What health care for undocumented migrants in Belgium?

n/

Severe acute malnutrition and mortality in children in the community : Comparison of indicators in a multi-country pooled analysis

Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Acknowledgments We would like to acknowledge the principal investigators of the original studies: Jan Van den Broeck for the DRC cohort, Michel Garenne for the Senegal cohort, and Keith West for the Nepal cohort. The DRC study was supported by the Centre de Développement Intégrale–Bwamanda, and funding was provided by the Flemish Inter-University Council (Vlaamse Interuniversitaire Raad), the Belgian Administration for Development Cooperation, and the Nutricia Research Foundation. Catherine Schwinger is affiliated to the Centre for Intervention Science in Maternal and Child Health (CISMAC), which is funded by the Research Council of Norway through its Centres of Excellence funding scheme (project number 223269), the University of Bergen (UiB), Norway.Peer reviewedPublisher PD

Inconsistent diagnosis of acute malnutrition by weight-for-height and mid-upper arm circumference : contributors in 16 cross-sectional surveys from South Sudan, the Philippines, Chad, and Bangladesh

Background: The two anthropometric indicators of acute malnutrition in children under 5 years, i.e. a Mid-Upper Arm Circumference < 125 mm (MUAC(125)) or a Weight-for-Height Z-score<-2 (WHZ(-2)), correlate poorly. We aimed at assessing the contribution of age, sex, stunting (Height-for-Age HAZ<-2), and low sitting-standing height ratio Z-score (SSRZ in the 1st tertile of the study population, called hereafter 'longer legs') to this diagnosis discrepancy. Methods: Data from 16 cross-sectional nutritional surveys carried out by Action Against Hunger International in South Sudan, the Philippines, Chad, and Bangladesh fed multilevel, multivariate regression models, with either WHZ -2 or MUAC(125) as the dependent variable and age, sex, stunting, and 'longer legs' as the independent ones. We also compared how the performance of MUAC125 and WHZ-2 to detect slim children, i.e. children with a low Weight-for-Age (WAZ=-2), was modified by the contributors. Results: Overall 23.1 % of the 14,409 children were identified as acutely malnourished by either WHZ-2 or MUAC125, but only 28.5 % of those (949/3,328) were identified by both indicators. Being stunted (+17.8 %; 95 % CI: 14.8 %; 22.8 %), being a female (+16.5 %; 95 % CI: 13.5 %; 19.5 %) and being younger than 24 months (+33.6 %; 95 % CI: 30.4 %; 36.7 %) were factors strongly associated with being detected as malnourished by MUAC125 and not by WHZ-2, whereas having 'longer legs' moderately increased the diagnosis by WHZ-2 (+4.2 %; 95 % CI: 0.7 %; 7.6 %). The sensitivity to detect slim children by MUAC125 was 31.0 % (95 % CI: 26.8 %; 35.2 %) whereas it was 70.6 % (95 % CI: 65.4 %; 75.9 %) for WHZ-2. The sensitivity of MUAC125 was particularly affected by age (57.4 % vs. 18.1 % in children aged = 24 months). Specificity was high for both indicators. Conclusions: MUAC125 should not be used as a stand-alone criterion of acute malnutrition given its strong association with age, sex and stunting, and its low sensitivity to detect slim children. Having 'longer legs' moderately increases the diagnosis of acute malnutrition by WHZ-2. Prospective studies are urgently needed to elucidate the clinical and physiological outcomes of the various anthropometric indicators of malnutrition

The impact of COVID-19 on diet quality, food security and nutrition in low and middle income countries: a systematic review of the evidence

