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Jan 2024 DOI 10.14302/issn.2692-5257.ijgp-23-4772
Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries. Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community. In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach. While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems. Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries. Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community. In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach. While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems.
May 2022 DOI 10.14302/issn.2379-7835.ijn-22-4149
In Ethiopia stunting, underweight and wasting in school children are very common. The aim of this research was to evaluate the impact of intestinal helminthes and schistosomiasis on malnutrition, anaemia and haematological indices in the school age children of Azezo Elementary School in Gondar town. Kato Katz technique was performed to determine infection and intensity of intestinal helminth infections. AnthroPlus software version 1.04 was used to get malnutrition indices while fully automated haematological analyzers were used to determine haematological and biochemical parameters. A total of 384 school children were recruited in this study. The overall prevalence of helminth infection was 45.8% (178/384) with the leading Ascarislumbericoides infection (20.6%) compared to the second leading Schistosomamansoni (17.4%) and third leading hook worm infections (13.3%). The prevalences of body mass indexes for age Z-scores (BAZ) indices were 9.6% (37) very sever thin, 17.2% (66) sever thin, 38.3% (147) thin, 34.4% (132) normal and 0.5% (2) overweight. On the other hand, the prevalences of height for age Z-scores (HAZ) indices were 12.2% (47) stunt, 87% (334) normal and 0.8% (3) over height. Of the total 384 school age children, 335 (87.2%) had normal blood glucose level (70 – 110 mg/dL) while the remaining 49 (12.8%) school age children were hypoglycemic. The number of the school children with normal total protein level (6.6 – 8 g/dL) was 259 (67.4%) while the remaining 125 (32.6%) school children were hypo-proteinaemic. The prevalence of anemia in the school age children was 33.1% (127). Intestinal helminth infections were statistically significantly associated (p = 0.000) with hypo-proteinaemia, anemia and number of lymphocytes compared with non-infected school children. The likelihood of anemia in intestinal helminth infected school children, when it was compared with uninfected, was 148 times higher for both Ascaris lumbericoides-Schistosoma mansoni co-infection, 38 times for Hookworm, 20 times for Schistosoma mansoni and 3 times for Ascaris lumbericoides mono-infections. Conclusion: Intestinal helminth infections in school age children aggravate malnutrition. Prolonged malnutrition and intestinal helminth infections could result in stunting in school-age children.
Aug 2020 DOI 10.14302/issn.2641-4538.jphi-20-3437
Acute malnutrition affects nearly 52 million of under five years children globally, 75% of them live in low to middle income countries. The treatment of acute malnutrition using supplement foods could help children recovering and could reduce the risk of sickness. The present study investigated the factors associated with recovery among children with moderate acute malnutrition (MAM) under a follow-up program at health facilities. A prospective study was conducted in 16 health centers of Kirehe District of Rwanda and included 200 children from 6 to 59 months. A semi-structured questionnaire was used for data collection. All children enrolled in the study spent three months in nutrition program at health centers. The results show that after 3 months in the program 77.5% recovered from MAM. Children aged above 36 to 59 months were recovered at 90% whereas children aged from 24-35 months were recovered at 73.5%. Micronutrients and deworming provided at health facility were contributed to the recovery as children who received them were recovered at 89.1% and for those who didn’t were recovery at 72.1%. The findings demonstrated that boys were 16 times more likely to recover from MAM in three months of intervention than girls (AOR=16.19, p<0.001, 95% CI: 5.39- 48.63). Children from moderate income families were 3 more likely to recover than those from very low income families (AOR=2.8, p=0.029, 95% CI: 1.11-7.51). Male gender, receiving micronutrients and deworming from health facilities and family income status were factors associated with MAM recovery status
Jan 2020 DOI 10.14302/issn.2379-7835.ijn-19-3111
The present paper describes the significance of anthropometric measurements in detecting nutritional status of individuals, specially children. It highlights evolution of anthropometry, discusses importance of various measurements & their role in determining undernutrition & obesity. There is a need to have one measurement to detect obesity & undernutrition both. An ideal such measure is yet to be established.
Jan 2019 DOI 10.14302/issn.2379-7835.ijn-19-2599
Background: Severe acute mal nutrition (SAM) among children still remains the major problem in Ethiopia. The shortening of the SAM recovery time by applying appropriate dietary means during treatment and also after recovery, can save huge sums of public health spending. Objectives: Determining the recovery time of SAM affected children and developing complementary food supplement (CFS). Methods: Hospital based retrospective cohort study was carried out on 401 SAM affected children. A structured and pre tested data abstraction form was used for data collection. The data were entered into Epi info and exported to SPSS for analysis. All of the nutritional properties of the developed product in three different ratios of the flours of maize, soybean and powder of moringaolifera leaves were assessed and compared to the control (100% maize). Results: The median recovery time was 16 days. There was a significant increase in protein, mineral and beta carotene content with increasing level of Moringaolifera leaf powder in the CFS. Conclusion: To increase the rate of recovery from sever acute malnutrition and also to prevent relapsing, moringa incorporated cheaper complementary fod supplements could be recommended for SAM affected children.
Aug 2018 DOI 10.14302/issn.2379-7835.ijn-18-2262
Objective: To analyse safety, tolerability, efficacy and logistic issues related to administration of 3 types of therapeutic feeds to children with severe acute malnutrition (SAM) from tribal district of Nandurbar, Maharashtra. Design: A three arm open label, block randomized trial using 3 therapeutic feeds i.e. commercially available ready to use therapeutic feed (C-RUTF), locally prepared ready to use therapeutic feed ( L-RUTF) & amylase rich food(ARF) was given to 1092 tribal children of SAM in Nandurbar District, Maharashtra, India during 2014-2015. Setting: Tribal district of Nandurbar, Maharashtra. Participants: 1092 children of SAM, 766 on C-RUTF, 184 on L-RUTF & 143 on ARF followed on treatment for 8 weeks. Outcomes: The recovery rates in the three groups, any untoward effects during treatment and logistic aspects of procurement, delivery, storage & administration of therapeutic feeds. Results: Total number of children with SAM were 1092. Gr 1 – Out of 765 children of SAM, 404 (52.8%) recovered on C-RUTF. Gr 2 – 80 (43.5%) recovered out of 184 on L-RUTF. Gr 3 – 64 (44.8%) recovered on ARF at the end of 8 weeks of treatment, the difference being statistically significant between C-RUTF & others. Out of 38 children on C-RUTF, it was observed that 1 had diarrhoea, 1 had vomiting, 1 had fever, 4 children reported more activity in terms of playfulness, more speaking & smiling. 31 children had nothing specific to report. Out of 34 children on L-RUTF, 6 children reported diarrhoea, 1 had vomiting & 4 children reported fever. 3 children reported more activity. 23 children had nothing specific to report. Out of 19 children on ARF, 1 had diarrhoea, 1 had vomiting, 1 had fever, 3 reported more activity. 13 had nothing specific to report. Untoward effects were noted in 3 out of 38 (7.89%) in C-RUTF group, 11 out of 34 (32.35%) in L-RUTF group and 3 out of 19 (15.7%) in ARF group. Conclusion: C-RUTF was found to be more efficacious, with least untoward effects, easy to administer and was more palatable when compared to L-RUTF & ARF.
Jul 2017 DOI 10.14302/issn.2379-7835.ijn-17-1607
Background Severe acute malnutrition (SAM) is rampant in the children of hilly and inaccessible tribal region of Nandurbar, Maharashtra in India. It is estimated that nearly 5% of the children under five years have SAM. Objectives To assess the therapeutic efficacy of 3 types of nutrition protocols administered largely at home in SAM children from Nandurbar, Maharashtra. Methodology This study is a part of a larger three arm open label trial using 3 therapeutic feeds i.e. C-RUTF (Centrally produced ready to use therapeutic food), L-RUTF (locally prepared ready to use therapeutic food) and ARF (locally prepared amylase rich food) in children of SAM who attended the health facility and completed the treatment protocols for 8 weeks (All ‘per protocol patients’) and were between 1 to 3 years of age. The larger study included children aged 6 months to 59 months who were given same therapeutic feeding protocol. Findings A total of 450 SAM babies between 12-36 months. attended the outpatient therapeutic program during the period of July 2014 to December 2015 and completed the given protocol of therapeutic feeding program. 242(53.7%) were males and 208(46.2%) females. Out of these, 150 received C-RUTF, 150 received L-RUTF and 150 received ARF. Out of C-RUTF group 83(55.3%) recovered, in L-RUTF 70(46.7%) recovered and from ARF group 69(46.0%) recovered. The difference was statistically significant.(p=0.03) Total recovery rate was 49.3% in comparison to another under publication study by our group on 3418 children aged 6 months to 59 months, where recovery was 36.8%. Average weight gain per day was 3.54 ± 2.36 g/kg/day, 2.61 ± 2.12 g/kg/day, 2.60 ± 1.50 g/kg/day in the 3 arms respectively. Conclusion This study proves that domiciliary treatment with 3 types of therapeutic feeds gives recovery rate of 49.3%, there by meaning that SAM Children without complications can be treated at home with visit to health facility once a week. Of all the therapeutic feeding protocols C-RUTF had best recovery rates (55.3%) compared to others, the difference being statistically significant. Average weight gain per kg per day inC-RUTF group was 35.8 % higher than the other 2 groups.
Feb 2017 DOI 10.14302/issn.2474-7785.jarh-16-1398
Oral nutritional supplements (ONS) have been shown to improve patient outcomes in the hospital setting, but limited results from long-term care or community settings exist. Using electronic health records (EHRs) from 2009 to 2014 for both adult inpatients and outpatients, we compare the demographic and clinical characteristics of patients who received ONS (n = 1,251) with a non-ONS control group (n =25,513). Multivariable logistic regression modeling was used to describe and compare differences in baseline characteristics between the groups including age, sex, race, tobacco use, and comorbidities. We found that patients receiving ONS were older and sicker than control patients. Hospitalized ONS patients were more likely to be admitted from the emergency department and have a hospitalization within the last month prior to the index date. Our results suggest that there is a need for nutrition screening and incorporating nutrition status into the EHR as an important way to coordinate hospital and community medical care. ONS can be an important therapy for vulnerable populations in both the hospital and the community settings.
Nov 2025 DOI 10.14302/issn.2379-7835.ijn-24-5360
Background Malnutrition is a significant public health issue in Bangladesh, particularly impacting women and children. Rajshahi, marked by socio-economic disparities, offers a distinctive context to explore the nutritional status and health outcomes of these vulnerable groups. Objectives This study aims to assess the nutritional status of women and children in Rajshahi and investigate associated health outcomes. Additionally, it seeks to identify socio-economic and cultural factors that influence nutrition. Methods A mixed-methods approach was utilized, incorporating a cross-sectional survey of 460 households and in-depth interviews with mothers and caregivers. Anthropometric measurements were taken to evaluate the nutritional status of women and children, while dietary assessments measured nutrient intake and diversity. Logistic regression analysis was performed to determine the likelihood of malnutrition based on socio-economic characteristics, thereby identifying key risk factors. Results The findings indicate a troubling prevalence of malnutrition, with 36% of children under five classified as stunted and 25% as underweight. The analysis highlights critical factors contributing to chronic undernutrition, including maternal education, employment, and dietary diversity. Notably, mothers aged 27-37 exhibit a lower risk of undernutrition, and urban households with secure food access demonstrate better nutritional outcomes. Discussion Maternal education and employment were positively associated with better nutritional outcomes, as educated and employed mothers had higher chances of maintaining a normal BMI. Regular ANC visits (≥4 visits) were crucial for improved maternal nutrition. Household food security emerged as a significant determinant, with food-secure households showing better maternal nutritional status. Safe water access and adequate dietary diversity were also linked to improved maternal BMI. Additionally, factors such as child birth weight, exclusive breastfeeding, and childhood diarrhea significantly influenced maternal nutrition. Moreover, frequent antenatal care visits and a diverse diet are vital in mitigating undernutrition risks among children. Conclusion This study emphasizes the urgent need for targeted interventions to combat malnutrition in Rajshahi. Recommendations include implementing community-based nutrition education programs and improving access to healthcare services. By addressing the socio-economic and cultural determinants of nutrition, stakeholders can enhance health outcomes for women and children in the region, ultimately contributing to broader public health objectives in Bangladesh.
Mar 2023 DOI 10.14302/issn.2379-7835.ijn-22-4116
Background In Low Middle-Income Countries (LIMCs), malnutrition, especially undernutrition is one of the leading causes of childhood mortality and morbidity. Poor complementary feeding practices are among the most notable contributors to poor nutritional indicators in children under five. This article provides an output of secondary data analysis of the Cost of Diet (CoD) and Optifood component of National Complementary Feeding Assessment conducted by UNICEF Pakistan along with Pakistan Demographic Health Survey (PDHS) 2018. Methods For correlation of Optifood data and CoD data with PDHS data of CF, GraphPad software, MS Excel was used along with manual quantifications. The analysis of DHS-2018 data was conducted using STATA software. Univariate analysis included comparison of categorical variables i.e. various individual, household and community level parameters with that of outcome variables of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum dietary diversity (MAD) using chi-square test. Findings The overall rate of MMF was 56.6% among children of 6-23 months of age with MDD in 18.6% and MAD in 13.8% of children. Percentage of annual cost spent on nutritious diet for MDD, MMF and MAD varies from 27.86% to 43.08% across all the provinces. Children aged 6–8 months and 9–11 months often consumed infant milk and cereals, while children aged 12–23 months often consumed eggs and grain products. Consumption of dairy products was highest in Punjab, Sindh, AJK, and Islamabad, that of grains roots and tubers was highest in KPK, FATA and GB. Conclusion Considering CF practices in Pakistan are inadequate as indicated by poor MDD, MMF, and MAD, therefore it is imperative that a holistic approach using both communication and non-communication based interventions is to be employed through active stakeholder engagement.
Dec 2022 DOI 10.14302/issn.2693-1176.ijgh-22-4218
Growth monitoring activities has been seen as the most effective ways to identify malnutrition and promotes early child development. This has been linked with long term health and social benefits for the child, family and the community. Over the years, the growth monitoring activities have centred round the health workers. Therefore, the study explored task shifting on Mother/ Caregivers capability to undertake growth monitoring roles at the health Facilities in Oyo State Nigeria. Qualitative methods using focused group discussion and Key informant interview guide were used for data collection among 6-8 groups of 10 mothers and 20 health workers providing the service. The data was analysed using inductive coding to generate the themes. The study showed mothers/caregivers low knowledge on growth monitoring and health workers documented some potential challenges encounter during the activities. The mothers/caregivers show low knowledge on growth monitoring. Therefore, mothers/caregivers were willing to take up the role.
Sep 2021 DOI 10.14302/issn.2379-7835.ijn-21-3926
Background The nutritional situation in prisons of developing countries and the health status of inmates remain a major human rights concern. The objective of the study was to assess the nutritional status of inmates jailed in a prison of the Democratic Republic of Congo (DRC). Methods This cross-sectional study was conducted over a 4-month period in the Central Prison of Mbuji-Mayi, DRC. Three hundred inmates were selected according to the Malnutrition Universal Screening Tool (MUST). Severe malnutrition was defined according to Buzby index and Nutritional Risk Index (NRI). Data were analyzed by Stata™ (version12.0). Results The inmates were aged between 18 and 70 years and primarily males (88.7%). Of them, 24% were suffering from severe malnutrition and 62% of moderate malnutrition as based on the NRI. At the time of study, 88% of inmates were incarcerated for more than 6 months. Multivariate logistic regression analysis showed that factors independently associated with severe malnutrition were incarceration of more than 6 months (OR=5.1; 95% CI (1.5-17.4)), origin of food (prison vs. family or NGO) (OR=4.7; 95% CI (1.6-13.8)) presence of tuberculosis, human immunodeficiency virus and/or intestinal infections (OR=2.6; 95% CI (1.4-4.7)). Conclusions The nutritional situation in the Central Prison of Mbuji-Mayi is precarious. There is urgent need to supply enough nutrient-rich food to improve health of inmates.
Oct 2020 DOI 10.14302/issn.2379-7835.ijn-20-3377
Introduction Sub-optimal dietary intake patterns have a major detrimental impact on the nutritional status of an alcoholic. These patterns exacerbate the status of alcoholism and the functioning of the alcoholic’s body. Objective This study aimed to examine alcoholic’s dietary intake patterns. Methods A cross-sectional study was conducted on 204 alcoholics undergoing alcohol rehabilitation in selected rehabilitation centers. A 24 hour food recall and food frequency questionnaire was used to assess dietary intake of the respondents. Factor analysis of food items and groups, cluster analysis of dietary intake patterns, and multivariate regressions were carried out. Results Three dietary intake patterns were identified among alcoholics namely a low calorie intake (described mainly by consumption of plant-based foods); a composite intake (distinguished by adequate consumption of both plant-based and animal-based foods) and a high calorie intake (characterized by high consumption of animal-based foods). Conclusion Optimal dietary intake promotion programs are needed to address the dietary intakes of recuperating alcoholics under rehabilitation to help prevent malnutrition and other associated comorbidities.
Apr 2020 DOI 10.14302/issn.2641-4538.jphi-20-3296
Preventable factors such as infectious diseases (pneumonia, diarrhea, and malaria), malnutrition and neonatal complications are still the leading cause of child mortality worldwide 1 In 2013, it is estimated that 6.3 million babies born worldwide died before the age of 5, and approximately 9.2% of these deaths were due to diarrheal diseases 23 in simple, accessible ways, and effective treatment can reduce diarrhea-related mortality and make hospital admissions unnecessary, and the role of mothers is the most important 4. Since the presentation of Oral Rehydration Therapy (ORT) in 1979, mortality has reduced. Diarrhea has had a steady downward trend 5. If mothers who have children under 5 years of age, used correctly ORS, they could easily resolve the problem of dehydration in acute diarrhea 6. Mothers didn’t use correctly ORS because of their Low literacy and lack of knowledge and wrong attitude about ORT7. Some health care workers provide mothers’ required equipments, regardless of their educational needs, and mothers may not use ORS. In this study, health workers identified mothers' educational needs and subsequently they trained them about using ORS at home in acute diarrhea in children under 5 years of age.
Mar 2020 DOI 10.14302/issn.2641-4538.jphi-20-3261
Efforts to control the Human Immunodeficiency Virus epidemic in Rwanda have seen remarkable success over the years. Effective antiretroviral therapy has played great role in improving longevity among people living with HIV/AIDS (PLWH). While this is the case, there are various nutritional challenges, which are often faced, among PLWH. Guided by the Rwanda country guidelines for nutritional management for PLWH and WHO recommendations, this study aimed to explore the perspectives of health care providers (HCPs) working with PLWH on nutritional challenges faced by their clients in Kigali, Rwanda. We conducted a qualitative study using in-depth interviews to collect data. A non-probability purposive sampling was employed to recruit HCPs. Data analysis was based on the naturalistic paradigm. We followed the hybrid approach in conducting thematic analysis. Three themes were identified. First, HCPs had good knowledge on nutritional requirements for PLWH. They demonstrated good communication skills and adequate counseling skills that were necessary for addressing concerns on nutrition from their clients. Secondly, it emerged that HCPs perceived a lack of resources to be the major challenge faced in nutritional management of their clients. From theme three, it emerged that, from HCPs experiences, food insecurity and lack of feeding supplements were the main causes of malnutrition among PLWH in Kigali, Rwanda. From the HCPs perspective, there is a need to improve healthcare institutions capacity to manage nutritional challenges faced by PLWH. To achieve this, policy makers need to channel adequate resources for this cause.
Nov 2019 DOI 10.14302/issn.2379-7835.ijn-19-3083
Background In November 2014, the World health Organization (WHO), in collaboration with United Nations Children's Fund (UNICEF), and the World Food Programme, produced interim guidelines (iGL) on providing nutritional support to patients in Ebola treatment units (ETUs). They have been translated into French and issued by the Ministry of Health, UNICEF and WHO in adapted versions to be used in the current outbreak in the Democratic Republic of the Congo (DRC). This paper evaluates the use and usefulness of the 2014 iGL in the West Africa and current DRC Ebola virus disease (EVD) outbreaks and identifies experiences and lessons learned from practitioners on the operational aspects of nutritional care and support in ETUs. Methods Key-informants (n=26), from 12 organizations (Non-Governmental Organizations, United Nations, Red Cross Red Crescent Movement) were interviewed who were actively engaged in the nutritional and/or clinical care of EVD patients. Results There was a consensus among key-informants that the 2014 iGL initially served a guiding purpose. However, the vast amount of learning from the 2014-2016 and current EVD outbreaks indicates that the interim guidelines need to be revised. Practitioners struggled to find operational solutions for nutritional care, and the challenges were plentiful, especially regarding 1) the different perceptions of the importance of nutritional care among ETU staff; 2) the difficulties around food preparation and distribution for EVD patients; 3) how to take into account the patients’ dietary preferences; 4) the nutritional care needed in relation to specific EVD symptoms; 5) who assumed roles in nutritional care in ETUs; 6) if and how feeding support was organized; 7) whether malnutrition needed to be addressed and how; and 8) whether the intake of specific nutrients could contribute to improved treatment outcomes. Information from the key-informants interviews resulted in numerous lessons learned and recommendations for nutritional support during current and future outbreaks. Conclusions This investigation underscored the importance of documenting experiences of practitioners on nutritional care in emerging infectious diseases for which limited scientific evidence exists and for which interim guidelines are produced to fill in knowledge gaps. It also emphasized the importance of nutritional care in ETUs during treatment.
Jul 2019 DOI 10.14302/issn.2379-7835.ijn-19-2774
Maternal nutrition is at the core of any principle-centered projection of Sustainable Development Goals. Without the developmental health of newborns – there is no quality future. Specifically, there are situations all around the globe where Indigenous and Artisanal coastal people suffer from maternal malnutrition inadvertently limiting future potentials in many locations that will be most challenged by climate change. Results from research with Artisanal Fisherfolk in the Philippines and analysis of harvest by the Canadian Inuit people are discussed in terms of the ethics of setting national as well as global education and research priorities.
Jul 2019 DOI 10.14302/issn.2379-7835.ijn-19-2721
Introduction In the past several decades, Zambia has suffered high levels of under nutrition particularly stunting among children below 5 years of age. Although appropriate complementary feeding practices are reported to reduce child deaths by 6%, they have not received the adequate attention from programme officers and caregivers in terms of implementation. Objectives The objective was to investigate issues surrounding the common complementary feeding practices practised by caregivers of children below five years in health facilities and areas where high rates of malnutrition admission come from. Design A cross sectional research using both qualitative and quantitative methods. The study used mostly proportions based mostly on global indicators on complementary feeding. Qualitative data was also analysed according to themes of global complementary feeding indicators Setting The study was conducted in five hospitals, namely Arthur Davison, Solwezi Central, Kabwe and Livingstone General, and University Teaching Hospital. Subjects The target populations were mothers whose children were admitted for malnutrition and those with children 0-59 months living in communities with the highest number of malnourished cases admitted to selected hospitals Results About45.2% (190) of caregivers introduced liquids before six months of age and 7.6% (32) after 6 months attributing child thirst, medication and advice from health worker as the main reasons. Slightly above half (54.2% of 224) of mothers/caregivers used cups to feed their babies. The use of feeding bottles was still common (8.2% of 34). Responsibility to feed the child is mostly left to the mother (86.4%, 362). In addition, children were being feed about 2.67 (SD 0-72) per day. Conclusions Child feeding practices were still poor. This contributes to poor child growth and health. More interventions should be planned to improve child care behaviour.
Apr 2019 DOI 10.14302/issn.2379-7835.ijn-19-2646
The potential of Nigerian indigenous tree leaves as vegetable source, pharmaceuticals and other therapeutic materials have been reported. However, Silk cotton (Ceiba pentandra) leaf is still underutilised as vegetable in parts of Nigeria where it exists despite its potential great health benefits. The aim of the study was to assess the micronutrient and phytochemical potential contribution to nutrient intake of its consumers, and acceptability of its cooked soup and sauce ‘as consumed’. Fresh young shoots and leaves of Ceiba pentandra were harvested from Ihitte/Uboma in Imo State, Nigeria. Composite sample of the leaf was prepared and divided into four portions. One portion was labelled as raw sample, and others blanched, cooked to soup and sauce. The four samples were analysed for proximate, minerals, vitamins and phytochemical composition using standard methods of AOAC. Sensory evaluation of soup and sauce was carried out using 9-point hedonic scale with 30 untrained panelists. Data were analysed using ANOVA at p<0.05 Raw Ceiba pentandraleaf contained 80.9g moisture, 3.9g protein, 0.8g fat, 15.3g carbohydrate, 68.40 kcal gross energy, 183.40mg potassium, 119.38mg calcium, 112.99mg phosphorus, and 3.46mg iron/100g sample. The leaf was rich in phytochemicals such as saponins, flavonoid and alkaloids. Raw sample was highest in water-soluble vitamins while the sauce was highest in β-carotene (339.72µg/100g). Cooking the leaf to soup and sauce significantly increased the mineral content of the products (P<0.05) with reduction in water-soluble vitamins and phytochemicals (P<0.05). The sensory attributes of the soup and sauce were generally acceptable to the panelists, with the sauce being more acceptable. The leaf and its products were rich in essential minerals, vitamins and phytochemicals. The sauce retained more nutrients compared to other samples. Inclusion of this underutilised vegetable in diets will reduce micronutrient malnutrition, promote dietary diversity, good health and wellness.
Jan 2019 DOI 10.14302/issn.2691-5014.jphn-18-2456
Vitamin D, the sunshine vitamin, is now recognized not only for its importance in promoting bone health in children and adults, but also for its other health benefits, including reducing the risk of chronic diseases such as autoimmune diseases, common cancer, and cardiovascular diseases. Ultraviolet radiation of the sun with wavelengths of 290-310 nm penetrates into the skin and converts 7-dehydrocholesterol to previtamin D3, which quickly transforms to vitamin D3. Vitamin D (D represents either D2 or D3) made in the skin or ingested through diet is biologically inert and requires two successive hydroxylations first in the liver on carbon 25 to form 25-hydroxyvitamin D 25(OH)D and then in the kidney for a hydroxylation on carbon 1 to form the biologically active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)2D) 121419. The concentration of the produced 25-hydroxy vitamin D in blood circulation is 1,000 times more than 1,25-dihydroxy vitamin D 4, and it is regarded as a standard indicator of vitamin D status in humans 3. 25-hydroxy vitamin D half-life is about 2-3 weeks and it is regulated by calcium (Ca), phosphorus (P), and serum parathyroid hormone (PTH) to some extent. 25-hydroxy vitamin D content also reflects the amount of vitamin D produced in the skin after exposure to sunlight or received through food intake 56. Guidelines for vitamin D insufficiency/deficiency defined by serum 25(OH)D concentrations have been published from many countries and regions all over the world 7891011. Vitamin D deficiency is a pandemic problem. According to global estimations, more than one billion people around the world suffer from vitamin D deficiency. Among Iranian population, the incidence of vitamin D deficiency varies from 2.5 to 98.5% based on geographic area 1213. Various factors may give rise to vitamin D deficiency, including skin pigments, low levels of vitamin D in diet (insufficient fish oil and egg yolk intake), malnutrition, genetic factors, exclusive breast feeding, vitamin D deficiency of mother during pregnancy, prematurity, chronic use of drugs (e.g., anticonvulsants, aluminum-containing anti-acids, rifampcin, isoniazid, antifungal drugs, antiviral drugs, and glucocorticoids), winter and obesity 113. Cultural habits, the need for full body coverage during outdoor activities and the lack of sunlight programs are the risk factors for low vitamin D levels in women 151617. Children enter foster care due to early childhood adverse experiences such as poor prenatal and infant health care, food insecurity, chronic stress, and the effects of abuse and neglect. As a result, they are at higher risk for poor physical, psychological, neuroendocrine and neurocognitive outcomes compared to others. Foster children are at risk for growth and nutritional deficiencies due to their poor nutritional environment prior to placement in foster care. Insufficient caloric intake results in growth deficiencies. Evidence showed that the risk of stunting and underweight is high in this population 18. The risk of developing hypovitaminosis D was significantly higher in children living in foster homes. One reason is that they are at higher risk of child abuse, emotional deprivation and physical neglect than children living with their families. Moreover, these children most likely do not spend much time outdoors and they lack adequate sun exposure. Another reason is that as children grow up in institutional care, they shift from a diet of vitamin D–fortified formula milk to cooked food, which may not be fortified with vitamin D 1. Iranian government has made some efforts to apply efficient interventions to reduce the prevalence of vitamin D deficiency, and the country’s healthcare system should be managed through accurate planning. Yet, in this country, studies on vitamin D deficiency in children living in foster homes are very limited, and given that timely diagnosis and treatment of this deficiency is vital, this research is conducted in Ali Asghar foster home in Mashhad, Iran.
Dec 2018 DOI 10.14302/issn.2381-862X.jwrh-18-2459
The objective of the study was to investigate the effect of Consciousness Energy Healing based DMEM medium on the level of alkaline phosphatase enzyme (ALP) activity in Ishikawa cells. The test item, DMEM medium was divided into two parts. One part of the test item received Consciousness Energy Healing Treatment by a renowned Biofield Energy Healer, Mahendra Kumar Trivedi and was labeled as the Biofield Energy Treated DMEM, while the other part did not receive any treatment, and defined as the untreated DMEM group. The cell viability using MTT assay of the Biofield Energy Treated DMEM group was observed as 108%, which indicated that the test item was safe and non-toxic. The estrogenic potential using ALP level showed a significantly increase by 73.21% in the Biofield Energy Treated DMEM group as compared to the untreated DMEM group. Overall, the experimental data suggested that the Biofield Energy Treated DMEM has significantly improved ALP level, which play a vital role for the promotion and maintenance of estrogen level. Based on the study outcomes, it is concluded that Biofield Energy Healing Treatment showed a significant improved ALP level, which can be used in various estrogenic disorders such as hypophosphatasia, osteoporosis, severe anemia, malnutrition, hypothyroidism, magnesium deficiency, heart surgery, aplastic anemia, chronic myelogenous leukemia, enteritis in children, Wilson’s disease, pernicious anemia, bacterial infection and intrauterine infection is a leading cause of pelvic inflammatory disease, subfertility, infertility, endometritis, early pregnancy loss, fetal defects, and preterm birth.
Nov 2017 DOI 10.14302/issn.2641-5526.jmid-17-1762
Despite widespread use of Geographic Information System (GIS) technology to strengthening health systems, the application of GIS to health systems strengthening in resource-poor Sub-Saharan Africa remains rare. Over the June 2012 to December 2013 period, the Ghana Health Service (GHS) conducted a pilot application of GIS to health systems development in one rural impoverished district of the Upper East Region (UER). Workers were deployed to gather coordinates of health care facilities throughout the UER. Coordinates were linked to routine health information data, and utilized to generate maps for guiding task prioritization. For example, geocoded Community-based Management of Severe Acute Malnutrition (CMAM) program data were used to target services in communities where the prevalence of childhood acute malnutrition was relatively high. GIS was pivotal in tracking and responding to infectious disease morbidity from causes such as diarrheal diseases and tuberculosis. UER Regional Health Administration (RHA) authorities are currently utilizing GIS to map antenatal care coverage, skilled birth deliveries, neonatal mortality, still births, family planning service caseloads as well as for targeting programmatic action. Experience emerging from this trial attests to the value of GIS in contributing to efforts to strengthen health systems in rural impoverished regions of Africa.
Jun 2016 DOI 10.14302/issn.2329-9487.jhc-15-905
Backgroud: Metabolic acidosis, a common condition particularly in end stage renal disease patients, results in malnutrition and inflammation. In this study, we focused on the importance of metabolic acidosis on manifestations of cardiovascular disease in patients on peritoneal dialysis. Methods: We studied 20 patients on continuous ambulatory peritoneal dialysis (CAPD), 15 males and 5 females, on mean age 61.6 ±11.3 years old. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22mmol/L, which were measured in gas machine. Dialysis adequacy was defined by total Kt/V/week for urea including peritoneal Kt/V for urea and residual GFR (ml/min/1.73m2). High sensitivity C-reactive protein (hsCRP) was measured using enzyme linked immunoabsorbed assay (ΕLISA). The concentrations of intact-parathormone (i-PTH) and beta2-microglobulin (beta2M) were measured by radioimmunoassays. Arterial stiffness was measured as carotid-femoral pulse wave velocity (c-f PWV) and augmentation index (AIx). We built a Cox regression analysis to predict coronary artery disease (CAD), congestive heart failure (CHF) and peripheral vascular disease (PVD). Results: Serum bicarbonate levels were inversely associated to beta2M, i-PTH and AIx (r=-0.451, p=0.04, r=-0.477, p=0.03 and r=-0.569, p=0.009 respectively). Cox- regression analysis revealed significant association of serum bicarbonate levels and PVD having as confounders traditional and specific for these patients risk factors. Conclusion: Metabolic acidosis may be an independent risk factor for arterial stiffening and peripheral vascular disease manifestation in patients on peritoneal dialysis.