Assessing the Nutritional Adequacy of Complementary Foods and Infant and Young Child Feeding Practices in Sodo Zurea Woreda, Wolaiyta Zone, Southern Ethiopia.

Objectives: To evaluate nutrient adequacy of complementary foods in the study area by comparison with recommendations. To determine the energy and nutrient intakes from complementary foods consumed by infants and young children. To assess TYCF and caring practices in the study area. Methods: A cross-sectional survey design was conducted. Socio-demographic status, anthropometry, breastfeeding, complementary feeding practices and behaviors were assessed and stratified two-stage cluster sampling technique was used to select adequately representative samples of 180 breastfed children aged 6–23 months from three rural Wolaiyta communities Results: Energy and nutrient intakes from complementary foods were calculated from 1-day inhome weighed food records. Only 20 % infants and young children were exclusively breastfed up to 6 months of age. No mothers with infants aged 6-11 months had fed them meat, chicken, or fish in the last 24 hours prior to data collection. Very few children (3.3 %) were fed according to the standard infant and young child feeding guidelines and responsive feeding was not practiced. Median energy intakes and densities of micronutrients from complementary foods (except for protein) were below the WHO recommendations. Prevalence of stunting was 16.7 % for infants aged 6–8 months, 33.3 % for infants aged 9–11 months and 50 % for children 12-24 months. Land ownership between families having stunted and non-stunted children was statistically significant (p< 0.001) and stunting with age group was statistically significant (p<0.001). Conclusions: Nutrition education interventions that address the WHO guiding principles for complementary feeding practices and behaviors on growth are desperately required in the study participants.

Iron Supplementation with or without Optimized Complementary Feeding Recommendations: Effect on Micronutrient Status and Growth of 1-2 Year Old Myanmar Children.

Objectives: Children under 2-years of age are at high risk of micronutrient deficiencies and growth faltering due partly to poor complementary feeding. This study aimed to compare the effect of optimized complementary feeding recommendations (CFRs) to iron supplementation on micronutrient status and growth of Myanmar children. Methods: A randomized, partially-blinded, placebo-controlled trial (NCT01758159) was conducted for 24 weeks among 1-2 year old children from Ayeyarwady, Myanmar. Optimized CFRs were developed by Linear Programming using locally available foods. Randomization by village for CFRs or non-CFRs and by child (n=432) for iron supplements or placebo, created: 1.CFR+Fe; 2.CFR-alone; 3.Fe-alone; or 4.Placebo-control groups. Mother from CFRs received regular training on optimized CFRs and children from Fe received 15mg Ferric-NaEDTA daily. Serum ferritin(SF), transferrin-receptor(sTfR), zinc(Zn), retinol-binding-protein(RBP); C-reactive protein, α-1 acid glycoprotein and anthropometry were assessed at baseline and endline. Results: At baseline, 88.4% of children had anemia (Hb<110g/L); after adjusting for infection, 36.1% had iron-deficiency-anemia(IDA) (Hb<110g/L, SF<12μg/L), 37.2% iron-deficiency(ID) (SF<12μg/L), 33.6% zinc-deficiency (Zn<9.9μmol/L), 54.9% low vitamin-A status (RBP<1.05μmol/L); and 27.7% were stunted. At endline, anemia was reduced by all 3 interventions. Fe-alone reduced ID and IDA [OR=0.02, 95%CI(0.02,0.44), P=0.002] and [OR=0.06, 95%CI(0.01,0.41) P=0.004] respectively but increased stunting [OR=2.96, 95%CI(1.05, 8.33), P=0.04]. There was no between-groups difference for zinc and vitamin-A deficiencies at endline. Conclusions: Optimized CFRs with or without iron supplementation can reduce anemia. Iron supplementation reduce ID and IDA but also increase stunting. It is interesting to study about competitive absorption of supplemental iron or dietary iron with dietary zinc with potential to zinc deficiency and stunting.

Impact of Infant and Young Child Feeding (IYCF) Practices on Growth in Young Children in Rural Cambodia.

