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Malnutrition and health in developing countries
Abstract
Malnutrition, with its 2 constituents of protein-energy malnutrition and micronutrient deficiencies, continues to be a major health burden in developing countries. It is globally the most important risk factor for illness and death, with hundreds of millions of pregnant women and young children particularly affected. Apart from marasmus and kwashiorkor (the 2 forms of protein- energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the main manifestations of malnutrition in developing countries. In these communities, a high prevalence of poor diet and infectious disease regularly unites into a vicious circle. Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients (especially in rural areas) have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein- energy malnutrition range from promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock. The fortification of salt with iodine has been a global success story, but other micronutrient supplementation schemes have yet to reach vulnerable populations sufficiently. To be effective, all such interventions require accompanying nutrition-education campaigns and health interventions. To achieve the hunger- and malnutrition-related Millennium Development Goals, we need to address poverty, which is clearly associated with the insecure supply of food and nutrition.
... In children, chronic undernutrition leads to stunted growth, impaired brain development, and increased susceptibility to infections, significantly reducing life expectancy [9]. In adults, deficiencies in essential vitamins and minerals contribute to chronic diseases such as anemia, osteoporosis, and cardiovascular disorders, further burdening healthcare systems [10]. ...
... Children under five years old are at high risk due to rapid growth demands and limited dietary diversity, making them more susceptible to stunting, wasting, and cognitive impairments [9]. Pregnant women require increased micronutrient intake to support fetal development, and deficiencies in iron and folic acid contribute to maternal anemia and complications during childbirth [10]. The elderly also face nutritional challenges, often resulting from decreased appetite, metabolic changes, and limited access to nutrient-dense foods, increasing their risk of frailty and chronic diseases [11]. ...
... Unlike food fortification, which involves adding nutrients during processing, biofortification enhances the nutritional profile of crops at the source, making them inherently richer in essential vitamins and minerals [9]. This method is particularly beneficial for populations in lowincome regions where access to diverse diets and fortified foods is limited, providing a long-term solution to micronutrient deficiencies [10]. ...
Nutritional deficiencies remain a significant global health challenge, exacerbated by growing food insecurity driven by climate change, economic instability, and geopolitical conflicts. As food supply chains become increasingly vulnerable, malnutrition rates rise, particularly in low-income and conflict-affected regions. This paper explores innovative strategies to combat nutritional deficiencies in the face of escalating food insecurity, emphasizing sustainable, scalable, and technologically driven solutions. Advancements in biofortification have introduced nutrient-dense staple crops, such as vitamin A-enriched sweet potatoes and iron-fortified beans, offering a cost-effective and sustainable approach to improving dietary intake in resource-limited settings. Simultaneously, alternative protein sources, including plant-based proteins, lab-grown meats, and insect-based nutrition, present viable solutions to combat protein-energy malnutrition while reducing environmental burdens. Precision agriculture and AI-driven food distribution systems are emerging as transformative tools for optimizing resource allocation, reducing post-harvest losses, and ensuring equitable access to essential nutrients. Furthermore, functional foods and nutraceuticals, enriched with essential vitamins and minerals, are gaining traction as preventive measures against micronutrient deficiencies, particularly in urban populations. Beyond technological interventions, policy-driven solutions, including targeted food subsidy programs, public-private partnerships, and educational initiatives, play a critical role in addressing the socioeconomic dimensions of food insecurity. The integration of these innovative strategies within global and regional frameworks is essential to building resilient food systems capable of mitigating nutritional deficiencies amidst crises. This study provides a comprehensive analysis of these novel approaches, outlining pathways for sustainable implementation to enhance global food security and nutritional equity.
... Macro-and micronutrient deficiencies are common among pregnant and lactating women around the world and have clear public health impacts. For example, protein deficiency among pregnant and lactating women, a common problem in developing countries, is linked to various communicable and noncommunicable diseases [5,6]. Some effects of protein deficiency in children can be mediated through dysbiosis [7]. ...
... Environmental insults during the developmental period can increase susceptibility to diseases later in life [5,6,15,16]. These perturbations can be partially mediated through dysbiosis [7,12,13]. ...
Background
Early-life exposure to environmental factors can have long-lasting impacts on offspring health into adulthood and therefore is an emerging public health concern. In particular, the impact of maternal environmental exposures such as diet and antibiotic use on the establishment of the offspring gut microbiome has been recently highlighted as a potential link to disease risk. However, the long-term effects are poorly understood. Moreover, interindividual host genetic differences have also been implicated in modulating the gut microbiome, suggesting that these differences may modulate susceptibility to environmentally induced dysbiosis and exacerbate related health outcomes. Our understanding of how the developmental environment and genetics interact to modulate offspring long-term gut microbiota and health is still limited.
Methods
In this study, we investigated the effects of early exposure to known or putative dietary insults on the microbiome (antibiotic exposure, protein deficiency, and vitamin D deficiency) in a novel population of mice. Dams were maintained on purified AIN93G antibiotic-containing (AC), low-protein (LP), low-vitamin D (LVD), or mouse control (CON) diets from 5 weeks prior to pregnancy until the end of lactation. After weaning, mice were transferred to new cages and fed a standardized chow diet. The parent-of-origin (PO) effect was determined via F1 offspring from reciprocal crosses of recombinant inbred intercross (RIX) of Collaborative Cross (CC) mice, where all F1 offspring within a reciprocal pair were genetically identical except for the X- and Y-chromosomes and mitochondrial genomes. We assayed offspring bodyweight and the gut bacterial microbiota via 16S rRNA gene sequencing at 8 weeks of age.
Results
Our study revealed that early developmental exposure to antibiotics, protein deficiency, and vitamin D deficiency had long-lasting effects on offspring bodyweight and gut microbial diversity and composition, depending on the genetic background. Several bacterial genera and ASVs, including Bacteroides, Muribaculaceae, Akkermansia, and Bifidobacterium, are influenced by developmental insults. We also observed a significant effect of PO on offspring gut microbiota and growth. For example, the offspring of CC011xCC001 mice had increased bodyweight, microbial diversity indices, and several differential bacterial abundances, including those of Faecalibaculum, compared with those of the corresponding reciprocal cross CC001xCC011.
Conclusion
Our results show that maternal exposure to nutritional deficiencies and antibiotics during gestation and lactation has a lasting impact on offspring gut microbiota composition. The specific responses to a diet or antibiotic can vary among F1 strains and may be driven by maternal genetics.
6GYxoqkF_YnYUWq_fg3yoqVideo Abstract
... Malnutrition increases susceptibility and severity of infections hence is a risk factor for morbidity and mortality (Blössner et al., 2005;Müller & Krawinkel, 2005). Factors such as poor diet, disease, environmental factors lead to malnutrition which in turn results in severe or repeated infections or death. ...
... Severe wasting alone is attributable to one in ten deaths among children under five years of age in low-and middle-income countries, as children experiencing wasting exhibit an elevated risk of mortality from infectious diseases (Lenters, Wazny, & Bhutta, 2016). This is frequently attributed to inadequate dietary intake and the synergistic relationship between malnutrition and infectious disease, which perpetuates a detrimental cycle in developing nations (Müller & Krawinkel, 2005). It has been estimated that the combined effects of stunting, severe wasting, and intrauterine growth restriction were responsible for 2·2 million deaths and 21% of disabilityadjusted life-years among children under five years of age (World Bank, Unicef, 2012 Prior to the COVID-19 pandemic, an estimated 47 million children under the age of five years suffered from moderate or severe wasting, with the majority residing in sub-Saharan Africa and South Asia (Headey et al., 2020). ...
Background: Acute malnutrition in children represents a substantial public health concern, significantly elevating the risk of morbidity and impaired development. The Family-led Mid-Upper Arm Circumference (FL-MUAC) facilitates community-driven early diagnosis and treatment of acute malnutrition, thereby reducing morbidity, mortality, and program expenditures. Aims: This investigation aimed to assess the ability of caregivers to accurately take MUAC measurements in children aged 6–59 months residing in rural Zimbabwean communities. Furthermore, this study aimed to elucidate the factors influencing the caregivers' ability to measure, focusing on their Knowledge, Attitudes, and Practices (KAPs) related to the FL-MUAC approach. Subjects and Methods: A cross-sectional study utilizing a mixed-methods approach was conducted to collect both quantitative and qualitative data from Seke and Makoni rural districts in Zimbabwe. Multistage stratified random sampling was applied to select caregivers who participated in the study. Quantitative data were analyzed using SPSS version 20, incorporating Pearson’s Chi-square test of association, Bland-Altman plot analysis, and binary logistic regression. Qualitative data were subjected to content analysis. Ethical clearance was obtained from the Medical Research Council of Zimbabwe (MRCZ/B/2223). Results: A total of 96 caregivers were enrolled, yielding a response rate of 87.3%. Bland-Altman plot analysis demonstrated a mean difference close to zero (-0.024 ± 0.479 cm), indicating no statistically significant disparity between maternal and nutritionist-derived measurements. The capacity of caregivers to accurately measure MUAC was significantly associated with geographical proximity to health facilities (p = 0.001). Furthermore, maternal nutrition knowledge scores were identified as a significant determinant of MUAC measurement accuracy (p = 0.044) In 93.8% of cases, mothers demonstrated accurate MUAC measurement following adequate training. Conclusions: This study establishes that, with appropriate exposure, maternal MUAC measurements exhibit a high degree of concordance with those obtained by nutritionists. Maternal nutrition knowledge scores significantly influence MUAC measurement accuracy. Therefore, the FL-MUAC approach demonstrates significant potential for enhancing community-based early diagnosis and management of acute malnutrition in this and comparable resource-constrained settings. Keywords: Mid-Upper Arm Circumference, Severe acute malnutrition, Family-led MUAC, malnutrition screening, Zimbabwe.
... There has been reduction in global meat production and alteration in the supply chain (Ijaz et al., 2021) resulting in limited availability of meat as a result of the covid-19 pandemic. Even before the incidence of the global crisis, the deficiency of protein is common in developing countries (Muller, 2005). In developing countries, protein-energy malnutrition has been responsible for up to 56% of child deaths (Pelletier et al., 1993;Muller, 2005), and this has posed chronic and acute effects on children. ...
... Even before the incidence of the global crisis, the deficiency of protein is common in developing countries (Muller, 2005). In developing countries, protein-energy malnutrition has been responsible for up to 56% of child deaths (Pelletier et al., 1993;Muller, 2005), and this has posed chronic and acute effects on children. There is a greater demand for animal-source protein to fill the gap (Judith et al., 2020). ...
A total number of thirty-two (32) TN breed weaned pigs, aged 7 weeks having the average weight of 10.5 ± 0.5 kg were used to assess the feeding value of varying levels of corn and cob meal (CCM) on weaned pigs. The proximate composition and milling proportion of CCM were analyzed and its effect on growth response, nutrient digestibility, and blood parameters of weaned pigs fed varying levels. The acclimatization period of the pigs lasted for seven days and they were randomly allotted to four (4) dietary treatments with eight (8) pigs as replicates. The experiment was carried out for seven weeks. The experimental design was completely Randomized Design. The feed had 0%, 10%, 20% and 30% CCM in the diets tagged D1, D2, D3 and D4 respectively. 97.63% of whole maize were millable using hammer mill of 2 mm screen size. The proportion maize to cob was 89.25% to 10.75%. CCM significant influenced (p < 0.05) the feed intake and weight gain of the pigs. The crude fibre, ether extract, nitrogen free extract and ash digestibilities were significantly affected (p < 0.05). The packed cell volume, haemoglobin, red blood cell, neutrophils and lymphocytes count were significantly influenced (p < 0.05). The aspartate transaminase, alanine transaminase, albumin, glucose, urea, cholesterol and high density lipoprotein level were also significantly affected (p < 0.05). In conclusion, CCM in pig nutrition is considered favourable up to 10% inclusion level for optimum growth performance.
... Poverty, disease and illness remain the major contributors to this situation. Bain et al. (2013) cited in Djoumessi (2022) and Muller and Krawinkel (2005) argued that malnutrition is globally the most important risk factor for illness and death, with hundreds of millions of pregnant women and young children particularly affected. They defined malnutrition as deficiencies in iron, iodine, vitamin A and zinc in developing countries. ...
... Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients (especially in rural areas) have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein-energy malnutrition range from promoting breastfeeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock (Muller & Krawinkel 2005). ...
Caregivers’ experiences and practices for malnourished children undergoing tuberculosis treatment in Eswatini.
... The ratio of both the fatty acids needs to be maintained in a ratio of 1: 1-4: 1, but recently it has been found that this ratio is 10: 1. The studies showed that fatty acids affects immune responses changing the organization of nuclear receptors [20]. Immune cells like epithelial cells, macrophages, dendritic cells, lymphoid cells, neutrophils, T and B cells are affected by lipid alterations in our body [21]. ...
... In Ayurveda Giloy is mention with another name "Madhunashini", which represents its properties to control blood sugar by production of insulin [61]. Some recent in silico studies based on molecular docking, network pharmacology and molecular dynamics on phytoconstituents of Giloy, has reported berberine (C 20 [62]. ...
COVID pandemic adversities had diverted our inclination towards the remedial compounds which inhibit the potency of inflammatory markers during COVID-19 infection and reduce the severity of disease. Precisely, the Indian diet had played major role to combat the disease during COVID pandemic. The uptake of immune booster's phyto-compounds in form of daily diet had reduced the rate of severity during COVID infection, thus lower the burden of emergencies in medical crises. This review takes insight to those health benefitting dietary compounds that are used at a large scale, in almost every household due to their better affordability and easy access.
... Key factors include socio-economic status (SES), maternal education, sanitation, access to clean water, and healthcare. These determinants influence community susceptibility, prevention capacity, and treatment access (Parker et al., 2015;Müller et al., 2013). ...
... Low SES increases vulnerability due to inadequate hygiene, nutrition, and healthcare access (Parker et al., 2015). Malnourished children face higher morbidity due to weakened immune systems (Müller et al., 2013). Financial constraints also delay medical care, increasing complications and mortality (Bhutta et al., 2013). ...
