Journal of Health, Population and Nutrition

Nutritional Disparities among Women in Urban India

2014-08-18T02:37:25+00:00

The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/ severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8 times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%). The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes, (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20052

J HEALTH POPUL NUTR 2013 Dec; 31(4): 531-537

Recurrent Sclerema in a Young Infant Presenting with Severe Sepsis and Severe Pneumonia: An Uncommon but Extremely Life-threatening Condition

2014-08-18T02:37:25+00:00

A one month and twenty-five days old baby girl with problems of acute watery diarrhoea, severe dehydration, severe malnutrition, and reduced activity was admitted to the gastrointestinal unit of Dhaka Hospital of icddr,b. The differentials included dehydration, dyselectrolytaemia and severe sepsis. She was treated following the protocolized management guidelines of the hospital. However, within the next 24 hours, the patient deteriorated with additional problems of severe sepsis, severe pneumonia, hypoxaemia, ileus, and sclerema. She was transferred to the Intensive Care Unit (ICU). In the ICU, she was managed with oxygen supplementation, intravenous antibiotics, intravenous fluid, including a number of blood transfusions, vitamins, minerals, and diet. One month prior to this admission, she had been admitted to the ICU also with sclerema, septic shock, and urinary tract infection due to Escherichia coli and was discharged after full recovery. On both the occasions, she required repeated blood transfusions and aggressive antibiotic therapy in addition to appropriate fluid therapy and oxygen supplementation. She fully recovered from severe sepsis, severe malnutrition, ileus, sclerema, and pneumonia, both clinically and radiologically and was discharged two weeks after admission. Consecutive episodes of sclerema, resulting in two successive hospitalizations in a severely-malnourished young septic infant, have never been reported. However, this was managed successfully with blood transfusion, broad-spectrum antibiotics, and correction of electrolyte imbalance.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20053

J HEALTH POPUL NUTR 2013 Dec; 31(4): 538-542

Prevalence of Vitamin A Deficiency in South Asia: Causes, Outcomes, and Possible Remedies

2014-08-18T02:37:25+00:00

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitots spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stern efforts are needed to address this issue of publichealth significance at local and international level in lower- and middle-income countries of South Asia.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.19975

J HEALTH POPUL NUTR 2013 Dec; 31(4): 413-423

A Qualitative Exploration of Social Contact Patterns Relevant to Airborne Infectious Diseases in Northwest Bangladesh

2014-08-18T02:37:25+00:00

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.19976

J HEALTH POPUL NUTR 2013 Dec; 31(4): 424-434

Milk and Protein Intake by Pregnant Women Affects Growth of Foetus

2014-08-18T02:37:25+00:00

The study assessed the effects of the daily intake of milk and protein by pregnant women on foetal growth and determined the growth pattern and velocity of growth. A total of 504 ultrasound observations from 156 respondents were collected following a cross-sectional design in the last trimester of pregnancy; majority of them were in the last month of pregnancy. De facto and purposive sampling was done, and direct interviews of affluent pregnant women were conducted. Kruskal-Wallis test shows that majority of the respondents had tendency to consume 155.65 to 465.17 mL of milk per day, resulting in better and higher foetal growth. Most respondents consumed about 50-70 g of protein per day, and the foetal growth measurements, such as abdomen-circumference, femur length, biparietal diameter, and head-circumference, on an average, were higher in the same group. Quadratic regression model exhibited that all the traits of growth pattern in Model 1 (low milk and protein intake) appeared to have more mode of decline, in contrast to Model 2 (more milk and protein intake), which shows better growth. In addition, velocity of growth pattern was obtained through the first derivative of quadratic regression of growth pattern. Moreover, 95% confidence interval calculated for regression line slope of Model 1 and Model 2 showed that the estimation point (2 B2) of Model 1 does not lay into 95% CI of Model 2; so, statistical significance assorted and also the same trend conversely hold for Model 2. The rate of growth was highly influenced by maternal milk and protein intake. These findings suggest that contribution of common nutrients or other nutritional factors present in milk and protein promote the growth of foetus.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.19991

J HEALTH POPUL NUTR 2013 Dec; 31(4): 435-445

Influence of Protein Intake from Haem and Non-haem Animals and Plant Origin on Inflammatory Biomarkers among Apparently-healthy Adults in Greece

