Undernutrition among Honduran children 12-71 months old

In 1996, the Ministry of Health of Honduras conducted a national micronutrient survey that included anthropometric measurements to determine the nutrition status of children 12-71 months old. Among the 1.744 children who participated, 38 percent of them were stunted, including 14 percent who were severely stunted; 24 percent were underweight, of which 4 percent were severely underweight; and 1 percent were wasted, of which 0,1 percent were severely wasted. The country can be divided into three groupings based on the level of stunting and underweight: 1) lowest prevalence: Tegucigalpa, San Pedro Sula, and medium cities; 2) medium prevalence: other urban areas, the rural north, and the rural south; and 3) highest prevalence: the rural west. Using logistic regression analysis, the important determinants of stunting were found to be: mother/caretaker's and father's schooling, source of water, the dominion (geographic location and strata) in which the child lived, and the "possession score" for ownership of such items as a radio, television, refrigerator, stereo system, and electric iron. The predictors for underweight were micronutrient status, diarrhea, maternal/caretaker's schooling, type of toilet, and possession score. Historical data indicate that the national prevalence of chronic undernutrition has changed little over the last 10 years despite the number of national food and nutrition plans implemented and the significant improvements in health services. It is possible that these positive interventions have been offset by the slow progress in economic development. Future nutrition interventions should take into account household-level perceived needs and priorities in order to set realistic nutrition targets

Vitamin A deficiency and anemia among children 12-71 months old in Honduras

Vitamin A deficiency (VAD) and iron deficiency anemia (IDA) have been recognized as public health problems in Honduras for over 30 years. This paper, based on the 1996 National Micronutrient Survey on 1.678 children 12-71 months of age, presents the results for vitamin A status and anemia prevalence, as well as the level of vitamin A in sugar at the household level. The results showed that 14 per cent of the children were subclinically vitamin A deficient (plasma retinol < 20 ug/dL) and 32 per cent were at risk of VAD (plasma retinol 20-30 ug/dL). These data indicate that VAD is a moderate public health problem in Honduras. Logistic regression analysis showed that children 12-23 monts old living in areas other than the rural south of the country were at greatest risk of subclinical VAD. Infection, indicated by an elevated alpha-1-acid-glycoprotein level, increased the risk of subclinical VAD more than three-fold. Children from households that obtained water from a river, stream, or lake were at twice the risk of subclinical VAD compared with other children. That same doubled risk was found for children from a household with an outside toilet. VAD can be controlled by fortifying sugar. Retinol levels in sugar at the household level were about 50 per cent of those mandated by Honduran law. There appears to be significant leakage of unfortified sugar into the market. This is particularly true in the rural north, where 33 per cent of samples contained no retinol. Overall, 30 per cent of children were anemic (Hb < 11 g/dL). Logistic regression analysis showed that children whose fathers lived with them but who had not attended at least grade 4 of primary school were at 33 per cent greater risk of being anemic. Infection and being underweight increased the risk of being anemic by 51 per cent and 21 per cent, respectively. Many of the anemic children had not been given iron supplements, suggesting health care providers may not be aware that anemia is widespread among young children and/or know how to diagnose it

Nutrition of Honduran mothers/caretakers

In 1996, the Honduran Ministry of Health conducted a national micronutrient survey of children 12-71 months old, which also included an assessment of the nutrition status of their mothers/caretakers. The 1.126 mothers/caretakers who participated in the survey tended to be short and plump. About 15 per cent of them were at obstetric risk by virtue of their short stature and/or low body weight. About 9 per cent had chronic energy deficiency (CED), but 27 per cent were at least 20 per cent overweight. CED was associated with socioeconomic indicators of poverty. Risk factors for being at least 20 per cent overweight included being over 30 years old, not breast-feeding, having attended no higher than grade 4, 5, or 6 of primary school, coming from a wealthier household, and living in San Pedro Sula or medium-sized cities. Among the women surveyed, 26 per cent of nonpregnant and 32 per cent of pregnant mothers/caretakers were anemic. The likely principal cause of anemia was the low intake of bioavailable iron from food and, in some cases, excessive iron loss associated with intestinal parasites, especially hookworm. Only 50 per cent of the mothers/caretakers participating in this study had received iron during their las pregnancy, and just 13 per cent had received post-partum vitamin A. The results highlight the need to develop and implement an effective program to control iron deficiency anemia in women of reproductive age, including by fortifying such widely consumed foods as processed wheat and maize flour and by routinely administering iron supplements to high-risk groups. Postpartum vitamin A supplementation should be encouraged to protect both the mother and newborn infant against vitamin A deficiency