Childhood diarrhea is a leading cause of morbidity and mortality among children under five, particularly in low- and middle-income countries like Pakistan. This study investigates the socio-demographic factors associated with the prevalence of diarrhea in children under five years of age in Peshawar, with the aim of identifying key determinants and providing evidence-based recommendations for targeted public health interventions. A cross-sectional study design was employed, involving 300 households selected through simple random sampling from urban and rural areas of Peshawar. Data were collected between January and June 2024 using a structured questionnaire covering socio-demographic characteristics, sanitation practices, healthcare access, and child health history. The data were analyzed using SPSS version 25, with descriptive statistics summarizing the study population and chi-square tests assessing associations between socio-demographic factors and diarrhea incidence. The findings revealed that children aged 1-3 years were most affected, with significant associations between diarrhea prevalence and maternal education, household income, family size, and sanitation practices. Poor hand hygiene, untreated water sources, and inadequate toilet facilities were identified as key risk factors. Despite the use of oral rehydration salts (ORS) and rotavirus vaccinations, gaps in awareness about diarrhea prevention persisted, highlighting the need for community education programs. This study underscores the critical role of socio-demographic and environmental factors in shaping the burden of childhood diarrhea in Peshawar. The results emphasize the importance of integrated strategies, including improved access to clean water and sanitation, parental education, and strengthened healthcare services, to reduce the incidence of diarrhea and improve child health outcomes. These findings provide valuable insights for policymakers and healthcare practitioners aiming to address this pressing public health issue.
... Oxidative damage to biomolecules, including lipids, proteins, and DNA, can be caused by an excess of ROS and has been linked to aging as well as several illnesses, including cancer, cardiovascular and and digestive disorders (Zuo et al., 2015). Excess ROS shows harmful consequences that sometimes lead to mortality (Muller and Krawinkel, 2005). According to Harman's 1956 free radical hypothesis, aging is a process associated with a cumulative and irreversible build-up of oxidative damage (Mariani et al., 2005). ...
Aim: Due to its antioxidant properties, lutein scavenges reactive oxygen species, including lipid peroxy radicals and singlet oxygen. Despite the therapeutic promise derived from its various physiological functions, lutein's absorption and stability issues make efficient distribution challenging. Nanotechnology applications in pharmaceuticals have been the subject in recent decades. Similar to nanopharmaceuticals, a new class of nanomaterials known as nanonutraceuticals has evolved due to the application of nanotechnology for improved nutraceutical delivery. Methods: For green synthesis, B. oleracea stalks and florets were utilized individually in a copper sulphate solution. The synthesized Copper nanoparticles were characterized and screened for their antibacterial and anti-biofilm activities. Results: At 400μg/ml concentrations, FLNP and FNP demonstrated 92 and 88% DPPH free radical scavenging, respectively. Comparing the different NPs to the positive control, FLNP demonstrated the highest H2O2 scavenging activity (IC50 72.55μg/ml), followed by FNP. When compared to the positive control, FLNP, FNP, and Lutein demonstrated antioxidant capacities of 94, 91, and 87% at 400µg/ml using the reducing power method. According to our ferrozine assay results, FLNP demonstrated an efficient ability to bind iron, suggesting that this property may be linked to its antioxidant properties. According to their different antioxidant capacities, FLNP and FNP demonstrated 92 and 88% FZ reduction ability. Conclusion: The present study was successful in synthesizing composite lutein-based copper nanoparticles and also confirmed of the potential antioxidant activity exhibited by the composite particles. The composite particles did exhibit enhanced antioxidant activity when compared to other controls.
... The prevalence of micronutrient deficiencies is high in South Asia, irrespective of economic growth, advancements in agricultural production, and healthcare services [28]. Often, deficiencies in vitamin A, iron, iodine, and zinc serve as key indicators of malnutrition in the global south, stemming from inadequate diets and the burden of infectious diseases [66]. The presence of micronutrient malnutrition can hinder the economic progress of the country, as investments in nutritional interventions are considered substantial economic commitments [67]. ...
Micronutrient malnutrition remains a critical challenge in the Global South, particularly in Sri Lanka, where vulnerable populations face food insecurity and limited dietary diversity. This review examines biofortification as a sustainable strategy to address these deficiencies, using Sri Lanka as a case study. Biofortification, through agronomic practices, traditional breeding, and genetic engineering, offers a solution to enhance the nutritional quality of staple crops by increasing levels of essential micronutrients like iron, zinc, and vitamin A. Given the prominence of rice in the Sri Lankan diet, fortifying native aromatic rice varieties with these micronutrients is emphasized. The potential of biofortifying other staples such as pulses, soybean, maize, and cassava is also explored, addressing diverse agroecological contexts. While highlighting challenges such as economic, cultural, and adoption barriers, the article advocates for biofortification as a key element of a comprehensive nutrition security strategy. The importance of consumer awareness, dietary guidelines, and integrated policy frameworks is underscored to promote the widespread adoption of biofortified crops. Policymakers are urged to prioritize biofortification initiatives within broader nutrition security agendas, offering a sustainable solution to combat micronutrient malnutrition and promote resilience in the Global South.
Graphical Abstract
... However, in some cases, even when mothers have the financial capacity, they are not able to make independent decisions regarding food. The head of the household, a mother-inlaw or husband, dominates in decisions about maternal and grandchildren's health and food in a joint family setup [16,17]. Previous literature has empirically tested the association between the health of a child and parental investment [10,16]. ...
Background:
Malnutrition among expectant mothers in underdeveloped areas is abundant and a serious public health concern. This study examines how maternal empowerment affects nutritional outcomes among under-five children in developing Asian nations.
Objective:
With an emphasis on nutritional outcomes, including stunting, wasting, and underweight, the main objective of this study is to investigate the connection between mother empowerment and child malnutrition and explore how better child health in developing Asian nations can be achieved through empowering mothers.
Methods:
Using Demographic and Health Survey (DHS) data of ten emerging Asian countries from three regions of Asia, this study evaluates maternal empowerment using the composite maternal empowerment index (CMEI) and examines how it relates to children's nutritional health. For the assessment of the significance of the association between maternal empowerment and child health outcomes, statistical analysis was conducted.
Results:
Our results indicated that maternal empowerment and child health have a statistically significant relationship, especially regarding a reduction in the prevalence of stunting, wasting, and underweight conditions in children. At the same time, maternal education showed a significant role in reducing malnutrition in children in all three regions of Asia.
Conclusion:
In conclusion, developing Asian nations require empowering women. Also, it is essential to initiate nutrition programs, extension education, and synergistic working models that are especially suited to rural women. By strengthening mothers' roles in promoting their children's health, these initiatives can help solve the widespread problem of child malnutrition.
... Good nutrition is a cornerstone of health that can affect immunity, susceptibility to disease, and physical and mental growth and development (Mohanty et al., 2019). One of the nutritional problems that still occurs today is malnutrition (Müller & Krawinkel, 2005 WHO is a medical condition caused by incorrect or insufficient intake or administration of nutrition. Malnutrition is more often associated with inadequate nutrient intake or often called undernutrition which can be caused by poor absorption or excessive loss of nutrients (Saunders et al., 2011). ...
The nutritional status of children under five is the condition of the body of a toddler with the fulfillment of balanced nutrition in the body of a toddler, things that every parent must know about the growth and development of children at the age of toddlers. Nutritional status is influenced by the availability of food at the family level, family parenting, environmental health, basic health services, family culture, socioeconomic, education level, and knowledge. This study aims to determine the nutritional status of toddlers at Romana Tanjung Anom Clinic, Pancur Batu District 2022. The type of design in this study is descriptive. The sampling technique in this research is total sampling. The results show that the nutritional status of toddlers at Romana Tanjung Anom Clinic, Pancur Batu District 2022, is mostly in the good category with 62 respondents (42.5%) where the nutrition of the toddlers is fulfilled according to their needs and also when the posyandu is always given additional food and information obtained during the posyandu. Parents should continue to maintain and monitor the nutritional development and growth of toddlers and be more active in seeking health information about toddlers.
... Even today, the majority of children don't receive one complete square meal in a day (Bhandari & Jinu K, 2024). Moreover, Muller (2005) stated that "Child malnutrition is one of the major causes of morbidity and mortality among children in Nepal, which has a larger impact on the long-term mental and physical development." To address the issue of malnutrition among the children, the school midday meal is formulated as stated in the School Education Sector Plan (2022-2032) and the National School Health and Nutrition Strategy. ...
The effective learning of children fundamentally depends on a healthy and hunger-free body. To enhance the quality of education, efficiency, and health indicators among children, Nepal introduced the Mid-Day Meal Program in 1976 AD, initially targeting 37 food-insecure and economically disadvantaged districts. Since then, the program has significantly improved school attendance and the quality of life for children from low-income, food-insecure families in community schools where it is implemented. Among various promotive factors for academic resilience, the Mid-Day Meal Program has emerged as a key contributor, particularly in government schools in rural areas. This paper employs a narrative review methodology to examine policy provisions and implementation mechanisms at the grassroots level in Nepal’s government schools, based on the Community School Mid-Day Meal Standard and Program Facilitation Book, 2019. Additionally, it assesses how the program promotes equity for intersectional students. Limited studies have reviewed existing Mid-Day Meal guidelines, highlighting gaps and strengths in enhancing academic resilience—particularly for students from poor, marginalized, and Indigenous communities in Nepal. The findings include that the Dropout rate reduced from 10.5% (2015) to 6.2% in 2023 due to the effective implementation of Mid- the Day Meal Program in community schools including a 12% increase in girls' enrollment in community schools. However, there is a need for implementation of existing plans and policies, particularly addressing the need for budget revision, and regular monitoring of its provisions to ensure the physical and mental well-being of the students getting benefits from the
midday meal programs.
... by year 2050 (van Dijk et al., 2021). Protein-energy and micronutrient malnutrition are significant health issues in developing countries, leading to millions of deaths, primarily among pregnant women and young children (Khan et al., 2022;Müller and Krawinkel, 2005). ...
Biosurfactant was produced using already available two strains YK20 and YK32 of the yeast Meyerozyma guilliermondii in the Fermentation laboratory of the department using previously optimized conditions. The highest production of biosurfactant equalled to 29.6g/L was recorded using in Meyerozyma guilliermondii YK32 utilizing butter waste as carbon source. Biosurfactant-mediated Zinc Oxide Nanoparticles (ZnO NPs) were synthesized and characterized using advanced techniques. The formation of ZnO NPs was indicated by a signature peak at 372nm in the UV-Vis spectrum. Dynamic light scattering analysis showed that 93.4% of ZnO NPs particles were of the size 92nm, with an average zeta potential of -34.42 mV. The FTIR analysis confirmed the presence of Zinc oxide in the NPs, as indicated by a peak at 402.27cm-1. The FE-SEM analysis confirmed the formation of oval to spherical shaped ZnO NPs. The influence of ZnO NPs on growth, yield and grain Zn content of wheat, as well as their antifungal activity against fungal phytopathogens was evaluated. Our findings revealed that none of the tested doses of ZnO NPs from 100 to 1500ppm, had any negative effect on the growth of fungi Bipolaris sorokiniana, Fusarium oxysporum and Fusarium graminearum. However, the growth of Rhizoctonia oryzae was inhibited at concentrations beyond 1000ppm. Foliar application of 200ppm ZnO NPs showed maximum increase in total chlorophyll content to 3.63mg/g in variety WH1105, which was significantly higher as compared to the RDF control (2.47mg/g) and biosurfactant seed treated control (3.09mg/g). The least amount of electrolyte leakage and malondialdehyde content of 10.08μS/cm and 12.561μmol/g, respectively, was recorded in variety WH1063 sprayed with 200ppm ZnO NPs. The similar dose of NPs correspondingly decreased the levels of superoxide dismutase and catalase from 12.40 to 8.72 units/g fresh weight and 0.035 to 0.021 U/min/mg protein, in variety WH1105, while lowering the levels of these enzymes to 6.78units/g and 0.031U/min/mg protein, in variety WH1063. The combination of biosurfactant seed treatment and ZnO NPs foliar application (200ppm) resulted in an increase in plant height by 10.70% and 14.16% in Zinc deficient variety WH1105 and Zinc fortified variety WH1063, respectively. Foliar treatment of 200ppm ZnO NPs increased the yield per 2.4m2 to 1115g and 925g, respectively in case of WH1105 and WH1063 wheat varieties, while the corresponding grain Zn content was increased to 40.02ppm and 42.23ppm. A harvest index of 42.20% and 39.16% was recorded in varieties WH1105 and WH1063 sprayed with 200ppm NPs. Conclusively, this study underscores the potential of biosurfactant-mediated ZnO NPs as an effective strategy for Zn fortification in wheat crops, paving the way for sustainable and cost-effective solutions to combat Zn deficiency in human diet.
... Vitamin A (VA) plays an important role in supporting sight, maintaining the functioning of the immune system of individuals, and in children's growth and development [1]. Vitamin A deficiency (VAD) can lead to anemia, weakened resistance to infections, blindness, and death [2,3]. Severe VAD remains a serious public health problem particularly in vulnerable populations of children and pregnant women in low-and middle-income countries (LMICs) [4]. ...
Background
Assessing vitamin A (VA) status using retinol and retinol-binding protein (RBP) in the presence of infection and inflammation remains challenging, as both markers prove to be unreliable during such physiological disturbances.
Objective
This study aimed to assess the association between common infections and inflammation and VA status of children in rural Burkina Faso.
Methods
Two community-based cross-sectional studies were conducted in the villages of Sourkoudougou and Banakeledaga, in Southwestern Burkina Faso, one during the dry season (November 2016– January 2017) and the second during the rainy season (August– September 2017). In total, 115 children, 36–59 months of age, were included. The ¹³C-retinol isotope dilution test (RID) was used to assess total body VA stores (TBS) and VA total liver reserves (TLR). Malaria infection and intestinal parasites were evaluated at enrollment. Serum C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) were measured. Univariable and multivariable linear regressions were used to test the associations between VA status and infection and inflammation status.
