Modelling protection behaviour towards micronutrient deficiencies: case of iodine biofortified vegetable legumes as health intervention for school-going children

BACKGROUND/OBJECTIVES: Despite successes recorded in combating iodine deficiency, more than 2 billion people are still at risk of iodine deficiency disorders. Rural landlocked and mountainous areas of developing countries are the hardest hit, hence the need to explore and advance novel strategies such as biofortification. SUBJECTS/METHODS: We evaluated adoption, purchase, and consumption of iodine biofortified vegetable legumes (IBVL) using the theory of protection motivations (PMT) integrated with an economic valuation technique. A total of 1,200 participants from three land-locked locations in East Africa were recruited via multi-stage cluster sampling, and data were collected using two, slightly distinct, questionnaires incorporating PMT constructs. The survey also elicited preferences for iodine biofortified foods when offered at a premium or discount. Determinants of protection motivations and preferences for iodine biofortified foods were assessed using path analysis modelling and two-limit Tobit regression, respectively. RESULTS: Knowledge of iodine, iodine-health link, salt iodization, and biofortification was very low, albeit lower at the household level. Iodine and biofortification were not recognized as nutrient and novel approaches, respectively. On the other hand, severity, fear, occupation, knowledge, iodine status, household composition, and self-efficacy predicted the intention to consume biofortified foods at the household level; only vulnerability, self-efficacy, and location were the most crucial elements at the school level. In addition, results demonstrated a positive willingness-to-pay a premium or acceptance of a lesser discount for biofortification. Furthermore, preference towards iodine biofortified foods was a function of protection motivations, severity, vulnerability, fear, response efficacy, response cost, knowledge, iodine status, gender, age. and household head. CONCLUSIONS: Results lend support for prevention of iodine deficiency in unprotected populations through biofortification; however 'threat' appraisal and socio-economic predictors are decisive in designing nutrition interventions and stimulating uptake of biofortification. In principle, the contribution is threefold: 1) Successful application of the integrated model to guide policy formulation; 2) Offer guidance to stakeholders to identify and tap niche markets; 3) stimulation of rural economic growth around school feeding programmes

Neonatologie/Pädiatrie – Leitlinie Parenterale Ernährung, Kapitel 13

There are special challenges in implementing parenteral nutrition (PN) in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated). Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.Eine besondere Herausforderung bei der Durchführung parenteraler Ernährung (PE) bei pädiatrischen Patienten ergibt sich aus der großen Spannbreite zwischen den Patienten, die von extrem unreifen Frühgeborenen bis hin zu Jugendlichen mit einem Körpergewicht von mehr als 100 kg reicht, und ihrem unterschiedlichen Substratbedarf. Dabei sind alters- und reifeabhängige Veränderungen des Stoffwechsels sowie des Flüssigkeits- und Nährstoffbedarfs zu berücksichtigen sowie auch die klinische Situation, in der eine PE eingesetzt wird. Das Vorgehen unterscheidet sich deshalb ganz erheblich von der PE-Praxis bei erwachsenen Patienten, z.B. ist der Flüssigkeits-, Nährstoff- und Energiebedarf von Früh- und Neugeborenen pro kg Körpergewicht höher als bei älteren pädiatrischen und bei erwachsenen Patienten. In der Regel benötigen alle Frühgeborenen <35. SSW und alle kranken Reifgeborenen während der Phase des allmählichen Aufbaus der enteralen Nahrungszufuhr eine vollständige oder partielle PE. Die Zufuhrmengen der PE bei Neonaten müssen berechnet (nicht geschätzt) werden. Der Anteil der PE sollte zur Minimierung von Nebenwirkungen sobald wie möglich durch Einführung einer enteralen Ernährung vermindert (teilparenterale Ernährung) und schließlich komplett durch enterale Ernährung abgelöst werden. Eine unangemessene Substratzufuhr im frühen Säuglingsalter kann langfristig nachteilige Auswirkungen im Sinne einer metabolischen Programmierung des Krankheitsrisikos im späteren Lebensalter haben. Wenn bei älteren Kindern und Jugendlichen dagegen der Energie- und Nährstoffbedarf eines Patienten im Vorschul- oder Schulalter durch eine enterale Nährstoffzufuhr nicht gedeckt werden kann, ist abhängig von Ernährungszustand und klinischen Umständen spätestens innerhalb von 7 Tagen eine partielle oder totale PE zu erwägen

Strategies for Success in Human Development

The paper explores the conditions making for success in Human Development (HD) in developing countries. For this purpose it defines success in HD in a materialistic and reductionist way as being measured by progress in improving life expectancy and reducing infant mortality rates. Drawing on general reasoning and previous empirical work, the paper identifies probable conditions for country success, including economic growth, income distribution, government expenditure patterns and female education and control over household resources. The four best HD performers over the years 1960-95 in each of three regions - Africa, Asia and Latin America- are identified using a number of indicators. Evidence is then presented on these countries performance on the elements earlier identified as being likely to lead to success. Considerable variation in performance on most elements is shown - e.g. some countries did well on economic growth, but others did poorly. Consistency was only observed on female education, which was outstandingly good for all successful countries. For the other elements, poor performance on one element was compensated for by good performance on others, e.g. low growth was compensated for by relatively equal income distribution and high government expenditure on HD priorities. Different combinations of performance on the various elements are identified among successful countries. The paper also discusses conditions needed for sustainability of HD success.

