infections. The management includes ventilatory support and broad-spectrum antiviral drugs, empirically utilized, as a targeted therapy and vaccines have not been developed. Based upon our limited knowledge on the pathogenesis of CoViD-19, a potential role of some anti-rheumatic drugs may be hypothesized, acting as direct antivirals or targeting host immune response. Antimalarial drugs, commonly used in rheumatology, may alter the lysosomal proteases that mediates the viral entry into the cell and have demonstrated efficacy in improving the infection. Anti-IL-1 and anti-IL-6 may interfere with the cytokine storm in severe cases and use of tocilizumab has shown good outcomes in a small cohort. Baricitinib has both antiviral and anti-inflammatory properties. Checkpoints inhibitors such as anti-CD200 and anti-PD1 could have a role in the treatment of CoViD-19. Rheumatic disease patients taking immunosuppressive drugs should be recommended to maintain the chronic therapy, prevent infection by avoiding social contacts and pausing immunosuppressants in case of infection. National and international registries are being created to collect data on rheumatic patients with CoViD-19