Open Access Editorial

Open Access Conference Proceeding (Abstract)

Low-dose B Vitamins Supplementation Improves Framingham Risk Score: A Double Blind Randomized Controlled Trial in Healthy Chinese Elderly

Linlin Wang, Hongtian Li, Yuan Zhou, Lei Jin, Jianmeng Liu

European Journal of Nutrition & Food Safety, Page 310-311
DOI: 10.9734/EJNFS/2015/20825

Objectives: We investigated whether daily supplementation with low-dose B vitamins in healthy elderly improves Framingham risk score (FRS), a cardiovascular disease predictor.

Methods: A double-blind randomized controlled trial was conducted in a rural area of North China during 2007-2012. 390 healthy participants aged 60-74 were randomly allocated to receive daily vitamin C (50 mg; control) or vitamin C plus B vitamins (400 µg folic acid, 2 mg B6, and 10 µg B12) for 12 months. The outcome was FRS.

Results: Compared with control, supplementation with B vitamins reduced FRS by 3.7% (mean difference, -0.38; 95% CI -1.06, 0.31; P=0.279) at 6 months, 7.6% (-0.77; 95% CI -1.47, -0.06; P=0.033) at 12 months, but this reduction effect vanished 6 months later after stopping supplementation (-0.7%; -0.07; 95% CI -0.80, 0.66; P=0.855). The reduction in FRS at 12 months after supplementation was more pronounced in individuals with folate deficiency (11.0%; -1.38; 95% CI -2.56, -0.20; P=0.023) than those without folate deficiency (5.0%; -0.47; 95% CI -1.20, 0.26; P=0.206). B vitamins elevated high-density lipoprotein cholesterol by 3.4% (0.04 mmol/L; 95% CI -0.02, 0.10; P=0.155) at 6 months, 9.2% (0.11 mmol/L; 95% CI 0.04, 0.18; P=0.003) at 12 months; the change magnitude declined to 3.3% (0.04 mmol/L; 95% CI -0.02, 0.10; P=0.194) after stopping supplementation, compared with control.

Conclusions: Daily supplementation with low-dose B vitamins for 12 months reduced FRS, particularly in healthy elderly with folate deficiency. These reduction effects declined after stopping supplementation, indicating a need for persistent supplementation to maintain the benefits.

Open Access Conference Proceeding (Abstract)

Socio-demographic Determinants of Vitamin A Supplementation in Bangladesh: Evidences from Recent Bangladesh Demographic & Health Surveys, 2007 & 2011

Manoj Raut, Daliya Sebastian, Ananta Basudev Sahu

European Journal of Nutrition & Food Safety, Page 312-313
DOI: 10.9734/EJNFS/2015/20826

Objectives: Alarmingly, according to the Bangladesh Demographic & Health Surveys, there is an absolute decline of 24 per cent in VAS supplementation from 2007 to 2011. So, this study tries to explore the socio-demographic causes of receipt of Vitamin A in Bangladesh in 2007 and 2011.

Methods: Both Bivariate and Multivariate analyses were carried out on two recent Bangladesh Demographic & Health Surveys, 2007 and 2011 data using SAS software to explore the association between socio-demographic factors and Vitamin A supplementation.

Results: After adjusting for related socio-economic and demographic factors, parent’s education, and among mass media channels, television seems to have an important role in predicting receipt of Vitamin A, (Prevalence Ratio [PR]: 1.0973, 95% Confidence Interval [CI] 1.0499-1.1469) in BDHS 2011. Similarly, in BDHS 2007, also those who watched television were more likely to have received vitamin A in a multivariate model, adjusting for potential confounders (Prevalence Ratio [PR]: 1.0542, 95% Confidence Interval [CI] 1.0304-1.0784).

Conclusions: It was found that exposure to television is strongly associated with the receipt of Vitamin A. Special efforts are required to ensure that the coverage of the national vitamin A programme is increased further so that the most vulnerable children are also better protected against morbidity, mortality, and blindness.It was observed that after adjusting for background socio-economic covariates, exposure to communication was found to be significant factors predicting the receipt of Vitamin A.

Open Access Conference Proceeding (Abstract)

Resolution of Bitot's Spots Following Mega-Dose Vitamin a Supplementation in Children between 1 and 5 Years of Age

Umesh Kapil

European Journal of Nutrition & Food Safety, Page 314
DOI: 10.9734/EJNFS/2015/20827

Objectives: To evaluate the responsiveness of BS over one year to MVAS administered as per national program in rural India.

Methods: Prospective community based follow-up of a cohort of 262 children with BS, aged between 1 and 5 years. Resolution or cure was defined if there was no discernible BS in either eye.

Results: During one year, only three children were lost to follow-up. At six months of follow-up (MVAS at baseline and 1 month later), 51.1% (95% CI 45.3% to 57.3%) were classified as cured. The corresponding figures at one year (additional MVAS at 6 months) were 59.9% (95% CI 54.1% to 65.9%). Amongst those cured at six months, about half and three-fourths had resolved at two and three months, respectively. There were no significant socio-demographic or clinical predictors of response.

Conclusions: Substantial non-response to MVAS at six months (49%) and one year (40%) of follow-up suggests that presently in the Indian subcontinent, Bitot's spot is a relatively crude indicator of severe current vitamin A deficiency. Thus for programmatic decisions and evaluation, public health burden of VAD should not be solely assessed through BS.

Open Access Conference Proceeding (Abstract)

Vitamin A Supplementation in Nigeria-Challenges and Prospects

Ignatius Onimawo, Isiaka Alo

European Journal of Nutrition & Food Safety, Page 317-318
DOI: 10.9734/EJNFS/2015/20829

Objectives: To assess the progress made in vitamin A supplementation in Nigeria.

To assess the challenges experienced and proffer solutions.

Methods: The method used for this study involved the review of data collated from different reports from State monitors of the Maternal, newborn and child health week (MNCHW), call-in data from all the states sent to operations centre, ward and Local Government Area summary sheet data, and data sent from UNICEF Consultants.

Desk review of MNCHW reports and interviews with key agencies using questionnaires were used. Field observations during November 2010 and 2011 MNCHW were also one of the sources of information gathering for this study. Furthermore, staff from all the partner organizations were interviewed for their assessment of the programmes in the states where they monitored. Data obtained were statistically analyzed.

Results: Due to the increasing interest in the MNCHW, by 2011 all the states increased their interventions to cover all the major services. One hundred percent of all the states of the federation provided vitamin A supplements for their children under-five. The overall coverage has increased from 27% to 57.4% in 2011.

Conclusions: The MNCHW made it possible to reach more children with vitamin A than the routine service. This round of 5 days long delivery of maternal and child survival interventions complement routine health services by ensuring that basic care reaches all mothers and children.

Challenges of data management, training and inter-agency cooperation could be improved for better service delivery. Vitamin A supplementation would help reduce under-five mortality rate in Nigeria

Open Access Conference Proceeding (Abstract)

Factors Affecting the Performance of Community Volunteers during Child Health Douala- Cameroon

Nankap Martin, Djebayi Alex Onla, Guntang Assiene Jules, Tarini Ann

European Journal of Nutrition & Food Safety, Page 319
DOI: 10.9734/EJNFS/2015/20830

Objectives: To identify factors that contribute to team performance.

Methods: Using tally sheets, teams were categorized in two: "acceptable performance" and "poor performance" and members of both teams were randomly selected and interviewed. Data were entered into Epi info, comparison were performed using the method two sample Z test for proportions (P-value 2-tailed). Was considered an influencing factor when the p value was less than 0.05.

Results: A total of 100 questionnaires were administered with 61% in the "poor performance" and 39% for "acceptable performance”. The main factors that influence the performance of teams are mastering the area to be covered by a team by their supervisor, parental refusal, signs that enable the community to clearly identify the volunteer, been already supplemented, the daily payment of voluntary, the encouragement by the heads of block/area, density of housing and the number of participants during the training prior to the event.

Conclusions: Factors affecting the performance community volunteers during child health days are of various orders and require different actions to address them.

Open Access Conference Proceeding (Abstract)

Iron / Zinc Supplementation and Postprandial Levels of Provitamin A Carotenoids from Papaya under Vitamin A Deficient Diet

Kana Sop Marie Modestine

European Journal of Nutrition & Food Safety, Page 320
DOI: 10.9734/EJNFS/2015/20831

Objectives: Iron deficiency anemia, zinc and Vitamin A deficiencies are serious public health problems in Cameroon. Traditional diets are usually poor in micronutrients The study aimed at determining the bioavailability of 3 provitamin A carotenoids (PACs) in young adult men, consuming a vitamin A deficient diet and zinc/iron supplementation.

Methods: Twelve healthy participants divided into three groups were supplemented with iron, zinc or iron+zinc over 2 weeks under a vitamin A and PACs deficient diet. A test meal containing 0.55 kg of fresh pealed papaya was the unique dietary source of PACs. Four blood samples were successively taken for various analyses.

Results: Iron and iron/zinc supplementation led to higher retinol levels in the serum. Zinc and iron/zinc were best for optimal absorption of α-carotene and β-carotene, compared to iron alone. Iron/Zinc was the best supplement for better β-kryptoxanthin absorption.

Conclusions: Supplementation with iron/zinc appears to allow for maximum bioavailability of PACs from local fruit consumption and should be considered for use on in populations that suffer from several micronutrient deficiencies.

Open Access Conference Proceeding (Abstract)

Dietary Diversity is a Good Indicator of Micronutrient Intake among Kenyan Women, Moderated by Season

Sofia Ngala, Olga Souverein, Martin Tembo, Alice Mwangi, Frans Kok, Inge Brouwer

European Journal of Nutrition & Food Safety, Page 321-322
DOI: 10.9734/EJNFS/2015/20832

Objectives: Determining that dietary diversity can be used as indicator of micronutrient adequacy irrespective of season, we examined seasonal variations in dietary diversity, nutrient adequacy, and their association among Kenyan women (reproductive age).

Methods: Repeated non-consecutive 24hr-recalls data collected during pre-harvest (period 1, Oct 2007, n=73), post-harvest (period 2, April 2008, n=203) and pre-harvest (period 3, Oct 2008, n=192) seasons. We constructed dietary diversity scores (DDS) based on 13 food groups, minimum intake of 15 g and calculated mean probability of adequacy (MPA) for 11 micronutrients. Correlations / regression analysis tested association between DDS and MPA and effects of season. Sensitivity/specificity analysis detected cut-off values of DDS indicating low nutrient adequacy.

Results: DDS ranged from 4.5±1.2 period 1 to 3.2±1.3 period 3, indicating low diverse diet, based on starchy staples, without consumption of organ meat and fish. MPA ranged from 0.36±0.07 period 1 to 0.11±0.08 period 3.  DDS and MPA were significantly associated in all seasons, the strength of association varied slightly per season, being stronger in the post/pre-harvest periods 2 and 3. DDS cut-off of 4 (MPA≤40%) periods 1 and 2, and DDS cut-off of 3 (MPA≤20%) period 3, maximized sensitivity/specificity detecting low adequacy.

Conclusions: DDS can be used as a simple indicator for micronutrient adequacy, but strength of association and cut-off level of DDS indicating inadequacy is moderated by season.

Open Access Conference Proceeding (Abstract)

The Status of Iodine Nutrition and Iodine Deficiency Disorders among School Children in Metekel Zone, NorthWest Ethiopia

Girma Kibatu, Endalkachew Kibret, Molla Gedefaw

European Journal of Nutrition & Food Safety, Page 323-324
DOI: 10.9734/EJNFS/2015/20833

Objectives: Iodine deficiency disorders are important public health problems in Ethiopia.  The aim of this study was to measure prevalence and severity of iodine deficiency disorders among school children in Metekel zone.

Methods: A cross-sectional school based descriptive study was conducted between February 2011 and July 2012.  One school covering 750 children aged between 6 and 18 years were randomly selected. Two hundred students from this school were selected by systematic random sampling. Physical examination was made according to WHO goitre classification system; 50 Salt samples from children's houses were tested for iodine using rapid field test kits and titration; a casual urine sample (5 ml) in 30 children was taken to measure urinary iodine spectrophotometrically and 5 ml venous blood sample in 37 children were collected to measure thyroid relevant blood constituents using ELISA.    

Results: The total goitre prevalence was found to be 39.5 %; 60 % of the salt samples were found to be with no iodine. The median urinary iodine concentration was found to be (range 20.54 - 62.2) 39.9 µg/L.  School children which were analyzed for thyroid hormones showed 18.92 % elevated and 27.03 % suppressed TSH levels. 

Conclusions: The study demonstrates iodine deficiency is still a severe public health problem in the district. There is a need to further strengthen the existing controlling and monitoring system   in order to achieve proper elimination of IDDs in the community.

Open Access Conference Proceeding (Abstract)

Vitamin D Status and Its Predictors among School Children in Adama Town and Rural Kebeles of Adama Woreda, Ethiopia: A Comparative Study

Tolassa Wakayo, Tefera Belachew, Susan J. Whiting

European Journal of Nutrition & Food Safety, Page 325-326
DOI: 10.9734/EJNFS/2015/20834

Objectives: Vitamin D deficiency is a public health problem world wide, even in countries with enough sunshine year round to promote adequate skin synthesis. There are few studies that look at vitamin D status in children living in sunny climates as it is assumed that they receive adequate vitamin D from sun exposure. But, no study has been done among children living in Ethiopia. This study is aimed to determine vitamin D status and its predictors among school children aged 11-18 years living in Ethiopia.

Methods: An institution based comparative cross-sectional study was conducted in Adama Town and rural kebeles of Adama Woreda on a total sample of 174 (89 urban, 85 rural) during May-June 2013. Children were randomly selected using multi-stage stratified sampling method.

Results: Vitamin D deficiency (serum 25(OH)D<50nmol/L) was noted in 42% of children. The proportion of deficiency was significantly higher among children in urban setting as compared to those in rural setting (61.8% and 21.2%, respectively; p <0.001). The significant predictors of vitamin D were study setting, maternal education, triceps skinfold thickness, sun exposure, body surface area exposed, having television/computer in the home and socioeconomic status [Adjusted OR (2.74-19.57): 95%CI(1.23, 69.21)].

Conclusions: Vitamin D deficiency was prevalent among school children living in a tropical country like Ethiopia both in urban and rural settings, with the prevalence being significantly higher among urban school children.

Open Access Conference Proceeding (Abstract)

A Good Practice of Use Social Marketing Approach to Promote Iron Folic Supplementation for Prevention and Control of Nutrition Anemia in the Mekong River Region of Vietnam

Quang Nguyen Dinh, Huong Vo Thi Xuan, Suong Nguyen Thi Ngoc

European Journal of Nutrition & Food Safety, Page 327-328
DOI: 10.9734/EJNFS/2015/20835

Objectives: To create a sustainable solution for prevention and control of women nutrition anemia, which is not depended on external supports.

Methods: The work process includes: 1/ conduct an assessment to get understandings about the demand and supply sides, other influence factors that needed for development of a proper social marketing strategy. 2/ selection and co-operation with companies with TORs and commitments for each side. 3/formulation of a joint action plan that focus on 4 Ps strategies: products, price, place and promotion. 4/implementation of the social marketing plan. 5/monitoring and response.

Results: After 15 months, the built partnership is strong. The model works in all 18 involved communes, bringing benefit to 3,474 pregnant women and 51,122 women of reproductive age. Routine monitoring report denoted that 97.5 % of pregnant women had good understanding of nutrition anemia. 78,7 % know of Rolivit (name of key local made promoted supplement). 96,9 % of pregnant women buys and uses iron folic. However, only 38% of none pregnant women practices this. Social marketing model has been scaled up to 73 new communes inside and outside the original province, bringing chance to about 21,000 pregnant women, and 310,000 none pregnant women.

Conclusions: Social marketing approach has worked in MRD provinces of Vietnam. It has been accepted by government programme as a good solution to be scaled up for prevention and control of nutrition anemia among targeted women.

Open Access Conference Proceeding (Abstract)

Current Status of Vitamin a Deficiency and the National Vitamin A Control Program in Mongolia: Results of the 2010 National Nutrition Survey

Otgonjargal Damdinbaljir

European Journal of Nutrition & Food Safety, Page 329-330
DOI: 10.9734/EJNFS/2015/20836

Objectives: To analyze the status of vitamin A deficiency among children under 5 years old children in Mongolia.

Methods: This cross-sectional studies was conducted in 21 provinces of 4 economic regions and capital Ulaanbaatar city. The study subjects were a total of 433 children aged 6-59 months and their families who participated in the 2010 Mongolian National Nutrition Survey (MNNS), a nationally representative survey. Households were selected by multi-stage sampling. A total of 125 primary sampling units were selected from sampled households were assessed via biochemically determined concentrations of retinol in plasma or serum.

Results: The prevalence of vitamin A deficiency among children under 5 years old was 32.4%. Prevalence rates of vitamin A deficiency in the highest and lowest areas were seen in Western (40.7%) and Central (16.7%) regions, respectively. Respondents for 72.8% (95%CI 67.4-77.6) of children reported that the child had received vitamin A supplementation. The proportion of children who received vitamin A supplementation was lowest in Eastern Region. After age 24-29 months, coverage declines slowly with age until only one-half of children 54-59 months of age received supplementation.

Conclusions: This study demonstrated that vitamin A deficiency among children under 5 years old appeared to be a significant public health problem in Mongolia. Education on reasonable ways of feeding and provision of complementary nutrients to children with vitamin A deficiency, should be the key points in the prevention and control programs on this problem.

Open Access Conference Proceeding (Abstract)

Reaching the Hard to Reach with Vitamin A Supplementation in Low-performing Health Zones of DR Congo

Aimerance Kabena, Damien Nahimana, Patrice Kabavulu, Geoffrey Oruru, Heather Katcher, Banea Mayambu, Jessica Blankenship

European Journal of Nutrition & Food Safety, Page 331-332
DOI: 10.9734/EJNFS/2015/20837

Objectives: Since 2002, mass campaigns have been held twice-yearly to reach children 6-59 months with vitamin A supplementation (VAS) and deworming, with coverage consistently over 80% in the majority of DR Congo's 515 health zones (HZ). However, between 2006-2010, 25 HZ achieved coverage <80% in at least 4/10 rounds, and were selected for formative research to identify barriers and motivators to receipt of VAS and inform delivery strategy.

Methods: Based on the formative research findings, a communication strategy was implemented to address barriers (husband disapproval, rumors, access to services) and motivators (will of God, self-motivation) in six low-performing HZ. A post-event coverage survey was conducted in December 2012 after two rounds of implementation using a WHO EPI methodology 30x30 cluster design to evaluate the effectiveness of these activities and identify remaining barriers to receipt.

Results: Eighty-five percent of caretakers reported their child received VAS during the last campaign (n=909) compared with administrative coverage of 104% and previous round administrative coverage of 72.8%. The primary sources of campaign information were town criers (65%), television (40%) and radio (40%). The most commonly cited reason for not receiving VAS was that the caretaker or child was not home when the distributors passed (37%).

Conclusions: Use of criers and television/radio spots broadcast in local languages were most effective in increasing awareness of the campaigns. Both community and national radio and television stations played a variety of communication advertisements prior to and during the campaign, which helped achieve coverage of over 80% to meet child mortality reduction guidelines.

Open Access Conference Proceeding (Abstract)

The One Goal Campaign: A Multi-sector Initiative for Better Child Nutrition in Asia

Kesso Gabrielle van Zutphen, Stefan Germann

European Journal of Nutrition & Food Safety, Page 333-334
DOI: 10.9734/EJNFS/2015/20838

Objectives: Tackling malnutrition requires a multi-sector approach engaging stakeholders who can build nutrition friendly environments and implement nutrition sensitive programmes, to maximize positive impact on top of nutrition-specific interventions. ‘One Goal', launched on November 26th 2013 integrates this approach and leverages the power of football for better nutrition by igniting and growing a social movement in support of child nutrition. The study's objective was to set up a campaign endorsing the engagement of stakeholders who­- powered by football­- aim to improve nutrition in Asia as reflected in the campaign's objectives and structure.

Methods: ‘One Goal' was introduced by the Asian Football Confederation (AFC) covering 47 countries with a population of 4.6 billion people and World Vision International (WVI) to potential lead partners: Royal DSM, the Global Alliance for Improved Nutrition (GAIN) and the Asian Football Development Project (AFDP). Workshops were organised by AFC/WVI and attended by the partners who shared constructive feedback resulting in the multi-sector objectives requiring nutrition friendly policies from football associations, National Governments, parents, corporates etc. The organizational structure of the campaign appointed the lead partners as the Board, the main decision making body of the campaign.

Results: A consortium was formed including WVI, the AFC, Royal DSM, GAIN and the AFDP, by endorsing stakeholder engagement through workshops, the objectives of the campaign and its organizational structure.

Conclusions: The double burden of malnutrition in Asia must be tackled with creativity. This new multi-sector partnership leverages the power and influence of football to create an enabling environment for better nutrition in Asia.

Open Access Conference Proceeding (Abstract)

Inclusive Social Enterprise to Alleviate Iron Deficiency in Women and Children in Cambodia

Gavin Armstrong, Alastair Summerlee

European Journal of Nutrition & Food Safety, Page 335
DOI: 10.9734/EJNFS/2015/20839

Objectives: Iron deficiency - particularly affects women and children, especially those living in poverty. Lack of iron leads to weakness, hampers cognitive development, reduces the capacity to work and increases susceptibility to disease. Most treatments involve supplementation but these are often not affordable nor available consistently. Such approaches are not sustainable. 

Methods: We are commercializing a health innovation in Cambodia that, with ensuring social enterprise is included in every step of the process, has the capacity not only to cure iron deficiency but also be a sustainable approach. The innovation is known as the Lucky Iron Fish™: a small fish made of iron that weighs approximately 175g. Placing the fish in the cooking pot when preparing meals or sterilizing water releases sufficient concentrations of iron to alleviate iron deficiency (Charles et al., 2011; 2014). 

Results: In the commercialization process, we are including social enterprise at every step in the process. The fish are made from local scrap metal by local dealers and the quality control and safety assurance are carried out by the Royal University of Phnom Penh – rejected fish are recycled into machine tools. The fish are packaged in containers made of recycled garbage, constructed by landmine victims and the product is sold through local sales teams. 

Conclusions: The elements of successful social entrepreneurial activities will be discussed.

Open Access Conference Proceeding (Abstract)

Vitamin A Baking and Storage Stability in Nigerian Retailed Bread

Florence Uchendu, Tola Atinmo

European Journal of Nutrition & Food Safety, Page 336-337
DOI: 10.9734/EJNFS/2015/20840

Objectives: Flour has been fortified with vitamin A in Nigeria but its stability in bread at point of consumption has not been determined. The objective of study therefore is to determine baking and storage stability of vitamin A in retailed bread as it is purchased and consumed.

Methods: Seventeen flour and fifteen oven-fresh samples of commonly consumed bread were selected from fifteen bakeries across five Local Government Areas (Agege, Ikorodu, Lagos Island, Mushin, and Oshodi/Isolo) in Lagos, Nigeria. Bread was stored for 5 days in white polythene nylons at room temperature. Vitamin A (retinol) content of flour was determined before bread was baked while bread samples were analyzed at oven-fresh and 5 days using High Performance Liquid Chromatography. Vitamin A stability was calculated as percentage of flour recommended (30IU/g) and bakery values. Data were analyzed using descriptive, T-test, and ANOVA statistics at p<0.05 significant level.

Results: Mean vitamin A content of flour was 16.7IU/g±10.7 while oven-fresh and 5 days bread had 7.6±6.7 IU/g and 2.6IU/g±2.3 respectively. Using recommended value (30IU/g), baking and storage stability in bread were 25.2±22.44 % and 8.8±7.64% respectively while flour bakery value gave baking and storage stability as 56.8±50.39% and 10.7±14.67% respectively. Statistically significant difference existed between baking and storage stability of vitamin A; baking stability obtained using recommended and bakery vitamin A values but none existed between storage stability values obtained using recommended and bakery values.

Conclusions: Vitamin A baking and storage stability in bread was low. Compliance and quality control should be ensured.

Open Access Conference Proceeding (Abstract)

Stability of Vitamin A in Nigerian Wheat Flour

Florence Uchendu, Tola Atinmo

European Journal of Nutrition & Food Safety, Page 338-339
DOI: 10.9734/EJNFS/2015/20842

Objectives: Flour has been fortified in Nigeria but vitamin A is unstable.  Study aimed at determining vitamin A stability in flour at point of consumption.

Methods: Seventeen commercial wheat flour samples were randomly collected from 15 bread bakeries in five Local Government Areas (LGAs) (Agege, Oshodi/Isolo, Mushin, Lagos Island and Ikorodu) in Lagos, Nigeria. Initial vitamin A (retinol) content of samples was analyzed using High Performance Liquid Chromatography.  All samples were stored for 30 days in airtight plastic containers. Final vitamin A content was determined at end of storage. Samples were then grouped according to post-production dates 1, 2 and 3 months. Stability was calculated as percentage of recommended value (30IU/g).Data were analyzed using descriptive, T-test, and ANOVA statistics at p<0.05 significant level.

Results: Vitamin A concentration in flour was 19-83% below recommended value in 88% (15/17) of samples tested and exceeded recommended value in 12% (2/17) with overages of 5.56-48.58%. Mean vitamin A content of flour samples was 18,221.26IU/kg±10.7 (1 month); 9,181.90IU/kg±7,441.50 (2 months) and 6,432.70IU/kg±5,193.62 (3 months). Vitamin A stability in flour at 1 month, 2 months and 3 months were 60.7%, 30.6%, and 21.4%. Statistically significant difference existed between vitamin A content of samples and recommended value (30IU/g). Time had a statistically significant effect on stability of vitamin A samples in various flour brands at 1 month, 2 months and 3 months.

Conclusions: Vitamin A stability was good at 1 month storage.  Stability in samples will be improved with high quality premix.

Open Access Conference Proceeding (Abstract)

Dietary Consumption of Iron Rich Food and Formulation of Iron Rich Complementary Food by Using Amaranth, Chickpea and Maize for Rural Kebeles of Hawassa City, SNNPR Ethiopia

Alemselam Zebdewos

European Journal of Nutrition & Food Safety, Page 340-341
DOI: 10.9734/EJNFS/2015/20843

Objectives: To assess the consumption of iron-rich foods by children & iron level & acceptability of complementary food prepared from amaranth, chickpea, and maize in Hawassa city rural kebeles, in Ethiopia.

Methods: Cross-sectional survey conducted to assess the consumption of iron-rich foods. Laboratory analyses were done to evaluate iron level and acceptability of porridge prepared from amaranth, maize, and chickpea flours mix. Porridge from maize used as control. Home made processing such as soaking in water, lemon-juice, and salt were applied to the grains to lower the phytate level.

Results: Most frequently consumed foods by children in study area were cereal, roots and tubers. Amaranth leaves (not grain) has been widely consumed by community but not given to the children. Porridge prepared from amaranth flour mix showed high content of iron & other micronutrients as compared with control (100%maize). Protein, fat, iron, and calcium level increased when the proportion of amaranth flour increased in the porridge. Socking of grains in water, lemon juice and salt significantly decreased phytate level. All formulated product with different proportion have accepted by panelists, mothers, and children.

Conclusions: Children of the study area have high risk of developing iron deficiency anemia due to low intake of iron-rich foods. Although amaranth plant is widely growing in study area & rich in Iron & other micro-nutrients, not used by community as complementary food due to lack of knowledge and cultural belief. The study revealed that amaranth can be effectively used at community level for production of low-cost iron-rich complementary food.

Open Access Conference Proceeding (Abstract)

Micronutrient Supplementation during Pregnancy among Mildly and Non-anemic Women: Effects on Iron Status and Hemoglobin

Zuguo Mei, Mary Serdula, Jian-meng Liu, Rafael Flores-Ayala, Linlin Wang, Rongwei Ye, Laurence Grummer-Strawn

European Journal of Nutrition & Food Safety, Page 342-343
DOI: 10.9734/EJNFS/2015/20844

Objectives: Universal prenatal iron-folic acid and other micronutrient supplements are recommended to prevent anemia during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. This study is to describe the iron status [serum ferritin (SF), serum transferrin receptor (sTfR), and body iron (BI)] before and after micronutrient supplementation during pregnancy.

Methods: Among 834 pregnant women with mild or no anemia (Hb >110 g/L) from a subset of participants in a randomized, double-blind trial in China, women were randomly assigned to daily 400 µg folic acid (FA) (control), folic acid plus 30mg iron (IFA,), or folic acid, iron, plus 13 additional multiple micronutrients (MM) provided before 20 weeks gestation to delivery. Venous blood was collected during study enrollment (<20 weeks gestation) and at 28-32 weeks gestation.

Results: At 28-32 weeks gestation , compared to FA group, both the IFA and MM group showed significantly lower prevalence of iron deficiency (ID) no matter which indicator (SF, sTfR, or BI) was used for defining ID. The prevalence of ID at 28-32 weeks gestation for IFA, MM, and FA were 35.3%, 42.7%, and 59.6% respectively using low SF; were 53.6%, 59.9%, and 69.9% respectively using high sTfR; and were 34.5%, 41.2%, and 59.6% respectively using low BI. However, there was no difference on anemia prevalence between FA and IFA or MM groups. 

Conclusions: Compared to FA alone, prenatal IFA and MM supplements provided to women with no or mild anemia improved later pregnancy iron status but did not affect perinatal anemia.

Open Access Conference Proceeding (Abstract)

High Coverage of Vitamin A Supplementation and Measles Vaccination during an Integrated Maternal and Child Health Week in Sierra Leone

Fatmata Fatima Sesay, Mary H. Hodges, Habib I. Kamara, Mohamed Turay, Adam Wolf, Thomas T. Samba, Aminata Shamit Koroma, Wogba Kamara, Amadu Fall, Pamella Mitula, Ishata Conteh, Nuhu Maksha, Amara Jambai

European Journal of Nutrition & Food Safety, Page 344-345
DOI: 10.9734/EJNFS/2015/20845

Objectives: Mass distribution of vitamin A supplementation (VAS) and measles vaccination has contributed to the reduction in child mortality in Sierra Leone from 267/1000 in 2005 to 118/1000 in 2010. In May 2012, the twice-yearly Maternal and Child Health Week (MCHW) integrated VAS and supplementary measles vaccination to reach all children 6-59 months in Sierra Leone.  Following the MCHW, a Post Event Coverage Survey (PECS) was conducted to validate coverage and assess Adverse Events Following Immunization (AEFI).

Methods: Using WHO EPI sampling methodology, 30 clusters were randomly selected with fourteen caregivers of children 6-59 months interviewed per cluster for precision of ±5%. In addition, one health worker was interviewed per cluster with all responses collected via mobile phones using EpiSurveyor.

Results: Overall coverage confirmed by campaign card for VAS and measles vaccination was 91.9% and 91.6%, respectively, with no significant differences by age group, sex, religion or occupation.  Major reasons given for not receiving VAS and measles vaccination were not knowing about the MCHW or being out of the area. No serious AEFI’s were reported during the MCHW or PECs. Significantly more mild AEFIs (fever, pain at injection site) were reported via PECS (29.1%) than during the MCHW (0.01%) (p<0.0001).

Conclusions: The MCHW reached >90% of children in Sierra Leone with equitable coverage. Increased reporting of mild AEFI’s during the PECs may be attributed to delayed onset after measles vaccination and/or direct enquiry from enumerators. While all reported AEFIs were mild, strengthened reporting of AEFIs during/after vaccination campaigns is recommended.

Open Access Conference Proceeding (Abstract)

Integrating a Six-Month Contact Point for Vitamin A Supplementation, Infant and Young Child Feeding Counselling and Family Planning within Routine Health Services in Sierra Leone

Mary Hodges, Fatmata Fatima Sesay, Habib Kamara, Emmanuel D. Nyorkor, Mariama Bah, Aminata Shamit Koroma, Adam Wolf, Joseph Kandeh, Rasmata Ouédraogo, Heather I. Katcher, Jessica L. Blankenship, Shawn Baker

European Journal of Nutrition & Food Safety, Page 346-347
DOI: 10.9734/EJNFS/2015/20846

Objectives: Since 2004, twice-yearly mass vitamin A supplementation (VAS) has reached >85% of children 6-59 months.  Although VAS coverage is consistently high, an additional 2.4% reduction in infant mortality could be achieved if all children receive VAS as soon as they turn six months. Therefore, the effectiveness of integrating a six-month contact point with VAS into the routine EPI schedule was examined.

Methods: Twelve health units matched according to staff levels, cadre and work load were assigned to provide either a ‘full package’ of 1)VAS, 2)Infant and Young Child Feeding counselling (IYCF), and 3)family planning (FP) counselling and commodities; a ‘mini package’ of 1)VAS and 2)IYCF  or  control’ with routine health services. 400 infants were enrolled into each group between birth and 3 weeks of age and followed until they were 12 months old. Caregivers of all enrolled children received modified child health cards with a six-month contact point

Results: More children in the full (74.5%) and mini (71.7%) groups received VAS at six months compared with the control group (60.2%)(p<0.05).  At 9 and 12 months of age, mean WAZ was significantly higher for the full (0.24±0.98; 0.90±0.81), versus the mini (-0.05±1.05; 0.26±0.93) and control groups (-0.55±1.24; 0.39±1.41)(p<0.0001, p<0.01), respectively.  FP commodities were provided to 67.3% of mothers in the full group compared with 3.0% in the mini and control groups (p<0.0001).

Conclusions: A six-month contact point integrated into the EPI schedule increased VAS coverage and provision of family planning commodities at six months and was associated with improved growth in late infancy.

Open Access Conference Proceeding (Abstract)

Experiences Using Mobile Phone Surveys to Monitor and Evaluate the Distribution of Health Services in Sierra Leone

Mary H. Hodges, Mohamed Turay, Fatmata Fatima Sesay, Habib Kamara, Mohamed Bah, Jusufu Paye, Heather Katcher, Jessica Blankenship

European Journal of Nutrition & Food Safety, Page 348-349
DOI: 10.9734/EJNFS/2015/20847

Objectives: Evidence-based programs to reduce child mortality and morbidity such as twice-yearly vitamin A supplementation (VAS) and mass drug administration (MDA) for neglected tropical diseases require real-time coverage data to ensure that all populations are reached with equitable coverage.

Methods: The EpiSurveyor platform was introduced in 2011 for 'in' and 'end' process monitoring of VAS distribution and MDA for lymphatic filariasis (LF), and was later used in 2012 for a LQAS of the supplementary measles immunization program.  In 2013, the Magpi platform was piloted for VAS distribution and MDA-LF, and the CommCare platform was piloted for routine reporting of MDA.

Results: Twelve nation-wide surveys were conducted with a total of 266 enumerators and 59,465 respondents. Data compilation was available to the account administrator within 48 hours of field-work completion with all three applications.  The CommCare platform had several benefits over EpiSurveyor/Magpi: (1) faster programming of skip logic with a friendlier interface (2) ability of the administrator to respond to an enumerator via SMS from the server (3) a prompt for photo evidence and/or Global Positioning System (4) automatic server-input synchronization during network availability (5) ability to program an 'other' category for questions allowing multiple responses.

Conclusions: Monitoring and evaluation was enhanced in timeliness and data quality by all three applications. CommCare was found to be more comprehensive and user-friendly compared with EpiSurveyor and Magpi.

Open Access Conference Proceeding (Abstract)

Effects of Daily Iron Supplementation on Physical Performance in Women of Reproductive Age: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Sant-Rayn Pasricha, Michael Low, Jane Thompson, Ann Farrell, Luz-Maria De-Regil

European Journal of Nutrition & Food Safety, Page 350-351
DOI: 10.9734/EJNFS/2015/20848

Objectives: Animal and human observational studies suggest iron deficiency impairs physical exercise performance but findings from randomized trials are conflicting. Iron deficiency and anaemia are especially common in women of reproductive age (WRA). We therefore performed a systematic review and meta-analysis to determine the effect of iron supplementation on exercise performance in WRA.

Methods: We searched the Cochrane Central Register of Clinical Trials, MEDLINE, Scopus (comprising Embase and MEDLINE), WHO regional databases and other sources in July 2013. Randomised controlled trials that measured exercise outcomes in WRA randomized to daily oral iron supplementation versus control were eligible. Random-effects meta-analysis was used to calculate Mean Differences (MD) and Standardised MDs (SMD). Risk of bias was assessed using the Cochrane risk-of-bias tool.

Results: Of 6757 titles screened, 22 eligible studies contained extractable data. Only 3 were at overall low risk of bias. Iron supplementation improved both maximal exercise performance, demonstrated by an increase in VO2 max (relative VO2 max: MD 2.35 mL/kg/min [95% CI 0.82, 3.88], P=0.003, 18 studies; absolute VO2 max: MD 0.11 L/min [0.03, 0.20], P=0.01, 9 studies; overall VO2 max: SMD 0.37 [0.11, 0.62] P=0.005, 20 studies), and submaximal exercise performance demonstrated by a lower heart rate (MD -4.05 beats per minute [-7.25, -0.85], P=0.01, 6 studies) and proportion of VO2 max (MD -2.68% [-4.94, -0.41], P=0.02, 6 studies) required to achieve defined workloads.

Conclusions: Daily iron supplementation improves maximal and submaximal exercise performance in WRA, providing a rationale to prevent and treat iron deficiency in this group.

Open Access Conference Proceeding (Abstract)

Efficacy and Safety of Daily Iron Supplementation in Children: Lessons from Three Systematic Reviews and Meta-analyses of Randomized Controlled Trials

Sant-Rayn Pasricha, Michael Low, Jane Thompson, Ann Farrell, Emily Hayes, Kongolo Kalumba, Beverley-Ann Biggs

European Journal of Nutrition & Food Safety, Page 352-353
DOI: 10.9734/EJNFS/2015/20849

Objectives: 47% of pre-school children and 25% of school-aged children are anaemic. Daily iron supplementation remains a key anaemia control intervention, but benefits and safety in children are debated. We systematically reviewed evidence for daily iron supplementation in 4–23m, 2-5y and 5-12y children.

Methods: Separate searches and systematic-reviews/meta-analyses were performed for each age-group. Electronic databases and other sources were searched for randomized controlled trials comparing daily iron supplementation with control. Random-effects meta-analysis was used. Risk-of-bias was estimated using the Cochrane tool.

Results: For children 4-23m, 2-5y and 5-12y respectively we identified 9533, 9169 and 16501 citations, from which 35, 15 and 32 eligible studies were identified, of which 9, 0 and 4 were at low overall risk-of-bias. Iron improved haemoglobin and ferritin and, in 4-23 m and 5-12y, reduced anaemia and iron deficiency. In 5-12y, iron improved global cognitive scores (SMD 0.50 [0.11, 0.90], p = 0.01) and in anaemic children, IQ (MD 4.55 [0.16, 8.94], p = 0.04). In 2-5y, limited data suggested a small improvement from iron in cognitive performance. No benefit was evident in 4-23 m (Bayley’s mental development index: MD 1·65 [–0·63, 3·94]) overall but was seen in iron deficient children (MD 5.90 [1.91, 10.00], p=0.005). Iron did not benefit growth in 4-23 m or 2-5y, but did improve growth in 5-12y. Vomiting and fever were increased in 4-23m receiving iron.

Conclusions: Although supplementation iron improves cognition in older children or children with ID, evidence of non-haematologic benefit in pre-school children is inadequate. Further research is needed to enable guideline development.

Open Access Conference Proceeding (Abstract)

Prevalence of Maternal Serum Zinc Deficiency and Its Associated Factors among Pregnant Women in Naivasha, Kenya

Agnes Mitheko, Judith Kimiywe, Patrisio Njeru

European Journal of Nutrition & Food Safety, Page 354-355
DOI: 10.9734/EJNFS/2015/20850

Objectives: To document serum zinc deficiency in pregnant women of Naivasha and to examine factors associated with zinc defeiency among pregnant women in Naivasha.

Methods: A cross-sectional analytical study design was conducted on 172 pregnant women in a mid-sized urban industrial area, applying systematic random sampling to obtain the sample size. Serum zinc levels were analyzed by atomic absorption spectrophotometer. Structured questionnaire was used to obtain socio and demographic factors of the women. Dietary intakes were assessed using 24-hr dietary recal and a food frequency questionnaire. Statistical analysis was done using logistic and linear regression.

Results: The mean serum zinc level was 66 µ66g/dl±14SD ranging from 39 to 123 µg/dl. ZD was observed in 66.9 percent of the study subjects and a 75 percent of them were in low socio-economic status. Parity was the only factor associated with ZD (AOR=3.65;95%CI:1.27-10.49;p=0.016). There was no significant association between dietary zinc intake, socio-econimc status with ZD, but women consuming Vitamin C below the RDA had a 2.62 fold risk (95%CI:0.55-12.37)  of developing ZD. A p-value of <0.05 statistical significant at 95% confidence level was used.

Conclusions: Zinc deficiency is a major public health concern in this area of Kenya. This high prevalence is related to other factors other than dietary zinc intakes. These includes factors related to absorption of zinc and inadequate provision of high bioavailable foods for optimal zinc absorption in the gut. Zinc levels should be assessed in a wider population of Kenyan pregnant women in order to determine zinc prevalence across Kenyan communities.

Open Access Conference Proceeding (Abstract)

Nutritional Composition of Locally-manufactured Complementary Infant Foods in Africa

William Masters, Marc Nene

European Journal of Nutrition & Food Safety, Page 356
DOI: 10.9734/EJNFS/2015/20851

Objectives: This study identifies the micronutrient and macronutrient density of composite foods produced and marketed in Africa for infants aged 6 to 24 months. These are typically dry mixtures of cereals, legumes and sometimes other ingredients, produced by small and medium enterprises in peri-urban settings.

Methods: We purchased random samples of products sold in a variety of small shops and supermarkets in Uganda and Ghana, and subjected them to laboratory tests for nutrient density in terms of total protein, fats and carbohydrates as macronutrients, iron and zinc as micronutrients, and also phosphorus as an antinutrients marker of phytic acid levels. We also conducted extensive interviews with manufacturers and stakeholders involved in complementary feeding, so as to identify the likely contributors to differences in nutritional composition.

Results: Our central finding is that many locally-made products are of high quality, with nutritional profiles comparable to international standards such as CSB 13 or the heavily-advertised multinational brand names, but other products have much lower density of both macro- and micro-nutrients. Products' nutritional density is only weakly correlated with packaging quality, price or labeled ingredients.

Conclusions: Africa has a large and growing market for pre-packaged complementary foods, but meeting infant needs and building consumer confidence will require more consistent nutritional profiles, including new systems for systematic quality assurance.

Open Access Conference Proceeding (Abstract)

Treatment of Anemia with Iron-fortified Rice in a School Lunch Program in Burundi

Megan Parker, Emily Mosites, Kathryn Reider, Nicolas Ndayishimiye, Melody Waring, Gloriose Nyandimbane, Domonique Masumbuko, Leonidas Ndikuriyo, Dipika Matthias

European Journal of Nutrition & Food Safety, Page 357-358
DOI: 10.9734/EJNFS/2015/20852

Objectives: This cluster-randomized trial tested the efficacy of fortified rice for the treatment of anemia in Burundi. Ultra Rice® (UR) premix kernels were manufactured to contain 100% of the recommended nutrient intakes (RNI) for iron, zinc, thiamin, and folic acid for children 7-9 years. The operational feasibility of providing a stable fortified rice product was also assessed in the Burundian context.

Methods: Twelve schools were randomly assigned to receive either UR fortified rice or traditional rice for seven months through a school feeding program. Hemoglobin status was evaluated at baseline and follow-up. Data were collected on the organoleptic acceptability of fortified rice, micronutrient stability with the UR technology, and the blend homogeneity of the rice.

Results: Anemia was highly prevalent in schools in Muyinga Province. The fortified rice product was considered acceptable to the local community, maintained stable micronutrient levels, and blended homogeneity. Over the course of the study, anemia status and hemoglobin levels improved in both the control and intervention groups. The intervention did not lead to a significantly greater change in hemoglobin level among those children eating fortified rice (β=0.085 g/dl, 95% CI: -0.21-0.38).

Conclusions: High prevalence of fever among the children and the high zinc content of the UR formulation are likely responsible for the non-significant improvement in hemoglobin. Anemia interventions in Burundi should implement multiple strategies to eliminate both iron deficiency and infectious causes of anemia. The zinc content of a multiple micronutrient grain should be studied more carefully to maximize iron uptake. *Funded by USDA/NIFA.

Open Access Conference Proceeding (Abstract)

Levels, Patterns and Determinants of Chronic Child Malnutrition in Cameroon, Seen through the Lens of Child Age

Caroline Combelles De Morais

European Journal of Nutrition & Food Safety, Page 359
DOI: 10.9734/EJNFS/2015/20853

Objectives: Often called the attic of Central Africa, Cameroon yet counts 32.3% of children victim of chronic malnutrition (stunting), and a child mortality rate as high as 122 ‰. While the Northern regions (Sahel) are regularly pointed at as accountable for such figures, what is the reality?

Methods: A sample of 4,961 children aged 0 to 5 were taken from DHS Cameroon 2011. Descriptive statistics and logistic regressions of stunting were run on a large spectrum of factors (at child, mother and household level): first on the national sample, then on sub-samples corresponding to sub-regions and different age ranges.

Results: Stunting appears and worsens essentially between 6 and 24 months. Diet diversification fails to scale up during that period, with only 1 child out of 4 getting (WHO) minimum diet diversity, and even falls back after 24 months, with 1 child out of 5. Even though stunting prevalence is higher in the Northern regions (39.0%) than elsewhere (23.0%), the main determinants of stunting are similar and not nutrition-related: poor water and sanitation (OR=2.9***), small birth size (OR=2.6***), and lack of access to health services, e.g. BCG vaccination (OR=1.7***). The impact coming from small birth size decreases with child age while the one coming from poor water and sanitation or unused health services increase with child age.

Conclusions: Not only should the lack of diet diversity be properly addressed, but fighting chronic malnutrition in Cameroon should be holistically approached, including widespread improvements in water and sanitation as well as accessibility to health services.

Open Access Conference Proceeding (Abstract)

Influence of Hyperferric and Hypoferric Diets on Iron Transporters Proteins in the Rat Mammary Glands

Júlio Mello Neto, Patrícia Aline Boer, Agnes Lopes, Célia Guadalupe Tardeli, Fernanda Humel, Aline Heloisa Vecensoti, Heloyse Hott

European Journal of Nutrition & Food Safety, Page 360
DOI: 10.9734/EJNFS/2015/20854

Objectives: This study aimed to assess the expression of transferrin, lactoferrin and ferroportin at mammary glands of rats after treatment with a diet containing high iron dose and another iron-deficient.

Methods: Female rats have received commercial food, formulated with different iron concentrations, from 2 weeks before mating to 15º day after delivery: Hyperferric – with 1,500 ppm of iron (n = 5); Control – with 35 ppm of iron (n = 5); Hypoferric – with 1 ppm of iron (n = 5). At the 15º Day after delivery, mammary glands were extracted and the expression of transferrin, lactoferrin and ferroportin was evaluated by western blotting technique.

Results: Considering control-treatment results as being 100% pattern of the protein expression, the hiperferric diet has increased 17.82% the mean of transferrin expression, 27.50% of the lactoferrin and 63.79% of the ferroportin. The hipoferric diet has increased 13.33% the mean of transferrin expression, 44.59% of the lactoferrin and 20, 50% of the ferroportin.

Conclusions: Both stimuli, hiperferric and hipoferric diet, have increased the expression of the 3 proteins related with iron transport. Under influence of hyperferric diet, remarkable increased was observed for ferroportin, protein related to iron exportation from the cell. Under influence of hypoferric diet a significant increased was observed for lactoferrin, one of the major iron-binding protein in milk.

Open Access Conference Proceeding (Abstract)

Feasibility and Effectiveness of Introducing a Six-month Contact Point for Vitamin A Supplementation into the Tanzanian EPI Vaccination Calendar

Christina Nyhus, Margaret Benjamin, Jeffrey Oruru, Meba Haruni, Temina Mkumbwa, Dafrosa Lyimo, Francis Modaha, Heather Katcher, Jessica Blankenship

European Journal of Nutrition & Food Safety, Page 361-362
DOI: 10.9734/EJNFS/2015/20855

Objectives: The study was seeking to;

1. Obtain the age at first vitamin A dose in comparison to current practices.

2. Assess acceptability of a new 6 month contact point by caretakers and health care workers.

Methods: A randomized, facility-based intervention trial was implemented in four intervention and two control health facilities. Children (435 intervention, 137 control) were enrolled at 12-14 weeks of age during their DPT3 visit and followed until they were nine months.  At intervention facilities, VAS, growth monitoring and IYCF counseling were provided at six months while standard care of growth monitoring was offered at control facilities.

Results: The median (IQR) age at first receipt of VAS was 6.3 (6.0, 6.8) months in the intervention group and 9.3 (9.1, 9.6) months in the control group (p<0.001).  At six-months of age, clinic attendance was 88% in the intervention group compared with 0% in the control group.  Health workers reported no negative effect on their routine work and 93% recommended the six-month contact point to be implemented in other facilities.

Conclusions: Introduction of a six-month contact point into the EPI vaccination calendar significantly reduced the age of first receipt of VAS for children and was well-accepted by health workers.

Open Access Conference Proceeding (Abstract)

Fortification Monitoring as a Lynchpin to Success: An Innovative Excel-based Tool to Collate National Fortification Data in Malawi

Laura Rowe, Martha Pigott, Flora Kamdonyo, Nathaniel Brooks, Johannes Korp

European Journal of Nutrition & Food Safety, Page 363-364
DOI: 10.9734/EJNFS/2015/20856

Objectives: The monitoring of fortified foods is a critical component to the success of any fortification program, yet it is often given little focused attention. The tool allows food quality data from inspectors at trade borders, markets, and domestic facilities to be entered by government staff into an excel tool allowing for fast and efficient tracking of compliance by collection point, brand, importer, and producer.

Methods: Following a request to address the country’s challenge of collecting, organizing, and acting upon fortification data, the tool was designed to house all monitoring information as a stand-alone platform. Malawi-specific data informed its creation; key individuals from Ministry of Health were trained on its use. The tool can be adapted to any country setting and learned in less than one month.

Results: Since adoption, the government has compiled more accurate, detailed, and timely data on fortified sugar and iodized salt compared to previous monitoring methods. Staff have reported the ability to rapidly and systematically identify missing or non-compliant data each quarter. The tool has been successful in motivating district officers to send expected samples on time due to its depiction of which district samples have or have not been received.

Conclusions: The tool has simplified the ability to obtain a comprehensive picture of sample collection and fortification compliance at key collection points and proven in Malawi to display results in a rapid, informative, and visually powerful format. It provides a means for managers to correct program shortcomings before impact studies are conducted saving time, resources, and lives.

Open Access Conference Proceeding (Abstract)

The Prevalence of, and Factors Associated with Single and Multiple Deficiencies of Iron, Vitamin A and Zinc amongst Children Aged 12 – 35 Months in Colombia

Louise Watson, Elaine L. Ferguson, Elizabeth Allen, Zulma Y. Fonseca Centeno, Ana Z Jiménez Soto, Helena Pachón

European Journal of Nutrition & Food Safety, Page 365-366
DOI: 10.9734/EJNFS/2015/20857

Objectives: Few national nutrition surveys have assessed the prevalence of single and multiple micronutrient deficiencies among young children, despite their potential negative impact on child health, growth and development. This study aimed to investigate the prevalence of iron, zinc and vitamin A deficiency among Colombian children aged 12 – 35 mo, and to explore associated socio-demographic factors.

