Archive for October, 2019

Uzbekistan Nutrition Survey Report 2017

Ministry of Health-Uzbekistan, UNICEF, GroundWork

October 2019 – Report Release, Tashkent, Uzbekistan

The 2017 Uzbekistan Nutrition Survey (UNS) is national nutrition and micronutrient survey that collected data on anemia and micronutrient deficiencies (i.e. iron, vitamin A, folate, vitamin B12, iodine) in children 6-59 months of age, and non-pregnant women 15-49 years of age, and pregnant women. The UNS also collected anthropometric measurements to estimate the prevalence of stunting and wasting in children, and overweight and obesity in non-pregnant women. The information collected by the UNS will enable the government and international agencies to monitor the current status of national nutrition programs (e.g. wheat fortification and salt iodization) and to plan future nutrition and health interventions. The UNS was conducted by the Ministry of Health, UNICEF, and GroundWork.

Hepcidin-guided screen-and-treat interventions against iron-defciency anaemia in pregnancy: a randomised controlled trial in The Gambia

Bah A, Muhammad AK, Wegmüller R, Verhoef H, Goheen MM, Sanyang S, Danso E, Sise EA, Pasricha SR, Armitage AE, Drakesmith H, Cross JH, Moore SE, Cerami C, Prentice AM

October 2019 – Lancet Global Health

WHO recommends daily iron supplementation for pregnant women, but adherence is poor because of side-effects, effectiveness is low, and there are concerns about possible harm. The iron-regulatory hormone hepcidin can signal when an individual is ready-and-safe to receive iron. We tested whether a hepcidin-guided screen-and-treat approach to combat iron-deficiency anaemia could achieve equivalent efficacy to universal administration, but with lower exposure to iron. We did a three-arm, randomised, double-blind, non-inferiority trial in 19 rural communities in the The Gambia among pregnant women aged 18–45 years at between 14 and 22 weeks of gestation. Women were randomly allocated women to either WHO’s recommended regimen, a 60 mg screen-and-treat approach, or a 30 mg screen-and-treat approach. Compared with WHO’s recommended regimen, the two screen-and-treat approaches did not result in significantly different hemoglobin concentrations. The hepcidin-guided screen-and-treat approaches had no advantages over WHO’s recommended regimen in terms of adherence, side-effects, or safety outcomes. Our results suggest that the current WHO policy for iron administration to pregnant women should remain unchanged while more effective approaches continue to be sought.

Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia

Tumilowicz A, Habicht JP, Mbuya MNN, Beal T, Ntozini R, Rohner F, Pelto GH, Fisseha T, Haidar J, Assefa N, Wodajo HY, Wolde TT, Neufeld LM

October 2019 – Maternal & Child Nutrition

A theory‐driven evaluation was conducted to assess performance of a trial to deliver micronutrient powder (MNP) through the Ethiopian Ministry of Health. We adapted an approach to coverage assessment, originally developed to identify bottlenecks in health service delivery, to examine sequential program outcomes and their correlates using cross‐sectional survey data of caregivers of children 6–23 months (N = 1915). Separate multivariable Poisson regression models were used to estimate adjusted risk ratios of conceptually relevant determinants of coverage and adherence. Caregivers of children >11 months were more likely to have received MNP than caregivers of younger infants, yet children 12–17 months were 32% (P < 0.001) and children 18–23 months 38% (P < 0.001) less likely to have been fed MNP in the 14 days preceding the survey than children 6–11 months. Among caregivers who initiated feeding MNP, the most frequently reported reasons for discontinuing use were not obtaining additional supply (36.1%) and perceived child rejection of food with MNP (22.9%). For each additional time a caregiver met with frontline workers in the 3 months preceding the survey, they were 13% more likely to have recently fed MNP (P < 0.001). Caregivers' perception that MNP produced positive changes in children was associated with a 14% increase in the likelihood of having recently fed it (P < 0.001). These results emphasize the importance of counselling for MNP and infant and young child feeding for initial use and the importance of multiple contacts with frontline workers for continued use.

Micronutrient Deficiencies, Nutritional Status and the Determinants of Anemia in Children 0–59 Months of Age and Non-Pregnant Women of Reproductive Age in The Gambia

Petry N, Jallow B, Sawo Y, Darboe MK, Barrow S, Sarr A, Ceesay PO, Fofana MN, Prentice AM, Wegmüller R, Rohner F, Phall MC, and Wirth JP

September 2019 – Nutrients

Data on micronutrient deficiency prevalence, nutrition status, and risk factors of anemia in The Gambia is scanty. To fill this data gap, a nationally representative cross-sectional survey was conducted on 1354 children (0–59 months), 1703 non-pregnant women (NPW; 15–49 years), and 158 pregnant women (PW). The survey assessed the prevalence of under and overnutrition, anemia, iron deficiency (ID), iron deficiency anemia (IDA), vitamin A deficiency (VAD), and urinary iodine concentration (UIC). Multivariate analysis was used to assess risk factors of anemia. Among children, prevalence of anemia, ID, IDA, and VAD was 50.4%, 59.0%, 38.2%, and 18.3%, respectively. Nearly 40% of anemia was attributable to ID. Prevalence of stunting, underweight, wasting, and small head circumference was 15.7%, 10.6%, 5.8%, and 7.4%, respectively. Among NPW, prevalence of anemia, ID, IDA and VAD was 50.9%, 41.4%, 28.0% and 1.8%, respectively. Anemia was significantly associated with ID and vitamin A insufficiency. Median UIC in NPW and PW was 143.1 µg/L and 113.5 ug/L, respectively. Overall, 18.3% of NPW were overweight, 11.1% obese, and 15.4% underweight. Anemia is mainly caused by ID and poses a severe public health problem. To tackle both anemia and ID, programs such as fortification or supplementation should be intensified.

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