Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh.

This prospective randomized trial was carried out to test the efficacy of a specific intervention for reducing the extent of their malnutrition and to change behaviour of mothers relating to child-feeding practices, care-giving, and health-seeking practices under the Bangladesh Integrated Nutrition Project (BINP). The study was conducted in rural Bangladesh among 282 moderately-malnourished (weight-for-age between 61% and 75% of median of the National Center for Health Statistics standard) children aged 6-24 months. Mothers of the first intervention group received intensive nutrition education (INE group) twice a week for three months. The second intervention group received the same nutrition education, and their children received additional supplementary feeding (INE+SF group). The comparison group received nutrition education from the community nutrition promoters twice a month according to the standard routine service of BINP. The children were observed for a further six months. After three months of interventions, a significantly higher proportion of children in the INE and INE+SF groups improved (37% and 47% respectively) from moderate to mild or normal nutrition compared to the comparison group (18%) (p < 0.001). At the end of six months of observation, the nutritional status of children in the intervention groups improved further from moderate to mild or normal nutrition compared to the comparison group (59% and 86% vs 30%, p < 0.0001). As the intensive nutrition education and supplementation given were highly effective, more children improved from moderate malnutrition to mild or normal nutritional status despite a higher incidence of morbidity. The frequency of child feeding and home-based complementary feeding improved significantly (p < 0.001) in both the intervention groups after three months of interventions and six months of observation. Body-weight gain was positively associated with age, length-for-age, weight-for-length, frequency of feeding of khichuri, egg, and potato (p < 0.05). Ability of mothers to identify malnutrition improved from 15% to 99% in the INE group and from 15% to 100% in the INE+SF group, but reduced from 24% to 21% in the comparison group. Use of separate feed pots, frequency of feeding, and cooking of additional complementary feeds improved significantly in the INE and INE+SF groups compared to the comparison group after three months of interventions and six months of observation. It can be concluded from the findings of the study that intensive nutrition education significantly improves the status of moderately-malnourished children with or without supplementary feeding.

Consulta aos rótulos de alimentos e bebidas por freqüentadores de supermercados em Brasília, Brasil / Usage of food and beverage labels by supermarket shoppers in Brasilia, Brazil

OBJETIVO: Investigar se a população adulta freqüentadora de supermercados do Plano Piloto de Brasília (DF), Brasil, utiliza as informações nutricionais contidas nos rótulos de bebidas e alimentos, assim como caracterizar essa utilização. MÉTODOS: Este trabalho foi realizado em duas etapas: uma etapa quantitativa, baseada em um estudo transversal, onde foram entrevistados 250 indivíduos selecionados aleatoriamente em cinco supermercados; e uma etapa qualitativa, na qual foram feitas 25 entrevistas individuais com participantes da etapa anterior. RESULTADOS: A leitura da informação nutricional dos rótulos de alimentos era realizada por 187 (74,8 por cento) dos consumidores pesquisados. Contudo, apenas 25,7 por cento dos consumidores nesse grupo liam os rótulos de todos os alimentos. Em geral (59,9 por cento), a consulta se dava somente aos rótulos de alimentos específicos, como leites e derivados, enlatados, embutidos e produtos diet e light. Foram citados como os mais importantes objetivos da consulta aos rótulos o interesse acerca do número de calorias e da quantidade de gordura e sódio. CONCLUSÕES: Os presentes resultados indicam a necessidade de aperfeiçoar as estratégias educativas já existentes para o consumo saudável de alimentos, e podem ser úteis nesse aperfeiçoamento. Sugere-se que, além dos consumidores, os produtores e distribuidores de alimentos também sejam integrados nas estratégias de educação nutricional.

