Dirk G Schroeder

Dirk G Schroeder
Emory University | EU · Department of Global Health

About

76
Publications
35,195
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5,894
Citations
Citations since 2017
0 Research Items
1492 Citations
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250

Publications

Publications (76)
Article
Full-text available
Diabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year. The prevalence of diabetes is over 50% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-...
Conference Paper
Objective: (1) To understand why enrollment and adherence rates in Diabetes management and prevention programs are so consistently low among Hispanics. (2) to undercover unique motivators and sustainable strategies for increasing enrollment and adherence rates. Methods: In close collaboration with Blue Cross Blue Shield of Texas and H-E-B, a larg...
Article
Full-text available
The most efficient way to improve health is to use locally available, sustainable, and effective approaches. In the 1970s policy developers tested the concept that public health interventions could be designed around uncommon, beneficial health behaviours that some community members already practised.(1 2) This concept-known as positive deviance(3...
Article
Full-text available
The authors analyzes the so-called hypothesis of the programming or fetal origin of chronic diseases and obesity in the context of the epidemiological and nutritional transition in the countries of Latin America.
Article
Full-text available
Community-based comprehensive primary healthcare programmes are a widely-promoted strategy for improving child survival in less-developed countries, but limited documentation exists concerning their effectiveness in actually reducing child mortality. This study examined the impact of a community-based comprehensive primary healthcare programme on c...
Article
The secular increase in height is assumed to result from long-term improvements in nutritional intakes and reductions in infectious disease burdens. Nutritional supplementation in early life reduces stunting in chronically undernourished populations. It is unknown whether these improvements can be transmitted to subsequent generations. Our objectiv...
Article
Full-text available
Positive deviance (PD) refers to a phenomenon that exists in many resource-poor communities that is the finding that a few individuals and families employ uncommon beneficial practices that allow them and their children to have better health as compared to their similarly impoverished neighbors. These PD behaviors are likely to be affordable accept...
Article
Full-text available
We compared the positive deviance (PD) approach in Save the Children's field guide with a case-control study (CCS) to identify behaviors associated with good nutritional status in Afghan refugee children 6 to 24 months of age in the Northwest Frontier Province (NWFP), Pakistan. The positive deviance inquiry (PDI), utilizing observations and intervi...
Article
Full-text available
Few prospective studies of child growth and its determinants take place in programmatic contexts. We evaluated the effect of Save the Children's (SC) community empowerment and nutrition program (CENP) on child growth, care, morbidity, empowerment, and behavioral determinants. This paper describes the research methods of this community-based study....
Article
Full-text available
Children who are weighed for growth monitoring are frequently clothed, especially in the cold weather. Health workers commonly estimate and subtract the weight of these clothes, but the accuracy of these estimates is unknown. We assessed the accuracy of child weights adjusted for estimated clothing typical of hot, cold, and extremely cold ambient t...
Article
Integrated nutrition programs are widely used to prevent and/or reverse childhood malnutrition, but rarely rigorously evaluated. The impact of such a program on the physical growth of young rural Vietnamese children was measured. We randomized six communes to receive an integrated nutrition program implemented by Save the Children. We matched six c...
Article
Forty-two percent of Vietnamese children are stunted by two years of age. Since 1990, Save the Children Federation/US (SC) has implemented integrated nutrition programs targeting young children. We evaluated the effect of SC's nutrition program on the complementary food intake of young rural Vietnamese children. Using a longitudinal, prospective, r...
Article
Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Viet Nam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to de...
Article
Rigorous assessments of program quality are uncommon in developing countries. We evaluated the quality of the two-week, volunteer-facilitated, caregiver-child rehabilitation "hearth," or nutrition education and rehabilitation program (NERP), sessions in Save the Children's integrated nutrition program in Viet Nam. Field workers observed attendance,...
Article
Empowerment is often cited as a fundamental component of health promotion strategies. Anecdotes suggest that Save the Children's integrated nutrition project empowers local women and health volunteers. The aim of this research was to document the degree to which this is being accomplished. Using qualitative methodologies, we conducted a cross-secti...
Article
Full-text available
Style of child feeding may be an important determinant of child nutrition and health outcomes. Responsive feeding refers to the level and kind of interaction between caregiver and child that lead to a positive feeding experience, adequate dietary intake, and enhanced developmental opportunities. Responsive feeding behaviors may include active physi...
Article
This study assessed barriers to exclusive breastfeeding in rural Viet Nam and identified how a few mothers were able to exclusively breastfeed despite barriers. A cross-sectional quantitative and qualitative assessment was carried out among 120 mothers of infants less than six months old in northern Viet Nam. Only 24% of the mothers exclusively bre...
Article
Globally, the caregiving behaviors that contribute to good nutritional status are well understood; but it is not clear why some caregivers perform these behaviors while others do not. This formative qualitative research was designed to improve understanding about what distinguishes caregivers who practice optimal behaviors from those who do not. Th...