2014-08-18T02:37:25+00:00

Intake of different types of protein may be associated with differences in biomarkers among various populations. This work investigated the influence of protein intake from haem and non-haem animals as well as protein from plants on haematological and biochemical parameters in inflammation among apparentlyhealthy adults living in Greece, a Mediterranean country. Four hundred and ninety apparently-healthy subjects (46±16 years, 40% men), who consecutively visited Polykliniki General Hospital for routine examinations, voluntarily agreed to participate in the study (participation rate 85%). Demographic, anthropometric and lifestyle characteristics were recorded. Participants completed a valid, semi-quantitative food frequency questionnaire. Protein intake was classified into three sources: protein from haem animals, protein from non-haem animals, and protein from plant origin. Fasting blood samples were taken from all participants; uric acid, creatinine, lipids, cystatin C, haptoglobin, haemoglobin, haematocrit, iron, ferritin, white blood cells, monocytes, platelets, and C-reactive protein were measured. Protein intake from only haem animals was associated with increased haemoglobin and haematocrit levels (p<0.05) whereas intake of protein from non-haem animals and plant origin was not associated with the investigated haematological and biochemical markers of low-grade chronic inflammation when lifestyle factors and overall dietary habits were taken into account. Intake of protein from only haem animals seems to be consistently associated with haematological markers. The confounding role of dietary habits and lifestyle variables on the tested parameters deserves further attention in future research.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.19992

J HEALTH POPUL NUTR 2013 Dec; 31(4): 446-454

Comparison of Seafood Consumption in a Group of Italian Mother-Child Pairs

2014-08-18T02:37:25+00:00

Seafood is an important component of healthful human diets. Intake of seafood is recommended both for young women and children. In fact, it is a good source of high-quality protein, low in saturated fats, and rich in essential nutrients (e.g. iodine, iron, choline, and selenium) and long-chain polyunsaturated fatty acids (LCPUFAs), especially omega-3. However, the relationship between maternal diet and the childrens dietary habits is controversial. This study investigated the possible association between the seafood consumption by mothers and that by their 8-11 years old children and compared maternal seafood intakes during pregnancy and about 10 years later. The seafood consumption by 37 pregnant women was assessed in 1999-2001. In 2009, mothers were asked to report their weekly intake and their childrens. Motherchild pairs showed a similar consumption pattern: the overall intake was 1.28±0.77 vs 1.19±0.64 (p=0.49) while the sum of specific items was 3.71±3.01 vs 3.18±2.90 (p=0.049). However, it cannot be discerned whether maternal diet affected the childrens nutritional habits or vice-versa. In fact, mothers showed to have a higher seafood intake about 10 years after pregnancy (3.71 vs 1.83; p<0.001), suggesting that a progressive modification of dietary habits occurred after delivery, possibly due to the influence of maternal diet on the nutritional habits of offspring or due to the presence of children in the family unit, that could have influenced maternal dietary habits. This dietary improvement could be brought forward through educational interventions addressed to young women, that could also allow a more informed choice of the healthier species of fish both for them and their children.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20000

J HEALTH POPUL NUTR 2013 Dec; 31(4): 455-461

Identifying Predictors of Childhood Anaemia in North-East India

2014-08-18T02:37:25+00:00

The objective of this study is to examine the factors that influence the occurrence of childhood anaemia in North-East India by exploring dataset of the Reproductive and Child Health-II Survey (RCH-II). The study population consisted of 10,137 children in the age-group of 0-6 year(s) from North-East India to explore the predictors of childhood anaemia by means of different background characteristics, such as place of residence, religion, household standard of living, literacy of mother, total children ever born to a mother, age of mother at marriage. Prevalence of anaemia among children was taken as a polytomous variable. The predicted probabilities of anaemia were established via multinomial logistic regression model. These probabilities provided the degree of assessment of the contribution of predictors in the prevalence of childhood anaemia. The mean haemoglobin concentration in children aged 0-6 year(s) was found to be 11.85 g/dL, with a standard deviation of 5.61 g/dL. The multiple logistic regression analysis showed that rural children were at greater risk of severe (OR=2.035; p=0.003) and moderate (OR=1.23; p=0.003) anaemia. All types of anaemia (severe, moderate, and mild) were more prevalent among Hindu children (OR=2.971; p=0.000), (OR=1.195; p=0.010), and (OR=1.201; p=0.011) than among children of other religions whereas moderate (OR=1.406; p=0.001) and mild (OR=1.857; p=0.000) anaemia were more prevalent among Muslim children. The fecundity of the mother was found to have significant effect on anaemia. Women with multiple children were prone to greater risk of anaemia. The multiple logistic regression analysis also confirmed that children of literate mothers were comparatively at lesser risk of severe anaemia. Mothers age at marriage had a significant effect on anaemia of their children as well.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20001

J HEALTH POPUL NUTR 2013 Dec; 31(4): 462-470

Factors Associated with Food Insecurity in Households of Public School Students of Salvador City, Bahia, Brazil

2014-08-18T02:37:25+00:00

This cross-sectional study was conducted to find out the factors associated with food insecurity (FI) in households of the students aged 6-12 years in public schools of Salvador city, Bahia, Brazil. The study included 1,101 households. Food and nutritional insecurity was measured using the Brazilian Food Insecurity Scale (BFIS). Data on socioeconomic and demographic characteristics as well as environmental and housing conditions were collected during the interviews conducted with the reference persons. Multivariate polytomous logistic regression was used in assessing factors associated with food insecurity. We detected prevalence of food insecurity in 71.3% of the households. Severe and moderate forms of FI were diagnosed in 37.1% of the households and were associated with: (i) female gender of the reference person in the households (OR 2.21, 95% CI 1.47-3.31); (ii) a monthly per-capita income below one-fourth of the minimum wage (US$ 191,73) (OR 2.63, 95% CI 1.68-4.08); (iii) number of residents per bedroom below 3 persons (OR 1.91, 95% CI 1.23-2.96); and (iv) inadequate housing conditions (OR 1.84, 95% CI 1.12-4.49). Socioeconomic inequalities determine the factors associated with FI of households in Salvador, Bahia. Identifying vulnerabilities is necessary to support public policies in reducing food insecurity in the country. The results of the present study may be used in re-evaluating strategies that may limit the inequalities in school environment.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20002

J HEALTH POPUL NUTR 2013 Dec; 31(4): 471-479

Nutritional Outcomes Related to Household Food Insecurity among Mothers in Rural Malaysia

2014-08-18T02:37:25+00:00

During the past two decades, the rates of food insecurity and obesity have risen. Although a relationship between these two seemingly-paradoxical states has not been repeatedly seen in men, research suggests that a correlation between them exists in women. This study examines nutritional outcomes of household food insecurity among mothers in rural Malaysia. A cross-sectional survey of low-income households was conducted, and 223 households with mothers aged 1855 years, who were non-lactating, non-pregnant, and had at least one child aged 212 years, were purposively selected. A questionnaire was administered that included the Radimer/Cornell Scale, items about sociodemographic characteristics, and anthropometric measurements. Of the households, 16.1% were food-secure whereas 83.9% experienced some kind of food insecurity: 29.6% of households were food-insecure, 19.3% contained individuals who were foodinsecure, and 35.0% fell into the child hunger category. The result reported that household-size, total monthly income, income per capita, and food expenditure were significant risk factors of household food insecurity. Although there was a high prevalence of overweight and obese mothers (52%) and 47.1% had at-risk waist-circumference (?80 cm), no significant association was found between food insecurity, body mass index, and waist-circumference. In conclusion, the rates of household food insecurity and overweight and obesity were high in the study population, although they are looking paradoxical. Longitudinal studies with larger sample-sizes are recommended to further examine the relationship between food insecurity and obesity.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20031

J HEALTH POPUL NUTR 2013 Dec; 31(4): 480-489

Dietary Pattern of Schoolgoing Adolescents in Urban Baroda, India

2014-08-18T02:37:25+00:00

Diet plays a very important role in growth and development of adolescents, during which the development of healthy eating habits is of supreme importance. There is a dual burden of undernutrition and overnutrition in this age-group. The study assessed the food habits, food preferences, and dietary pattern of schoolgoing urban adolescents in Baroda, India. Both quantitative and qualitative methods were used in this study. A quantitative survey was carried out using a pre-tested self-administered structured questionnaire among 1,440 students from class 6 to 12 in 7 English medium and 23 Gujarati medium schools. Focus group discussions, 5 each with adolescent boys and girls, were held, along with 5 focus group discussions with teachers of Gujarati and English medium schools. Nearly 80% of adolescents had consumed regular food, like dal, rice, chapati, and vegetables, including green leafy vegetables. Nearly 50% of them had consumed chocolates, and about one-third consumed fast foods. Nearly 60% of adolescents had their breakfast daily while the remaining missed taking breakfast daily. Nearly one-third of adolescents were missing a meal once or twice a week. A large majority had consumed regular foods. However, more than half of them had consumed chocolates, soft drinks, and over one-third had taken fast foods.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20047

J HEALTH POPUL NUTR 2013 Dec; 31(4): 490-496

Assessing the Validity and Reliability of a Questionnaire on Dietary Fibre-related Knowledge in a Turkish Student Population

2014-08-18T02:37:25+00:00

This study aimed to validate a questionnaire on dietary fibre (DF)-related knowledge in a Turkish student population. Participants (n=360) were either undergraduate students who have taken a nutrition course for 14 weeks (n=174) or those in another group who have not taken such a nutrition course (n=186). Testretest reliability, internal reliability, and construct validity of the questionnaire were determined. Overall internal reliability (Cronbachs alpha=0.90) and test-retest reliability (0.90) were high. Significant differences (p<0.001) between the scores of the two groups of students indicated that the questionnaire had satisfactory construct validity. It was found that one-fifth of the students were unsure of the correct answer for any item, and 52.5% of them were not aware that DF had to be consumed on a daily basis. Only 36.4 to 44.2% of the students were able to correctly identify the food sources of DF.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20048