Vitamin A deficiency in Latin America and the Caribbean: an overview

Vitamin A deficiency (VAD) has been known to exist in Latin America and the Caribbean since the mid-1960s; however, except for pioneering work by the Institute of Nutrition of Central America and Panama/Pan American Health Organization on sugar fortification in Central America, there was little interest in controlling it because of the low frequency of clinical findings. More recently, implications of the effect of subclinical VAD on child health and survival has generated increased interest in assessing the problem and a greater commitment to controlling it. The information available by mid-1997 on the magnitude of VAD in countries of the Region was extensively reviewed. Internationally accepted methods and cutoff points for prevalence estimations were used to compile information from relevant dietary, biochemical, and clinical studies carried out between 1985 and 1997 in samples of at least 100 individuals. VAD in the Region of Latin America and the Caribbean is mostly subclinical. The national prevalence of subclinical VAD (serum retinol < 20 mg/dl) in children under 5 years of age ranges between 6% in Panama and 36% in El Salvador. The problem is severe in five countries, moderate in six, and mild in four. There are no recent data from Chile, Haiti, Paraguay, Uruguay, Venezuela, and the English-speaking Caribbean. The population affected amounts to about 14.5 million children under 5 years of age (25% of that age group). Schoolchildren and adult women may also have significant VAD. Actions currently implemented to control VAD include (a) universal or targeted supplementation, with sustained high coverage rates through national immunization days in some countries; (b) sugar fortification, which is well established in El Salvador, Guatemala, and Honduras (a significant effect has been documented in Guatemala and Honduras) and is under negotiation in Bolivia, Colombia, Costa Rica (to be resumed), Ecuador, Nicaragua, and Peru; and...

Se sabe que la deficiencia de vitamina A (DVA) ha existido en América Latina y el Caribe desde mediados de los años sesenta. No obstante, si se exceptúan algunas iniciativas tempranas del Instituto de Nutrición de Centro América y Panamá, había escaso interés en controlarla debido a la detección infrecuente de signos clínicos. En época más reciente, las consecuencias de la DVA para la salud y la supervivencia infantiles ha suscitado gran interés en evaluar el problema y despertado un mayor empeño por controlarlo. La información que estaba disponible a mediados de 1997 sobre la frecuencia de la DVA en países de la Región se revisó minuciosamente. Se aplicaron métodos y puntos de corte aceptados mundialmente para la estimación de la prevalencia a fin de recopilar infomación obtenida de estudios alimentarios, bioquímicos y clínicos efectuados entre 1985 y 1997 con muestras de 100 personas como mínimo. La DVA en la Región de América Latina y el Caribe es eminentemente subclínica. La prevalencia nacional de la forma subclínica de DVA (retinol sérico < 20 µg/dL) en niños menores de 5 años oscila de 6% en Panamá a 36% en El Salvador. El problema es grave en cinco países, moderado en seis y leve en cuatro. No hay datos recientes para Chile, Haití, Paraguay, Uruguay, Venezuela y el Caribe de habla inglesa. En total la población afectada se aproxima a 14,5 millones de niños menores de 5 años (25% de ese grupo de edad). Los escolares y las mujeres en edad adulta también pueden tener una frecuencia elevada de DVA. Las medidas que actualmente están en marcha para controlar la DVA incluyen, entre otras, a) la suplementación dirigida a toda la población o a grupos particulares, con elevadas tasas de cobertura logradas durante los días en que se efectúan las inmunizaciones de alcance nacional en algunos países; b) la fortificación del azúcar, que ya se ha instaurado en El Salvador, Guatemala y Honduras (se ha observado un efecto notable en Guatemala...