Methods: Data from the 2005 Colombian National Nutrition Survey (ENSIN) were used to investigate the prevalence of single and concurrent low biochemical status for iron (plasma ferritin <12.0 mg/L), zinc (serum zinc < 9.2 µmol/L), and vitamin A (serum retinol < 20 µg/dL) (n=2740). Logistic regression was performed to investigate socio-demographic factors associated with single and multiple micronutrient deficiencies.

Results: The prevalence of single micronutrient deficiencies amongst 12 – 23 and 24 - 35 mo children, respectively, were 26.4% (95% CI 23.8%, 29.4%) and 16.7% (95% CI 14.4%, 19.1%) for low serum ferritin, 30.2% (95% CI 28.7%, 31.7%) and 24.6% (95% CI 23.2%, 26.0%) for low serum zinc and 6.7% (95% CI 5.9%, 7.5%) and 5.4% (95% CI 4.7%, 6.1%) for low serum retinol. Overall, 12.2% (95% CI 11.3%, 13.1%) of children aged 12 – 23 mo and 5.4% (95% CI 4.8%, 6.0%) of children aged 24 – 35 mo had 2 or more deficient biomarkers. Factors significantly associated with single or multiple deficiencies were age-group (12 – 23 mo > 24 - 35 mo) and region, with children in Atlántica being at highest risk.

Conclusions: Future interventions should regionally target children aged 12 – 23 mo.

Open Access Conference Proceeding (Abstract)

Determination of the Vitamin A Status and Body Pool Size of Ghanaian Infants Given Fortified Home Based Complementary Foods

Sam Newton, Seth Owusu-Agyei, Kwaku Poku Asante, Esi Amoaful, Emmanuel Mahama, Kofi Tchum, Sherry Tanumihardjo

European Journal of Nutrition & Food Safety, Page 367-368
DOI: 10.9734/EJNFS/2015/20858

Objectives: Vitamin A deficiency is a public health problem which can be addressed using micronutrient powders in single dose sachets known as “Sprinkles”. This food-based approach offers an alternative to high dose Vitamin A supplements given directly to young infants. This strategy was evaluated by assessing the Vitamin A body pool using deuterium or 13C-retinol as a tracer. The primary objective was to investigate the impact of Vitamin A home fortification on the infant’s Vitamin A pool size using stable 13C2-retinol as a tracer among children who receive Sprinkles with or without VA. The Vitamin A status of infants at baseline was assessed using the modified relative dose response (MRDR) test and the 13C-retinol dilution test at follow-up.

Methods: This was a community-based study involving 93 infants aged 7-9 months and randomised to receive daily Sprinkles with or without Vitamin A. Mothers were instructed to mix a single sachet of Sprinkles with a small amount of food which was given to the child. Infants were followed for 5 months.

Results: At baseline the mean ratio (95%CI) of MRDR for infants in the intervention group was 0.032 (0.025-0.038) compared to 0.031(0.024-0.038) in the control group (p =0.80). At end line the mean Vitamin A concentration of infants in the intervention and control group 304.711 µmol vs. 252.207 µmol respectively but difference was not statistically significant.

Conclusions: The vitamin A status of the infants was found to be adequate and the study demonstrated the use of stable isotopes as tracers to quantitatively estimate total body stores.

Open Access Conference Proceeding (Abstract)

Factors Associated with Dietary Practices and Nutritional Status of Pregnant Women in Wondo Genet District, Sidama Zone, Southern Ethiopia

Desalegn Kuche, Pragiya Singh, Debebe Moges

European Journal of Nutrition & Food Safety, Page 369
DOI: 10.9734/EJNFS/2015/20859

Objectives: To assess dietary practices, nutritional status and associated factors among pregnant women in study area.

Methods: A cross-sectional survey was employed for the study. Two-stage cluster sampling was used. 153 pregnant women aged 19-49 years were the subjects. Energy and nutrient intakes were calculated from one day weighed food records on a sub-sample (n = 77). Structured questionnaire was used to collect data.

Results: Energy intake of study participants in 2nd and 3rd trimesters pregnancy were 2308 kcal for 2340 kcal and 1420.5 kcal for 2452 kcal. Vitamin A intake was 3 micro grams for 800 micro grams. Protein intake of the study respondents in 2nd and 3rd trimester pregnancy was 45.9 g and 31.5 g for 71 g. Majority (75.2%) of study participants did not take additional meal during pregnancy. 69.3% skipped one of their regular meals. As indicated by mid upper arm circumference a total of 9.2% of the study subjects were undernourished. Factors associated with nutritional status and dietary practices were number of pregnancy, consumption of cereal foods, household size, growing khat and vegetables.

Conclusions: Energy and the nutrient intake of study participants were lower than recommended intakes. Dietary practices and nutritional status of study participants were not adequate to support their increased energy and nutrient requirement.

Open Access Conference Proceeding (Abstract)

Preference and Acceptability of Alternative Delivery Vehicles for Prenatal Calcium Supplementation among Pregnant Women in Urban Bangladesh

Jo-Anna Baxter, Daniel Roth, Abdullah Al Mahmud, Tahmeed Ahmed, Munirul Islam, Stanley Zlotkin

European Journal of Nutrition & Food Safety, Page 370-371
DOI: 10.9734/EJNFS/2015/20860

Objectives: Prenatal calcium supplementation is recommended by the WHO to decrease the risk of preeclampsia when dietary calcium intake is low; yet, this recommendation has not been successfully implemented to date. We aimed to evaluate the preference and acceptability of 4 different options for delivering prenatal calcium supplements (conventional tablets, chewable tablets, unflavoured powder, and flavoured powder) at the WHO recommended dose among pregnant women in urban Bangladesh.

Methods: In a modified discrete-choice experiment, pregnant women (n = 132) completed a 4-day ‘run-in period' in which each delivery vehicle was sampled once, followed by a 21-day ‘selection period' during which participants freely selected a single vehicle per day. Preference was objectively based on the probability of selection of each vehicle; acceptability was assessed using questionnaires.

Results: Conventional tablets had the highest probability of selection (62%); the probability of selection of chewable tablets (19%), flavored powder (12%), and unflavored powder (5%) were all significantly lower than for conventional tablets (P < 0.001). Palatability and product characteristics of the conventional tablets were more acceptable based on subjective report than for the other delivery vehicles.

Conclusions: Our methodological approach used both objective and subjective measures to consistently identify the most preferred and accepted prenatal calcium delivery vehicle. Observation of participants' actual supplement use, in addition to expressed perceptions of acceptability, demonstrated that a conventional tablet is likely to be the most successful calcium delivery vehicle for future use in field studies and scale-up of the WHO recommendation for prenatal calcium supplementation in Bangladesh.

Open Access Conference Proceeding (Abstract)

Acceptability of Millet Mix Based Recipes and their Iron Bioavailability

Aruna Narayanan, Anbu Malar Micheal

European Journal of Nutrition & Food Safety, Page 372
DOI: 10.9734/EJNFS/2015/20861

Objectives: This study aims to use the underutilised millets that are drought resistant, less water intensive but highly nutritious to address this problem.

Methods: Pearl (Pennisetum glaucum), Finger (Eleusine coracona), & Barnyard Millet (Echinochloa spp) were used to formulate M-A (40, 20, 40), MM-B (40, 15, 45) and MM-C (45, 10, 45), analysed for nutrient content & incorporated in Onion pakoda & Kara Sev at 10, 15 and 20%. Mixes were made into porridges. Organoleptic evaluation was done on a five point scale. Iron bioavailability was determined.

Results: Millet mixes A, B and C had 436, 430, 455 kcal respectively. The protein (14.2 gm%), minerals (2.8 gm%) and fibre (1.2 gm%) content of millet mix- C were highe. The calcium and iron content of MM-A, B and C was 64 & 5.12, 61.2 & 5.0 and 124 & 6.0 mg/gm% respectively. Porridge made with MM-B was highly acceptable (83%) with 75 Kcal, 2.99 g of protein and 3.247 mg of Iron per 100 gm .Onion Pakoda (90%) and Kara Sev (82%)  with 20% MM-A were best acceptable. Energy, Protein & Iron content of Onion Pakoda and Kara Sev were 410 & 520 kcal, 7.46 & 9.05 gm% & 2.33 & 3.76 mg/gm%. Porridge, Sev and Onion Pakoda had 8.79, 16.15 and 23.91% acid ionisable iron& 20.03, 34.78 and 35.27% of acid ionisable iron & 20.03, 34.78 and 35.27% of acid soluble iron.

Conclusions: Millet mixes can be used in traditional Indian foods to increase their iron content.

Open Access Conference Proceeding (Abstract)

Ultra Rice Technology: Acceptable Micronutrient Losses and Limited Microbial Growth Enable Shelf Life Extension

Rahul Tripathi, Megan Parker, Zoey Chanin, Seema Kapoor, Domonique Masumbuko, Dipika Matthias, Peiman Milani

European Journal of Nutrition & Food Safety, Page 373-374
DOI: 10.9734/EJNFS/2015/20862

Objectives: The objective of this research was to determine if Ultra Rice (UR) fortified grains are shelf stable and suitable for consumption after 24 months (m) of storage and to document micronutrient losses to determine overages that must be included in the initial formulation. A longer shelf life will prevent the unnecessary disposal of fortified grains at 12m, enable fortified rice grains to be blended prior to transport, and increase the likelihood that it will reach vulnerable populations.

Methods: UR premix kernels were sampled from a World Vision warehouse in Burundi every 6m over 24 m. The growth of microorganisms was tested in a certified laboratory and compared with the World Food Programme's (WFP) food safety standards for fortified rice: 10,000 /gram for Aerobic colony count, 50 /gram for Bacillus cereus, 0/gram for E. coli, 10 /gram for Coliforms, 100 /gram for Yeasts and moulds, and negative results for Salmonella. Micronutrient losses were calculated between 0 and 24 m, accounting for moisture.

Results: Microorganism growth remained at or below the WFP acceptable limits after 24 m of storage. The micronutrient data indicated losses of 0.5% folic acid, 15.0% thiamine, 18.5% iron, and 18.1% zinc after 24 m of storage.

Conclusions: The lack of bacterial growth within UR fortified rice suggests it can be safely consumed for at least 24 m following production and the shelf life can be extended to 24 m under similar storage conditions. Micronutrient losses were small and these amounts will be used to calculate overages with greater precision when formulating future micronutrient premix. *Funded by USDA/NIFA.

Open Access Conference Proceeding (Abstract)

Enabling Factors for Iron Folic Acid Compliance among Women in Indonesia: Insights from the Recent Indonesia Demographic & Health Survey, 2012

Manoj Raut, Daliya Sebastian, Ananta Sahu

European Journal of Nutrition & Food Safety, Page 375-376
DOI: 10.9734/EJNFS/2015/20863

Objectives: Iron deficiency anaemia is one of the most widely prevalent nutritional deficiency contributing to substantially to the global burden of disease in the world, including in Indonesia. According to Indonesia’s National Household Health Survey, 2001 the prevalence of anaemia among pregnant women was 40.1% [1]. The prevalence in 2008 was 44% [2] which indicated that the situation had not improved over time; in fact anaemia prevalence had increased marginally. So, this study tries to explore the socio-demographic enablers of Iron Folic Acid (IFA) compliance

[1] Indonesia Health Profile 2010. Ministry of Health, Republic of Indonesia, 2011.

[2] Tracking Progress on Child and Maternal Nutrition: A Survival and Development Priority. UNICEF, 2009.

Methods: Both Bivariate and Multivariate analyses were carried out on the recent Indonesia Demographic & Health Survey, 2012 data using SPSS software.

Results: After adjusting for related socio-economic and demographic factors, exposure to newspaper seem to have an important role in predicting consumption of IFA, (Adjusted Odds Ratio [AOR]: 1.179, 95% Confidence Interval [CI]: 1.084-1.283) and those who listened to radio are more likely to consume IFA (AOR: 1.099, 95% CI: 1.017-1.188). In addition to this, it was found that those who had received a Tetanus Toxoid injection were more likely to consume IFA.

Conclusions: Focus needs to be there on mass media channels and the ANC channel of contact with the pregnant women, where she can be given the full course of IFA, while taking the weight and giving TT injection, during ANC checkups to increase compliance.

Open Access Conference Proceeding (Abstract)

Consumer Preference on Cakes, Acceptability and Nutritional Evaluation of Food Fortified Cakes

Aruna Narayanan, Sowmiya Sundar

European Journal of Nutrition & Food Safety, Page 377
DOI: 10.9734/EJNFS/2015/20864

Objectives: To enhance the micronutrient content of cakes by food fortification using locally available under exploited but nutritionally rich indigenous food fortificants.

Methods: Lotus stem and Carrots were chosen as food fortificants. The nutrient analysis of the fortificants was carried out. Lotus stem powder (LS) and carrot powder (CA) were incorporated individually (15, 20 and 25 percent) as well as in mixed form (MF) (2:1, 1:1, 1:2.) in Chocolate (CH) and Orange cake (OR) and the highly acceptable cakes were analyzed for iron, β carotene and quality parameters.

Results: Lotus stem powder had iron (80 mg/100 g), β carotene (543 µg/100 g) and fibre (31.6 g/100 g).Carrot powder had iron (5 mg/100 g), β carotene (6875 µg/100 g) and fibre (1.46 g/100 g). Among all the variations LSCK2 (84.5 percent), CAOR1 (84 percent) MFCK1 (88 percent) and MFOR1 (87.3 percent) cakes were highly acceptable.LSCK2 had the highest iron content (12.50 mg/100 g) and CAOR1 (760 µg/100 g) had highest β carotene content. Total solids were above the standard value of 60 percent. pH of MFCK1 and MFOR1 were 6.2. The microbial count of the cakes was found to be within the satisfactory limit.

Conclusions: Fortification of cakes is a possible venture to alleviate micronutrient malnutrition in people.

Open Access Conference Proceeding (Abstract)

Optimal Iron to Zinc Ratios for Increased Soluble Iron in Fortified Rice

Megan Parker, Paul Johns, Gaurav Patel, John Lasekan, Matthew Frey, Peiman Milani

European Journal of Nutrition & Food Safety, Page 378
DOI: 10.9734/EJNFS/2015/20865

Objectives: Previous studies evaluating the ability of fortified rice to improve hemoglobin and ferritin concentrations have produced mixed results. The literature indicates that combining iron (Fe) and zinc (Zn) can reduce the effects on iron status expected from iron supplementation alone. Our objective is to examine the relationship between the Fe/Zn molar ratio in fortified rice and improvements in hemoglobin and ferritin concentrations.

Methods: Fe/Zn molar ratios of several fortified rice trials were examined in relation to changes in hemoglobin and serum ferritin concentration. The effect of exogenous zinc on iron solubilization of fortified rice was further evaluated using an in vitro assay to test fortified rice blends with known ratios of iron to zinc.

Results: Although the fortified rice Fe/Zn ratios ranged from approximately 1 to 50, only in cases where the ratio exceeded 10 was a significant improvement in iron status (hemoglobin and/or ferritin) observed. The in vitro evaluation clearly associated exogenous zinc, in a dose-dependent manner, with inhibition of iron solubilization. Iron solubilized from fortified rice blends increased exponentially as the Fe/Zn ratio increased from 3.5 to 13.0. The plot of soluble iron vs. Fe/Zn further enabled prediction of the iron solubilization expected for any given Fe/Zn ratio.

Conclusions: Iron fortification programs have the potential to significantly reduce iron deficiency anemia (IDA) and iron deficiency (ID). This research aimed to establish the relationship between the Fe/Zn molar ratio and health outcomes. Further research is needed to identify the most cost-effective Fe/Zn molar ratio to reduce IDA and/or ID. *Funded by USDA/FAS.

Open Access Conference Proceeding (Abstract)

Clinical Assessment of Goiter and Low Urinary Iodine Concentration Depict Presence of Severe Iodine Deficiency in Pregnant Ethiopian Women: A Cross-sectional Study in Rural Sidama, Southern Ethiopia

Getahun E. Lombamo, Henok Tadele, Alemtsehay Bogale, Cherinet Abuye, Barbara Stoecker

European Journal of Nutrition & Food Safety, Page 379-380
DOI: 10.9734/EJNFS/2015/20866

Objectives: To determine iodine status and knowledge of iodine deficiency disorders (IDD) of pregnant women in rural Sidama, southern Ethiopia.

Methods: A cross-sectional community-based study was conducted in three kebeles which were selected randomly from the eight kebeles in the study area using probability proportional to size methods. Data were collected in January, 2009, from 172 pregnant women. Main outcome measures were urinary iodine concentration (UIC), % of population with UIC < 20 µg/L, % of households using iodized salt, iodine content of salt and total goiter rate (TGR).

Results: Median UIC was only 15 µg/L compared to the 150 µg/L minimum recommendation from WHO/UNICEF/ICCIDD for pregnant women. The UIC of 60% of the women was < 20 µg/L. More than 90% of households were not using iodized salt and median salt iodine content was almost zero compared to the recommended 15-40 mg/kg. TGR was 49% (95% CI: 42, 56) which is much higher than the 5% TGR cut-off signifying a problem of public health significance. In addition, > 90% of participants didn't know about IDD, about the cause of goiter or why iodized salt is important.

Conclusions: Results indicated the presence of severe iodine deficiency in the study population; urgent intervention, through universal salt iodization, and iodine supplementation to high risk groups is required.

Open Access Conference Proceeding (Abstract)

Socio-Demographic Factors Affect Zinc Status of Infants and Preschool Children in East Gojjam, Amhara Region, Ethiopia

Adamu Belay, Grace Marquis, Gulelat Desse, Frances Aboud, Aregash Samuel

European Journal of Nutrition & Food Safety, Page 381-382
DOI: 10.9734/EJNFS/2015/20867

Objectives: The main objective of this study was to assess the prevalence and risk factors of zinc deficiency among infants and preschool children.

Methods: A community based, cross-sectional study was conducted in East Gojjam zone between October 2011 and April 2012. Sub-samples about 240 infants and preschool children were randomly selected in the study. Data on potential determinants of zinc deficiency were collected using a structured questionnaire. Serum zinc concentration was measured using Atomic Absorption Spectrometer. Statistical analysis was done using ANOVA and Student’s independent t-test and linear regression model.

Results: The mean serum zinc concentration of infants and preschool children was 62.98 (±13.03) µg/dl (95% CI: 61.32, 64.63 µg/dl). About 57.1% of the subjects were zinc deficient. The main determinants of low serum zinc status of infants and preschool children were age and number of family members living on the same land. Zinc status of older children was 3.67 µg/dl (95% CI: -5.58,-1.77 µg/dl) lower than children who were aged 6-10 months. Serum zinc status of infants and preschool children is decreased by 0.83 µg/dl (95% CI:-1.36, -0.30 µg/dl) with each additional family member. Food insecurity, dietary diversity, sex, child health, anthropometric indices, maternal education and wealth index were not associated with serum zinc status.

Conclusions: The prevalence of zinc deficiency was more than two-fold of the value set by International Zinc Nutrition Consultative Group. Such potential deficiencies require urgent attention including the endorsement of food fortification programs, complementary food preparation education and family planning implementation.

Open Access Conference Proceeding (Abstract)

Blending Whey Powder with Haricot Bean Powder for Weaning Food Production

Mathewos Moges, Shimelis Admassu

European Journal of Nutrition & Food Safety, Page 383
DOI: 10.9734/EJNFS/2015/20868

Objectives: Produce weaning food by blending whey powder with haricot bean powder.

Methods: The raw materials used were whey and haricot bean (Phaseolus vulgaris), Roba 1 variety. Whey was filtered through ultra-filtration membrane. Permeate was stored and pre-heated at 55ºC for 40 min. Vacuum pump was used to concentrate the soluble solid to 60%. Finally, it was dried by means of a pressure-nozzle spray dryer. The bean seeds were weighed and soaked for 12 h at 25ºC. The pan was covered and kept in darkness to sprout. Seeds that sprouted within four days were dried, ground and stored. Whey and haricot bean powder were mixed in various mix ratios and analyzed for their physico-chemical and bacteriological quality.

Results: The protein, iron and fat content of whey powder was 7.9%, 1.14% and 1.12% respectively and increased to 13.94%, 3.02% and 1.95% respectively through blending with haricot bean powder. The Ca, Mg and K contents of the blended product were within the recommended range. The microbiological results of all fortified products were within the acceptable limits.

Conclusions: The nutritional content of a mix of whey: haricot bean powder in the ratio 80:20 was the best composition for fulfilling the nutritional requirements for young children. This study shows that there is a possibility of blending of whey powder with the high protein content of haricot bean powder, providing an option to develop low-cost weaning foods from pulses.

Open Access Conference Proceeding (Abstract)

Simultaneous Quantification of Iron, Vitamin A and Inflammation Status Markers Using a Multiplex Immunoassay Method

Eleanor Brindle, Daniel Stevens, Chris Crudder, Carol Levin, Dean Garrett, Chris Lyman, David Boyle

European Journal of Nutrition & Food Safety, Page 384-385
DOI: 10.9734/EJNFS/2015/20869

Objectives: Deficiencies of vitamin A and iron affect a significant portion of the world's population, and efforts to characterize deficiency patterns have been hampered by a lack of measurement tools appropriate for large-scale use. Since vitamin A and iron are not easily measured directly, reliable proxy markers indicative of deficiency status have been identified and widely adopted. Inflammation or infection must be assessed at the same time, as these affect vitamin A and iron status markers. To address these technical challenges, we developed a multiplex immunoassay method for simultaneous measurement of five markers relevant to assessing vitamin A and iron status and infection: retinol binding protein, soluble transferrin receptor, ferritin, alpha-1-acid glycoprotein and c-reactive protein.

Methods: Using affordable technology from Quansys Biosciences, antibodies are coated in five discrete regions of the well of a microtiter plate and the five analytes are assayed in a single volume of sample. Assay performance was evaluated by comparing multiplex and conventional assay results for plasma from 72 US volunteers.

Results: Results of the new and established conventional assay methods were highly correlated (0.606 to 0.991, p<.0001). Inter-assay imprecision for the multiplex panel varied from 1% to 8%, and all samples fell within the limits of quantification for all assays at a single dilution. Absolute values given by the multiplex and conventional assays differed, indicating a need for further work to devise a new calibration curve.

Conclusions: This multiple micronutrient assay has excellent potential for use in population assessment of vitamin A and iron deficiencies.

Open Access Conference Proceeding (Abstract)

Nutritional Status and Associated Factors among Pregnant Women in Boricha Woreda, Sidama Zone, Southern Ethiopia

Mathewos Moges, Amare Worku, Eskindir Loha

European Journal of Nutrition & Food Safety, Page 386
DOI: 10.9734/EJNFS/2015/20870

Objectives: Assessessment of nutritional status of pregnant women in Boricha wereda.

Methods: Community based cross sectional study design was used. Data were collected Data were collected from December 10-25, 2012 G.C on 417 pregnant women who are randomly selected from six rural and one urban kebele of Boricha wereda. Data were collected by using structured interviewer administered questionnaire and HemoCue® Blood Hemoglobin Photometer. Hemoglobin level was categorized as “anemic” and “non-anemic,” according to The World Health Organization’s accepted values to define anemia.

Results: The prevalence of anemia was 20.9%. Living in rural areas (AOR [95% CI] = 3.2 [1.32, 7.55]), antenatal care follower (AOR [95% CI] = 1.4 [1.34, 2.85]), those who were consumed iron (AOR [95% CI] = 2.5 [1.37, 4.44]) and those who were diseased by malaria (AOR [95% CI] = 9.3 [5.23, 16.74]) had significant association with anemia.

Conclusions: The prevalence of malnourished pregnant women in hemoglobin level was high when it compared to regional prevalence. Hence, maternal nutrition interventions should be integrated in a stronger manner into maternity services.

Open Access Conference Proceeding (Abstract)

Prevalence of Malnutrition among the Children Residing in India and Ethiopia

Preeti Ghate

European Journal of Nutrition & Food Safety, Page 387
DOI: 10.9734/EJNFS/2015/20871

Objectives: The present study was conducted to assess the nutritional status and prevalence rate of malnutrition of 7 to 9 year school going children of India [Nagpur] and Ethiopia [Nekemte].

Methods: Nutritional status of children was assessed in terms of dietary assessment, anthropometric measurement, biochemical and clinical assessment.

Results: The results of the study revealed that food and nutrient intake was inadequate and consumption of all the nutrients by the children was comparatively less than the recommended dietary allowances. Anthropometry revealed that out of total children screened (N=200), mean height and weight in all the age group was significantly less than the NCHS standards. According to Gomez’s classification of weight for age shows that 76% of the children suffered from moderate malnourished in Nekemte and 23% of the children suffered from severe malnourished in Nagpur. Waterlow’s classification of weight for height depicts 73% and 79% of the children suffered from severe wasting in Nagpur and Nekemte. According to Waterlow’s classification of height for age, 56% of the children suffered from moderate stunting in Nagpur. According to BMI-for-Age (WHO 2007), 31% of the children were below -3SD score in Nekemte. 79% of anaemia prevalence rate was observed among the children of Nagpur. In Nekemte 26% of children had calcium deficiency and skin infection.

Conclusions: It is concluded the disease or morbid condition, poor health and poor nutritional conditions at the population level, which may be due to lower intake of food and nutrients than recommended.

Open Access Conference Proceeding (Abstract)

Assessment of Nutritional Status of Children Residing In India and Ethiopia

Preeti Ghate

European Journal of Nutrition & Food Safety, Page 388
DOI: 10.9734/EJNFS/2015/20872

Objectives: The present study was conducted to assess the nutritional status of 200 children in age group of 1-3 years of India (Nagpur) and Ethiopia (Nekemte).

Methods: Nutritional status of children was assessed in terms of demographic and socio-economic profile, dietary assessment, anthropometric measurement, biochemical and clinical assessment.

Results: The study reveals that there were lower consumption in several macro and micro nutrients intake compared to Recommended Dietary Allowances. It is important to note that the milk intake was negligible in Nekemte i.e. 7.2% only. The intakes of micronutrients such as β carotene, calcium, riboflavin and iron were inadequate in Nekemte i.e, about 9.68%, 24.10%, 36.67% and 57.55% of RDA. The intakes of micronutrients such as β carotene, zinc, and iron were inadequate in Nagpur i.e, about 6.55%, 30.80% 36.67% and 48.44% of RDA. According to Gomez’s classification of weight for age shows that 39% and 44% of the children suffered from severe malnourished in Nagpur and Nekemte. The prevalence of Marasmus was 1% and 2% in Nagpur and Nekemte.

Conclusions: In conclusion it may be stated that the nutritional status of the children belonging to low socio-economic group is more severe. There is a need to sensitize the community through nutrition and health education, in order to improve household income by providing income generating activities, better housing and sanitary conditions, improving access to health care facilities and literacy status of the community to improve the overall health and nutritional status of the community.

Open Access Conference Proceeding (Abstract)

A Comparative Study on Nutritional Problems in Preschool Aged Children of Nepal

Jib Acharya, Edwin van Teijlingen, Jane Murphy, Martin Hind

European Journal of Nutrition & Food Safety, Page 389
DOI: 10.9734/EJNFS/2015/20873

Objectives: Measure the level of knowledge, attitudes & beliefs about nutritious food for children amongst poor rural and urban mothers.

Methods: Quantitative questionnaire study.

Results: The study included more urban mothers (56%) than rural mothers (44%). Major barriers to recommending nutritious foods included: lack of knowledge (15%); high market prices (19%); and cultural influences or beliefs (6%). The study shows nearly 55% children are providing fruits once in week. Similarly nearly 15% of families never give salad to their children. Nearly 16% of mothers cannot choose nutritious food from the grocery store. Likewise 12% respondents lacked food. Nearly 57% children had been taken at least once to a spiritual healer and 16% on multiple occasions for the treatment. Nearly 20% of mother believed eating green leafy vegetables and fruits during illness affect child health. Nearly 8% respondent feed meat, fish, egg and milk during times of illness to their children but 92% do not.

Conclusions: Knowledge and attitudes towards nutritious food of rural and urban mothers are still poor in both societies. Beliefs about food practice are still strongly embedded in Nepal. Urban mother had better food recommendation, whereas rural mother experienced huge barriers. Meat, fish, egg and dairy products are not provided to children due to cultural influences. Mothers from both communities have high faith in spiritual healers.

Open Access Conference Proceeding (Abstract)

Effects of Processing, Cooking, and Storage on β-carotene Retention and Bioaccessibility in Biofortified Cassava (Manihot esculenta)

Michael La Frano, Chenghao Zhu, Betty Burri

European Journal of Nutrition & Food Safety, Page 390-391
DOI: 10.9734/EJNFS/2015/20874

Objectives: Biofortification of cassava with β-carotene is currently being tested in African populations where cassava is a staple food and vitamin A deficiency is a public health problem. The objective of the present study was to measure the impact of traditional African processing and cooking methods on β-carotene concentration and bioaccessibility of cassava-based foods in order to help direct plant breeding efforts and estimate the potential impact of biofortified cassava on vitamin A status.

Methods: Biofortified cassava was processed and cooked to prepare the following traditional dishes: gari, eba, fermented and non-fermented fufu, and boiled cassava. β-carotene concentrations were measured using HPLC and bioaccessibility was tested using simulated in vitro digestion.

Results: Eba, non-fermented fufu, and gari retained the most β-carotene (43.6, 42.2, and 41.0%, respectively) and boiled cassava and fermented fufu retained the least (24.9, and 21.7%, respectively). Gari and boiled cassava bioaccessibility was 17- and 12-fold higher than raw cassava, respectively (P < 0.001). Increases in bioaccessible β-carotene concentrations in eba, and fufu products were not significant. After three days of storage at room temperature, fermented flour and gari preparations lost >62% β-carotene, while nonfermented flour was more stable.

Conclusions: These results suggest that biofortified cassava prepared as gari or boiled might provide useful amounts of β-carotene to alleviate vitamin A deficiency, if storage conditions are optimized.

Open Access Conference Proceeding (Abstract)

Effects of High and Low Dose Iron-Containing Micronutrient Powders for In-Home Fortification of Complementary Foods on the Gut Microbiome and Gut Inflammation in Kenyan Infants

Tanja Jaeggi, Guus Kortman, Diego Moretti, Christophe Chassard, Penny Holding, Alexandra Dostal, Jos Boekhorst, Harro Timmerman, Dorine Swinkels, Harold Tjalsma, Jane Njenga, Alice Mwangi, Jane Kvalsvig, Christophe Lacroix, Michael Zimmermann

European Journal of Nutrition & Food Safety, Page 392-393
DOI: 10.9734/EJNFS/2015/20875

Objectives: Primary outcome was change in composition of gut microbiome, after 3 weeks and 4 months. Secondary outcomes were changes in faecal calprotectin, treated diarrhoea, anaemia, iron status and systemic inflammation.

Methods: We performed two randomized controlled trials in 6-month-old Kenyan infants consuming home-fortified maize porridge daily for four months. 1) infants received an MNP containing 2.5 mg iron as NaFeEDTA (+2.5 mgFeMNP) or the identical MNP without iron (-2.5 mgFeMNP). 2) a different MNP containing 12.5 mg iron as ferrous fumarate (+12.5 mgFeMNP) or the identical MNP without iron (-12.5 mgFeMNP).

Results: We enrolled 117 infants, and 101 infants completed the studies between March 2010 and September 2012. Baseline prevalence of anaemia and systemic inflammation were 67.3% and 29.7%, respectively. At baseline, 63% of the total microbial 16S rRNA could be assigned to Bifidobacteriaceae; using qPCR, Salmonella was detected in 22.8% of infants, B. cereus in 38.6%, S. aureus in 71.3%, C. difficile in 53.5%, and C. perfringens in 86.1%. Body iron stores increased in the +12.5 mgFeMNP (p=0.001), but not in the +2.5 mgFeMNP. Using pyrosequencing, +FeMNPs increased enterobacteria, especially Escherichia/Shigella (p=0.048), the enterobacteria/ bifidobacteria ratio (p=0.020), and Clostridium (p=0.03) compared to -FeMNPs; +FeMNPs also increased faecal calprotectin (p=0.002). Most of these effects were confirmed using qPCR, and many were statistically stronger in ±12.5 mgFeMNP study than in ±2.5 mgFeMNP study. During the trial, 27.3% of infants in the +12.5 mgFeMNP group required treatment for diarrhoea vs. 8.3% in the -12.5 mgFeMNP group (p=0.092).

Conclusions: In rural Africa where infectious disease burden is high, provision of iron-containing MNPs to infants increases gut inflammation and modifies the gut microbiome toward a potentially more pathogenic profile.

Open Access Conference Proceeding (Abstract)

Dietary Intake of Pregnant Women Accessing Primary Health Care Services in Ogun State, Nigeria: A Rural–Urban Comparison

Oluwafolahan Sholeye, Olubukunola Jeminusi, Adebukola Badejo

European Journal of Nutrition & Food Safety, Page 394-395
DOI: 10.9734/EJNFS/2015/20876

Objectives: Poor maternal nutrition in pregnancy leads to increased morbidity and negative pregnancy outcomes. This study compares the dietary intake of pregnant women accessing rural and urban primary health centres in Ogun State, Nigeria.

Methods: A cross-sectional comparative study was carried out among 360 rural and 360 urban women accessing antenatal care at selected primary health centres, in Ogun State, using multi-stage sampling technique. Data was collected using semi-structured, interviewer-administered questionnaires and 24-hour dietary recall forms. Data was analyzed using SPSS version 15.00 and total dietary intake software. Relevant inferential statistics were calculated

Results: Over 50% of respondents in both rural and urban locations were aged between 26 and 33 years. The mean intake of most nutrients was significantly higher (p<0.05) among the rural women than their urban counterparts, except for Vitamin A, Zinc and Iron. There was no significant difference (p>0.05) in the pattern of vegetable consumption between the rural and urban respondents. The types of snacks consumed were significantly different (p=0.032), but there was no difference (p=0.652) in frequency of snack consumption between both groups. More urban women took micronutrient supplements routinely.

Conclusions: The rural women had higher nutrient consumption compared to their urban counterparts. Continuous nutrition education will go a long way in ensuring adequate nutrient intake among pregnant women.

Open Access Conference Proceeding (Abstract)

Engaging Health Officials in the Philippines: Application of a Bottleneck Analysis Tool to Improve Health and Nutrition Program Implementation at the Local Government Level

Shakira Bandolin, Willibald Zeck, Henry Mdebwe, Maria Evelyn Carpio, Suzinne Pak-Gorstein, Jonathan Gorstein

European Journal of Nutrition & Food Safety, Page 396-397
DOI: 10.9734/EJNFS/2015/20877

Objectives: For children in the Philippines, malnutrition remains a challenge, especially for the youngest and most vulnerable children. An innovative systems analysis tool with local government officials has been developed that uses existing data on IYCF practices and engages local public health workers to identify bottlenecks in service delivery and targeted interventions to improve effective coverage.

Methods: A bottleneck analysis tool was developed based on the Tanahashi model. The tool requires the development of a determinants matrix and key indicators to reveal bottlenecks in key components of IYCF programs. The tool helps assess the current status of program delivery and engages local government officials and nutrition experts to identify bottlenecks and propose solutions.

Results: The analysis revealed several critical bottlenecks to IYCF program implementation across LGUs in the Philippines. For example, there was a large discrepancy in mother's awareness and knowledge of breastfeeding. These localities proposed culturally appropriate breastfeeding campaigns in their localities or creating targeting educational materials.

Conclusions: The results of this initiative demonstrate the utility of targeted bottleneck analysis at a local level to engage and empower local government officials and stakeholders to assess data and identify interventions in a timely manner for improving key IYCF programs in their communities. By creating a collaborative environment, an open discussion regarding data usage, analysis of available data, and positive program improvements can be achieved.

Open Access Conference Proceeding (Abstract)

Suboptimal Thiamin Status is Common in Women of Childbearing Age in Rural and Urban Cambodia

Kyly C. Whitfield, Yazheng Liu, Crystal D. Karakochuk, Aminuzzaman Talukder, Hou Kroeun, David D. Kitts, Eunice CY Li-Chan, Judy McLean, Tim J. Green

European Journal of Nutrition & Food Safety, Page 398-399
DOI: 10.9734/EJNFS/2015/20878

Objectives: Thiamin deficiency causes beriberi, which is often fatal in infants who do not receive rapid treatment. Infantile beriberi appears to be common in Cambodia, likely because thiamin deficient mothers produce breast milk low in thiamin. Strategies may be needed to improve thiamin status; however, population representative thiamin data is required. Therefore, we measured erythrocyte thiamin diphosphate (TDP) concentration to assess thiamin status in Cambodian women of childbearing age.

Methods: A representative sample of non-pregnant and non-lactating women of childbearing age (20-45 y) in urban Phnom Penh (n=146) and rural Prey Veng (n=156), and for comparison purposes, a convenience sample of urban women in Vancouver, Canada (n=49) were recruited. TDP was measured using HPLC.

Results: The response rates were 91% in Phnom Penh and 98% in Prey Veng. Mean ± SD erythrocyte TDP was 100±38 and 87±26 nmol/L in Phnom Penh and Prey Veng, respectively; which were lower than in Canadian women, [128±38 nmol/L (P<0.001)]. Among Cambodian women, thiamin deficiency (TDP < 70 nmol/L) was more prevalent in Prey Veng (24%) than Phnom Penh (12%). Similarly, insufficient thiamin status (TDP < 90 nmol/L) was more prevalent among women living in Prey Veng (59%) than Phnom Penh (39%). Of Canadian women, 84% were thiamin sufficient (TDP > 90 nmol/L).

Conclusions: We found a high prevalence of suboptimal thiamin status in Cambodian women of childbearing age, particularly in rural Prey Veng. Supplementation, fortification, and/or food-based strategies may be required to improve thiamin intake in Cambodian women.

Funding: UBC Vitamin Research Fund.

Open Access Conference Proceeding (Abstract)

Hepcidin Screening to Guide Iron Supplementation in African Children

Sant-Rayn Pasricha, Sarah Atkinson, Andrew Armitage, Shivani Khandwala, Jacobien Veenemans, Sharon Cox, Lucy Eddowes, Theodore Hayes, Conor Doherty, Ayse Demir, Edwin Tijhaar, Hans Verhoef, Andrew Prentice, Hal Drakesmith

European Journal of Nutrition & Food Safety, Page 400-401
DOI: 10.9734/EJNFS/2015/20879

Objectives: Hematologic and non-hematologic benefits from iron supplementation are chiefly seen in iron deficient individuals; concerns that iron might promote infection especially in non-iron deficient individuals have complicated global anemia control policies, particularly in malaria-endemic settings. Iron homeostasis, including intestinal absorption, is controlled by hepcidin. Hepcidin is regulated by iron, erythropoietic drive, and inflammation, suggesting its potential utility to appraise iron status and thus guide iron supplementation.

Methods: In 1338 African pre-school children we evaluated the Area Under the ROC Curve (AUCROC) for plasma hepcidin concentration as a diagnostic test of iron status, anemia type and erythrocyte incorporation of oral iron, determining and modeling the effects of cutoffs.

Results: Hepcidin detected iron deficiency with an AUCROC = 0.85 (optimal sensitivity/ specificity at a cutoff of 5.5 ng/ml); this was not significantly affected by gender, wasting, malaria or carriage of inherited red cell disorders. In anemic children, hepcidin distinguished iron deficiency anemia from anemia of inflammation (AUCROC=0.89, optimal sensitivity/specificity cutoff 5.4 ng/ml). Hepcidin was the best predictor for >20% incorporation into erythrocytes of orally-administered 57Fe (AUCROC=0.90, optimal sensitivity/ specificity cutoff <6.9 ng/ml). If a hepcidin cutoff of 5.5 ng/ml had been used to guide iron supplementation in this population, 77% of iron deficient children would have received supplements while 80% of children with P. falciparum and 86% of children with anemia of inflammation would have avoided iron.

Conclusions: In African children, hepcidin ascertains iron status, distinguishes iron deficiency anemia from anemia of inflammation, and hence could guide iron supplementation toward groups in whom it will likely be beneficial and safe.

Open Access Conference Proceeding (Abstract)

Genetic Hemoglobin Disorders and Anemia in Cambodian Women of Reproductive Age

Crystal D. Karakochuk, Kyly C. Whitfield, Suzanne Vercauteren, Aminuzzaman Talukder, Judy McLean, Timothy J. Green

European Journal of Nutrition & Food Safety, Page 402-403
DOI: 10.9734/EJNFS/2015/20880

Objectives: To examine associations between anemia (Hb <120 g/L) and genetic hemoglobin disorders in Cambodian women (18-45 y).

Methods: Blood samples of 450 women from Prey Veng province were analyzed with consent. A complete blood count was performed and the presence and typing of hemoglobin disorders was carried out by PCR and hemoglobin electrophoresis. Serum ferritin, serum transferrin receptor, c-reactive protein and other micronutrients were also assessed.

Results: Overall, the prevalence of anemia in women was 33.1%, of which 61% was microcytic (Hb <120 g/L and MCV <80 fl). The prevalence of genetic hemoglobin disorders was > 55% (most commonly alpha-thalassemia, Hb E and Hb Constant Spring) and were significantly correlated with anemia. Of women with anemia, over two-thirds had an abnormal genetic hemoglobin type.  Less than 5% of women had a low serum ferritin (< 15 µg/L).

Conclusions: The most common form of anemia in Cambodian women is microcytic anemia. Genetic Hb disorders are major contributors to anemia in this region. Low serum ferritin was uncommon suggesting that iron deficiency is not a major problem. However, genetic Hb disorders and concurrent infections may be confounding the interpretation of ferritin and leading to an underestimation of iron-deficiency anemia. Other indicators of iron status and other micronutrients involved in anemia are being examined.

Open Access Conference Proceeding (Abstract)

Comparison of the Associations of Different Socio-economic Indices with Various Indicators of Child Malnutrition in the Philippines

Bradley Woodruff, Fabian Rohner, Grant J. Aaron, May A. O. Lebanan, Pura Rayco-Solon, Ofelia P. Saniel

European Journal of Nutrition & Food Safety, Page 404-405
DOI: 10.9734/EJNFS/2015/20881

Objectives: To compare associations between different indices of socio-economic status (SES) and child malnutrition. 

Methods: A cross-sectional survey in poor urban areas in the Philippines collected information on child wasting, stunting, anemia, iron deficiency, and vitamin A deficiency, as well as data to calculate three measures of SES: household income; a Philippines government measure using housing conditions, income, education, and occupation; and a wealth index calculated from ownership of durable goods and other factors.

Results: All forms of malnutrition were associated with all three SES measures; however, the government measure and the wealth index were more strongly associated. The odds ratios for anemia comparing the poorest group to the richest group were 1.7 for household income, 3.3 for the government measure, and 3.5 for the wealth index.  Similarly, for iron deficiency, the odds ratios were 1.5 for household income, 2.9 for the government measure, and 2.4 for the wealth index. The odds ratios for vitamin A deficiency were 3.4 for income, 3.4 for the government measure, and 11.9 for the wealth index. In addition, the correlations with anthropometric z-scores, hemoglobin, ferritin, and retinol binding protein concentrations were higher for wealth index than for household income when analyzed as continuous variables.

Conclusions: In this study, measurements of wealth based on a broader variety of household characteristics were better correlated with malnutrition than household income alone. Estimates of SES in surveys assessing nutritional status should thus be based on a broader mix of data than just household income.

Open Access Conference Proceeding (Abstract)

Assessing the Potential of Biofortified Cassava for Improving Indices of Vitamin A Status: Update on Human Studies

Betty Burri, Chenghao Zhu, Josh Katz, Jade Tso, Michael La Frano

European Journal of Nutrition & Food Safety, Page 406-407
DOI: 10.9734/EJNFS/2015/20882

Objectives: Cassava usually contains essentially no beta-carotene (BC). However, cassava is being bred to increase its BC content. Our objective was to test how effective biofortified cassava is at increasing BC and vitamin A (VA) concentrations in healthy adult women.

Methods: Ten American women participated in a cross-over trial.  They ate 3 treatments in random order: a breakfast containing 100 g boiled biofortified cassava, with or without 15 mL oil; or 100 g white cassava with 15 mL oil.  Carotenoid concentrations in cassava were measured by HPLC, spectrophotometry, and colorimetry. VA and BC concentrations in triacylglycerol-rich plasma were measured by HPLC, before and after each dietary intervention.

Results: Carotenoid concentration differences in cassava preparations were monitored successfully by spectrophotometry and colorimetry as well as by the more expensive HPLC. VA and BC increased after both biofortified cassava treatments. BC concentration increases in triacylglycerol-rich plasma varied >10-fold between women, for unknown reasons. VA conversion was very good, approximately 4 µg β-carotene: 1 µg retinol, for both biofortified cassava treatments. Data from this study were used to predict BC intakes for African women if biofortified cassava replaced white cassava in their diet. The model predicts that completely replacing white with biofortified cassava provides recommended VA intakes for 92% (Nigeria) to 100% (Congo) of adult women where cassava is a staple crop.

Conclusions: These results suggest that current varieties of biofortified cassava, when boiled gently, could be a useful intervention for improving VA status. This research was supported by grant 8227 from HarvestPlus.

Open Access Conference Proceeding (Abstract)

The Prevalence of Anemia in women of Childbearing Age in Kazakhstan: Some Causes, Risk Factors and Interventions

Toregeldy Sharmanov, Shamil Tazhibayev, Oksana Dolmatova, Aigul Nurgabilova, Altyn Sarsembayeva, Orynkul Mukasheva, Ayan Yergaliyeva

European Journal of Nutrition & Food Safety, Page 408-409
DOI: 10.9734/EJNFS/2015/20883

Objectives: An assessment of the causes, risk factors and availability of fortified flour on anemia prevalence among women of reproductive age (WRA) in Kazakhstan.

Methods: Results of comparative analysis of the National Nutrition Surveys (NNS) in 2006 and 2011 with randomized sampling of 4089 WRA in 2006 and 1214 WRA in 2011. Hemoglobin levels in blood of WRA measured by HemoCue spectrometry, Serum Ferritin and C-Reactive Protein (CRP) levels - by ELISA, Fortified Wheat Flour (FWF) - by Spot Test For Iron. The WRA were interviewed on risk factors.

Results: In 2006 44.5% of women, including 51.8% of Kazakh and 31.6% of Russian, had anemia, and in 2011 these indicators showed reduction anemia 39.0%, 43.6% and 27.5%, accordingly. The prevalence of low ferritin levels with CRP ≤5 mg/L and low ferritin levels with anemia were 43.8% and 57.15%, accordingly. In 2006 FWF was available in 28.4% of households, and the incidence of anemia among women living in these households was lower (41.2%) than in those who hadn't FWF (46.2%). In 2011 in West Kazakhstan Oblast, where 64% of households had FWF, the difference in anemia prevalence (34.6% and 63.3%, accordingly) was more significant. Use of Intrauterine Devices (IUD) increases the prevalence of anemia among women (47.5) than in those, who did not use IUD (36.3%). The influences of some other factors on anemia incidences are also revealed.

Conclusions: Iron deficiency, the availability of FWF in households, nationality, use of IUD and some other factors influence on the prevalence of anemia in women.

Open Access Conference Proceeding (Abstract)

The CDC Model for Biomonitoring of Iodine Status in Pregnant Women in the National Health and Nutrition Examination Survey

Amir Makhmudov, Kathleen Caldwell

European Journal of Nutrition & Food Safety, Page 410-411
DOI: 10.9734/EJNFS/2015/20884

Objectives: Iodine is a trace element involved in the metabolism of thyroid hormones, important for development and normal physiological function. Adequate iodine intake during pregnancy and lactation is especially critical to normal brain development in the fetus. Strategies to combat the prevalence of iodine deficiency disorders focus on ensuring adequate dietary intake.Dairy, grain, seafood, and to a lesser degree, iodized salt are the major dietary sources of iodine in the United States.Since 1971, National Health and Nutrition’s Examination Survey (NHANES) has measure urinary iodine in the United State population. A sizable decrease in urinary iodine concentrations (UIC) was detected between (1988-1994). This decline may have been due to the dairy industry’s effort in the mid-1980s to reduce the iodine residue in milk.

Methods: NHANES is a program of studies designed to assess the health and nutrition status of adults and children in the United States.

Results: CDC hasbeen continuously monitoring US iodine level since 2000. NHANES data indicates that the U.S. median UIC been relatively stable since the initial drop that had occurred from NHANES I to NHANES III. However some findings indicate that some pregnant women in the US do not appear to have an adequate iodine intake.

Conclusions: Our iodine data supports the continued need to monitor the iodine status in the population because changes in patterns of dietary habit and iodine content in the food supply maynegatively affect populations at risk for iodine deficiency disorders.

Open Access Conference Proceeding (Abstract)

SPRINKLES for Ethiopian Staple Food Fortification/ Home Fortification

Sisay Tesema

European Journal of Nutrition & Food Safety, Page 412
DOI: 10.9734/EJNFS/2015/20885

Objectives: To show use of sprinkles are best for home fortification in Ethiopian staple food.

Methods: More than 90% of Ethiopian population prepared their staple foods at household level, so we proposed new innovative strategy home fortification with MMP vitamin and mineral with sprinkle sachets.

The sprinkles developed for Teff (Injera), Wheat (Bread), Maize, etc.  Multiple fortified Salt.

The estimated shelf life of the products is from six month to one year in different weather condition.

 Results: As per the assessment is undertaken the price of the products are very affordable and can be used one sachet for five family members for three days in five birr which goose 0.70centies/day/person by covering 25% tax and all operation cost of the company including getting enough profit margin. The product process will be finalized abroad and the only thing is packaging in sachets form is here in Ethiopia, due to highly expensiveness of aluminum foil cost.

Products is very simple; logistics and start up budget also is not huge as per the economic development impact which will be recorded by the country. Hence the demand of the product projected to be high. The Verification test is already undertaken by EHNRI.

 Conclusions: While the nutrition status of the population is changed through achieving MDG goals and Ethiopia will save billions of Birr ordollars, Such huge economic gain will result from safe-guarding human resource depletion linked to ill-health, increasing intellectual capacity and decreasing early death. The GDP also increased.

Open Access Conference Proceeding (Abstract)

Dietary Diversity is Low and Associated with Nutritional Status of Women in Early Pregnancy in Rural Bangladesh

Rolf Klemm, Abu Ahmed Shamim, Saijuddin Shaikh, Hasmot Ali, Kerry Schulze, Parul Christian, Alain Labrique, Keith West

European Journal of Nutrition & Food Safety, Page 413-414
DOI: 10.9734/EJNFS/2015/20886

Objectives: To evaluate the association between nutritional status and other risk factors with dietary diversity in the 1st trimester of pregnancy among women in rural Bangladesh.