Results
No VA deficiency (TLR ≤ 0.1 µmol/g liver) was detected using RID method. Geometric means (95% confidence interval) of TBS and TLR were respectively 473 (412; 543) µmol and 0.86 (0.75; 0.99) µmol/g liver. One-third of study participants were found to have hypervitaminosis A (TLR > 1.0 µmol/g liver). Elevated CRP (> 5.0 mg/L) and AGP (> 1.0 g/L) were respectively detected in 1.9% and 28.6% of children. Positive malaria was diagnosed in 5 children. Intestinal parasites were found in one out of two (47.6%) participants, and other morbidities were detected in 2 participants. In a multivariable adjusted regression, significant positive weak associations were found between Log TLR and CRP concentrations (N = 79, β = 0.058, p = 0.004) and between Log TBS and CRP concentrations (N = 79, β = 0.054, p = 0.005).
Conclusion
Study children were apparently healthy with high prevalence of asymptomatic intestinal parasites and chronic inflammation. TLR and TBS were positively associated with the acute phase protein CRP warranting further investigation.
Trial registration
The study was registered retrospectively (22 March 2018) as a clinical trial with the Pan African Clinical Trials Registry (Cochrane South Africa; PACTR201803002999356).
... (5) Malnutrition is a public health concern in both children and adolescents. Undernutrition still remains a big challenge in developing countries, despite economic growth (6). The prevalence of undernutrition and overweight in adolescent girls in our study was 15.4% and 20.5% respectively. ...
Introduction: Adolescence is a transitional stage of physical and psychological development. Especially for girls, late adolescence is a challenging period to move from adolescence and step into womanhood. Material and methods: A cross-sectional study was conducted among 156 adolescent girls coming to the weekly health camps organized by the institute, aged 17 to 19 years living at Garhi Harsaru in Gurugram, from June 2023 to September 2023. Results: Mean age for adolescent girls was 18.23±0.52 years. Majority of the girls were unmarried (99.4%) and belonged to nuclear family (61.5%) with monthly family income upto 5 lakh (57.7%). The proportion of undernutrition and overweight among the adolescent girls was 15.4% and 20.5% respectively. The majority of the girls were satisfied with their looks (87.8%) and complexion (91.7%) and 28.2% of girls were concerned for their height and weight. Regarding social dimensions, most of the girls (69.9%) were scolded at home and 30.8% were beaten at home. Other social problems encountered ranged from feeling humiliated (19.9%), hurt physically (7.7%) and forced for sex (5.8%). Approximately half (55.8%) of the girls have expressed their desire to report the violence incidence. Conclusion: The social dimension of adolescent girls needs urgent action. Physical dimension of health also needs to be addressed. Overall empowerment of adolescent girls is needed in the society.
... Günlük ağız bakımında ne yaptıkları-yapmadıklarına (diş fırçalama, diş ipi, gargara vs) dair sorular bulunmaktadır [10]. [14,22]. Glikoz vücutta gerekenden fazla alındığında depolanması-birikmesi inflamasyonu tetiklemektedir [23]. ...
Aim: To investigate the effect of the Faculty of Nursing education process on the micronutrition and periodontal status of the students. Material and Methods: 109 students who are in the Faculty of Nursing education process were included in the study. A questionnaire including demographic data, socioeconomic data, oral and dental health data and Wilhom index (WI) was applied to the students included in the study. A Wi score between 65-75 was classified as "aware of what you eat and how to eat", 40-64 points as "careful in this regard" and less than 40 points as "poor nutrition". Periodontal examinations were performed and diagnoses were made according to the 2017 Periodontal diseases and conditions classification. Blood tests were obtained from the hospital archives and Hemoglobin, HemoglobinA1c, Vitamin D, Vitamin B12, Iron and ferritin levels were obtained and all data were analyzed statistically. Results: The number of students reporting toothache and gum bleeding in the 3rd and 4th grades is higher than in the 1st grade. (p<0.05). Although the oral and dental health habits in the survey were stated to be similar, it was determined that the number of students with stage 1 periodontitis in the examination was higher in the 4th grade. While there was no difference in WI according to the grade level, there was a statistically significant difference in body mass index and vitamin B12. (p<0.05) Conclusions: The level of education in the nursing faculty may have an effect on micronutrition and periodontal health/ disease. Students' awareness should be increased with education programs.
... Undernutrition is a leading cause of child mortality [7,8] due to its impact on immune competence and susceptibility to infections such as pneumonia, diarrhea, and measles. Conversely, childhood obesity is a risk factor for adult obesity and is associated with chronic diseases like cardiovascular disease, type 2 diabetes, cancer, and other obesityrelated disorders [9]. ...
Background/Objectives: Limited data exist on the nutritional status of Vietnamese children aged 5 years and older. This study aimed to (1) determine the nutritional status and (2) assess the associations between malnutrition and socio-demographic factors among children and adolescents aged 5–19 years old in selected provinces in Vietnam. Methods: A cross-sectional study was conducted on 3055 children aged 5–19 years old. Children’s weight and height were collected to calculate BMI for Age Z-score and Height for Age Z-score to determine the prevalence of overweight/obesity, stunting, thinness/underweight, stunted-overweight, stunted-underweight, at least one type of undernutrition, and at least one type of malnutrition. Results: The prevalence of stunting and thinness/underweight was around 10%, overweight and obesity was 14.5%, while the prevalence of malnutrition was 36.5%, with 19.7% of children experiencing at least one form of undernutrition. Significant associations were found between malnutrition and socio-demographic factors such as age, ethnicity, and the number of household possessions. Stunting was more prevalent among older children and those from lower-income households, whereas overweight and obesity were more common in wealthier families. Conclusions: These novel findings highlight the need for targeted interventions addressing both undernutrition and obesity in Vietnam’s diverse demographic groups.
... Malnourished children who do undergo cleft repair face poorer outcomes and a higher risk of post-surgical complications compared to their well-nourished peers with CL/P [8][9]. In addition to the feeding difficulties caused by oral motor dysfunction common among children with CL/P, those in LMICs are further disadvantaged by poverty, limited access to healthcare, and food insecurity, all of which contribute to the high rates of malnutrition in this population [10][11]. While various nutritional interventions for CL/P have been well-documented in highresource countries, there is limited research evaluating the effectiveness of preoperative nutrition programs for children with CL/P in LMICs, despite the benefits of such support for children with CL/P [12][13][14][15][16]. ...
Background
Children with cleft lip and/or palate (CL/P) are highly susceptible to malnutrition, which may restrict surgery eligibility and delay repair. Preoperative nutrition programs for children with unrepaired CL/P are an effective treatment to overcome malnutrition for safe surgical intervention in high-resource settings; however, the effectiveness of such programs has not been demonstrated in the setting of low- and middle-income countries (LMICs). We studied the impact of a preoperative nutrition program on improving nutritional status and achieving surgical eligibility for children with CL/P.
Methods
A retrospective review of patients treated by the Operation Smile (OS) Durgapur Cleft Centre in India from March 2021 to December 2022 was conducted. Patient gender, weight, age, cleft type, parental demographics, and income were recorded. The patients’ malnutrition status was categorized as “mild”, “moderate”, or “severe” based on the Indian Academy of Pediatrics (IAP). Patient IAP classifications were noted at multiple timepoints, where change in nutrition status overtime served as the primary outcome of this study. Whether the child became eligible for surgery was assessed as a secondary outcome. Descriptive statistics used t-tests for continuous variables and chi-squared tests for categorical variables. P-values < 0.05 were considered significant.
Results
The study included 236 patients who presented for nutritional intervention after being deemed ineligible for surgery. Initial IAP malnutrition classifications were 36.9% (n = 87) mild, 42.8% (n = 101) moderate, and 20.3% (n = 48) severe malnutrition. After intervention, 179 (75.8%) patients improved in IAP nutrition status, 49 (20.7%) maintained baseline status, and only eight (3.4%) declined. Final improvement levels were significantly associated with younger age at intake (p < 0.001) and maternal education background (p = 0.011). At study end, a total of 183 (77.5%) patients were eligible for cleft repair while 53 (22.5%) patients were malnourished and remained enrolled in the program. A total of 162 (68.6%) patients underwent surgery.
Conclusion
Malnutrition prevents children with CL/P from receiving surgical care in LMICs. This nutrition intervention enabled 228 (96.6%) patients to improve or maintain baseline nutrition and 183 (77.5%) to become surgically eligible who would not have been eligible otherwise. Preoperative nutrition programs offer a promising solution to addressing malnutrition as a barrier to timely, safe cleft repair in resource-constrained settings.
... The deficiency of vitamins and minerals in the diet has interconnected consequences. Those with serious consequences include zinc, iodine, iron and vitamin A deficiencies, a greater burden is seen in low-income countries; disproportionately affecting women of reproductive age and children (9)(10)(11). Other associated avitaminosis consequences include beriberi, rachitis, blindness, pellagra to mention a few. ...
Background: Malnutrition is certainly a growing public health concern worldwide. This is worse in developing world more especially in countries where rain fed agriculture is being practised. Although two main categories of malnutrition are common such as underfeeding and overfeeding, both of them are equally important. Levels of socio-economic predispositions and inequalities coupled with cultural background have an influence in the occurrence of malnutrition. Methodology: An extensive literature review on the subject was done to determine the extent of the problem, why does it happen, how, when, where, who is affected and what can be done about it. Conclusion: An attempt to maintain equity and equality in various social groups at all levels may seem to be an epitome to address the issue while having a better understanding of the matter. This is where evidence based public health practice comes in.
... Moreover, underdeveloped countries like Pakistan are grappling with malnutrition, a severe health problem affecting at least half of its children under the age of three [23][24][25]. Among these concerns, underweight, stunting, and wasting are common in children [26]. ...
Objectives: the current study investigates the link between health insurance coverage and child nutritional status in Pakistan. Methods: Using data from the Pakistan Demographic and Health Survey (PDHS) 2017–18, encompassing 4499 children under 5, a binary logistic regression was applied to analyze the relationship between health insurance and child nutritional status. Due to the non-randomized sample, assessing health insurance continuously posed a practical challenge. To mitigate the sample selection bias, the cross-sectional-based propensity score matching (PSM) using the nearest neighbor method was utilized for the causal relationship, based on potential socio-economic covariates. Results: The prevalence rates of stunting, underweight, and wasting among children under five were 38.13%, 23.04%, and 8.05%, respectively. Malnutrition was found in 43.64% of non-insured children compared with 5% in insured children. The findings of PSM supported a causal relationship, given the cross-sectional nature and potential misplaced variables, as the PSM findings revealed that insured children had significantly better nutritional outcomes compared with non-insured children, with a significance level of 1%. The logistic regression outcomes for the covariates of child nutritional outcome indicated that health insurance coverage, higher wealth status, mother’s education, improved water and sanitation facilities, mother’s normal BMI, and urban residence reduced the likelihood of child malnutrition. The logistic regression results for the covariates of child health insurance depicted that factors such as higher birth order, mother’s low BMI, poor water and sanitation facilities, higher wealth status, women’s employment, higher education level, and child illnesses like diarrhea and malnutrition increased the likelihood of obtaining health insurance. The logistic results confirmed that health insurance coverage reduced the likelihood of child malnutrition, and, similarly, child malnutrition and other illnesses increased the chances of obtaining health insurance coverage. Conclusions: The findings underscore the critical need for health insurance, highlighting its role in enhancing child nutritional status. The government should expand health insurance programs, with a special emphasis on child nutrition and health.
... Vitamin deficiency remains a global issue and over 2 billion people worldwide were found to lack adequate levels of vitamins and minerals according to data provided by the World Health Organization (WHO) [4]. In some developing countries or impoverished nations, severe vitamin deficiency is widespread as a result of food shortages and malnutrition [5]. While, this issue is largely absent in the general population in more affluent nations, where overall health standards are higher. ...
Background
Some evidence highlights individuals lacking an adequate level of vitamins may experience heightened susceptibility to post-anesthesia complications. The current study summarized the previous evidence assessing the impact of deficient vitamin levels on complications and outcomes following anesthesia.
Methods
A comprehensive search in scientific English databases was conducted from January 2000 to January 2024. The inclusion and exclusion criteria were applied, the full-texts were thoroughly analyzed, and the risk-of-bias was assessed.
Results
A multitude of 1322 published articles were discovered based on search strategy and 14 eligible papers were enrolled. The mean age of patients was 39.3 years and the majority were male. Patients with vitamin B12 deficiency experienced both neurological and hematologic consequences post-anesthesia. Delirium was observed among patients lacking sufficient levels of vitamin D, and those deficient in vitamin K presented symptoms indicative of epidural hematoma. Post-anesthesia consequences were manifested with a delay, ranging from hours to days following the anesthesia procedure in vitamin K and B12 deficiency, while patients deficient in vitamin C and B1 experienced an acute onset of symptoms during surgery. Significantly, a notable proportion (42%) had pre-existing risk factors for vitamin deficiency prior to the surgery, while 35% of the risk-factors for vitamin deficiency were diagnosed after the surgery. There was a wide range of complete or partial recovery periods following surgical intervention, spanning over a few days up to several months according to the severity of symptoms.
Conclusions
Based on the evidence from the reviewed studies, this study robustly suggests that serum vitamins level before surgery should be measured among patients who are at risk of vitamin deficiency or have some related clinical symptoms.
... Malnutrition continues to be a significant global public health issue, impacting individuals of all ages across both developed and developing countries (1). Malnutrition also manifests in various forms, including undernutrition, over-nutrition, and micronutrient deficiencies (2). ...
Purpose
Malnutrition continues to be a widespread and critical public health issue, yet there is a lack of comprehensive evidence synthesizing empirical findings and assessing the practicality of nutrition interventions in diverse contexts. This paper analyzes contextual data to establish a benchmark for selecting effective nutrition strategies, thereby maximizing their impact and ensuring targeted, sustainable outcomes.
Methods
This study employed a cross-sectional design to examine the key drivers of nutrition in mining communities, focusing on children under five and their caregivers. A sample of 711 participants was selected using a systematic random sampling technique. Data collection involved structured questionnaires, direct measurements of children, and interviews with caregivers. Anthropometric measurements were conducted according to WHO standards to assess underweight status. Statistical analysis included descriptive statistics and chi-square tests to evaluate the effectiveness and feasibility of context-specific nutrition interventions.