Objectives: To evaluate the impact of IYCF education and practices on growth compared to an ecological control. Methods: As part of a randomized controlled effectiveness trial of micronutrient Sprinkles and IYCF education, all mothers received IYCF education. Group and individual sessions were delivered by health staff and trained village health workers. Anthropometry and IYCF were recorded at baseline (age 6 mo), endline (age 12 mo), and at two follow up points (age 18 mo and 24 mo) and compared with same aged children in the same province from the 2005 Cambodia Demographic and Health Survey (CDHS). Results: There was no treatment effect on growth so intervention and control groups were combined. At 6, 12 and 18 mo, 59%, 86% and 73% of children met minimum adequate WHO IYCF practices respectively in the study group compared to 33%, 62% and 47% for CDHS children. Stunting (HAZ <-2) prevalence at 6, 12, 18 and 24 mo was 11%, 19%, 32% and 38% in the study group compared to 11%, 37%, 62%, and 44% for CDHS children. Underweight (WAZ <-2) prevalence at 6, 12, 18 and 24 mo was 14%, 16%, 21% and 26% in the study group compared to 18%, 28%, 37% and 21% for CDHS children. Differences for stunting and underweight were significant (p<0.05) at 12 and 18 mo. Conclusions: IYCF education to study mothers improved IYCF practices and slowed stunting and underweight significantly at 12 and 18 months of age compared to CDHS children. Strengthened IYCF education and practices improved growth in children in this low-income, rural population.

Impact of Genetic Hemoglobin (Hb) Disorders on the Effectiveness of Micronutrient Sprinkles in Reducing Anemia in Young Children in Rural Cambodia.

Objectives: To evaluate the impact of genetic Hb disorders on the effectiveness of 6 months of daily micronutrient Sprinkles for infants age 6-12 months on anemia. Methods: As part of a randomized controlled effectiveness trial, subjects were screened for genetic Hb disorders at aged 18 months on whole blood using the SEBIA MINICAP analyser, HEMOGLOBIN (E) program, and IC α THAL test to detect major Hb variants and α-thalassemia. Anemia (Hb < 110 g/L) was measured at baseline (age 6 mo), endline (age 12 mo), and at two follow up points (age 18 mo and 24 mo) for children with and without genetic Hb disorders. Results: Half of all children had a genetic haemoglobin disorder (at least 15 types). At baseline, overall prevalence of anemia for children with normal Hb was 81% versus 88% for those with any genetic Hb disorder. At endline, anemia prevalence for the intervention group with normal Hb vs genetic Hb disorder was 60.2% versus 72.0% (P = 0.02) and for the control group 81.1% versus 88.8% (P = 0.03), respectively. At further follow-up, anemia decreased in both the control and intervention groups. However those with any genetic Hb disorder remained more anemic with varying levels of anemia according to the disorder type. Conclusions: Sprinkles had a similar proportional effect regardless of overall genetic Hb status indicating that children with genetic Hb disorders can effectively utilize iron and micronutrients to reduce anemia. Sprinkles can be effective in populations with a high prevalence of genetic Hb disorders.

Modelling the Impact of Fortification on the Prevalence of Inadequate Micronutrient Intakes in Ethiopia: Results from the Ethiopian National Food Consumption Survey.

Objectives: To estimate the potential impact of national fortification of wheat flour and vegetable oil on inadequate intakes of vitamin A, zinc and iron in Ethiopian women of childbearing age. Methods: Nationally representative 24-hour dietary recall data were collected from children (6-35 months), women (15-45 years), and males (19-45 years, urban only). Prevalence of inadequate and excessive intakes of vitamin A, zinc and iron were analysed using IMAPP after adjusting usual intake distributions with external within-person variance estimates. Modelling was based on fortification of oil with vitamin A (2000 μg / 100g), and wheat with vitamin A (380 μg / 100 g), zinc (9 mg / 100 g) and iron (6 mg / 100 g). Results: Across 8267 households, 50% and 20% of women consumed oil and wheat, respectively. Vitamin A fortification of oil and wheat was estimated to reduce inadequacy from 59% to 36%. Zinc fortification of wheat could reduce inadequacy from 61% to 50%. For iron, <1% had inadequate current intakes. It was estimated that fortification would be more effective in urban areas, despite a similar initial prevalence of inadequacy, as higher proportions consumed fortifiable products (percentage change in vitamin A inadequacy: urban 65%, rural 24%; and zinc inadequacy: urban 51%, rural 12%). Fortification with vitamin A and zinc did not expose any population sub-group to >3% excessive intakes. Conclusions: Fortification of oil and wheat with vitamin A, and wheat with zinc could reduce inadequacy in Ethiopian women, with greatest impact in urban areas. Iron fortification is not justified as intakes appear high and fortification could expose the population to excessive intakes.