Methods: A cross-sectional analysis of data among women enrolled during the 1st trimester of pregnancy into the JiVitA-1 weekly vitamin A or beta-carotene supplementation trial in rural Bangladesh from 2001 to 2007. A dietary diversity score (DDS) based on 9-conventionally defined food groups was calculated based on data collected from a 7-day food frequency questionnaire. Mid-upper arm circumference (MUAC) from the main trial (n=67,690), and BMI and serum markers of micronutrient status from a substudy (n=1,869) of women were used as indicators of maternal nutritional status. Other individual, household and seasonality factors were examined for their association with DDS, and as potential confounders in the association between DDS and maternal nutritional status.

Results: Overall mean (sd) DDS was low at 2.1 (1.1) (Max. Score=9). In a multivariate model, selected individual (maternal education, being a wage earner, and selected morbidity symptoms), household (living standard index, smaller household size, food security, and ownership of a fruit grove, home garden or fish pond) factors and seasonality (non-lean season) were positively associated with maternal DDS. Maternal MUAC, BMI and serum levels of lycopene (biomarker for vegetable/fruit intake) were also associated with DDS.

Conclusions: In this rural setting of northern Bangladesh, dietary diversity is low and maternal nutritional status is poor. Dietary diversity, measured by a simple score summed over one week, was positively associated with maternal nutritional status in early pregnancy.

Open Access Conference Proceeding (Abstract)

Formulation of Quality Protein Maize (QPM) Based Nutritionally Improved Complementary Food (CF): The case of Shebedino Woreda, Southern Ethiopia

Beruk Berhanu, Kebede Abegaz, Esayas Kinfe

European Journal of Nutrition & Food Safety, Page 415-416
DOI: 10.9734/EJNFS/2015/20887

Objectives: To develop complementary food from blend of quality protein maize, orange fleshed sweet potato, chickpea and red teff.

Methods: Before CF development, flavor optimization was done in seven different blending proportion of QPM: chickpea using sensory evaluation. Porridge prepared from 50:50 and 60:40 QPM and chickpea blend were selected using 30 panelists. Based on that, 72gm of 50:50 or 60:40 blend of raw, germinated or soaked QPM and chickpea, 18gm of OFSP and 10 gm of red teff were used for Complementary Food formulation. The 2x3 factorial design was used and the effect of blending proportion and processing method on nutrient composition and anti-nutrients were studied. Sensory evaluation of porridge was done at the community level.

Results: Addition of 50% chickpea on QPM was accepted using a flavor optimization test at the laboratory level. Increment in chickpea content in 72:18:10 formulated complementary flour, slightly increased protein, fat, zinc and iron contents and reduced viscosity of complementary porridge. Germination and soaking improved CFs by reducing phytate, tannin and viscosities. All CFs prepared in this study were accepted at community (3.47 to 4.20) level using five point hedonic scales.

Conclusions: All CFs prepared in this study satisfy the minimum RDA for energy, protein and 2/3 of RDA for iron and zinc. QPM based CFs prepared from 72 (50:50) of germinated QPM and chickpea is best on nutrient content, bioavailability and viscosity. Nutritionally improved CFs can be prepared from a blend of QPM, chickpea, Orange Flesh Sweet Potato (OFSP) and red teff.

Open Access Conference Proceeding (Abstract)

Assessing Dietary Consumption, Developing and Evaluation of Sensory and Nutritional Quality of Orange Flash Sweet Potato Incorporated Recipes to Increase Vit-A Intake for Preschool Children in Southern Ethiopia

Omer Seid, Getenesh Berhanu, Pragya Singh

European Journal of Nutrition & Food Safety, Page 417-418
DOI: 10.9734/EJNFS/2015/20888

Objectives: Assessing dietary consumption, developing and evaluation of sensory and nutritional quality of OFSP incorporated recipes to increase Vit-A intake for preschool children in Southern Ethiopia.

Methods: Two stage cluster sampling was used to select 576 preschool children's to assess dietary consumption of Vit-A. For this  crross-sectional survey, modified 7 day HKI FFQ and 24 hr FANTA DDS were used. Flatbreads were developed, OFSP to sorghum flour of 0%:100% (control), 25%:75%, 30%:70% and 35%:65%. Sensory evaluation of flatbreads was carried out by semi trained panelist and consumers by using 9 and 5 point hedonic scales respectively. Randomization was used for coding and presenting of flatbreads during sensory evaluation. Nutritional evaluated was carried out at EHNRI Addis Ababa, Ethiopia. Data were analyzed using SPSS version 19. ANOVA was used to see sensory attributer mean variance and LSD was used to see significance mean difference of sensory attributer (p< 0.05).

Results: Mean FF of animal source of Vit-A was 1.42 times and animal plus plant source (weighted by source) was 3.01 times for the last 7 days. Only 15% of study subject's had high DDS. OFSP incorporated sorghum flatbeds in different proportion are accepted in all sensory attributers by semi-trained panelists and consumers (p≤0.05). All OFSP incorporated flatbreads were excellent source of Vit-A

Conclusions: Dietary intake of Vit-A rich food is low. OFSP flour up to 35% can be incorporated to the traditional sorghum flatbread to increase its Vit-A content which can serve as a vehicle for delivering Vit-A to the preschool children.

Open Access Conference Proceeding (Abstract)

Helicobacter pylori is not a Cause of Anaemia amongst People Living with HIV and AIDS in Tanzania

Elisaphinate Moses Urio, Godwin David Ndossi, Simon Rupia Tatala

European Journal of Nutrition & Food Safety, Page 419-420
DOI: 10.9734/EJNFS/2015/20889

Objectives: Helicobacter pylori is the most common infection worldwide. Several reports have indicated an association between H. pylori infection and anaemia. The aim of the study was to determine the prevalence of H. pylori co-infection with HIV and its correlation with anaemia and CD4 cell counts.

Methods: A cross sectional study of 77 people infected with human immunodeficiency virus at SHIDEPHA+ Post Test Club Mwananyamala in Dar-es-Salaam, were assessed for Helicobacter pylori infection using 13C urea breath tests, immune integrity by use of CD4 cell count and anaemia using Beckman Coulter Counter.

Results: Of the 77 subjects who were HIV positive 31 (40%) were H. pylori positive, compared to 14 out of 25 (56%) H. pylori positive amongst HIV negative controls. The mean (SD) haemoglobin level in H. pylori negative subjects was 11.7 (1.6) g/dl, compared to 11.4 (1.75) g/dl amongst those who were H. pylori positive (unpaired t test, p=0.43). Of the 15 subjects with CD4 counts below 200/ml, 4 (26%) were H. pylori positive, compared to 27/62 (48%) of those with CD4 counts above 200/ml (Chi squared, p<0.005).

Conclusion: Our data demonstrates that H. pylori colonization is unlikely to contribute to anaemia amongst HIV positive subjects studied. Although this suggests that H. pylori colonization does not lead to significant problems in this population, both adequate nutrition and treatment of problems such as iron deficiency remain important components of the management of HIV positivity and AIDS throughout Africa.

Open Access Conference Proceeding (Abstract)

Quality Control of Salt Iodation and Handling Practices among Large and Medium Salt Manufacturers, Packers and Distributors in Tanzania

Elifatio Towo, Vicent Assey, Celestin Mgoba

European Journal of Nutrition & Food Safety, Page 421-422
DOI: 10.9734/EJNFS/2015/20890

Objectives: The salt industry is the most critical partner to enhancing progress in eliminating iodine deficiency through its role in production of adequately iodated salt. In Tanzania data shows that about 90% of Tanzanian households used salt with some level of iodine, however only 47% of the salt samples were found to be adequately iodated and median UIC was within WHO recommended level in women of reproductive age. This study aims at assessing the salt iodations, quality control and handling practices among large and medium salt manufacturers, packers and distributors.

Methods: A cross-sectional survey with purposive sampling approach was conducted to salt manufacturing facilities located in various regions. Structured questionnaires for salt factory/salt packers, wholesale shops and distributors were used to collect information. A total of 266 salt samples were collected handled careful, transported and analyzed for iodine content.

Results: In general, salt handling and storage practises were low. Laboratory results shows that the median salt iodine content was 20 ppm. The distribution indicated that 33% of samples have inadequate iodine content (<10 ppm) and 35% contain adequate content for optimal intake defined as ≥ 15 ppm iodine. Only 3% of salt samples had excess iodine >75ppm. Salt samples with inadequate. iodine content were found more at distributors (63%) followed by, manufacturers (33%), and packers (4%).

Conclusions: There is a need of conducting refresher training to salt manufactures, salt packers, and distributors on iodation procedures, handling and storage practices of iodated salt. Coordination and social marketing activities need to be strengthened.

Open Access Conference Proceeding (Abstract)

Lessons and Experiences from Implementing Small Scale Fortification in Asia

Melanie Galvin, Macha Raja Maharjan, Rozy Afrial Jafar

European Journal of Nutrition & Food Safety, Page 423-424
DOI: 10.9734/EJNFS/2015/20891

Objectives: Small scale fortification remains an essential focus in many countries with the majority of flour milling and salt processing occurring in villages or on small holdings. Large-scale processing methods are not replicable in these environments. Two adapted methodologies were tested in Nepal (flour) and Indonesia (salt) to address these concerns.

Methods: Nepal: MI through NGOs installed, trained and monitored the functioning of 100 small mills covering 3,000 households, including devising a revolving premix fund, extensive local monitoring and a final evaluation after two years of implementation.

Indonesia: MI provided mobile iodization units for real time salt crushing/iodizing on salt farm sites. Mini mobile labs were equipped and government workers trained to test iodized salt while it was being harvested. This real-time and mobile approach was further supported by development of farmer's cooperatives, established to organize these disparate farmers into a single legal entity to empower members while enhancing their bargaining position among traders, buyers or agents.

Results: Nepal: >160 metric tons of fortified flour produced and 75% of the premix costs were recovered. The evaluation found reductions in anemia among villagers (from 33% to 18%) with fortified flour in 80% of households and nearly 50% of women consuming this flour on a daily basis.
Indonesia: Iodized salt production increased from 5800 metric tons in 2008 to 25,000MT (87% of all salt) and cooperatives continue to function well.

Conclusions: Small scale fortification work requires tailored approaches based on country context. By thoughtful programming, success can be achieved using a variety of methods.

Open Access Conference Proceeding (Abstract)

Iodine Deficiency Disorders (IDD) in Burie and Womberma Districts, West Gojjam, Ethiopia

Aweke Kebede, Girmay Ayana, Adamu Belay, Cherinet Abuye

European Journal of Nutrition & Food Safety, Page 425-426
DOI: 10.9734/EJNFS/2015/20892

Objectives: To assess the magnitude and causes of goiter in West Gojjam, Amhara National Regional state, Ethiopia.

Methods: The study was conducted in July 2010. The sample size was determined by assuming 50% prevalence of total goiter rate, 5% error, 95% confidence interval, design effect of 1 (random) and 5% of non-response rate. Two stage random sampling; sub-district and village was used to select children aged 6-12 years and their biological mothers from 10 randomly selected villages in each of the districts. Overall, 403 households participated in the study. The assessment was conducted using palpation of thyroid size, urinary iodine level determination, household level interview and Focus Group Discussion (FGD).

Results: The study revealed a total goiter prevalence rate of 54% and 30.1% in children and their biological mothers respectively. More than 64% of the children were severely iodine deficient. Younger age mother were more affected than older and female children are more afected than male ones. The major cause for goiter as revealed by urinary iodine level and concentration of iodized salt is dietary iodine deficiency. There are no goitrogenic foods such as cassava, however, goitrogenic chemicals such as Dichloro Diphenyl Trichloroethane (DDT) and 2,4-Dichlorophenoxyacetic acid (2,4-D) were widely used. The study areas are known for surplus produce of cereals, legumes and chilli.

Conclusions: In order to reverse the problem, immediate and sustainable distribution of iodated salt/oil capsule, prohibition of direct application of pesticides on foods and awareness creation on adverse effects of IDD and benefits of iodine nutrition is highly recommended.

Open Access Conference Proceeding (Abstract)

Food Fortification Strategy to Control Micronutrient Deficiencies in Tanzania

Elifatio Towo, Celestin Mgoba, Vicent Assey, George Kaishozi

European Journal of Nutrition & Food Safety, Page 427-428
DOI: 10.9734/EJNFS/2015/20893

Objectives: Micronutrient deficiencies are widespread in Tanzania affecting people of all ages and socio-economic groups. The primary cause being insufficient intake of bioavailable minerals and vitamins from foods. Food fortification of some staple foods was made mandatory by the Government recently as the strategy to control micronutrient deficient.

Methods: National Food Fortification Alliance was created to coordinate the programme. The operational approach was based on production, distribution, quality control and social marketing of fortified foods. Ssurvey was conducted to find the suitable vehicles and knowledge, attitude and practices on fortification aspects using structured questionnaire. The whole program was strengthened through capacity building for the stakeholders in the chain.

Results: The national nutrition strategy identifies food fortification an important strategies to reduce the prevalence of micronutrient deficiencies. Wheat flour, maize flour and edible oil were identified as suitable food vehicles. The baseline status of micronutrients in targeted groups is known. These data will allow a long-term assessment of the effect of the program.  Standards, regulations and guidelines on food fortification are available. The program was launched officially on 15th May 2013 by His Excellency President of the United Republic of Tanzania. Currently, industries are producing fortified edible oils and wheat flour. Social marketing campaigns, capacity building to implementers and sensitization sessions are going on.

Conclusions: The program helped in setting important health indicators of the selected vulnerable groups and develop a good strategy to progressively eradicate micronutrient deficiencies. Challenges includes inspection, monitoring and evaluation systems of the production and distribution lines for sustainability.

Open Access Conference Proceeding (Abstract)

The Challenge of Attaining Universal Salt Iodisation in Zambia

Cyprian Katongo, Dominique Brunet, Gladys Kabaghe, Freddie Mubanga, Kabaso F. Kabwe, Ward Siamusantu

European Journal of Nutrition & Food Safety, Page 429
DOI: 10.9734/EJNFS/2015/20894

Objectives: To assess whether iodine deficiency disorders were still not a public health concern and whether Universal Salt Iodisation had been attained.

Methods: Urine and salt samples collected from school children and determined by ammonium persulfate digestion method and iodometric method respectively.

Results: The Median Urinary Iodine Concentration of 245 µg/L was observed and 53% of households accessing adequately iodised salt.

Conclusions: Iodine deficiency still no longer a public health concern in Zambia; however, Universal Salt Iodisation not attained.

Open Access Conference Proceeding (Abstract)

Hookworm and S. haematobium infections, unlike Afebrile P. falciparum Malaria, do not Impair Intestinal Iron Absorption

Dominik Glinz, Richard F. Hurrell, Aurélie A. Righetti, Christophe Zeder, Lukas G. Adiossan, Harold Tjalsma, Jürg Utzinger, Eliézer K. N' Goran, Rita Wegmüller

European Journal of Nutrition & Food Safety, Page 430-431
DOI: 10.9734/EJNFS/2015/20895

Objectives: In sub-Saharan Africa, parasitic diseases and low intake of bioavailable iron are the main causes of anemia. Anemia is further increased by inflammation during malarial infections blocking iron recycling and decreasing iron absorption. The influence of hookworm and Schistosoma infections on iron absorption and recycling is not known. Our objectives were to compare the influence of malaria, hookworm, and Schistosoma infections on inflammation, iron absorption and iron incorporation.

Methods: Ivorian adolescents (12-17 years) presenting with a single infection of afebrile P. falciparum, hookworm or S. haematobium consumed 200 mL of test syrup containing 3 mg iron as ferrous sulfate labeled with 57Fe. Fractional absorption of the stable iron isotope was measured during infection and two weeks after treatment when subjects were free of infection. Erythrocyte incorporation of intravenous iron labeled with 58Fe and inflammation biomarkers were also measured.

Results: Geometric mean iron absorption was 12.1% (95% CI: 9.2 - 18.0) during afebrile P. falciparum infection and increased to 23.6% (95% CI: 19.6 - 28.5) (P < 0.05) after treatment. Inflammation biomarkers were elevated during malarial infection and decreased after treatment. Light to moderate hookworm and S. haematobium infections did not increase inflammation and did not influence iron absorption (P > 0.05). Erythrocyte incorporation of intravenous iron was not affected by P. falciparum, hookworm or S. haematobium infections (P > 0.05).

Conclusions: Unlike afebrile P. falciparum infection, light to moderate hookworm and S. haematobium infections do not lead to low-grade inflammation, and do not decrease iron absorption.

Open Access Conference Proceeding (Abstract)

Liver intake in 24-59-month-old Children from an Impoverished South African Community Provides Enough Vitamin A to Meet Requirements

Martha E. Van Stuijvenberg, Jana Nel, Serina E. Schoeman, Lisanne M. du Plessis, Muhammad A. Dhansay

European Journal of Nutrition & Food Safety, Page 432-433
DOI: 10.9734/EJNFS/2015/20896

Objectives: To assess the contribution of liver to the vitamin A intake of 24-59-month-old children from an impoverished South African community where liver is frequently consumed. Vitamin A deficiency was previously shown to be absent in this community, but the prevalence of stunting was high.

Methods: Vitamin A intake from liver was assessed in 150 children using a single 24-hour recall and a quantified liver frequency questionnaire. In addition, information on vitamin A intake via the national fortification programme was obtained from the 24 h-recall, and information on vitamin A supplementation from the Road-to-Health Chart.  Height, weight, and socio-economic data were also collected.

Results: Stunting, underweight and wasting were prevalent in 36.9%, 25.5% and 12.1% of children. Mean vitamin A intake from liver was 537 and 325 µg RE measured by the 24-hour recall and liver frequency questionnaire, respectively. Liver was consumed in 92.7% of households and by 84.7% of children; liver intake was inversely related to several indicators of socio-economic status (p< 0.05). The food fortification programme contributed 80 µg RE, and the vitamin A supplementation programme 122 µg RE to vitamin A intake.

Conclusions: The study showed that liver alone provided more than 100% of the Estimated Average Requirement of the pre-school children in this impoverished community. The results also challenge the notion generally held by international health bodies that vitamin A deficiency, poor anthropometric status, and poverty go together, and reinforces the fact that South Africa is a diverse country for which targeted rather than blanket interventions are required.

Open Access Conference Proceeding (Abstract)

Burden of Micronutrient Deficiencies by Socio-economic Strata in Children aged 6 Months to 5 years in the Philippines

Simon Wieser, Rafael Plessow, Klaus Eichler, Olivia Malek, Mario V. Capanzana, Imelda Adgeppa, Urs Bruegger

European Journal of Nutrition & Food Safety, Page 434-435
DOI: 10.9734/EJNFS/2015/20897

Objectives: Micronutrient deficiencies (MNDs) have severe health consequences and are particularly harmful during early childhood. We estimate the burden of iron deficiency (IDA), vitamin A deficiency (VAD) and zinc deficiency (ZnD) in 2 age groups (6-23 and 24-59 months) of Filipino children by socio-economic strata in 2008.

Methods: We build a health economic model simulating the consequences of MNDs in childhood over the entire lifetime. The model is based on a health survey and a nutrition survey carried out in 2008. Direct medical costs, production losses and intangible costs are computed and long term costs are discounted to present value.

Results: Total lifetime costs of IDA, VAD and ZnD amounted to direct medical costs of 30 million dollars, production losses of 618 million dollars and intangible costs of 122,138 disability adjusted life years (DALYs). Direct medical costs are dominated by costs due to ZnD (89% of total), production losses by losses in future lifetime (90% of total) and intangible costs by premature death (47% of total DALY losses) and losses in future lifetime (43%). Costs of MNDs differ considerably between socio-economic strata (SES) as costs in the poorest third of the households are 5 times higher than in the wealthiest third.

Conclusions: MNDs lead to substantial costs in 6-59-month-old children in the Philippines. Costs are highly concentrated in the lower SES and in children 6-23 months old. These results may have important implications for the design, evaluation and choice of the most effective and cost-effective policies aimed at the reduction of MNDs.

Open Access Conference Proceeding (Abstract)

Cost-Effectiveness of Price Reductions in Fortified Powdered Milk for the Reduction of Micronutrient Deficiencies in 6-23 Month Old Children in the Philippines

Simon Wieser, Beatrice Brunner, Rafael Plessow, Klaus Eichler, Noel Solomons, Olivia Malek, Joerg Spieldenner, Urs Bruegger

European Journal of Nutrition & Food Safety, Page 436-437
DOI: 10.9734/EJNFS/2015/20898

Objectives: To estimate the effectiveness and cost-effectiveness of price-based interventions with commercially distributed packaged fortified powdered milk (FPM) for the reduction of iron and vitamin A deficiencies in 6-23 months old Filipino children.

Methods: We carried out a survey stratified by socio-economic status among 1600 households and performed a hypothetical marketing experiment to estimate the price elasticity of the demand for FPM. These results were then combined with a systematic review on the efficacy of food fortification in controlled trials and with a model of the lifetime cost-consequences of micronutrient deficiencies (MNDs) in infancy.

Results: While a high proportion of children living in wealthier households consume substantial amounts of FPM, consumption is much lower in poorer households. Demand for FPM is considerably more elastic in poor households (price elasticity of -0.8 in lowest versus -0.3 in the highest socio-economic decile). A relative 20% reduction in disability adjusted life years (DALYs) lost can be achieved by discounting prices by 30% among the poorest 20% of the population. This intervention has a cost-effectiveness ratio of 329 USD per DALY gained.

Conclusions: Interventions with commercially distributed FPM have the potential to efficiently reduce the burden of MNDs in the Philippines. Interventions targeting poor households are more cost-effective because of the higher prevalence of MNDs, lower levels of current consumption and higher price elasticity of demand.  These results may have important implications for the design and implementation of complementary feeding interventions aimed to reduce MNDs.

Open Access Conference Proceeding (Abstract)

Adequacy of Iron and Zinc Contents and Estimated Bioavailability in Commercially Available Complementary Foods in Ethiopia

Endale Amare, Claire Mouquet-Rivier, Isabelle Rochette, Christian Picq, Abdulaziz Adish, Gulelat Desse

European Journal of Nutrition & Food Safety, Page 438-439
DOI: 10.9734/EJNFS/2015/20899

Objectives: Evaluate the adequacy of iron and zinc contents and estimated bioavailability of complementary foods (CFs) processed in Ethiopia.

Methods: Seven locally-produced fortified and non-fortified cereal-based CFs were purchased from supermarkets in Addis Ababa, Ethiopia. Iron and zinc contents were determined by atomic absorption spectrometry and results were compared with recommendations for fortified CFs. Phytate particularly myo-inositol hexaphosphate (IP6) was determined using high-performance anion-exchange chromatography. Iron and zinc bioavailability was estimated by calculating IP6-to-mineral molar ratios.

Results: Iron and zinc contents of CFs were in the range of 5.85-22.31 and 0.80-12.07 mg/100g DM, respectively. The contribution to iron and zinc requirement assuming a daily intake of CF equal to the recommendations  (i.e. 40 and 60 g for the 6-11 and the 12-23 month-old children, respectively) was 21-81% and 6-97% for 6-11 months and 50-100% and 10-100% for 12-23 month-old children respectively. With IP6 content in the range of 235-893 mg / 100 g DM, the molar ratios of [IP6]:[Fe](0.89-7.07) and [IP6]:[Zn] (1.93-30.63) were above the recommendations for most CFs analyzed.

Conclusions: All CFs analyzed had iron content below the recommendation for 6-11 month-old children but 5 out-of 7 CFs contained adequate iron for 12-23 month-old children. Regarding zinc, only 2 out-of 7 CFs could contribute to more than 80% of the requirement for both age groups. Mineral-to-phytate molar ratios also predicted low bioavailability. Therefore, manufacturers need to consult nutritionists to define proper fortification of processed CFs and for further modification of their processing methods to improve mineral bioavailability, so that children meet their daily nutrient requirements.

Open Access Conference Proceeding (Abstract)

Acceptability of and Willingness to Pay for Micronutrient Powder in Somaliland

Adam Haibeh, Megan Kays, Aden Qodax, Abel Irena, Manuela Tolmino

European Journal of Nutrition & Food Safety, Page 440
DOI: 10.9734/EJNFS/2015/20900

Objectives: Under five nutritional deficiencies in Somaliland constitute a major health concern. In response, Population Services International (PSI) undertook a study to examine practices related to acceptability of and willingness to pay for (WTP) MNP.

Methods: 72 female caregivers from different socioeconomic groups trialed MNP. Focus group discussions on MNP were conducted with the trialists, a control group of 120 female caregivers, and 30 men. WTP exercises, using both the price sensitivity meter (PSM) and Becker-DeGroot-Marschak (BDM) methods were conducted with women.

Results: 95.7% of the MNP trialists used the product; 61.2% would use MNP in the future. 64.2% would prefer to purchase in pharmacies and 28.4% in clinics. Although the PSM exercise indicated a high WTP (4,596 Somaliland Shillings), the BDM exercise resulted in a lower value (2,773 SS). 45.7% bid above the estimated cost (2,958 SS ) and the average bid 93.7% of the estimated cost.

Conclusions: MNP would, therefore, be a suitable product for Somaliland; it is relevant to nutrition needs and caregivers show WTP close to the product's cost recovery price, necessitating minimal subsidies.

Open Access Conference Proceeding (Abstract)

Zambia's Micronutrient Program Portfolio Options: A Vitamin A Case Study, 2013 to 2042

John L. Fiedler, Keith Lividini

European Journal of Nutrition & Food Safety, Page 441-442
DOI: 10.9734/EJNFS/2015/20901

Objectives: There is an urgent need to better understand the interactions of multiple nutrition programs so that they can be managed more effectively to improve coverage and impact, reduce costs and protect persons from the risk of excess micronutrient intakes. The objective was to examine Zambia’s micronutrient program portfolio options over the next 30 years.

Methods: 2006 Living Conditions Monitoring Survey food consumption and acquisition data and a Zambian food composition table were used to estimate usual intakes of calories and key micronutrients and the prevalence of inadequate intakes. The annual coverage, impact and cost of six vitamin A interventions were analyzed. The interventions included four potentially fortifiable staples, vitamin A supplementation through Child Health Week (CHW) and a biofortified high pro-vitamin A maize. All 62 possible combinations of the six interventions’ annual costs, changes in the prevalence of inadequate intake and the total number of disability-adjust life years (DALYs) saved annually were estimated from 2013-2042, drawing on the IFPRI IMPACT model’s predictions of food production and consumption patterns.

Results: Oil and sugar offer the greatest coverage (67%-69%) while biofortification can reach greater than 50%. Supplementation and sugar and oil fortification produce the greatest impacts.  The most cost-effective 1, 2, and 3-program interventions portfolios are oil fortification; oil plus biofortification; and oil plus biofortification and supplementation.

Conclusions: Each intervention plays a significant role in combating micronutrient deficiency in Zambia. The choice of combinations of the specific vehicles and the order in which interventions are sequenced affects the optimal mix.

Open Access Conference Proceeding (Abstract)

Zinc added in Different Amounts to Small-quantity Lipid-based Nutrient Supplements (SQ-LNS) or provided as a Tablet did not affect Diarrhea or Malaria Morbidity in young, Rural Burkinabe Children

Jérôme W. Somé, Souheila Abbeddou, Elizabeth Yakes Jimenez, Zinéwendé P. Ouédraogo, Rosemonde M. Guissou, Janet M. Peerson, Sonja Y. Hess, Steve A. Vosti, Jean-Bosco Ouédraogo, Kenneth H. Brown

European Journal of Nutrition & Food Safety, Page 443-444
DOI: 10.9734/EJNFS/2015/20902

Objectives: Meta-analyses find that supplemental zinc reduces the incidence of diarrhea and acute lower respiratory tract infections, but its effect on malaria is inconsistent. We assessed the effects of different amounts of zinc in SQ-LNS compared with zinc in a dispersible tablet on the incidence of diarrhea and malaria in young children in a community-based, double-blind, placebo controlled, randomized trial in rural, southwestern Burkina Faso.

Methods: 2469 children 9 months of age, were assigned to receive one of four interventions: LNS without zinc and placebo tablet (LNS-Zn0; negative control), LNS with 5 mg zinc and placebo tablet (LNS-Zn5), LNS with 10 mg zinc and placebo tablet (LNS-Zn 10) and LNS without zinc and 5 mg zinc tablet (LNS-TabZn5; positive control). Children received 20 g of LNS and one placebo or zinc tablet daily for 9 months. Weekly morbidity surveillance was conducted at children's homes; malaria treatment was provided for confirmed malaria, and ORS provided for reported diarrhea.

Results: Prevalence of malaria at baseline (59.4% overall) did not differ among groups. During the 9-month follow-up, the incidence of diarrhea was 1.15 (±1.18 SD) and the incidence of malaria was 0.55 (±0.54 SD) episodes per 100 child-days, and did not differ by treatment group (p=0.673 and p=0.535, respectively). Incidence of severe diarrhea and severe malaria also did not differ by treatment group.

Conclusions: The inclusion of 5 or 10 mg zinc in SQ-LNS did not affect diarrhea or malaria morbidity compared to both positive and negative control groups in this population.

Open Access Conference Proceeding (Abstract)

Food Fortification in India: A Literature Review

Pam Liu, Subrata Kumar Dutta, Rita Bhatia, Helena Pachón

European Journal of Nutrition & Food Safety, Page 445
DOI: 10.9734/EJNFS/2015/20903

Objectives: The purpose of this review was to identify and analyze single or multiple micronutrient (MMN) food fortification studies for their efficacy and effectiveness in India.

Methods: A comprehensive fortification search (n=10 databases) was completed, and retrieved citations were screened by two independent researchers. Data were abstracted from selected published documents to summarize intervention designs and results on human health indicators (biological markers, anthropometry, cognition, morbidity).

Results: Forty-seven published studies conducted in 13 Indian states and comprised mainly of randomized controlled trials (n=26) were included for analysis. The food vehicles were cereals (e.g. wheat, rice, (n=6)), oils and salts (n=18), and other (e.g. beverages, school meals, (n=23)). Children ≤12 y were the main targeted population (n=36). Improvements in one or more biological markers were reported in 76.9% of all publications and in 91.3% reporting MMN fortification. Improvements in ≥1 iron biomarker were noted in all documents (n=9) using iron as the sole fortificant. Eight of 18 documents showed a positive impact of fortification on anthropometry, of which 7 fortified with MMNs. Improvements in cognitive domains were observed in 3 of 7 publications, all of which were MMNs. Morbidity symptoms improved in 1 of 9 publications.

Conclusions: Food fortification research in India suggests it effectively improves biological markers of nutritional status, particularly when fortifying with MMNs or iron. MMN fortification consistently improved anthropometric but not cognitive outcomes. Fortification had limited impact on morbidity symptoms. Evidence of fortification effects on other functional outcomes is scarce.

Open Access Conference Proceeding (Abstract)

The Contribution of Wheat Flour Fortification to Reducing Anemia in Indonesia

Katherine Kendrick, Karen Codling, Siti Muslimatun, Helena Pachon

European Journal of Nutrition & Food Safety, Page 446-447
DOI: 10.9734/EJNFS/2015/20904

Objectives: Mandatory wheat flour fortification with iron, zinc, thiamine, riboflavin, and folic acid became effective in Indonesia in 2002. There are no evaluations of its effectiveness on reducing anemia. This study estimated the contribution of fortified wheat flour to changes in hemoglobin concentration and anemia prevalence from the period before to after the introduction of mandatory fortification.

Methods: The Indonesian Family Life Survey is a longitudinal study that followed over 30,000 Indonesians. Data from 6,488 non-pregnant women of child-bearing age with hemoglobin measurements in 1997, 2000, and 2007 were analyzed. Anemia prevalence was calculated, adjusting for smoking status and altitude. Households were categorized by their food purchases. Logistic regression was used to predict the effect of covariates on anemia status, while linear regression was used for hemoglobin concentration.

Results: Mean hemoglobin significantly increased (p<0.0001) and anemia prevalence significantly decreased (p<0.0001) from the pre-fortification period during 1997-2000 (12.35 g/dL & 34.0%) to the post-fortification period in 2007 (12.67 g/dL & 25.1%). The proportion of weekly household food expenditures spent on foods containing heme iron and flour remained constant from 1997 to 2007. The percentage of household-purchased foods containing heme iron and flour, only heme iron, only flour, or neither in the past week was not significantly associated with hemoglobin concentration or anemia status.

Conclusions: Wheat flour fortification does not appear to have significantly contributed to the reduction in anemia prevalence among women of child-bearing age in Indonesia. It is recommended that the fortification iron source be changed from electrolytic iron to a more bioavailable form.

Open Access Conference Proceeding (Abstract)

Is Weekly Iron Folic Acid Supplementation and Deworming in Vietnamese Women of Reproductive Age Sustainable? The Yen Bai Cohort 6 Years on

Beverley-Ann Biggs, Gerard Casey, Ta Tinh, Nong Tien, Luca Cavalli-Sforza, Antonio Montresor

European Journal of Nutrition & Food Safety, Page 448-449
DOI: 10.9734/EJNFS/2015/20905

Objectives: Weekly iron-folic acid supplementation (WIFS) and regular deworming for women of reproductive age (WRA) is an effective way of preventing anaemia and iron deficiency in a population but long-term sustainability is challenging. The objectives of this study were to:
1) Determeine the effectiveness of a free WIFS and biannual deworming program for WRA that has been implemented in rural Vietnam for six years.

2) Assess compliance and identify challenges and barriers to ongoing sustainability.

Methods: In July 2012, we conducted a follow-up survey in this rural mountainous province to evaluate haematological parameters (haemoglobin and ferritin), soil transmitted helminth burden and compliance in a cohort of women first recruited in 2005, and who have had access to an externally funded WIFS/deworming program since May 2006.

Results: Of the original cohort of 389, 256 (65.8%) women attended the survey. Mean haemoglobin had increased to from 122 g/L [95% C.I. 120, 124] to 135g/L [95% C.I. 133g/L, 138g/L] and anaemia prevalence reduced from 37.8% [95% C.I. 31.0%, 44.7%] to 14.3% [95% C.I. 9.5%, 19.1%]. The prevalence of hookworm infection was lower at 10.2% [95% C.I. 5.4%, 15.0%]. Seventy two per cent of survey participants continued to take the weekly supplements regularly. Without further support the WIFS program will cease in 2014.

Conclusions: Anaemia rates continued to fall duringr the six year period, and soil transmitted helminth infections have been eliminated as a public health risk. Complianace was well maintained but sustainability is a major challenge. The issues surrounding long term sustainability of WIFS for WRA will be discussed.

Open Access Conference Proceeding (Abstract)

Association of Iron, Zinc, and Vitamin a Maternal Plasma Levels with Breast Milk Composition in Rural Southern Ethiopia

Tesfaye Hailu Bekele, Susan J. Whiting, Hiwot Abebe, Cherinet Abuye

European Journal of Nutrition & Food Safety, Page 450-451
DOI: 10.9734/EJNFS/2015/20906

Objectives: Nutritional status of mothers in Ethiopia is currently a major public health concern. There are three key factors of maternal nutrition that could have an impact on human milk composition: Dietary intake, nutrient store, and alterations in nutrient utilization. The aim of this study is to assess the association between maternal plasma status and breast milk content of iron, zinc and vitamin A.

Methods: Community-based cross sectional data were collected from April to May 2012 from mothers living in the Boricha district of southern Ethiopia who were lactating and had infants between 6-12 months. Plasma levels and breast milk composition of iron, zinc, and retinol were assessed using HPLC, and AAS. Pearson’s correlations were performed to identify any associations betweenplasma levelsandbreast milk content of these micronutrients.

Results: The prevalence of anemia (Hb< 120 g/L), zinc deficiency (plasma zinc < 0.7 mg/L), and vitamin A deficiency (plasma retinol ≤ 30 μg/dL) was 36%, 100% and 7.3%, respectively. Breast milk iron (0.24±0.1 mg/L) and breast milk zinc (0.08±0.06 mg/L) showed no relationship to plasma levels. The breast milk retinol (128.6±22.0 μg/L) showed a significant association with plasma retinollevels (r=0.22, p<0.05).

Conclusions: Maternal micronutrient malnutrition is a serious problem in the Boricha district. Our results support other studies that demonstrate low vitamin A status reduces levels in milk. This can have detrimental effects on children whose complementary food intake may be of poor nutritional quality.

Open Access Conference Proceeding (Abstract)

Dietary Intakes Based on food Composition Data May underestimate Contribution of Potentially Exchangeable Contaminant Iron from Soil

Rosalind S. Gibson, Anna A. Wawer, Rachel Hurst, Scott Young, Martin R. Broadley, Allan D. C. Chilimba, Louise Ander, Michael J. Watts, Benson Chilima, Jellita Gondwe, Dalitso Kang’ombe, Alexander Kalimbira, Susan J. Fairweather-Tait, Karl B. Bailey, Edwin W. P. Siyame

European Journal of Nutrition & Food Safety, Page 452-453
DOI: 10.9734/EJNFS/2015/20907

Objectives: Soil-iron contaminant has the potential to contribute to total iron intakes, depending in part on food preparation practices, although whether contaminant iron joins the common non-heme iron pool and is available for absorption is uncertain. Therefore we compared dietary Iron intakes analyzed from diet composites with those calculated from food composition data and examined them in relation to iron biomarkers, adjusted for inflammation.

Methods: Weighed duplicate diet composites, diet records, and fasting blood samples were collected on the same day from a convenience sample of women aged 18 to 50 y from Zombwe in Mzimba (n=60) and Mikalango in Chikhwawa (n= 60) in rural Malawi. Diet composites were analyzed by ICP-MS, and blood for hemoglobin, ferritin, transferrin receptor, and inflammatory biomarkers.

Results: Median analyzed iron intakes (mg/d) were higher than calculated intakes in Zombwe (16.6 vs. 10.1; p<0.001) and Mikalango (29.6 vs. 19.1; p<0.001) and accompanied by high levels of Al and Ti, markers of soil contamination. Less than 15% of women had storage iron depletion (ferritin 12 µg/L and haemoglobin >120 g/L) or iron deficiency (total body Fe<0 mg/kg), despite negligible intakes of readily absorbable heme iron and high phytate intakes in both districts.

Conclusions: Assessment of iron intakes from food composition data where soil contaminant iron is likely yielded an underestimate of total iron intake. Some contaminant iron may be exchangeable and available for absorption, depending on soil mineralogy. In such settings, collection and chemical analysis of weighed duplicate diet composites are preferable for assessing total iron intakes.

Open Access Conference Proceeding (Abstract)

Vitamin A and Zinc Status of Children 0-5 Years Living in Ten Orphanages of Abuja, Nigeria

Ngozi Nnam, Chizoba Steve-Edemba

European Journal of Nutrition & Food Safety, Page 454-455
DOI: 10.9734/EJNFS/2015/20908

Objectives: Vitamin A and zinc are very important micronutrients for normal growth and development of a child. Vitamin A deficiency predisposes children to infectious diseases and poor growth. Zinc deficiency inhibits growth in children and reduces the child's ability to utilize vitamin A. Dietary intake of the micronutrients may not give accurate picture of the micronutrient status of a child because of bioavailability and bio-conversion. The study examined the vitamin A and zinc status of children (0-5 years) living in ten orphanages of Abuja, Nigeria. The result will provide evidenced based information for nutrition intervention in the orphanages.

Methods: Two hundred under-five orphans aged 0-59 months living in ten orphanages in Abuja, Nigeria were used for the study. Serum retinol and serum zinc levels of the children were determined using High Performance Liquid Chromatography (HPLC) and Atomic Absorption Spectrometry, respectively. Results were compared with normal serum retinol > 20 µg/dl and serum zinc >80 µg/dl.

Results: Twenty percent of the children had mean serum retinol level of 19.38 µg/dl (<20 µg/dl), which is indicative of vitamin A deficiency while eighty percent had normal serum retinol level (mean value of 28.21 µg/dl). Sixty percent of the children were zinc deficient with mean serum      zinc level of 56.87 µg/dl (<80 µg/dl) while 40% had normal zinc levels with mean serum zinc of 94.52 µg/dl.

Conclusions: Some of the children are deficient in vitamin A and zinc. There is need for nutrition intervention to improve dietary intake of vitamin A and zinc rich foods in the orphanages.

Open Access Conference Proceeding (Abstract)

Iron Status of Children Aged 6-59 Months in Kaduna State of Nigeria

Ngozi Nnam, Esther Okwori, Paul Eme

European Journal of Nutrition & Food Safety, Page 456
DOI: 10.9734/EJNFS/2015/20909

Objectives: Iron deficiency and iron deficiency anaemia (IDA) are serious public health problems in Nigeria especially in the under-five children. Iron is of great importance for adequate development of brain, which is completed by age 5. Iron deficiency has serious consequences for cognitive, psychomotor, physical and mental development of children. Iron deficiency in childhood lowers IQ scores, impairs mental development and psychomotor functions, reduces work capacity and causes irreversible abnormalities in brain growth and differentiation. The study examined the iron status of children 6-59 months in Kaduna State of Nigeria. The result of the study will be useful in planning nutrition programmes for under- five children in the State.

Methods: Eighty under- five children aged 6-59 months were used for the study. Their iron status was assessed using haemoglobin levels. Haemogloblin was determined using the Cyanomethemoglobin method.

Results: Haemoglobin (Hb) levels showed that 22.6% of the children had mild anaemia (Hb 10.00-10.99 g/dl), 15.50% had moderate anaemia (Hb 8.00-9.99 g/dl), 15.50% had severe anaemia (Hb <8.00 g/dl) while 46.40% were normal (Hb ≥11.00 g/dl). More than 50% of the children were anaemic.

Conclusions: There is high prevalence of anemia in the children studied. Nutrition intervention to improve iron status of U-5 children in Kaduna State of Nigeria is imperative to save the children from irreversible abnormalities in brain growth and development.

Open Access Conference Proceeding (Abstract)

Achieving USI in Pakistan by Improved Quality Control and Better Government Ownership and Capacity

Tausif Akhter Janjua, Khawaja Masuood Ahmed, Noor Ahmad Khan, Zia Haider

European Journal of Nutrition & Food Safety, Page 457-458
DOI: 10.9734/EJNFS/2015/20910

Objectives: An evaluation in 2010 of 850 processors involved for over a year in a Universal Salt Iodization (USI) support program indicated 36% of their salt as adequately iodized. The main reasons were identified as limited technical capacity of medium and large salt processors for quality control, and inadequate monitoring and enforcement by regulatory authorities due to the large number of processors and geographical spread of the industry.

The objective of the program was to increase the proportion of salt containing ≥ 30 ppm iodine by strengthening the capacity of the government to provide external quality assurance support to processors while also enforcing regulations.

Methods: To ensure an adequate regulatory framework, the program facilitated enactment of USI legislation in 56 districts. District and provincial Iodine Deficiency Disorders Control Committees were established and activated to oversee external monitoring. Health managers, food and sanitary inspectors and field monitoring staff were trained on quality control and 64 quality control laboratories were established. Salt samples were collected from 1350 salt processors and tested on regular basis. Data on iodization levels was analyzed, provided as feedback regularly to salt processors and used to inform further technical assistance needs.

Results: The proportion of salt containing ≥ 30ppm iodine increased from 36% in 2010 to 57% in 2012.

Conclusions: Strengthened monitoring and mechanisms for effective enforcement within a strengthened enabling environment plausibly contributed significantly to increased availability of adequately iodized salt in Pakistan and to improved population iodine status.

Open Access Conference Proceeding (Abstract)

Low Intake of Calcium and Vitamin D is Associated with Stunting in 2-5-Year-Old Children from an Impoverished South African Community

Martha E. van Stuijvenberg, Jana Nel, Serina E. Schoeman, Lisanne M. du Plessis, Muhammad A. Dhansay

European Journal of Nutrition & Food Safety, Page 459-460
DOI: 10.9734/EJNFS/2015/20911

Objectives: To identify nutritional and other factors contributing to the high levels of stunting in 2-5-year-old children from an impoverished South African community where liver is frequently eaten and vitamin A deficiency known to be absent.

Methods: Dietary intake was assessed by a single 24-hour recall (n=149). Heights were measured, and information was obtained on breastfeeding history, current milk intake, and substance use during pregnancy.

Results: The prevalence of stunting was 36.9% and increased with age (49% in the 4-5-year-old category). Median intake of energy, carbohydrate and protein was adequate. Median intake for all micronutrients was at least 80% of the EAR, except for calcium, vitamin D and vitamin E, which was 21%, 15%, and 32%, respectively. Median intake of iron, zinc, niacin, vitamin B6 and vitamin B12 exceeded 200% of the EAR. There was a significant difference in intake of fat, calcium, phosphorous, vitamin D, riboflavin and vitamin B12 between children who were stunted and those not stunted (p<0.05). There was also a significant difference in height-for-age between children who drank milk and those who did not (p=0.004). Birth weight correlated significantly with height-for-age (r=0.250; p=0.003); birth weight was lower when mothers smoked and used alcohol during pregnancy than when they abstained (2425g vs 2961g; p<0.0001).

Conclusions: Low intake of calcium and vitamin D, presumably due to inadequate milk intake after weaning, seems to significantly contribute to the high levels of stunting in this community.  Smoking and alcohol use during pregnancy, resulting in low birth weight, also seems to play an important role.

Open Access Conference Proceeding (Abstract)

Engaging the Community in the Design and Implementation of an Intervention to Increase Household Consumption of Iodised Salt in Khyber Pakhtunkhwa, Pakistan

Nicola Lowe, Elizabeth Westaway, Akhtar Munir, Saba Tahir, Fiona Dykes, Monique Lhussier, Mick McKeown, Mukhtiar Zaman

European Journal of Nutrition & Food Safety, Page 461-462
DOI: 10.9734/EJNFS/2015/20912

Objectives: Pakistan's Iodine Deficiency Disorders Control Programme (IDDCP) was launched in 1994 however, approximately half of Pakistan's population of 200 million are affected with IDD. The National Nutrition Survey in Pakistan revealed marked provincial variation; within Khyber Pakhtunkhwa (KP), 25.7% of children 6-12 years of age have some form of IDD. The objective of this research was to engage the community in the design and implementation of an intervention to increase awareness, knowledge and promote use of iodised salt in KP.

Methods: The study was undertaken in a community of 5,000 households, living in chronic rural poverty. A baseline survey of 1,043 households and 28 shopkeepers was conducted and focus groups were held with a range of stakeholders to explore the barriers to iodised salt use. Thematically analysed transcripts informed the design of a 4-month intervention, including leaflet and poster distribution, house to house visits, education sessions in schools, and awareness-raising through religious and social gatherings and a health centre.

Results: At baseline, 2.6% of households reported use of iodised salt and 3.5% knew of its health benefits. 67.9% of shopkeepers stocked iodised salt, which cost Rs. 5-7 more than simple salt. Reasons for not using iodised salt included expense (35.7%), belief about a negative impact on reproduction (42.9%) and lack of awareness (7.1%). Following the intervention, iodised salt sales from the local shops increased by 45%.

Conclusions: Engaging the community in the design and implementation of an intervention helped to overcome the barriers to the use of iodised salt.

Open Access Conference Proceeding (Abstract)

Effects of Governance Structures in Ethiopia on Implementation of Nutrition Interventions

Eileen Kennedy, Masresha Tessema, Aregash Samuel, Tarik Kassaye, Habtamu Fekadu, Tesfaye Hailu, Tsehay Assefa, Desalegn Kuche, Girmay Ayana, Dilnesaw Zerfu, Tibebu Moges, Adamu Belaye, Abinet Tesfaye

European Journal of Nutrition & Food Safety, Page 463-464
DOI: 10.9734/EJNFS/2015/20913


1. Assess factors that enhance or constrain implementation of nutrition interventions at national and sub national levels.

2. Analyze how direct nutrition interventions and multi sector approaches are implemented at national, regional, zonal and woreda levels.

3.  Identify models of effective governance for nutrition interventions.

Methods: Key informants were interviewed using a structured questionnaire. National level interviews from the agricultural, health, education, finance, economic development, social protection sectors and UN agencies, civil society and donors were included. Parallel interviews were conducted in four regions - Amhara, Oromia, SNNPR and Tigray - and 16 woredas for a total of 312 interviews at the subnational level.

Results: While there was general awareness of the Government's activities as part of the SUN movement, key individuals at the national level were, in general, not able to identify specific actions that had been launched as a result of the 2013 National Nutrition Programme.

Linkages between policy and program initiatives between national and sub national levels varied. The vertical and horizontal collaborations were most active where a specific, coordinating body or mechanism had been established.

Several models of effective implementation are identified and most often originate outside the health sector.

Conclusions: Two dominant models of implementing a multi pronged strategy to alleviate malnutrition exist in Ethiopia.  The appropriateness of these models and factors associated with each are discussed.

Open Access Conference Proceeding (Abstract)

Effect of Demographic Variables on 25(OH)D Level and on the Risk of Vitamin D Insufficiency in SEANUTS Countries

Bee Koon Poh, Nipa Rojroongwasinkul, Le Nyugen Bao Khanh, Sandjaja Sandjaja, Paul Deurenberg, Panam Parikh

European Journal of Nutrition & Food Safety, Page 465-466
DOI: 10.9734/EJNFS/2015/20914

Objectives: Vitamin D insufficiency is endemic in western countries. Emerging evidence suggests this may be true also for countries with abundant sunshine. This study aimed to evaluate the vitamin D status and associated risk factors in a sub-sample of children from the South East Asian Nutrition Surveys (SEANUTS).

Methods: SEANUTS was conducted in Indonesia, Malaysia, Thailand and Vietnam in a country representative sample of 16744 children aged 0.5 to 12 years. Information on socio-demographic variables, lifestyle habits and anthropometric measures were collected. In a sub-sample of 2016 children, serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Data were analysed using SPSS complex sample with weight factors to report population representative data.

Results: In Malaysia and Thailand, urban children had lower 25(OH)D levels than rural children. Except Vietnam, boys in all countries had higher 25(OH)D levels and older children had lower 25(OH)D levels. Regional differences persisted in all countries even after correcting for age, sex and area of residence. In Malaysia and Thailand, 25(OH)D status was also associated with religion.

The percentage of children with adequate 25(OH)D levels (>75nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50nmol/L) was noted in nearly 40% to 50% of children in all countries. Girls, urban area, region and religion significantly increased the odds of being vitamin D insufficient.

Conclusions: The high prevalence of vitamin D insufficiency in SEANUTS countries suggests a need for a tailored approach to successfully combat this problem. Promoting active and outdoor lifestyle along with food fortification can be feasible options.

Open Access Conference Proceeding (Abstract)

Vitamin a Supplementation Program in Burkina Faso: Coverage Performance during the Last Ten Years and Ways Forward

Robert L. J. C. Kargougou, Bertine Ouaro, Biram N'Diaye, Denis Garnier, Djibril Cisse

European Journal of Nutrition & Food Safety, Page 467-468
DOI: 10.9734/EJNFS/2015/20915

Objectives: Analyze the process, achieved coverages of the Burkina Faso'VAS program during the last ten years and ways forward to improve the quality of services and monitoring and evaluation system.