Results
Chi-square analysis highlights a complex interplay of factors influencing underweight in children under 5 years of age, including expenditure priorities (p = 0.002), access to resources such as primary grocery stores (p = 0.001) and farmers’ markets (p < 0.001), food preparation practices (p = 0.006), agricultural empowerment (p < 0.001), and feeding styles/strategies (p = 0.004). Multivariate logistic regression further reveals that key determinants of child underweight include age (aOR = 15.24, p < 0.001), caregiver disability or chronic illness status (aOR = 0.14, p < 0.001), inadequate food production (aOR = 1.94, p = 0.009), and expenditure priorities (aOR = 2.46, p = 0.007). These factors collectively highlight the multifaceted nature of child undernutrition.
Conclusion
The findings highlight the critical importance of considering contextual factors when developing nutrition interventions. Key elements such as expenditure priorities, access to food resources, food preparation practices, agricultural empowerment, and feeding strategies play a significant role in shaping child nutrition outcomes. Understanding these factors is essential for designing interventions that are not only effective but also sustainable and culturally appropriate.
... The Pakistan National Nutrition Survey reports that 31% of children are underweight, 24% are malnourished, 17% are wasted, and 33% suffer from iron deficiency. The relationship between malnutrition and hematological disorders is well established, as severe acute malnutrition (SAM) induces extensive alterations in the hematopoietic system, affecting all blood cell components (1)(2)(3)(4). Anemia, a frequent consequence of SAM, is primarily driven by iron deficiency, which stems from inadequate dietary intake, reduced milk consumption, suboptimal infant and young child feeding (IYCF) practices, and parasitic infections (5,6). However, anemia in malnourished children is multifactorial, also linked to diminished protein intake, impaired absorption, erythropoietin insufficiency, and reduced red blood cell synthesis due to altered muscle-to-fat ratios (7)(8)(9). ...
Background: Severe acute malnutrition (SAM) remains a critical public health issue, particularly in resource-limited settings, significantly impacting child morbidity and mortality. Malnutrition adversely affects hematopoiesis, leading to anemia, leukocyte abnormalities, and thrombocytopenia, which further compromise immune function and increase susceptibility to infections. Understanding the hematological alterations in children with SAM is essential for early detection, appropriate management, and improved clinical outcomes. This study aimed to assess the hematological profile of children with SAM and identify specific abnormalities associated with the condition. Objective: To evaluate the hematological parameters of children with severe acute malnutrition and compare them with healthy controls. Methods: This descriptive cross-sectional study was conducted over nine months, from January to September 2023, at the Nutrition Unit of PEDS Shaikh Zayed Hospital, Larkana. A total of 216 children aged 7 months to 5 years were included, with 108 diagnosed with SAM based on WHO criteria and 108 healthy controls. Hematological parameters, including red blood cell (RBC) count, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), white blood cell (WBC) count, and platelet count, were analyzed using an automated hematology analyzer (XN-350). Socioeconomic and demographic data were collected through structured questionnaires. Results: Among the 108 children with SAM, 56 (51.8%) were male, and 52 (48.1%) were female. The majority, 68 (49.2%), were aged 7–24 months. Rural residency was reported in 67 (62%) cases, and 74 (68.5%) belonged to low-income families. Normochromic normocytic anemia was the most prevalent type, affecting 42 (38.88%) children, followed by iron deficiency anemia in 28 (25.9%) and megaloblastic anemia in 2 (1.85%). Hemoglobin levels were significantly lower in SAM cases (8.13±1.09 g/dL) than in controls (9.80±1.21 g/dL) (p=0.0005). Hematocrit was also reduced in cases (25.07±3.34%) compared to controls (30.88±4.02%) (p=0.0005). RBC count was lower in cases (3.99±0.71 ×10⁶/µL) than controls (4.10±0.51 ×10⁶/µL) (p=0.0003). MCV, MCH, and MCHC were all significantly reduced in cases (60.45±4.93 fL, 18.75±2.15 pg, and 30.11±1.74 g/dL, respectively) compared to controls (70.35±6.14 fL, 24.39±2.99 pg, and 32.94±1.72 g/dL, respectively) (p<0.05). WBC count was lower in the SAM group (6.99±1.64 ×10³/µL) compared to controls (8.24±4.28 ×10³/µL) (p=0.005), and platelet count was also significantly reduced (262.36±85.22 ×10³/µL vs. 302.11±128.15 ×10³/µL) (p=0.002). Conclusion: Children with severe acute malnutrition exhibited significant hematological abnormalities, including anemia, leukocyte alterations, and thrombocytopenia. The high prevalence of normochromic normocytic anemia and iron deficiency anemia underscores the profound impact of malnutrition on hematopoiesis. These findings emphasize the need for early identification, targeted nutritional interventions, and routine hematological monitoring to improve health outcomes in malnourished children.
... Children who have sedentary lifestyles-a life that is immobile, unhealthy, and inactive-are more likely to experience long-term health issues. Children's body growth indices are shown to be lower than the global average in low-income nations, where malnutrition and bad lifestyles are more prevalent (Müller & Krawinkel, 2005). But there is more to this issue than just the nations' economic circumstances. ...
Childhood obesity has been a significant concern worldwide. According to World Health Organization data the pandemic, pose a danger to the world between March 2020 and May 2023, has deepened this concern given the restriction measures such as closures taken to avoid the spread. Following the pandemic, a gap in the literature has arisen concerning the assessment of the long-term impact and potential side effects of physical activity restrictions on children. This study aims to address this gap by developing a comprehensive, needs-based physical activity school program and a web application for home settings, specifically designed for elementary schoolers in Türkiye. To gather essential information on the needs and current status of children in terms of physical and emotional well-being, as well as motor skills and physical activity habits from the perspectives of their caregivers, a thorough needs analysis study was conducted. This study used surveys. 27 volunteer parents participated in the study. The data were analyzed using content analysis. With these findings, an individual activity program consisting of different components was developed, taking into account the development levels and physical fitness levels of elementary school students. Individualized physical activity programs developed within this framework were created taking into account the individual needs and abilities of students and in order to support these needs, and were planned in two separate structures to be implemented with teachers at school and with parents at home.
... The mean age of the participants, 30±5 years, aligns with findings from similar studies in countries like Nigeria, where lactating women showed similar demographic characteristics [23][24][25]. Most of the women in this study had a university-level education and were housewives with moderate incomes, further reflecting trends in developing regions, where income plays a significant role in determining access to food and, consequently, maternal and child nutrition [25][26][27]. ...
Breastfeeding is a natural process that provides essential nutrition for the healthy growth and development of infants. Proper maternal nutrition is crucial for maintaining both the mother's and the infant's health. This study aimed to assess the nutritional status of lactating women in Benghazi, Libya. A cross-sectional study was conducted with a randomly selected sample of N=202 lactating women from Benghazi Medical Center and Pediatric Hospital. Data were collected through a self-administered questionnaire and a 24-hour dietary recall, and analyzed using SPSS. The majority of participants were aged 30±5 years, with 62.9% having an income between 500 and 1,000 Libyan dinars. About 64% of the women were either overweight or obese. The mean daily energy intake was 1571±581 kcal, with carbohydrate and protein intake significantly below the recommended levels, while fat intake was close to the recommended range. Additionally, a large proportion of the women were anemic, particularly those with low incomes and those breastfeeding for more than six months. The current study concluded that most lactating women were consuming nearly sufficient amounts of fat, but their intake of energy, carbohydrates, and protein fell below the recommended dietary allowances. Over half of the women were overweight or obese, and a majority was anemic, with higher prevalence among low-income women and those breastfeeding longer. Nutritional interventions and education programs are recommended to improve the dietary habits and overall health of lactating women.
... Malnutrition was identified as a critical issue affecting early childhood development in the ASAL regions. There is consistent evidence that malnutrition continues to be a major public health problem throughout the developing world, particularly in developing countries such as those in sub-Saharan Africa [33]. The consequences of malnutrition, as reported by our participants, are consistent with findings from the literature. ...
Introduction
Children growing up in arid and semi-arid regions of Sub-Saharan Africa (SSA) face heightened risks, often resulting in poor developmental outcomes. In Kenya, the arid and semi-arid lands (ASAL) exhibit the lowest health and developmental indicators among children. Despite these risks, some children grow up successfully and overcome the challenges. However, there is limited comprehensive data on sources of risks and resilience in these children, particularly research that incorporates community perspectives and indigenous knowledge. Systematic documentation of factors influencing child outcomes is crucial for understanding the overall burden, informing policy and implementing targeted interventions. This study aimed at bridging this gap.
Methods
The study was conducted in 10 ASAL counties in Kenya. Purposive and snowballing techniques were used to recruit 11 key informants per site with varied levels of involvement in early childhood development and primary caregivers. Using a semi-structured interview guide, 103 telephonic interviews were conducted between June and August 2022, involving 68 key informants and 35 caregivers. Thematic approach was used to analyze the data, using NVIVO software.
Results
The mean age of the participants was 44years (SD = 11 years). The findings, viewed through the lens of Bronfenbrenner’s ecological systems theory, reveal a complex interplay of contextual factors impacting children’s development. These factors range from individual and biological aspects to family, community, systemic, and environmental level, including climatic challenges. Identified risk factors encompassed issues such as young caregiver’s age, low literacy, mental health issues, drug abuse, domestic violence, malnutrition, poverty, lack of paternal involvement, early marriages, female genital mutilation, drought, heat stress, and insecurity. Nonetheless, sources of resilience include breastfeeding, immunization, responsive caregiving, family and community support, higher socio-economic status (SES), cultural practices, self-motivation, hard work, community role models, religious activities and quality service provision.
Conclusion
Urgent attention is needed to address the multifaceted challenges faced by children in ASAL regions. The study underscores the importance of addressing the root causes of risks while harnessing community strengths and resources to safeguard and promote the holistic development of these children.
... The majority of the body's iron and vitamin B12 requirements are met by consuming red meat and other animal-derived proteins. A decrease in these micronutrients consumption can lead to a wide variety of health problems for individuals, including anemia and vulnerability to infections (27). As well, the reduction in zinc and vitamin A intake might have an impact on several metabolic processes in the body. ...
Background: The household income level, food prices, and the amount of money spent on food are effective factors in food choices and people's health. Our objective was to determine and compare households’ food patterns based on food prices and their income in different socioeconomic statuses (SES). Method: 621 households were randomly selected from five of the Kermanshah city districts based on their SES. Data were collected using a personal information questionnaire, SES questionnaire, semi-quantitative weekly food purchase registration questionnaire, outdoor food purchase registration questionnaire, and a medium and long-term food purchase reminder questionnaire. Results: The average total cost of households for food per day was 2.51±0.18 $. The highest and lowest daily food expenditures were related to the protein (39.9%) and the dairy groups (3.8%). Households in the first SES spent 75.2% of their total income on food and there was a direct and significant correlation between SES, education, and income level with energy, macronutrients, and fiber (p<0.001). Conclusion: Our findings showed that SES can influence the amount and type of nutrients purchased by households. Increasing nutritional knowledge and making the right decisions by food policymakers may reduce food insecurity at the community level.
... In India, zinc deficient soils occupying almost 50% of the agricultural area are a critical constraint in getting higher yield of cowpea since the crop is very sensitive to the deficiency of zinc, which plays a vital role in nitrogen fixation through nodule formation. Its deficiency causes one of the major widespread micronutrient disorders that contribute to public health problems in developing countries Muller and Krawinkel (2005). Considering the above points in view, the experiment was conducted to find out the optimum dose of phosphorus and zinc for higher yield and nutrient uptake of cowpea crop. ...
A field experiment was conducted at Raja Balwant Singh College Research farm Bichpuri, Agra during rabi season of 2017-18 to study the effects of phosphorous and zinc application on yield and nutrient uptake of cowpea. The experiment consists of (a) four levels of phosphorous namely-(control) P 0 , (20) P 1 , (40)P 2 and (60) P 3 Kg P 2 O 5 ha-1 and (b) three levels of zinc viz. (control) ZN 0 , 10 Zn 1 , and 20 Zn 2 Kg ZnSO 4 ha-1. The results revealed that the application of 60 Kg P 2 O 5 ha-1 + 20 Kg ZnSO 4 ha-1 recorded significantly higher grain and straw yield over control. Similarly, the nitrogen, phosphorous, potassium and zinc uptake found higher with increased levels of phosphorous and zinc i.e., 60 kg P 2 O 5 ha-1 + 20 kg ZnSO 4 ha-1. It can be suggested that farmers may be used 60 kg P 2 O 5 ha-1 + 20 Kg ZnSO 4 ha-1 for better production and nutrient uptake of cowpea.
... However, research has shown that modern varieties of staple crops tend to have lower concentrations of essential micronutrients compared to their traditional counterparts (Bouis and Saltzman 2017;Bouis et al. 2019). This focus on high-yield crops often led to the neglect of traditional, nutrient-rich crops, contributing to a reduction in dietary diversity (Pingali 2012;Müller and Krawinkel 2005). ...
Hidden hunger, characterized by micronutrient deficiencies despite adequate caloric intake, affects over 2 billion people globally, primarily due to deficits in iron, vitamin A, and iodine. This phenomenon underscores a critical paradox in global food security: the Green Revolution, which significantly increased crop production through high‐yielding varieties (HYVs) of staple crops, has simultaneously contributed to widespread nutritional deficiencies. This article examines the dual legacy of the Green Revolution, exploring how its emphasis on yield over nutritional quality has led to decreased concentrations of essential micronutrients in staple crops, exacerbating hidden hunger. The extensive use of synthetic fertilizers, while boosting crop yields, has resulted in environmental degradation and economic burdens for smallholder farmers. Additionally, the shift towards dietary monoculture has reduced agricultural biodiversity and increased the prevalence of diet‐related non‐communicable diseases. Through diverse case studies from India, Zambia, Guatemala, the Philippines, Brazil, Mexico, and Ethiopia, this article illustrates various strategies to combat hidden hunger, including biofortification, multisectoral approaches, and sustainable agricultural practices. This article highlights the necessity for a multifaceted approach that integrates improved agricultural practices, dietary diversity, and supportive policies to enhance food security and public health. By addressing both caloric and nutritional needs, this comprehensive strategy aims to build resilient food systems that ensure a sustainable agricultural future.
