Assessing support needs in children with intellectual disability and motor impairments: measurement invariance and group differences.

BACKGROUND: This study assessed the equivalence of the measurement of support needs between children with intellectual disability (ID) and children with intellectual and motor disabilities (IMD) and compared both groups in the different domains of support. METHOD: The Supports Intensity Scale-Children's Version was used to assess the support needs of 713 children with ID and 286 children with IMD, mainly associated with cerebral palsy. RESULTS: The results supported measurement invariance between the group of ID and IMD, which allowed to conduct comparison between them. Children with IMD scored higher on support needs than did children without IMD, suggesting that children with IMD needed more support than their peers without motor impairments. Furthermore, the ID levels interacted with motor impairments: at the highest levels of ID, groups tended to be similar in support needs, with high scores and low variability. The greatest differences were found in the domains of Home and Community activities. CONCLUSIONS: This study points to the across-condition of the construct of support needs in populations with intellectual and developmental disabilities. However, additional mobility impairments should be considered during the evaluation and planning of systems of support. In this regard, the Supports Intensity Scale-Children's Version might have limitations when discriminating between samples with high support needs.

How do the new WHO discharge criteria for the treatment of severe acute malnutrition affect the performance of therapeutic feeding programmes? New evidence from India.

BACKGROUND/OBJECTIVES: To assesses how the introduction of new WHO discharge criteria for the treatment of severe acute malnutrition (SAM) may affect the performance of therapeutic feeding programmes in India. SUBJECTS/METHODS: The analysis concerns 6041 children admitted to Nutrition Rehabilitation Centers (NRCs) in Jharkhand, Madhya Pradesh and Uttar Pradesh between 1 July 2009 and 31 December 2011. RESULTS: A total of 217 children (3.6%) had bilateral pitting oedema, 1803 (29.8%) had severe wasting with medical complications, 4021 (66.6%) had uncomplicated severe wasting and 4810 (79.7%) were in the age group 6-23 months old. The programme has high survival (>99%), default (⩾ 15%) and discharge (> 75%) rates. The use of weight gain ⩾ 15% as recovery criteria (old criteria) translates into recovery rates in NRCs that range from 33.6% for children admitted with weight-for-height z-score (WHZ) ⩽ -3 to 35.2% for children admitted with mid-upper-arm circumference (MUAC) < 115 mm. The use of WHZ ⩾ -2 as recovery criteria reduces recovery rates by ~ 2-fold (17.5%) while the use of MUAC ⩾ 125 mm as recovery criteria reduces recovery rates by 3.5-fold (10%). The new criteria tends to keep longer in the programme children who are younger and/or have poorer anthropometry at admission (that is, more vulnerable). CONCLUSIONS: The new WHO discharge criteria reduce the recovery rates currently reported by programmes for the treatment of children with SAM in India. However, their introduction in the programme practice will increase programme impact-particularly if accompanied by a general improvement in the strategy and protocols currently used-as they prioritize the most vulnerable children.

Management of children with severe acute malnutrition: experience of Nutrition Rehabilitation Centers in Uttar Pradesh, India.

OBJECTIVE: To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in Nutrition Rehabilitation Centers (NRC). DESIGN: Review of data. SETTING: 12 NRCs in Uttar Pradesh, India. PARTICIPANTS: Children admitted to NRCs (Jan 1, 2010 - Dec 31, 2011). INTERVENTION: Detection and treatment of SAM with locally-adapted protocols. OUTCOMES: Survival, default, discharge, and recovery rates. RESULTS: 54.6% of the total 1,229 children admitted were boys, 81.6% were in the age group 6-23 months old, 86% belonged to scheduled tribes, scheduled castes, or other backward castes, and 42% had edema or medical complications. Of the 1,181 program exits, 14 (1.2%) children died, 657 (47.2%) children defaulted, and 610 (51.7%) children were discharged The average (SD) weight gain was 12.1 (7.3)g/kg body weight/day and the average (SD) length of stay was 13.2 (5.6) days. 206 (46.8%) children were discharged after recovery (weight gain >15%) while 324 (53.2%) were discharged, non-recovered (weight gain <15%). CONCLUSIONS: NRCs provide life-saving care for children with SAM; however, the protocols and therapeutic foods currently used need to be improved to ensure the full recovery of all children admitted.

Influence of supplemental dietary sprouted wheat on reproduction in artificially inseminated doe rabbits.

The sprouted wheat contains great amounts of 6-methoxybenzoxazolinone (6-MBOA) a phenol compound that stimulates reproduction in certain small wild herbivorous mammals. The objective of the present study was to evaluate the effect of dietary sprouted wheat as supplement on reproduction in artificially inseminated doe rabbits. Two-month-old New Zealand White doe rabbits (n = 48) were randomly allocated to one of two treatments: (1) pelleted diet plus sprouted wheat for 6 consecutive days prior to service, (2) pelleted diet only (control). First insemination occurred when does reach 3200g body weight and bred 6 days after parturition across 6 months period during summer and autumn. Records from 41 does completing the experiment accounted for 192 inseminations and 142 kindlings equivalent to 4.6 +/- 0.15 and 3.5 +/- 0.15 litters per doe, respectively. Mean daily intake of sprouted wheat on wet and dry matter bases were 196.1 +/- 7.5 and 75.4 +/- 2.9g, respectively. The number of young born produced per doe during the trail was significantly (P = 0.02) greater in does fed sprouted wheat (28.1 +/- 1.2 versus 23.6 +/ -1.3 control). Does fed sprouted wheat had 0.65 +/- 0.06 receptivity rate at AI over 28 per cent greater (P = 0.001) than does in the control treatment. Sexual receptivity was not influenced by physiological status of does and season (P > 0.05). Diet and season had no effect (P>0.05) on kindling rate. However, physiological status had an effect (P = 0.002) on this variable. Kindling rates for nulliparous, lactating and non-lactating does were 0.95 +/- 0.08, 0.63 +/- 0.04 and 0.78 +/ -0.11, respectively. Sexually receptive does had a greater (P = 0.0001) kindling rate (0.95 +/- 0.05) than non-receptive females (0.63 +/-0.05). Does fed sprouted wheat produced larger (P = 0.02) litters than those in the control group: 7.7 +/- 0.30 and 6.8 +/- 0.32, respectively. There was an effect of season (P = 0.04) on the size of the litter at birth. Largest litters were born during autumn (7.9 +/- 0.37) than during summer (6.6 +/- 0.41). Receptive does had more (P = 0.002) young in the litter (7.9 +/- 0.28) than non-receptive (6.6 +/- 0.35). Feeding sprouted wheat as a source of biological 6-MBOA enhanced sexual receptivity and prolificacy in artificially inseminated doe rabbits bred in summer and autumn.

Influence of short-term relocation and male exposure on sexual receptivity and reproduction in artificially inseminated lactating doe rabbits.

A study was conducted to evaluate the effect of short-term relocation and male exposure on receptivity rate, kindling rate and total born per litter in lactating does under an artificial insemination (AI) programme. Thirty-two, 2-month-old New Zealand White rabbits were randomly allocated to one of four treatments: (1) relocation and male exposure; (2) relocation without male exposure; (3) no relocation with male exposure; (4) no relocation without male exposure (control). Relocation and male exposure were done 8-10 h before the time of service. First insemination was when does reached 3200 g body weight and does were bred 4-13 days after parturition across parities during a 6 month reproduction period. Of all breeding records, 125 inseminations and 91 kindlings were from nursing does. The mean interval from parturition to insemination for nursing does was 10.3 days. Relocation of lactating does resulted in greater (P<0.01) receptivity rate at service (74.8%) as compared with no relocation (55%). Receptivity rate was not influenced by male exposure. However, the interaction of relocationxmale exposure tended to be significant (P=0.07). Receptivity rate in relocated does exposed to males was 62.8 and 86.7% without exposure while in non-relocated does male exposure showed no effect. Kindling rate was not influenced by relocation or male exposure. The mean total born per litter in relocated and non-relocated does was 8.05 +/- 0.33 and 7.39 +/- 0.36, respectively, but no significant difference was observed. There was no effect of male exposure on total born per litter (7.85 +/- 0.34 versus 7.59 +/- 0.34 without male exposure). However, interaction of relocationxmale exposure on this variable was significant (P=0.009). Male exposure in relocated does decreased the size of the litter (7.52 +/- 0.46 versus 8.58 +/- 0.47 without male exposure) whereas mean values in non-relocated does increased when they were exposed to males (8.18 +/- 0.52 versus 6.60 +/- 0.49). Short-term relocation improved receptivity rate and reproduction in lactating does under an artificial insemination programme. Preliminary results indicated that male exposure in non-relocated does improves the total born per litter at a similar level than relocated does without male exposure. Relocation combined with male exposure decreased receptivity rate and total born per litter as compared with relocated does without male exposure, but the reproductive performance in the former was greater as compared with those does where no relocation occurred without male exposure.

[Monetary value of breast milk in Bolivia]. / Valor monetario de la leche materna en Bolivia.

OBJECTIVE: To estimate the volume of breast milk consumed by Bolivian children under 36 months of age, and the monetary value of replacing that volume of breast milk with commercial substitutes. METHODS: The analysis took into account the distribution of the infant population by age groups, the prevalence of breast-feeding practices (exclusive or partial) in every age group, the average volume of breast milk consumed by the infants of a given age group, and the cost of breast milk production and replacement. RESULTS: Bolivian infants annually consume more than 161 million liters of breast milk, which represents an average volume of 573 mL/day per infant under 1 year of age. The monetary value of breast milk consumed by the Bolivian infants amounts to US$ 274 million annually. The average cost of replacing breast milk with commercial substitutes for an infant adequately breast-fed for the first year of life would be US$ 407. DISCUSSION: For the formulation and consolidation of policies and programs to protect, promote, and support breast-feeding to become a reality, it is necessary that the political leaders of Bolivia be aware of the enormous monetary value of breast milk.

School-administered weekly iron supplementation--effect on the growth and hemoglobin status of non-anemic Bolivian school-age children. A randomized placebo-controlled trial.

BACKGROUND: Recent data suggest that daily iron supplementation of iron-replete children could impair their growth. If verified for weekly iron supplementation these results would markedly complicate targeting and implementing school-based weekly iron supplementation programs. AIM OF THE STUDY: To ascertain the effect of weekly iron supplementation on the growth and hemoglobin status of non-anemic school-age children. SUBJECTS AND METHODS: 73 Bolivian non-anemic school-age children randomly assigned to the treatment group (n = 37; receiving supplements containing FeSO4 during 18 weeks) or the control group (n = 36; receiving a placebo during the same period). Hemoglobin concentration and anthropometric measures were determined for each child at the beginning (T0) and the end (T18) of the study. RESULTS: The treatment group did not show any significant variation in hemoglobin concentration between T0 and T18 (-1.6 +/- 10.4 g/L; P = 0.40) whereas the control group showed a significant decrease in hemoglobin concentration (-4.6 +/- 10.9 g/L; P = 0.03). Anthropometric changes were not significantly different between the treatment and the control groups for weight, (1.63 +/- 1.11 kg vs 1.88 +/- 0.79 kg; P = 0.30), height (2.35 +/- 0.94 cm vs 2.11 +/- 1.03 cm; P = 0.34) or mid-upper arm circumference (0.29 +/- 0.57 cm vs 0.22 +/- 0.54 cm; P = 0.64). CONCLUSION: In our study, weekly iron supplementation of non-anemic school-age children had no negative effect on their growth while having a positive effect in preventing significant decreases in hemoglobin concentration. These results suggest that in regions where iron deficiency anemia (IDA) is prevalent, a simple and cost-effective way to control IDA in school-age children is to give weekly iron supplements to all children at school.

Nutrition advocacy and national development: the PROFILES programme and its application.

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies.

PIP: This paper describes a database approach to nutrition policy development and advocacy. The PROFILES nutrition advocacy and policy development program was applied in such developing countries as Bangladesh, Philippines, and Ghana. It has been used to increase awareness among decision-makers of the need for greater investment in nutrition, to facilitate the design and selection of programs, and to promote particular interventions that were already being designed. The program uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance, and labor productivity from the size and nutritional condition of populations. Nutritional condition changes were estimated from the costs, coverage and effectiveness of proposed programs. This nutritional program contributes to economic growth and is cost-effective in improving child survival and development. Thus, this approach has been successful: in Bangladesh, it played a vital role in bringing the government to accept the young child nutrition program and obtaining approval for assisted funding; in the Philippines, PROFILES also helped in developing and advocating an early childhood development program that included a large nutrition component in combination with health, family planning and educational components; in Ghana, it helped make nutrition the government's top priority, as evidenced by the Ministry of Health's new child survival strategy.

Weekly iron supplementation is as effective as 5 day per week iron supplementation in Bolivian school children living at high altitude.

OBJECTIVE: To compare the efficacy of a daily and a weekly iron supplementation on the hematological status of anemic children living at high altitude. DESIGN: Double blind iron supplementation trial including a placebo control group. SETTING: A socioeconomically disadvantaged district of La Paz, Bolivia (altitude of 4000 m). SUBJECTS: Anemic (hemoglobin concentration < or = 144 g/L), 3.3-8.3 y old children of both sexes. INTERVENTION: Children received a placebo (n = 57) or a dose of 3-4 mg of elemental iron per kg body weight (FeSO4 tablets) 1 d per week (n = 58) or 5 d per week (n = 58) for 16 weeks. RESULTS: Hemoglobin and zinc erythrocyte protoporphyrin concentrations improved significantly in supplemented groups but not in the placebo group. Changes in hemoglobin during the study were not significantly different between supplemented groups (weekly group: 15.2 +/- 6.9 g/L and daily group: 18.6 +/- 11.1 g/L) but were different from the placebo group (0.5 +/- 7.1 g/L, P < 0.001). At the end of the supplementation period, the hemoglobin distribution was Gaussian, and similar in both supplemented groups. Adjusting for the initial hemoglobin concentration, final hemoglobin and its changes were similar in both supplemented groups. CONCLUSION: Weekly iron supplementation is as efficacious as daily iron supplementation in improving iron status and correcting moderate iron deficiency anemia in Bolivian school children living at high altitude. SPONSORSHIP: Program supported in part by ORSTROM, the French Ministry of Foreign Affairs and the National Secretary's Office of Health, Bolivia.

Definition and prevalence of anemia in Bolivian women of childbearing age living at high altitudes: the effect of iron-folate supplementation.

This paper discusses the effect that high altitudes have on iron metabolism and summarizes the results of an iron-folate supplementation trial. The two main objectives of the trial were to determine hemoglobin cut-off values for the diagnosis of anemia in Bolivian women of childbearing age living at high altitudes, and to estimate the prevalence of anemia in this population. The study showed that nutritional anemia is an important public health problem in such populations and that many methods of assessing it lead to an underestimation of prevalence. The cut-off values defined through this study, one of the few iron supplementation trials conducted at high altitudes, confirm the need to establish revised hemoglobin values for the diagnosis of anemia in populations living at high altitudes.