J HEALTH POPUL NUTR 2013 Dec; 31(4): 497-503

Breastfeeding Twins: A Qualitative Study

2014-08-18T02:37:25+00:00

The purpose of this qualitative research was to explore the needs and difficulties of mothers who had multiple babies at Sakarya County by focusing on their breastfeeding experience. Ten mothers who gave birth to multiple infants participated in the study voluntarily. The framework method of data analysis was applied systematically both within and across cases, with categories and themes identified by reading transcripts of interviews. Major themes generated from focus narrative interviews are described. These themes are: willingness of mothers to breastfeed and continue, management of breastfeeding, use of pacifier, daily life, ?nstructions of healthcare personnel, and advices from practice of experienced mothers. This study showed that women were aware of the importance of mothers milk for their babies. They all, somehow, made intensive efforts to breastfeed their twins. Women who expect and/or have multiple babies need much more support and guidance, which may include advice for nutritional and daily care.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20049

J HEALTH POPUL NUTR 2013 Dec; 31(4): 504-509

Access and Barriers to Immunization in West Bengal, India: Quality Matters

2014-08-18T02:37:25+00:00

While many studies attempted to evaluate performance of immunization programmes in developing countries by full coverage, there is a growing awareness about the limitations of such evaluation, irrespective of the overall quality of performance. Availability of human resources, equipment, supporting drugs, and training of personnel are considered to be crucial indicators of the quality of immunization programme. Also, maintenance of time schedule has been considered crucial in the context of the quality of immunization. In addition to overall coverage of vaccination, the coverage of immunization given at right time (month-specific) is to be considered with utmost importance. In this paper, District Level Household and Facility Survey-3 (DLHS-3) 2007-2008 data have been used in exploring the quality of immunization in terms of month-specific vaccine coverage and barriers to access in West Bengal, India. In West Bengal, the month-specific coverage stands badly below 20% but the simple non-month-specific coverage is as high as 75%. Among the demand-side factors, birthplace of the child and religion of the household heads came out as significant predictors while, from the supply-side, availability of male health workers and equipment at the subcentres, were the important determinants for month-specific vaccine coverage. Hence, there should be a vigorous attempt to make more focused planning, keeping in mind the nature of the barriers, for improvement of the month-specific coverage in West Bengal.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20050

J HEALTH POPUL NUTR 2013 Dec; 31(4): 510-522

Estimation of Gestational Age, Using Neonatal Anthropometry: A Cross-sectional Study in India

2014-08-18T02:37:25+00:00

Prematurity is a significant contributor to neonatal mortality in India. Conventionally, assessment of gestational age of newborns is based on New Ballard Technique, for which a paediatric specialist is needed. Anthropometry of the newborn, especially birthweight, has been used in the past to predict the gestational age of the neonate in peripheral health facilities where a trained paediatrician is often not available. We aimed to determine if neonatal anthropometric parameters, viz. birthweight, crown heel-length, head-circumference, mid-upper arm-circumference, lower segment-length, foot-length, umbilical nipple distance, calf-circumference, intermammary distance, and hand-length, can reliably predict the gestational age. The study also aimed to derive an equation for the same. We also assessed if these neonatal anthropometric parameters had a better prediction of gestational age when used in combination compared to individual parameters. We evaluated 1,000 newborns in a cross-sectional study conducted in Guru Teg Bahadur Hospital in Delhi. Detailed anthropometric estimation of the neonates was done within 48 hours after birth, using standard techniques. Gestational age was estimated using New Ballard Scoring. Out of 1,250 consecutive neonates, 1,000 were included in the study. Of them, 800 randomly-selected newborns were used in devising the model, and the remaining 200 newborns were used in validating the final model. Quadratic regression analysis using stepwise selection was used in building the predictive model. Birthweight (R=0.72), head-circumference (R=0.60), and mid-upper arm-circumference (R=0.67) were found highly correlated with gestation. The final equation to assess gestational age was as follows: Gestational age (weeks)=5.437×W0.781×W²+2.815×HC0.041×HC²+0.285×MUAC22.745 where W=Weight, HC=Head-circumference and MUAC=Mid-upper arm-circumference; Adjusted R=0.76. On validation, the predictability of this equation is 46% (±1 week), 75.5% (+2 weeks), and 91.5% (+3 weeks). This mathematical model may be used in identifying preterm neonates.

DOI: http://dx.doi.org/10.3329/jhpn.v31i4.20051

J HEALTH POPUL NUTR 2013 Dec; 31(4): 523-530