Zinc is a trace mineral that is required by the human body. Despite testing being readily available in the Middle East, zinc deficiency and its management is poorly understood within the family medicine model. Diagnosis can be difficult because manifestations can vary from mild to severe symptoms. We must exercise caution due to co-existing alternative mineral deficiencies. Understanding the difference between acquired and genetic deficiencies can guide treatment. This paper will focus on diagnosing and treating symptoms of zinc deficiency within the community setting. Keywords: zinc, zinc deficiency, severe symptoms, treatment
Visceral leishmaniasis (VL) is a widespread highly morbid tropical infection. Protein-calorie and micro-nutrient deficiencies contribute to susceptibility and disease severity. This study aimed to delineate the effects of protein-calorie malnutrition, selenium (Se), zinc (Zn), and copper (Cu)] level derangements on immune responses in VL patients. Following informed consent, 77 sequential parasitologically confirmed VL patients and 112 apparently healthy controls were recruited. Weight for height Z-score (WHZ), albumin, Se, Zn, and Cu were markers for protein-calorie and micro-nutrient disturbances. Leishmanin skin test (LST), direct agglutination test (DAT), and IL-10/TNF-α/IFN-γ levels in supernatants of soluble Leishmania –antigen whole blood-stimulated samples were measured as indicators of immune responses. VL patients have significantly lower baseline WHZ levels compared to controls (−2.2 ± 1.1 and −1.4 ± 1.3, respectively, P = 0.0006). Albumin levels were similarly reduced (2.9 and 3.4 g/dL, P = 0.06). Patients had marginally significant lower Se levels compared to controls (57.6 ± 13.1 and 61.7 ± 13.4 µg/L, respectively, P = 0.04). Pretreatment Se levels were significantly lower compared to post-treatment ones (56.9 ± 13.1 and 65.2 ± 22.1 µg/dL, respectively, P = 0.02). Zn levels were significantly lower in patients compared to controls (36.2 ± 17.3 and 72.9 ± 12.5 µg/L, respectively, P = 0.0002). Cu levels were four-fold higher in patients compared to controls [median 336 and 73.5 µg/L, respectively P = 0.00001]. The Cu:Zn ratio was significantly higher in patients compared to controls (9.6 and 1.0, respectively, P = 0.0001). LST was non-reactive in all VL patients with DAT levels >6400. Pre- and post-VL treatment levels of IFN-γ and IL-10 levels were comparable in patients and controls. Pretreatment TNF-α levels were significantly higher compared to post-treatment ones (median: 64.1 and 36.7 pg/mL, respectively, P = 0.0002). Five per cent (6/112, 5.4%) of the healthy controls developed VL during follow-up, and 15.2% (17/112) developed subclinical infection with LST conversion in 14/17 (82.4%, mean induration of 8.5 ± 2.6 mm). Three (3/17, 17.6%) converted in DAT and LST. Low WHZ, Se, and Zn levels with high Cu/Cu: Zn ratios probably increase susceptibility to VL.
Background/Objectives: Poor diet is a leading modifiable cause of chronic disease in the US. In addition to targeting nutrients of concern (saturated fat, added sugars, and sodium), nutrients with both inadequate intakes and associations with major health outcomes require identification. We aimed to identify priority nutrients to address both malnutrition and diet-related disease in the US population. Methods: An established method for identifying priority nutrients across multiple demographic groups was adapted for the US population. This method evaluates and scores nutrients consumed at insufficient or excessive levels, with proposed revised requirements, and shows associations with established health priorities, based on the degree of deviation from recommendations and the number of linked health priorities. Priority nutrients were defined as those scoring in the top 25%. For each priority nutrient, a comparison of intake levels against the Dietary Reference Intake (DRI) was conducted. Results: There were 21 of 24 nutrients with consumption below recommended levels in at least one demographic group. Certain nutrients, such as dietary fiber, vitamin D, and choline, exhibited particularly high inadequacy rates, exceeding 90% throughout different life stages. The highest priority nutrients included vitamin D, vitamin E, calcium, magnesium, and dietary fiber, with vitamin D, omega-3 fatty acids, zinc, folate, and potassium showing priority for specific demographic groups. Comparing current intake levels with those known to benefit health priorities indicated that higher intakes of vitamin D, vitamin E, and calcium could be beneficial. Conclusions: Ten essential nutrients play a role in the prevention of diet-related disease, yet are consumed inadequately across the US population, suggesting that the prioritization of these nutrients can help to address the burden of chronic disease. Priority nutrients should be considered in diet and nutrition policies and guidelines.
Fortified foods and beverages (FFBs) play a pivotal role in addressing nutritional deficiencies amid evolving dietary preferences in India. This research aims to explore Indian consumer perceptions of FFBs, emphasizing factors influencing adoption. To understand FFB acceptance in India’s culturally diverse and nutritionally varied context, the study integrated two influential consumer behavior models—the Health Belief Model and the Theory of Planned Behavior. Structural equation modeling was employed for data analysis, with online questionnaires collected from 421 FFB consumers. Factors like perceived susceptibility, perceived severity, perceived benefit, subjective norms, perceived behavioral control, and health consciousness were considered. All factors except perceived barrier significantly influenced behavioral intention to use FFBs. Moderating variables like age, gender, and income provided additional insights. The research outcomes offer valuable guidance to industry stakeholders, policymakers, and nutrition advocates, aiming to enhance nutritional standards and public health by encouraging FFB adoption in India.
Millions of people in sub‐Saharan Africa (SSA) depend on maize as their primary source of calories and income. To keep on feeding the fast‐growing population and facing the challenges of the changing climate, there is a need to look for different technological advancements to bridge the yield and quality gaps of this vital crop through breeding and improved management. As most of the maize farmers in Africa are small‐scale with small (on average ≤ 1 ha), fragmented and degraded plots of land, increasing production per hectare has been suggested to be the preferred approach to uplift the total production. This can be achieved using improved technologies, including the development and dissemination of crop hybrids, which combine better yields under multiple stresses. The development and deployment of maize hybrids in SSA began in the early 1950s. Consequently, many hybrids have been released for production in most countries of the region. However, the extent and rate of adoption have been low and slow, which can be attributed to several factors including lack of resilient genetics, which perform under the changing climate and the associated multiple biotic and abiotic stresses. Evaluation of hybrids has been done by public institutions and private seed companies under optimal and stress growing conditions using different physiological, molecular, genetics and genomics protocols. In this article, attempts have been made to review the efforts made, the successes achieved, the challenges faced and the opportunities set forward to improve maize yields over decades in SSA, through conventional and state‐of‐the‐art breeding approaches for coping with multiple biotic and abiotic stresses.
Background: Bone age is an indicator of the skeletal and biological maturity of an individual. Skeletal ossification progression studies are one of them and are admissible in court as unparalleled scientific evidence for age estimation. Age group of juveniles between 12 -18 years is dealt with special laws for medico-legal cases.
Aim: To study the age of fusion of ossification centres of upper end of femur in adolescent population of Jaipur region.
Material & Methodology: An observational prospective study was conducted on Healthy Adolescents of 12-18 years of age group from Jaipur region were taken in the study. The present study had been conducted in the Department of Forensic Medicine & Toxicology, SMS Hospital, Jaipur in association with Department of Radiology, SMS Medical College and Attached Hospitals, Jaipur during the period from June 2021 to May 2022.
Result & Observation: This observational study examined the stages of skeletal maturation and the fusion of the upper end of the femur among male and female adolescents. The study was conducted on a sample of male and female subjects aged 12 to 18 years. The key findings indicate that in male subjects aged 12-15 years, the greater trochanter and head of femur were not fused in all subjects. Fusion began to appear at age 15-16years, with a progressive increase in the number of fused cases in older age groups. Among female subjects, the pattern is similar, with no fusion observed in subjects aged 12-15 years. Fusion starts appearing at age 15-16 and becomes more prevalent in older subjects. These findings provide valuable insights into the timeline and progression of skeletal maturation in adolescents, highlighting age-specific variations in the fusion of the greater trochanter and head of femur. This data can inform clinical practices, forensic investigations, and educational frameworks related to adolescent health and development.
Conclusion: Complete fusion of ossification centres for greater trochanter and head of femur can be implemented in routine forensic practice for 12 –18 years age group to opine about age of subjects with lesser age range.
Efforts to reduction poverty and reduce social inequality in Indonesia, especially in East Java, still face major challenges, such as the high level of poverty that has an impact on public health. In Tambak Kalisogo Village, Sidoarjo, the establishment of the Family Medicinal Plants Self-Help Group (Asman Toga) by the local government and the support of PT Perusahaan Gas Negara through the HERBAMAN programme aims to improve health and economic welfare through women's empowerment. This qualitative study used purposive sampling to understand the impact of the programme on family health and economy. The results show that the HERBAMAN programme succeeded in increasing household income, reducing fire risk, and improving the environment. This success was supported by the cooperation of various parties, showing that community synergy and innovation can bring sustainable positive change.
In recent times, the demand for healthy and functional foods that enhance immunity and combat diseases has surged. Micronutrients are crucial in maintaining immune function, as their deficiency can lead to various metabolic disorders. The most common metabolic diseases are due to deficiencies of iron, vitamin A, and iodine which can strategically be addressed through diverse dietary inclusions, food fortification and awareness programmes. Amongst these strategies, food fortification presents a viable approach to tackle micro-nutrient deficiency and in this context, meat products can be enriched with micronutrients to address deficiencies in essential nutrients in the human diet. Meat products can be enriched with a complex of microelements like zinc, manganese, iron, copper, and cobalt, along with riboflavin and lysine. Functional meat products with essential nutrients such as iodine, calcium, and iron may be developed that cover daily human needs for these micronutrients. As enriching meat with micronutrients presents a promising approach to improve the nutritional quality of meat products and addressing nutrient deficiencies in the population, this chapter will discuss the importance of micronutrients in detail and the role of muscle foods in delivering the micro-nutrients to tackle associated deficiencies.
Conventional laboratory protein detection techniques are not suitable for point-of-care (POC) use because they require expensive equipment and laborious protocols, and existing POC assays suffer from long development timescales. Here, we describe a modular cell-free biosensing platform for generalizable protein detection that we call TLISA (T7 RNA polymerase–linked immunosensing assay), designed for extreme flexibility and equipment-free use. TLISA uses a split T7 RNA polymerase fused to affinity domains against a protein. The target antigen drives polymerase reassembly, inducing reporter expression. We characterize the platform and then demonstrate its modularity by using 16 affinity domains against four different antigens with minimal protocol optimization. We show that TLISA is suitable for POC use by sensing human biomarkers in serum and saliva with a colorimetric readout within 1 hour and by demonstrating functionality after lyophilization. Altogether, this technology has the potential to enable truly rapid, reconfigurable, modular, and equipment-free detection of diverse classes of proteins.
Background and Objective: In low income countries like Pakistan the prevalence of malnutrition is quite high and this physical condition of children is associated with the educational status of their mothers. This study was conducted to find out the frequency of malnutrition among school children of 5-8 years of age, and its relationship with the literacy status and occupation of their mothers. Methods: A Cross-sectional study was carried out in Public sector schools of Wah Cantt from Sep. 2013 to Feb. 2014. Four hundred and ten school children of 5-8 years of age were included in the study by simple random sampling technique. The height and weight was measured and frequency of overweight , underweight, stunting, muscle wasting and status of mothers' education were determined. Results were summed and statistically analyzed using SPSS 19. Chi-Square test was applied to find out the significance of association between mother's education and malnutrition of their children. Results: Out of 410 children there were 149 (36.3%) boys and 261 (63.7%) girls. The mean age was 75.01 ± 6.5 months. Frequency of malnutrition was 59.5%, 53.4%, 40.3% and 43.7% in children with mother's education up to Primary, Matric/Intermediate, Graduate and Postgraduate respectively. A significant inverse relationship was found between mother's education and frequency of underweight and stunting among children (p-value 0.003 and 0.042).
Background: Disability and dementia are significant health concerns that share common risk factors, and their co-occurrence can profoundly affect the health and well-being of middle-aged and older adults. Dementia involves the decline of cognitive functions such as memory, thinking, and reasoning, while disability refers to the inability to perform essential daily activities, including seeing, hearing, walking, climbing, remembering, or concentrating. Both conditions hinder an individual's ability to manage daily life and routines. Forcibly Displaced Myanmar Nationals (FDMN), commonly known as Rohingya refugees, living in refugee camps in Bangladesh, are particularly vulnerable to physical and cognitive impairments. Despite this heightened vulnerability to social, psychological, and quality-of-life challenges, there is a lack of research exploring the impact of loneliness on disability, the relationship between disability and dementia, and the factors associated with these conditions among Rohingya refugees.
Objectives: This study aims to examine the impact of loneliness on disability among refugees residing in camps in Bangladesh. Additionally, it seeks to explore how disability influences dementia within these communities. Specifically, the study will: (a) investigate the relationship between disability and loneliness among middle-aged and older FDMN in Bangladesh; (b) explore the link between disability and dementia within this group, using existing survey data; and (c) examine the factors associated with disability and dementia among Rohingya individuals aged 50 and older living in refugee camps in Bangladesh.
Methods: To achieve these objectives, a retrospective analysis was conducted using data from the Needs and Gaps Assessment Survey. The first part of the survey included 543 FDMN, while the second part focused on 497 FDMN aged 50 and older residing in Bangladesh. Data were collected in 2020. Disability was assessed across six domains: seeing, hearing, walking, concentrating, self-care, and communication. Dementia was evaluated using the Mini Mental State Examination (MMSE), which included 11 questions covering orientation (time and place), location, registration, attention and calculation, delayed recall of three objects, naming, repetition, comprehension of simple commands, reading and obeying instructions, writing, and copying. Dementia was defined as an MMSE score of 17 or lower out of 30. Descriptive statistics were used to summarize the data, chi-square tests were conducted to examine initial associations, and logistic regression was applied to assess the relationships between variables.
Results: The average age of participants was 61.6 years (SD: 10.2). Seven out of 10 middle-aged and older FDMN had a disability. Disability was found to be associated with increasing age (OR=7.42, 95% CI: 1.70-32.45) and loneliness (OR=1.84, 95% CI: 1.02-3.30) among this group. The prevalence of dementia among middle-aged and older FDMN was 52.9%. Dementia prevalence was higher in the oldest age group (70.8%), among women (62.3%), those with two or more chronic conditions (65.4%), those living alone (56.5%), individuals with moderate acute malnutrition (81.6%), and those with disabilities (58.5%). Prevalence rates were also higher among individuals experiencing difficulties with seeing (55.5%), hearing (59.7%), walking (57.9%), concentrating (68%), self-care (72.8%), and communication (72.2%). Multivariate logistic regression analysis identified several factors associated with dementia, including age (70-79), female gender, chronic morbidities, moderate acute malnutrition, disability, and difficulties with walking, concentrating, self-care, and communication.