Methods: An indepth analysis using the conceptual framework from MI and UNICEF (2006).Thus VAS coverages from the tally-sheet system are analyzed and compared with data from DHS

Results: Data from the tally sheet system give at least 100% of VAS coverage in 83% of VAS events organized from 2001 to 2012. In 17% of case, low VAS coverage noted at the startup period of the program are associated with a lack of universal coverage based on the health district approach. Thus, the proportion of children protected against vitamin A deficiency moves from 60% in 2000 to 100% in 2012. However VAS coverage from DHS in 2003 and 2010 are lower than those provided by the tally-sheet information system during these two years (33% and 63% versus 69% and 100% of VAS coverage in 2003 and 2010, respectively). VAS coverages from survey could be affected by the lack of memory among caregivers about the service delivered.

Conclusions: This analysis shows significant progress of VAS coverage during the last ten years in Burkina Faso but the quality of services should be improved with the universal VAS coverage principle and the promotion of VAS at 6 months using the routine immunization platform. In addition post VAS event survey should be systematized as part of the quality control system.

Open Access Conference Proceeding (Abstract)

Iron Contamination in Cereal-based Products in Africa Can Challenge the Accurate Estimation of Iron Intakes

Claire Mouquet-Rivier, Kaleab Baye, Christèle Icard-Verniere, Jean-Pierre Guyot

European Journal of Nutrition & Food Safety, Page 469-470
DOI: 10.9734/EJNFS/2015/20916

Objectives: To characterize the changes in iron content through cereal processing for a better evaluation of iron intakes and its origin.

Methods: Most frequently used processing methods of maize, millet, sorghum, barley, wheat and teff were followed (n≥3) in households in Benin, Burkina Faso and Ethiopia. Iron contents in raw materials, intermediary and final products were analyzed by atomic absorption spectrometry. In vitro iron dialyzability studies were performed on final products to characterize iron behavior during digestion.

Results: Threshing, decortication, soaking, milling, sieving, fermentation and cooking were the unit operations most often included in traditional processing of cereals. Although decortication or soaking led to iron losses, other processing steps often led to substantial increases in iron contents (3 to 10 times or more) in final products. This contaminant iron came either from the soil or from processing equipments used for decortication and milling or cooking utensils.

After in vitro digestion of dishes prepared with iron-contaminated or uncontaminated flours, the contaminant iron was mainly found in the insoluble fraction and thus not likely available for absorption. However, in some cases, a small proportion of the contaminant iron was found in the soluble or dialyzable fractions, suggesting that a very small part could be absorbable.

Conclusions: Iron content in “as eaten foods” is the result of gains and losses that occur during processing. Contaminant iron in African cereal-based foods may lead to an overestimation of the satisfaction of iron requirement, implying the necessity to determine the share between intrinsic and extrinsic iron.

Open Access Conference Proceeding (Abstract)

Enhancing Salt Iodization Programs in Africa through the Establishment of Financially Viable Potassium Iodate (KIO3) Supply Systems

Greg S. Garrett, Roman Prczewlofsky

European Journal of Nutrition & Food Safety, Page 471-472
DOI: 10.9734/EJNFS/2015/20917

Objectives: Donated or subsidized KIO3 for Universal Salt Iodization (USI) programs supports iodization in resource-constrained contexts. However, sustainable and reliable supply systems are required. To address this, GAIN supported the establishment of financially viable supply systems with KIO3 cost recovery to ensure a stable and quality supply in Ghana and Ethiopia where donated KIO3 has previously been supplied.

Methods: National assessments of KIO3 supply reviewed annual demand, iodization capacity, current donations and subsidies, and existing procurement and distribution arrangements. GAIN then tailored revolving fund systems with mechanisms to: accurately forecast demand; recover costs to replenish stocks from approved suppliers; and effectively distribute stock. Two hosting institutions were recommended: Environmental Processing & Associates Ltd (EPA) in Ghana and the Pharmaceutical Fund and Supply Agency (PFSA) in Ethiopia.

Results: Since establishment in 2011, using initial GAIN-supplied seed stock, the EPA system has functioned as an independent business, purchasing and effectively distributing 6.5 MT of KIO3. This helped produce 1,750 MT of iodized salt monthly, sufficient to cover 5.8 million Ghanaians with iodized salt. The PFSA supply system, using seed stock from GAIN, UNICEF and the Micronutrient Initiative, became operational in January 2013. In August 2013 the PFSA, using recovered costs from sales, launched a tender for 14 MT of KIO3, enough to cover 55 million Ethiopians with iodized salt.

Conclusions: A well-designed KIO3 supply system which includes mechanisms for appropriate cost recovery, forecasted demand, and distribution can transform a donation-based scheme into a financially viable system with distribution in support of national USI programs in Africa.

Open Access Conference Proceeding (Abstract)

Modification of Local Diets Could Fill Gaps in B-Vitamin Intakes but Calcium, Iron, and Zinc Intake Gaps Require External Solutions for Breastfed Children in Rural Kenya

Elaine Ferguson, Peter Chege, Judith Kimiywe, Doris Weismann, Christine Hotz, Enock Musinguzi

European Journal of Nutrition & Food Safety, Page 473-474
DOI: 10.9734/EJNFS/2015/20918

Objectives: The objective of this study was to identify gaps in the adequacy of nutrient intakes, and food-based recommendations to fill those gaps, from complementary diets of 6-23 mo old children in two agro-ecological zones of rural Kenya.

Methods: In a high rainfall area of Western Kenya (Vihiga) and a semi-arid area of Eastern Kenya (Kitui), food and nutrient intakes from complementary diets of 6-8, 9-11, and 12-23 mo old breastfed children were quantified using 24-hour dietary recalls. Optifood, an automated linear programming tool, was used to identify recommended nutrient intakes (RNIs) that could not be achieved using locally available foods (problem nutrients) and optimal food-based recommendations that would improve dietary adequacy for 11 nutrients, if adopted. Model constraints ensured they conformed to local food patterns.

Results: Problem nutrients were iron and zinc (all age/location subgroups), plus calcium in Vihiga and vitamin B12 in 12-23 mo olds in Kitui. Dietary vitamins A and C were adequate in most subgroups, while most B-vitamins were moderately inadequate in most subgroups. Specific recommendations varied somewhat by subgroup, but included increased weekly servings of green leafy vegetables, legumes, existing fortified cereals, dairy products, plus millet flour and meat, fish or egg in Kitui, and sardines in Vihiga.

Conclusions: In conclusion, food-based recommendations alone can ensure >65% of RNIs for all nutrients, except for iron and zinc (all subgroups), and folate or niacin (12-23 mos), which require external solutions such as new targeted fortified foods. These results provide an evidence base for designing appropriate interventions for improved complementary diets.

Open Access Conference Proceeding (Abstract)

Addition of Zinc to Soaking Water during Parboiling Increases the Zinc Content of Bangladeshi Rice

Christine Hotz, Kandakar Kabir, Sharifa Dipti, Joanne Arsenault, Moniruzzaman Bipul

European Journal of Nutrition & Food Safety, Page 475-476
DOI: 10.9734/EJNFS/2015/20919

Objectives: In Bangladesh, zinc deficiency affects 45% of preschool children and 57% of women. As zinc deficiency is linked to child growth stunting, diarrheal disease, pneumonia, and increased risk of child mortality, large-scale programs for its prevention are required. Most rice produced in Bangladesh is parboiled and this presents a technical opportunity to increase rice zinc content by adding zinc during soaking. The objective of this study was to evaluate the increase in zinc content achievable by this strategy in milled Bangladeshi rice using local parboiling conditions, and its potential effect on adequacy of zinc intakes.

Methods: A major local rice variety (BR29) and zinc sulfate were used. Paddy was steamed for 2 minutes, soaked in distilled, deionized water for 9 hours with addition of 0, 100, 150, 200, or 300 mg zinc/kg paddy. Drained paddy was steamed in a pressurized autoclave before drying and milling. Zinc content was determined by X-Ray Fluorescence.

Results: Rice zinc content was 12.3, 16.0, 16.7, 21.6, and 23.6 mg/kg dry weight, respectively, where the highest level represents a 92% increase over the control. Using existing dietary intake data from two districts, we estimated that if parboil-fortified rice with 300 mg/kg zinc were consumed by 70% of the population, the prevalence of inadequate intakes would decrease from 34 to 16% among preschool children and 98 to 43% among women.

Conclusions: This strategy has potential to substantially decrease the prevalence of dietary zinc deficiency in Bangladesh, although the technical feasibility of implementing in large-scale mills requires further study.

Open Access Conference Proceeding (Abstract)

Assessment of Iron Bioavailability and Iron Biofortification of Staple Food Crops: Guiding the Breeding Approach with in vitro and in vivo Screening Tools

Raymond Glahn, Elad Tako

European Journal of Nutrition & Food Safety, Page 477-478
DOI: 10.9734/EJNFS/2015/20920

Objectives: The objective of this presentation will be to demonstrate how the combination of in vitro screening and an animal model can be extremely useful to develop and monitor Fe-biofortified crops, and evaluate meal plans in advance of human studies to determine if the crop is adequately biofortified with Fe prior to expensive human testing.

Methods: In recent years much has been learned about how to properly screen varieties of staple food crops to improve the Fe content and bioavailability. Research has shown that simply measuring Fe content and levels of known inhibitors such as phytic acid and total polyphenols is not adequate to guide crop breeding efforts, as it leads to misdirection because of inability to assess all of the genetic, environmental, and environment by genotype interactions that play a role in Fe bioavailability from staple foods.  Moreover, once Fe-biofortified crops are developed and released, there needs to be cost effective methodology in place to monitor and maintain the nutritional quality of successive harvests.

Results: This presentation reports on  a decade of applications of  a high throughput bioassay (in vitro digestion/Caco-2 model) and a poultry feeding model that have been developed and applied to a variety of staple food crops (eg. beans, lentils, maize, sorghum and pearl millet). Recent comparisons to human efficacy trials involving black beans, pearl millet and red mottled beans from Rwanda will be presented and discussed.

Conclusions: Overall, these results show a positive correlation with human studies and support this approach for future Fe-biofortification efforts.

Open Access Conference Proceeding (Abstract)

Acceptability of a Micronutrient Gel among Elementary School Children in Haiti

Robert Hackman, Keith Fair, Kaleab Baye

European Journal of Nutrition & Food Safety, Page 479-480
DOI: 10.9734/EJNFS/2015/20921

Objectives: School-aged children in Haiti consume a diet primarily of rice and beans, with limited sources of micronutrient-rich foods. Edible forms of micronutrient supplements must be considered, since children may not be able to safely swallow pills or capsules, and taste preferences must therefore be evaluated.

Methods: This study assessed the acceptability of a ready-to-eat micronutrient gel among 4-to 8-year old children at four school locations (two urban and two rural) in Haiti. The gels were provided in single serving stick packs. Two flavors of gel, orange or mango, were tested among 400 children. The gels were randomly assigned daily for two school weeks as a mid-morning snack, and consumption rates, hedonic ratings and safety were monitored.

Results: The gels were widely accepted.  Both the orange and mango flavors were fully consumed by over 90 percent of 6- to 8-year olds at the urban and rural locations. Intakes of 50 percent or greater were noted among 4- and 5-year olds in both locations, with the mango-flavored gel preferred in the rural locations. Hedonic ratings closely followed consumption data, and no adverse events were reported. Teachers reported that the gel was easy to dispense, and that the children thought the gel was a treat. Some teachers reported subjective improvement in attention and alertness among some of their students.

Conclusions: The sensory acceptability of a micronutrient gel that tastes good and is easy to transport, store and dispense offers a way to integrate a micronutrient intervention into elementary schools in Haiti and other countries. 

Open Access Conference Proceeding (Abstract)

The Effect of Intermittent Antenatal Iron Supplementation on Infant Outcomes in Rural Vietnam: A Cluster Randomized Trial

Sarah Hanieh, Tran Ha, Julie Simpson, Gerard Casey, Nguyen Khuong, Dang Thoang, Tran Thuy, Sant-Rayn Pasricha, Thach Tran, Tran Tuan, Terence Dwyer, Jane Fisher, Beverley-Ann Biggs

European Journal of Nutrition & Food Safety, Page 481-482
DOI: 10.9734/EJNFS/2015/20922

Objectives: Intermittent antenatal iron supplementation is an attractive alternative to daily dosing during pregnancy, however the impact of this strategy on infant outcomes remains unclear. We compared the effect of intermittent antenatal iron supplementation with daily iron supplementation on maternal and infant outcomes in rural Vietnam.

Methods: This cluster randomised trial was conducted in Ha Nam province, Vietnam. 1,258 pregnant women in 104 communes were assigned to daily iron-folic acid (IFA), twice weekly IFA, or twice weekly multiple micronutrient (MMN) supplementation. Primary outcome was birth weight.

Results: There was no difference in birth weights of infants of women receiving twice weekly IFA compared to daily IFA (mean difference [MD] 28 g; 95% CI -22 to 78), or twice weekly MMN compared to daily IFA (MD -36.8 g; 95% CI -82 to 8.2). At 32 wk gestation, maternal ferritin was lower in women receiving twice weekly compared to daily IFA (geometric mean ratio (GMR) 0.73; 95% CI 0.67 to 0.80), and in women receiving twice weekly MMN compared to daily IFA (GMR 0.62; 95% CI 0.57 to 0.68), with no difference in hemoglobin levels. Infants of mothers who received twice weekly IFA had higher cognitive scores at 6 mo of age compared to those who received daily IFA (MD 1.89; 95% CI 0.23 to 3.56).

Conclusions: Twice-weekly antenatal IFA supplementation achieved similar mean birthweight, and improved cognitive scores in infants at 6 months of age, compared to daily IFA supplementation, and should be considered for use in settings with low anemia prevalence.

Open Access Conference Proceeding (Abstract)

Modelling the Impact of Fortification on the Prevalence of Inadequate Micronutrient Intakes in Ethiopia: Results from the Ethiopian National Food Consumption Survey

Michelle Gibbs, Aregash Samuel, Sara Wuehler, Kiflu Tesfaye, Rosalind Gibson

European Journal of Nutrition & Food Safety, Page 483-484
DOI: 10.9734/EJNFS/2015/20923

Objectives: To estimate the potential impact of national fortification of wheat flour and vegetable oil on inadequate intakes of vitamin A, zinc and iron in Ethiopian women of childbearing age.

Methods: Nationally representative 24-hour dietary recall data were collected from children (6-35 months), women (15-45 years), and males (19-45 years, urban only). Prevalence of inadequate and excessive intakes of vitamin A, zinc and iron were analysed using IMAPP after adjusting usual intake distributions with external within-person variance estimates. Modelling was based on fortification of oil with vitamin A (2000 μg / 100g), and wheat with vitamin A (380 μg / 100 g), zinc (9 mg / 100 g) and iron (6 mg / 100 g).

Results: Across 8267 households, 50% and 20% of women consumed oil and wheat, respectively. Vitamin A fortification of oil and wheat was estimated to reduce inadequacy from 59% to 36%. Zinc fortification of wheat could reduce inadequacy from 61% to 50%. For iron, <1% had inadequate current intakes. It was estimated that fortification would be more effective in urban areas, despite a similar initial prevalence of inadequacy, as higher proportions consumed fortifiable products (percentage change in vitamin A inadequacy: urban 65%, rural 24%; and zinc inadequacy: urban 51%, rural 12%). Fortification with vitamin A and zinc did not expose any population sub-group to >3% excessive intakes.

Conclusions: Fortification of oil and wheat with vitamin A, and wheat with zinc could reduce inadequacy in Ethiopian women, with greatest impact in urban areas. Iron fortification is not justified as intakes appear high and fortification could expose the population to excessive intakes.

Open Access Conference Proceeding (Abstract)

Strengthening Zinc Supplementation and ORS Distribution in the Treatment of Childhood Diarrhoea in Select Rural and Urban Areas of Afghanistan through Capacity Building of Public and Private Sector Health Personnel and Strengthening Supply Chain Management

Ibrahim Shinwari, Manoj Kumar Raut

European Journal of Nutrition & Food Safety, Page 485-486
DOI: 10.9734/EJNFS/2015/20924

Objectives: Though the Government of Afghanistan has officially included zinc supplements in the diarrhoea treatment plan for young children, coverage remains abysmally low. The aim of this project is to strengthen the capacity of the government systems and involve private doctors and chemists to increase coverage and utilization of zinc along with ORS for the treatment of childhood diarrhea.

Methods: The project was implemented in diverse geographic settings through the public sector in two provinces (population of ~650,000) and through the private sector in five cities (4,000,000 population). In this project, capacity was strengthened through (i) training health providers in the public and private sector on use of zinc supplements (ii) provision of zinc and ORS supplies (iii) Increased focus on individual and group counseling skills (iv) Strengthened program monitoring.
A January 2014 endline survey will measure whether program goals of coverage and utilization of zinc and ORS were met.

Results: In the public sector, 453 community health workers (CHWs) from health posts and 1400 private doctors and pharmacists were trained. Data from government monitoring systems reported use of zinc supplements in 40% of childhood diarrheal cases treated in the two rural provinces. A rapid assessment of newly trained private sector providers in Kabul city revealed that 80% of doctors and 40% of chemists were including zinc in all diarrheal prescriptions for children.

Conclusions: It is possible to introduce zinc supplements for childhood diarrhea treatment through existing government and private health providers and improve coverage and utilization.

Open Access Conference Proceeding (Abstract)

Innovative Approach to Address the Dilemma of "Hidden Hunger"

Mehdi Maqbool

European Journal of Nutrition & Food Safety, Page 487
DOI: 10.9734/EJNFS/2015/20925

Objectives: The objective of this paper is to illustrate the importance of micronutrients and the consequences of not having enough amount of these nutrients in our diet. The paper also focuses on the innovative approach and the strategy being adopted by Crops For the Future Research Centre to address this problem.

Methods: To achieve its objective, Crops For the Future Research Centre under one of its programme, FoodPLUS will lead to the identification of dietary needs, the increased use of a diverse array of crops for the benefit of consumer health, more efficient land use and the delivery of nutritionally superior products through sustainable and economically efficient supply chains.

Results: Through its approach and strategy, it is expected that the programme will achieve multiple objectives such as, a range of plant-based foods, especially from underutilised fruits and vegetables will be available for the community to improve its nutritional status, the leakages of desired nutrients along the supply chain will be reduced with measureable  impacts  on the community's nutritional status, novel techniques will be developed to minimise post-harvest quantitative and qualitative losses of micronutrients along the chain and new methods will be devised to increase the bioavailability of desired nutrients extracted from underutilised fruits and vegetables.

Conclusions: It is intended that FoodPLUS Programme will be able to contribute to the improvement of community nutrition through the diversification of diets that include identifying the availability of micronutrients obtainable from underutilised fruits and vegetables.

Open Access Conference Proceeding (Abstract)

Improving Coverage of Vitamin A among the Urban Poor through Establishing Additional Dosing Points and Additional Human Resources - Experiences from Bhopal City, India

Ritu Ghosh, Mini Varghese, Pragya Tiwari

European Journal of Nutrition & Food Safety, Page 488-489
DOI: 10.9734/EJNFS/2015/20926

Objectives: Due to rapid urbanization and the absence of an urban health policy until 2013, India's large and rapidly growing urban poor has very limited access to health and nutrition services. The Government of Madhya Pradesh sought assistance to systematically increase coverage of bi-annual Vitamin A supplementation in urban slums of Bhopal - a city of 2.37 million people. The objective was to improve access to and utilization of services provided during biannual VAS rounds in urban-poor settings.

Methods: Formative research was undertaken to identify factors affecting utilization of services. Mapping exercises identified new delivery points and staffing needs across under-served slum areas. Based on findings, community awareness generation activities were carried out to reach care-givers and service-providers. Health workers and managers were reoriented on biannual child health round and trained on demand generation, counseling, estimation and management of supplies, program review, monitoring and reporting. Private practitioners were oriented to participate in VAS campaigns.

Results: Eight new delivery points in two administrative zones were identified and staffed with trained VAS distributors. VAS coverage by government monitoring systems was 65% in August 2013, a substantial increase from the 22% measured in the November 2012 survey.

Conclusions: Mapping, identifying and establishing additional service delivery sites, and capacity building of service providers resulted in improved access to and utilization of Vitamin A services in urban slums. Based on preliminary successes, various components of the program were replicated in other locations of Bhopal city and were included in government plans and budget.

Open Access Conference Proceeding (Abstract)

Streamlining and Standardizing the Collection, Compilation and Use of VAS Program Indicators in the Government HMIS in Indonesia

Elvina Karyadi, Iwan Ariawan, Tutut Purwanti, S. Kaushik, Dhian Dipo

European Journal of Nutrition & Food Safety, Page 490-491
DOI: 10.9734/EJNFS/2015/20927

Objectives: The current vitamin A supplementation (VAS) program recording and reporting system in Indonesia faces inadequacies in terms of accuracy and completeness. This exercise was implemented to identify the bridge these gaps and inform the design of more accurate and efficient monitoring and reporting system.

Methods: A review of existing forms and systems was undertaken and health workers and managers were interviewed to identify gaps. The tools were revised to overcome the gaps and field tested.

Results: The key gaps identified were the absence of indicators to track stocks, VAS coverage among postpartum women and tracking of children who received VAS in both semesters. Recording forms also lacked parents’ name, severely limiting health workers’ ability to track children. The forms were revised to overcome these gaps.

Errors were also identified in the roll up of numbers from health facility to the national level. In order to empower managers to identify and correct these errors, an easy to use tool was developed. Further, a tool to assess data quality across different dimensions of completeness, accuracy, timeliness and data use was developed. These improvements reportedly limited errors and facilitated the feedback loop toward implementing data and program improvements.

The revised monitoring tools and the data quality and accuracy assessments were field tested and found to be easily usable by health personnel.

Conclusions: Streamlining the information flow and empowering managers with simple tools can be very useful for them to initiate corrective action. The Government has initiated replication of these tools and methods in additional districts.

Open Access Conference Proceeding (Abstract)

Intensified Monitoring of Vitamin A Supplementation Programs in Hard-to-Reach Districts and Urban Slums of Pakistan Results in Improved Coverage

Tausif Akhter Janjua, Khalid Nawaz, Zia Haider, S. Kaushik

European Journal of Nutrition & Food Safety, Page 492-493
DOI: 10.9734/EJNFS/2015/20928

Objectives: Although national coverage of VAS is high in Pakistan (>95%), large pockets of low coverage have been identified. A VAS coverage survey conducted by the Micronutrient Initiative (MI) in 2010 identified the reasons for low coverage as inadequate attention to VAS during training, stock-outs of VAC with frontline workers, and insufficient VAS monitoring. In response, an intensified monitoring and training strategy was initiated in low-coverage areas. This abstract describes this strategy and its results on VAS coverage.

Methods: The program was piloted in April and October 2012 rounds of National Immunization Days (NIDs) in 22 hard-to-reach and low coverage districts of Balochistan and Khyber Pakhtoonkhwa and slums of two cities. The strategy comprised of increased attention to VAS during NID training of health workers and managers, enhanced measures to ensure adequate supplies of VAS throughout the supply chain, improved tracking of children missed from VAS dosing (including door markings and addition of VAS-specific columns on tally sheets). A baseline survey (March 2012) and endline survey (November 2012) was conducted to measure VAS coverage.

Results: VAS coverage increased from 48% to 59% (baseline) to 90% to 96% (endline) in study sites. The difference in coverage between VAS and polio vaccinations also narrowed during the project period. The incidence of stock-outs of VAS and proportion of parents reporting vaccination teams not visiting their homes also declined.

Conclusions: The improvements demonstrated through these strategies in these pilot areas garnered sufficient attention that now they will be adopted in all the provinces/areas by the government of Pakistan.

Open Access Conference Proceeding (Abstract)

External Monitoring of Small and Medium Salt Processors Results in Improved Salt Iodization Levels in India

Suvabrata Dey, Sucharita Dutta, Ranjan Kumar Jha, M. A. Ansari

European Journal of Nutrition & Food Safety, Page 494-495
DOI: 10.9734/EJNFS/2015/20929

Objectives: Small & medium scale salt processors are the main defaulters in the production of adequately and uniformly iodized salt. Monitoring of these processors by enforcement agencies is inadequate given the scale and geographic spread of the salt industry. The Government Salt Department requested Micronutrient Initiative’s (MI) support to strengthen the monitoring system of salt processors to improve enforcement and improve quality of salt produced.

Methods: The salt samples are collected from 400 small and medium scale salt processors on daily basis and results of iodometric titration is communicated to the salt producers for corrective action. The results are analysed using web based software and shared with enforcement agencies and other stakeholders at routine intervals, for initiating necessary action to improve salt iodization.

Results: In the past six years, this system has monitored an average of two million tonnes of salt produced per year by small and medium scale processors. Through this process, MI was able to engage directly with salt producers on technical issues, including encouragement to adopt improved iodization processes.  Sharing monitoring data with the government and salt associations enhanced the effectiveness of government enforcement mechanisms and provided a platform to discuss problems and resolve issues. These activities contributed to improvement in adequately iodized salt, from 9% in 2007 to 35% in 2013.

Conclusions: External monitoring of small salt processors resulted in more effective enforcement and adoption of better production processes. The increased compliance of small and medium scale processors has contributed to India’s progress towards Universal Salt Iodization.

Open Access Conference Proceeding (Abstract)

How Salt Iodization Using Knapsack Hampers Universal Salt Iodization (USI) in Ethiopia

Wondie Alemu, Atalel Fetene, Abinet Tekele, Abdulaziz Adish, Noor Khan

European Journal of Nutrition & Food Safety, Page 496
DOI: 10.9734/EJNFS/2015/20930

Objectives: To determine the effect of Knapsack on quality of Salt iodization and USI program in Ethiopia.

Methods: Samples of Iodized salt were collected in two different times with two different groups of experts and were tested and analysed indipendatly. The samples were collected during joint monitoring visit at afar salt processing sites and during routine monitoring at semera check point.

Results: It was found that the coffecient of Variation (CoV) were 80.4% and 101.1%, adequately iodized salt wwere only 38.46% and 35% and the range were 99.3 ppm and 262.2 ppm.

Conclusions: The Coefficient of Variation (CoV) beyond 20% is unacceptable and the method of processing providing the CoV beyond 20% will be concidered unacceptable. Therefore, Use of knapsack for salt iodization should be discontinued and mechanisms that could improve the sustainalbe supply of Iodized salt to the country should be given in due consideration.

Open Access Conference Proceeding (Abstract)

Involving Government Health Personnel for Validation of Vitamin A Coverage Data from Health Management Information Systems (HMIS): A Method for Strengthening HMIS in Uttar Pradesh, India

Chandrashekar Pandey, Pravin Khobragade, Amita Jain, Amit Ghosh

European Journal of Nutrition & Food Safety, Page 497-498
DOI: 10.9734/EJNFS/2015/20931

Objectives: Estimates from robust cross sectional surveys have brought into question the accuracy of HMIS of VAS in India, including potential errors as HMIS data is rolled up at various levels from health worker- to state-level, limiting the usefulness of these data for program feedback and improvement.

In response, we sought to identify errors in monitoring data at different levels, suggest corrective action and establish coverage by a cross sectional survey triangulated with HMIS data.

Methods: This exercise was conducted in 16 districts where 48 primary health centers (PHCs) were selected randomly. Data on Vitamin A coverage recorded at districts, PHCs, sub-health centers (SHCs) and health worker/volunteer level were cross-verified with coverage figures recorded at their respective constituent units. Discrepancies between coverage data recorded at health facilities and that aggregated from their constituent units were computed. A 30X7 cluster survey was also undertaken in each of these centers to establish population-based coverage.

Results: Overall, there was a 7% discrepancy between figures reported by PHCs and that aggregated from their SHCs. In some PHCs the discrepancy was as large as 40%. The cross-sectional household survey identified 10% higher coverage than that reported by the state government (52% vs 42%). District specific findings were used to identify and facilitate systemic changes in reporting and data compilation.

Conclusions: This is a cost-effective method and useful exercise for improving internal data quality and minimizing reporting error. The involvement of government functionaries in the process increased the ownership of study results and facilitated corrective actions.

Open Access Conference Proceeding (Abstract)

Feasibility of Using Electronic Rapid Testing Kits for Improved Monitoring of Salt Processors

Ranjan Kumar Jha, Suvabrata Dey, Venkatesh Mannar

European Journal of Nutrition & Food Safety, Page 499-500
DOI: 10.9734/EJNFS/2015/20932

Objectives: Quality control is a process to detect and correct production default from specified standards during actual processing. In salt iodization units, iodized salt samples are collected and tested through iodometric titration, in a laboratory attached to the production unit.  Small and medium-scale producers do not have these adjacent laboratories. The time-lag between sample collection, testing, and incorporation of corrective guidance increases the risk of producing non-standard iodized salt. The objective of this study was to assess real-world accuracy of a recently developed electronic Rapid Testing kit (eRTK, Innovative design) as a more rapid method of controlling iodine levels in salt, particularly in small-scale production sites.

Methods: 3198 iodized field salt samples were tested using 15 eRTKs, in accordance to the standard operating protocol of the instrument and compared with results from standard iodometric titration.  Sample types included free flow salt, washed and crushed salt, crushed salt and crystal salt from eight different geographical areas, representing each type of salt produced in India.

Results: The instrument is accurate to ±3 ppm in salt iodization between 15 – 55 ppm. Results from the study report a sensitivity of 76.3%, specificity of 81.9%, positive predictive value of 79.5% and negative predictive value 79%. The cost of testing iodized salt samples using eRTK is 25% of that of iodometric titration.

Conclusions: eRTK was found to be a rapid, accurate and portable alternative to titration testing that is suitable for salt traders, retailers and enforcement agencies to ensure the iodization levels of salt.

Open Access Conference Proceeding (Abstract)

Demonstrating Effectiveness of Delivering Weekly Iron and Folic Acid Supplementation (WIFS) through Government Systems in Chhattisgarh, India

Manpreet Chadha, Pravin H. Khobragade

European Journal of Nutrition & Food Safety, Page 501-502
DOI: 10.9734/EJNFS/2015/20933

Objectives: Recognizing that low iron stores pre-conception continue during pregnancy, the government of Chhattisgarh and Micronutrient Initiative (MI) implemented weekly IFA supplementation (WIFS) program from July 2011 till May 2012 among school-going adolescent girls in classes 9 to 12 (SG) and out-of-school adolescent girls aged 11-18 years (OG).

The aim of this program was to demonstrate effective approaches of achieving high rates of coverage and utilization of WIFS among SG and OG.

Methods: The project involved multi-department government coordination and was implemented through schools for SG and ‘community based centres for women and children’ - anganwadi centres (AWCs) – for OG. A cascade approach was adopted to train teachers, peer guides and anganwadi workers. Supervised weekly dose of enteric coated IFA was administered to over 95,000 adolescent girls in 424 schools and 6,832 AWCs after counselling for probable side-effects. MI facilitated supportive supervision, program reviews and completion of baseline and endline surveys.

Results: 93.8% SG and 73% OG received free IFA tablets. 48.1% of SG and 31.4% of OG completed at least 80 % of the recommended dosage. Post side-effect counselling added to an incremental compliance of 15.4% to a full recommended weekly dose. There was 22.5% increase in the knowledge level among adolescent girls on atleast three causes and prevention of anaemia.

Conclusions: Effective multi-department coordination, health and nutrition education and effective counselling on side effects are important success factors for WIFS. Convinced with the impact of WIFS, the program is being scaled up across the state.

Open Access Conference Proceeding (Abstract)

An Implementation Study to Assess a Health Worker-based Platform for a Home Fortification Program in Bihar

Priya Kekre, Melissa Young, Pankaj Verma, Meggha Sheth, Arup Das, Shamik Trehan, Indrajit Chaudhari, Amlan Majumdar, Aimee Webb-Girard, Usha Ramakrishnan, Sridhar Srikantiah, Reynaldo Martorell

European Journal of Nutrition & Food Safety, Page 503-504
DOI: 10.9734/EJNFS/2015/20934

Objectives: The main objectives of the study were to explore the feasibility of using Frontline health Workers (FLW) as a platform to deliver Multiple Micronutrient Powders (MMP) to the target population (children of 6-18 months) and to assess the acceptability of MMP among the community. This work was part of a multi-phase formative research study for contextualizing a home fortification strategy in Bihar.

Methods: The program was implemented in three Health Sub Centers (HSCs) in West Champaran over a two-month duration. Key programmatic activities included FLW training for MMP distribution and counseling on complementary feeding; and community sensitization events to increase MMP acceptability. We conducted 5 focus group discussions and 3 in-depth interviews with FLWs along with monthly monitoring at the household level (n=20/HSC) to assess the program implementation.

Results: Important implementation findings emerged through the soft roll-out. Firstly, the HSC meetings were found to be suitable as a FLW training platform but not for MMP distribution to FLWs due to logistical constraints. Secondly, the counseling brochures and community sensitization meetings were perceived to be important facilitators for MMP uptake by the community. Thirdly, FLWs reported positive levels of engagement, low perceptions of work burden and adopted diverse strategies for program delivery. Lastly, community uptake was found to be positive and primary barriers to compliance were mainly associated with supply issues rather than user preferences.

Conclusions: The implementation study proved to be a valuable step in identifying critical operational and programmatic factors to inform future large-scale program activities.

Open Access Conference Proceeding (Abstract)

Effect of Ambient Temperature, Cold Fluorescent Light and Oxidative Oil Quality on the Stability of Retinyl Palmitate and Its Antioxidant Activity in Soybean Oil

Marc Pignitter, Stephanie Gartner, Bettina Dumhart, Georg Steiger, Klaus Kraemer, Veronika Somoza

European Journal of Nutrition & Food Safety, Page 505-506
DOI: 10.9734/EJNFS/2015/20935

Objectives: Fortification of soybean oil with retinyl palmitate is known to be an effective strategy to counteract vitamin A deficiency. However, stability of vitamin A in vegetable oils strongly depends on environmental factors, e.g. temperature, light, oxygen availability, oxidative oil quality, and storage time. The current study investigated the stability of retinyl palmitate and its effect on the oxidative status of soybean oil stored under household conditions.

Methods: Soybean oil was fortified with retinyl palmitate (31.6 IU/g) and filled in transparent 0.5 L PET bottles. The closed bottles were either stored in the dark or exposed to cold fluorescent light at 22ºC or 32ºC for 56 days. By intermittent opening for sampling, the headspace volume increased, thereby mimicking consumer handling.

Results: After 56 days of storage, the concentration of retinyl palmitate was significantly reduced by 84.8±5.76%, independent of temperature and light exposure. When retinyl palmitate was added to already oxidized soybean oil, characterized by a peroxide value of 17.3 meq O2/kg, a retinyl palmitate reduction by 80.3±13.6% was determined already after 28 days of storage. Addition of retinyl palmitate to soybean oil also increased its antioxidant capacity by exhibiting a tocopherol-saving effect.

Conclusions: In conclusion, fortification of soybean oil with retinyl palmitate increased its oxidative stability, although a significant loss of retinyl palmitate during household storage and handling was demonstrated over time. When retinyl palmitate was added to highly oxidized soybean oil, this storage-associated loss was accelerated.

Open Access Conference Proceeding (Abstract)

Concentration and Intake of Micronutrients by Infants through Milk and Baby Foods in Morogoro Municipality, Tanzania

Maria Ngilisho, Akwilina Mwanri, Stelyus Mkoma, Bernad Chove

European Journal of Nutrition & Food Safety, Page 507
DOI: 10.9734/EJNFS/2015/20936

Objectives: This study aimed to determine the levels of Zinc and Copper, in human-, cow- and tinned baby- milk and canned baby foods marketed in Morogoro Municipal and intake of these mineral elements by infants.

Methods: Human milk was collected from 41 mothers at different postpartum periods, cow milk was bought from dairy farms and infant formulas were purchased from shops. Atomic Absorption Spectrometry flame mode was used to analyze 97 samples. Intake of these micro elements were assessed for compliance with Recommended Daily Intake by World Health Organization.

Results: Mean Zinc and Copper concentration in the seven days postpartum was higher and lowest in the 9-months postpartum. Human-, cow- and tinned baby- milk showed significant differences (p < 0.05) in the two elements. Concentrations in different brands of baby foods were significantly different in Copper except for Zinc (p > 0.05). Concentration in human milk was found to be below recommendations. Cow milk had low concentration, tinned baby milk had high concentration and tinned baby foods were lacking Zinc and Copper.

Conclusions: This study concludes that the intake of Zinc and Copper is below recommendations for human milk; tinned baby foods should be fortified with Zinc and Copper to ensure infants consume enough for their growth and development.

Open Access Conference Proceeding (Abstract)

Effect of Postharvest Practices (Sorting & De-hulling) on Total Mineral (Ash), Zinc and Iron Contents of Chickpea and Faba Bean Flours

Abadi Gebre Mezgebe, Tadesse Fikre Teferra, Robert Bob Tyler, Abrehet Fisseha Gebremeskel

European Journal of Nutrition & Food Safety, Page 508-509
DOI: 10.9734/EJNFS/2015/20937

Objectives: Various factors influence utilization and nutrient content of pulses including pre-harvest and postharvest practices. Pulses are usually exposed to postharvest practices (harvesting, cleaning, sorting, drying, de-hulling, processing). The effect of these practices on the micronutrient content is still less studied. Understanding the influence of postharvest practices on micronutrient content will help to consider further food processing and other intervention methods.

Methods: In this study chickpea (local and improved variety) and faba bean (local variety) were considered. The samples were exposed to sorting and de-hulling practices in laboratory. Sorting was done manually, while de-hulling was done with impact de-huller machine. Treated samples were milled in hammer miller and flour samples were analyzed for contents of ash (total mineral), zinc (Zn) and Iron (Fe).

Results: The result showed that Zn and Fe contents of local chickpea, improved chickpea and faba bean were significantly different (p<0.05). Faba bean was higher in Zn and Chickpea was higher in Fe. There was no statistical difference in ash contents. The postharvest practices influenced the Fe content of improved chickpea and ash content of local chickpea. Sorting followed by de-hulling and de-hulling have reduced Fe content of improved chickpea and ash content of local chickpea.

Conclusions: During formulation, processing and preparation of pulse based foods, less intensive post-harvest practices should be considered or processing and preparation method that compensate loss of micronutrients should be selected.

Open Access Conference Proceeding (Abstract)

Towards a Micronutrient-Rich, Aflatoxin-Free Peanut Value Chain in Ghana: Results of a Comprehensive Assessment

William Masters, Shibani Ghosh, Daniel Sarpong

European Journal of Nutrition & Food Safety, Page 510-511
DOI: 10.9734/EJNFS/2015/20938

Objectives: This study analyzes the potential for high-value peanut production, processing and marketing in Ghana, identifying opportunities for new investment and interventions to improve nutrition and livelihoods on a commercial scale.

Methods: Our research combined an extensive desk review of the available data from 75 project reports and articles, followed by 40 key informant interviews in Ghana during July and August of 2013. Our focus is on the nutritional content of peanut-based products, particularly regarding the extent of aflatoxin contamination and opportunities for aflatoxin control.

Results: Our central finding is that new investments to produce micronutrient-fortified, aflatoxin-free peanut products can be commercially viable, helping to improve livelihoods and nutritional status among farm households in northern Ghana, and contributing to improved nutrition among consumers. The most robust new supply chain for aflatoxin-free peanuts is likely to involve aggregators' spot and contract purchases from rainfed smallholder producers, including particularly women farmers, potentially supplemented by other sources such as imports and contracts for production under irrigation.

Conclusions: Ghana is a promising site for new peanut-based products, offering both sufficient scale of production in the north, and sufficient demand in the south, with adequate infrastructure as well as institutional frameworks for development. Building supply for this new value chain will require equipping farmers and aggregators with select new technologies to which they do not yet have access, including improved seed varieties and techniques for aflatoxin control, but the result could be commercially viable and offer potentially large gains in livelihoods and nutritional status especially for women and children.

Open Access Conference Proceeding (Abstract)

Zinc Deficiency in Sri Lanka: Prevalence and Risk Factors

Renuka Jayatissa, Aberra Bekele, Priyantha Ekanayaka, J. M. Ranbanda, Yasoma Kumari

European Journal of Nutrition & Food Safety, Page 512-513
DOI: 10.9734/EJNFS/2015/20939

Objectives: Optimum zinc nutrition is essential for adequate growth of young children. In Sri Lanka, available information on zinc deficiency is very limited. This study was conducted to estimate the prevalence of zinc deficiency among children between 6-59 months and to identify the risk factors.

Methods: Cross-sectional study was conducted among randomly selected 4,473 children aged 6-59 months. Demographic, socioeconomic, and dietary information was collected. Anthropometric and biochemical indices were determined. Serum zinc was determined using Atomic Absorption Method. Anthropometric data were analysed using World Health Organisation standards.

Results: The mean serum zinc value was 82.3±15.8 µg/dL. Nine per cent of children were zinc deficient (serum zinc < 70 µg/dL). Prevalence between districts varied from 2.1% to 21.9%. A higher level of diarrhea, upper respiratory tract infections and viral fever during the last 2 weeks was documented among children with zinc deficiency (P>0.05) compared to non-deficient children. Children who received worm treatment during the last 6 months had significantly lower level of zinc deficiency (P=0.008). Mean height (P=0.18) and mean HAZ (P=0.5) were lower and stunting (P=0.5) was higher among zinc deficient children. Children with zinc deficiency had consumed rice (P=0.000), kankun (P=0.03), coconut (P=0.000) and milk (P=0.03) for lesser number of days during the last 7 days than non-deficient children.

Conclusions: Zinc deficiency is a mild public health problem in Sri Lanka. It may be related to adequate food consumption patterns in the country. It is important to improve dietary practices in districts with high prevalence of zinc deficiency.

Open Access Conference Proceeding (Abstract)

The Formulation, Application and Development of YingYangBao for Early Child Nutrition Improvement in China

Chunming Chen, Yuying Wang, Wu He

European Journal of Nutrition & Food Safety, Page 514-515
DOI: 10.9734/EJNFS/2015/20940

Objectives: To describe the development process of home-fortification in complementary food (YingYangBao, YYB) for nutrition security of early children in China and evidence needed for policy-making.

Methods: We summarized the effectiveness and experiences of YYB delivery in pilot research and small to large scale trial of YYB in the fields.

Results: The YYB program development was in three phases. First, research data collected during 2001-2009 in Gansu province, showed that YYB could reduce the anemia rate and growth failure of children under 24 months old, improve mental development until age of 9 years old. Secondly, YYB was applied in earthquake-affected areas in 2008, and General Standards on Complementary Food Supplements (GB/T 22570-2008) was established. Finally, the YYB projects were scaled up to the communities. A 3-years observation in Ledu County and an 18-months project covered 30,000 children in 8 counties were done during 2009-2012. Based on the scientific evidences, Qinghai provincial government decided to invest 10 million Yuan (1.7 million US dollars) to carry out early child development activities in 15 counties in 2011. Chinese government decided to initiate Children Nutrition Improvement Program in Poor Areas, with free YYB for children 6-24 month old in 100 poor counties in 2012 and the Program is expanded to 300 counties in 2013.

Conclusions: Process from science to action for child nutrition improvement was described. An integrated program for government-leading program is developing. Future challenges and efforts on the policy sustainability in respects of demand-supply, public-private partnership and multi-sectoral coordination are discussed.

Open Access Conference Proceeding (Abstract)

Nutrition Survey Toolkit for Improved Micronutrient Surveys

Tiffany Duque, Kevin Sullivan, Donnie Whitehead, Carine Mapango, Katie Tripp

European Journal of Nutrition & Food Safety, Page 516-517
DOI: 10.9734/EJNFS/2015/20941

Objectives: The Survey Toolkit, developed by the U.S. Centers for Disease Control and Prevention and hosted by the Micronutrient Initiative, provides epidemiological support and guidance through standardized tools to countries for the assessment and monitoring of population micronutrient status and interventions.  An important component of micronutrient programs is periodic surveys of micronutrient status and coverage of interventions. Execution of such surveys can be improved through use of tools and materials for planning, organizing, training and educating, implementing, and reporting of results. 

Methods: The toolkit offers a web-based, publicly accessible compilation of over 200 qualitative and quantitative survey tools.  Tools were collated from various sources such as subject-matter experts, relevant organizations, and journal articles pertinent to the assessment of micronutrient deficiencies in populations, or were specifically created for inclusion.  A user-friendly interface and search function enable users to identify tools needed for their specific task. The toolkit is currently being revised and a second edition is expected to be publicly released in 2015.

Results: Tools include sample size calculators; lists of equipment and supplies; budget templates; specimen collection, processing and storage procedures; training materials, data collection templates, and survey report outlines.  Additionally, examples of how the tools have been used in real-world settings are included.

Conclusions: The Nutrition Survey Toolkit can help improve the validity and efficiency of surveys of vitamin and mineral deficiency and related interventions.

Open Access Conference Proceeding (Abstract)

Dietary Vitamin A Consumption and Associated Factors in 12 to 59 Month Old Children in Tula, SNNPR

Genet Bekele, Stocker Barbara, Debebe Moges

European Journal of Nutrition & Food Safety, Page 315-316
DOI: 10.9734/EJNFS/2015/20828

Objectives: The purpose of this study was to assess dietary intake of vitamin A and factors associated with it.

Methods: A community-based cross sectional study with both quantitative and qualitative elements that involved in 556 children with the age of 12 to 59 months from Tula, Sidama zone in August and September, 2012. A two stage clustered sampling procedure was employed to select the required households. A modified 7 day Helen Keller International (HKI) food frequency questionnaire and 24 hr Individual Dietary Diversity Score (IDDS) were used to assess dietary intake of vitamin A. Logistic regression model was used to identify the factors associated to dietary vitamin A consumption.

Results: The majority (53.2%) of the children were in the lowest IDDS group. The total mean frequency of consumption of animal products was 2.5 days/week if breast milk was included. The mean frequency consumption of weighted by source (plant and animal) vitamin A rich food was 3.3 days/week. Children who had at least one childhood illness in the past two weeks before survey had 1.70 (95% CI: 1.10-2.64) times more likely low consumption of vitamin A source foods than their countnterpart. Mothers who had no awareness about vitamin A had 4.2 (95%CI: 2.77-6.43) times more likely less consumption of vitamin A source foods than their counterparts.

Conclusions:  The finding showed that frequency of consumption of Vitamin A rich foods was below the threshold value of HKI. Improving Vitamin A consumption needs to improve access and availability to vitamin A rich food sources.

Open Access Conference Proceeding (Abstract)

Biofortified Pearl Millet (Pennisetum glaucum L.) Provides More Bioavailable Iron than Standard Pearl Millet: Studies In vivo (Gallus gallus) and an In vitro Digestion/Caco-2 Model

Elad Tako, Binu Cherian, Raymond Glahn

European Journal of Nutrition & Food Safety, Page 518-519
DOI: 10.9734/EJNFS/2015/20942

Objectives: Pearl millet (Pennisetum glaucum L.) is the most widely grown type of millet, primarily in Africa and India. Our objective was to compare the capacities of two isolines of pearl millet (standard and Fe biofortified) to deliver iron (Fe) for hemoglobin (Hb) synthesis.

Methods: In-vitro analysis indicated that the biofortified line should provide more Fe (P<0.05), and indicate the presence of high levels of polyphenolic compounds that inhibit Fe-absorption. Pearl millet based diets (75% w/w) were formulated except for Fe (dietary Fe concentrations were 22.1±0.5 and 78.6±0.5μg/g) to be tested in-vivo (Gallus gallus). Diets were fed for 6 weeks; Hb, liver ferritin and Fe-related transporter/enzyme gene-expression were measured. Hb-maintenance efficiency (HME) and total body Hb-Fe values were used to estimate Fe-bioavailability from the diets.

Results: From week 5 onward, Hb values were higher (P<0.05) in biofortified group vs. standard. Final total Hb-Fe content was higher in the biofortified vs. the standard  (26.7±1.4 and 15.5±0.8 mg, respectively) groups (P<0.05). DMT-1, Dcyt-B, and ferroportin expressions were higher and liver ferritin was lower (P<0.05) in the standard group vs. the biofortified group, indicating adaptive response to Fe-deficiency.

Conclusions: We conclude that the biofortified pearl millet diet delivered more absorbable Fe and thus represents a promising vehicle for increasing intakes of bioavailable Fe in human populations that consume this dietary staple. In vitro studies indicate that a strong polyphenolic inhibitory effect on Fe-bioavailability is evident; thus further research into improving the nutritional content of pearl millet should involve assessment and if possible modification of the polyphenolic profile. 

Open Access Conference Proceeding (Abstract)

Dietary Zinc Deficiency affects Blood Linoleic Acid: Dihomo-γ-linolenic Acid (LA:DGLA) Ratio; A Sensitive Physiological Marker of Zinc Status In vivo (Gallus gallus)

Spenser Reed, Raymond Glahn, Thomas Brenna, Elad Tako

European Journal of Nutrition & Food Safety, Page 520-521
DOI: 10.9734/EJNFS/2015/20943

Objectives: Zinc (Zn) is a vital micronutrient used for over 300 enzymatic reactions and multiple biochemical and structural processes in the body. To date, sensitive and specific biological markers of Zn status are still needed. The aim of this study was to evaluate the sensitivity of a previously unexplored potential zinc biomarker, erythrocyte linoleic acid: dihomo-γ-linolenic acid (LA:DGLA) ratio in vivo (Gallus gallus).

Methods: Diets identical in composition (except Zn concentration) were formulated and two groups of birds (n=12) were randomly separated upon hatching into two diets, Zn(+) (Zn-adequate control, 42 µg/g Zn), and  Zn(-) (Zn-deficient, 2.5 µg/g Zn). Dietary Zn intake, body weight, and serum Zn were measured weekly. Additional blood was collected each week for erythrocyte fatty acid analysis. At the conclusion of the study, tissues were collected for gene expression analysis.

Results: As expected, body weight, feed consumption, Zn intake, and serum Zn were significantly higher in the Zn(+) versus Zn(-) group (P<0.05). Hepatic TNF-α, IL-1β, and IL-6 gene expression were higher in the Zn(+) group (P<0.05). Hepatic Δ6-desaturase was significantly higher in the Zn(+) group (P<0.001). The LA:DGLA ratio was significantly elevated in the Zn(-) group compared to the Zn(+) group (22.6±0.5 and 18.5 0.5), % w/w, respectively, P<0.001).

Conclusions: This study suggests erythrocyte LA:DGLA is able to differentiate Zn status between Zn adequate and Zn deficient birds, and may be a biomarker to assess dietary Zn manipulation in vivo. This justifies further feeding trials, especially those in which a diet more representative of the target Zn-deficient population is used.

Open Access Conference Proceeding (Abstract)

Juxtaposing Nutrient Intake Estimates from 24-Hour Recall, 7-Day Recall, and Household Income and Expenditure Survey (HIES): Comparing Bangladesh’s Integrated Household Survey (BIHS 2011-12) and Its Income and Expenditure Survey (2010 HIES)

Celeste Sununtnasuk, John Fiedler

European Journal of Nutrition & Food Safety, Page 522-523
DOI: 10.9734/EJNFS/2015/20944

Objectives: Understanding food consumption patterns and nutrient intakes is essential for informing nutrition policymaking. However, there is no consensus on which is the “best” method for measuring them. This study juxtaposes nutrient intake estimates using three alternative dietary assessment methods: A 24-hour recall (24HR) and a household-based 7-day recall (7DR)—both collected in the 2011-2012 BIHS—and a 14-day diary (14DD) collected in the 2010 HIES.

Methods: Food Composition Tables (FCTs) were used to estimate the nutrient content of the foods consumed. To calculate individual nutrient intake from household consumption in the 7DR and 14DD, we applied the concept of Adult Male Equivalents (AME). We then compared the estimated values with results from the 24HR.

Results: On average, the 7DR estimates of the daily intakes of kilocalories, iron, zinc, and vitamin A were 13%, 15%, and 18% higher, respectively, than 24HR estimates at the national and subnational levels. Vitamin A estimates varied more markedly: they were 32% higher at the national level and up to 58% higher at the subnational level. Comparisons of the same measures will also be made with the 14DD data.

Conclusions: With the exception of vitamin A, estimates based on the 7DR are relatively close to measures of individual nutrient intake provided in the 24HR. For many applications, the two methods provide adequately precise measures of nutrient intakes. Further work is needed to determine the sources of variation in the methods, how to improve the precision of the estimates, and how to assess the external validity of these findings.

Open Access Conference Proceeding (Abstract)

Iron-folic Acid Distribution and Consumption through Antenatal Care: Identifying Barriers across Countries

Celeste Sununtnasuk, John Fiedler, Alexis D'Agostino

European Journal of Nutrition & Food Safety, Page 524-525
DOI: 10.9734/EJNFS/2015/20945

Objectives: Despite renewed efforts, the prevalence of maternal anemia is unacceptably high in developing countries. Iron-folic acid (IFA) supplementation and coverage through antenatal care (ANC) is persistently low and remains under-resourced and underutilized. In recognition of these barriers, USAID's SPRING Project developed a rapid, initial assessment tool to help identify constraints within ANC programs that inhibit pregnant women from getting and consuming an ideal minimum number of 180 IFA tablets.

Methods: The tool identifies four sequential points at which the ANC system might falter: ANC attendance, IFA receipt or purchase, IFA consumption, and compliance with WHO-recommendations for the ideal minimum number of tablets. Twenty-two high-burden countries were analyzed based on secondary analysis of Demographic and Health Survey (DHS) data.

Results: Across all countries, 83% of all pregnant women had at least one ANC visit, and 81% of those women received IFA tablets of which 95% consumed at least one tablet. Overall adherence to daily iron supplementation, however, is low. Only 9% of pregnant women consumed 180 or more IFA tablets. Just two countries had more than 30% of women consume 180 or more tablets during pregnancy.

Conclusions: Although the tool cannot isolate the direct causes of a system’s faltering performance, it provides an instrument by which policymakers may investigate its shortcomings. Given the significance of the fourth falter point across all countries, potential areas for investigation include the adequacy of IFA tablet supplies and the technical knowledge, practices, and availability of ANC providers.

Open Access Conference Proceeding (Abstract)

Establishment of a Regional Iodine Resource Laboratory and External Quality Assessment Program at the Kazakh Academy of Nutrition

Tiffany Duque, Amir Makhmudov, Feruza Ospanova, Shamil Tazhibayev, Katie Tripp, Aigul Nurgabilova

European Journal of Nutrition & Food Safety, Page 526-527
DOI: 10.9734/EJNFS/2015/20946

Objectives: The need for and lack of iodine resource laboratories in Central and Eastern Europe led to an agreement between the Centers for Disease Control and Prevention (CDC) and UNICEF for developing a regional iodine reference laboratory at the Kazakh Academy of Nutrition (KAN).  Objectives included conducting reliable iodine measurements, KAN capacity strengthening, operating an external quality assurance (EQA) program, and self-sustainability.  An underlying aim was ensuring quality laboratory data for management and decision-making of iodine disorder elimination programs. 

Methods: Creation of the laboratory at KAN was undertaken through technical support, training, funding, and material resources from CDC and UNICEF.  Initial activities included building a fully-functioning laboratory, developing partnerships, and creating and operating a website and EQA program.  Later activities included a landscape analysis, harmonized guidelines, an inaugural workshop attended by 17 regional laboratories, and a business sustainability plan.

Results: The KAN reference laboratory was established and an operational plan is being implemented that will ensure sustainability. The plan includes contracts with the Kazakh government for multiple micronutrient analyses in four surveys, and fee-based trainings and assessments for regional laboratories as provided for Serbia, Kyrgyzstan, and Moldova. Participation in at least one EQA round by 78% of regional laboratories and consistent participation from 11/18 labs indicates that KAN assistance was well received.  

Conclusions: An up-to-date, high-quality reference laboratory and resource center for iodine assessments, led by technical experts capable of managing reliable iodine measurements in salt and urine and coordinating an EQA service for national iodine laboratories, has been established in the region.

Open Access Conference Proceeding (Abstract)

Designing Co-packaging for Zinc & Oral Rehydration Salts (ORS) to Influence Caregiver and Provider Behaviours for Treating Childhood Diarrhea in Guatemala

Marion Roche, Rosario Garcia, Ali MacLean, Noel Solomons

European Journal of Nutrition & Food Safety, Page 528-529
DOI: 10.9734/EJNFS/2015/20947

Objectives: The Guatemalan Ministry of Public Health and Social Assistance has scaled-up co-adjunctive zinc as a national policy, yet utilization of this newly-available life-saving commodity remains a concern.  The purpose of this study was to design effective co-packaging for zinc and ORS, informed by social-marketing, to influence both caregivers' and providers' behaviours in a demonstration project at the health post level in the department of San Marcos, Guatemala. 

Methods: Local concepts, perceptions and experiences relating to diarrhea and care seeking were explored in 8 focus group discussions (n=82) and 24 key informant interviews with caregivers. Prototype co-packaging and messages were developed and reviewed with 14 mothers and 10 providers in 4 municipalities to pretest the candidate materials.

Results: Formative research identified two major challenges to correctly using zinc and ORS to treat childhood diarrhea: 1) the concept of adherence to zinc once symptoms disappeared; and 2) dissolving a tablet in a spoon was a new skill. A campaign of Zinc-10 was created and tested to promote the concept of 10 days of adherence to zinc; additional visual aids focussed on showing dissolving of zinc on a spoon. These candidate concepts and messages were highly accepted by caregivers and providers, yet revisions were needed for images and materials used.

Conclusions: Using a social-marketing approach, packaging and promotional messages were developed that were more acceptable to caregivers and providers than the original prototypes. These materials will be tested in a randomized community trial to see the effectiveness of the co-packaging on caregiver adherence and provider behaviour.

Open Access Conference Proceeding (Abstract)

Results from a Compliance Study of Food Fortification in Nigeria and Implications on Regulatory Monitoring

O. A. Ogunmoyela, Larry Umunna, Francis Aminu, Greg Garrett, Dora Panagides

European Journal of Nutrition & Food Safety, Page 530-531
DOI: 10.9734/EJNFS/2015/20948

Objectives: The aim of this study was to: 1) ascertain the levels of compliance with national fortification standards for vitamin A and iron; and 2) use the results as an advocacy tool to improve compliance and regulatory monitoring.

Methods: The study was carried out in 2012 using quantitative devices (BioAnalyt iCheck Ex-Flouro, Ex-Chroma and Ex-Iron) for the measurement of vitamin A and iron in sugar, vegetable oil and flour. Laboratory analyses were also carried out using high performance liquid chromatography and atomic absorption spectroscopy for comparison. A total of 293 samples were collected from six geopolitical zones.

Results: 16.7%, 11.6% and 2% of sugar, vegetable oil and flour respectively met the minimum levels of fortification standards for vitamin A. 28.6% of flour samples met minimum levels for iron. Based on the results, the National Agency for Food and Drug Administration and Control (NAFDAC) developed a monitoring tool for retail samples.  Trained food and port inspectors have been put in place.

Conclusions:  The outcome of this study revealed that food fortification compliance in Nigeria is low. The study and its effective dissemination prompted remedial action from NAFDAC. Monitoring tools and capacity building activities were revised and are now being implemented. Compliance studies can be used to inform stakeholders of the status of food fortification efforts and help guide programs towards improved health impact.

Open Access Conference Proceeding (Abstract)

Practice-Based Implementation Research on the National Scale-Up of Micronutrient Powders in Bolivia

Stanley Zlotkin, Claudia Schauer, Kimberly B. Harding, Ali MacLean, Marion L. Roche, Oriana Vaccarino

European Journal of Nutrition & Food Safety, Page 532-533
DOI: 10.9734/EJNFS/2015/20949

Objectives: Bolivia is among few countries to have scaled-up Micronutrient Powders (MNPs) for children to the national level. Here we explore Bolivia’s experience as an early-adopter and in doing so, identify enabling conditions and stakeholders that led to scale-up, and barriers to increasing coverage and adherence.

Methods: We reviewed a wide variety of documents spanning several years of program implementation (2006-2012) and communicated with those involved with the program.  We defined scale-up as the process of increasing coverage to benefit more children and used a health system model to identify programmatic components.

Results: Bolivia replaced iron syrup for children 6-23 months of age with MNPs in 2006. In 2012, MNP coverage reached 65% of Bolivia's approximately 536,000 children in this age group. Adherence rates in 2010 for children consuming all 60 sachets were 45% and 52% in urban and rural areas, respectively. Enabling political factors included integrating MNPs into the existing public health system. Politicians and policy makers helped accelerate scale-up by including MNPs within the national development plan and prioritizing effective coordination, including private sector engagement. Training of healthcare providers, support for supply chain management, communications, and program monitoring remain critical components of MNP scale-up.  Behaviour change and demand creation strategies targeting the healthcare provider and caregiver were identified as key factors to sustain and increase coverage and adherence rates.

Conclusions: Countries considering replacing iron syrup and transitioning to MNP implementation can benefit from Bolivia’s experience, particularly in creating an enabling environment whereby MNPs can be integrated within existing health and nutrition programs.

Open Access Conference Proceeding (Abstract)

A Formative Research Study to Integrate Home Fortification of Complementary Foods into a Family Health Program in Bihar: Process and Methodology

Melissa Young, Priya Kekre, Pankaj Verma, Meggha Sheth, Arup Kumar Das, Shamik Trehan, Indrajit Chaudhuri, Amlan Majumdar, Amy Webb Girard, Usha Ramakrishnan, Sridhar Srikantiah, Reynaldo Martorell

European Journal of Nutrition & Food Safety, Page 534-535
DOI: 10.9734/EJNFS/2015/20950

Objectives: The objective of this formative research was to develop a locally appropriate home fortification program for children (6-24mo) and to explore feasibility and acceptability within an integrated family health program in Bihar.

Methods: The study consisted of three phases over a six month period. In Phase 1, we tested the acceptability of multiple micronutrient powders and developed contextualized packaging and counseling materials integrated with existing complementary feeding messages. We used focus group discussions (FGD, n=11) with frontline workers (FLWs), community members, mothers, mothers-in-law, and fathers to obtain feedback on product and supportive tools. In Phase 2, we explored community acceptability in 27 households (HHs) with children 6-24mo using a Trials of Improved Practices methodology. In-depth interviews (IDI) were held with HHs at baseline, midline and endline (day 10). Phase 3 was designed to evaluate the implementation process using existing program delivery platforms with FLWS in 3 health sub-centers (HSC). FLWs were trained to distribute products and counsel HHs on home fortification and complementary feeding. 5 FGDs and 3 IDIs were held with FLWs in addition to monthly HH monitoring data (n=20/HSC).

Results: As a result of this formative work, counseling materials, FLW trainings and delivery approach were substantially revised to better reflect local context and program realities. Preliminary data suggest home fortification is well-accepted by community members and FLWs are willing to incorporate into existing work activities.

Conclusions: This formative research methodology was vital for developing an integrated and locally acceptable home fortification program and informing future scale-up activities.

Open Access Conference Proceeding (Abstract)

Nepal's National Scale-up of The Iron Intensification Program Improved Iron Folic Acid Supplementation Coverage in Pregnancy and Showed Potential for Reducing Anemia

Marion Roche, Roman Pabayo, Macha Raja Maharjan, Deepika Chaudhery, Lynnette Neufeld

European Journal of Nutrition & Food Safety, Page 536-537
DOI: 10.9734/EJNFS/2015/20951

Objectives: A national scale-up of an integrated facility and community-based delivery of iron and folic acid (IFA) supplements in Nepal spanned almost ten years through the Iron Intensification Program (IIP), over which time national coverage of IFA in pregnant women increased from 23% to 80%. The objective of this research was to estimate the potential effect of duration of district-level exposure to IIP on IFA coverage, and on anemia in mothers in Nepal.

Methods: With data of the 2006 and 2011 Demographic Health Surveys (DHS), we used multiple regression modelling and controlled for IIP district exposure, age, pregnancy status, wealth, religion, parity in the last 5 years, weight, education, and ecological region (Terai, Hills & Mountain regions).

Results: In 2006, women who had given birth during the intervention implementation period (n=5,110) exposed to the intervention for 1-3 years had a 7% reduced the odds of having anemia (OR: 0.93; 95CI 0.91, 0.95). In 2011, among women who had given birth in the previous 5 years in the Terai (n=864), intervention exposure for 3-5 years suggested a 45% reduction in the odds of having anemia (OR: 0.55; 95CI 0.31, 0.99).  Intervention exposure also suggested benefits in likelihoods of mothers receiving IFA (6-11%), and de-worming (12-28%).

Conclusions: These results suggest that the IIP had a role in increasing IFA and de-worming coverage and may have protected against anemia. Nepal's example suggests that large scale national programs with long term commitment can successfully impact IFA coverage and potentially impact anemia.

Open Access Conference Proceeding (Abstract)

Optical Brain Imaging as an Assessment Tool for Nutrition Related Cognitive Development in Rural Gambia: Studies from Birth to 24 Months of Age

Sarah Lloyd-Fox, Drew Halliday, Katarina Begus, Helen Maris, Maria Papademetriou, Nick Everdell, Momodou Darboe, Andrew Prentice, Sophie Moore, Clare Elwell

European Journal of Nutrition & Food Safety, Page 538-539
DOI: 10.9734/EJNFS/2015/20952

Objectives: Appropriate nutrition in the first 1000 days of life is essential for optimal brain development and function. Neurobehavioral assessments of cognitive function can only detect effects of nutritional deficiencies once they reach the point of observable behaviour, thus reducing the efficacy of early intervention strategies. The aim of this study was to demonstrate the use of optical imaging as an assessment tool for cognitive function in the first two years of life for nutrition based studies in a resource poor settings.

Methods: Near infrared spectroscopy (NIRS) is an optical imaging technique which has been widely used to study cognitive function in infants in the developed world. Systems are portable and easy to setup, protocols are tolerant of participant motion, and non experts can easily be trained to perform the studies. We transported an NIRS system to a field station in rural Gambia to study infants from three age groups (4-8 month-olds n = 24; 9-13 month olds n = 26; 18-24 month-olds, n = 20) and used it to measure brain activation to visual and auditory social and non social stimuli.

Results: Significant localised brain activation was seen during auditory social (e.g., laughter) compared to auditory non social (e.g., toy rattles) conditions - as well as to visual social (human peek-a-boo) compared to visual non social (transport images).

Conclusions: These results confirm the viability of optical neuroimaging in resource poor settings, and its potential as an assessment tool for nutrition related studies of cognitive function.

Open Access Conference Proceeding (Abstract)

Development of Food Based Dietary Guidelines for Kenyan Women Using Linear Programming

S. A. Ngala, S. M. Akter, A. M. Mwangi, I. D. Brouwer

European Journal of Nutrition & Food Safety, Page 540
DOI: 10.9734/EJNFS/2015/20953

Objectives: Women in Kenya are at high risk of multiple micronutrient deficiencies due to low intake through monotonous diets. Country-specific food based dietary recommendations (FBRs) facilitate dietary improvement. Main objective was to develop and evaluate FBRs based on the existing diet using linear programming for women of reproductive age from Mbooni division, Eastern Kenyan.

Methods: A consumption study was conducted among 205 woman (19-50 yrs.) using three non-consecutive 24-hour recalls. Excel, Access and SPSS were used to prepare required model parameters (foods consumed by >10% of women, including median portion size, weekly frequency consumption, food composition values, food group patterns (median and range), staple/snacks. Linear programming (‘Optifood') was used to develop and evaluate FBRs.

Results: Out of 62 foods, 30 foods were consumed by more than 10% of the surveyed women. Fat, iron, folate and vitamin-B12 requirements could not be met both in worst (≥70%RNI) and best case (≥100% RNI) scenario diets, covering 43.6%, 48.4%, 30.0% & 18.8% of RNI. Calcium, vitamin A, riboflavin, niacin, B6 and zinc intake was inadequate, but requirements could be met by inclusion of kale, pumpkin leaves, red beans, cow's milk and cooking fat.

Conclusions: Realistic food based dietary guidelines based on locally available foods for Kenyan women were successfully developed using linear programming. These guidelines will ensure at least 70% RNI of energy, protein, calcium, vitamin A, C, B1, B2, B5, B6, and zinc. To obtain adequate amounts of fat, folate, iron and vitamin-B12 in the women's diet, alternative strategies are required.

Open Access Conference Proceeding (Abstract)

Vitamin A Supplementation and Stunting Levels among Two Year Olds in Kenya: Evidence from the 2008-09 Kenya Demographic and Health Survey

Elizabeth Kimani-Murage, Crispin Ndedda, Katherine Raleigh, Penina Masibo

European Journal of Nutrition & Food Safety, Page 541-542
DOI: 10.9734/EJNFS/2015/20954

Objectives: Further analysis of KDHS 2008/09.

Methods: The study uses data from the 2008-09 Kenya Demographic and Health Survey, involving children aged 24-35 months, a weighted sample of 1029 children. Descriptive and logistic regression analyses were conducted. The outcome variable of interest is stunting, while the exposure variable of interest is ever receiving a dose of vitamin A supplement. Secondary outcomes include underweight and wasting status.

Results: The prevalence of stunting in the study group was 46%; underweight 20%; and wasting 6%. The prevalence of ever receiving vitamin A supplement was 78%. Receiving vitamin A supplement was significantly negatively associated with stunting and underweight status, adjusting for other co-risk factors. The odds of stunting were 50% higher (p=0.038), while for underweight were 75% higher (p=0.013) among children who did not receive Vitamin A supplement compared with those who did.

Conclusions: This study demonstrates that receiving vitamin A supplement may be beneficial to growth of young children in Kenya. However, though freely offered through immunization services to children 6-59 months, some children do not receive it, particularly after completing the immunization schedule. There is need to establish innovative and effective ways of maximizing utilization of this intervention.

Open Access Conference Proceeding (Abstract)

Daily Dietary Intake of Zinc is positively Associated With Height-for-Age Z-score (Haz) among Ethiopian Children 6-35 Months of Age

Girmay Ayana, Sara Wuehler, Tibebu Moges, Aregash Samuel, Aweke Kebede, Dilnesaw zerfu, Andinet Abera, Girma Mengistu, Birhanu Wodajo, Katherine A. Birks, Jalal Chowdhury, Amha Kebede

European Journal of Nutrition & Food Safety, Page 543-544
DOI: 10.9734/EJNFS/2015/20955

Objectives: In Ethiopia, 44% of children under five years-of-age are stunted (i.e., height-for-age (HAZ) below -2SD). This is considered a major public health concern by the Ethiopian Ministry of Health’s National Nutrition Plan. Future efforts to reduce stunting depend largely on understanding the local determinants of stunting. Zinc deficiency is a recognized risk factor for stunting in this age group and we hypothesized this was also true in Ethiopia. Our objectives were to determine the association between daily dietary zinc intake (DDZI) and HAZ and to also identify determinants of DDZI among children 6-35 months of age.

Methods: We used regionally representative data from the 2011 Ethiopian National Food Consumption Survey, weighted for relative population sizes (N=6752 children). Univariate general linear models served to assess the association between HAZ and DDZI and to identify determinants of DDZI. Models included potential socioeconomic, demographic and physiological confounders.

Results: DDZI was positively associated with HAZ (p<0.0001). Socio-economic status, maternal education, and maternal age were positively associated with DDZI, while the number of children under 5 years-of-age in a household was negatively associated with DDZI (p<0.0001). Children from the Amhara and SNNPR regions, and those reportedly sick in the previous 2 weeks were most likely to report low DDZI (p<0.0001).

Conclusions: Low height-for-age remains a major public health problem in Ethiopia. Our findings suggest that height-for-age is associated with low zinc intake in Ethiopia, providing evidence for Ethiopia’s National Nutrition Plan to emphasize increased consumption of zinc rich foods in young children.

Open Access Conference Proceeding (Abstract)

Supply Chain Challenges Affecting Access to IFA, Calcium, Oxytocin and Misoprostol in Kakamega County, Kenya

Crispin Ndedda, James Riungu, Alex Muturi, Rebecca Njue, Papa Ndao

European Journal of Nutrition & Food Safety, Page 545-546
DOI: 10.9734/EJNFS/2015/20956

Objectives: The broad objective was to assess components of the supply chain aiming at identifying facilitating factors and barriers to uninterrupted availability of IFA, oxytocic drugs, misoprostol, magnesium sulphate and calcium with a view of formulating innovative solutions.

Methods: A cross-sectional design was used to conduct supply chain assessment in Kakamega County, Kenya. It included a random selection of 7 dispensaries, 8 health centres, 3 district hospitals and 1 referral hospital. Data was collected through record reviews, observations, key informant interviews and client exit interviews.

Results: The study found glaring gaps in commodity forecasting and quantification, sub-optimal inventory management, and there were frequent prolonged stock outs. Commodity specific gaps were identified including lack of inclusion in the essential drugs list, absence of service delivery guidelines and a large proportion of commodities available in the market that did not meet the recommended dose composition for the intended purposes. For example, only 12% of the combined IFA formulations found in the market met the recommended doses for antenatal supplementation. There was also inadequate local manufacturing capacity of these commodities.

Conclusions: In conclusion, there are glaring weaknesses in the supply chain. Streamlining the supply chain entails addressing policy issues, advocacy for local manufacture, strengthening forecasting and quantification capacity as well as a carefully thought out procurement processes.

Open Access Conference Proceeding (Abstract)

Preventing Malnutrition in Infancy through Optimal Breastfeeding: A Study of Mothers’ Perception in Sagamu, South Western Nigeria

Oluwafolahan Sholeye, Doyinsola Somade, Olamide Agunbiade, Omolara Ogundipe, Omotola Banwo, John Olaye

European Journal of Nutrition & Food Safety, Page 547-548
DOI: 10.9734/EJNFS/2015/20957

Objectives: Breastfeeding is an evidence-based cost-effective means of preventing malnutrition in early childhood, thereby improving the chances of survival. Despite its nutritional advantages breastfeeding has been sub-optimal in Nigeria, due to misconceptions.

This study assessed the perception of breastfeeding among mothers accessing child health services in Sagamu, Ogun State.

Methods: A cross-sectional descriptive study was carried out among 283 mothers, who utilized the child health services provided at three primary health centres in Sagamu, Ogun State, Nigeria, selected through multi-stage sampling. Data collection was done using pre-tested, semi-structured, interviewer-administered questionnaires. Data was analyzed using SPSS version 17.00. Ethical approval was obtained from the hospital’s research ethics committee.

Results: Most respondents were aged between 26 and 30 years; 4% were aged less than 21 years; and only 2% were older than 40 years. Most (47.7%) had tertiary education; 38.5% had secondary education; while 2.5% had no formal education. Majority (82%) felt breastfeeding was essential for child survival, while 18% felt otherwise. Most respondents (74.2%) knew about exclusive breastfeeding; 29.3% felt it was not practicable; 1.1% felt there were cultural inhibitions to breastfeeding; while 40% felt it was impossible to feed babies on expressed breast milk. About 83% felt breast size determined milk ejection rate; 41% felt breastfeeding reduced breast size; 73.9% felt it caused the breasts to sag; and 2.5% felt it did not benefit the mother.

Conclusions: The perception of respondents was fair on breastfeeding and its benefits to infants and mothers. Existing misconceptions can be corrected through continuous health education.

Open Access Conference Proceeding (Abstract)

Impact of Nutritional Interventions on Mental Development of Children Under-two in Developing Countries: A Systematic Review of Randomized Controlled Trials

Leila Larson, Aisha Yousafzai

European Journal of Nutrition & Food Safety, Page 549-550
DOI: 10.9734/EJNFS/2015/20958

Objectives: High levels of early child malnutrition in developing countries are of concern not only because they affect later growth but because they may affect mental and motor development. This systematic review updates and goes beyond previous ones by answering two important questions: 1) are effects on mental development associated with indicators of nutritional change; and 2) are effects on mental development associated with improvement in motor development?

Methods:  Our systematic review of articles on Medline, PsycINFO, and Global Health was limited to randomized trials in developing countries, with mental development of children from birth to age two as an outcome. The initial yield of 1740 studies was reduced to 24.

Results: Of the 17 postnatal and 7 prenatal nutritional interventions, the majority used zinc, iron/folic acid, vitamin A or multiple micronutrients, with a few evaluating fatty acids. Most studies used groups that were comparable at baseline; most used the Bayley Mental and Motor tests.  The mean (range) effect size (d) for postnatal and prenatal nutritional interventions on mental development was 0.12(-0.56 to 1.1) and 0.002(-0.31 to 0.19), respectively. Among the postnatal interventions, the percentage (number) of studies with an effect size above 0.1 for weight-for-age and height-for-age was 27% (3) and 33% (4), respectively. Motor development fared better with an effect size of 0.19(-0.29 to 1.28).

Conclusions: In summary, nutritional interventions had small effects on mental development. They might have greater effect if they addressed hygiene and sanitation, as well as macronutritional deficiencies, and were longer in duration.

Open Access Conference Proceeding (Abstract)

The Effect of Neonatal Vitamin A Supplementation on the Risk of Atopy; Long-term Follow-up on a Randomized Controlled Trial in Guinea-Bissau

Sofie Aage, Nick Kiraly, Kassarai Da Costa, Stine Byberg, Morten Bjerregaard-Andersen, Ane Bærent Fisker, Peter Aaby, Christine Stabell Benn

European Journal of Nutrition & Food Safety, Page 551-552
DOI: 10.9734/EJNFS/2015/20959

Objectives: Neonatal vitamin A (NVAS) is currently being considered as policy in low income countries at risk of deficiency. We conducted NVAS trials in Guinea-Bissau and found sex-differential effects of NVAS on mortality, the effect being negative for females. We examined the effect of NVAS on atopy in long term follow-up of trial participants.

Methods: In 2002-2004 we randomised 4345 normal birth weight neonates to NVAS (50,000 IU) or placebo together with their Bacille Calmette Guérin-vaccination. In 2013, we visited the 1692 (39%) children who were still living in the study area, and 1478 (87%) were found at home. Provided consent, a skin prick test was performed, and history of allergic symptoms was recorded. Associations of NVAS and atopy (defined as a skin prick test reaction of >3 mm) were analysed using binomial regression, overall and stratified by sex.

Results: Of the 1430 children with a valid skin prick test, 228 were positive (16%; boys 20%, girls 12%). NVAS did not increase the overall risk of atopy (RR 1.10; 95% CI=0.87-1.40). However, NVAS was associated with significantly increased risk for females (1.78; 1.17-2.72) but not for males (0.86; 0.64-1.15), resulting in a significant interaction between NVAS and sex (p=0.01). Furthermore NVAS tended to increase the risk of wheezing for girls (RR 1.73; 0.99-3.03).

Conclusions: NVAS increased the risk of atopy and tended to increase the risk of wheezing among females. Further studies on NVAS and atopy are warranted. These findings might have implications for future policy decisions.

Open Access Conference Proceeding (Abstract)

Building on Uganda's Progress in Reducing Anemia among Children: From Evidence to Action

John Fiedler, Deepali Godha, Manisha Tharaney, Jolene Wun, Sarah Ngalombi, Alex Mokori

European Journal of Nutrition & Food Safety, Page 553-554
DOI: 10.9734/EJNFS/2015/20960

Objectives: Anemia is a problem of public health significance in Uganda. In 2001, 71% of children under-five were anemic. In 2011, the prevalence of anemia had declined to 50% among children. This large decline in anemia prevalence has prompted questions of what factors have contributed to the reductions in prevalence. The SPRING project with the MOH, undertook a secondary analysis of the Uganda Demographic and Health Surveys (UDHS) to understand changes in anemia prevalence among children.

Methods: The study analyzed the trends in anemia prevalence and explored the plausibility of different programs having played a role in the prevalence of anemia in among children 6-59 months using the UDHS 2001, 2006 and 2011.

Results: There were broad based reductions of anemia prevalence across all strata of children in country between 2006 and 2011. There was also a striking growth in the number of anemia-relevant programs that Ugandan children engaged in. When participation in deworming, vitamin A supplementation, and bed nets programs was measured-the mean number of programs that children 6-23 months participated in increased from 1.31 in 2006 to 1.63 in 2011, and among 24-59m olds, the number increased from 1.28 to 1.71, an increase of 34%.

Conclusions: Although the changes in anemia prevalence cannot be causally linked to changes in anemia-related program coverage due to the limitations of the data, the greatest reductions in anemia prevalence were seen among children engaged in anemia-related programs. Program participation in Uganda seems to be a significant factor in changing anemia prevalence among children in Uganda.

Open Access Conference Proceeding (Abstract)

Lessons in Scale-up of a Public Sector Zinc ORS Intervention for Childhood Diarrhoea Management in the Indian State of Bihar

Mahesh Srinivas, Sanjeev Kumar, Devaji Patil, Rakesh Chandra Jha, Rajiv Ranjan, Meena Haribhau Jadhav

European Journal of Nutrition & Food Safety, Page 555-556
DOI: 10.9734/EJNFS/2015/20961

Objectives: The Government of India introduced guidelines on therapeutic supplementation of zinc in the management of childhood diarrhoea in the year 2007, but programmatic constraints delayed its introduction into public health programs.

Micronutrient Initiative, with support from a donor, initiated a program in 2010 to demonstrate and scale-up the use of zinc through public sector channels, in the state of Bihar.

Methods: The project was implemented in 15 demonstration districts with a population of 36 million. Over 40,000 community level health workers were oriented on use of zinc. Support was provided to strengthen procurement and supply chain mechanisms. A robust system of monitoring and evaluation was introduced to track performance. Meaningful engagement with the government ensued throughout the demonstration phase.

Results: Use of Community-level volunteers (CLVs) is a pre-requisite to scaling-up access to care. More than one-million children were reported to be provided care. The CLVs need to be engaged through a relevant supportive supervision model. Supply chain mechanisms need to be strengthened to prevent stock-outs at service delivery points. Simple reporting tools need to be introduced for improved case- reporting.

Conclusions: It is feasible and viable to introduce and scale-up therapeutic zinc supplementation as an adjuvant to ORS in the management of childhood diarrhea through public sector channels. The community-based approach of service delivery and proactive engagement with the government are key essentials in achieving the above objectives.

Open Access Conference Proceeding (Abstract)

Improving Public Sector Case-reporting for Childhood Diarrhea through Capacitating Female Community Level Volunteers (CLVs) in the Indian State of Bihar

Sanjeev Kumar, Rajiv Ranjan

European Journal of Nutrition & Food Safety, Page 557-558
DOI: 10.9734/EJNFS/2015/20962

Objectives: CLVs play an important role in prevention and treatment of diarrhoea. However, only a small proportion of the cases treated by these semi-literate CLVs are reported and fed into the Health Management Information Systems (HMIS). Micronutrient Initiative capacitated and equipped semiliterate female CLVs to report on childhood diarrhoea cases as part of the ‘Reducing deaths from diarrhoea’ in the Indian state of Bihar.

Methods: Simple pictorial reporting tools that could be used by semiliterate CLVs were developed, pilot tested and provided to 42,258 CLVs. Hands-on training was undertaken for the CLVs and their capacities were continuously enhanced through an appropriate supportive supervision mechanism.

Results: In 15 demonstration districts between 2011 to 2013, a total of 1,037,910 diarrhoea cases have been reported treated in the public sector of which 55% of the cases were treated by CLVs. Majority of the above cases were not being reported previously. The successful demonstration has encouraged the state government to scale-up the involvement of CLVs in reporting on childhood diarrhoea through use of pictorial tools.

However, 64% of CLVs do not report regularly due to non-availability of tools and poor accountability. The programme is considering strengthening of supportive supervision and provision of incentives to improve compliance to reporting.

Conclusions: Reporting from CLVs is feasible by providing simple reporting tools and imparting them training to use the tools along with continuous follow-up and handholding. Improved reporting of childhood diarrhoea cases treated by CLVs is useful in informing program decisions and initiating corrective action.

Open Access Conference Proceeding (Abstract)

Effects of Prenatal Multiple Micronutrient Supplementation on Miscarriage in Developing Countries: A Meta-analysis of Randomized Controlled Trials

Zheng Yao, Hong-tian Li, Jian-meng Liu

European Journal of Nutrition & Food Safety, Page 559-560
DOI: 10.9734/EJNFS/2015/20963

Objectives: The potential adverse impact of prenatal multiple micronutrient supplementation (MMN) versus iron-folic acid (IFA) on perinatal mortality is concerned. It has been speculated that MMN might survive frail fetuses to late pregnancy or early infancy, resulting in an increase in perinatal death. If the speculation holds true, MMN would prevent miscarriages. We aimed to assess the speculation.

Methods: Pubmed, Embase, Web of Knowledge, and Cochrane Library were searched. Primary outcome was miscarriages. Secondary outcomes were stillbirths, perinatal deaths, and infant deaths; death events combined with miscarriages. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were estimated with fixed- or random-effect model, depending on heterogeneity tests. Pre-specified stratified and sensitivity analyses were planned to assess whether results varied by maternal baseline or trial characteristics.

Results: In total, 15 trials were identified. MMN versus IFA significantly reduced miscarriage risk (RR 0.91, 95% CI 0.83-1.00). MMN significantly reduced infant death risk within 90 days (RR 0.86, 95% CI 0.78-0.95); this reduction remained when miscarriage and stillbirth were included (RR 0.88, 95% CI 0.82-0.94). MMN insignificantly increased perinatal death risk (RR 1.08, 95% CI 0.93-1.25), but the increased risk vanished when miscarriages were included (RR 0.99, 95% CI 0.89-1.10). No difference for other death events between groups was observed, irrespective of whether miscarriages were accounted for.

Conclusions: MMN versus IFA supplementation prevented miscarriages and infant deaths within 90 days. The modestly increased perinatal mortality risk is a fallacy due to the survival bias resulting from protective effect on miscarriages.

Open Access Conference Proceeding (Abstract)

Composition, Acceptability, and Use of Fortfied Supplementary Food for the Management of Moderate and Acute Malnutrition (MAM) in the Philippines

Mario Capanzana, Joyce Tobias, Trinidad Archangel, Charlie Adona, Abbie Pedrones

European Journal of Nutrition & Food Safety, Page 561-562
DOI: 10.9734/EJNFS/2015/20964

Objectives: Malnutrition remains a public health problem in the Philippines, particularly among infants and young children and in time of disasters and calamities. The study aimed to develop and utilize locally available, affordable and culturally acceptable raw materials for the production of fortified supplementary foods suitable for MAM children following the international guideline.

Methods: Standardization trials were done in the food laboratory to determine the most acceptable formulation and processing conditions for the production of ready-to-serve fortified complementary foods. The most acceptable formulations were tested for the physico-chemical, microbiological and sensory properties during storage study using suitable packaging materials.  Retention of the micronutrients added was assessed. The estimated shelf life of the product was also determined. The product was fed to young children to determine the serving portion size and level of acceptability.

Results: The fortified complementary foods using locally available and culturally acceptable raw materials was lied very much by young children, compared with the currently available complementary foods used by development partners. The micronutrients added were retained and remained stable during one year storage period. Minimal changes in its physico-chemical, sensory and microbiological parameters were noted.

Conclusions: The study concluded that fortified complementary foods is highly acceptable and can be used to help solve the persisting problem of MAM. The product is now ready for commercialization and effectiveness study.

Open Access Conference Proceeding (Abstract)

Household Food Processing Methods to Enhance Iron and Zinc Bioavailability in Formulated Haricot Bean and Maize Complementary Food

Getenesh Berhanu, Addisalem Mesfin, Afework Kebebu, Carol Henery, Susan Whiting

European Journal of Nutrition & Food Safety, Page 563-564
DOI: 10.9734/EJNFS/2015/20965

Objectives: This study aimed to test the nutritional quality of white haricot bean-maize complementary food needing household food processing to decrease phytate content and enhance the bioavailability of iron and zinc.

Methods: Community consultation was conducted with mothers to find out traditional processing practices and preference for incorporation of pulse product to infant and young children diets. Germination and roasting methods of household processing and preparation methods were selected and used to process the white haricot beans and soaking was selected to process maize. Proximate nutrient analysis was done for treated and untreated samples at Saskatchewan Food Industry Development Center, and University of Saskatchewan, Canada and Ethiopian Health and Nutrition Research Institute. Community acceptability test was done on 36 mother-child pair. Means and standard deviations were calculated for proximate lab results and acceptability. ANOVA and Duncan’s multiple significant tests were conducted to determine significantly different means. Differences were considered significant at p<0.05.

Results: The community didn’t use haricot bean for complementary food. White haricot bean was selected instead and maize was selected for cereal as it is a staple in the diet. There were no significant differences in iron, zinc and phytate content between 48 and 72 hr germinated white haricot bean. However, processed products showed in reduction of phytate. And there were no significant mean differences among porridge samples for sensory attributes.

Conclusions: This study showed that processing such as soaking and germination of pulse is necessary for improved bioavailability of iron and zinc, and that pulse-cereal porridge is suitable as a complementary food.

Open Access Conference Proceeding (Abstract)

Zinc Status of Filipinos by Serum Zinc Level: 7th National Nutrition Survey, Philippine 2008

Mario Capanzana, Juanita Marcos, Leah Perlas, Phoebe Trio, Joselita Ulanday, Revelita Cheong, Josefina Denacido

European Journal of Nutrition & Food Safety, Page 565-566
DOI: 10.9734/EJNFS/2015/20966

Objectives: National data on the prevalence of zinc deficiency in the Philippine is not available.  Data on zinc status of Filipinos is important to design appropriate programs and policies for the improvement of nutrition and health status of Filipino population.  This study aimed to assess the prevalence and magnitude of zinc deficiency in the Philippines.

Methods: The serum zinc levels of blood samples collected during the 7th national nutrition survey conducted by the FNRI was determined by atomic absorption spectrometry.  The results were evaluated using the suggested lower cut-offs and guidelines for public health concern of the International Zinc and Nutrition Consultative Group (IZINCG).

Results: The national estimate of zinc deficiency in the Philippines was 30%, with a mean serum zinc level of 84.0+/-0.5 ug/dL. Zinc deficiency was observed in 21.6% of pre-school children, 30.8% in school children, 28.9% in adolescents, 31.0% in adults, 28.4% in elderly, 21.55 in pregnant and 39.7% in lactating women, with a mean serum zinc level (+/-SE) of 94.5+/-0.9 ug/dL, 79.9+/-0.8 ug/dL, 85.2 +/-0.9 ug/dL, 84.2+/-0.6 ug/dL, 91.4+/-1.1 ug/dL, 75.1+/-1.7 ug/dL. and 72.7+/-1.1 ug/dL, respectively.

Conclusions: Zinc deficiency was considered of high magnitude (>20%) in all Filipino population groups, both in the national level (30%) and in different age/physiologic groups.  The highest prevalence was noted among lactating women and those in the 1st six months of lactation. Males has higher deificency rates than females, except adults, 20-29 and 30-39 years old. The results can be used as basis for developing national programs and policies for the improvement of health and nutritional status of Filipinos.

Open Access Conference Proceeding (Abstract)

Early Childhood Stunting, Household Food Security, Micronutrient Rich Foods Consumption Southern Ethiopia

Masresha Tessema

European Journal of Nutrition & Food Safety, Page 567
DOI: 10.9734/EJNFS/2015/20967

Objectives: This study aims to assess micronutrient rich food consumption, household food security status and its association with stunting.

Methods: Community based cross-sectional design was employed to obtain data from 584 participants from three rural communitie. A two stage stratified sampling procedure was employed.

Results: Only 14.4% of the mother fed their children optimally. The prevalence of stunting was higher for the Infant aged 6 to 8 months (43.04%) compared to other. Only 21.2% of household were food secure. Eighty six percent of the children had diets below the minimum dietary diversity group The prevalence of Vitamin A and iron rich food consumptions were very low. The majority (93.1%) of mothers in this study reported that children consumed complementary foods made from grains, roots, and tubers. Consumption of fruits and vegetables was also minimal (37.9%). Moreover, only 6.3% of children consumed vitamin-A rich fruits and vegetables. In this study, only 1.9 % of the children consumed meat, fish, poultry. Children who had never consumed Vitamin A rich sweet potato were 16 times more likely to be stunted than those who consumed (P<0.05).

Conclusions: The feeding practices of most mothers were not according to the recommendation of WHO standard and consumption of micronutrient rich foods were very minimal. There is a need for promotion of optimal feeding and micronutrient rich food consumption for improving nutritional status.

Open Access Conference Proceeding (Abstract)

Zinc Deficiency was a Significant Public Health Problem in Adolescent School Girls from Northern Ethiopia

Afework Mulugeta, Mahmud Abdelkadir, Mehari Gebre, Araya Gebreyesus, Asfaw Gebretsadik, Barbara Stoecker

European Journal of Nutrition & Food Safety, Page 568-569
DOI: 10.9734/EJNFS/2015/20968

Objectives: Determine the prevalence and factors contributing to zinc deficiency in adolescent school girls from Tigray, Northern Ethiopia.

Methods: Cross-sectional study was conducted in 413 randomly selected adolescent school girls. Anthropometric data were collected following standard procedures. Z scores were calculated using the WHO Anthroplus software. Serum zinc was analyzed by ICPMS. To avoid zinc contamination, trace mineral free gloves and pipette tips and only plasticwares were used during analysis and reagent preparation, respectively. Quality control samples (Utak Laboratories, Inc., Valencia, CA) utilized in order to verify method performances were within recommended ranges.

Results: Mean (sd) serum zinc concentration was 72.3 (14.3) µg/dL. About 49.2% of the adolescent girls were zinc deficient (< 70 µg/dL). Stunted (72.3±15.9 µg/dL) and non-stunted (72.3±13.9 µg/dL) girls had comparable serum zinc concentrations. Zinc deficiency was severe in 12 and 13 year old girls as were stunting and thinness. Area of residence (p = 0.0001), water source to households (p = 0.0007) and access to household toilet facilities (p=0.0110) were significantly associated with zinc status.

Conclusions: Zinc deficiency was common in adolescent girls. The fact that zinc deficiency, stunting and thinness were prevalent at 12 and 13 years of age may reflect the higher growth rate and zinc requirements related to the growth spurt. Improving hygiene and sanitation of households and multicenter surveys to better understand zinc status in Ethiopian adolescent population are recommended.

Open Access Conference Proceeding (Abstract)

Vitamin A Status and Serum Carotenoid Levels of Adolescent School Girls from Northern Ethiopia

Afework Mulugeta, Mahmud Abdelkadir, Mehari Gebre, Araya Gebreyesus, Asfaw Gebretsadik, Barbara Stoecker

European Journal of Nutrition & Food Safety, Page 570-571
DOI: 10.9734/EJNFS/2015/20969

Objectives: Determine the vitamin A status and serum carotenoid levels of adolescent school girls from Tigray, Northern Ethiopia.

Methods: Serum samples separated from nonfasting venous blood were analyzed for retinol, α-carotene and β-carotene using reversed phase HPLC. The chromatographic separation was performed by isocratic elution with a mixture of methanol, dichloromethane and acetonitile (60:20:20 by volume) and at a flow rate of 0.8 mL/min. The concentrations of retinol and carotenoids were quantified at 325 and 450 nm, respectively.

Results: Mean levels of serum retinol and α-carotene were 35.9µg/dL and 10.5µg/dL, respectively and the median value of β-carotene was 46.4µg/dL. About 3% of the school girls were vitamin A deficient and 26% had serum retinol values indicative of marginal vitamin A status. Clinical assessments revealed that 3.7% and 3.2% had Bitot’s spot and night blindness, respectively. About 27% of the girls mentioned the word “HIMA”, a local term for night blindness. Residence, age, hematocrit and β-carotene were the significant predictors of serum retinol concentrations (p < 0.0001).

Conclusions: Our results demonstrated high levels of marginal vitamin A deficiency in adolescent girls. Because of cultural differences in food preparation, food consumption and food taboos in different parts of the country, our study is not generalizeable to all regions from Ethiopia and thus multicenter studies to substantiate our results and establish the vitamin A status of adolescents are recommended.

Open Access Conference Proceeding (Abstract)

Factors Associated with Anemia in Women of Reproductive Age in Ethiopia: Using Ethiopian Demographic and Health Survey Data 2011

Beshir Mohamed, Oumer Seid, Wondwossen Terefe, Afework Mulugeta

European Journal of Nutrition & Food Safety, Page 572-573
DOI: 10.9734/EJNFS/2015/20970

Objectives: Asses factors associated with anemia in women of reproductive age in Ethiopia.

Methods: Anemia status of 15,568 women was determined from their hemoglobin measurements. Pearson chi-square tests, bivariate and multivariable logistic regression with stepwise variable selection procedure were used to determine factors contributing towards maternal anemia.

Results: Residence [AOR=2.55; 95% CI: 1.983-3.280], antenatal care [AOR=1.21; 95% CI: 1.044-1.444] and iron supplementation during pregnancy [AOR=5.66; 95% CI: 4.495, 7.138] were significantly associated with maternal anemia. Women from Somali, Afar and Diredawa regions were 3 [AOR=3.30; 95% CI: 1.489-6.182], 2.5 [AOR=2.46; 95% CI: 1.211-5.002] and 1.7 times (AOR=1.73; 95% CI: 1.387-2.146) more likely but women from SNNP region were 58% less likely to be anemic compared to women from Addis Ababa, respectively. Uneducated women were 4.4 times [AOR=4.37; 95% CI: 3.733-5.119] and those with primary education were 2.6 times (AOR=2.61; 95% CI: 2.209-3.075) more likely to be anemic compared to women with secondary education. Women with 1 - 2 years of birth interval were 43% [AOR =1.43; 95% CI: 1.154-1.771] and 3 - 4 years were 31% [AOR=1.31; 95% CI: 1.0 92-1.565] more likely to be anemic compared to those with five or more years of birth interval.

Conclusions: Residence, educational level, birth interval, ANC and iron supplementation during antenatal follow up were significant contributors for maternal anemia. Interventions aimed at focused health and nutrition education, family planning and girl’s education are recommended.

Open Access Conference Proceeding (Abstract)

The Impact of Integrated Health and Nutrition Interventions on the Prevalence of Vitamin A Deficiency among Pre-school and School Children in Ethiopia

Sisay Sinamo, Asrat Dibaba, Etsub Brhanesillasie, Tigist Mamo

European Journal of Nutrition & Food Safety, Page 574-575
DOI: 10.9734/EJNFS/2015/20971

Objectives: The purpose of this article is to inform participants on the impact of integrated health and nutrition interventions (micronutrient supplementation, de-worming, immunization, hygiene and sanitation, IYCF and dietary diversification and modification) on prevalence of Vitamin A deficiency among pre-school and school children. World Vision Ethiopia implemented micronutrient and health project for eight years in partnership with ministry of health.

Methods: A quasi-experimental design was used to conduct a baseline, mid-term and final evaluations. The study covered 8 intervention woredas/districts and two comparison sites. A total of 1197 children under five and 2997 students were examined clinically.

Results: The prevalence of Bitot’s spots among under-five children decreased from 6.4% at baseline survey (BLS) to 1.4% at midterm (MT) and nil at the end of program (EOP). The prevalence of Bitot’s spots in school children dropped from 7.5% at BL to 1.8% at EOP. Similarly, the prevalence of night blindness decreased from 4.9% to 0.1% in pre-school children and from 11.4% to 3.2% in school children.  However, the situation remained higher in the comparison sites. Vitamin A supplementation coverage was significantly higher in intervention area compared with the comparison sites (P=0000). The mean consumption of vitamin A rich animal products and fruits is higher among the intervention than the comparison sites (p<0.05). Significant improvements were also noted in the prevention and control of diseases that contribute to the loss of vitamin A.

Conclusions: The project achieved a significant reduction in vitamin A deficiency in the targeted community through undertaking integrated health and nutrition interventions.

Open Access Conference Proceeding (Abstract)

Adequate Iodized Salt Supply: A Key Success Factor to Impact Goiter Prevalence Rate in Highly Endemic Areas in Ethiopia

Asrat Dibaba, Tigist Mamo, Sisay Sinamo, Etsub Brhanesillasie

European Journal of Nutrition & Food Safety, Page 576-577
DOI: 10.9734/EJNFS/2015/20972

Objectives: The purpose of this article is to inform participants on the key lessons learned from implementing interventions to impact iodine deficiency as part the World Vision Ethiopia micronutrient and health project which was operational for eight years (1997-2005).

Methods: A quasi-experimental design was used to conduct a baseline, midterm and final evaluation. The study covered 8 intervention project woredas/district and two comparison sites. Three successive surveys were conducted to assess the impact of the interventions. 5,996 households including pregnant and lactating mothers were interviewed and participated in iodized salt testing and 2997 students clinically examined for goiter rating.

Results: At the end of the project, 39.8% of women of childbearing age identified the two major causes of goiter (iodine deficiency and food related) correctly. This proportion was higher than that in the baseline (7.9%) and comparison site at end line (11.4%) (p=0.000). Lower proportion of mothers (15.1%) reported that they lacked knowledge about the treatment of goiter, compared to 46.6% at baseline and 44.9% at comparison areas. The prevalence of palpable and visible goiter at the end of the project (30.9%) was lower compared to the baseline (42.4%) (p=000). This change would have been higher if there was continuous supply of iodized salt. This was shown during iodized salt testing done at the end of the survey where almost all households (97.7%) do not have iodized salt.

Conclusions: Though effective education increased the knowledge lack of adequate supply of iodized salt affected iodized salt utilization and its impact on total goiter rate.

Open Access Conference Proceeding (Abstract)

A Randomised Trial of High-dose Vitamin A at Vaccination Contacts After 6 Months of Age: Sex-differential Effects on Mortality

Ane Fisker, Carlito Bale, Amabelia Rodrigues, Ibraima Balde, Manuel Fernandes, Mathias Jul Jørgensen, Niels Danneskiold-Samsøe, Linda Hornshøj, Julie Rasmussen, Emil Christensen, Bo M. Bibby, Peter Aaby, Christine Stabell Benn

European Journal of Nutrition & Food Safety, Page 578-579
DOI: 10.9734/EJNFS/2015/20973

Objectives: Though VAS at vaccination contacts has been recommended for many years, the policy has never been evaluated for its effect on overall mortality in randomised controlled trials. We evaluated the effect of the WHO recommendation of vitamin A supplementation (VAS) at routine vaccination contacts after 6 months of age.

Methods: We conducted a randomised controlled trial of VAS. Children aged 6-23 months were randomised 1:1 to VAS (100,000 IU if aged 6-11 months, 200,000 IU if aged 12-23 months) or placebo at vaccination contacts in Guinea-Bissau. Mortality rates were compared in Cox proportional-hazards models overall, and by sex and vaccine.

Results: Between August 2007 and November 2010, 7587 children were enrolled. Within 6 months of follow-up there were 81 non-accident deaths (VAS: 39; placebo: 42). The mortality rate ratio (MRR) comparing VAS versus placebo recipients was 0.93 (95% CI: 0.60-1.44) and differed significantly between boys (MRR=1.92 (0.98-3.75)) and girls (MRR=0.49 (0.26-0.92)) (p=0.004 for interaction between VAS and sex). At enrolment 42% (3161/7587) received live measles vaccine, 29% (2154/7587) received inactivated diphtheria-tetanus-pertussis-containing vaccines and 21% (1610/7587) received both live and inactivated vaccines. The effect of VAS did not differ by vaccine group.

Conclusions: This is the first randomised trial of the effect of VAS at routine vaccination contacts on mortality. VAS had no overall effect, but the effect differed significantly by sex. More trials to ensure an optimal evidence-based vitamin A policy are warranted.

Open Access Conference Proceeding (Abstract)

Does Vitamin A Supplementation at Birth Prime a Beneficial Response to Subsequent Doses?

Ane Bærent Fisker, Ibraima Balde, Peter Aaby, Christine Stabell Benn

European Journal of Nutrition & Food Safety, Page 580-581
DOI: 10.9734/EJNFS/2015/20974

Objectives: A previous follow-up study of a neonatal vitamin A supplementation (NVAS) trial in Guinea-Bissau indicated that NVAS primed for a beneficial response to subsequent VAS in girls. We aimed to test this hypothesis in another study population.

Methods: In 2004-2007 we conducted a NVAS trial in Guinea-Bissau randomising newborns 2:1 to VAS (50,000 IU or 25,000 IU) or placebo. We followed the children to 24 months and registered reception of subsequent VAS provided in campaigns or by our assistants. Mortality according to NVAS and subsequent VAS between 6 months (the earliest age of subsequent VAS) and 24 months was compared in Cox proportional-hazards models.

Results: Among 6048 children enrolled in the NVAS-trial, 5507 children (91%) remained in the study area after 6 months of age. Between 6 months and the first VAS opportunity, 33 non-accident deaths occurred (28 NVAS, 5 placebo). NVAS was associated with a mortality rate ratio (MRR) of 2.71 (1.04-7.04). After reception of VAS, 12 children died (7 NVAS, 5 placebo) and the MRR was 0.69 (0.22-2.18), p=0.07 for different effect of NVAS before and after subsequent VAS.  The effect was similar in boys and girls.

Conclusions: The effect of NVAS tended to differ by reception of a subsequent VAS, but we could not confirm that the effect differed for girls only. More studies are needed to identify in which situations VAS is beneficial and in which it is not, in order to define a vitamin A policy which optimises the impact on child survival.

Open Access Conference Proceeding (Abstract)

Nutrition Status and Haemoglobin Levels of Pregnant Women Attending Kapenguria Hospital in West Pokot County, Kenya

Lillian Marita, Judith Waudo, Elizabeth Kuria

European Journal of Nutrition & Food Safety, Page 582-583
DOI: 10.9734/EJNFS/2015/20975

Objectives: To determine the nutritional status and haemoglobin levels of pregnant women in West Pokot County and, to establish the relationship between maternal demographic and socioeconomic factors and the nutritional status of the pregnant women.

Methods: The study was done in West Pokot County, Kenya and used cross sectional analytical design using researcher administered questionnaires. A total 145 pregnant women aged 19-49 years who were randomly selected from among those attending Antenatal Clinic (ANC) at Kapenguria Level IV Hospital. Anthropometry measurements of MUAC of the pregnant women were taken using a standard MUAC tape. Whole blood was drawn from the finger for haemoglobin analysis which was done using HemoCue photometer. Data were analyzed using SPSS version 16 and 24 hour recall was analyzed using Nutri- Survey soft ware.

Results: Based on MUAC cut offs, 31.7% were malnourished (MUAC <21.0 cm) while 68.3% of the respondents were normal (MUAC >21.0 cm). MUAC was positively correlated with the socio economic status (r=0.229, p=0.006). Anaemia prevalence was 73.6%. Linear regression showed that the age and parity were significant predictors of the MUAC of the pregnant women (p=0.001). The total assets owned were also found to significantly predict the MUAC of the pregnant women (p=0.028).

Conclusions: Malnutrition and anaemia prevalence among pregnant women was high with no significant differences in the trimesters however, the age, parity and socioeconomic status were significant predictors of the nutrition status.

Open Access Conference Proceeding (Abstract)

Community Based Intervention Improves Micronutient Intake among Pregnant Women and Children Under 1 (CU1) in Bethlehem Villages

Han'a Al-Rabadi

European Journal of Nutrition & Food Safety, Page 584-585
DOI: 10.9734/EJNFS/2015/20976

Objectives: Micronutrient deficiencies, particularly iron and vitamin A, are major health problems in Palestine, especially among pregnant women and children. Anemia is reported by the Ministry of Health to affect more than half of children under five years and at least 30% of pregnant women.

The intervention study assessed the effectiveness of targeted and timely home visits by trained community health workers (CHWs) for increased knowledge and improved practices among mothers in iron, folic acid (FA), vitamin A supplementation and dietary modification.

Methods: World Vision implemented this intervention in eleven villages surrounding Bethlehem. Pregnant women and mothers (n=360) of infants during the year 2011 and 2012 were identified by 17 trained CHWs. The CHWs conducted organized home visits to mothers throughout 14 months. Baseline and endline data were collected through household interviews.

Results: During pregnancy, regular intake of iron supplements increased from 48.5% to 70.1% (p<0.001); consumption of proper meals (with iron sources) increased from 41.6% to 65.9% (p<0.001); FA intake increased from 49.0% to 70.1% (p<0.001). For CU1, regular vitamin A supplementation increased from 44.6% to 75.6% (p<0.001), regular iron supplementation increased from 38.8% to 76.7% (p<0.001), adequate complementary meals rich in iron and vitamin A increased from 28.5% to 78.9% (p<0.001).

Conclusions: Home-based interventions by trained CHWs have improved micronutrient intake through increasing maternal and child supplementation and food modification in Bethlehem villages. Scale-up plans to other communities is recommended.

Open Access Conference Proceeding (Abstract)

Scaling up Weekly Iron and Folic Acid Supplementation in Jharkhand, India Minimizing Challenges, Maximizing Opportunities

Deepika Mehrish Sharma, Sangita Jacob, K. Vidyasagar, Mridula Sinha, Khyati Tewari, Nishant Diwan, Binod Kumar, Vani Sethi, Job Zachariah, Victor M. Aguayo

European Journal of Nutrition & Food Safety, Page 586-587
DOI: 10.9734/EJNFS/2015/20977

Objectives: Jharkhand is a predominantly tribal Indian state. Home to 3.5 million adolescent girls, two-thirds of Jharkhand's adolescent girls were reported to be anaemic. In 2000, the Government of Jharkhand launched the Adolescent Girls Anemia Control Programme (AGACP) in five of its 24 districts with technical support by UNICEF. This presentation summarizes a decade of experience in scaling up Jharkhand's AGACP.

Methods: In its initial phase, the programme covered around 250,000 school-going adolescent girls in 2800 schools. The intervention included weekly iron and folic acid (IFA) supplementation, bi-annual deworming, and nutrition counselling. The second phase was launched in 2009 to cover two million adolescent girls. During this phase the programme faced important challenges due to a break-down in the supply chain of IFA supplements and deworming tablets. However, weekly nutrition counselling sessions continued. The third phase of the programme was inaugurated in 2012 with the advent of the National Weekly Iron and Folic Acid Supplementation (WIFS) programme implemented in a convergent manner by the Departments of Health and Family Welfare, Women and Child Development, and Education.

Results: The programme has been universalized across all 24 districts, by the state government. Currently, the programme covers 3 million adolescents. 

Conclusions: Approaches used for stabilizing the programme are valuable lessons (do's and dont's) in piloting, stabilizing and scaling up a large scale programme for the control of anaemia in adolescent girls in resource-constrained settings.

Open Access Conference Proceeding (Abstract)

Efficacy of Amaranth Grain Flour or Multi-micronutrient Fortified Maize Porridge on Iron of Kenyan Pre-school Children: A Randomized, Controlled Intervention

Catherine Macharia-Mutie, Alice Mwangi, Inge Brouwer

European Journal of Nutrition & Food Safety, Page 588-589
DOI: 10.9734/EJNFS/2015/20978

Objectives: Adding iron-rich foods or multi-micronutrients powder (MNP) could be options to control iron deficiency anaemia (IDA) in children. Data evaluating the impact of fortification with iron-rich foods such as amaranth grain and MNP containing low doses of highly bio-available iron to control IDA is limited. We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan pre-school children.

Methods: In a 16-week intervention trial, children (n=279; 12-59 months) were randomly assigned to: unrefined maize porridge (control; 4.1 mg of iron/meal); unrefined maize (30%) and amaranth grain (70%) porridge (amaranth group; 23 mg of iron/meal); or unrefined maize porridge with MNP (MNP group; 6.6 mg iron/meal; 2.5 mg iron as NaFeEDTA). Primary outcomes were anaemia and iron status with treatment effects estimated relative to control.

Results: At baseline, 38% were anaemic and 30% iron deficient. Consumption of MNP reduced prevalence of anaemia [-46% (95% CI= -67,-12)], ID [-70% (95% CI=-89,-16)], IDA [-75% (95% CI= -92,-20)] and soluble transferrin receptor [-10% (95% CI=-16,-4)] concentration while significantly increasing haemoglobin [2.7 g/L (95% CI= 0.4, 5.1)] and plasma ferritin [40% (95% CI=10, 95)] concentration. There was no significant change in haemoglobin or iron status in the amaranth group.

Conclusions: Consumption of maize porridge fortified with low dose highly bio-available iron MNP can reduce the prevalence of IDA in pre-school children. In contrast, fortification with amaranth grain even when shown to have high iron concentration without reduction of phytic acid may not show significant improvement in iron status.

Open Access Conference Proceeding (Abstract)

Scaling Up Vitamin a Supplementation in India: Much Progress, Some Challenges

Jee Hyun Rah, Rakesh Kumar, Sila Deb, Victor Aguayo

European Journal of Nutrition & Food Safety, Page 590-591
DOI: 10.9734/EJNFS/2015/20979

Objectives: Preventive vitamin A supplementation (VAS) is an proven child survival intervention. Since 2006, the National and State Governments of India supported by UNICEF and other development partners have made combined efforts to strengthen the implementation of biannual VAS rounds. This presentation reviews the VAS programme in India, aiming to characterize the coverage at national and state levels since 2006, and identify better practices, enabling factors, and bottlenecks.

Methods: We carried out a thorough analysis of the VAS programme coverage data, a review of relevant literature, field observations and interviews with key stakeholders.

Results: The national full VAS coverage increased from 33% in 2006 to 63% in 2012, with a record 61 million children protected in 2012. However, the programme is implemented in different ways in different states, with variable degrees of success. The coverage has remained high (≥80%) in Bihar and Odisha, while it underwent significant fluctuations in Karnataka and Tamil Nadu. A few states have had persistently low coverage (<50%). Notably, programme coverage has significantly increased in the districts with the highest concentration of poor households, scheduled caste, and scheduled tribe populations. The critical success factors for the VAS programme include strong leadership of the government, a stable procurement mechanism of VAS, effective micro-planning, and flexible dosing mechanisms to cover hard-to-reach areas.

Conclusions: Despite the remarkable progress in improving the coverage and equity of the VAS programme, a large number of Indian children - potentially the most vulnerable and undoubtedly the hardest-to-reach - are not yet benefitting from this life saving intervention. 

Open Access Conference Proceeding (Abstract)

Zinc Programs and the Antimicrobial Dilemma: Continued Inappropriate Treatment of Uncomplicated Pediatric Diarrhea in Benin, Ghana, and Uganda

Kathryn Banke, Vicki MacDonald, Emily Sanders, Marianne El-Khoury

European Journal of Nutrition & Food Safety, Page 592-593
DOI: 10.9734/EJNFS/2015/20980

Objectives: WHO/UNICEF recommend zinc plus oral rehydration solution as the first-line treatment for uncomplicated pediatric diarrhea. We conducted research in Benin, Ghana, and Uganda to determine the magnitude of incorrect management of uncomplicated pediatric diarrhea and examine possible reasons for this ongoing challenge to zinc programs.

Methods: USAID's SHOPS project used a multi-stage sampling approach to survey caregivers of children under five with diarrhea in Benin (n=392), Ghana (n=754), and Uganda (n=803). We also surveyed convenience samples of providers in Benin (n=60) and Uganda (n=71).

Results: Many children were incorrectly treated with antimicrobials (20% in Benin, 62% in Ghana, and 36% in Uganda). Even children correctly treated with zinc often received antimicrobials (29% in Benin; 21% in Uganda). The majority (59.8%) of caregivers in Ghana who gave antimicrobials incorrectly to their children stated that it was because a provider gave them. In Uganda, over half (52.5%) of caregivers who treated with antimicrobials said it was because the provider recommended them. However, providers reported that caregivers frequently request antimicrobials (58% in Uganda and 36% in Benin), and 21% of Ugandan providers who do not recommend zinc said that it was because of caregiver preference for antimicrobials. Many providers in Benin (53%) and Uganda (35%) stated they believed zinc is only a nutritional supplement and not an effective diarrhea treatment.

Conclusions: Both caregivers and providers likely play roles in the continuing incorrect use of antimicrobials to treat uncomplicated pediatric diarrhea. Zinc programs must explore ways to reduce both consumer demand and provider recommendation/prescription of antimicrobials.

Open Access Conference Proceeding (Abstract)

Scaling Up Edible Oil Fortification in Madhya Pradesh: Lessons from the Field

Ruchika Chugh Sachdeva, Rajan Sankar

European Journal of Nutrition & Food Safety, Page 594-595
DOI: 10.9734/EJNFS/2015/20981

Objectives: Showcasing Soybean oil fortification with Vitamin A and D as a demonstration project in Madhya Pradesh (MP), a state with worst nutritional indicators in India.

Methods: A program cycle approach was followed for selection of state, fortifiable vehicle, micronutrient and delivery channel.

Results: Soyabean oil was identified as a fortifiable vehicle as MP is soybean oil producing state with 94% household penetration and Industry having necessary infrastructure. Knowledge on fortification process and lack of awareness among consumers/ key stakeholders (KS) were the gap areas. Soybean oil fortification was launched by 12 millers in June in the open market with technical and part financial support from GAIN. With four months of launch, 4 new partners have joined in, increased investment from Industry partners on communication, capacity building was observed. 73% of the branded oil is being fortified and 18.4 million consumers are being reached monthly. 16-20% growth in fortified oil sales was observed. Soyabean oil fortification was found to be cost effective (Vitamin A and D premix: Sale price of oil = 1/1000). Social marketing campaign is creating demand. Advocacy efforts led to state food fortification alliance formation which is advocating for mandatory fortification of oil and usage of proven interventions in public funded programs. The reason for quick scale up is capacity building of industry, KS analysis and management, usage of pretested marketing campaigning, fortification logo, advocacy and monitoring plan. 

Conclusions: Soya bean oil fortfication was found to be a viable complementary strategy to address vitamin A and D deficiency.

Open Access Conference Proceeding (Abstract)

Accelerating Progress to Universal Salt Iodization in India Achievements, Challenges, and Future Actions

Mohammad Ansari, Jee Hyun Rah, Victor Aguayo, Chandrakant Pandav, Kapil Yadav, Rakesh Kumar, Rajan Sankar, Arijit Chakrabarty, Suvabrata Dey

European Journal of Nutrition & Food Safety, Page 596-597
DOI: 10.9734/EJNFS/2015/20982

Objectives: India was one of the first countries to introduce salt iodization. This presentation reviews the national efforts towards universal salt iodization (USI) in India, documents achievements and progress, and highlights key challenges in programme implementation.

Methods: The Salt Department of the Government of India and its development partners have made concerted efforts to improve availability, access and use of adequately iodized salt.

Results: National and state level advocacy meetings were carried out to ensure high political commitment and prioritization of the USI programme. The National Coalition for Sustained Iodine Intake was launched to improve the overall programme management and coordination. The technical capacity of salt producers was enhanced and salt wholesalers and retailers were mapped, sensitized and equipped with tools and skills to procure only adequately iodized salt. A state-of-the-art management information system was launched to improve the efficiency in monitoring the flow of iodized salt. In addition, awareness and communication activities were scaled up to generate demand for iodized salt. As a result, the national household coverage of adequately iodized salt increased from 51% in 2005 to 71% in 2009. However, data indicate a clear urban-rural and rich-poor differential, leaving some of the most disadvantaged populations vulnerable to iodine deficiency.

Conclusions: An evidence-based, well-defined strategy will be necessary to reach the last 30% of households, which are are likely to be least accessible and most socio-economically vulnerable. Both national and state level policies should mainstream the use of adequately iodized salt in feeding programmes for the benefit of all.

Open Access Conference Proceeding (Abstract)

Hand Washing with Soap and Nail Clipping: Effect on Anaemia and Thinness in School-aged Children in Ethiopia: A Factorial Randomised Controlled Trial

Mahmud Abdulkader Mahmud, Mark Spigt, Afework Mulugeta Bezabih, Ignacio Lopez Pavon, Geert-Jan Dinant, Roman Blanco Velasco

European Journal of Nutrition & Food Safety, Page 598-599
DOI: 10.9734/EJNFS/2015/20983

Objectives: To assess the impact of hand-washing with soap and nail clipping on the prevalence of anaemia and thinness among school-aged children.

Methods: We randomly assigned 369 parasite negative school-aged children to receive both, one or the other, or neither of the interventions. Soap and nail clippers were provided and field workers visited households weekly for six months to encourage hand-washing and do nail clipping. Haemoglobin was determined using a HemoCue spectrometer at the end of the trial. Weight and height were measured following intervention, and children below -2Z scores for BMI-for-age were classified as thin. Analysis was by intention-to-treat.

Results: Children that received hand-washing with soap intervention had a 51% lower prevalence of anaemia (OR 0.49, 95% CI: 0.28 to 0.88) and a 46% lower prevalence of thinness (OR 0.54, 95% CI: 0.35 to 0.86) than controls. Compared with controls, finger nail clipping did not result into significant reduction of anaemia (p=0.063) and thinness (p=0.218) prevalence. When looking at the four groups individually, children that received both interventions had a 69% lower anaemia (OR 0.31, 95% CI 0.14 to 0.70) and a 59% lower thinness prevalence (OR 0.41, 95% CI 0.21 to 0.79) than controls. Children in the hand-washing with soap only group had a 60% lower prevalence of anaemia than controls (OR 0.40, 95% CI: 0.18 to 0.87). Prevalence of anaemia and thinness did not differ significantly between children in the nail clipping only group and those in the control group.

Conclusions: Hand-washing with soap was effective in reducing anaemia and thinness.

Open Access Conference Proceeding (Abstract)

Strategy of Kazakhstan in Establishing of Biological Monitoring of Iodine Deficiency Disorders (IDD)

Feruza Ospanova, Arailym Beisbekova, Zhanar Tolysbayeva

European Journal of Nutrition & Food Safety, Page 600-601
DOI: 10.9734/EJNFS/2015/20984

Objectives: Achievement the complete elimination of iodine deficiency and control of the situation is necessary to establish a well-functioning monitoring model using clearly-defined evaluation criteria and methodology. In this regard, the purpose is implementation of iodine status monitoring of indicator groups of the population in the framework of the State Program of Kazakhstan for 2011-2015 "Salamatty Kazakhstan".

Methods: A population based cross sectional study was surveyed to analyze data of iodine intake among children and women in each region of Kazakhstan. Urinary iodine excretion was measured in casual urine samples and iodine intake was defined in resource iodine lab of Kazakh Academy of Nutrition which successfully participated in external quality control program EQUIP (CDC, Atlanta). The women were interviewed about salt iodization issue and salt samples were collected from their households for iodine determination.

Results: Implementation of IDD monitoring began in 2011 covering all 16 regions of Kazakhstan and reflects the current situation. From 2012 a survey has conducted annually in three or four oblasts. It means in 2015 all oblasts of Kazakhstan will cover with situation analysis in each oblast to take corrective measures and improvements iodine issue in Kazakhstan.

Conclusions: Thus, the strategy of establishing biological monitoring will provide an objective picture of IDD status in each oblast at intervals of 5 years, which will monitor the situation of supplementation iodine intake of Kazakhstan population. Effective and long-term strategy of monitoring supported by government will lead to reduce iodine consequences and brain damage.

Open Access Conference Proceeding (Abstract)

Utilization of Fenugreek (Trigonella foenum-graecum Linn) to Develop Value Added Biscuits and Breads

Tamiru Kasaye

European Journal of Nutrition & Food Safety, Page 602-603
DOI: 10.9734/EJNFS/2015/20986

Objectives: The general objective of the research was to develop value added food products (Bread and Biscuit) through supplementation of Fenugreek flour. The specific objectives was to study the proximate composition, anti-nutritional factors, physical properties, sensory analysis and microbiological characteristics of value added food products.

Methods: Fenugreek seed germinated for 24,48 and 72 hours at room temperature. The best germinated fenugreek flour was selected and supplemented at 5, 10, and 15% levels in wheat flour for the production of biscuits and breads to improve the nutritional profile of value added food products.

Results: Germinated fenugreek flour (for 72 hour) samples had 29.89% crude protein, 7.91% crude fat, 11.35% crude fiber and 2.94% ash on dry weight basis. And this fenugreek flour had 191.9 mg/100g, 176.0 mg/100 g,13.9 mg/100g, and 3.9 mg/100g of Ca, Mg, Fe and Zn, respectively.

The result of microbiological analysis of products for, coliform, E.coli, and yeast was found nil (absent), and total aerobic bacteria plate count and mould was found <1.3x103 and <1.3x103, respectively. The nutritive values in terms of protein, fiber, ash as well as minerals calcium, magnesium, iron and zinc content of products increased as a result of the addition of germinated fenugreek flour. The sensory evaluation of the bread samples made by supplementation at 5 and 10% levels and 5% levels for biscuit was rated acceptable.

Conclusions: There fore development and consumption of such therapeutic bakery products would help to raise the nutritional status of the population.

Open Access Conference Proceeding (Abstract)

Public Private Partnerships in Nutrition - Perspectives from India

Rahul Dutta, Kalpana Beesabathuni

European Journal of Nutrition & Food Safety, Page 604-605
DOI: 10.9734/EJNFS/2015/20987

Objectives: Recently, India has witnessed an increase in the number of public private partnerships (PPP) in various areas except nutrition. This paper explores barriers to private investment in improving nutrition outcomes in India, highlights success stories and recommends areas where PPP are more acceptable

Methods: A need analysis was done based on secondary literature and data review. Primary interviews were then conducted with a representation of various stakeholders from the public, private sectors and civil society.

Results: The public sector is more open to industry investment in improving services than in fortified food and supplements. It was perceived that the industry's capabilities in efficient logistics, training frontline staff and effective marketing would be useful for scaling public health nutrition programs such as the Integrated Child Development Services. Transparency was quoted as the key attribute for a successful PPP. The centralized kitchen model for school lunch programs is the only partnership operating at scale across 20 states in India. Some ongoing pilots in the use of mobile phones for training and social marketing and computerized distribution systems have the potential to scale.

Conclusions: The ecosystem for PPP to address the high burden of undernutrition in India has begun to take shape. There are opportunities for the telecommunication industry, warehouse and logistics providers and advertising agencies to strengthen public health nutrition programs. Further, food and nutrition industry's expertise would be helpful in implementation research, and product development.

Open Access Conference Proceeding (Abstract)

India's Adolescent Anemia Control Programme: Ten Make-or-break Elements for Sustaining Success

Vani Sethi, Sushma Dureja, Sheetal Rahi, Anshu Mohan, Gayatri Singh, Victor M. Aguayo

European Journal of Nutrition & Food Safety, Page 606-607
DOI: 10.9734/EJNFS/2015/20988

Objectives: In India, 56% of adolescent girls are anemic. In response to this situation and building on 13 years of evidence-generation using a knowledge-centred framework (evidence, innovation, evaluation and replication), India's adolescent girls anemia control programme was universalized in 2013 covering 130 million adolescents. Implemented jointly by Ministries - Health, Education and Women and Child Development, services delivered by the programme include: 1) weekly iron and folic acid supplementation; 2) bi-annual deworming; and 3) nutrition counselling.  UNICEF is technically supporting the government in roll out of the programme in 14 Indian states that house 88 percent of total adolescent girls in India.

Methods: Using information emanating from programme reports analyses, structured interviews with state programme implementors and a national consultation, this presentation highlights ten make-or-break elements to address the most important challenges encountered in the universal rollout of the programme.

Results: Ten make-or-break elements are: 1) political will along with well-defined inter-ministerial convergence and accountability mechanisms; 2) solving procurement challenges and continued supply monitoring; 3) instituting emergency response mechanisms (teams, helplines, standardized tools) for managing undesirable events; 4) sustained media engagement; 5) ensuring technical human resource support to state governments where capacity is sub-optimal; 6) devising a supplementation strategy during school vacations; 7) monitoring and evaluating the programme implementation independently through civil society/academia; 8) associating celebrities, parliamentarians and religious/peer leaders to mass communication campaigns; 9) ensuring functional review mechanisms; and 10) specific strategies to reach the unreached.

Conclusions: All the ten make-or-break elements are critical for ensuring success of an universal adolescent anemia control programme.

Open Access Conference Proceeding (Abstract)

Evolution of Foods in Europe: Novel Foods, Foods Reformulation, Food Fortification and Nutrient Profiles

Hans Verhagen

European Journal of Nutrition & Food Safety, Page 608-609
DOI: 10.9734/EJNFS/2015/20989

Objectives: Food development in the European Union (EU) is subject to changes, based on developments in food legislation or on changing demands in food composition for better nutrition and improved public health.

Methods: The legal environment in Europe is laid down in Regulation 178/2002 ( and in Regulation 1169/2011 on the provision of food information to consumers (food labeling).

Results: Novel food (ingredients) have not been used for human consumption to a significant degree in the EU before 15 May 1997 (Regulation 258/97). Prior to marketing a risk assessment needs to be.

Food fortification is relevant for adequate provision of micronutrients. Applicable are Regulation 1925/2006 and Directive 46/2002. Models are available for estimating maximum safe levels of micronutrients in foods and food supplements. Risk managers need to decide how to divide between food fortification and/or food supplements.

Nutrient profiling is the science of categorizing foods according to their nutritional composition. Nutrient profiling in EU is relevant to identify food products eligible to bear a nutrition or health claim (article 4 of Regulation 1924/2006).

Reformulation of foods is considered one of the key options to achieve population nutrient goals. The composition of foods can be modified to bring the diet more in line with dietary recommendations. Food reformulation is not subject to a particular regulation. Europe focuses on reducing levels of salt/sodium and saturated fatty acids.

Conclusions: Regulation 178/2002 is the overarching Regulation in the EU. There are many Regulations and Directives for foods in EU. This is a fluid system which is updated constantly.

Open Access Conference Proceeding (Abstract)

Integrated Risk-benefit in Food and Nutrition

Hans Verhagen

European Journal of Nutrition & Food Safety, Page 610-611
DOI: 10.9734/EJNFS/2015/20990

Objectives: Integrated Risk-Benefit Analysis (RBA) compares the risk of a situation to its related benefits and addresses the acceptability of the risk. Over the past years RBA in relation to food and food ingredients has gained attention. Food, and even the same food ingredient, may confer both beneficial and adverse effects. Measures directed at food safety may lead to suboptimal or insufficient levels of ingredients from a benefit perspective.

Methods: In RBA, benefits and risks of food (ingredients) are assessed in one go and may conditionally be expressed into one currency. This allows the comparison of adverse and beneficial effects to be qualitative and quantitative. A RBA should help policy-makers to make more informed and balanced benefit-risk management decisions. Not allowing food benefits to occur in order to guarantee food safety is a risk management decision much the same as accepting some risk in order to achieve more benefits.

Results: In 2012-2013 the large EU projects in this area closed (QALIBRA:, BENERIS:, BRAFO:, BEPRARIBEAN: Many papers have been published, thereby making significant progress in this area. There are ample examples were benefits outweigh potential risks for public health, including for micronutrient fortification (e.g. folic acid).

Conclusions: The results can be used for ranking of risks and benefits, and reporting to policy makers to make effective decisions, and to convey these to a wider stakeholder audience. The improved awareness, understanding, availability and exchange of knowledge in benefit-risk analysis will be vital to implement benefit-risk assessment, ranking, management and communication.

Open Access Conference Proceeding (Abstract)

Publishing Grey Literature Government Reports in the European Journal Nutrition and Food Safety

Hans Verhagen, Nick Vos, Manisha Basu

European Journal of Nutrition & Food Safety, Page 612-613
DOI: 10.9734/EJNFS/2015/20991

Objectives: Governmental research institutes in Europe/world are confronted with the problem that good scientific reports are produced directly for governmental sponsors and are published on an institute's website only. However, scientists like to publish their work in the scientific arena. As reports are not disseminated into the scientific world because they are not identified by normal literature attending systems, this leads to frustration with the scientists, very good scientific work being unnoticed by a wider audience, possible re-duplication of the work in other countries, a loss of resources, and hence to a slower progression of science.

Methods: The Open Access Journal "European Journal Nutrition and Food Safety" (EJNFS) publishes governmental reports in a peer-reviewed scientific journal. EJNFS publishes (extended) abstracts of governmental reports (in English language only) following a regular peer review system. Area (nutrition and food safety), scientific excellence, open access and English language are the prerequisites.

Results: Upon acceptance of the work, an abstract will contain the title of the work, the authors as well as a hyperlink to the original full report, so that the reports will be opened to a worldwide scientific. Many reports have already been published in this way, including on micronutrient fortification.

Conclusions: By peer review and uptake of "extended abstracts with hyperlink", scientists will inherently get knowledge of the content of many good reports being produced worldwide, thereby contributing to the positioning of their institute and their personal achievements. Information:

Open Access Conference Proceeding (Abstract)

Stability and Content of Inherent or Added Iodine in Most Commonly Used Indian Recipes

T. Longvah, Avinash Upadhyay

European Journal of Nutrition & Food Safety, Page 614
DOI: 10.9734/EJNFS/2015/20992

Objectives: To study the stability and content of inherent food iodine or iodine from iodized salt in commonly used Indian recipes.

Methods: The study was carried out in 23 states in India covering 48 districts and the most commonly used recipes from each selected district were taken for the study.

Results: Iodine content in bread and milk increased as a positive fallout of universal salt iodization. Iodine content in prepared without iodized salt was very low (2.9±2.4 µg/100g). Retention of inherent iodine and iodine from iodized salt in the recipes was comparable. The Mean ± SD retention of iodine in 140 most common Indian recipes was 60±21%. Significant correlation (r = - 0.194 P<0.05) was observed between iodine retention and time of iodized salt addition to the recipe. The retention of iodine was observed to be minimum in shallow frying with oil (52% ± 23%) and maximum in pressure cooking (82.2% ± 6.2%). Therefore, with allowances for cooking losses the average iodine intake by a person would be 242 µg per day which is adequate to meet the daily iodine requirement.

Conclusions: Iodization of frequently consumed foods such as bread and milk can have positive impact on the daily iodine intake. Without universal salt iodization programme the general Indian population would become iodine deficient. The data provide an estimate of iodine availability and intake by the Indian population that can be used as an integral part of monitoring food supply post implementation of universal salt iodization in the country.

Open Access Conference Proceeding (Abstract)

Proxy Markers of Serum Retinol Concentration, Used Alone and in Combination, to Assess Population Vitamin A Status in Kenyan Children

Elise F. Talsma, Hans Verhoef, Inge D. Brouwer, Anne Mburu-deWagt, Paul J. M. Hulshof, Alida Melse-Boonstra

European Journal of Nutrition & Food Safety, Page 615-616
DOI: 10.9734/EJNFS/2015/20993

Objectives: To assess the diagnostic performance of serum concentrations of retinol-binding protein (RBP), transthyretin, retinol concentration measured by fluorometry and RBP:transthyretin molar ratio, either alone or in combination, to estimate the prevalence of vitamin A deficiency (serum retinol concentration <0.70 μmol/L measured by high-performance liquid chromatography(HPLC)).

Methods: A cross-sectional study was conducted in 15 primary schools in Kibwezi and Makindu districts in Eastern province, Kenya in June 2010 with 375 schoolchildren (6-12 years), 25 randomly selected from each school by lot quality assurance sampling.

Results: Complete data were collected for 372 children. Mean serum concentration of retinol (HPLC), RBP and transthyretin were 0.87 (SD 0.19) µmol/L, 0.67 (SD 0.17) µmol/L and 3.0       (SD 0.62) µmol/L. The mean RBP: Transthyretin molar ratio was 0.23. The prevalence of vitamin A deficiency measured with HPLC was 18%. Transthyretin and RBP showed the largest area under the curve (AUCs 0.96 and 0.93, respectively). Logistic regression resulted in a model predicting vitamin A deficiency based on RBP, transthyretin and C-reactive protein (AUC: 0.98) and prevalence depending cutpoints for the linear predictor were calculated.

Conclusions: Combination of transthyretin, RBP and C-reactive protein in a linear predictor showed excellent diagnostic performance in assessing vitamin A status, and has great potential to eventually replace serum retinol concentration measured by HPLC as the preferred method to assess the population burden of vitamin A deficiency. Further research is needed to confirm whether this linear predictor yields similar results in different populations and laboratories. Our methodology can be widely applied for other diagnostic aims.

Open Access Conference Proceeding (Abstract)

Qualitative Research to Inform the Implementation of Home Fortification with Nutrition Education with Seasonal Malaria Chemoprevention through Early Childhood Development Centres for Children Aged 6-59 Months in Sikasso, Mali

Seybou Diarra, Kathy Ho, Yahia Dicko, Modibo Bamadio, Philippe Thera, Natalie Roschnik, Judy McLean

European Journal of Nutrition & Food Safety, Page 617-618
DOI: 10.9734/EJNFS/2015/20994

Objectives: 93.4% of children aged 6-59 months old have malaria in Sikasso, Mali, and 83.5% have anemia. Our qualitative research sought to inform the home fortification with micronutrient powders (MNP) component of a malaria and anemia prevention project with seasonal malaria chemoprevention, delivered through early childhood development centers in 90 villages in Sikasso, Mali. We sought to understand the knowledge, attitudes and practices on infant and young child feeding, anemia prevention, and any opportunities and barriers for proper MNP use at the household level.

Methods: 8 focus groups, and 46 in-depth interviews with stakeholders, beneficiaries and providers of the service, and 3 cooking and feeding observations were conducted in 4 villages, purposively selected to represent similar socio-economic status, accessibility to health centers and markets, agricultural and environmental climate as the remaining intervention villages.

Results: Age-inappropriate feeding practices, and poor quality and quantity of complementary foods were identified. There is great awareness on the occurrence of anemia but knowledge on causes and preventive measures was lacking. All respondents showed positive interest in MNPs and additional stakeholders and potential barriers were identified, such as multiple family households and the intra-household sharing of meals.

Conclusions: These results informed the creation of training materials and cooking demonstrations with MNPs as well as additional people to engage with to create a supportive and enabling environment. This helped guide the implementation of a malaria and anemia prevention project with seasonal malaria chemoprevention and MNP with nutrition education delivered through early childhood development centers in 90 villages in Sikasso, Mali.

Open Access Conference Proceeding (Abstract)

The Home Fortification Community of Practice: An Approach to Improve Inter-country Communication and Collaboration to Support the Implementation and Scaling-up of Home Fortification Programs

Arnold Timmer, Abel Irena, Kathy Ho, Ruth Situma, Amy Dempsey, Scott Schaffter

European Journal of Nutrition & Food Safety, Page 619-620
DOI: 10.9734/EJNFS/2015/20995

Objectives: Home fortification is an innovative way to improve the diet with essential nutrients for targeted vulnerable groups who have higher requirements or do not benefit from other micronutrient interventions. As a relatively new program, there is a tremendous need for technical support. The idea of a community of practice was developed to facilitate inter-country and inter-agency dialogue and learning, with the following objectives:

1. To provide an opportunity and space to exchange information and experiences between program. Implementers.

2. To enhance learning, generate new knowledge and document lessons learned and best practices; and 3. To facilitate coordination, harmonization and support for the scale up of home fortification.

Methods: Online survey and informal interviews were conducted to incorporate target users’ opinions on the online community’s organizational, technical and operational features, and the desired benefits and potential barriers to participation. Lessons from existing successful online communities were used to inform stakeholders’ engagement and increase their awareness and involvement.

Results: The Home Fortification Network ( was branded and created as an online discussion forum with organized topics and with document-sharing capabilities. A moderator helps to connect users and facilitate discussion. Different stakeholders around the world are engaged and promote its global awareness and participation.

Conclusions: The Home Fortification Network at is an online community of practice created to facilitate and improve inter-country and inter-agency communication and collaboration to support the implementation and scaling-up of home fortification programs around the world.

Open Access Conference Proceeding (Abstract)

Multivitamin and Iron Supplementation to Prevent Periconceptional Anemia in Rural Tanzanian Women

Nilupa Gunaratna, Honorati Masanja, Sigilbert Mrema, Francis Levira, Donna Spiegelman, Ellen Hertzmark, Naomi Saronga, Kahema Irema, Mary Shuma, Ester Elisaria, Wafaie Fawzi

European Journal of Nutrition & Food Safety, Page 621-622
DOI: 10.9734/EJNFS/2015/20996

Objectives: Women's nutritional status during conception and early pregnancy can influence maternal and infant outcomes. This study examined the efficacy of pre-pregnancy supplementation with iron and multivitamins to reduce anemia prevalence during the periconceptional period among rural Tanzanian women and adolescent girls.

Methods: A double-blind, randomized controlled trial was conducted in which non-pregnant women aged 15-29 years (n=802) were randomized to receive daily oral supplements of folic acid alone, folic acid and iron, or folic acid, iron, and vitamins A, B-complex, C, and E at approximately single recommended dietary allowance doses for six months.

Results: The study arms were comparable in participant characteristics including compliance (p>0.05). In total, 561 (70%) completed the study and were included in the intention-to-treat analysis. Hemoglobin levels were not different across treatments (median: 11.1 g/dL, Q1-Q3: 10.0-12.4 g/dL, p=0.65). However, compared with the folic acid arm (28%), there was significant reduction in the risk of hypochromic microcytic anemia in the folic acid and iron arm (17%, RR: 0.61, 95% CI: 0.42-0.90, p=0.01) and the folic acid, iron, and multivitamin arm (19%, RR: 0.66, 95% CI: 0.45-0.96, p=0.03). Inverse probability of treatment weighting (IPTW) to adjust for potential selection bias due to loss to follow-up did not materially change results. The regimen effect was not modified by baseline characteristics or compliance (p>0.2).

Conclusions: Daily oral supplementation with iron and folic acid among non-pregnant women and adolescents reduces risk of anemia. The potential benefits of supplementation on the risk of periconceptional anemia and adverse pregnancy outcomes warrant investigation in larger studies.

Open Access Conference Proceeding (Abstract)

Understanding Barriers and Facilitating Factors for Uptake of Zinc and ORS in Kenya; a case of Kitui County

Elijah Mbiti, Catherine Lengewa, Jacqueline Kung'u, Stewart Kabaka

European Journal of Nutrition & Food Safety, Page 623-624
DOI: 10.9734/EJNFS/2015/20997

Objectives: Diarrhea is a key public health challenge in Kenya with a prevalence of 17% and contributes to 21% of underfive child deaths. Whereas effective treatment is available, its uptake is very low with 39% and less than 1% receiving ORS and Zinc respectively. Current diarrhea prevention and treatment approaches are generalized thus missing out on regional variability, challenges and uniqueness. The objective of this paper is to explore factors that facilitate or hinder diarrhea management in one region in Kenya.

Methods: Cross sectional study employing both quantitative and qualitative approaches involving 764 household interviews, 15 key informant interviews and 10 focus group discussions targeting caregivers of children below five years, key influencers, and community health workers in the two districts and 8 health facilities.

Results: Key facilitating factors: Availability of diarrhea policy, zinc/ORS at public health facilities for free, good knowledge by caregivers on ORS for diarrhea treatment (85%), need for child with diarrhea to drink more fluids (90%) and that diarrhea is life threatening (93%). Key barriers include poor health seeking behavior for diarrhea, limited access to diarrhea messages, misconception that only children with 5 or more loose stools need treatment, cultural practices like gum massage during teething which lead to contamination hence diarrhea, inappropriate treatment practices (use of herbs and body piercing), low uptake of zinc and ORS, non-participation by men and challenges with water and sanitation.

Conclusions: Kitui experiences unique challenges related to knowledge, cultural practices which hinder appropriate diarrhea management and must be overcome through region-specific program adaptations.

Open Access Conference Proceeding (Abstract)

Acceptability of Two Lipid-based Complementary Food Supplements in a Peri-urban South African Community

Marinel Rothman, Crisitiana Berti, Marius Smuts, Mieke Faber, Tonderai Matsungo, Namukolo Covic

European Journal of Nutrition & Food Safety, Page 625-626
DOI: 10.9734/EJNFS/2015/20998

Objectives: This pilot study preceding an efficacy trial in a peri-urban South African community aimed to:

1) Evaluate the acceptability of two newly developed lipid-based multi-nutrient supplements (LNS) containing micronutrients, essential fatty acids (EFAs) with docosahexaenoic acid (DHA), arachidonic acid (ARA) and phytase (Product B), and micronutrients and EFA with no DHA (Product A). 

2) Compare the acceptability in terms of "general liking" of each of the two products with that of the maize porridge commonly used by the target population.

3) Evaluate the practical feasibility of usage of the two test products. 

Methods: Pairs of mothers and 6-12 months old infants were enrolled in a two part study. Part 1 (n=20) was a cross-over randomized acceptability study and a five-point hedonic scale was used for acceptability evaluation (very bad=1; very good=5). Part 2 (n=41) was a two-week home-use trial followed by focus group discussions.

Results: Part 1: the mean (± SD) general liking score of the mothers was 4.6±1.0 and 4.6±1.1 for products A and B, respectively; and for the infants as perceived by the mothers 3.9±1.8 and 4.2±1.6.

Part 2: the mean (95% CI) adherence over two weeks was 62% (47-77%) and 65% (49-81%) for products A and B, respectively. FGDs confirmed that both these products were well accepted.

Conclusions: The high general liking score and satisfactory home usage indicate that LNS containing EFAs may be well accepted in this population.

Open Access Conference Proceeding (Abstract)

Safety and Efficacy of Antenatal Iron Supplementation in a Malaria-endemic Area in Kenya: A Randomised Trial

Martin N. Mwangi, Johanna M. Roth, Menno Smit, Laura Trijsburg, Alice Mwangi, Ayşe Y. Demir, Petra Mens, Andrew M. Prentice, Pauline E. A. Andang’o, Hans Verhoef

European Journal of Nutrition & Food Safety, Page 627-628
DOI: 10.9734/EJNFS/2015/20999

Objectives: Whereas coverage of antenatal iron supplementation is low and benefits are uncertain, there are concerns that it can increase the burden of malaria, with potentially devastating effects on maternal and neonatal health outcomes. We aimed to measure the effect of iron supplementation during pregnancy on maternal Plasmodium infection assessed at delivery, birth weight, gestational age, fetal growth and maternal and infant iron status.

Methods: Rural Kenyan women (n=470) with singleton pregnancies, gestational age 13─23 weeks and haemoglobin concentration ≥ 90 g/L  were randomised to supervised daily supplementation with iron (60 mg as ferrous fumarate) or placebo until 1 month postpartum. To prevent severe anaemia, all women additionally received 5.7 mg iron/day through flour fortification. Intermittent preventive treatment against malaria was given as usual. Plasmodium infection was assessed at birth by dipstick tests, PCR and histological examination of placental biopsies.

Results: There was no evident effect on Plasmodium infection (both intervention groups: 45%; difference, 95% CI: 0%, ─9% to 9%). Iron supplementation increased birth weight by 143g (95% CI: 58─228g) and reduced the prevalence of low birth weight (<2,500g) by 65% (95% CI: 13%─86%). The effect on birth weight was larger in women who were initially iron-deficient than in those who were iron-replete (250 g versus ─13 g; p-interaction=0.008), and the improved birth weight seemed achieved mostly through improved fetal growth. Iron supplementation resulted in improved maternal iron status at 1 month postpartum, and improved infant iron stores.

Conclusions: Coverage of universal antenatal iron supplementation must be increased.

Open Access Conference Proceeding (Abstract)

Differentials in Vitamin A Supplementation and its Association with Child Morbidity in Ethiopia

Demewoz Haile, Sibhatu Biadglign

European Journal of Nutrition & Food Safety, Page 629-630
DOI: 10.9734/EJNFS/2015/21000

Objectives: To determine the associated factors for childhood vitamin A supplementation and its association with childhood illness in Ethiopia.

Methods: A secondary data analysis was made from Ethiopia Demographic Health Survey (EDHS) 2011. A total of 10,631 children of age 6-59 months were included for this analysis. Binary and multivariable logistic regression model were used in the statistical analysis.

Results: There was a regional difference in vitamin A supplementation coverage in Ethiopia (P <0.001). Absence of checking after delivery was a significant negative predictor of not receiving vitamin A in the last 6 months (AOR 0.771, 95% 0.612-0.97). Infants who were in the age group of 6-11 months were 80% less likely to receive vitamin A in the last 6 months compared to children of age 47-59 months(OR 0.20, 95% CI, 0.151-0.273). There was no statistically significant association between educational status, place of residence, wealth index, place of delivery and ANC attendance with childhood vitamin A supplementation. Vitamin A supplementation was negatively associated with reporting cough [OR 0.864, 95% CI 0.786-951) but not with diarrheal morbidity and fever in the last two weeks.

Conclusions: Absence of checking after delivery and being in the youngest age group were the significant predictors of not receiving vitamin A for the last 6 months. Vitamin A supplementation was not associated with diarrhea and fever morbidity but negatively associated with reporting cough. Provision and promotion of postnatal care and further research with strong study design to investigate the effect of Vitamin A supplementation on childhood illness were recommended.

Open Access Conference Proceeding (Abstract)

Estimate of Likely Micronutrient Deficits across Life Stages in Five Sub-Saharan African Countries

Kaleab Baye, Tilahun Bekele

European Journal of Nutrition & Food Safety, Page 631
DOI: 10.9734/EJNFS/2015/21001

Objectives: To identify likely micronutrient deficits in the available national food supply per capita for Burkina Faso, Ethiopia, Madagascar, Malawi and Sierra Leone.

Methods: Micronutrient densities in the daily available food supply per capita were calculated from the micronutrient contents of 95 food commodities using the International Minilist Nutrient database. The micronutrient contribution of food groups was calculated. Densities were compared with reference nutrient density goals adequate to meet basal or normative estimated needs for at least 95% of individuals over two years of age.

Results: Daily food supplies were low in animal products, fruits and vegetables. Cereals, legumes or starchy roots and tubers were the main source of iron, zinc, calcium, vitamin B6, niacin, riboflavin and thiamin. Of the eight micronutrients, Madagascar had likely deficits for seven; Burkina Faso, Sierra Leone and Malawi for six, and Ethiopia for four. The most frequent deficits were for calcium, iron, zinc, riboflavin and vitamin B12. Deficits exceeding 50% of the nutrient density goals were likely for iron, calcium and vitamin B12 in children and adolescents of  7, 12, and 15 years of age (both sex), and in females 17 and 25 years of age. The food supply is likely inadequate for the provision of iron, zinc and calcium for pregnant and lactating women.

Conclusions: Inadequate dietary intakes of multiple micronutrients are likely in these five Sub-Saharan African countries. Although the first one thousand days are a critical period for micronutrient interventions, a more comprehensive Lifecycle approach is needed.

Open Access Conference Proceeding (Abstract)

Myths and Perceptions on Diarrhea and Use of ORS/Zinc among Mothers and Caregivers of under Five Years Old Children among a Nomadic Community in Kenya

John Nduba, Josephat Nyagero, Elijah Mbiti, Bob Akach, Jacqueline Kung'u, Stewart Kabaka, Christopher Wanyoike

European Journal of Nutrition & Food Safety, Page 632-633
DOI: 10.9734/EJNFS/2015/21002

Objectives: Diarrheal disease is the second leading cause of death in children aged below five years in Kenya. Community and individual myths, perceptions and attitudes toward diarrhea does influence caregiver decisions and practices in the diarrhea prevention and management. This paper explores these myths and perceptions among mothers and caregivers the under five year old children in a nomadic Maasai community in Kenya. 

Methods: Qualitative data was collected from 42 Key informants including chiefs, laibons, village elders, religious leaders and 12 focus group discussions, comprising of 86 caregivers of children under 5 years.  Transcriptions were entered into MAXQDA version 11 qualitative analysis programme to retrieve segments under each thematic area including myths and perceptions related to causation, prevention and treatment of diarrhea among under five years.

Results: The reported myths and perceptions related to causation of diarrhea include: when child is teething, breast feeding while mother is pregnant, and having too much sex while child is still breast feeding.  The use of special herbs and deworming tablets were reported to protect children from diarrhea.  In addition, it was widely believed that herbs mixed with either blood or alcohol work better than modern drugs used in diarrhea management. The laibons and traditional birth attendants were the main sources of the herbal medicines in the community. Some respondents showed a strong lack of faith in the use of ORS for diarrhea management.

Conclusions: There are serious myths and perceptions that can compromise prevention and management of diarrhoea in this community which need to be addressed.

Open Access Conference Proceeding (Abstract)

Public-private Partnership Approaches for Scaling up Zinc with ORS

Vicki MacDonald, Joseph Addo-Yobo

European Journal of Nutrition & Food Safety, Page 634-635
DOI: 10.9734/EJNFS/2015/21003

Objectives: Based on evidence from four previous private sector programs, USAID's SHOPS project, in partnership with the Ghana Health Service,  developed a strategy to maximize availability of, demand for, and use of zinc plus oral rehydration solution (ORS) for the treatment of pediatric diarrheas. This abstract describes the private sector-focused strategy for addressing high diarrhea prevalence among children under five in Ghana.

Methods: SHOPS established a conducive policy and regulatory environment, engaging stakeholders from both sectors; collaborated with regulatory bodies to train over 10,000 chemical sellers and pharmacy staff and 350 clinicians in diarrhea management; partnered with pharmaceutical manufacturers to increase availability of quality, affordable products; developed an innovative campaign to increase awareness and demand; and partnered with NGOs to promote use through community mobilization. We conducted in-depth interviews and mystery client surveys with providers to assess reported and actual prescribing behavior.

Results: Private sector sales of zinc tablets increased ten-fold after training providers and 300% after the media campaign, treating over 2 million children with diarrhea to date. Most (75%) providers mentioned zinc as their preferred diarrhea treatment; 65% actually prescribed zinc with ORS as treatment. Retail audits confirm over 60% of chemist shops and pharmacies carry zinc and ORS.  These results are notable in that zinc was completely unknown and unavailable in Ghana prior to the initiation of the program in 2012.

Conclusions: In a single year, significant progress in scaling up diarrhea treatment was realized through strategic partnerships with the private sector in Ghana.

Open Access Conference Proceeding (Abstract)

Formative Work to Design the Packaging of a Lipid-based Nutrient Supplement for a Home Fortification Program in the Democratic Republic of Congo (DRC)

Katie Tripp, Svenja Jungjohann, Heather Clayton, Simeon Nanama, Fanny Sandalinas, Winnie Mujinga, Cristina Palma, Aissata Moussa Abba, Eric Ategbo, Roland Kupka, Zuguo Mei, Ambroise Nanema

European Journal of Nutrition & Food Safety, Page 636-637
DOI: 10.9734/EJNFS/2015/21004

Objectives: To determine a culturally appropriate product name and package design that would communicate important usage instructions for a lipid-based nutrient supplement (LNS) for a target population with diverse languages and low literacy.

Methods: Formative work was conducted in two locations in Katanga region, DRC: Mabaya, a rural village and Kipushi, a peri-urban area. In each site, focus group discussions with parents of children aged 0-24 months (3 with mothers, and 1 with fathers) were conducted.  Additionally, two key informant interviews with mothers and health workers were conducted in each location. Two sets of 7 images, one for each LNS sachet in the strip, were tested to assess perceptions of use. Different color options and product names were tested to identify culturally appropriate packaging. 

Results: The majority of participants read the different images on the multi sachet strip as a story line. Participants retained the main messages that the strip should convey: Optimal child feeding and care, product use, target group and potential product benefits. All participants recognized the mother and children in the images as "Congolese". Green and brown were identified as suitable colors for the packaging and were associated with qualities such as growth, and healthy development. The names Kulazuri (eating well) and Afiabora (good health) were preferred. A combination of the first two name proposals "Kulabora" (eating better) was decided upon.

Conclusions: The results from this formative assessment were used to finalize the design of the LNS product, which is currently being distributed in Kasenga health zone.

Open Access Conference Proceeding (Abstract)

Creating an Enabling Environment for Scaling up Diarrhea Treatment with Zinc and ORS

Vicki MacDonald, Kathryn Banke

European Journal of Nutrition & Food Safety, Page 638-639
DOI: 10.9734/EJNFS/2015/21005

Objectives: Analyses of childhood diarrhea practices from 46 countries indicate a significant portion of caregivers from all wealth quintiles seek private sector care. We describe advantages of and strategies for working through the private sector and coordinating with the public sector to successfully scale up diarrhea management efforts.

Methods: In Nepal, Pakistan, Benin, and Ghana, we created private-public partnerships to increase correct treatment of pediatric diarrhea with zinc and ORS. Key strategies include collaboration with Ministries of Health to develop appropriate policy and treatment protocols, identification of public and private sector champions to promote scale-up, and working with regulatory agencies and local manufacturers/ international non-governmental organizations to expedite product registration, regulate quality, and assure supply and distribution of affordable products. We partnered with professional associations to train providers and used private sector media channels to disseminate caregiver behavior change campaigns. Household surveys examined zinc and ORS coverage and use before and after program interventions.

Results: Caregiver use of zinc and ORS increased from near zero at program initiation in all countries to a range of 7% (Pakistan) to 15% (Nepal) to 31% (Benin) in a single year.  Private sector supply increased from zero (all countries) to as high as 65% (Ghana) coverage. Thousands of providers were trained with corresponding increases in provider knowledge that zinc is the first line treatment (66% in Ghana; 87% in Benin).

Conclusions: Engaging and leveraging the resources of the private sector can significantly enhance the potential for a successful scale-up of diarrhea management in developing countries.

Open Access Conference Proceeding (Abstract)

Fortification of Wheat Flour and Maize Meal with Different Iron Compounds: Results of a Series of Baking Trials

Philiip Randall, Quentin Johnson, Anna Verster

European Journal of Nutrition & Food Safety, Page 640-641
DOI: 10.9734/EJNFS/2015/21006

Objectives: Flour fortification is a preventive food-based approach to improve the micronutrient status of populations. In 2009, the World Health Organization (WHO) released guidelines on addition levels for iron, folic acid, vitamin B12, vitamin A, and zinc at various levels of average daily consumption. To address food industry concerns about possible adverse effects from iron compounds, baking trials were undertaken to determine possible adverse interactions.

Methods: Wheat flour and maize meal were sourced in Kenya, South Africa, and Tanzania, and the iron compound (sodium iron ethylenediaminetetraacetate [NaFeEDTA], ferrous fumarate, or ferrous sulfate) was varied and dosed at rates according to the WHO guidelines for consumption of 75 to 149 g/day of wheat flour and > 300 g/day of maize meal and tested again for 150 to 300 g/day for both. Bread, and other products were prepared locally and assessed on whether the products were acceptable under industry-approved criteria, by academic sensory analysis using a combination of trained and untrained panelists and in direct side-byside comparison.

Results: Industry (the wheat and maize milling sector) scored the samples as well above the minimal standard, and under academic scrutiny no differences were reported. Side-by-side comparison by the milling industry did indicate some slight differences, mainly with respect to color, although these differences did not correlate with any particular iron compound.

Conclusions: The levels of iron compounds used, in accordance with the WHO guidelines, do not lead to changes in the baking and cooking properties of the wheat flour and maize meal.

Open Access Conference Proceeding (Abstract)

Estimates of Dietary Mineral Supply in Malawi Based on Soil Type and Household Survey Data

Edward Joy, Martin Broadley, Michael Watts, Allan Chilimba, Scott Young, Louise Ander, Colin Black

European Journal of Nutrition & Food Safety, Page 642-643
DOI: 10.9734/EJNFS/2015/21007

Objectives: Mineral deficiencies due to inadequate dietary supply are likely to be widespread in Malawi. However, there is insufficient reliable data on mineral supplies and deficiency risks at scales useful for policy-makers. This study provides mineral supply estimates at the level of Extension Planning Area (EPA).

Methods: Food samples were collected and analysed by inductively coupled plasma mass spectrometry (ICPMS) to generate a national food mineral composition database for Malawi according to soil type. Composition data were combined with food consumption data from the Third Malawi Integrated Household Survey in order to provide spatially-disaggregated dietary mineral supply estimates.

Results: There is great regional variation in dietary mineral supplies due to soil type and dietary choices. On "calcaric" soils, the national average diet contains 791 mg Ca, 77 µg Se and 14 mg Zn, while on "non-calcaric" soils the average diet contains 715 mg Ca, 36 µg Se, and 11 mg Zn. Supplies of Ca by EPA ranged from 123 mg to > 2000 mg capita-1 d-1, while Se ranged from 10 µg to > 100 µg and Zn from 4.4 mg to > 20 mg. Fish provide 52, 38 and 22% of all Ca, Se and Zn supplies, respectively, in the national average diet.

Conclusions: Our estimates of spatially-disaggregated dietary mineral supplies can guide policy-makers in designing region-specific nutrition interventions.

Open Access Conference Proceeding (Abstract)

A New Approach to Estimate Safe Maximum Fortification Levels for Micronutrients

Janneke Verkaik-Kloosterman, Arnold L. M. Dekkers, Kevin W. Dodd, Sharon I. Kirkpatrick, Hans Verhagen, Marga C. Ocké

European Journal of Nutrition & Food Safety, Page 644-645
DOI: 10.9734/EJNFS/2015/21008

Objectives: Maximum fortification levels for voluntarily fortified foods are meant to guard against excessive micronutrient intake. Existing methods of estimating safe maximum levels take a conservative approach by considering a single point in the intake distribution of the micronutrient of interest. The free space for fortification has traditionally been estimated as the tolerable upper intake level minus an observed high intake value (e.g., 95th percentile), with or without considering the contribution of supplements. Using a single value from the distribution results in a single estimate of a safe maximum fortification level. This potentially results in unrealistically high estimates. We propose a probabilistic approach for setting safe maximum fortification levels.

Methods: We build upon the estimation of i) a measure of the amount of the food supply that is potentially fortifiable with a micronutrient (i.e., the ‘fortifiable pool'), and ii) a ‘free space' available for intake from voluntarily fortified sources. As a proxy for the fortifiable pool, we utilize the fraction of energy provided by potentially fortifiable foods. The energy from the fortifiable pool and nutrient intake from food and supplemental sources are then jointly modeled.

Results: Applying this probabilistic approach to the estimation of safe maximum fortification levels provides a distribution of safe maximum fortification levels from which an appropriate level can be chosen.

Conclusions: This approach can estimate safe maximum fortification levels that more realistically convey the potential benefits to be achieved by increased micronutrient intake through voluntary fortified foods, as well as the risks associated with excessive intake.

Open Access Conference Proceeding (Abstract)

Daily Zinc Supplementation, But Not Intermittent or Therapeutic Zinc Supplementation, Increases Plasma Zinc Concentration and Does Not Affect Iron and Vitamin A Status in Young Children

Elodie Becquey, Cesaire Ouedraogo, Sonja Hess, Noel Rouamba, Jean-Bosco Ouedraogo, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 646-647
DOI: 10.9734/EJNFS/2015/21009

Objectives: To assess the effect of three zinc supplementation strategies, provided with diarrhea and malaria treatment, on zinc, iron and vitamin A status.

Methods: During a community-based, cluster-randomized, zinc supplementation trial, we collected venous blood at baseline and after 48 weeks in a random subsample of 451 rural Burkinabe children 6-18 mo old assigned to 4 groups: 7 mg zinc/d, ORS+placebo for diarrhea (DPZ); 10 mg zinc/d for 10d/16wks followed by daily placebo, ORS+placebo for diarrhea (IPZ); daily placebo, ORS+20mg zinc/d for 10d for diarrhea (TDZ); no intervention (NI). Supplemented children were treated for fever and malaria. Blood hemoglobin concentration (Hb) was measured by HemoCue®. Plasma zinc concentration (pZn), measured by ICP-AES, and plasma ferritin (pF), transferrin receptor (TfR) and retinol-binding protein (RBP) concentrations, measured by ELISA, were adjusted for inflammation.

Results: High baseline rates of anemia (88.5% had Hb<11 g/dL), iron deficiency (50.5% had pF<12 ug/L; 89.9% had TfR>8.3 mg/L ), vitamin A deficiency (48.9% had RBP<0.83 umol/L) and zinc deficiency (43.5% had pZn<65 ug/dL) were not different by group. Over 48 weeks, pZn increased significantly more in DPZ (+5.8±1.9%) than in TDZ (-0.7±1.8%) and NI (-1.7±1.3%) but not than in IPZ (+2.3±1.7%). 48-week changes in Hb, pF, TfR and RBP did not differ by group.

Conclusions: Daily preventive, but not intermittent preventive or therapeutic zinc supplementation, increased pZn over 48 weeks. Zinc supplementation with malaria and diarrhea treatment did not affect iron and vitamin A status.

Open Access Conference Proceeding (Abstract)

A Paper Test Card Provides Quantitative Measurement of Iodate to Improve Quality Control of Iodized Salt in Low-resource Settings

Marya Lieberman, Nicholas M. Myers, Rebecca Spohrer, Rizwan Yusufali

European Journal of Nutrition & Food Safety, Page 648-649
DOI: 10.9734/EJNFS/2015/21010

Objectives: Monitoring iodine content in iodized salt is necessary for program effectiveness. Iodometric titration is the most precise method but requires skills, facilities, and reagents. The WYD Iodine Checker® and Bioanalyt iCheck® are quantitative, but are expensive, require reagents and electrical power. Iodometric titration has been adapted onto a paper test card to quantitatively measure iodate in iodized salt in low-resource settings. A cell phone is used to evaluate test results. Researchers internally validated the test cards to demonstrate accuracy and conducted a field test to demonstrate applicability for quality control in factory settings.

Methods: For each sample, 3 drops of a 1:5 salt-to-water dilution were placed onto the test card and mixed for 3 minutes before taking a cell phone image. Images were analyzed against a calibration curve. Two researchers internally blindly validated the test cards against titration at a university lab in Indiana, USA. The field test was performed by a quality technician in a salt factory in Mombasa, Kenya.

Results: During internal validation, 78 of 100 samples ranging from 0-75 ppm iodate analyzed were within 20% of the titration result. In the field factory, 24 of 32 samples ranging from 19-55 ppm iodate analyzed by the technician were within 20% range of titration. The technician was trained within 30 minutes and carried out 24 analyses in 3 hours, compared with 15 titrations in 3 hours.

Conclusions: The paper test card offers a rapid field-friendly method with sufficient accuracy to use for quality control of iodized salt.

Open Access Conference Proceeding (Abstract)

Assessing the Association between the Methylenetetrahydrofolate Reductase (MTHFR) 677C->T Polymorphism on Blood Folate Concentrations: A Systematic Review and Meta-analysis of Trials and Observational Studies

Becky Tsang, Amy Cordero, Claire Marchetta, Joseph Mulinare, Patricia Mersereau, Jing Guo, Yan Ping Qi, R. J. Berry, Jorge Rosenthal, Krista Crider

European Journal of Nutrition & Food Safety, Page 650-651
DOI: 10.9734/EJNFS/2015/21011

Objectives: The methylenetetrahydrofolate reductase (MTHFR) 677C->T polymorphism is a risk factor for neural tube birth defects (NTDs). The T allele produces an enzyme with reduced folate processing capacity, which has been shown to produce lower blood folate concentrations in some studies. Our objective was to assess the association between MTHFR C677T genotypes (CC, CT, TT) and blood folate concentrations among women aged 12-49 years.

Methods: We conducted a systematic review of literature published between 1/1992-7/2013 to identify controlled trials and observational studies that reported serum, plasma, or red blood cell (RBC) folate concentrations and MTHFR C677T genotype. We applied a Bayesian random-effects model to predict differences in blood folate concentrations between MTHFR C677T genotypes, stratified by folate assay.

Results: Thirty-eight studies met criteria for inclusion. Serum/plasma folate concentrations showed a consistent genotype trend with the highest concentrations for CC (CC > CT > TT) regardless of assay type. RBC folate concentrations measured by microbiologic assay also demonstrated this trend; however, this trend was reversed (CC < CT < TT) in studies using protein-binding assays.

Conclusions: Meta-analyses results showed blood folate concentrations differed by assay type and genotype. Previous evidence has shown that RBC folate concentrations measured with a radioimmunoassay requires adjustment for genotype-dependent folate recovery; our results suggest that other protein-binding assays could have similar limitations. Compared to CC individuals, TT individuals have lower blood folate concentrations, which may increase a woman's risk for an NTD-affected pregnancy.

Open Access Conference Proceeding (Abstract)

Risk-benefit Models for Food Fortification with Micronutrients

Maaike Bruins, Klaus Kraemer

European Journal of Nutrition & Food Safety, Page 652
DOI: 10.9734/EJNFS/2015/21012

Objectives: Micronutrient deficiency can have serious health and economic implications. Food fortification with micronutrients is a main strategy countries can use to address population-wide deficiency. The objective was to compare different risk-benefit models that can be used to set micronutrient fortification levels.

Methods: Different models to assess risks and benefits of food fortification were compared.

Results: The EAR approach for setting micronutrient fortification levels uses point estimates at the lower and upper end of the intake range which should be both nutritionally adequate and safe. This approach considers the risk in terms of proportion of the population with intakes below the Estimated Average Requirement (EAR) and above the Tolerable Upper Intake Level (UL). However, the UL is based on the no- or lowest-observed adverse effect level (NOAEL or LOAEL) and includes an uncertainty factor and the adverse health consequences at intakes below the EAR may be very different from those above the UL both in terms of nature and severity.

Risk-benefit methods exist that equally consider the health impact of micronutrient intake at the two ends of the intake spectrum. A common health metric (e.g. Disability-Adjusted Life Year) is used capturing severity, duration and incidence of the affected health condition(s) and death. Future integrated risk-benefit assessments of country-wide food fortification for example with vitamin A will illustrate the benefits and risks of fortification in terms of health impact.

Conclusions: Estimating the health consequences of micronutrient fortification at both ends of the intake spectrum may assist in making deliberate decisions on food fortification programs.

Open Access Conference Proceeding (Abstract)

Girls' Collectives Address Adolescents' Anemia and Social Norms in Socially-excluded Tea Estates in India: A Public-private Partnership in Assam

Vandana Joshi, Anirudha Kulkarni, Neelam Bhatnagar, Sandip Ghosh, Pushpendra Kumar Dixit, Ved Prakash Gautam, Tulika Goswami Mahanta, Vani Sethi, Jeroo Master, Victor M. Aguayo

European Journal of Nutrition & Food Safety, Page 653-654
DOI: 10.9734/EJNFS/2015/21013

Objectives: To generate evidence on engaging girls' collectives to address anemia and social norms in self-contained, privately-managed tea plantations in India.

Methods: In 2006, UNICEF India partnered with a federation of tea companies in Assam's Dibrugarh district, and Twinning Corporate Social Responsibility to establish 158 girls' collectives across 117 of 273 tea gardens. These collectives meet weekly to discuss and address social issues such as child marriage, child labor, school dropout, and life skills. In 2012, supervised weekly iron folic acid (IFA) supplementation, biannual deworming and nutrition education were weaved in these peer interactions and implemented in 15 tea estates through 45 girls' collectives comprising 7097 adolescent girls, with the objective to address anemia. Visual aids, recipe demonstrations, and home gardening were used to make sessions interesting. Government positioned adequate supplies at tea estate hospitals/outposts. Two peer monitors per tea estate supervised the activities of the collectives. The follow up of this cohort included a baseline (2011) and an end line (2013) survey.

Results: Compliance with weekly IFA supplementation (4 tablets per month) increased from 25% (2012) to 82% (2013). Home gardens were introduced in 1,002 homes and 55 community patches. Provisional end line data shows a 1.25 g/dl improvement in mean hemoglobin levels (9.77 to 11.2 g/dl). There is also evidence of increased girls' re-enrollment in high school and a reduction in the proportion of child marriages.

Conclusions: Lessons from this public-private partnership can be adapted to similar programming environments that aim at reaching out to adolescent girls with anemia control interventions.

Open Access Conference Proceeding (Abstract)

Predicted Impact of Large-scale Fortification on Adequacy of Vitamin A Intakes among Women and Young Children in Cameroon: Simulations Using Nationally-representative 24-h Recall Data

Reina Engle-Stone, Martin Nankap, Alex Ndjebayi, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 655-656
DOI: 10.9734/EJNFS/2015/21014

Objectives: WHO recommends using information on dietary intakes to design food fortification programs, but nationally-representative, individual dietary data are rarely available in low-income countries. Prior to initiating a fortification program in Cameroon, we assessed intakes of vitamin A (VA) and fortifiable foods (vegetable oil, sugar, wheat flour, and bouillon cube), to simulate the effects of fortification with different foods and VA levels on VA intakes.

Methods: In a nationally-representative, cluster survey with 3 strata (North, South, Cities), we conducted 24-h dietary recalls among 912 women 15-49 y and 883 children 12-59 mo (with duplicates in a subset).

Results: Among women, 50% had usual VA intakes < 500 μg RAE/d (17% South, 99% North, 44% Cities); 58% of non-breastfeeding children had VA intake < 210 μg RAE/d (41% South, 86% North, 60% Cities). Oil fortification with 12 mg VA/kg, as currently mandated, would decrease the prevalence of inadequate intakes to 33% among women and 34% among children (73% and 55% in the North region, where VA deficiency is most common). Increasing the VA in oil or fortifying a second food would further decrease the prevalence of inadequate intakes, but would also increase the prevalence of retinol intakes above the UL, mainly among children.

Conclusions: The current food fortification program can be expected to improve dietary VA adequacy among women and children in Cameroon. Modifications to the program must balance the potential to further increase VA intakes with the risk of retinol intake above the UL among children.

Open Access Conference Proceeding (Abstract)

Scaling Up Micronutrient Interventions: Bridging the Gap between Theory and Implementation

Noelimanjaka Ramalanjaona, Simeon Rakotonirina, Ietje Reerink, Amal Tucker Brown, Jennifer Peterson, Abel Irena

European Journal of Nutrition & Food Safety, Page 657-658
DOI: 10.9734/EJNFS/2015/21015

Introduction: Home-based fortification of complementary food with micronutrient powders (MNPs) has been proven to reduce anemia. In resource constrained contexts - like Madagascar - where child diet is of poor quality and anemia levels high, the challenge lies in finding viable approaches for ensuring sustainable access to MNPs by vulnerable populations.


Objective: To assess the effect of social marketing through community-based and private sector channels on access to MNP in rural and urban areas of Madagascar.


Methods: Marketing research was conducted to develop product brand and logo. Quantitative and qualitative information was collected to assess infant feeding practices before and after introduction of IYCF [1] activities, awareness of child nutrition, and mothers' aspirations. Willingness-to-pay data helped determine price points and margins for intermediaries.

[1] Infant and young child feeding practices.

Results: Initial outcomes indicate high trial and acceptability rates among mothers both in urban and rural areas. The revenue from sales from the private channel is used to reinforce activities linked to the community based distribution. Between February and October 2013, 5,615 children received MNP. Of the 5,615 children, 21% (1,200 children) consumed 90 sachets in 6 months. Challenges with poor quality product (taste, odor) – influencing continuation rates -- were partially overcome through CHW counseling on food diversification.

Conclusion: Social marketing appears a viable option for ensuring access to MNPs even by vulnerable segments of the population. Findings show this approach can improve communication around IYCF and provide evidence of a solid public-private sector partnership model that can be taken to scale.

Open Access Conference Proceeding (Abstract)

Determining Iodine Status and Knowledge of Dietary Salt Restricted Hypertension Patients in Addis Ababa Hospitals, Ethiopia

Girmay Ayana, Cherinet Abuye, Hiwot Abebe

European Journal of Nutrition & Food Safety, Page 659-660
DOI: 10.9734/EJNFS/2015/21016

Objectives: Hypertension is public health problem worldwide and the trends of prevalence have increased in economically developing countries. Reducing dietary sodium is one of the main recommendations to treatment hypertension. Restriction of salt consumption could cause a reduction of iodine intake from iodized salt. This study aims in determining iodine status and knowledge of dietary salt restricted hypertensive patients and compare with non hypertensive individuals.

Methods: Institution based cross-sectional design was employed and 239 hypertensive and non hypertensive individuals were selected randomly. Urine samples were collected immediately after interviewing using iodine free cups.

Results: T The MUIC were 41.56(SE9.41μg/L) and 46.14(SE7.86μg/L) in hypertensive and non hypertensive respectively. More than 76% were iodine deficient and greater than 30% were severely deficiency. The prevalence of iodine deficiency is higher in salt restricted hypertensive patients than non restricted patients but the difference was not statistically significant (P. value=0.12). Females had better knowledge about iodine than males. Hypertension patients on medication were 88% more likely to be iodine deficient than those do not receive medication. UIE of both groups are lower than the recommended intake and dietary salt restricted patients are more likely to be iodine than unrestricted.

Conclusions: Iodine deficiency is a problem of dietary salt restricted hypertensive patients and to address this problem, an alternative iodine intervention mechanism should be in place. Besides, the contribution of salt for iodine status and degree of salt restriction needs to be studied.

Open Access Conference Proceeding (Abstract)

Cost-Effectiveness of Zinc Supplementation for the Prevention or Treatment of Diarrhea among Young Children in Rural Burkina Faso

Lea Prince, Stephen Vosti, Oula Ouattara, Elodie Becquey, Césaire Ouédraogo, Sonja Hess, Noel Rouamba, Jean-Bosco Ouédraogo, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 661-662
DOI: 10.9734/EJNFS/2015/21017

Objectives: Zinc supplements may decrease incidence of diarrhea among young children at risk of zinc deficiency. We estimated the cost-effectiveness of three approaches for delivery of preventive and therapeutic zinc supplements in rural Burkina Faso.

Methods: Cost estimates were derived from data collected during a community-based randomized zinc trial, information on ongoing child-health days to distribute public health services, and an in-depth study of the current health care system.  Diarrhea incidence reduction is based on intent-to-treat analysis of zinc trial data.  Activity-based costing using an ingredients approach accounts for the costs of mutually exclusive inputs related to defined program activities for each approach. Cost-effectiveness is analyzed and compared across an intermittent preventive zinc (IPZ) approach (quarterly delivery of 10-days of 10 mg/d supplements to childrens’ homes), and a therapeutic approach (10-days of 20 mg/d supplements delivered during an ill-child consultation at a local clinic (TZ-CSPS) or via community-based health worker (TZ-CHW)). We assume 81.6% of children are reached with IPZ and .06% and 52% of diarrhea cases treated with TZ-CSPS and TZ-CHW, respectively.

Results: Estimated annual program cost per additional child reached is $3.52 (IPZ), $3.49 (TZ-CSPS) and $17.59 (TZ-CHW). Cost per death averted in the first program-year is estimated to be $3164 (IPZ), $7363 (TZ-CSPS), and $14068 (TZ-CHW), assuming a diarrhea case fatality rate of 0.3% and 2.64 episodes of diarrhea/child/year.  Estimated cases of diarrhea averted per year are 11.5% (IPZ), 0.9% (TZ-CSPS), and 8.2%(TZ-CHW).

Conclusions: IPZ is the most cost-effective approach for a zinc program among our study population.

Open Access Conference Proceeding (Abstract)

Factors Associated with Anemia in Pregnancy in Cascades Region in Burkina Faso

Ilboudo Bernard, Savadogo G. Léon Blaise, Kinda Maurice, Guiguemde T. Robert, Dramaix-wilmet Michèle, Donnen Philippe

European Journal of Nutrition & Food Safety, Page 663-664
DOI: 10.9734/EJNFS/2015/21018

Objectives: To analyze the factors associated with anemia in pregnancy in the Cascades region in Burkina Faso.

Methods: A cross-sectional study was carried out in antenatal clinics of the Cascades region in Burkina Faso during one month from May to June 2012. We collected data on socio-demographics and health characteristics of pregnant women attending these clinics. Hemoglobin was measured to assess anemia. Factors associated with anemia were identified through a multivariate analysis.

Results: A total of 1763 pregnant women, irrespectively of pregnancy stage, were enrolled. The mean (SD) hemoglobin level was 10.6 (1.4) g/dl. The prevalence of anemia in pregnancy was 58.9%, 3.2% of them being severe. Factors associated with anemia were the absence of intermittent preventive treatment of malaria with sulfadoxin-pyrimetamin (OR = 1.3, 95% CI: 1.0-1.7), number of pregnancies >6 (OR = 1.4, 95% CI: 1.1-1.9). Moderate consumption of local alcohol extracted from Palmyra was associated with a lower prevalence of anemia (OR = 0.7, 95% CI: 0.5-0.9). Surprisingly, anemia was not associated with supplementation with folic acid + iron (p = 0.60).

Conclusions: Interventions which aim to reduce the prevalence of anemia in pregnancy in Burkina Faso should improve the coverage of the intermittent preventive treatment of malaria and support the limitation of births.

Open Access Conference Proceeding (Abstract)

Validation of a Photo Atlas for Food Portion Estimation for a National 24-hr Recall Dietary Survey in Kenya

Zipporah Bukania, Jacqueline Kungu, Lucy Murage, Gladys Mugambi, Terry Wefwafwa

European Journal of Nutrition & Food Safety, Page 665-666
DOI: 10.9734/EJNFS/2015/21019

Objectives: Reliance on respondents’ individual recall ability for accurate dietary data collection is always a challenge. We developed a photo atlas to aid respondents in recall of foods eaten during the interactive 24 hr recall multiple pass approach for data collection during the Kenya National Micronutrient Survey 2011. Photographs of foods are preferred for estimating portion sizes because the amount eaten is easier for the respondent to visualize. However, it was necessary to validate the photo atlas before using it.

Methods: Seven common Kenyan food items were chosen for validation of the atlas: cassava root, tomatoes, eggplant, raw chicken wings and legs, watermelon and fried dough. Each color photo displayed three differently sizes of each food item to capture “large,” “medium,” and “small”. Actual food portions were used for comparison with the photos. Volunteers were asked to rate the level of similarity between the actual-life food item and the item in the photograph on a scale of 1 to 5. Five indicated “Perfect Match” and one indicated “Not a Match.” 84 volunteers from KEMRI and Kibera were conveniently selected for the validation exercise.

Results: Exact matches were highly observed in all sizes of whole foods (onions (52.4; 61.9%; 59%), tomatoes (59.5%; 58.3%; 63.1%) and eggplants 35.7%; 27.4% and 63.1%) compared to sliced food items. No significant differences observed between female and male matches of food items.

Conclusions: Identification of difficult to recall foods can be presented as food albums and used as dietary data collection tools.

Open Access Conference Proceeding (Abstract)

Examining Means of Reaching School and Non School Attending Adolescent Girls for Iron Supplementation in Tigray Region, Northern Ethiopia

Afework Mulugeta, Kiday H/Silassie, Masresha Tessema, Oumer Seid, Aweke Kebede, Gebremedhin Kidane

European Journal of Nutrition & Food Safety, Page 667
DOI: 10.9734/EJNFS/2015/21020

Objectives: To examine means of reaching school and non-school attending adolescent girls for iron supplementation in Tigray region.

Methods: The study employed cross-sectional survey consisting of both quantitative and qualitative approaches. Stratified multi-stage systematic random sampling technique was used to collect data from 828 adolescent girls in nine districts. Data was cleaned, coded and analyzed using SPSS version 20 for windows.

Results: A significant proportion of adolescent girls (30%) were non-school attending. Symptoms of anemia; paleness and fatigue are known by 18% and 42% of the subjects respectively. Eating iron rich foods (87.6%) and taking iron supplements (36.7%) were mentioned as the preferred methods of preventing anemia.  Radio (84%) is selected as the best media. Schools (39%) and health facilities (69%) were the preferred public facilities for provision of supplements. According to key informants low community awareness, perception of iron tablet as contraceptive, cultural influences and lack of knowledge were some of the potential barriers.

Conclusions: Nutrition information communication through radio and health development army and use of school and health facilities to distribute iron supplements were recommended.

Open Access Conference Proceeding (Abstract)

Increasing Use of Zinc for Pediatric Diarrhea Treatment in Benin: The Vital Role of Health Providers

Emily Sanders, Kathryn Banke, Vicki MacDonald, Julie Williams, Njara Rakotonirina

European Journal of Nutrition & Food Safety, Page 668-669
DOI: 10.9734/EJNFS/2015/21021

Objectives: Treatment of uncomplicated pediatric diarrhea with zinc sulfate plus ORS could avert over 20 percent of worldwide childhood deaths. Results from two household surveys evaluating 3 years of program implementation in Benin highlight the important role of caregiver-health provider interactions and contribute to a significant gap in global literature on programmatic experiences in introducing zinc.

Methods: Population-based surveys were conducted to assess caregivers' knowledge, attitudes, and practices related to pediatric diarrhea treatment at one and three years following implementation of demand and supply-side interventions accompanying the introduction of OraselZinc, a diarrhea treatment kit (containing zinc sulfate plus ORS), in Benin in 2008. A multi-stage sampling approach was used to select caregivers of children under 5 with diarrhea in the past 2 weeks in 28 communes in 2009 (n=294) and 2011 (n=392).

Results: Zinc use increased from 31% in 2009 to 54% in 2011 (p<0.01). Most zinc users in 2011 (62%) treated with zinc because a provider recommended it. Logistic regressions showed that speaking to health personnel about zinc (p<0.05) and seeking treatment from a professional health provider (p<0.05) were significantly associated with zinc use.

Conclusions: Providers are an important source of treatment information and can play a major role in encouraging use of zinc among caregivers. Educating providers about correct pediatric diarrhea treatment is vital for programs seeking to increase correct use among caregivers. Demand generation campaigns can sensitize caregivers and providers to zinc as an effective diarrhea treatment, influencing both care-seeking and prescribing behavior.

Open Access Conference Proceeding (Abstract)

Academy of Science of South Africa Consensus Study on Improved Nutritional Assessment of Micronutrients: Iron

Namukolo Covic, Este Vorster

European Journal of Nutrition & Food Safety, Page 670-671
DOI: 10.9734/EJNFS/2015/21022

Objectives: The academy of Science of South Africa commissioned a consensus study on improved nutritional assessment of micronutrients in the country. For iron the objectives were to, evaluate usefulness of available indicators for South Africa and other African countries facing similar challenges, review the type and quality of research information on iron status in South Africa and formulate recommendations on suitability and work required for more effective monitoring of iron status and possible gains from intervention programmes.

Methods: The study was done by reviewing research that has been done in relation to iron status primarily in South Africa.

Results: Haemoglobin, Serum Ferritin (SF) and transferrin receptor were the most commonly used indicators in addition to dietary intake. There was lack of consistency in the use of acute phase proteins to address infection and inflammation making interpretation of SF difficult against the background of high infection prevalence eg. HIV/AIDS, worm infestation and obesity. The study found a strong bias toward low socio-economic sectors of the population while the national food fortification programme exposes the entire population to multiple micronutrients including iron. Some studies reported that some pockets of the population may be at risk of iron overload.

Conclusions: Regular monitoring across population subgroups is recommended. Standard mechanisms to correct SF for inflammation/infection should be explored for more effective monitoring of interventions. Pockets of the population with potential risk of iron overload require attention.

Open Access Conference Proceeding (Abstract)

Maternal Thyroid Function and Birth Outcomes after Iodine Supplementation in Mild-to-moderately Iodine-deficient Pregnant Women in Thailand

Sueppong Gowachirapant, Alida Melse-Boonstra, Pattanee Winichagoon, Ratanaporn Pornkul, Michael Zimmermann

European Journal of Nutrition & Food Safety, Page 672-673
DOI: 10.9734/EJNFS/2015/21023

Objectives: To evaluate the effects of iodine supplementation in mild-to-moderately iodine-deficient pregnant Thai women on maternal thyroid function and birth outcomes.

Methods: An RCT with 200 µg KI per day was conducted among 514 mild-to-moderately iodine-deficient pregnant Thai women. Blood samples were collected at baseline (<14 weeks of gestation), and follow up samples were collected in the 2nd, and 3rd trimester and at delivery in cord blood. Free T4 (fT4), thyroglobulin (TG) and thyroid-stimulating hormone (TSH) concentration were measured. Neonatal data was obtained from hospital records. Thyroid volume of the newborns was measured using ultrasonography. Data were analyzed per protocol by linear mixed models and linear regression models.

Results: Cumulative loss to follow up was 20% in the 2nd trimester, 23% in the 3rd trimester, and 28% at delivery. Median maternal fT4, TG and TSH concentration did not differ significantly between treatment groups (p>0.05). Mean birth weight was 3150±410 g in the iodine group as compared to 3088±473 g in the placebo group (p>0.05); 4.8% of infants in the iodine group were low birth weight versus 7.9% in the placebo group. There were no significant differences in median fT4, TG and TSH concentration, and mean thyroid volume of the newborns between treatment groups (p>0.05).  

Conclusions: Maternal iodine supplementation normalized iodine status and resulted in lower maternal TSH concentrations during pregnancy. Further data analysis should reveal whether iodine supplementation has led to any improvement in child development in this population.

Open Access Conference Proceeding (Abstract)

Poor Pregnancy and Birth Outcomes are Associated with the Indicators of Inadequate Dietary Intakes of Micronutrients in Rural Women of the Amhara Region of Ethiopia

Husein Mohammed, Grace S. Marquis, Frances Aboud, Karim Bougma, Kimberly B. Harding, Aragash Samuel

European Journal of Nutrition & Food Safety, Page 674-675
DOI: 10.9734/EJNFS/2015/21024

Objectives: High prevalence of poor pregnancy (miscarriage) and birth (stillbirth) outcomes has been reported among poor women in Ethiopia. This study evaluated the underlining associated factors.

Methods: The study used a cross-sectional design to interview 5192 mothers of children under 5 years of age, who were living in 60 villages, across 60 sub-districts in 6 zones of the Amhara Region of Ethiopia. Socio-demographic, obstetric, and birth information were collected using standardised questionnaires and household salts were tested with rapid test kits. The study protocol received ethical approval from McGill University, Ethiopian Health and Nutrition Research Institute, and the Ethiopian National Research Ethics Review Committee.

Results: Households were mainly individual dwellings (83.4%) with agricultural land (90.9%) and rearing livestock (94.1%). Majority of household heads and mothers were illiterate (63.7% and 81.2%, respectively). Sanitation (61.0% scored ≤ 1 out of 3), assets (84.1% scored ≤5 out of 10) and use of iodised salt (6.4%) were very poor and goiter presence in the family was high (41.7%). Prevalence of miscarriage was 95.4 per 1000 pregnancies and stillbirth was 22.7 per 1000 live births. The use of non-iodised salt was associated with miscarriage (r=0.06; p<0.05). Self-reported anaemia, vomiting, and urinary tract infection during pregnancy were common (37.2%, 26.08%, and 19.47% respectively) and were associated with prevalence of miscarriage and stillbirth(r=0.04 to 0.06; p<0.05).

Conclusions: Poor pregnancy and birth outcomes occur frequently in rural Ethiopia and are associated with indicators of inadequate dietary intakes of micronutrients.

Open Access Conference Proceeding (Abstract)

The Micronutrient Survey Manual: A Manual for Assessing Vitamin and Mineral Nutritional Status and Interventions Using Cross-sectional Surveys

Kevin Sullivan, Juan Pena-Rosa, Arnold Timmer, Luz De-Regil, Tiffany Gust, Parmi Suchdev, Mary Serdula, Ralph Whitehead, Maria Jefferds, Katherine Tripp, Carine Mapango, Jalal Chowdhury

European Journal of Nutrition & Food Safety, Page 676-677
DOI: 10.9734/EJNFS/2015/21025

Objectives: An important component of public health nutrition programs is the periodic assessment of vitamin and mineral nutritional status and coverage of micronutrient interventions.  Performing high quality cross-sectional surveys can be enhanced by the availability of guidance on steps in survey methods, sample size, sampling methods, data collection, analysis and interpretation, dissemination of results, and appropriate feedback to improve intervention programs. A manual to assist implementers is described.

Methods: A previously published manual, "Indicators and Methods for Cross-Sectional Surveys of Vitamin and Mineral Status of Populations", by the Centers for Disease Control and Prevention (CDC) and the Micronutrient Initiative (MI) served as the basis for this newer manual. New technical partners, WHO and UNICEF, have collaborated in the development of this up-to-date "Micronutrient Survey Manual".

Results: In addition to updated resources for the assessment of anemia and iodine, iron, and vitamin A deficiencies, the manual has added information on folate and zinc deficiencies. Program indicators for assessing fortification of staple foods, point-of-use fortification with micronutrient powders, micronutrient supplementation, and dietary counselling are included. The manual contains detailed information on biologic sample collection and processing, sample size calculations, and analysis of survey data. Quality assurance throughout the survey process is emphasized. The issues of ethics, confidentiality, and informed consent are addressed.

Conclusions: The "Micronutrient Survey Manual" can assist survey managers to improve the validity, efficiency, and standardization of cross-sectional surveys to better serve public health practice.

Open Access Conference Proceeding (Abstract)

Monitoring of Flour Fortification Programs: Case Studies in Three Countries

Philip Randall, Laird Ruth, Michèle Schmit, Mary Serdula, Arnold Timmer, Helena Pachon

European Journal of Nutrition & Food Safety, Page 678-679
DOI: 10.9734/EJNFS/2015/21026

Objectives: Although monitoring should be an integral part of any fortification program, little is publicly known about the design, implementation, and results of flour fortification monitoring systems. The objectives are to assess the monitoring systems in three countries including the strengths and weaknesses of each system, how weaknesses are addressed, and lessons learned.

Methods: South Africa, Indonesia, and Chile were selected using predetermined criteria (e.g., mandatory fortification legislation, represent different world regions, importation of flour, and existence of a functioning flour fortification monitoring system). Eight categories of regulatory and household/individual monitoring were assessed.

Results: The monitoring systems for each country had different strengths and weaknesses. Overall, strengths included having a structured plan for at least some aspects of monitoring, an adequate number of trained inspectors, and the ability to modify regulations and protocols. Monitoring weaknesses included an insufficient multiple agency approach with poor communications within and between organizations, absent commercial monitoring, and lack of laboratory resources and funds.  None of the countries had a cohesive monitoring program with regular collection of regulatory and household/individual monitoring information. 

Conclusions: A functioning flour fortification program depends on having an effective monitoring system in place. Critical to a successful monitoring system was the planning, budget, human resources, and political will necessary to implement monitoring and review monitoring data on a regular basis. 

Open Access Conference Proceeding (Abstract)

Refinements to Assessment of Iodine Nutrition

Kevin Sullivan, Michael Zimmermann, Jonathan Gorstein, Gregory Gerasimov, Arnold Timmer, Juliawati Untoro

European Journal of Nutrition & Food Safety, Page 680-681
DOI: 10.9734/EJNFS/2015/21027

Objectives: The main target groups of iodine programs are pregnant women (PW) and non-pregnant women of reproductive age (NPW), yet surveys frequently focus on school age children (SAC). It is unclear whether median urinary iodine concentration (mUIC) in SAC can be used as a surrogate for PW and NPW. It is also unclear what range of iodine intake is adequate in SAC. The objectives of this research were to: 1) Compare mUIC values in SAC with those in PW and NPW; and 2) determine if the current mUIC range for SAC is appropriate by assessing thyroglobulin (Tg), a functional biomarker of iodine status.

Methods: 1) The Iodine Task Force (ITF) reviewed surveys where mUIC in SAC, PW, and NPW were available and compared iodine status across groups; and 2) for determining the adequate range of mUIC in SAC, the ITF analyzed and interpreted a multicenter study.

Results: 1) When SAC had adequate or above adequate iodine status, PW were inadequate in 47% of the surveys. 2) In SAC, the two current WHO/UNICEF/ICCIDD mUIC categories for classification of iodine nutrition as "adequate" and "above adequate" could be combined into a single "adequate" range based on Tg results showing no negative effect on the thyroid at the current "above adequate" range.

Conclusions: A number of refinements to the current global recommendations in assessing iodine status were identified, including the importance of including PW and/or NPW in population-based assessments, and reconsideration of current mUIC criteria for the classification of optimal iodine nutrition in SAC.

Open Access Conference Proceeding (Abstract)

Effects of Locally Produced and Consumed Vegetables on Anthropometric Indices and Micronutrient Intakes of Preschoolers in Vegetables Home Garden Households in Owerri Municipality

C. O. Asinobi Chinagorom Onyemaechi, Oly-Alawuba Nkiru

European Journal of Nutrition & Food Safety, Page 682-683
DOI: 10.9734/EJNFS/2015/21028

Objective: To assess the effect of vegetable home garden on anthropometric indices and micronutrient intakes of preschoolers in households producing and consuming vegetables in Owerri Municipality.

Methodology: Anthropometric measurements of 90 preschoolers aged 4 months- 60months were taken from 76 vegetables home garden households (VHGH) and 52 preschoolers from 39 non vegetable home garden households (NVHGH). Growth deviations from median, percentage prevalence and severities of under nutrition were calculated bases on the National Centre for Health Statistics (NCHS) reference. Also calculated were mean daily food nutrient intakes and adequacy ratios using food composition table.

Associations between anthropometric indicators of the preschoolers and levels of micronutrient intakes were assessed. Significance of differences was determined by Chi-Square and students t-test.

Results: On average the nutrient adequacy ratios of both males and females were lower than requirements in iron, riboflavin, and niacin in both households.  However, the growth deviations of the preschoolers were above median - <2SD but higher in preschoolers in VHGH than their counterparts. The differences in the growth deviations were significant and highest in the age group 48 – 60months in both households but higher in VHGH than in NVHGH. There were significant associations between the anthropometric indices of the preschoolers and the levels of micronutrient intakes in VHGH.

Conclusions: Preschoolers in VHGH that produced and consumed home produced vegetables had better anthropometric indices and micronutrient intakes than their counterparts. Vegetables home garden practices in urban areas should be encouraged to alleviate the problem of micronutrient deficiencies in preschoolers.

Open Access Conference Proceeding (Abstract)

Short-term, Daily Supplementation with Vitamin A, But Not Beta-carotene, Increases Plasma and Breast Milk Retinol Concentration in Lactating Filipino Women

Reina Englestone, Akoto Osei, Dolly Reario, Joanne Arsenault, Kenneth Brown, Marjorie Haskell

European Journal of Nutrition & Food Safety, Page 684-685
DOI: 10.9734/EJNFS/2015/21029

Objective: To assess the usefulness of breast milk vitamin A (BMVA) for evaluating the impact of food-based vitamin A (VA) interventions.

Methods: We assessed the effect of daily supplementation with 600 ug VA activity as either retinyl palmitate or β-carotene (BC) or 0 ug VA activity as corn oil (CO) on BMVA and BC concentrations in lactating women (n=83) who were randomly assigned to receive one of the three treatments, 6 d/wk for 3 wk. Treatments were administered as capsules (containing either 300 ug or 0 ug VA ), 2 times/d, with morning and noon meals consisting of low VA foods. Plasma and milk concentrations of VA and BC were measured before and after the intervention.  

Results: Initial mean plasma retinol concentration was 1.29±0.41 umol/L, and the mean change in plasma retinol was greater in the VA group than in the BC and CO groups (0.13, 0.03, -0.04 umol/L, respectively, P<0.01). Initial mean BMVA was 28.0±14.6 nmol/g fat, and the mean change in BMVA was greater in the VA group than in the BC and CO groups (4.6, 0.5, -3.6 nmol/g fat, respectively, P<0.001). Initial plasma BC concentration was 0.33±0.22 umol/L, and the mean change in plasma BC was greater in the BC group than in the VA and CO groups (0.74, 0.02, 0.07 umol/L, respectively, P<0.0001). 

Conclusions: Both BMVA and plasma retinol concentrations increased in response to supplementation with retinyl palmitate, but bioconversion of BC to VA is limited in this population. 

Open Access Conference Proceeding (Abstract)

Revised Codex Alimentarius Guidelines on Formulated Complementary Foods for Older Infants and Young Children - Better Formulations, Increased Fortification Levels and Smaller Serving Sizes to Protect Breastfeeding

Jonathan Siekmann, Jane Badham, Stanley Zlotkin, Anna Lartey, Zhenyu Yang, Dominic Schofield

European Journal of Nutrition & Food Safety, Page 686-687
DOI: 10.9734/EJNFS/2015/21030

Objectives: The Codex Alimentarius guidelines on formulated complementary foods for older infants and young children have important implications for maintaining nutritional status and health and preventing malnutrition. Governments and companies rely on these guidelines, yet they were outdated due to the lag between advances in science and the lengthy process required to establish Codex guidance.

Methods: In 2008, Ghana initiated and led revision of these guidelines, which were adopted by Codex in 2013.

Results: Benefits of the revised Guidelines include: (1) Smaller recommended serving sizes to protect breastmilk intake; (2) Specific mention of essential fatty acids and their optimal ratio; (3) At least 50% RNI of essential vitamins and minerals per serving; (4) Expanded scope of complementary foods to include small-quantity lipid-based nutrient supplements and multi-nutrient supplements; (5) Processing techniques to minimize or reduce anti-nutrients and trans-fatty acids.

Conclusions: The revised guidelines help countries to develop national regulations covering all forms of formulated complementary foods and provide updated guidance for formulating good quality foods used for infants and young children, particularly in developing countries.

Open Access Conference Proceeding (Abstract)

Improving the Accuracy of Iodization of the Dietary Salt Supplies of Populations

Pieter Jooste, Frits Van Der Haar

European Journal of Nutrition & Food Safety, Page 688
DOI: 10.9734/EJNFS/2015/21031

Objectives: The mandate of this working group was to assess the importance of salt iodine quality in successful IDD prevention and control. Examine the role of salt iodine content in quality assurance, inspection, surveillance, and coalition oversight of IDD programs.

Methods: Scientific literature, technical reports and a range of data and information sources were reviewed to determine whether accurate salt iodization was making a critical contribution toward safe and successful IDD programs.

Results: Evidence and examples were collected on salt iodine data in quality assurance of iodization by salt industry, assessments of iodized salt quality by inspectors in factories and markets, surveillance of USI strategies and dietary iodine supplies by program managers, and in provision of coalition oversight by high-level officials.

Conclusions: Because salt iodization is a supply-based strategy, reliable accuracy at the source is most critical. It is therefore vital that each salt factory should adopt a quality management system, with standard operating procedures at least for the manufacturing and packaging of iodized salt. Titration is preferred but other quantitative methods with e.g. the WYD Checker, i-Reader or Bioanalyt can also yield accurate data. Improved accuracy down the supply chain is desirable, especially in surveillance, but commonly points to the need for ensured accuracy at the source when quality failures are discovered. The need remains for an agreed approach to obtain reliable data of the use of iodized salt in the food manufacturing industry. 

Open Access Conference Proceeding (Abstract)

Correlates of Iron Deficiency in Women and Children in Rural Communities of Cambodia and Kenya

Bridget Aidam, Edward Anbrasi, Hafizur Rahman, Anna Paden, Annette Ghee, Jane Chege

European Journal of Nutrition & Food Safety, Page 689-690
DOI: 10.9734/EJNFS/2015/21032

Objectives: Over 2 Billion people globally are estimated to be anemic, primary due to iron deficiency anemia. The prevalence is exacerbated in rural populations, in countries with extreme resource deficiencies resulting in debilitating consequences of impaired health and productivity. In Kenya and Cambodia the national estimates are 69% and 63.4% for children under 5 years. The World Vision MCH strategy is a multifaceted targeted intervention to address major disease burden and under-nutrition including iron deficiency anemia. This study is a collaborative multi-stakeholder research engaging academic research institutions, NGO and Ministry of health to determine the impact of the interventions in Zambia, Cambodia, Kenya and Guatemala.

Methods: The study was designed as a mixed methods research using a quasi-experimental design with comparison communities in World Vision's Area Development Programs in  Cambodia and Kenya to explore the determinants of iron deficiency amongst the rural populations  and assess coverage, capacity and quality of the delivery systems for the control of iron deficiency. Total samples of 1,180 mother and child pairs are included in baseline assessments in Cambodia while in Kenya 1582 women and 942 children are included.

Results: Applying multi-level modeling, the results will document correlates of iron deficiency, and present a profile of capacity and quality of the services provided.

Conclusions: The findings will provide valuable scientific evidence of multi-platform interventions addressing community oriented and health facility focused strategies to enhance service delivery and outcomes for addressing iron deficiency in rural communities with minimal access to care.

Open Access Conference Proceeding (Abstract)

Impact of Home Fortification of Complementary Feeding with Vitamins and Minerals in Brazilian Infants: A Multi-center Pragmatic Trial

Marly Cardoso, Rosangela Augusto, Gisele Bortolini, Cristieli Oliveira, Daniela Tietzman, Leopoldina Sequeira, Maria Claret Hadler, Maria do Rosario Peixoto, Pascoal Muniz, Marcia Vitolo, Pedro Lira, Patricia Jaime

European Journal of Nutrition & Food Safety, Page 691-692
DOI: 10.9734/EJNFS/2015/21033

Objectives: To assess the effectiveness of home fortification with vitamins and minerals for the prevention of anemia and iron deficiency in infants younger than 1 year of age: a multi-center Brazilian study.

