The current project aims to deliver a complementary food supplement (Koko Plus) to infants and young children in three districts in Eastern Ghana. We completed a spatially representative survey, using the Simple Spatial Survey Method (S3M) design, two months into the project with the aim of assessing coverage and barriers to coverage early in the program cycle. The S3M approach allowed for fine scale geographical coverage maps and wide-area population-level estimates to be produced. The data presented here are from an S3M sample with d = 8km (i.e. no person lived more than 8 km from a sampling point). A variable geometry sample design was used. This allowed a mixed urban, peri-urban, and rural sample to be taken with a spatial resolution that matched population density. The sample was taken from m = 58 PSUs spread over three administrative districts. The data reported are for n = 971 mother / child pairs in the sample (n = 671 in the 6 - 24 month target group for consumption of the supplement). Overall 64% (95% CI, 58 - 71%), 23% (95% CI, 19 - 27%), and 15% (95% CI, 12% - 19%) of the target group had ever heard of the supplement, ever used the supplement, and used the supplement at least once in the week prior to the survey respectively. These indicators are mapped in Figure 1. The two main reasons for non-consumption in the target group were caregivers' lack of awareness of the product (61%), and perceived lack of need for the product (14%). These results were reported back to the program within two weeks of survey completion to provide a quick feedback loop to guide programming efforts. Grant Funding Source: Study sponsor: USAID
Multiple-micronutrient (MMN) fortification of beverages may be an effective option to deliver micronutrients to vulnerable populations. The aim of the present systematic review and meta-analysis is to evaluate the nutritional impacts of MMN fortified beverages in the context of low-middle income countries. A systematic search of published literature yielded 1022 citations, of which 10 randomized controlled trials (nine in school-aged children and one in pregnant women) met inclusion criteria. Results of school-aged children were included in the meta-analysis. Compared to iso-caloric controls, children who received MMN fortified beverages for 8 weeks to 6 months showed significant improvements in hemoglobin (+2.76 g/L, 95% CI [1.19, 4.33], p = 0.004; 8 studies) and serum ferritin (+15.42 pmol/L, [5.73, 25.12], p = 0.007; 8 studies); and reduced risk of anemia (RR 0.58 [0.29, 0.88], p = 0.005; 6 studies), iron deficiency (RR 0.34 [0.21, 0.55], p = 0.002; 7 studies), and iron deficiency anemia (RR 0.17 [0.06, 0.53], p = 0.02; 3 studies). MMN fortified beverage interventions could have major programmatic implications for reducing the burden of anemia and iron deficiency in school-aged children in low-middle income countries. Additional research is needed to investigate effects on other biochemical outcomes and population subgroups.
Objectives: To develop and operationalize a survey tool that can be used by nutrition programmers to assess and classify coverage and consumption patterns in targeted (point-of-use) and large-scale (staple) fortification programs.Methods: We focused on developing a tool that is low-cost, and rapid for programs to implement, analyze, and assess coverage and barriers to coverage during the program cycle.Indicators were adapted from validated guidelines, and subject matter experts were consulted.We emphasize simple spatial survey (S3M) methods, which allow for fine scale geographical coverage maps and wide-area population-level estimates to be produced.The FACT tool can also be implemented using cluster survey methods.Results: A pilot FACT survey using S3M methods was first undertaken in three administrative districts in Ghana to refine the survey methods and instruments.Results were reported back to the program within two weeks of survey completion to provide a quick feedback loop to guide programming efforts.Subsequent implementation of the FACT tool has been applied to a statewide S3M survey in Rajasthan, India, and National cluster survey in Senegal. Conclusions:We have developed and operationalized a tool that can be applied to coverage assessments of targeted and large-scale fortification programs.Further surveys assessing coverage in programs supported by The Global Alliance for Improved Nutrition (GAIN) programs Conference
Over a third of all deaths of children under the age of five are linked to undernutrition. At a 90% coverage level, a core group of ten interventions inclusive of infant and young child nutrition could save one million lives of children under 5 y of age (15% of all deaths) (Lancet 2013). The infant and young child nutrition package alone could save over 220,000 lives in children under 5 y of age. High quality proteins (e.g. milk) in complementary, supplementary and rehabilitation food products have been found to be effective for good growth. Individual amino acids such as lysine and arginine have been found to be factors linked to growth hormone release in young children via the somatotropic axis and high intakes are inversely associated with fat mass index in pre-pubertal lean girls. Protein intake in early life is positively associated with height and weight at 10 y of age. This paper will focus on examining the role of protein and amino acids in infant and young child nutrition by examining protein and amino acid needs in early life and the subsequent relationship with stunting.