Article
Full-text available
The positive deviance (PD) approach offers an alternative to needs-based approaches for development. The "traditional" application of the PD approach for childhood malnutrition involves studying children who grow well despite adversity, identifying uncommon, model practices among PD families, and designing an intervention to transfer these behavior...
Article
This study assessed barriers to exclusive breastfeeding in rural Viet Nam and identified how a few mothers were able to exclusively breastfeed despite barriers. A cross-sectional quantitative and qualitative assessment was carried out among 120 mothers of infants less than six months old in northern Viet Nam. Only 24% of the mothers exclusively bre...
Article
Full-text available
Save the Children's (SC) successful integrated nutrition program in Viet Nam, the poverty alleviation and nutrition program (PANP), uses the positive deviance (PD) approach to identify key growth promoting behaviors and provides participatory adult education allowing mothers to develop skills related to these behaviors. We investigated whether impr...
Article
Full-text available
The purpose of the study was to assess the validity of a 52-item semi-quantitative food-frequency questionnaire (FFQ) by comparing it with multiple 24-hour dietary recalls. Three non-consecutive 24-hour dietary recalls and one FFQ were administered over a one-month period. Four communities of El Progreso, Guatemala. Seventy-three individuals aged 2...
Article
Full-text available
Fetal undernutrition has been hypothesized to program inappropriate metabolic responses to nutritional abundance in later life. Most studies have been conducted in industrialized countries. We studied the relationship between birth weight and risk factors for cardiovascular disease (CVD) among 187 men and 198 women age 20-29 y (mean age 24 y) who h...
Article
Full-text available
Migration to cities may increase cardiovascular disease risk factors in developing countries. We examined rural and urban individuals who were born in the same villages and shared similar childhood experiences. Blood lipids and glucose, blood pressure, anthropometry, body composition, physical activity, and food, tobacco and alcohol consumption wer...
Article
Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Vietnam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to det...
Article
Full-text available
Style of child feeding may be an important determinant of child nutrition and health outcomes. Responsive feeding refers to the level and kind of interaction between caregiver and child that lead to a positive feeding experience, adequate dietary intake, and enhanced developmental opportunities. Responsive feeding behaviors may include active physi...
Article
Integrated nutrition programs are widely used to prevent and/or reverse childhood malnutrition, but rarely rigorously evaluated. The impact of such a program on the physical growth of young rural Vietnamese children was measured. We randomized six communes to receive an integrated nutrition program implemented by Save the Children. We matched six c...
Article
Full-text available
The positive deviance (PD) approach offers an alternative to needs-based approaches for development. The “traditional” application of the PD approach for childhood malnutrition involves studying children who grow well despite adversity, identifying uncommon, model practices among PD families, and designing an intervention to transfer these behavior...
Article
Few prospective studies of child growth and its determinants take place in programmatic contexts. We evaluated the effect of Save the Children's (SC) community empowerment and nutrition program (CENP) on child growth, care, morbidity, empowerment, and behavioral determinants. This paper describes the research methods of this community-based study....
Article
Globally, the caregiving behaviors that contribute to good nutritional status are well understood; but it is not clear why some caregivers perform these behaviors while others do not. This formative qualitative research was designed to improve understanding about what distinguishes caregivers who practice optimal behaviors from those who do not. Th...
Article
This study assessed barriers to exclusive breastfeeding in rural Viet Nam and identified how a few mothers were able to exclusively breastfeed despite barriers. A cross-sectional quantitative and qualitative assessment was carried out among 120 mothers of infants less than six months old in northern Viet Nam. Only 24% of the mothers exclusively bre...
Article
Rigorous assessments of program quality are uncommon in developing countries. We evaluated the quality of the two-week, volunteer-facilitated, caregiver-child rehabilitation “hearth,” or nutrition education and rehabilitation program (NERP), sessions in Save the Children's integrated nutrition program in Viet Nam. Field workers observed attendance,...
Article
We compared the positive deviance (PD) approach in Save the Children's field guide with a case-control study (CCS) to identify behaviors associated with good nutritional status in Afghan refugee children 6 to 24 months of age in the Northwest Frontier Province (NWFP), Pakistan. The positive deviance inquiry (PDI), utilizing observations and intervi...
Article
Save the Children's (SC) successful integrated nutrition program in Viet Nam, the poverty alleviation and nutrition program (PANP), uses the positive deviance (PD) approach to identify key growth promoting behaviors and provides participatory adult education allowing mothers to develop skills related to these behaviors. We investigated whether impr...
Article
Empowerment is often cited as a fundamental component of health promotion strategies. Anecdotes suggest that Save the Children's integrated nutrition project empowers local women and health volunteers. The aim of this research was to document the degree to which this is being accomplished. Using qualitative methodologies, we conducted a cross-secti...
