Complementary feeding: a Global Network cluster randomized controlled trial

Background: Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children in low resource settings. Animal source foods in particular are cited as essential to achieve micronutrient requirements. The efficacy of the recommendation for regular meat consumption, however, has not been systematically evaluated. Methods/Design: A cluster randomized efficacy trial was designed to test the hypothesis that 12 months of daily intake of beef added as a complementary food would result in greater linear growth velocity than a micronutrient fortified equi-caloric rice-soy cereal supplement. The study is being conducted in 4 sites of the Global Network for Women\u27s and Children\u27s Health Research located in Guatemala, Pakistan, Democratic Republic of the Congo (DRC) and Zambia in communities with toddler stunting rates of at least 20%. Five clusters per country were randomized to each of the food arms, with 30 infants in each cluster. The daily meat or cereal supplement was delivered to the home by community coordinators, starting when the infants were 6 months of age and continuing through 18 months. All participating mothers received nutrition education messages to enhance complementary feeding practices delivered by study coordinators and through posters at the local health center. Outcome measures, obtained at 6, 9, 12, and 18 months by a separate assessment team, included anthropometry, dietary variety and diversity scores, biomarkers of iron, zinc and Vitamin B(12) status (18 months), neurocognitive development (12 and 18 months), and incidence of infectious morbidity throughout the trial. The trial was supervised by a trial steering committee, and an independent data monitoring committee provided oversight for the safety and conduct of the trial. Discussion: Findings from this trial will test the efficacy of daily intake of meat commencing at age 6 months and, if beneficial, will provide a strong rationale for global efforts to enhance local supplies of meat as a complementary food for young children

Biomarkers of Nutrition for Development (BOND)—Iron Review

This is the fifth in the series of reviews developed as part of the Biomarkers of Nutrition for Development (BOND) program. The BOND Iron Expert Panel (I-EP) reviewed the extant knowledge regarding iron biology, public health implications, and the relative usefulness of currently available biomarkers of iron status from deficiency to overload. Approaches to assessing intake, including bioavailability, are also covered. The report also covers technical and laboratory considerations for the use of available biomarkers of iron status, and concludes with a description of research priorities along with a brief discussion of new biomarkers with potential for use across the spectrum of activities related to the study of iron in human health. The I-EP concluded that current iron biomarkers are reliable for accurately assessing many aspects of iron nutrition. However, a clear distinction is made between the relative strengths of biomarkers to assess hematological consequences of iron deficiency versus other putative functional outcomes, particularly the relationship between maternal and fetal iron status during pregnancy, birth outcomes, and infant cognitive, motor and emotional development. The I-EP also highlighted the importance of considering the confounding effects of inflammation and infection on the interpretation of iron biomarker results, as well as the impact of life stage. Finally, alternative approaches to the evaluation of the risk for nutritional iron overload at the population level are presented, because the currently designated upper limits for the biomarker generally employed (serum ferritin) may not differentiate between true iron overload and the effects of subclinical inflammation

The vaccination status of Aboriginal and Torres Strait Island children in far North Queensland

A survey was undertaken to ascertain the vaccination status of all 773 Aboriginal and Torres Strait Island children who were born and remained in Far North Queensland during the 1993-94 financial year. Only 42% had received all 15 vaccines scheduled in the first two years of life by their second birthday. More who resided in remote communities were fully vaccinated (64%) by then than those who lived in rural towns (32%) or an urban setting (21%) (

The health impacts of traffic-related exposures in urban areas: Understanding real effects, underlying driving forces and co-producing future directions

The world is currently witnessing its largest surge of urban growth in human history; a trend that draws attention to the need to understand and address health impacts of urban living. Whilst transport is instrumental in this urbanisation wave, it also has significant positive and negative impacts on population health, which are disproportionately distributed.In this paper, we bring together expertise in transport engineering, transport and urban planning, research and strategic management, epidemiology and health impact assessment in an exercise to scope and discuss the health impacts of transport in urban areas. Adopting a cross-disciplinary, co-production approach, we explore the key driving forces behind the current state of urban mobility and outline recommendations for practices that could facilitate positioning health at the core of transport design, planning and policy.Current knowledge on the health-related impacts of urban transport shows that motor vehicle traffic is causing significant premature mortality and morbidity through motor vehicle crashes, physical inactivity and traffic-related environmental exposures including increases in air pollution, noise and temperature levels, as well as reductions in green space. Trends of rapid and car-centred urbanisation, mass motorisation and a tendency of policy to favour car mobility and undervalue health in the transport and development agenda has both led to, and exacerbated the negative health impacts of the transport systems. Simultaneously, we also argue that the benefits of new transport schemes on the economy are emphasised whilst the range and severity of identified health impacts associated with transport are often downplayed. We conclude the paper by outlining stakeholders’ recommendations for the adoption of a cross-disciplinary co-production approach that takes a health-aware perspective and has the potential to promote a paradigm shift in transport practices