All posts by webadm1ngroundw0rk

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.

Growth Status, Inflammation, and Enteropathy in Young Children in Northern Tanzania

Wirth JP, Kitilya B, Petry N, PrayGod G, Veryser S, Mngara J, Zwahlen C, Wieringa F, Berger J, de Onis M, Rohner F and Becquey E

November 2018 – The American Journal of Tropical Medicine and Hygiene

Recent evidence suggests that enteropathy of the gut due to environmental conditions (i.e., environmental enteropathy [EE]) in young children is negatively associated with linear growth. Using a case–control study design, we examined the potential determinants of stunting in stunted and non-stunted children 22–28 months of age. Potential determinants included inflammation biomarkers C-reactive protein, alpha-1-acid glycoprotein (AGP), and endotoxin-core antibody (EndoCAb) measured in serum samples; enteropathy markers alpha-1-antitrypsin, neopterin, myeloperoxidase (MPO) measured in stools samples; and demographic, health, feeding, and household characteristics. We also explored the determinants of EE by testing associations of composite EE scores and individual biomarkers with potential risk factors. Fifty-two percent of children (n = 310) were found to be stunted, and mean height-for-age Z scores (HAZ) were −1.22 (SD ± 0.56) among non-stunted (control) children and −2.82 (SD ± 0.61) among stunted (case) children. Child HAZ was significantly (P < 0.05) and inversely associated with AGP, and child stunting was significantly associated (P < 0.05) with low dietary diversity, severe household hunger, and absence of soap in the household. Alpha-1-acid glycoprotein and EndoCAb concentrations were also significantly higher (P < 0.05) among children in households with no soap. Our study documented a seemingly localized cultural practice of young children (25%) being fed their dirty bathwater, which was associated with significantly higher concentrations of MPO (P < 0.05).

Micronutrient Deficiencies, Over- and Undernutrition, and Their Contribution to Anemia in Azerbaijani Preschool Children and Non-Pregnant Women of Reproductive Age

Wirth JP, Rajabov T, Petry N, Woodruff BA, Shafique NB, Mustafa R, Tyler VQ, Rohner F

October 2018 – Nutrients

A nationally representative cross-sectional survey was conducted to assess the prevalence of micronutrient deficiencies, over- and undernutrition, and to disentangle determinants of anemia in children and women in Azerbaijan. The survey generated estimates of micronutrient deficiency and growth indicators for children aged 0–59 months of age (6–59 months for blood biomarkers) and non-pregnant women 15–49 years of age. In total, 3926 household interviews were successfully completed with a response rate of 80.6%. In the 1455 children, the prevalence of wasting and stunting were 3.1% and 18.0%, respectively; and 14.1% of children were overweight or obese. In children, the prevalence of anemia, iron deficiency, and iron deficiency anemia was 24.2%, 15.0%, and 6.5%, respectively. Vitamin A and zinc deficiencies were found in 8.0% and 10.7% of children. Data from 3089 non-pregnant women showed that while undernutrition was scarce, 53% were overweight or obese, with increasing prevalence with increasing age. Anemia affected 38.2% of the women, iron deficiency 34.1% and iron deficiency anemia 23.8%. Vitamin A insufficiency was found in 10.5% of women. Folate and vitamin B12 deficiency were somewhat more common, with prevalence rates of 35.0% and 19.7%, respectively. The main risk factors for anemia in children were recent lower respiratory infection, inflammation and iron deficiency. In women, the main risk factors for anemia were iron deficiency and vitamin A insufficiency. Anemia is a public health problem in Azerbaijani children and women, and additional efforts are needed to reduce anemia in both groups.

Implications of the Ebola virus disease outbreak in Guinea: Qualitative findings to inform future health and nutrition-related responses

Kodish SR, Rohner F, Beaulière JM, Mamady D, Ayoya MA, Wirth JP, Ngnie-Teta I

August 2018 – PLOS ONE

Due to the close relationship between EVD and nutrition, the humanitarian community implemented various nutrition-specific and -sensitive interventions to stem the Ebola Virus Disease (EVD) outbreak in West Africa. To understand stakeholder and community members’ perspectives toward this response in Guinea, we aimed to firstly understand how EVD may have influenced the nutrition situation; and secondly to assess the perceived acceptability and effectiveness of the nutrition response. Using 27 in-depth interviews conducted in April and May 2016, this descriptive, qualitative study had three iterative phases in an emergent design. Overall, several plausible pathways through an interrelated network of bio-social factors help describe EVD impacts on the nutrition situation of Guinea. At a basic level, complex social dimensions of health, response unpreparedness, and market disruptions were perceived to be major determinants affecting the nutrition situation, especially among IYC. At an underlying level, household food security was negatively impacted, along with weakened care-seeking practices, IYC feeding practices, and coping strategies. Consequently, treatment coverage for childhood illnesses and IYC diets were negatively impacted during the outbreak. In hindsight, most participants had positive perceptions toward the overall EVD response, but described salient considerations for improving upon this nutrition response during future outbreaks.

Ghana Micronutrient Survey Report

University of Ghana, GroundWork, University of Wisconsin, KEMRI-Wellcome Trust, & UNICEF

June 2018 – Report Release, Accra, Ghana

The 2017 Ghana Micronutrient Survey (GMS) is national and comprehensive micronutrient survey that collected data on micronutrient deficiencies, anemia, malaria, and blood disorders (e.g. sickle cell, alpha-thalassemia) in children 6-59 months of age, and non-pregnant women 15-49 years of age, and pregnant women. The GMS 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 GMS will enable the government and international agencies to monitor the current status of national nutrition programs (e.g. wheat and vegetable oil fortification and vitamin A supplementation) and to plan future nutrition and health interventions. The GMS was conducted by the University of Ghana and GroundWork and their nutrition partners (e.g. University of Wisconsin, Kemri-Wellcome Trust, UNICEF, Ghana Health Service, and others). Funding was provided by UNICEF and the Canadian Government.

Affordable Nutritious Food for Women (ANF4W) product availability and consumption study

GroundWork, University of Ghana

March 2018 – Report Release, Accra, Ghana

Women of reproductive age, particularly during pregnancy and lactation, have increased nutrient needs and are therefore more vulnerable to nutritional deficiencies. In Ghana, despite two decades of sustained economic growth and reductions in some forms of malnutrition, progress on eliminating micronutrient deficiency has been slow. The “Affordable Nutritious Foods for Women” (ANF4W) program thus aimed to increase the local supply of and demand for affordable nutritious foods for women of reproductive age in developing countries. The ANF4W evaluation included two cross‐sectional surveys, and this report presents the situation after a 6 months branded and unbranded marketing campaign, which followed the product launch in March 2017.