Article
Children who are weighed for growth monitoring are frequently clothed, especially in the cold weather. Health workers commonly estimate and subtract the weight of these clothes, but the accuracy of these estimates is unknown. We assessed the accuracy of child weights adjusted for estimated clothing typical of hot, cold, and extremely cold ambient t...
Article
Forty-two percent of Vietnamese children are stunted by two years of age. Since 1990, Save the Children Federation/US (SC) has implemented integrated nutrition programs targeting young children. We evaluated the effect of SC's nutrition program on the complementary food intake of young rural Vietnamese children. Using a longitudinal, prospective, r...
Article
Full-text available
Between 1987 and 1998 Save the Children conducted a child survival programme in Mali with the goal of reducing maternal and child morbidity and mortality. An integral part of this programme was a computerized demographic surveillance and health information system (HIS) that gathered data on individuals on an on-going basis. To assess the overall co...
Article
Full-text available
To evaluate the effects of a Habitat for Humanity housing improvement programme in northern Malawi on the prevalence of childhood illnesses. Household based cross sectional study. Setting: Rural communities centred near the small northern Malawi town of Ekwendeni. 318 children under 5 years old. Prevalence of respiratory, gastrointestinal, and mala...
Article
The objective was to review whether nutrition during pregnancy and the first 3 y of life predisposes individuals to be fatter as adults. The roles of undernutrition, overnutrition and breastfeeding were considered. The evidence that poor nutrition in early life is a risk factor for increased fatness later in life is inconclusive. Overnutrition, as...
Article
Full-text available
Mass-produced fortified foods are widely used in developing countries to prevent malnutrition. To determine current use of, beliefs about, and acceptance of Incaparina, a mass-produced fortified food that was first introduced in the 1960s, 100 Guatemalan caretakers of children 6 to 23 months old in rural and periurban communities were surveyed and...
Article
To examine correlates of fasting glucose, a precursor for type 2 diabetes mellitus, in young adults in Guatemala, a country undergoing an epidemiologic transition. Cross-sectional. Anthropometric, lifestyle, dietary, serum lipid, and socioeconomic characteristic data were collected on 189 men and 201 women (mean age 24.4 years) born in four village...
Article
Full-text available
We used data from the 1996 Honduras National Micronutrient Survey to investigate the co-occurrence of vitamin A deficiency (VAD), anemia and stunting in a representative sample of Honduran children 1-5 y old. Observed frequencies of co-occurrence were compared with frequencies expected by chance in children 12-35.9 mo old (n = 633) and 36-59.9 mo o...
Article
Full-text available
Data on fertility milestones were collected in 1994 and linked to information collected in a trial conducted in eastern Guatemala between 1969 and 1977, to examine whether early childhood nutrition was associated with the timing of fertility milestones. In the original trial, two pairs of villages were randomly allocated to receive either a high en...
Article
Body mass index (BMI; wt in kg/ht2 in m) has been proposed as a simple and valid measure for monitoring fatness. Using data from a 25-y longitudinal study of rural Guatemalans, we found that, as children, this population was stunted (mean height-for-age z = -2.6) and had low triceps skinfold thicknesses (≃10% of reference medians), yet had mean BMI...
Article
Body mass index (BMI; wt in kg/ht2 in m) has been proposed as a simple and valid measure for monitoring fatness. Using data from a 25-y longitudinal study of rural Guatemalans, we found that, as children, this population was stunted (mean height-for-age z = -2.6) and had low triceps skinfold thicknesses ( approximately 10% of reference medians), ye...
Article
Full-text available
Current knowledge on the role of intergenerational effects on linear growth is reviewed on the basis of a literature search and recent findings from an ongoing study in Guatemala. Fourteen studies were identified, most of which examined the intergenerational relationships in birth weight. Overall, for every 100 g increase in maternal birth weight,...
Article
Full-text available
To examine whether poor growth in utero or young childhood is associated with adult abdominal fatness in a developing country context, the authors analyzed prospectively collected data on 372 female and 161 male Guatemalans measured as children between 1969 and 1977 and remeasured as adults in 1988-1989 (men and women) and 1991-1994 (women only). C...
Article
Human error is lower and it is easier to standardize field personnel with electronic digital instruments (DI) than with mercury sphygmomanometers (MS). Three observers measured blood pressure simultaneously connecting in parallel a MS and a low-cost (under 90 dollars) DI used by many people at home (model UA-767, A&D Medical, Milpitas, CA). They us...
Article
Increasing energy (E) density & manipulating the viscosity of complementary foods are common approaches to improving infant feeding in developing countries. Little is known, however, about the impact of these approaches on breastfeeding (BF) frequency and intakes. The impact of 3 E-dense, rice-black bean porridges was assessed in a rural Guatemalan...