Objective. To investigate whether adults who shop in supermarkets in one part of Brasilia, the capital city of Brazil, use the information contained in food and beverage labels, as well as to characterize this usage. Methods. This study was done in five supermarkets in the Plano Piloto (Pilot Plan) central core area of Brasilia. The research was carried out in two stages: (1) a quantitative stage, based on a cross-sectional study, during which 250 individuals were randomly selected and surveyed in the supermarkets; and (2) a qualitative stage, in which 25 individuals who had participated in the first stage underwent more extensive individual interviews. Results. Of the 250 persons surveyed, 187 of them (74.8%) reported that they usually read food and beverage labels. However, only 25.7% of the consumers who consulted the labels did so for all foods and beverages. Of the persons who read the labels, the majority (59.9%) only read the labels for specific foods, including milk, dairy products, canned foods, sausages, and diet products. The information that shoppers most often wanted to know from the labels was the number of calories and the fat and sodium content. Conclusions. Our study shows the need to utilize our findings in improving the existing educational strategies for promoting healthy eating. We suggest that consumers, food producers, and food distributors all be involved in developing strategies for nutrition education

Managing nutritional programmes in developing countries

Improving community nutrition in developing countries requires a detailed epidemiological picture of the prevalent nutritional problems in different regions and age groups. This makes it possible to identify priorities, sensitize policy-makers, establish political commitment and design appropriate community programmes for income generation and education for the best use of food resources. Experiences acquired from community-based nutritional programmes show that ownership of a programme by the community and using a tailor-made approach are essential factors in the successful implementation of programmes. A multifaceted approach is needed, involving a range of sectors-agriculture, commerce, education and health-- and commitment at all levels from government to communities and individuals

Augmenting cognitive learning of community nutrition by tutorials.

Community health interventions are increasingly being considered a priority area in medical curriculum. In the topic of nutrition, a situation analysis of final MBBS students in our institution revealed significantly lower levels of knowledge in community applications as compared to basics and clinical aspects, indicating the need for some educational intervention. An improvised tutorial was conducted to address this deficiency at cognitive level. The intervention was a special scheme of flow of discussion with a positive bias in favour of nutritional applications at community level. Half of the learners were given routine tutorial, as part of existing teaching schedule in nutrition and the remaining were subjected to educational intervention, to provide control and study groups respectively. Before and after assessment of the recall of learners on community applications demonstrated a positive impact of improvised tutorial. The learners' level of knowledge in two groups was comparable before the tutorial but it was significantly higher ('P' < 0.001) in study group as compared to control, after the tutorial (mean scores: 134.38/150 and 91.20/150 respectively). No extra resources, tutor time or student's learning hours were needed for the improvised tutorial. Tutor's positive bias in favour of applied aspects can bring about a desired change even in conventional teaching-learning process, without asking for extra resources. It can be a supplement to community-based learning.

A comparative study of nutrition and health of mothers in Japan and the Philippines.

When comparing nutrition and health among mothers in both Japan and Philippines, it can be concluded that, in regard to nutrition, the results of the total dietary scores for mothers in divided into pregnant and after-delivery stages showed that pregnant Filipino mothers' average are lower than those of pregnant Japanese mothers. Pregnant Filipino mothers and those just after delivery to 4 months had lower average dietary scores than Filipino mothers 5 months and later after delivery. These results are thought to be an important factor in the improvement of health condition and life expectancy of Filipino mothers and their children. In Japanese mothers, such differences were not found. When comparing individual dietary scores and the rate of nutrients consumed to the optimum amounts, significant differences were found among mothers in both countries. Analysis of food diaries of mothers from both countries found that Japanese mothers had average intakes of nutrients such as energy, protein, fat, vitamin B1 and vitamin B2 and were deficient in calcium, iron and vitamin A. Filipino mothers took in average amounts of protein, calcium, iron, vitamin B2 and vitamin C and were deficient in energy, fat and vitamin B1.

Impact of nutrition education and medical supervision on pregnancy outcome.