Background & Aims: The current global pandemic of Coronavirus (COVID-19), and measures adopted to reduce its spread, threaten the nutritional status of populations in Low- and middle-income countries (LMICs). Documenting how the COVID-19 affects diets, nutrition and food security can help generating evidence-informed recommendations for mitigating interventions and policies. Methods: We carried out a systematic literature review. A structure search strategy was applied in MEDLINE (Pubmed®), EMBASE®, Scopus® and Web of Science®. Grey literature was retrieved by screening a pre-set list of institutions involved in monitoring the impact of COVID-19 pandemic on nutrition and food security. The first search was done on 20th August 2020, and updated in mid-November 2020 and mid-January 2021. All research steps were described as recommended in the PRISMA statement. Results: Out of the 2085 references identified, thirty-five primary studies were included. In spite of their heterogeneity, studies converge to demonstrate a detrimental effect of COVID-19 pandemic and associated containment measures on diet quality and food insecurity. One of the major direct effects of COVID-19 on food and nutrition outcomes has been through its impact on employment, income generating activities and associated purchasing power. Other channels of impact, such as physical access, availability and affordability of food provided a heterogeneous picture and were assessed via binary and often simplistic questions. The impacts of COVID-19 manifested with various intensity degrees, duration and in different forms. Factors contributing to these variations between and within countries were: 1) timing, duration and stringency of national COVID-19 restriction measures and policies to mitigate their adverse impacts; 2) context specific food value chain responses to domestic and international containment measures; 3) differentiated impacts of restriction measures on different groups, along lines of gender, age, socio-economic status and employment conditions. Dietary changes and food insecurity manifested various intensity degrees, duration and in different forms between and within countries. Shorter value chains and traditional smallholder farms were somewhat more resilient in the face of COVID-19 pandemic. Additionally, the impact of the pandemic has been particularly adverse on women, individuals with a low socio-economic status, informal workers and young adults that relied on daily wages. Finally, there were heterogeneous government responses to curb the virus and to mitigate the damaging effects of the pandemic. It has been demonstrated that existing and well-functioning social protection programmes and public distribution of food can buffer the adverse effects on food insecurity. But social safety nets cannot be effective on their own and there is a need for broader food systems interventions and investments to support sustainable and inclusive food systems to holistic achieve food and nutrition security. Conclusion: In conclusion, the current economic and heath crisis impact diet quality and food security, and this raises concerns about long term impacts on access to and affordability of nutrient-rich, healthy diets and their health implications. Women and individuals with a low socio-economic are the most at risk of food insecurity. Social safety nets can be effective to protect them and must be urgently implemented. We advocate for improved data collection to identify vulnerable groups and measure how interventions are successful in protecting them

Economic hardship and sexually transmitted diseases in Haiti's rural Artibonite Valley.

A study was conducted to determine the prevalence rate and risk factors for sexually transmitted diseases (STDs) in Haiti's rural Artibonite Valley. Women attending antenatal services at Hospital Albert Schweitzer from October to December 1996 were tested for gonorrhea, chlamydia, trichomonas, syphilis, and human immunodeficiency virus (HIV). Of the 476 women tested, 121 (25.4%) had trichomonas, 11/475 (2.3%) had gonorrhea, 51/475 (10.7%) had chlamydia, 32/474 (6.8%) were seropositive for syphilis, 20/469 (4.3%) were seropositive for HIV, and 191 (40.1%) had at least one STD. Nearly 30% of the women reported having entered a sexual relationship out of economic necessity and had increased odds of HIV infection, Odds Ratio (OR) 6.3 (P < 0.001). We postulate that due to recent economic hardship in rural Haiti, women are entering into sexual relationships out of economic necessity and that this trend is contributing to the growing HIV epidemic. We recommend STD prevention and development programs that target young people and economically disadvantaged women

Nutritional profile of foods offered and consumed in a Belgian university canteen

Objective: To evaluate the nutritional profile of a lunch offered and consumed in a university canteen in Belgium. Design: The qualitative and quantitative content of 4365 meals theoretically available and 330 meals consumed was recorded during five weekdays spread over three weeks. Meal combinations were evaluated using a scoring system based on recommendations for Na content, energy from fat, and fruit and vegetable portions. Setting: University canteen in Belgium. Results: Only a 5 % of the meal combinations available and consumed complied with the three basic dietary recommendations for a hot lunch. The nutritional profile of the meals consumed was in line with that of the meals available. Conclusions: Our results show how the nutritional profile of what is eaten is largely determined by what is offered. To ensure overall compliance with dietary recommendations, considerable changes on the supply side, i.e. an increase in fruit and vegetable portions and a reduction in salt and fat of the lunch, are needed first in our setting. Our assessment provides baseline data to pilot a nutrient profiling intervention and shows how a nutrient profiling system can be used for meal evaluation purposes

The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity : a cluster-randomized controlled trial

Background: Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program. Methods and Findings: We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p < 0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (-29.3%; 95% CI: 20.5, 37.2; p < 0.001) and fever episodes (-22.5%; 95% CI: 14.0, 30.2; p < 0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions. Conclusions: Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity