The impact of preschool feeding programmes on the growth of disadvantaged young children in developing countries: a systematic review of randomised trials

Background: Childhood malnutrition in developing countries contributes to developmental delays, as well as increased morbidity and mortality. The effectiveness of feeding programmes as a strategy to improve childhood malnutrition has been questioned.Objective: A systematic review was undertaken to examine the effectiveness of preschool feeding programmes in fostering the growth of children in developing countries.Design: A systematic literature search was undertaken to identify published studies that related to the objective. Studies had to be randomised intervention studies that reported on the growth outcomes of children from birth to six years of age in order to be included.Setting: An initial literature search yielded 59 studies, of which 44 were excluded based on initial screening. Five more were omitted based on detailed data extraction. Ten studies met the inclusion criteria. The results of these studies were compared and narratively described in the context of the objective.Results: The studies showed a great level of heterogeneity with regard to sample characteristics, intervention and reporting of results. In the context of recovery from malnutrition, most studies reported there to be a positive effect from feeding programmes. In studies that reported on weight gain, those that employed a supervised intake of food supplements resulted in higher rates of weight gain. Micronutrient fortification was described as having a positive influence on the rate of linear growth in studies that reported on linear growth. Intensive nutrition education aimed at mothers and caregivers is a sustainable way in which to change child feeding behaviour and may contribute to the effectiveness of nutrition intervention.Conclusion: The limitations of the study included the following: there was a low number (59) of identified studies in the initial search because of the use of limited search terms, assessment of risk of bias was carried out by only one reviewer using a self-designed grading system, there were high levels of heterogeneity, and less than half of the individual studies were  rated to be of a high quality. In view of these limitations, no firm conclusion can be drawn. Additional research, aimed at determining the impact of supplementary feeding programmes in supporting the growth of disadvantaged children, is encouraged.Keywords: preschool feeding programmes, growth, disadvantaged children, developing countrie

Monetary policy transmission in the euro area: What do aggregate and national structural models tell us?

This paper analyses the monetary transmission mechanism in the euro area through the use of large scale macroeconomic models at the disposal of the European Central Bank and the National Central Banks of the Eurosystem. The results reported are based on a carefully designed common simulation experiment involving a 100 basis point rise in the policy interest rate for two years accompanied by common assumptions regarding the path of long-term interest rates and the exchange rate. Aggregating the country level results, the fall in output is found to reach a maximum of 0.4% after 2 years. The maximum aggregate fall in prices is also 0.4%, but it occurs 2 years later. The dominant channel of transmission in the first two years is the exchange rate channel, but in terms of the impact on output, the user cost of capital channel becomes dominant from the third year of the simulation onwards JEL Classification: C50, E17, E5macroeconomic models, Monetary policy transmission mechanism

Walter Pagel, ELS, Oral History Interview, August 10, 2012

Major Topics Covered: Personal and educational background The craft of the scientific editor A reader-centered philosophy of editing Department of Scientific Publications: history, role of, services for faculty and institution MD Anderson publications (e.g. The Heart Bulletin, The Year Book of Cancer, Cancer Bulletin, Breast Diseases, Neuro-oncology, The First Twenty Years, the Cancer Care Series) Electronic publishing Work with national biomedical editing organizationshttps://openworks.mdanderson.org/mchv_interviewsessions/1169/thumbnail.jp

Walter Pagel, ELS, Oral History Interview, August 1, 2012

Major Topics Covered: Personal and educational background The craft of the scientific editor A reader-centered philosophy of editing Department of Scientific Publications: history, role of, services for faculty and institution MD Anderson publications (e.g. The Heart Bulletin, The Year Book of Cancer, Cancer Bulletin, Breast Diseases, Neuro-oncology, The First Twenty Years, the Cancer Care Series) Electronic publishing Work with national biomedical editing organizationshttps://openworks.mdanderson.org/mchv_interviewsessions/1168/thumbnail.jp

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania : a cross-sectional study

Background: Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. Methods: This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. Results: The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Conclusions: Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives