Social protection networks in Central America and the Dominican Republic: Do they have a nutritional dimension?

BACKGROUND: It is not known whether the social protection networks in the Central American subregion and the Dominican Republic have a nutritional dimension. OBJECTIVE: To explore whether the social protection networks in Central America and the Dominican Republic have a nutritional dimension. METHODS: A survey was conducted during 2009 of 110 social protection programs and 10 national plans in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic. RESULTS: Most of the social protection programs did not have a nutritional dimension. CONCLUSIONS: With few exceptions, the social protection programs were not prepared to prevent undernutrition. There may be a similar situation in other regions. It is recommended to incorporate the nutritional dimension into all social protection programs and social safety nets in Central America and the Dominican Republic as well as in all other countries with low-income populations, worldwide.

Decreasing stunting, anemia, and vitamin A deficiency in Peru: results of the Good Start in Life Program.

BACKGROUND: The rates of stunting, iron-deficiency anemia, and vitamin A deficiency in Peru are among the highest in South America. There is little scaled-up experience on how to solve these problems countrywide. OBJECTIVE: To evaluate the Good Start in Life Program during the period from 2000 to 2004. METHODS: Data on weight, height, hemoglobin, serum retinol, urinary iodine, and age were obtained from children under 3 years of age during two transverse surveys in 2000 and 2004. RESULTS: In 2004, the program covered 75,000 children, 35,000 mothers, and 1 million inhabitants from 223 poor communities. The rate of stunting decreased from 54.1% to 36.9%, the rate of iron-deficiency anemia decreased from 76.0% to 52.3%, and the rate of vitamin A deficiency decreased from 30.4% to 5.3% (p < .01). The annual cost per child was US$116.50. CONCLUSIONS: Adaptations of this participative program could contribute to decreased stunting, iron-deficiency anemia, and vitamin A deficiency at the national scale in Peru and many other countries.

Release of iron, zinc, and lead from common iron construction bars and zinc metallic bars in water solutions and meals.

BACKGROUND: The use of iron pots has decreased the prevalence of anemia. OBJECTIVE: To investigate the release of iron, zinc, and lead from metallic iron and zinc bars incubated in water and in meals. METHODS: Iron, zinc, and lead concentrations were measured at different incubation conditions in water and in meals. RESULTS: The iron concentration in water was 1.26 mg/L after incubation with one iron bar at pH 7 and 100 degrees C for 20 minutes and in meals was 0.97 mg per 100 g of wet meals, rich in phytate, cooking at 100 degrees C during 20 minutes. The maximum contents were 7720 mg/L of iron and 1826 mg/L of zinc in vinegar at pH 3 and 20 degrees C after 90 and 32 days, respectively. Lead was released from the bars, but at concentrations well below the upper tolerable limits. DISCUSSION: In outreach populations, the use of iron and zinc metallic bars in water and meals could contribute to sustainable, very low-cost prevention of iron and zinc deficiencies, and home-fortified vinegar could be used for treatment of both deficiencies. CONCLUSIONS: Field trials should be performed to determine the impact that the use of iron and zinc metallic bars in water and meals might have on the iron and zinc status of population groups.

We know much about what to do but little about how to do it: experiences with a weekly multimicronutrient supplementation campaign.

BACKGROUND: Global population growth is concentrated in urban areas, but there is little understanding of how to implement the necessary interventions to control food and nutrition insecurity. In the urban area of Peru, food insecurity is characterized mainly by micronutrient deficiencies and not by energy deficiency. OBJECTIVE: To increase the effectiveness and cost-effectiveness of weekly multimicronutrient supplementation programs in poor urban communities. METHODS: A series of operational studies were conducted of preventive weekly multimicronutrient supplementation to reduce micronutrient-deficiency anemia in a population consisting of 8,081 children under 5 years of age and 20,082 women and adolescent girls of reproductive age (12 through 44 years). RESULTS: This is one of a series of papers that describe in as much detail as possible the experiences of a multimicronutrient intervention program for poor urban mothers and their young children and summarizes the lessons learned for consideration of future programming. CONCLUSIONS: This paper shows that such programs can achieve a high compliance with good training of program staff involvement of the community, education and motivation of beneficiaries, adequate supplies, and careful monitoring.

Baseline evaluation of nutritional status and government feeding programs in Chiclayo, Peru.

BACKGROUND: Because of the rapid growth of the urban population in Peru, food and nutrition insecurity will occur increasingly in this population. For appropriate policy setting and programming, the food and nutrition situation of the urban poor requires better understanding. OBJECTIVE: To gain information about the nature, magnitude, severity, and causes of the nutritional problems of the population in low-income areas of the city of Chiclayo, Peru. METHODS: A cross-sectional nutrition survey was conducted in 1,604 households, covering children under 5 years of age and their parents. RESULTS: The prevalence rates of stunting, wasting, overweight. and anemia in children were 15.4%, 1.3%, 4.6%, and 65.7%, respectively; one third of adults were overweight, and one tenth were obese; 2.1% of the mothers were underweight; and 34.3% of mothers and 12.2% of fathers had anemia. Governmental feeding programs did not address these problems adequately. CONCLUSIONS: Interventions must have adequate targeting; address appropriate responses at the household, community, and national levels; and reduce stunting, obesity, and iron-deficiency anemia.

Costs of the multimicronutrient supplementation program in Chiclayo, Peru.

BACKGROUND: There is little information on the cost parameters of weekly multimicronutrient supplementation programs. OBJECTIVE: To assess the cost parameters and cost-effectiveness of a weekly multimicronutrient supplementation program in an urban population of Peru. METHODS: Data from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]), which distributed capsules and foodlets to women and adolescent girls and to children under five, were extrapolated to a population of 100,000 inhabitants. RESULTS: The annual cost per community member was US$1.51. The cost-effectiveness ratio was US$0.12 per 1% of prevented anemia per community member. CONCLUSIONS: These costs are in the upper margin of iron supplementation alone. They will decrease notably when weekly multimicronutrient supplementation programs are integrated into health packages and participation by women increases. Focusing on micronutrient deficiencies would prevent these problems, and food-distribution programs would be effectively targeted to food-deficient populations.

Lessons learned from the scaling-up of a weekly multimicronutrient supplementation program in the integrated food security program (PISA).

BACKGROUND: Weekly multimicronutrient supplementation was initiated as an appropriate intervention to protect poor urban populations from anemia. OBJECTIVE: To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru. METHODS: Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost. RESULTS: Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program. CONCLUSIONS: To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.

Vacinaçäo / Vaccination

Faz-se uma análise de eficiência e eficácia do Programa Nacional de Imunizaçöes. Säo utilizados dados levantados pela Pesquisa Nacional por Amostra de Domicílios (PNAD)-1981, Suplemento Saúde, juntamente com dados fornecidos pelas Secretarias Estaduais de Saúde. O resultado mais expressivo, contudo, foi obtido através de uma estratégia especial, os dias nacionais de vacinaçäo contra a poliomielite (p189). Por esta estratégia, que vem sendo realizada desde 1980, a poliomielite encontra-se sob controle no Brasil, em todas as regiöes e independentemente de variáveis como rendimento familiar, grau de instruçäo, zona rural ou urbana de residência. Para as demais doenças tais como, sarampo, coqueluche, difteria, tétano e formas graves de tuberculose, apresentam ainda elevada incidência em quase todas as áreas do País. Nenhuma destas doenças está controlada em termos nacionais, nem ao menos próxima desta situaçäo. Näo obstante, säo evidentes as desigualdades regionais quanto as coberturas vacinais no Brasil: mais baixas no Norte, no Nordeste e no Centro Oeste do que no Sudeste e Sul. Observa-se também que nas populaçöes de baixa renda e de menor grau de instruçäo, as coberturas vacinais säo significativamente mais baixas. Uma perspectiva de mudanças neste panorama, é a aplicaçäo de vacinas tríplice (DPT) e anti-sarampo em dias nacionais de vacinaçäo, tal como tem sido feita a vacinaçäo contra a poliomielite, que tem alcançado ótimos resultados

Vigilancia alimentario nutricional: donde estamos 10 años más tarde? / Nutritional and food surveillance: where we are ten years later?

Se analiza la situación atual de los sistemas de vigilancia nutricional existentes en América Latina y se proponen estrategias realistas para suplementar dichos sistemas. La definición del sistema, en términos teóricos, es la de prover información sobre los aspectos de la dinámica alimentaria y la condición nutricional de una población, y en términos practicos se necesita de una definición pragmática, concreta y realista. Se enumeran las principales características de un sistema y las que no son deseables del mismo

Programas para mejorar la nutrición de las mujeres embarazadas y madres lactantes / Programs to improve the nutrition of pregnant and lactanting women

Las carencias nutricionales, frecuentes en las poblaciones de América Latina, constituyen un importante problema de salud pública y un grave obstáculo al desarrollo social y económico en muchos países. El problema de la malnutrición materna es especialmente agudo, en parte porque las mujeres embarazads suelen adolecer de una malnutrición especialmente marcada y en parte porque los problemas nutricionales de las madres tienden a afectar el estado nutricional de su hijo. Este artículo presenta algunas pautas básicas para programas encaminados a mejorar el estado nutricional de las mujeres embarazadas y lactantes en América Latina (AU)