Article
Full-text available
Increasing the nutrient density of complementary food mixtures is a common strategy for improving child nutrition in developing countries. Such modification, however, typically increases the viscosity of the mixtures, which may not appeal to caretakers or children. To assess maternal preference for complementary food consistency, 46 rural Guatemala...
Article
Studies about effects of IUGR on growth in childhood as well as on body size, body composition and physical performance in adolescence and adulthood are reviewed. The review is based on 12 studies that distinguished IUGR from other types of low birthweight and compared outcomes of IUGR cases with those of non-IUGR controls. This information is comp...
Article
A community-based, randomized trial was conducted to evaluate a locally available diet for the management of acute diarrhea (n = 99 episodes) in 90 Guatemalan children, 4-42 months of age. The Test Diet (TD), a combination of a semi-solid pap (maize flour, black beans, oil) and a liquid gruel, Incaparina (maize flour, cotton seed flour, sugar), in...
Article
The influence of early childhood determinants on age at menarche was investigated in a sample of Guatemalan women who participated as children in a nutrition intervention study conducted from 1969 to 1977. Age at menarche was retrospectively estimated in 1991 and 1992. Mean age at menarche was 13.7 (±1.3) years. Data on linear growth, diarrhea and...
Article
Data on fertility milestones (i.e. age at menarche, first sex, first union, first pregnancy and first birth) were collected recently as part of a follow up to a longitudinal study (1969-77) that was carried out in four villages in eastern Guatemala. Sociodemographic data and pregnancy and childhood outcomes related to growth and maturation, diet, i...
Article
Energy intake of infants is often limited by the low energy density and/or high viscosity of traditional weaning foods. The addition of germinated corn amylase rich flour (ARF) reduces viscosity and/or allots increasing solid (and energy) contents Intake of three rice-black bean porridges was assessed in a rural community: control traditional porri...
Article
Full-text available
Supplementary feeding programs are common in developing countries. These programs often cannot demonstrate an impact on child growth, however, possibly because they tend to reach older children. This study examines the impact of nutritional supplementation on annual growth rates in length and weight from birth to 7 y of age in 1208 rural Guatemalan...
Article
Full-text available
Length and weight data from a longitudinal study of rural Guatemalan subjects birth to 7 y of age and height and weight data from a cross-sectional study of the same subjects when they were 11-24.9 y old are compared to reference data for the USA general population and for Mexican-Americans. At birth, the median length of Guatemalan children is at...
Article
Full-text available
Retrospective data on age at menarche were collected for 832 Guatemalans 15-30 y in age to test whether exposure to a high energy and high protein supplement (Atole: 163 kcals/682 kJ and 11.5 g protein per cup or 180 mL) during childhood led to earlier menarche than did exposure to a low energy, no protein supplement (Fresco: 59 kcals/247 kJ in 180...
Article
This paper study the predictive factors associated to enrollment and adherence in a breast cancer screening program in Barcelona, Spain; the Program is targeted to women 50-70 years of age who are members of a Health Maintenance Organization. Data were collected by personal interview for the attending women and by telephone in the non-attending gro...
Article
Full-text available
Conventional methods of classifying causes of death suggest that about 70% of the deaths of children (aged 0-4 years) worldwide are due to diarrhoeal illness, acute respiratory infection, malaria, and immunizable diseases. The role of malnutrition in child mortality is not revealed by these conventional methods, despite the long-standing recognitio...
Article
Full-text available
epidemiological methodtoestimate thepercent- ageofchild deaths (aged6-59months) whichcould beattributed tothepotentiating effects ofmalnutri- tion ininfectious disease. Theresults from53developing countries withnationally representative data onchild weight-for-age indicate that 56%ofchild deaths wereattributable tomalnutrition's potentiating effect...
Article
Full-text available
According to conventional methods of classifying cause of death, approximately 70% of child deaths (0-4 y) worldwide are due to a small number of priority infectious diseases which, in turn, receive the vast majority of donor and national resources in the health sector. Despite the long-recognized synergism between malnutrition and infection in the...
Article
The growth literature from developing countries is reviewed to assess the extent to which stunting, a phenomenon of early childhood, can be reversed in later childhood and adolescence. The potential for catch-up growth increases as maturation is delayed and the growth period is prolonged. However, maturational delays in developing countries are usu...
Article
Full-text available
By pooling the results from five previously published prospective studies, we have obtained estimates of the relative risks of mortality among young children 6-24 months after they had been identified as having mild-to-moderate or severe malnutrition. These risk estimates, along with global malnutrition prevalence data, were then used to calculate...
Article
We examined the association between water and hygiene-related behaviors and persistent diarrhea (duration > or = 14 days) among children under age three years in an indigenous rural Guatemalan community. Behavior indicators were specific aspects of the appearance of the mother, study child, other children and household that could be observed using...

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