Conclusions: Disability was found to be associated with both advancing age and loneliness. This highlights the urgent need for practical, targeted interventions to address disability among FDMN, particularly for the high-risk subgroups identified. Dementia, on the other hand, was associated with age, gender, chronic morbidities, disability, and difficulties with walking, concentrating, self-care, and communication. The high prevalence of dementia emphasises the critical need to identify key risk factors within this population. Understanding these factors can inform the development of targeted strategies aimed at risk reduction and prevention, addressing the unmet needs of this vulnerable group.
Approximately one-third of children under the age of five are stunted in developing countries and many of them are micronutrient-deficient. We designed a comprehensive intervention package including egg/milk-based snacks to improve linear growth and dietary diversity among 6 to 12-month-old children in rural Bangladesh. In this 1-year community-based cluster randomized controlled longitudinal experiment, 412 mother–infant pairs were randomly assigned to receive either monthly food vouchers (for eggs, milk, semolina, sugar, and oil) to prepare egg and milk-based snacks for their children, along with multiple micronutrient powder (MNP), counseling on child feeding and handwashing, or regular government health communication alone (control; n = 206, treatment; n = 206). The trial was conducted in 12 clusters (small administrative units of sub-district). The primary inclusion criteria were ultra-poor households with limited resources and having children under 2-years-old. The primary and secondary outcomes were differences in children's length gain and dietary diversity. The effect of intervention on child growth was examined using a mixed effect linear regression model. Mean weight and length of the children did not significantly differ between groups at baseline. Around 90% of the children in both groups were breastfed. After receiving intervention for 12 months, LAZ score increased by 0.37 (CI 0.24, 0.51, p < 0.001) and risk of stunting reduced by 73% (OR: 0.27, CI 0.13, 0.58, p = 0.001). This comprehensive intervention package improved the growth and dietary diversity of children in extremely poor Bangladeshi households. A scaling-up of this intervention in contexts with limited resources should be taken into consideration.
Trial registration: This trial registered retrospectively at ClinicalTrials.gov as NCT03641001, 21/8/2018.
The causes of childhood malnutrition are diverse, multidimensional, and interrelated. An analytical framework suggested by the United Nations Children's Fund (UNICEF) categorizes the causes into (a) immediate causes: inadequate dietary intake and illness, (b) underlying causes: insufficient access to food in a household; inadequate health services and unhealthy environment; and inadequate care for children and women at the household level, and (c) basic causes: insufficient current and potential resources at societal level. The World Health Organization (WHO) has reported hunger and related malnutrition as the greatest single threat to the world's public health. So, this study aim is to find out mother’s knowledge on malnutrition can help to improve the conditions related to malnutrition among the children as to improve the health status. In this study Quantitative research approach applied. In the present study an descriptive research design used. The research variable in the present study Mother’s knowledge. The research areas for the research study were 10 selected rural areas of himachal pradesh. The population comprises of under-five children and their mothers from rural areas of himachal pradesh who fulfills the inclusion criteria. Under-five children and their mothers residing in selected rural areas of himachal pradesh. The sample of study was under five children and their mother. In this study purposive sampling technique used. Study shows that 24% mothers had average knowledge, 76% had poor level of knowledge and 0 % mothers had good level of knowledge.
Undernutrition has always been a significant public health challenge in middle and lower-income countries. However, due to improved socioeconomic conditions and lifestyle changes, undernutrition is decreasing while overnutrition is increasing rapidly. This has led to a dual burden of malnutrition, particularly among women. This cross-sectional study was conducted in two phases in 2019 and 2022, among adult women (18 to <60 years) in the Midnapore municipal area of Paschim Medinipur, West Bengal, India, with the aim of assessing the nutritional status of adult women in the area. The study also aimed to examine the socioeconomic factors that influence the nutritional status of the study population. Primary data were collected using structured surveys and interviews, and anthropometric measurements were taken using standard procedures. Total 200 participants were included in the study using purposive sampling method. Statistical significance was considered at p-values ≤0.05. The study found that overnutrition is highly prevalent among the participants (45%), while undernutrition is also a concern, affecting a significant number of women (8%). Additionally, central obesity is high among the participants. Factors such as age, education, occupation, and physical activity were found to be statistically associated with the nutritional status of the participants. In India, the focus of academic and awareness programs has historically been on combating undernutrition. However, with the changing circumstances, there is a need to realign the focus and promote healthy eating and lifestyle habits.
Objective
To explore the prevalence and determinants of undernutrition among infants and children aged 6 months to 5 years in sub-Saharan African countries.
Background
Despite substantial progress over the past 20 years, undernutrition has remained an alarming global challenge. Sub-Saharan Africa is the only region where the prevalence of stunting in children younger than 5 years has significantly increased. This study seeks to update the evidence on the prevalence and determinants of childhood undernutrition in this vulnerable region.
Methods
This systematic scoping review was conducted following the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched on December 14, 2022, with no date or language restrictions. Primary studies presenting evidence on the prevalence and determinants of childhood undernutrition among infants and children aged 6 months to 5 years were included. Data on the prevalence of stunting, wasting, and underweight, and on determinants of undernutrition were extracted, described, and compared with national survey data.
Results
A total of 59 publications from 11 countries were included, with most studies conducted in Ethiopia (n = 38) and Tanzania (n = 7). Stunting prevalence ranged from 8% to 64%, wasting prevalence ranged from 1% to 58%, and the prevalence of underweight ranged from 2% to 63%. The most frequently reported determinants of undernutrition were the child’s age (>24 months), male sex, maternal illiteracy, diarrhea or illness in the past 2 weeks, low household socioeconomic status, or living in a larger household (n > 4 members). Overall, 56% of the included studies reported higher stunting prevalence, 60% reported higher wasting prevalence, and 57% reported a higher prevalence of underweight than reported by relevant national surveys.
Conclusion
The prevalence of childhood undernutrition reported by primary studies is often higher than that reported by national surveys. Several immediate and underlying determinants influence childhood undernutrition. Future research should incorporate the findings from primary research to develop holistic, multistrategy approaches to address childhood undernutrition in sub-Saharan African countries.
Although most studies on the effect of vitamin A supplementation have reported reductions in childhood mortality, the effects on morbidity are less clear. We have carried out two double-blind, randomised, placebo-controlled trials of vitamin A supplementation in adjacent populations in northern Ghana to assess the impact on childhood morbidity and mortality.The Survival Study included 21 906 children aged 6-90 months in 185 geographical clusters, who were followed for up to 26 months. The Health Study included 1455 children aged 6-59 months, who were monitored weekly for a year. Children were randomly assigned either 200 000 IU retinol equivalent (100 000 ID under 12 months) or placebo every 4 months; randomisation was by individual in the Health Study and by cluster in the Survival Study. There were no significant differences in the Health Study between the vitamin A and placebo groups in the prevalence of diarrhoea or acute respiratory infections; of the symptoms and conditions specifically asked about, only vomiting and anorexia were significantly less frequent in the supplemented children. Vitamin-A-supplemented children had significantly fewer attendances at clinics (rate ratio 0·88 [95% Cl 0·81-0·95], p=0·001), hospital admissions (0·62 [0·42-0·93], p=0·02), and deaths (0·81 [0·68-0·98], p=0·03) than children who received placebo. The extent of the effect on morbidity and mortality did not vary significantly with age or sex. However, the mortality rate due to acute gastroenteritis was lower in vitamin-A-supplemented than in placebo clusters (0·66 [0·47-0·92], p=0·02); mortality rates for all other causes except acute lower respiratory infections and malaria were also lower in vitamin A clusters, but not significantly so.Improving the vitamin A intake of young children in populations where xerophthalmia exists, even at relatively low prevalence, should be a high priority for health and agricultural services in Africa and elsewhere.
Objective To study the effects of zinc supplementation on malaria and other causes of morbidity in young children living in an area holoendemic for malaria in west Africa. Design Randomised, double blind, placebo controlled efficacy trial. Setting 18 villages in rural northwestern Burkina Faso. Participants 709 children were enrolled; 685 completed the trial. Intervention Supplementation with zinc (12.5 mg zinc sulphate) or placebo daily for six days a week for six months. Main outcome measures The primary outcome was the incidence of symptomatic falciparum malaria. Secondary outcomes were die severity of malaria episodes, prevalence of malaria parasites, mean parasite densities, mean packed cell volume, prevalence of other morbidity, and all cause mortality. Results The mean number of malaria episodes per child (defined as a temperature greater than or equal to 37.5 degreesC with greater than or equal to 5000 parasites/mul) was 1.7, 99.7% due to infection with Plasmodium falciparum. No difference was found between the zinc and placebo groups in the incidence of falciparum malaria (relative risk 0.98, 95% confidence interval 0.80 to 1.11), mean temperature, and mean parasite densities during malaria episodes, nor in malaria parasite rates, mean parasite densities, and mean packed cell volume during cross sectional surveys. Zinc supplementation was significantly associated with a reduced prevalence of diarrhoea (0.87, 0.79 to 0.95). All cause mortality was non-significantly lower in children given zinc compared with those given placebo (5 v 12, P= 0.1). Conclusions Zinc supplementation has no effect on morbidity from falciparum malaria in children in rural west Africa, but it does reduce morbidity associated with diarrhoea.
A group of 134 school children aged 3-9 y, with signs of conjunctival xerosis, from the rural area of the Sakorn Nakhon province in Northeast Thailand were selected for a controlled study on the short-term effect (2 wk) of a single, oral high dose of vitamin A on iron metabolism. After collection of the baseline data, children within villages were randomly assigned to receive the capsules (n = 65) or serve as control subjects (n = 69). Two weeks after supplementation significant increases of retinol, retinol-binding protein, hemoglobin, hematocrit, serum iron, and saturation of transferrin were found in the supplemented group. Ferritin concentrations did not change significantly. These short-term changes completely exclude seasonal effects and change in morbidity. This study provides further evidence of a causal association between vitamin A and iron metabolism. In areas where vitamin A deficiency is endemic, periodic massive vitamin A dose programs can also improve iron status of the population.
The literature of the relative risks of diarrhoea morbidity to infants on different feeding modes suffers from several methodological problems. Thirty-five studies from 14 countries were reviewed; 83% of studies found that exclusive breast-feeding was protective compared to partial breast-feeding, 88% that exclusive breast-feeding was protective compared to no breast-feeding, and 76% that partial breast-feeding was protective compared to no breast-feeding. When infants receiving no breast milk are contrasted with infants on exclusive or partial breast-feeding, the median relative risks are 3.0 for those aged 0-2 months, 2.4 for those ages 3-5 months, and 1.3-1.5 for those aged 6-11 months. Above 1 year of age no protective effects of breast-feeding on diarrhoea morbidity is evident. When infants receiving no breast milk are contrasted with those on exclusive breast-feeding, median relative risks are 3.5-4.9 in the first 6 months of life. The literature does not suggest that the relative risks of diarrhoea morbidity for the bottle-fed infants are higher in poor families than in more wealthy families. The protective effects of breast-feeding do not appear to continue after the cessation of breast-feeding. There is evidence of considerably increased diarrhoea severity among bottle-fed infants. There is a limited, and mostly pre-1950, literature on the relative risks of diarrhoea mortality to infants on different feeding nodes. Nine studies from 5 countries were reviewed most of which showed that breast-feeding protects substantially against death from diarrhoea. When infants receiving no breast milk are contrasted with those on exclusive breast-feeding, the median relative risk of death from diarrhoea during the first 6 months of life is 25. When partially and exclusively breast-fed infants are contrasted, the median relative risk of death from diarrhoea is 8.6. Breast-feeding can be promoted by changes in hospital routine and by giving information and support to mothers. A review of 21 studies from 8 countries show that, by such promotion, the most likely reductions in the prevalence of non-breast-fed infants are 40% among infants aged 0-2 months, 30% among those aged 3-5 months, and 10% among those between 6 months and 1 year old. Theoretical calculations based on these data show that such promotion can reduce diarrhoea morbidity rates by 8-20% and diarrhoea mortality rate by 24-27% in the first 6 months of life. For children aged 0-59 months, diarrhoea morbidity rates would be reduced by 1-4% and mortality rates by 8-9%. A recent study in Costa Rica has documented a substantial impact of breast-feeding promotion on neonatal diarrhoea morbidity and mortality, and on diarrhoea morbidity in infants aged 0-5 months. The Costa Rican data show good agreement with the theoretical computations presented in this paper. Several important aspects of breast-feeding and diarrhoea remain to be clarified by research. However, the need for this research should not delay action to promote breast-feeding and to monitor its effects upon feeding practice and upon diarrhoea.
In developing countries the duration and severity of diarrheal illnesses are greatest among infants and young children with malnutrition and impaired immune status, both factors that may be associated with zinc deficiency. In children with severe zinc deficiency, diarrhea is common and responds quickly to zinc supplementation.
To evaluate the effects of daily supplementation with 20 mg of elemental zinc on the duration and severity of acute diarrhea, we conducted a double-blind, randomized, controlled trial involving 937 children, 6 to 35 months of age, in New Delhi, India. All the children also received oral rehydration therapy and vitamin supplements.
Among the children who received zinc supplementation, there was a 23 percent reduction (95 percent confidence interval, 12 percent to 32 percent) in the risk of continued diarrhea. Estimates of the likelihood of recovery according to the day of zinc supplementation revealed a reduction of 7 percent (95 percent confidence interval, -9 percent to +22 percent) in the risk of continued diarrhea during days 1 through 3 and a reduction of 38 percent (95 percent confidence interval, 27 percent to 48 percent) after day 3. When zinc supplementation was initiated within three days of the onset of diarrhea, there was a 39 percent reduction (95 percent confidence interval, 7 percent to 61 percent) in the proportion of episodes lasting more than seven days. In the zinc-supplementation group there was a decrease of 39 percent (95 percent confidence interval, 6 percent to 70 percent) in the mean number of watery stools per day (P = 0.02) and a decrease of 21 percent (95 percent confidence interval, 10 percent to 31 percent) in the number of days with watery diarrhea. The reductions in the duration and severity of diarrhea were greater in children with stunted growth than in those with normal growth.