Sixty Punjabi women from low and lower middle income groups were selected from eight villages of Ludhiana district. The supplements of iron, folic acid and calcium in the form of Folifer and Calcium Sandoz tablets were regularly supplied to experimental (E) group from second trimester onwards. A pamphlet about the diet during pregnancy was distributed to the E group along with four individual and three group contacts during the second half of pregnancy. The control (C) group was provided iron and folate supplements as per Government practice. Body height, weight, mid-upper arm circumference (MUA) and skinfold thickness of the subjects were recorded. Weight gained during pregnancy and post partum weight were also recorded and body mass index was calculated. In addition, crown heel length (CHL), birth weight (BW), skinfold thickness, MUA, head circumference (HC), Chest circumference (CC) and ponderal index (PI) of the neonates were recorded within eight hours of their birth. The gain in weight during pregnancy was 6.30 and 5.7 kg in E and C groups respectively. The study revealed that BW, CHL, skinfold thickness and PI of the newborns were significantly (p < 0.01) higher in E group. The mean BW of newborns in E and C groups was 2700 g and 2300 g, respectively. Weight gained during pregnancy had significant (p < 0.05) correlation to MUA, BW and skinfold thickness of the newborn.

Nutritional situation of Dhaka.

The paper presents the nutritional situation of Dhaka. Dhaka is the capital city of Bangladesh with an area of 414 square Km. The population size of Dhaka city is about 7 millions of which nearly 3 millions live in the slums. Socio-economic and socio-cultural situation has been discussed. In the pre-school children, protein-energy malnutrition (PEM) appeared to be a serious problems. A high rate of advanced vitamin A deficiency along with severe PEM has been demonstrated. A recent survey showed that slum children below five years of age had higher prevalence of acute (11%) and chronic (50%) malnutrition. This paper also discussed the nutritional status of school children and pregnant women. A national nutrition survey revealed that average energy intake by the industrial laborers was only 74% of the daily requirement. To date no data is available on the nutritional situation of the adolescent and elderly people. Poverty, lack of knowledge, illnesses, lack of sufficient services and socio-cultural barriers are the major causes of nutritional problem. There are several Government and Non-Government organizations in Dhaka city working for improving community health and nutritional status through a number of interventions; such as health and nutrition education, vitamin A capsule distribution, immunization, growth monitoring and feeding through rehabilitation centers. A positive impact of vitamin A oral dosing has been demonstrated and improved nutritional status by nutrition education and feeding through the centers have been reported. Community participation and sustainability of the program have also been discussed.

The nutritional situation in metropolitan Kuala Lumpur, with focus on squatters.

Kuala Lumpur is the capital city of Malaysia with an estimated population of 1.55 million. Approximately 12% of the population live in squatter settlements occupying about 7% of the city total area. The squatter settlements generally are provided with basic amenities such as piped water, toilet facilities and electricity. Health indicators for the overall population of Kuala Lumpur are better off than for the rest of the country; however, intra-city differentials prevail along ethnic and socio-economic lines. Malays and Indians have higher rates for stillbirths, and neonatal, infant and toddler mortality than the Chinese. The wide disparity in the socio-economic status between the advantaged and the poor groups in the city is reflected in the dietary practices and nutritional status of young children from these communities. The percentage of preschool children from urban poor households with inadequate intakes of calories and nutrients is two to three times higher than those from the advantaged group. Compared to rural infants, a lower percentage of urban infants are breastfed. A lower percentage of Malays from the urban advantaged group breastfed, compared with the urban poor group. The reversed trend is found for the Chinese community. Growth attainment of young children from the urban poor is worse than the urban advantaged, though better than the rural poor. Health and nutritional practices implications related to both undernutrition and overnutrition are discussed, to illustrate the twin challenges of malnutrition in the city.

Nutrition situation in metro Manila.