This study evaluated the effects of a multi-micronutrient fortified juice drink given in different frequencies of consumption on hemoglobin (Hb) concentration of schoolchildren. Hb was measured in 2423 schoolchildren aged 6- to 9-years-old at baseline. All anemic children (
There is a need to further understand the relationship between inflammation and nutrition biomarkers and refine the relative contribution of nutritional and other risk factors for anemia across settings. The CDC, GAIN, and NICHD formed a collaborative research group called Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia (BRINDA). We identified data from nationally and regionally representative surveys that included preschool children (PSC, 6–59 mo), school‐age children (SAC, 5–14 yr) and women of reproductive age (WRA, 15–49 yr) that at minimum measured hemoglobin, inflammation (C‐reactive protein and/or alpha1‐acid glycoprotein), and iron status. Of 23 datasets identified, permission to date was received for 15. Individual country and aggregated analyses will be performed. Priority research topics generated include: 1) association among inflammation, anemia, iron, and vitamin A, as well as and approaches to account for the effect to adjust for the effects of inflammation on nutrient interpretation; and 2) risk factors and their relative contribution to anemia. BRINDA results will inform guidelines on the measurement and interpretation of anemia and micronutrients. Findings will also guide the development of a research agenda for future longitudinal studies. Research support: Bill & Melinda Gates Foundation, CDC, GAIN, NICHD
Iron deficiency anemia (IDA) is a major public health problem in sub-Saharan Africa. The efficacy of iron fortification against IDA is uncertain in malaria-endemic settings. The objective of this study was to evaluate the efficacy of a complementary food (CF) fortified with sodium iron EDTA (NaFeEDTA) plus either ferrous fumarate (FeFum) or ferric pyrophosphate (FePP) to combat IDA in preschool-age children in a highly malaria endemic region. This is a secondary analysis of a nine-month cluster-randomized controlled trial conducted in south-central Côte d'Ivoire. 378 children aged 12-36 months were randomly assigned to no food intervention (n = 125; control group), CF fortified with 2 mg NaFeEDTA plus 3.8 mg FeFum for six days/week (n = 126; FeFum group), and CF fortified with 2 mg NaFeEDTA and 3.8 mg FePP for six days/week (n = 127; FePP group). The outcome measures were hemoglobin (Hb), plasma ferritin (PF), iron deficiency (PF < 30 μg/L), and anemia (Hb < 11.0 g/dL). Data were analyzed with random-effect models and PF was adjusted for inflammation. The prevalence of Plasmodium falciparum infection and inflammation during the study were 44-66%, and 57-76%, respectively. There was a significant time by treatment interaction on IDA (p = 0.028) and a borderline significant time by treatment interaction on iron deficiency with or without anemia (p = 0.068). IDA prevalence sharply decreased in the FeFum (32.8% to 1.2%, p < 0.001) and FePP group (23.6% to 3.4%, p < 0.001). However, there was no significant time by treatment interaction on Hb or total anemia. These data indicate that, despite the high endemicity of malaria and elevated inflammation biomarkers (C-reactive protein or α-1-acid-glycoprotein), IDA was markedly reduced by provision of iron fortified CF to preschool-age children for 9 months, with no significant differences between a combination of NaFeEDTA with FeFum or NaFeEDTA with FePP. However, there was no overall effect on anemia, suggesting most of the anemia in this setting is not due to ID. This trial is registered at clinicaltrials.gov (NCT01634945).
In the context of lower‐income countries, fortification has mostly focused on centrally processed foods and condiments. Less information is available about the overall impacts of beverage fortification. Multiple PubMed searches were conducted to identify relevant studies. A total of 992 citations were screened, of which 10 randomized controlled trials were included in the review (pooled n = 4645). Compared to iso‐caloric controls, children who received MMN beverages for 8 weeks to 6 months showed significant improvements in hemoglobin (+2.76 g/L, 95% CI [1.19, 4.33], p = 0.004; 8 studies) and serum ferritin (+15.42 pmol/L, [5.73, 25.12], p = 0.007; 8 studies). Consumption of fortified beverages significantly reduced the risk of anemia (RR 0.58 [0.29, 0.88], p = 0.005; 6 studies), iron deficiency (RR 0.34 [0.21, 0.55], p = 0.002; 7 studies), and iron deficiency anemia (RR 0.17 [0.06, 0.53], p = 0.02; n = 3). No significant effects were found for serum retinol (5 studies), zinc (4 studies), or vitamin B12 (3 studies). Although the number of data points precluded meta‐analysis, several studies found favorable effects of beverage fortification on riboflavin (n = 2), folate (n = 2), vitamin B6 (n = 1), vitamin C (n = 2), thiamin (n = 1), and urinary iodide (n = 1). Weight gains were modestly but significantly greater in the intervention compared with the control groups (+0.30 kg [0.01, 0.58], p =0.04; 6 studies), while neither height gains nor weight‐for‐age nor height‐for‐age Z‐scores differed significantly between groups (5, 4, and 3 studies respectively). MMN beverage interventions are effective at reducing the risk of anemia and iron deficiency in school age children. Grant Funding Source : The Coca‐Cola Company. The funding source had no role in the work