For infants and young children with acute diarrhea, zinc supplementation results in clinically important reductions in the duration and severity of diarrhea.
A beneficial effect of periodic vitamin A supplementation on childhood mortality has been demonstrated, but the effect on morbidity is less clear. We investigated the effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections (ALRI) in children from northeastern Brazil in a randomised, double-blind, placebo-controlled community trial. 1240 children aged 6-48 months were assigned vitamin A or placebo every 4 months for 1 year. They were followed up at home three times a week, and data about the occurrence and severity of diarrhoea and ALRI were collected. Any child with cough and respiratory rate above 40 breaths per min was visited by a paediatrician. The overall incidence of diarrhoea episodes was significantly lower in the vitamin-A-supplemented group than in the placebo group (18.42 vs 19.58 x 10(-3) child-days; rate ratio 0.94 [95% Cl 0.90-0.98]). The benefit of supplementation was greater as regards severe episodes of diarrhoea; the incidence was 20% lower in the vitamin A group than in the placebo group (rate ratio 0.80 [0.65-0.98]). With the standard definition of diarrhoea (> or = 3 liquid or semi-liquid stools in 24 h) the effect of vitamin A on mean daily prevalence did not reach significance, but as the definition of diarrhoea was made more stringent (increasing number of stools per day), a significant benefit became apparent, reaching for diarrhoea with 6 or more liquid or semi-liquid stools in 24 h a 23% lower prevalence. We found no effect of vitamin A supplementation on the incidence of ALRI. The reduction in severity of diarrhoea may be the most important factor in the lowering of mortality by vitamin A supplementation.
Glutathione S-transferases (GSTs) are principally involved in detoxification. These enzymes can be induced by an increased flux of substrate, such as occurs during pro-oxidative stress or antioxidant deficiency. We tested the hypothesis that the postulated oxidative stress in severe malnutrition would result in induction of GSTs in erythrocytes. Erythrocyte GST activity towards 1-chloro-2,4-dinitrobenzene (CDNB) was measured in 271 malnourished children (22 undernourished; 92 marasmic; 82 kwashiorkor; 75 marasmic-kwashiorkor) and 48 healthy children. GST activity in the malnourished children was significantly higher than the control group (P < 0.01). The GST activity in the four classes of malnutrition did not differ. There was a weak relationship between GST activity and the height deficit, but not with the weight deficit, or the clinical features displayed by the children. The 11 children that died had a higher value than the survivors. There was no change in GST with anthropometric recovery. We conclude that erythrocyte GST has been induced in children with malnutrition. Induction of erythrocyte GST may be the result of exposure of the children to oxidative stress during the months prior to their presentation with severe malnutrition.
Using the WHO Global Database on Child Growth, which covers 87% of the total population of under-5-year-olds in developing countries, we describe the worldwide distribution of protein-energy malnutrition, based on nationally representative cross-sectional data gathered between 1980 and 1992 in 79 developing countries in Africa, Asia, Latin America, and Oceania. The findings confirm that more than a third of the world's children are affected. For all the indicators (wasting, stunting, and underweight) the most favourable situation--low or moderate prevalences--occurs in Latin America; in Asia most countries have high or very high prevalences; and in Africa a combination of both these circumstances is found. A total 80% of the children affected live in Asia--mainly in southern Asia--15% in Africa, and 5% in Latin America. Approximately, 43% of children (230 million) in developing countries are stunted. Efforts to accelerate significantly economic development will be unsuccessful until optimal child growth and development are ensured for the majority.
Despite broad agreement that severe malnutrition contributes to child mortality in developing countries and that malnutrition has a physiologically synergistic relationship with morbidity, evidence of an epidemiologic synergism has been lacking. Also, the literature provides conflicting evidence concerning the existence of elevated mortality among children with mild to moderate malnutrition. A review of published population-based studies of anthropometry-mortality relationships was undertaken to clarify these relationships.
Six studies with the relevant data were reanalyzed to test for synergism and elevated mortality in mild to moderate malnutrition.
The results demonstrate that mortality increases exponentially with declining weight for age. This effect is consistent across studies and there is no apparent threshold effect on mortality. The primary difference across studies is in baseline levels of mortality, which determine the quantitative impact of malnutrition on mortality in a population.
These results indicate that mild to moderate malnutrition is associated with elevated mortality and that there is an epidemiologic synergism between malnutrition and morbidity. This previously undemonstrated finding has significant implications for child survival policies and research.
To study the effect of vitamin A supplementation on morbidity and mortality from infectious disease.
A meta-analysis aimed at identifying and combining mortality and morbidity data from all randomised controlled trials of vitamin A.
Of 20 controlled trials identified, 12 trials were randomised trials and provided "intention to treat" data: six community trials in developing countries, three in children admitted to hospital with measles, and three in very low birth weight infants. Combined results for community studies suggest a reduction of 30% (95% confidence interval 21% to 38%; two tailed p < 0.0000001) in all cause mortality. Analysis of cause specific mortality showed a reduction in deaths from diarrhoeal disease (in community studies) by 39% (24% to 50%; two tailed p < 0.00001); from respiratory disease (in measles studies) by 70% (15% to 90%; two tailed p = 0.02); and from other causes of death (in community studies) by 34% (15% to 48%; two tailed p = 0.001). Reductions in morbidity were consistent with the findings for mortality, but fewer data were available.
Adequate supply of vitamin A, either through supplementation or adequate diet, has a major role in preventing morbidity and mortality in children in developing countries. In developed countries vitamin A may also have a role in those with life threatening infections such as measles and those who may have a relative deficiency, such as premature infants.
The realization that acrodermaitis enteropathica (AE) was a zinc-responsive syndrome (Moynahan and Barnes 1973) provided the archetype of severe human zinc deficiency which aided the recognition of sporadic severe zinc deficiency accompanying total parenteral nutrition (TPN) in adults (Kay et al. 1976) and children (Arakawa et al. 1976) and in a variety of other conditions. This chapter outlines the features of severe zinc deficiency and the various conditions in which this has been observed.
Southern Africa is undergoing a food crisis of surprising scale and novelty. The familiar culprits of drought and mismanagement of national strategies are implicated. However, this crisis is distinct from conventional drought-induced food shortages with respect to those vulnerable to starvation, and the course of impoverishment and recovery. We propose that these new aspects to the food crisis can be attributed largely to the HIV/AIDS epidemic in the region. We present evidence that we are facing a new variant famine. We have used frameworks drawn from famine theory to examine the implications. HIV/AIDS has created a new category of highly vulnerable households--namely, those with ill adults or those whose adults have died. The general burden of care in both AIDS-affected and non-AIDS-affected households has reduced the viability of farming livelihoods. The sensitivity of rural communities to external shocks such as drought has increased, and their resilience has declined. The prospects for a sharp decline into severe famine are increased, and possibilities for recovery reduced.
Objectives: This study assessed the effects of zinc supplementation in the prevention of diarrhea and pneumonia with the use of a pooled analysis of randomized controlled trials in children in developing countries. Study design: Trials included were those that provided oral supplements containing at least one half of the United States Recommended Daily Allowance (RDA) of zinc in children <5 years old and evaluated the prevention of serious infectious morbidity through household visits. Analysis included 7 “continuous” trials providing 1 to 2 RDA of elemental zinc 5 to 7 times per week throughout the period of morbidity surveillance and 3 “short-course” trials providing 2 to 4 RDA daily for 2 weeks followed by 2 to 3 months of morbidity surveillance. The effects on diarrhea and pneumonia were analyzed overall and in subgroups defined by age, baseline plasma zinc concentration, nutritional status, and sex. The analysis used random effects hierarchical models to calculate odds ratios (OR) and 95% CIs. Results: For the zinc-supplemented children compared with the control group in the continuous trials, the pooled ORs for diarrheal incidence and prevalence were 0.82 (95% CI 0.72 to 0.93) and 0.75 (95% CI 0.63 to 0.88), respectively. Zinc-supplemented children had an OR of 0.59 (95% CI 0.41 to 0.83) for pneumonia. No significant differences were seen in the effects of the zinc supplement between the subgroups examined for either diarrhea or pneumonia. In the short-course trials the OR for the effects of zinc on diarrheal incidence (OR 0.89, 95% CI 0.62 to 1.28) and prevalence (OR 0.66, 95% CI 0.52 to 0.83) and pneumonia incidence (OR 0.74, 95% CI 0.40 to 1.37) were similar to those in the continuous trials. Conclusions: Zinc supplementation in children in developing countries is associated with substantial reductions in the rates of diarrhea and pneumonia, the 2 leading causes of death in these settings. (J Pediatr 1999;135:689-97)
Marasmus and kwashiorkor are manifestations of protein energy malnutrition. The pathophysiology of these disorders is poorly understood. We studied a number of blood antioxidants [glucose-6-phosphate dehydrogenase (G6PDH), glutathione reductase (GR) and its cofactor flavin adenine dinucleotide (FAD), the tripeptide glutathione as the major nonprotein thiol], serum albumin, and retinol-binding protein in 12 children suffering from kwashiorkor with all classical symptoms, in 13 patients with clinically severe marasmus, in 19 marasmic but active children, and in 23 controls. Significant changes were observed for erythrocyte glutathione and correspondingly for nonprotein thiols in whole blood (0.72 ± 0.29 mM thiols in controls, 0.50 ± 0.22 mM in marasmus, 0.35 ± 0.23 mM in severe marasmus, and 0.22 ± 0.13 mM in kwashiorkor). These differences were paralleled by a decrease in serum albumin concentration so that the molar ratio of nonprotein thiols/albumin had an average value of approximately 1.5 in all groups. The erythrocyte glutathione-reducing system, represented by G6PDH and glutathione reductase, showed only slight differences among the four groups of children; the supposition that kwashiorkor occurs predominantly in children with aberrant G6PDH could not be substantiated. Unexpectedly, erythrocyte FAD, an index of riboflavin status, was normal in most malnourished patients. Discussed is the prospect of administering glutathione in kwashiorkor patients.
Major advances have been made during the past decade in the way the international community responds to the health and nutrition consequences of complex emergencies. The public health and clinical response to diseases of acute epidemic potential has improved, especially in camps. Case-fatality rates for severely malnourished children have plummeted because of better protocols and products. Renewed focus is required on the major causes of death in conflict-affected societies--particularly acute respiratory infections, diarrhoea, malaria, measles, neonatal causes, and malnutrition--outside camps and often across regions and even political boundaries. In emergencies in sub-Saharan Africa, particularly southern Africa, HIV/AIDS is also an important cause of morbidity and mortality. Stronger coordination, increased accountability, and a more strategic positioning of non-governmental organisations and UN agencies are crucial to achieving lower maternal and child morbidity and mortality rates in complex emergencies and therefore for reaching the UN's Millennium Development Goals.
Summary in English. Thesis (Ph. D.)--University of the Orange Free State, 2000. Bibliography (leaves 128-171).
The treatment of severe PEM includes--as appropriate in individual patients--fluid and electrolyte therapy, antimicrobial drugs, dietary management, and social and behavioral counseling. Except in the case of severe anorexia or life-threatening infections or dehydration, nutritional rehabilitation can be completed in the community setting, using centrally-processed or locally-prepared food mixtures and, when necessary, supplemental vitamins, minerals, and trace elements. Energy intakes should be maximized to promote rapid recovery, and protein: energy ratios must be increased according to the expected rate of weight gain. Nutrient: energy densities should meet or exceed the RDAs. Cultural and economic factors must be considered in the formulation of mixed diets, and organoleptic characteristics of the enhanced recipe(s) must be appropriate for young children. Selected issues concerning implementation of a community-based rehabilitation program are discussed.
A time and motion study was carried out in all five professional MCH-facilities in the study area. The chain of decision making process--from (i) collecting information, (ii) interpreting it as indicating risk to (iii) action--was followed while taking care not to interfere with it. At each step specific shortcomings were identified: a great number of commonly accepted risk factors was not looked for (e.g. outcome of previous pregnancies in a woman in labour). On the other hand, information indicating risk was collected, but not recognized as such (e.g. weight loss). The most striking feature of both under fives' (UFC), antenatal clinics (ANC) and maternity care was the consistent lack of any action taken as a consequence of a recognized risk factor. The possible underlying causes for the poor functioning of the risk approach in the studied peripheral services are discussed: (i) implementation failure, (ii) inappropriateness of cut-off points for risk definition leading to an unmanageably great proportion of risk clients, and (iii) a conceptual problem, i.e. the reluctance of the auxiliary staff as well as the patients to act on the basis of risk prediction, i.e. something that has not yet happened.
From an analysis of the clinical features of vitiligo and of the chemicals that cause depigmentation, a melanocyte self-destruct hypothesis for the etiology of vitiligo and graying of hair can be derived. A melanin precursor, one that is either a phenol or a catechol derivative or the phenol-tyrosinase complex, is lethal for melanocytes. When the natural mechanism that protects against the precursor is lost, the melanocytes are destroyed.