Summarizing the general characteristics of food consumption pattern and dietary status of the country's central urban region, the following are brought to focus: Metro Manila as compared to all urban and rural areas consumes less cereal grains but more sugars and fats and oils; consumes more of the high quality protein foods such as meat, poultry, eggs, milk and dried beans; and consumes less of fruits and vegetables. Availability and affordability of foods in the respective sectors could have affected to a large extent the magnitude of consumption differences. Although urban households had the advantage of a more varied and quantitatively higher food consumption, their nutrient intake was not really very different from rural households. Metro Manila still had a 13.7 percent calorie gap in its intake in 1987, and intake of ascorbic acid was notably lower than the rural sector. However, intake of thiamin and riboflavin as well as fat was appreciably higher in the metropolis. Briefly identifying the trends in food consumption with reference to six survey year periods from 1974 to 1987 (excluding 1984 and 1985), Metro Manila diet disclosed the following: increasing trend for sugars and syrups as well as dried beans, nuts and seeds and decreasing trend for cereal products, fruits and vegetables and condiments and others. There was a decrease in overall food consumption among Metro Manila households during the economic crisis that transpired in 1984 and 1985. However, there was a steady consumption of rice which was under price control, and a significant increase in the intake of some food items particularly green leafy and yellow vegetables which were among the cheapest food items available in Metro Manila markets. Some food adjustments were evidently resorted to during the period of economic dislocation showing the resiliency of the urban population. Metro Manila has been apparently drawing inordinately large amounts of the food supply from the rest of the country. There is therefore an "urban bias" of food supply to Metro Manila, that is, there is a much higher demand capacity for Metro Manila to draw food supply because of its higher income level and bigger population. The impact of this situation in terms of nutrition and food supply in the rural areas should be carefully examined so as not to put the rural areas in extreme disadvantage. FNRI nutrition surveys have shown that dietary energy inadequacy remains rampant in Metro Manila, while protein continues to be a marginal problem.(ABSTRACT TRUNCATED AT 400 WORDS)

Relation of childhood malnutrition to parental education and mothers' nutrition related KAP.

Severely malnourished children (26), weight for age 55.27 +/- 3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P less than 0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea.

Assessment of knowledge and attitudes in human nutrition among nurses of Delhi.

The present study revealed that the majority of nurses had adequate knowledge about dietary practices during the antenatal and post-natal period. However, their knowledge about nutritive value of foods and nutrition advice during disease conditions was inadequate. It is recommended that to make the training more meaningful, the identification of the incorrect dietary beliefs of trainees should be done at the beginning of the training course. Each incorrect belief should be explained in detail for better comprehension of the correct knowledge in nutrition.

Knowledge of nutritive values of foods and diet during diseases amongst nursing students.

Knowledge about nutritive value of foods and diet during diseases was assessed amongst forty nine nursing students at the beginning of their training course in Human Nutrition. Majority of the students had correct knowledge about dietary advice during antenatal and postnatal period. The knowledge of nutritive values of foods and diet during disease conditions was inadequate.

Effect of retraining on nutrition among tribal women volunteers in Bangladesh.

Training programme on Nutrition was carried out on 42 tribal women nutrition volunteers from Rangamati, Khagrachari and Banderban districts of Chittagong Hill Tracts during July 1987 to June 1988. There were a basic training for 10 days and five retrainings of 6 days on the same group. Assessments on the level of their knowledge before and after each training were conducted by a standard questionnaire. Mean score obtained by the trainees initially was 46.28% which increased to 97.23% in the last round. Although the knowledge gain was found statistically significant in each retraining but the retention of knowledge in pre-test of each retraining was found statistically significant (P less than 0.001) upto second round (i.e. 1st retraining) and thereafter the retention was found insignificant (P greater than 0.05).

Assessment of a mobile training programme on nutrition for Bangladesh rural development board (BRDB) women's programme in Bangladesh.

About half of the total population of the country are women and without their active participation no development programme can be achieved. This study involved a total number of 690 trainees from 23 upazilas of different districts in Bangladesh. The results obtained from both pre and post tests were compared and analyzed to find out the impact of the mobile training programme on nutrition. The mean age of the trainees was 29.54. The mean number of children per trainee was 3.73 and the mean income was close to Taka 1048.26. Analysis of the results regarding knowledge of the training about nutrition at pre and post training stages reveal that at post training stage they were more aware of the importance of nutrition. The difference in knowledge level at pre and post training stages was statistically significant (P less than .001).