Strategies for Success in Human Development

This paper analyzes the various policy dimensions which have contributed to successful human development (HD) performance in developing countries over the past three decades. We identify the four best HD performers in each of the regions, taking their level of life expectancy and infant mortality, as well as improvements in these dimensions over time, as the indicators. Examining the elements underlying HD performance reveals that a variety of combinations of vigorous economic growth, government social expenditure ratios and equitable distribution of income can lead to successful human development. None of the 'successful' countries performed well in every dimension conducive to HD success; rather, it appears that doing well with respect to some elements can compensate for relative weakness in others, even weak economic growth. It does appear, however, that one condition crucial in every case was a relatively high female primary enrolment ratio; in many cases the extent of female control over the family's income also proved significant.

A feminist political economy analysis of public policies related to care: a thematic review

Unpaid care work is directly linked to the economic empowerment of women and girls. There is a large and robust body of evidence about the extent of unpaid care work that women and girls do, and its contributions to both the economy and human development outcomes. But is this evidence being used to inform public policy? Doing so would include recognising the role of women and girls in the provision of unpaid care; the need to reduce the drudgery of unpaid care; and the need to redistribute unpaid care work (from women to men, and from the family to communities and the state), thus laying the basis for true gender equality. This review of secondary material aims to identify the political economy conditions of where, why, when and how unpaid care concerns become more visible on domestic policy agendas

Long-term consequences of early childhood malnutrition

"This paper examines the impact of preschool malnutrition on subsequent human capital formation in rural Zimbabwe using a maternal fixed effects-instrumental variables (MFE-IV) estimator with a long-term panel data set. Representations of civil war and drought 'shocks' are used to identify differences in preschool nutritional status across siblings. Improvements in height-for-age in preschoolers are associated with increased height as a young adult and number of grades of schooling completed. Had the median preschool child in this sample had the stature of a median child in a developed country, by adolescence, she would be 4.6 centimeters taller and would have completed an additional 0.7 grades of schooling." Authors' AbstractCivil war Africa ,

Effect of Preventive Supplementation with Zinc and other Micronutrients on Non-Malarial Morbidity in Tanzanian Pre-School Children: A Randomized Trial.

The efficacy of preventive zinc supplementation against diarrhea and respiratory illness may depend on simultaneous supplementation with other micronutrients. We aimed to assess the effect of supplementation with zinc and multiple micronutrients on diarrhea and other causes of non-malarial morbidity. Rural Tanzanian children (n = 612) aged 6-60 months and with height-for-age z-score < -1.5 SD were randomized to daily supplementation with zinc (10 mg) alone, multi-nutrients without zinc, multi-nutrients with zinc, or placebo. Children were followed for an average of 45 weeks. During follow-up, we recorded morbidity episodes. We found no evidence that concurrent supplementation with multi-nutrients influenced the magnitude of the effect of zinc on rates of diarrhea, respiratory illness, fever without localizing signs, or other illness (guardian-reported illness with symptoms involving skin, ears, eyes and abscesses, but excluding trauma or burns). Zinc supplementation reduced the hazard rate of diarrhea by 24% (4%-40%). By contrast, multi-nutrients seemed to increase this rate (HR; 95% CI: 1.19; 0.94-1.50), particularly in children with asymptomatic Giardia infection at baseline (2.03; 1.24-3.32). Zinc also protected against episodes of fever without localizing signs (0.75; 0.57-0.96), but we found no evidence that it reduced the overall number of clinic visits. We found no evidence that the efficacy of zinc supplements in reducing diarrhea rates is enhanced by concurrent supplementation with other micronutrients. By reducing rates of fever without localizing signs, supplementation with zinc may reduce inappropriate drug use with anti-malarial medications and antibiotics. ClinicalTrials.gov NCT00623857

Short run and long run dynamics of impact of health status on economic growth Evidence from Pakistan

The paper investigates the impacts of different health indicators on Economic growth in Pakistan. The Cointegration and Error Correction techniques were applied on the time series data of Pakistan for the period of 1972-2006. We find that Per capita GDP is positively influenced by health indicators in the long run and health indicators are having significant impact on per capita GDP. However, in the short run the health indicators fails to put significant impact on per capita GDP. It reveals that health indicators have a long run impact on economic growth. . It suggests that impact of health is only a long run phenomenon and in the short run there is no significant relationship exists between health variables and economic growth. The major policy implication of the study is that if we desire a high levels of per capita income, we can achieve it by increasing and improving the stock of health human capital, especially if current stocks are at lower end. Moreover, study also points out a rather diminutive role of public health expenditure in determining the per capita GDP.Health human capital; Economic growth; Per capita GDP; Cointegration; Error Correction