Dietary Intakes Based on food Composition Data May underestimate Contribution of Potentially Exchangeable Contaminant Iron from Soil.

Objectives: Soil-iron contaminant has the potential to contribute to total iron intakes, depending in part on food preparation practices, although whether contaminant iron joins the common non-heme iron pool and is available for absorption is uncertain. Therefore we compared dietary Iron intakes analyzed from diet composites with those calculated from food composition data and examined them in relation to iron biomarkers, adjusted for inflammation. Methods: Weighed duplicate diet composites, diet records, and fasting blood samples were collected on the same day from a convenience sample of women aged 18 to 50 y from Zombwe in Mzimba (n=60) and Mikalango in Chikhwawa (n= 60) in rural Malawi. Diet composites were analyzed by ICP-MS, and blood for hemoglobin, ferritin, transferrin receptor, and inflammatory biomarkers. Results: Median analyzed iron intakes (mg/d) were higher than calculated intakes in Zombwe (16.6 vs. 10.1; p<0.001) and Mikalango (29.6 vs. 19.1; p<0.001) and accompanied by high levels of Al and Ti, markers of soil contamination. Less than 15% of women had storage iron depletion (ferritin 12 µg/L and haemoglobin >120 g/L) or iron deficiency (total body Fe<0 mg/kg), despite negligible intakes of readily absorbable heme iron and high phytate intakes in both districts. Conclusions: Assessment of iron intakes from food composition data where soil contaminant iron is likely yielded an underestimate of total iron intake. Some contaminant iron may be exchangeable and available for absorption, depending on soil mineralogy. In such settings, collection and chemical analysis of weighed duplicate diet composites are preferable for assessing total iron intakes.

Factors influencing growth and intestinal parasitic infections in preschoolers attending philanthropic daycare centers in Salvador, Northeast Region of Brazil / Crescimento linear e infecções parasitárias intestinais em pré-escolares matriculados em creches filantrópicas de Salvador, Nordeste do Brasil

Poor growth and intestinal parasitic infections are widespread in disadvantaged urban children. This cross-sectional study assessed factors influencing poor growth and intestinal parasites in 376 children aged three to six years in daycare centers in Salvador, in the Northeast Region of Brazil. Data was obtained from seven daycare centers on child weight, height, socio-economic status, health and intestinal parasites in stool samples. Prevalence of moderate underweight (< -1SD > -2SD), wasting and stunting was 12%, 16% and 6% respectively. Socioeconomic status, birth order, and maternal weight were predictors of poor anthropometric status. Almost 30% of children were infected with more than one intestinal parasite. Helminths (17.8%), notably Trichuris trichiura (12%) and Ascaris lumbricoides (10.5%), and protozoan Giardia duodenalis (13%) were the most common types of parasites detected. One percent of children had hookworm and Cryptosporidium sp. and 25% had non-pathogenic protozoan cysts. Boys from families with very low socio-economic status had lower linear growth and presented a greater risk of helminth infection. Deworming is considered an alternative for reducing the prevalence of intestinal parasitic infections in this age group.

Déficit de crescimento e parasitoses são comuns entre crianças residentes em periferias. Em estudo transversal com 376 pré-escolares (3-6 anos) de creches em Salvador, Nordeste do Brasil, avaliamos fatores predisponentes para déficit de crescimento e parasitose. Obtiveram-se dados em sete creches sobre peso da criança, altura, nível socioeconômico, estado de saúde e parasitos em amostras de fezes. Prevalência de baixo peso (-1 < DP > -2), desnutrição e baixa estatura foram 12%, 16%, e 6%, respectivamente; nível socioeconômico, ordem de nascimento e peso materno foram preditores da antropometria. Aproximadamente 30% estavam infectados com ≥ 1 parasita. Helmintos (17.8%), notavelmente Trichuris trichiura (12%) e Ascaris lumbricoides (10.5%) e protozoário Giardia duodenalis (13%) foram os mais comuns; < 1% tinha ancilostomíase e Cryptosporidium sp.; 25% apresentaram protozoários cistos não patogênicos. Meninos de famílias muito pobres tiveram menor crescimento e maior risco de helmintose. A desparasitação pode ser considerada uma alternativa para a redução da prevalência de parasitoses intestinais nesse grupo etário.