Archive for March, 2019

Respiratory infections drive hepcidin-mediated blockade of iron absorption leading to iron deficiency anemia in African children

Prentice AM, Bah A, Jallow MW, Jallow AT, Sanyang S, Sise EA, Ceesay K, Danso E, Armitage AE, Pasricha S, Drakesmith H, Wathuo M, Kessler N, Cerami C, Wegmuller R

March 2019 – Science Advances

Iron deficiency anemia (IDA) is the most prevalent nutritional condition worldwide. We studied the contribution of hepcidin-mediated iron blockade to IDA in African children. We measured hepcidin and hemoglobin weekly, and hematological, inflammatory, and iron biomarkers at baseline, 7 weeks, and 12 weeks in 407 anemic (hemoglobin < 11 g/dL), otherwise healthy Gambian children (6 to 27 months). Each child maintained remarkably constant hepcidin levels (P < 0.0001 for between-child variance), with half consistently maintaining levels that indicate physiological blockade of iron absorption. Hepcidin was strongly predicted by nurse-ascribed adverse events with dominant signals from respiratory infections and fevers (all P < 0.0001). Diarrhea and fecal calprotectin were not associated with hepcidin. In multivariate analysis, C-reactive protein was the dominant predictor of hepcidin and contributed to iron blockade even at very low levels. We conclude that even low-grade inflammation, especially associated with respiratory infections, contributes to IDA in African children.

The Gambia Micronutrient Survey 2018

National Nutrition Agency (NaNA)-Gambia, UNICEF, Gambia Bureau of Statistics (GBOS), GroundWork

March 2019 – Report Release, Banjul, The Gambia

The 2018 Gambia Micronutrient Survey (GMNS) is national and comprehensive micronutrient survey that was implemented in tandem with The Gambia’s 2018 Multiple Indicator Cluster Survey (MICS). The GMNS collected data on micronutrient deficiencies, anemia, and malaria in children 6-59 months of age, and non-pregnant women 15-49 years of age, and pregnant women. The GMNS also measured the prevalence of diet-related non-communicable diseases and conditions in non-pregnant women (e.g. overweight, obesity, diabetes, hypertension) and stunting, wasting, and underweight in children. The information generated by the GMNS will enable the government and international agencies to enhance existing national programs, such as vitamin A supplementation, and commercial fortification of wheat flour, rice, and vegetable oil. In addition, GMNS results will help nutrition stakeholders in The Gambia plan future nutrition and health interventions, in particular related to the double burden of malnutrition. The GMNS was conducted by the Gambia’s National Nutrition Agency (NaNA), UNICEF, GBOS, and GroundWork.

Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review

Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmuller R, Dary O, & the HEmoglobin MEasurement (HEME) Working Group

February 2019 – Annals of the New York Academy of Sciences

Anemia affects over 800 million women and children globally. Defined as a limited or insufficient functional red blood cell supply in peripheral blood, anemia causes a reduced oxygen supply to tissues and can have serious health consequences for women and children. Hemoglobin (Hb) concentration is most commonly measured for anemia diagnosis. Methods to measure Hb are usually invasive (requiring a blood sample); however, advances in diagnostic and clinical chemistry over the past decade have led to the development of new noninvasive methods. Accurate diagnosis at the individual level is important to identify individuals who require treatment. At the population level, anemia prevalence estimates are often the impetus for national nutrition policies or programs. Thus, it is essential that methods for Hb measurement are sensitive, specific, accurate, and reproducible. The objective of our narrative review is to describe the basic principles, advantages, limitations, and quality control issues related to methods of Hb measurement in clinical and field settings. We also discuss other biomarkers and tests that can help to determine the severity and underlying causes of anemia. In conclusion, there are many established and emerging methods to measure Hb concentration, each with their own advantages, limitations, and factors to consider before use.

Consensus building around nutrition lessons from the 2014 – 16 Ebola virus disease outbreak in Guinea and Sierra Leone

Kodish SR, Simen-Kapeu A, Beauliere JM, Ngnie-Teta I, Jalloh MB, Pyne-Bailey S, Schwartz H, Wirth JP

February 2019 – Health Policy and Planning

To understand the nutrition challenges faced during the Ebola virus disease outbreak in West Africa, participatory workshops in Guinea and Sierra Leone were conducted in February 2017. Workshops followed the Nominal Group Technique, which is a methodological approach for idea generation and consensus building among diverse participants. Those findings were triangulated with qualitative interview data from participants representing government, United Nations bodies, civil society, nongovernmental organizations and local communities in both Guinea and Sierra Leone. In both countries, this research identified five key nutrition challenges, including reduced access and utilization of the health system, poor caretaking and infant and young child feeding practices, implementation challenges during nutrition response, household food insecurity and changing breastfeeding practices. (2) In Sierra Leone, organizational factors that facilitated this response included the use of standard operating procedures and psychosocial counselling. In contrast, in Guinea, hygiene assistance was distinctly important. Political will, Increased funding, food assistance and to a lesser extent, enhanced coordination, were deemed ‘most important’ response factors. Disease outbreaks pose widespread nutrition challenges to populations in resource-constrained settings where global health security is not a guarantee. These findings should be considered for emergency nutrition preparedness and inform evidence-based priority setting in the post-Ebola virus context of Guinea and Sierra Leone.

Jordan National Micronutrient & Nutrition Survey (JNMNS 2019)

Project Ongoing

In collaboration with the Jordan Health Aid Society-International (JHASi), GroundWork is conducting the Jordan National Micronutrient and Nutrition Survey (JNMNS 2019), a national micronutrient and nutrition survey that is being implemented in all governorates of Jordan and in Syrian refugee camps. The survey is funded by UNICEF and WFP, and is supported by the Ministry of Health (MOH) and the Department of Statistic in Jordan. Key collaborators of the JNMNS also include BioLabs, the American University of Beirut (AUB), and the University of Wisconsin. With guidance from MOH, GroundWork and JHASi are leading the planning of the survey, organizing for field and laboratory logistics, data entry and analysis, and reporting and dissemination.