The relationship between dietary zinc, vitamin A, and retinol-binding protein (RBP) was studied in pregnant rhesus monkeys. Beginning on day 0 of gestation, monkeys were divided into three groups; 1) eight ad libitum-fed controls (AL) fed a diet containing 100 micrograms/g zinc, 2) 15 zinc-deprived (ZD) fed a diet containing 4 micrograms/g zinc, 3) 11 pair-fed controls (PF) fed the 100 micrograms/g control diet in amounts equal to those consumed by ZD animals. ZD monkeys had lower plasma zinc levels than did the AL and PF groups at day 135 of gestation, and at 1 and 3 months gestation. A positive correlation between plasma vitamin A and plasma zinc was observed (r = 0.5150, p less than 0.05) and between RBP and zinc (r = 0.883, p less than 0.001) in the ZD group at day 135 of pregnancy. By 3 months postpartum, plasma zinc levels increased in all groups; a positive correlation between zinc and vitamin A was observed in the ZD group (r = 0.5162, p less than 0.05) and in the PF group (r = 0.6353, p less than 0.05); however, no correlation between zinc and RBP was observed. In ZD monkeys, the ratio of RBP to vitamin A was higher (p less than 0.05) than in controls at day 135 of pregnancy. Polynomial regression of the interaction between plasma vitamin A and zinc, and the RBP/vitamin A and zinc, indicated a curvilinear relationship between plasma zinc and these two parameters.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper examines the usefulness of various anthropometric classification systems of nutritional status in prognosticating the subsequent risk of mortality among 2019 children aged 13 to 23 months residing in a rural area of Bangladesh. The indices investigated included: weight-for-age; weight-for-height; height-for-age; arm circumference-for-age; arm circumference-for-height; weight quotient; and height quotient. Cross-sectional anthropometry was conducted during October 1975 to January 1976 and the mortality experience of the study children was followed prospectively over 24 months. Results indicated that severely malnourished children, according to all indices, experienced substantially higher mortality risk. Normal, mild, and moderately malnourished children all experienced the same risk. All indices were found to discriminate mortality risk; weight/age and arm circumference/age were strongest and weight/height weakest. For each index, a threshold level was noted below which mortality risk climbed sharply. The discriminating power of anthropometry was enhanced when maternal weight, maternal height, or housing size were included.
In this investigation, the ultrastructural features of the nutritional cardiomyopathy of protein-calorie-malnourished rats were examined. Protein-calorie malnutrition was induced in young rats by feeding them a low-protein diet (4% protein) for 6 weeks. Control animals were fed a high-protein diet (16% protein). The deficient rats showed severe restriction of body-weight gain, fatty liver and hypoproteinaemia. The results of the present study clearly demonstrated that the experimentally induced protein-calorie malnutrition brings about striking morphological changes in the heart of the rat. On light microscopy hyalinization an vacuolization of muscle fibres, loss of cross striations and myofibrils, small foci of necrosis, interstitial fibrosis and mononuclear-cell infiltration could be detected. The ultrastructural lesions were characterized by myofibrillar degeneration, contraction-band formation, dilatation of sarcoplasmic reticulum, mitochondrial swelling, dehiscence of intercalated discs, and widened interstitial spaces, especially around vessels, due to oedema fluid and cellular infiltration by mononuclear cells an activated fibroblasts with collagen fibres and microfibrils. In addition, an increase in relative heart weight was also observed. The potential role of catecholamines in the pathogenesis of this cardiomyopathy is discussed.
A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine its effectiveness. The results of the evaluation indicated that almost all (95.6%) of the children were covered by the CHVs. In addition the participation rate was high (78.5%). However, only 50% of the children were adequately covered. Nonetheless, 81% of them gained adequate weight. Indeed, malnutrition levels declined by 34.5%. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries.
Micronutrient deficiency is increasingly recognized as a priority nutritional problem in the developing world; at least 20% of the world’s population is at risk of a deficiency in vitamin A, iodine, or iron (Trowbridge et al. 1993). Vitamin A deficiency is the most important cause of preventable blindness whereas iodine deficiency is a significant cause of permanent brain damage, mental retardation, and reproductive failure. A deficiency of either of these nutrients is associated with a decrease in childhood survival.
An evaluation of the performance of the Kersey Nutrition Rehabilitation Centre in Nigeria was undertaken with particular focus on mortality, rate of weight gain, and the management strategy. During 1987-1991 the total number of admissions for protein-energy malnutrition (PEM) was 803. The age group most commonly represented were those aged 12-29 months. Kwashiorkor cases formed the largest proportion of admissions (66%). Marasmic cases consistently predominated among children aged < 18 months. Average mortality was 22% during the 5 years. Mortality among oedematous patients was 25% compared with 15% among marasmic cases. The rate of weight gain averaged 7 g/kg/d for marasmic and marasmic-kwashiorkor cases and 6 g/kg/d for kwashiorkor cases. Specific recommendations are made to improve case-management, focusing particularly on the prevention of deaths in the first few days after admission.
Domiciliary treatment of severely malnourished children could have economic and practical advantages over other methods. We compared three approaches in a controlled trial. 437 children in Dhaka (< 60% weight-for-height, and/or oedema) aged 12-60 months were sequentially allocated to treatment as inpatients, to day-care, or to care at home after one week of day-care. Institutional and parental costs incurred to reach 80% weight-for-height were compared. Costs for inpatient, day-care, and at-home groups averaged 6363, 2517, and 1552 taka (60 taka = UK pound 1). Mortality was low (< 5%) in all three groups. Day-care treatment approached inpatient care for speed of recovery at less than half the cost, but it was unpopular with parents. The at-home group took significantly longer to attain 80% weight-for-height than the other groups, but did so at the lowest average cost. Parental costs were highest for the at-home group as no food supplements were provided; nevertheless this was the most popular option. We conclude that at-home management of severely malnourished children after 1 week of inpatient care is a cost-effective strategy.
Although the association between nutritional status and mortality risk is obvious for extreme malnutrition, the issue is not so clear for mild to moderate undernutrition. We have investigated this association in children of 0-5 years in the rural area of Bwamanda, Zaire, where an integrated development project, with good medical facilities, has operated for 20 years. A random cluster sample of 5167 children was taken; newborn infants and immigrants were included at six quarterly survey rounds from October, 1989, until February, 1991. All surveys included clinical and anthropometric assessment of nutritional status. Deaths were recorded up to April, 1992; there were 246 deaths. Marasmus, kwashiorkor, and other causes of death were defined by the verbal autopsy method and checked against medical records kept at the central hospital and the peripheral dispensaries. As expected, we found an increased risk of death in severe malnutrition. When deaths directly attributed to marasmus or kwashiorkor were excluded, mild to moderate stunting or wasting were not associated with higher mortality in the short term (within 3 months of the previous study round) or in the long term (from 3-30 months after study entry). The commonest causes of death were malaria and anaemia. Extreme marasmus and kwashiorkor caused 16% of deaths, and are important causes of death even in this favoured area with an integrated development project. Nutritional interventions should be targeted more selectively so that children with moderate malnutrition can be protected from progression to marasmus or kwashiorkor.
PIP
In May 1993 in France, Doctors without Borders, Epicentre, and INSERM met to develop a practical protocol for treatment of severely malnourished children in refugee camps and to discuss use of WHO's oral rehydration solution (ORS) for treating the children who may be dehydrated. The suggested treatment formula for catch-up growth for severely malnourished children is 80 gm dried skimmed milk; 50 gm sugar; and 60 gm oil, minerals, and vitamins per liter of feed (energy density; 1 kcal/ml). Adequate potassium, magnesium, zinc, copper, selenium, iodine, and each of the vitamins must be part of this diet. (Concentrations adequate for repletion and rapid recovery of malnourished children ingesting 100-200 ml/kg/day are tabulated in the article.) The various vitamins and minerals must be packaged separately to assure stability. During the early treatment stages, refugee workers should give this formula, diluted 3:1, either orally or through a nasogastric tube. They should administer 100 ml/kg/day of the formula (133 ml with water) during the first few days. Once the children regain their appetite, refugee workers should increase the undiluted feed to about 200 ml/kg/day. Refrigeration or lactobacillus fermentation prevent pathogenic contamination of the formula. Fermentation reduces the pH and the risk of lactose intolerance and generates antibacterial products. The potassium concentration of WHO-ORS is too low and the sodium concentration too high for severely malnourished children, especially those with kwashiorkor and marasmic-kwashiorkor. Further, it does not contain the minerals needed to stop diarrhea. Refugee workers can mix 1 WHO-ORS packet, 1 sachet of each mineral used in making the formula, and 50 gm sugar in 2 l of water to make an isotonic rehydration solution. A field trial in refugee camps in Ethiopia showed that this formula and modified WHO-ORS are practical and acceptable. Participants also suggested administering broad-spectrum antibiotic treatment, parenteral vitamin A, and measles vaccine to all children, regardless of HIV status.
A two-part meta-analysis of studies examining the relationship of vitamin A supplementation and child mortality.
We identified studies by searching the MEDLARS database from 1966 through 1992 and by scanning Current Contents and bibliographies of pertinent articles.
All 12 vitamin A controlled trials with data on mortality identified in the search were used in the analysis.
Data were independently extracted by two investigators who also assessed the quality of each study using a previously described method.
We formally tested for heterogeneity across studies. We pooled studies using the Mantel-Haenszel and the DerSimonian and Laird methods and adjusted for the effect of cluster assignment of treatment groups in community-based studies. Vitamin A supplementation to hospitalized measles patients was highly protective against mortality (DerSimonian and Laird odds ratio, 0.39; 95% confidence interval, 0.22 to 0.66; P = .0004) (part 1 of the meta-analysis). Supplementation was also protective against overall mortality in community-based studies (DerSimonian and Laird odds ratio, 0.70; clustering-adjusted 95% confidence interval, 0.56 to 0.87; P = .001) (part 2 of the meta-analysis).
Vitamin A supplements are associated with a significant reduction in mortality when given periodically to children at the community level. Factors that affect the bioavailability of large doses of Vitamin A need to be studied further. Vitamin A supplements should be given to all measles patients in developing countries whether or not they have symptoms of vitamin A deficiency.
A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with oedematous malnutrition. A likely cause of this continuing high mortality is faulty case-management. A survey of treatment centres worldwide (n = 79) showed that for acutely ill children, inappropriate diets that are high in protein, energy and sodium and low in micronutrients are commonplace. Practices that could have fatal consequences, such as prescribing diuretics for oedema, were found to be widespread. Evidence of outmoded and conflicting teaching manuals also emerged. Since low mortality levels from malnutrition can be achieved using appropriate treatment regimens, updated treatment guidelines, which are practical and prescriptive rather than descriptive, need to be implemented as part of a comprehensive training programme.
Kwashiorkor is an edimatous form of severe malnutrition and is the predominant form of childhood malnutrition in Malawi. Potassium depletion is common and contributes to the high mortality. The aim of this study was to determine if high potassium supplementation improves the outcome of kwashiorkor treatment.
We performed a randomised, double-blind, placebo-controlled, clinical trial of high potassium supplementation in 99 children with kwashiorkor. Controls (n = 51) received a standard potassium intake of 4.7 mmol/kg/day. The intervention group (n = 48) received 7.7 mmol/kg/day. All cases (intervention and control groups) were treated in the hospital-based Nutrition Rehabilitation Center and received a standard treatment regime of mild feeds, mineral and vitamin supplements, and antibiotics.
There was no significant difference in length of hospitalization, or time for resolution of oedema between groups. The case-fatality rate was reduced by 33% in the high potassium intervention group (13/48) compared to controls (21/51). There was a significant reduction in late deaths (13 in controls vs 3 in intervention group; odds ratio 5.3, 95% confidence interval 1.2-31.0) but no difference in early deaths (0-5 days). The intervention group also had significantly fewer presumed septic episodes (3 vs 18, odds ratio 8.9, confidence interval 2.2-50.9), respiratory symptoms, and new skin ulcerations than controls.
The high potassium supplementation reduced mortality and significant morbidity in kwashiorkor. This may be due to improved myocardial and immune function from earlier repletion of intracellular potassium. We recommend that the standard potassium supplement for the initial phase of treatment of kwashiorkor be increased from 4 to 8 mmol/kg/day.
Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons.
DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed.
Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene.
The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.
Along with the onset of severe kwashiorkor symptoms, a 20-month-old child showed biochemical signs of markedly increased lipid peroxidation, with a decrease of plasma antioxidants and decreased proportions of polyunsaturated fatty acids in plasma and red cell phospholipids. Additionally, plasma concentrations of the lipid peroxidation products malondialdehyde and hexanal, as well as the urinary excretion of leukotriene E4, were found to be increased. All biochemical alterations normalized along with subsequent clinical improvement. These findings suggest that the extent of lipid peroxidation is strongly related to the severity of the kwashiorkor syndrome.
Similarities between the geographical and climatic prevalences of kwashiorkor and of exposure to dietary aflatoxins, and between the biochemical, metabolic and immunological derangements in kwashiorkor and those in animals exposed to aflatoxins, prompted investigation of the associations between kwashiorkor and aflatoxins. Studies in Africa in the 1980s indicated a role for these toxins in the pathogenesis of the disease. Paediatric cases of kwashiorkor are less prone to severe Plasmodium falciparum malaria than normal children. In mice infected with P. berghei, aflatoxin exposure inhibits parasite growth and ameliorates morbidity. Aflatoxins occur in < or = 40% of samples of breast milk from tropical Africa, usually as low concentrations of the relatively non-toxic derivatives of aflatoxin B1 (AFB1) but sometimes as high concentrations of the very toxic AFB1. This could explain kwashiorkor in breast-fed babies. Aflatoxin exposure occurs in > or = 30% of pregnancies in tropical Africa and the toxins are often in cord blood, sometimes at extremely high concentrations. Aflatoxins are now incriminated in neonatal jaundice and there is circumstantial evidence that they cause perinatal death and reduced birthweight. Aflatoxin-induced immunosuppresion may explain the aggressive behaviour of HIV infection in Africa. There are similarities between observations on HIV cases in Africa and those on heroin addicts in Europe, where 'street' heroin is frequently contaminated with aflatoxin. Aflatoxins were found in 20% of random urine samples from heroin addicts in the U.K. and the Netherlands. Aflatoxins have also been incriminated in episodes of food poisoning which have been associated with serious morbidity and mortality, particularly among young children.
Provision of zinc supplements to children should be considered when their usual diet is low in absorbable zinc; severe stunting, low plasma zinc, or both; or persistent diarrhea. Inadequate zinc intakes are highly prevalent in developing countries, especially during the period of complementary feeding when zinc requirements are high and breast milk contributes little. To date, systematic evaluation of the acceptability of different zinc salts used as supplements is lacking. Some zinc salts are unpalatable and cause problems, such as nausea, at higher doses. Zinc carbonate and oxide are insoluble and poorly absorbed. Little information on the bioavailability of different zinc supplements in the presence of dietary inhibitors of zinc absorption exists. More information is needed on the quantity and frequency of dosing. Consideration should be given to the routine inclusion of zinc in iron supplements provided to children and to the simultaneous inclusion of other micronutrients in zinc supplements.