Scaling up health technology assessment capacities in selected African countries - A conceivable route ahead.

BACKGROUND: This study aimed to provide a structured description of the commonalities and differences in healthcare structures across Africa to establish a reliable basis for the health technology assessment (HTA) of nutrition and nutrition interventions. A ranking of current nutrition conditions in the general population of the participating countries was included to gain a better understanding of the factors influencing hospital malnutrition (HMN), which will inform future multi-country research. METHOD: A questionnaire on the structure of the health systems was distributed among ten African countries. Subsections were included that inquired about the drivers or barriers to using principles of HTA to assess nutritional care. Analysis and ranking of malnutrition data were based on data from the Global Hunger Index report and two poverty indicators used by the World Bank. RESULTS: The health system structure of each country was identified and described, whereas questions about HTA could not always be analyzed due to a lack of adequate in-depth knowledge and skills in most countries. Early experience from some countries demonstrates a conceivable route ahead for African countries in strengthening the capacity for and implementing HTA in accordance with distinct national healthcare contexts and social determinants of health. CONCLUSION: Problems related to nutritional care represent one of the major priorities in the surveyed countries. A future HMN multi-country study will provide valuable insight into the potential of low-cost primary prevention orientations.

[Evaluation of nutritional Status in lung cancer using bio electrical impedance analysis and mini nutritional assessment]. / Evaluation de l'état nutritionnel par impédencemétrie et Test MNA au cours de cancer primitive du poumon.

BACKGROUND: Malnutrition and cachexia were a frequent problem in lung cancer and increases the risks of morbidity and mortality in these patients. Bioelectrical impedance analysis (BIA) is easy, non-invasive and reproducible method that can be performed. AIM: Evaluate nutritional status in patients with primary lung cancer by Mini Nutritional Assessment (MNA), BIA and anthropometric values (weight, arm and calf circumferences) and correlate the nutritional parameters to severity of cancer and histopathology. METHODS: The nutritional status of 73 cases of primary lung cancer was evaluated by anthropometric parameters, MNA test and impedencemetrie Results: According to body mass index (BMI), malnutrition, overweight and obesity were noted in 34,2%, 13,7% and 5,5%. According to BMI, free-fat mass index (FFMI) and fat mass index (FMI), the investigations occurred malnutrition and depletion of muscle in respectively 19,2% and 23,3% of cases. Fat depletion was noted in 21,9%. Overweight and obesity were detected in 6,8% and 5,5% of cases. Assessment by MNA, revealed that 28,7% of patients were already malnourished and 49,3% of patients were at risk of malnutrition. A significant correlation existed between the score of MNA and arm and calf circumferences, FFMI and FMI. FMI was significantly lower in group of patients with small lung carcinoma. CONCLUSION: Only FFMI allows early detection of malnutrition in cancer patients overestimated by measuring BMI and arm circumference was the better indicator of depletion of muscle.

Dietary intakes of essential nutrients among Arab and Berber ethnic groups on rural Tunisian island.

OBJECTIVE: The dietary intake was investigated and food sources were identified among Tunisian ethnic groups from Jerba Island in the south of Tunisia. METHODS: Ninety-four subjects of moderate socioeconomic status (47 Berbers and 47 Arabs) aged 32 to 64 y completed a 1-mo qualitative food-frequency questionnaire and a single 24-h dietary recall, and dietary intakes and demographic status were observed from 2006 to 2007. RESULTS: The prevalence of overweight and obesity was not significantly associated with Arab men compared with Berber men. Therefore, obesity was significantly associated with Berber women (P<0.001). Height was significantly different between Arab and Berber women (P<0.001). There were no significant differences in energy intake between men and women. Protein intake was not significantly different between ethnic groups. Milk and dairy products in the Berber group were significantly different from the Arab group. Intakes of calcium, zinc, iron, and folate were below recommended nutrient intakes in men and women in the two ethnic groups. Vitamin E intake was greater in Berbers than in Arabs (P<0.01). CONCLUSION: Ethnicity was significantly associated with dietary intakes in the two ethnic groups of Jerba Island.

[Bio-impedance analysis: screening of malnutrition in a group of Tunisian with cancer patients]. / Apport de l'impédancemétrie dans le dépistage de la dénutrition chez un groupe de patients tunisiens atteints de cancer.

Malnutrition increases the risks of morbidity and mortality in cancer patients. It is characterized by changes in cellular membrane integrity and alterations in fluid balance, both of which can be detected by bioelectrical impedance analysis (BIA). We investigated whether BIA-mesured variables could detect malnutrition, as defined by body mass index (BMI) and anthropometric indices, in 83 Tunisian cancer patients (18 men and 65 women) hospitalized in surgery. The investigations occurred within the first 24 hours following hospital admission. Analysis revealed that 4.8 % of the patients were at risk for malnutrition according to body mass index. By impedancemetry, 26.5 % of all patients had free-fat mass index (FFMI) below the normal range and 15.6 % had a low fat mass index (FMI) despite a normal or relatively high BMI. While males lose their fatty reserves early, females tend to lose free-fat, muscular mass regardless of their BMI. The BMI can be misleading in an overweight or obese patient and conceal losses in muscular mass in patients exposed to latent malnutrition. The FFMI and FMI appear to be better indicators of the nutritional status than the BMI.

[Effects of treatments on serum vitamin E levels in lung cancer]. / Effet des traitements sur les concentrations sériques de vitamine E dans le cancer bronchopulmonaire.

Previous evidence suggests that malignant tumours cause an decrease in the serum vitamin E level. We followed the serum alpha tocopherol in 55 lung cancer patients. The objective of the study was to evaluate the effects of treatments of lung cancer on serum vitamin E evolution. The vitamin E of patients symptomatically treated decreases from the first month and this decrease is significant (p < 0.001) in patients affected by SCLC and in those with NSCLC classified stage III and IV. The reduction of the vitamin E is also noted in the patients treated with chemotherapy (p < 0.001). Vitamin E levels improve gradually to reach standard values in the patients who followed a curative radiotherapy or benefited from the surgical ablation of the tumour. At 4 months after the surgical removal of the tumour, there was an increase in serum vitamin E concentrations and reached the normal values. This data indicates that surgical removal of lung cancer increases serum vitamin E concentrations compared to the baseline values possibly reflecting the relief of oxidative stress caused by malignant tumours.