Methods: A pragmatic controlled trial in the primary healthcare. A total of 983 infants was recruited from Rio Branco, Olinda, Goiânia and Porto Alegre. At study baseline, a control group (CG) of infants 10 to 15 months of age (n= 521) was recruited in the routine healthcare. In parallel, an intervention group (IG) of infants 6 to 8 months of age (n= 462) was submitted to an intervention involving home fortification with multiple micronutrient powder (MNP) given once a day with semi-solid foods (fruit puree or salty meals) during 60 days. After 6 months of the intervention, hemoglobin and transferrin soluble receptor (TfR) were analyzed by comparing IG and CG, both comprising infants 10-15 months of age.

Results: The intervention group had significantly higher hemoglobin and lower TfR concentrations than did the CG. Mean values (SD) of hemoglobin and median (IQ) of TfR were statistically different in IG when compared with CG: 120.4 (10.6) g/L and 28.74 (10.4; 52.1) mcg/dL versus 116.6 (13.4) g/L and 32.6 (12.3, 83.1) mcg/dL, respectively. The overall prevalence of anemia and iron deficiency was lower in IG (14.3% and 30.1%) when compared with CG (23.1% and 37.4%), respectively.

Conclusions: Home fortification of complementary feeding in a routine primary healthcare was effective for reducing the prevalence of anemia and iron deficiency in our study population.

Open Access Conference Proceeding (Abstract)

Love, Laughter and Leafy Green Vegetables: Communicating about Gender Roles and Iron Rich Foods for Improved Maternal and Child Nutrition through Social and Behavior Communication Strategies for Health and Agriculture Programs in Tanzania and Ethiopia

Lydia Clemmons

European Journal of Nutrition & Food Safety, Page 693-694
DOI: 10.9734/EJNFS/2015/21034

Objectives: Our objective is to increase intake of intake of iron-rich foods (IRFs) among women of reproductive age and children under five, and enhance pro-nutrition gender roles, through evidence-based social and behavior change communication (SBCC) materials and interventions in Feed The Future programs in Ethiopia and Tanzania.

Methods: We developed behavioral profiles for pregnant and lactating women and their husbands using formative research and the evidence base. Creative concept testing, audience motivation testing and pretesting helped focus the tone, design, and positioning of messages and materials for these audiences. All SBCC materials underwent technical reviews by Tanzanian and Ethiopian experts in nutrition, health, agriculture and communications.

Results: The creative design process established that love, humor and happiness are effective themes for promoting small doable behaviors and enhanced gender roles contributing to increased iron intake by women and children. SBCC materials include love songs promoting specific actions for husbands to help improve the diets of their pregnant/lactating wives and children, peer group sessions where men and women practice discussing and deciding together about raising or buying animal source foods for family consumption, maternal nutrition and complementary feeding menu planning games with playing cards showing iron-rich foods and IFA supplements, interactive agriculture-nutrition radio programs, and a cell phone call-in service with pre-recorded nutrition reminders for agriculture and health extension workers.

Conclusions: Notwithstanding critical influences on iron intake at higher levels of systems and structures, SBCC can help programs increase women and children's access to and consumption of iron-rich foods by promoting family actions that are not only "doable" but also through appropriate and enjoyable interventions

Open Access Conference Proceeding (Abstract)

Factors Associated with the Micronutrient Consuming Pattern of Mothers and Children in a Remote Area of Sri Lanka

Dilka Peiris, Sumal Nandasena, Shivantha Mendis

European Journal of Nutrition & Food Safety, Page 695-696
DOI: 10.9734/EJNFS/2015/21035

Objectives: To assess the coverage and the associated factors of micronutrient consumption by mothers and under five children in Navagaththegama area, Sri Lanka.

Methods: A descriptive cross-sectional study was conducted among a representative sample (n =493) of children under 5 years (Total children population = 1434). Children were selected by cluster sampling. Mother or guardian was administered a structured questionnaire to ascertain socio-demographic characteristics, micro nutrient utilization pattern etc. Focus group discussions were conducted with mothers. Ethical approval was obtained.

Results: Out of mothers responded to questionnaires (n = 431), iron tablets have taken by the 78% (n= 336) throughout the prescribed period and 46% after the first 6 months of delivery. About 62 % (n= 271) have received the vitamin A mega dose within the first 2 months of delivery. About 6% of the infants have received vitamins and minerals at least one occasion during first 6 months of life. Vitamin A megados have received by 67% (n= 304) children between the age of 6 to 60 months. Mothers' education or family income level was not significantly associated micronutrient consumption pattern. Mothers claimed forgetfulness, nausea and lack of awareness were the main reasons for less compliance to take iron tablets.

Conclusions: Although the micronutrients are given free of charge to mother, it has not consumed by a considerable proportion of mothers. Education and income were not associated with the micronutrient consumption pattern.

Open Access Conference Proceeding (Abstract)

Household Agriculture-Nutrition Do-able Actions to Reduce Maternal Anemia: The HANDS Framework for Social and Behavior Change Communication Interventions in Integrated Nutrition Programming

Lydia Clemmons

European Journal of Nutrition & Food Safety, Page 697-698
DOI: 10.9734/EJNFS/2015/21036

Objectives: Our objective is to increase pregnant and lactating women's access to iron-rich foods through effective agriculture-nutrition social and behavior change communication (SBCC) programming at household and smallholder farm level. 

Methods: Formative research and a comprehensive review of the literature on maternal nutrition, agriculture and food security, and maternal health leads to the development of country-specific matrices. The information summarizes the evidence base of family, community, and smallholder farming actions that increase consumption of iron-rich foods by pregnant and lactating women. The information also includes maternal anemia-related behavioral profiles, including household-level behavior barriers and motivators for pregnant/lactating women and their husbands. The matrices are refined to sort do-able actions for smallholder farming families, including gender roles and family support, into five distinct categories: (1) Raise & Grow; (2) Earn & Buy; (3) Prepare, Process and Store; (4) Rest, Share and Eat, and (5) Discuss and Decide Together. Each category promotes specific behaviors, skills, and enabling technologies such as solar drying or sack gardens to increase access to animal source foods and iron-rich vegetables. 

Results: This process results in a completed Household Agriculture-Nutrition Doable Actions ("HANDS") Framework. "HANDS" has helped Feed the Future programs in Tanzania and Ethiopia to develop evidence-based maternal anemia SBCC materials and interventions for agriculture extension workers, pregnant or lactating women, and their families. 

Conclusions: "HANDS" can be easily adapted for other countries by inputting country-specific content in each of the five categories of doable actions for maternal anemia reduction. 

Open Access Conference Proceeding (Abstract)

Assessment of Anemia and Its Associated Factors among Pregnant Women Attending Antenatal Care in Karamara Hospital Jigjiga Town, Eastern Ethiopia

Alemnesh Amen, Kiday Girmay

European Journal of Nutrition & Food Safety, Page 699-700
DOI: 10.9734/EJNFS/2015/21037

Objectives: To assess anemia prevalence and its associated factors among pregnant women attending antenatal care in Karamara hospital.

Methods: Cross sectional study was conducted among antenatal care attendants in Karamara hospital, from March 11 to May 18, 2013. Structured questionnaire was administered. Blood and stool samples were taken. Completeness of data was checked, coded, edited, and entered into Epi info, exported to SPSS, cleaned and analyzed. The relationships between variables were examined through bivariate analysis, by computing odds ratio at 95% confidence level. Confounders were controlled by Multivariate logistic regression at 95% CI. A P value< 0.05 was considered as statistically significant.

Results: The participants were 411 antenatal care attendants from 15 to 45 years of age with complete data. The PCV value was between 11.49 g/dl and 42.81 g/dl with the Median and IQR of 10.60 and 3.83 respectively. Of which 44.2% was mild, 26.6% was moderate, 27.9% was severe anemia and 1.3% was very severe Anemia. Age, trimester, drinking tea immediately after meal and consuming iron rich food 24 hours before survey were significantly associated.

Conclusions: In the present study, the prevalence of anemia is 56.7%. And, it is severe public health significance. Age, third trimester, drinking tea after meal and consumption of organic iron rich foods are factor associated with anemia in pregnant women. Therefore, hemoglobin values adjustment, educating pregnant women to attained early antenatal care, not to drink tea right after meal, and eating organic iron rich food are recommended.

Open Access Conference Proceeding (Abstract)

Integrated Delivery of Nutrition-Specific and Nutrition-Sensitive Interventions in Ghana to Address Child Malnutrition

Melani 0'Leary, Raymond Owusu, Alison Mildon

European Journal of Nutrition & Food Safety, Page 701-702
DOI: 10.9734/EJNFS/2015/21038

Objectives: Interventions to improve household diet quality and food security under the Integrated Malnutrition, HIV/AIDS, and TB (IMHAT) project (2008-2012) were planned, implemented and monitored jointly with the Ministry of Food and Agriculture (MOFA) and Ghana Health Services (GHS). The objective was to accelerate reductions in child malnutrition by integrating nutrition-specific and nutrition-sensitive interventions.

Methods: Strong collaboration between GHS and MOFA was established through joint program design and quarterly follow up meetings. Extension agents from both GHS and MOFA were trained in Behaviour Change Communication and Infant and Young Child Feeding (IYCF) counseling and jointly implemented household visits, distribution of vegetable seeds and small animals, food demonstrations using highly nutritious indigenous crops, and training on food preparation, food preservation and household budgeting.

Lot Quality Assurance Sampling was used for baseline and final evaluation. Respondents (114) for each sampling group (Caregivers with children 0-6months, Caregivers of children 12-23 months, Caregivers with children 6-59 months, Respondents aged 15-49) were included. Sampling for anthropometry included 232 children aged 6-59 months.

Results: There was an increase in consumption of animal source foods (43% to 58.8%) and vitamin A rich foods (0 to 56.1%) by children age 6-59 months. Exclusive breastfeeding for 6 months increased from 63.2% to 74.6%. Stunting was reduced to 24.6% from 45%, underweight to 16.8% from 22.6%, and wasting to 3% from 6.3%.

Conclusions: Integrated delivery of interventions through strong collaboration between government ministries was successful in improving diet quality and growth in young children. Scale up of the approach is planned.

Open Access Conference Proceeding (Abstract)

Factors Associated with Non-use of Antenatal Iron and Folic Acid Supplements among Pakistani Women: A Cross Sectional Household Survey

Yasir B. Nisar, Michael Dibley, Ali Mir

European Journal of Nutrition & Food Safety, Page 703-704
DOI: 10.9734/EJNFS/2015/21039

Objectives: To determine the prevalence of use of antenatal iron-folic acid (IFA) supplements, and to identify socio-demographic risk factors for non-use of antenatal IFA supplements.

Methods: A cross sectional household cluster sample survey was conducted in 14 districts in Pakistan. Trained female fieldworkers conducted interviews with married women of reproductive age from December 2011 to March 2012. Women with live births in the preceding five years of the survey were selected for this study. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Multivariate logistic regression models were constructed to identify the independent factors for non-use of antenatal IFA supplements.

Results: Out of 6,266, 2,400 (38.3%, 95% CI: 36.6%, 40.1%) women took antenatal IFA supplements during their last pregnancy. Common sources of supplements were doctors (49.4%) and community health workers (40.3%). The mean (±SD) month of pregnancy at initiation of supplementation was 5.3 (±1.7) months. Living in Dera Ghazi Khan district (Adj OR=1.72), maternal age ≥45 years (Adj OR=2.01), no maternal education (Adj OR=2.33), no paternal education (Adj OR=1.58), belonging to the lowest household wealth index quartile (Adj OR=1.47), and no antenatal care services used (Adj OR=13.44) were risk factors for non-use of antenatal IFA supplements.

Conclusions: The coverage of antenatal IFA supplements is low in the surveyed districts of Pakistan, and the lack of parental education, older aged women, belonging to poorest households, residence in Dera Ghazi Khan district and no antenatal care services used were risk factors for non-use of IFA supplements.

Open Access Conference Proceeding (Abstract)

Perceptions of Antenatal Iron-folic Acid Supplements in Urban and Rural Pakistan: A Qualitative Study

Yasir B. Nisar, Ashraful Alam, Brekhna Aurangzeb, Michael Dibley

European Journal of Nutrition & Food Safety, Page 705-706
DOI: 10.9734/EJNFS/2015/21040

Objectives: To understand women and healthcare providers’ perceptions, and to investigate the cultural and behavioural factors influencing the use of antenatal IFA supplements in rural and urban settings of Pakistan.

Methods: Focus group discussions and in-depth interviews with mothers, currently pregnant women, community health workers and doctors were conducted in rural and urban areas of two districts of Pakistan. Data was collected between August and November 2012.

Results: The majority of women were aware of the perceived benefits of antenatal IFA supplements. The facilitating factors for the women’s use of supplements were: they had knowledge of benefits; they had trust in the healthcare providers; the supplements were available; they had the financial capacity to buy them; they felt better after taking these supplements; and they received support from family members. The barriers to the women’s use of supplements were: they forgot to take them; the non-availability of supplements; their limited financial capacity to buy them; the lack of antenatal care services; family members not allowing use of the supplements; not knowing about the benefits or no education; fear or experience of side effects; considering them as contraceptives; and felt better thus stopped.

Conclusions: The coverage of antenatal IFA supplementation can be improved by reducing the barriers related to the use of antenatal IFA supplementation in Pakistan. Interventions focused on providing adequate awareness, good quality counselling, reminder messages, availability of free supplements throughout pregnancy and reducing the side effects should be developed and implemented.

Open Access Conference Proceeding (Abstract)

Antenatal Iron-folic Acid (IFA) Supplementation Reduces Mortality in Children Less than 5 years of Age in Nepal

Yasir B. Nisar, Michael Dibley, Saba Mebrahtu, Naveen Paudyal, Madhu Devkota

European Journal of Nutrition & Food Safety, Page 707-708
DOI: 10.9734/EJNFS/2015/21041

Objectives: To examine the effect of antenatal iron-folic acid (IFA) supplements on the risk of childhood mortality in Nepal using pooled data from 3 Nepal Demographic and Health Survey (DHS) 2001, 2006 and 2011.

Methods: Survival information was used from 13,009 singleton most recent live-born infants. Primary outcomes were mortality indicators in children <5 years and the main exposure variable was any use of IFA supplements. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Analyses used multivariate Cox proportional hazards regression adjusted for 24 potential confounders based on Mosley and Chen framework for childhood survival in developing countries.

Results: Any use of IFA supplements significantly reduced risk of early neonatal deaths by 45% (aHR: 0.55, 95% CI: 0.38, 0.79), and total neonatal deaths by 42% (aHR: 0.58, 95% CI: 0.39, 0.85). Similarly, the risk of infant and under-5 mortality was significantly reduced by 32% and 48%, respectively. For mothers who started ≤4 months of pregnancy and used ≥150 supplements under-5 mortality was significantly reduced by 57% (aHR: 0.43, 95% CI: 0.23, 0.78). Population attributable risk estimates found 15% of under-5 deaths were attributed to non-use of IFA, and 29,000 under-5 deaths could be prevented in the next 5 years with universal IFA coverage.

Conclusions: Antenatal IFA supplementation significantly reduces the risk of neonatal and under-5 deaths in Nepal. The greatest impact on child survival was found in women who started early in pregnancy and took ≥150 supplements. Universal IFA coverage could improve childhood survival.

Open Access Conference Proceeding (Abstract)

Enhanced Iron-folic Acid (IFA) Supplementation Program Reduces Risk of Under 5 Mortality in Nepal

Michael Dibley, Yasir B. Nisar

European Journal of Nutrition & Food Safety, Page 709
DOI: 10.9734/EJNFS/2015/21042

Objectives: To investigate the impact of a decade-long program to improve coverage of antenatal IFA supplementation on child survival in Nepal over a 15 year period from 1996 to 2011.

Methods: We used pooled data of 3 Nepal Demographic and Health Survey (DHS) 2001, 2006 and 2011 with survival information from 13,106 most recent live-born infants. Primary outcomes were mortality indicators in children <5 years and the main exposure variable was the implementation of an improved IFA supplementation program. The improved program was implemented in 70 out of 75 districts in a phased manner at district level starting in 2003-04 and continuing till 2011. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Analyses used multivariate Cox proportional hazards regression adjusted for 22 potential confounders.

Results: After the phased implementation of the program to improve coverage of IFA supplementation, the risk of mortality on day 0 (first day of life) and early neonatal mortality (0-7 days) significantly reduced by 56% and 55% respectively compared to before the implementation of program after the adjustment of other confounders. The protective effect of implementation of improved IFA supplementation program was also observed in infant (aHR: 0.53, p=0.011) and under five mortality (aHR: 0.64, p=0.046) compared to before the program started.

Conclusions: An enhanced IFA supplementation program significantly reduces the deaths on first day of life and in early neonatal period in Nepal. The protective effect of the program was also seen in infants and in children <5 years of age.

Open Access Conference Proceeding (Abstract)

Antenatal Iron-folic Acid Supplementation Reduces Risk of Low Birth Weight in Pakistan

Yasir B. Nisar, Michael Dibley

European Journal of Nutrition & Food Safety, Page 710
DOI: 10.9734/EJNFS/2015/21043

Objectives: To examine the effect of iron-folic acid (IFA) supplementation on perceived birth size and birth weight using Pakistan Demographic and Health Survey (PDHS) 2006-07.

Methods: Information from 5,692 most recent live-born infants within 5 years prior to survey was used. The primary outcomes were maternal perception of birth size and birth weight and the main exposure was any use of antenatal IFA supplements. Birth weight was reported for only 10% of live births in PDHS 2006-07. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Analyses used multivariate logistic regression adjusted for 14 potential confounders.

Results: The risk of having less than average birth size babies was significantly reduced by 18% (aOR: 0.82, 95% CI 0.71, 0.96) for mothers who used any IFA supplements compared to no IFA use. A similar (18%), but non-significant reduction in the risk of low birth weight babies was found with maternal use of IFA supplements. Mothers who started IFA in the first trimester of pregnancy, significantly reduced the risk of having less than average birth size babies by 19%. Population attributable risk estimates showed 11% of ‘less than average birth size’ were attributed to non-use of antenatal IFA supplementation and universal coverage of IFA supplementation could prevent 112,000 newborns to have ‘less than average birth size’ each year in Pakistan.

Conclusions: Antenatal IFA supplementation significantly reduces the risk of less than average birth size and low birth weight babies in Pakistan. Universal coverage of supplementation improves birth size.

Open Access Conference Proceeding (Abstract)

Relationship of Antenatal Iron-folic Acid (IFA) Supplementation and Birth Size: Evidence from Nepal

Yasir B. Nisar, Michael Dibley

European Journal of Nutrition & Food Safety, Page 711-712
DOI: 10.9734/EJNFS/2015/21044

Objectives: To determine the effect of antenatal IFA supplementation on maternal perceived birth size in Nepal using pooled data from 3 Nepal Demographic and Health Survey (DHS) 2001, 2006 and 2011.

Methods: We used survival information from 13,111 most recent live-born infants. Primary outcome was maternal perceived birth size and the main exposure variable was the antenatal IFA supplementation. Birth weight was reported in 19% of live births. Perceived birth size was considered as surrogate for birth weight. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Analyses used multivariate logistic regression adjusted for 18 potential confounders.

Results: Maternal use of IFA supplementation during pregnancy significantly reduced the risk of less than average birth size by 15% (aOR: 0.85 p=0.01) compared to no IFA use after adjustment for other confounders. The protective effect of IFA supplementation on less than average birth size remained there whether other antenatal services used or not (aOR: 0.81, p=0.001) compared to no IFA supplementation and no antenatal services. A slightly greater magnitude of protective effect was observed when mother used ≥90 supplements in their pregnancy (aOR: 0.84, p=0.03) than those mothers who never used any IFA supplements after adjustment for other confounding factors.

Conclusions: Maternal use of IFA supplements during pregnancy significantly reduces the risk of less than average birth size in Nepal. The magnitude of protective effect on the risk of having less than average birth size was greater in infants whose mothers used ≥90 supplements in their pregnancy.

Open Access Conference Proceeding (Abstract)

Iodine Status of Young Burkinabe Children Receiving Small-quantity Lipid-based Nutrient Supplements and Iodized Salt

Sonja Hess, Souheila Abbeddou, Elizabeth Yakes Jimenez, Jean-Bosco Ouedraogo, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 713-714
DOI: 10.9734/EJNFS/2015/21045

Objectives: To assess the impact of supplementing local complementary foods with LNS on iodine status in young Burkinabe children exposed to iodized salt.

Methods: In a partially masked, placebo-controlled, randomized trial, 34 communities were assigned to immediate (II) or non-intervention (NI). II children were randomly assigned to receive 20 g LNS/d containing 90 µg iodine with 0 or 10 mg zinc, and NI children received no LNS. Urinary iodine (UI) was assessed in spot samples and thyroxin (T4) and thyroid-stimulating hormone (TSH) concentrations in dried blood spots at 9 and 18 mo among a subset of 123 II children and 56 DI children. Salt samples (n=106) were collected at homes of randomly selected participants for assessment of iodine content by titration.

Results: Mean iodine content of salt samples was 37±15 ppm (range 5-86 ppm). 37% had an iodine content <30ppm. At baseline and 18 mo, UI, T4 and TSH did not differ among groups. At 18 mo, median (IQR) UI was 334.8 (193.9-555.7) µg/L, T4 114 (99-138) nmol/L and TSH 0.76 (0.49-1.09) mU/L in all groups combined. While no child had elevated TSH at 18 mo, more children in NI (8.9%) had low T4 (<65 nmol/L) than in II (1.6%) (p=0.0325).

Conclusions: Although the majority of household salt samples contained iodine above the target of 30 ppm, provision of iodine in LNS significantly reduced the percentage of children with abnormally low T4 concentrations at 18 mo.

Open Access Conference Proceeding (Abstract)

Small-quantity Lipid-based Nutrient Supplements, Together with Malaria and Diarrhea Treatment, Improve Growth and Development in Young Burkinabe Children

Sonja Hess, Souheila Abbeddou, Elizabeth Yakes Jimenez, Jerome Some, Elizabeth Prado, Zinéwindé Ouédraogo, Rosemonde Guissou, Stephen Vosti, Jean-Bosco Ouédraogo, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 715-716
DOI: 10.9734/EJNFS/2015/21046

Objectives: Small-quantity lipid-based nutrient supplement (SQ-LNS) is a promising home fortification product to supplement young children's diets, but the optimal zinc level to include is uncertain. We assessed growth and development in young Burkinabe children who received SQ-LNS without or with varied amounts of zinc.

Methods: In a partially masked, placebo-controlled, randomized trial, 34 communities were assigned to immediate (II) or non-intervention (NI). 2469 eligible II children were randomly assigned to 1 of 4 groups to receive 20 g LNS/d containing 0, 5 or 10 mg of zinc (and placebo tablet) or LNS without zinc and 5 mg zinc tablet from 9-18 mo of age, along with treatment of malaria and diarrhea. Children in NI (n=797) received neither SQ-LNS, tablets nor morbidity treatment. At 9 and 18 mo, length, weight, and mid-upper arm circumference (MUAC) were measured in all children. In a randomly selected subgroup, motor, language, and personal-social development was assessed at 18 mo (n=747 II; n=376 DI).

Results: Reported adherence was 97±5% for SQ-LNS and tablets. Length, weight, MUAC and developmental scores were significantly greater at 18 mo in children who received SQ-LNS and morbidity treatment (p<0.001) compared to NI, but did not differ by II group. Stunting prevalence at 18 mo was 39% in children in NI and significantly reduced to 24-33% in children in the II groups (p<0.0001).

Conclusions: Providing daily 20 g LNS with or without zinc along with malaria and diarrhea treatment significantly improved growth and motor, language, and personal-social development in young children.

Open Access Conference Proceeding (Abstract)

Impact of Genetic Hemoglobin (Hb) Disorders on the Effectiveness of Micronutrient Sprinkles in Reducing Anemia in Young Children in Rural Cambodia

Susan Jack, Kevanna Ou, Mary Chea, Lan Chhin, Robyn Devenish, Mary Dunbar, Chanthol Eang, Kroeun Hou, Sokhoing Ly, Mengkheang Khin, Sophanneary Prak, Ratana Reach, Aminuzzaman Talukder, La-ong Tokmoh, Sophia Leon de la Barra, Philip Hill, Peter Herbison, Rosalind Gibson

European Journal of Nutrition & Food Safety, Page 717-718
DOI: 10.9734/EJNFS/2015/21047

Objectives: To evaluate the impact of genetic Hb disorders on the effectiveness of 6 months of daily micronutrient Sprinkles for infants age 6-12 months on anemia.

Methods: As part of a randomized controlled effectiveness trial, subjects were screened for genetic Hb disorders at aged 18 months on whole blood using the SEBIA MINICAP analyser, HEMOGLOBIN (E) program, and IC α THAL test to detect major Hb variants and α-thalassemia. Anemia (Hb < 110 g/L) was measured at baseline (age 6 mo), endline (age 12 mo), and at two follow up points (age 18 mo and 24 mo) for children with and without genetic Hb disorders.

Results: Half of all children had a genetic haemoglobin disorder (at least 15 types). At baseline, overall prevalence of anemia for children with normal Hb was 81% versus 88% for those with any genetic Hb disorder. At endline, anemia prevalence for the intervention group with normal Hb vs genetic Hb disorder was 60.2% versus 72.0% (P = 0.02) and for the control group 81.1% versus 88.8% (P = 0.03), respectively. At further follow-up, anemia decreased in both the control and intervention groups. However those with any genetic Hb disorder remained more anemic with varying levels of anemia according to the disorder type.

Conclusions: Sprinkles had a similar proportional effect regardless of overall genetic Hb status indicating that children with genetic Hb disorders can effectively utilize iron and micronutrients to reduce anemia. Sprinkles can be effective in populations with a high prevalence of genetic Hb disorders.

Open Access Conference Proceeding (Abstract)

Impact of Infant and Young Child Feeding (IYCF) Practices on Growth in Young Children in Rural Cambodia

Susan Jack, Kevanna Ou, Mary Chea, Lan Chhin, Robyn Devenish, Mary Dunbar, Chanthol Eang, Kroeun Hou, Sokhoing Ly, Mengkheang Khin, Sophanneary Prak, Ratana Reach, Aminuzzaman Talukder, La-ong Tokmoh, Sophia Leon de la Barra, Philip Hill, Peter Herbison, Rosalind Gibson

European Journal of Nutrition & Food Safety, Page 719-720
DOI: 10.9734/EJNFS/2015/21048

Objectives: To evaluate the impact of IYCF education and practices on growth compared to an ecological control.

Methods: As part of a randomized controlled effectiveness trial of micronutrient Sprinkles and IYCF education, all mothers received IYCF education. Group and individual sessions were delivered by health staff and trained village health workers. Anthropometry and IYCF were recorded at baseline (age 6 mo), endline (age 12 mo), and at two follow up points (age 18 mo and 24 mo) and compared with same aged children in the same province from the 2005 Cambodia Demographic and Health Survey (CDHS).

Results: There was no treatment effect on growth so intervention and control groups were combined. At 6, 12 and 18 mo, 59%, 86% and 73% of children met minimum adequate WHO IYCF practices respectively in the study group compared to 33%, 62% and 47% for CDHS children. Stunting (HAZ <-2) prevalence at 6, 12, 18 and 24 mo was 11%, 19%, 32% and 38% in the study group compared to 11%, 37%, 62%, and 44% for CDHS children. Underweight (WAZ <-2) prevalence at 6, 12, 18 and 24 mo was 14%, 16%, 21% and 26% in the study group compared to 18%, 28%, 37% and 21% for CDHS children. Differences for stunting and underweight were significant (p<0.05) at 12 and 18 mo.

Conclusions: IYCF education to study mothers improved IYCF practices and slowed stunting and underweight significantly at 12 and 18 months of age compared to CDHS children. Strengthened IYCF education and practices improved growth in children in this low-income, rural population.

Open Access Conference Proceeding (Abstract)

Malaria Infection Affects the Interpretation of Biomarkers of Iron and Vitamin A Status, Even After Adjusting for Systemic Inflammation, but Does Not Affect Plasma Zinc Concentrations

K. Ryan Wessells, Sonja Hess, Noel Rouamba, Zinewende Ouedraogo, Jean-Bosco Ouedraogo, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 721-722
DOI: 10.9734/EJNFS/2015/21049

Objectives: To assess how asymptomatic malaria infection affects the interpretation of biomarkers of iron, vitamin A and zinc status after adjustment for elevated acute phase proteins (APP).

Methods: Plasma ferritin (pF), transferrin receptor (sTfR), retinol binding protein (RBP) and zinc (pZn) concentrations were measured among 451 asymptomatic children aged 6-23 months in Burkina Faso, and adjusted for elevated APP (C-reactive protein ≥5 mg/L and/or alpha-1-acid-glycoprotein ≥1g/L) based on a four-group categorical model, as per Thurnham. Histidine-rich protein II (HRP2) concentrations >0.75 ng/mL were considered indicative of current or recent malaria parasitemia.

Results: 57.4% of children had at least one elevated APP, and 48.5% had elevated HRP2. After adjusting for APP, children with elevated HRP2 had higher pF (23.5+1.5 vs. 11.1+0.8 µg/L, P<0.001) and lower RBP (0.79+0.01 vs. 0.92+0.01 µmol/L, P<0.001) vs. those without. Controlling for APP, there were no differences in pZn among those with and without elevated HRP2 (62.9+0.8 vs. 62.9+0.8 µg/dL, P=0.98). sTfR did not differ by APP status when controlling for HRP2, but was increased in children with elevated HRP2 vs. those without (17.6+0.5 vs. 12.3+0.4mg/L, P<0.0001). After adjusting for HRP2, along with APP, the estimated prevalence of iron deficiency (pF<12 µg/L) increased from 38.7% to 50.6% and vitamin A deficiency (RBP<0.84µmol/L) decreased from 33.4% to 27.7%.

Conclusions: Current or recent malaria parasitemia affects indicators of micronutrient status, even after adjusting for APP. Adjusting indicators of iron and vitamin A status based only on APP may inaccurately estimate the prevalence of micronutrient deficiencies in settings with a high prevalence of malaria and inflammation.

Open Access Conference Proceeding (Abstract)

Informing National Scale-up of Micronutrient Powders: Evidence from a 12-month Effectiveness Study in Rural Rwanda

Kristina Michaux, Fidele Ngabo, Abiud Omwega, Jennifer Foley, Tim Green, Judy McLean

European Journal of Nutrition & Food Safety, Page 723-724
DOI: 10.9734/EJNFS/2015/21050

Objectives: While the efficacy of Micronutrient Powders (MNP) at reducing anaemia is known, effectiveness within a Community-Based Nutrition Programme (CBNP) in Rwanda is needed to inform scale-up and policy.

1. Determine the acceptability and effectiveness of MNP on the reduction of anaemia in children aged 6-23 months in Nyaruguru and Musanze districts.
2. Investigate the feasibility of national scale-up of MNP within a CBNP.

Methods: A 12-month quasi-experimental control trial was conducted with 1049 mother/child pairs (intervention: n=569; control: n=480). Information on household demographics, IYCF knowledge, attitudes and practices, and morbidity, as well as children’s anthropometry and hemoglobin (Hb) were collected at baseline, 6 and 12 months. Caregivers were interviewed on the acceptability and perceived benefits of MNP at midline and endline. 

Results: At endline, 98% of caregivers were willing to continue using MNP. A high percentage of mothers perceived benefits of MNP, including improved appetite (84%), increased activity levels (87%), and improved health (88%) of their child. Hb levels of children with moderate to severe anemia significantly improved in the intervention group compared to children in the control group (P<0.05).

Conclusions: Our results illustrate nearly universal acceptance of MNP among mothers. Together with the reduction in anemia, these findings demonstrate the feasibility of implementing national scale-up of MNP within Rwanda’s CBNP and will help achieve sustainable improvements in infant and young children’s health.

Open Access Conference Proceeding (Abstract)

Prevalence of Anemia among Pregnant Women and its Determinants in Northern Nigeria

Abiodun Rauf Oladipo, Adetunji Falana, Femi Adegoke, Asabe Sambo, Jacqueline Kungu

European Journal of Nutrition & Food Safety, Page 865-866
DOI: 10.9734/EJNFS/2015/21134

Objectives: We conducted a baseline survey in Northern Nigeria to determine the coverage, adherence, prevalence, barriers and facilitating factors affecting utilization of prenatal iron and folate supplementation (IFAS) from service delivery and recipient perspectives.

Methods: The survey employed both quantitative and qualitative methods. Anemia (hemoglobin concentration Hb<110 g/L. g/L, Hemocues®) was measured among 1664 pregnant women 15-45 years.

Results: The prevalence of anemia was high across all states surveyed (Jigawa 71.1%, Katsina 61.4%, Yobe 88.8%, Zamfara 62.2%). Although 70% of women from all states received some IFAS in their last pregnancy, <50% reported consuming IFAS ≥90 days. Utilization of IFAS among pregnant women was affected by such factors as misconception about IFAS, influences of male spouse and older women. Religion and cost were not found to constitute barriers to IFA utilization. Knowledge of health workers on how to track IFAS utilization was generally low. Most health facilities surveyed reported no IFA stock-out in the three-month preceding the survey. Over 55% of interviewed women knew the benefits of ANC in pregnancy from all the state and >60% knew the benefits of IFAS in pregnancy.

Conclusions: This study has confirmed that anaemia is a problem among pregnant women in Nigeria. Despite awareness about ANC and IFAS and relatively high coverage of distribution of IFAS, utilization is relatively low. Neither the awareness of IFAS nor ANC attendance translates to IFA utilization. There is a need to address some misconceptions about IFAS resulting from cultures, beliefs and influence of male spouses and older women through Behaviour Change Communication (BCC) interventions.

Open Access Conference Proceeding (Abstract)

Prevalence of Anemia in Children Caused by Deficiencies of Iron, Folic Acid and B12 Vitamin in Tegucigalpa, Honduras

Rebeca Rivera, Maria Felix Rivera, Ivette Rivera

European Journal of Nutrition & Food Safety, Page 725-726
DOI: 10.9734/EJNFS/2015/21051

Objectives: Anemia is a worldwide health problem in children, particularly in developing countries; we stress the importance of recognizing its multifactorial etiology for developing effective control programmes. This is the first study in Honduras related with prevalence and etiology of anemia. Objective: To determine the prevalence of anemia and those caused by deficiencies of iron, folic acid and B12 vitamin.

Methods: It is a descriptive transversal study; the subjects were all first grade children of public schools. The sample consisted of 450 children; cluster sampling distributed over 8 schools in the city’s perimeter. Each child was identified by name, age, sex, and school name; the average age was 6.66 years old. Automatized methods were used for hemoglobin, hematocrit, ferritin, folic acid and B12 vitamin measurement.

Results: The prevalence of anemia (hemoglobin < 11.5 g/dl) was 8.7%, 17.2% of the children had hemoglobin between 11.5 g/dl and 11.9 g/dl and one child had hemoglobin of 8.8 g/dl. Of the total of anemic children, 8.3% were deficient in ferritin, 5.5% in B12 vitamin and 5.5% deficient in both ferritin and B12 vitamin; none had folate deficiency. Children without anemia were also evaluated for the same micronutrients, we found 5.3% were deficient in ferritin, 8.5% deficient on B12 vitamin and 0.8% were deficient on both ferritin and B12 vitamin.

Conclusions: Anemia in schoolchildren is a public health problem in Honduras that needs prevention and intervention. We found more deficiency in B12 vitamin than iron, a fact important for intervention programmes.

Open Access Conference Proceeding (Abstract)

Building Strategic Capacities to Strengthen the Enabling Environment for Nutrition Policies and Programs in Four African Countries

David Pelletier, Suzanne Gervais, Hajra Rafeez-Ur-Rehman, Barnabas Natamba, Dia Sanou, Jackson Tumwine

European Journal of Nutrition & Food Safety, Page 727-728
DOI: 10.9734/EJNFS/2015/21059

Objectives: Undernutrition has received significant attention at global and national levels in recent years but translating this attention into effective action at the country and district levels poses many challenges. We describe the observed national environments that support and challenge actors in moving national multisectoral nutrition policies and plans forward and how this on-going action research (AR) project seeks to strengthen strategic capacities and leadership in Burkina Faso, Mali, Ethiopia and Uganda.

Methods: Participant observation and meetings with stakeholders provide insight into the enabling environment and its challenges. This AR then uses boundary-spanning tools such as shared history, practitioner profiles, PAG workshops among others to engage stakeholders in collaborative learning and to facilitate informal strategic and adaptive management approaches to nutrition policies and program implementation.

Results: All four countries have developed multisectoral national nutrition policies and/or plans and created coordinating committees. Further multisectoral progress however faces challenges seen elsewhere, such as the dominance of sectoral goals and incentives, uneven understanding of multisectoral roles, responsibilities and leadership; uneven participation and ownership; uneven human and institutional capacities; lack of effective sub-national multisectoral platforms; and persistence of unaligned donor- and NGO-driven approaches. On-going work focuses on the formation of strategic alliances, leadership development, strengthening of sub-national platforms and experiences to inform the design of multisectoral strategies at the national level and strengthening linkages with global initiatives.

Conclusions: Together these activities help create crucial elements of a sustainable enabling environment for reducing malnutrition in these countries.

Open Access Conference Proceeding (Abstract)

Formulation of a Complementary Food Fortified with Broad-beans (Vicia faba) in Southern Ethiopia

Afework Kebebu Gebrie, Susan J. Whiting, Kebede Abegaz Ali, Carol J. Henery, Wendy J. Dahl

European Journal of Nutrition & Food Safety, Page 729-730
DOI: 10.9734/EJNFS/2015/21060

Objectives: Formulation of complementary diet for young children (from broadbean, maize and berly) and determine its nutrient value and acceptability.

Methods: Randemized controled trial was used to prepare samples for processing and analysis. Laboratory based study was conducted at Hawassa University and Ethiopian Health and Research Institute to process and evaluate Proximate, phytate and mineral content of sample.

Samples were obtained from local market and bought in bulk. Barley and maize were soaked sundried and roasted. Broad-bean was soaked, germinated sundried and roasted. The three samples were made into fine flour. Samples were stored in airtight plastic bag. Four types of porridge were prepared by mixing broad-bean as treatment and barley-maize as base food. Acceptance testing was conducted using mother child pair.

Results: Laboratory result showed that processing significantly decreases phytate content of ingredients. The highest levels of protein and iron content were in the porridge made with 30% broad bean, wherein protein content increased by 6 grams per 100 g. The lowest level of phytate was observed in the porridge made with 20% bean. Sensory evaluation showed preference for 10% broad-bean added porridge. All broad-bean added porridges had similar overall acceptability to the maize-barley control.

Conclusions: The formulation of a broad bean-containing porridge as complementary food produced a higher protein food with acceptable sensory characteristics compared to the customary porridge of the region. This study demonstrated successful use of locally-available and affordable foods to enhance nutritional quality of complementary foods.

Open Access Conference Proceeding (Abstract)

Prevalence of Goitre among School-age Children in Jimma Town, South West Ethiopia

Hiwot Kifle Sime, Amare Worku Tadesse

European Journal of Nutrition & Food Safety, Page 867
DOI: 10.9734/EJNFS/2015/21135

Objectives: Assess the prevalence of goitre among school-age children in Jimma town, south west Ethiopia.

Methods: A two-stage cluster design was used to select schools and classrooms based on proportion-to-population-size. Systematic random sampling technique was used to select 752 schoolchildren. WHO/UNICEF/ICCIDD classification scheme was used to evaluate goitre. UNICEF's field test kits were used to measure iodine content in salt.

Results: The overall prevalence of goitre was 37.2% (264/709), of which 25.8% were grade I and 11.4% were grade II goitre. The prevalence of goitre among girls was 41.1% (162/394) and boys was 32.4 (102/315). Only 10.3% of table salt sample from the children's home had adequate level of iodine (>15 ppm).

Conclusions: The prevalence of goitre among school-age children in Jimma is high, indicating severe Iodine Deficiency Disorder necessitating immediate intervention with iodine capsules. A massive effort is necessary from the government and stakeholders in advocating the use of iodized salt and more support is needed for female school-age children. Further research should be carried out to enhance better understanding of associated factors and appropriate response to Iodine Deficiency Disorder.

Open Access Conference Proceeding (Abstract)

Accelerating towards Achieving Universal Salt Iodization Goal through Social Marketing in Nepal

Giriraj Subedi, Saba Mebrahtu, Macharaja Maharjan, Naveen Paudyal, Rajat Rana, Nandakishor Adhikari

European Journal of Nutrition & Food Safety, Page 731-732
DOI: 10.9734/EJNFS/2015/21061

Objectives: Iodine deficiency disorders have been a prevailing problem in Nepal. With the objective to improve household use of adequately iodized salt, Nepal Government endorsed a strategy to promote adequately iodized salt with two child logo in poor performing districts of Nepal from 2007 to 2011.

Methods: Social Marketing approach used a methodology of community mobilization under public private partnership, engaging mother credit and saving groups with interpersonal communication to each beneficiary. In this process, 650 women group mobilized with IEC/ BCC component, intensive supervision monitoring to promote iodized packet salt.

Results: As a result of iodized salt social marketing campaign, household use of two child logo salt in intervention areas increased from 31% in 2005 to 55% in 2011. This increase in use of two child logo salt directly translated into the increase in household use of adequately iodized salt (with 15 ppm or more iodine) from 52% in 2005 to 70% in 2011. On overall, this increase contributed in the improvement of national use of adequately iodized salt up to 80% level (and that of salt with any iodine to over 95%) in 2011.

Conclusions: Community Group mobilization is an effective tool to increase iodized salt consumption in Nepal, which established a direct relationship between iodized packet salt promotions with the household use of adequately iodized salt. With the result achieved, Nepal is on the verge of meeting universal salt iodization goal - 90% household using adequately iodized salt.

Open Access Conference Proceeding (Abstract)

Vitamin A Status under Type 2 Diabetes Mellitus and Hypertension in Urban Ghanaians

Ina M. Ott, Ina Danquah, George Bedu-Addo, Frank P. Mockenhaupt, Andrea Henze, Jens Raila, Florian J. Schweigert

European Journal of Nutrition & Food Safety, Page 868-869
DOI: 10.9734/EJNFS/2015/21136

Objectives: Sub-Saharan Africa (SSA) is affected by a double burden of malnutrition: While vitamin A deficiency (VAD) still prevails, type 2 diabetes mellitus (DM2) and hypertension (HTN) are emerging. Serum retinol, retinol binding protein-4 (RBP4), transthyretin (TTR) and their ratios are potent biomarkers for vitamin A status which are influenced by metabolic disorders. This study investigated the associations of DM2 and HTN with these biomarkers.

Methods: A case-control study on risk factors of DM2 and HTN was conducted in Kumasi, Ghana. 1219 samples (328 controls, 197 DM2, 354 HTN, 340 DM2+HTN) were analyzed for serum retinol by rpHPLC and RBP4 and TTR by ELISA. Retinol-RBP4-ratio and RBP4-TTR-ratio were calculated and group differences analyzed by non-parametric tests. Multiple-adjusted linear regression evaluated the associations of DM2 and HTN with Ln-normalized biomarkers.

Results: Among the predominantly female study population, 10% were affected by VAD (retinol<1.05µmol/L) with the highest prevalence in the control group (19%) and the lowest in the DM2+HTN group (4%; p<0.01). Retinol-RBP4-ratio and RBP4-TTR-ratio were significantly higher in DM2 (0.98±0.26 and 0.67±0.99, respectively) and HTN (0.95±0.28 and 0.64±0.28, respectively) than in controls (0.90±0.26 and 0.58±0.27, respectively; p<0.001). These associations were most pronounced for DM2, remaining statistically significant after multiple adjustment in linear regression analyses.

Conclusions: Our findings may have additional implications for retinol-RBP4- and RBP4-TTR-ratios as diagnostic markers for vitamin A status among patients with DM2 and HTN in SSA as they run the risk of overestimated serum retinol due to altered metabolic dysfunction.

Open Access Conference Proceeding (Abstract)

Innovations in Reaching Out to the Most Vulnerable Population with Vitamin a Supplementation in Bihar, India

Farhat Saiyed, Jee Hyun Rah, Sanjay Kumar, Victor Aguayo

European Journal of Nutrition & Food Safety, Page 733-734
DOI: 10.9734/EJNFS/2015/21062

Objectives: The state of Bihar historically has reported a high prevalence of vitamin A deficiency. Yet, in 2006 only 26% of preschool children were receiving vitamin A supplements (VAS) bi-annually. This presentation reviews the innovative strategy implemented by the Government of Bihar with UNICEF support to improve VAS coverage by reaching out to all children, including the most vulnerable in the hard-to-reach communities.

Methods: More than 80,000 anganwadi centres and 11,000 primary health centres have been mapped out to become the core distribution sites of the biannual VAS rounds. Every primary health center is required to map all the underserved communities in their catchment area. The underserved and hard-to-reach communities are clustered and 3,500 temporary sites have been created to deliver VAS.

Results: The village-based frontline workers and volunteers have been trained to administer VAS to children and counsel mothers on how to improve the vitamin A content of their children's diet. Additionally, left-behind communities are mapped annually and reached out through additional sites. Intensive communication and mobilization drives are undertaken at all levels to raise awareness about the benefits of VAS and mobilize communities. As a result, the full VAS coverage increased to 96% in 2012.

Conclusions: The Government of Bihar has demonstrated that it is feasible to implement a successful and inclusive VAS programme in India, that reaches all children if efforts are made to understand who the most vulnerable children are and where they live, and if political decisions are made to assign the required human and programme resources.

Open Access Conference Proceeding (Abstract)

Validation of a New Rapid Test for Vitamin A in Premix and Fortified Flour

Andriette de Jager, Hannalien Meyer

European Journal of Nutrition & Food Safety, Page 870
DOI: 10.9734/EJNFS/2015/21137

Objectives: Wheat flour is a possible food vehicle for vitamin A fortification. Recently a new portable rapid test (iCheckTM FLUORO) has been available to measure vitamin A in various fortified food samples such as premix and flour. In this study the performance of the rapid test was compared with the reference vitamin A method.

Methods: For the method comparison, 58 fortified wheat flour samples were analyzed with both the new rapid test method and the reference HPLC (high performance liquid chromatography) vitamin A method.

Results: The coefficient of variation of 5 replicate measurements with the new method was 1.8% and 3.2% for the premix and wheat flour samples, respectively. Vitamin A levels in the flour samples were between 0.5 - 63.4 mg RE/kg. The Spearman coefficient for iCheckTM FLUORO vs. HPLC is 0.9763. The Bland-Altman analysis shows that HPLC and iCheckTM FLUORO results differ on average by as low as 0.1 mg RE/kg and 98% of samples were in range.

Conclusions: The new iCheck FLUORO method shows a good agreement with HPLC and a good reproducibility for flour. Intrinsic flour fluorescence causes difficulties when low levels of vitamin A are analysed resulting currently in a higher detection limit of 1 mg RE/kg. Because of its simplicity, speed and accuracy the method is well suited for quality control of fortified flour samples.

Open Access Conference Proceeding (Abstract)

Regulatory Monitoring Systems of Fortified Salt and Wheat Flour in Selected ASEAN Countries

Annoek Van den Wijngaart, France Bégin, Karen Codling, Philip Randall, Quentin Johnson

European Journal of Nutrition & Food Safety, Page 735-736
DOI: 10.9734/EJNFS/2015/21063

Objectives: An increasing number of countries in the Association of Southeast Asian Nations (ASEAN) are adopting or in the process to adopt mandatory food fortification to overcome vitamin and mineral deficiencies. The objective of this study was to review regulatory monitoring systems for iodized salt and fortified wheat flour in selected ASEAN countries.

Methods: Regulatory monitoring includes monitoring activities at production level, customs warehouses, and retail stores by regulatory authorities. Producers also monitor during production as part of quality control and assurance. We reviewed regulatory monitoring systems through desk reviews in Philippines, Indonesia, Cambodia, Viet Nam and Malaysia and through interviews with stakeholders in the Philippines and Indonesia.

Results: Challenges in regulatory monitoring systems include inefficient and ineffective government monitoring, lack of legal definitions of roles and responsibilities of agencies and industry, and a focus on end-product testing rather than process control and internal quality assurance systems.

Conclusions: Without appropriate enforcement and quality assurance mechanisms, i.e., regulatory monitoring, to create a safe and fair environment for food fortification, national legislation will not necessarily lead to high coverage of fortified products and associated health outcomes.

Open Access Conference Proceeding (Abstract)

Validation of Administrative Coverage for Vitamin a Supplementation and Deworming through Integrated National Immunization Days in Guinea

Mohamed Yattara, Lansana Massandouno, Mohamed Fofana, Mariam Hann, Souleymane Dioubaté, Jessica Blankenship, Heather Katcher, Mamady Daffé, Marily Knieriemen

European Journal of Nutrition & Food Safety, Page 871-872
DOI: 10.9734/EJNFS/2015/21138

Objectives: Since 2007, distribution of vitamin A supplementation (VAS) and deworming has been integrated with polio vaccination through twice-yearly National Immunization Days (NIDs) in Guinea. Although reported administrative coverage for VAS and deworming are consistently ≥90%, validation of coverage is needed as denominators are based on the number of children reached during the previous year and many districts report coverage of >100%.

Methods: A post-event coverage (PEC) survey was conducted in the regions of Boké and Faranah to validate coverage following the NIDs in May 2013. Boké and Faranah regions were selected as their administrative VAS coverage was among the lowest (87%) and highest (102%) reported in Guinea, respectively. 900 caretakers were interviewed in each region using a PPS randomized 30x30 cluster design and WHO EPI sampling methodology.

Results: VAS coverage by PECS for children 6-59 months was similar in Boké (89.4%) and Faranah (92.4%) among children 6-59 months despite large variability in administrative data. Deworming coverage reported by PECS was significantly lower than VAS and polio coverage in Boké (73.9%, 88.9%, 87.1%) and Faranah (65.2, 93.1%,91.8%), respectively, for children 12-59 months and significantly lower than deworming administrative coverage (Boke: 93.1%, Faranah: 111%).

Conclusions: Despite significant variability in administrative coverage, VAS coverage measured by PEC survey in Boké and Faranah regions of Guinea was comparable and high. Deworming coverage however was significantly lower than that reported by administrative data and that reported for similar interventions. Follow-up is needed to address the large discrepancy between PEC and administrative data for deworming.

Open Access Conference Proceeding (Abstract)

Constraints to Attending the Maternal, Newborn and Child Health Weeks in North West Nigeria

Cynthia Yohanna-Dzingina, Jayne Webster, Isaac Akinyele, Rasheed Okunola, Wasiu Afolabi, Olutayo Adeyemi, Hussiani Lawal, Elaine Ferguson

European Journal of Nutrition & Food Safety, Page 737
DOI: 10.9734/EJNFS/2015/21064

Objectives: This study aimed to understand the barriers to MNCHW attendance in order to develop recommendations for strengthening its social mobilization activities.

Methods: In the states of Jigawa and Zamfara in northern Nigeria, 19 in-depth interviews were conducted with government officials and community leaders; and 36 focus group discussions with women with a child under 5-years of age, their husbands, town criers, health workers, community volunteers, and religious leaders on MNCHW social mobilization and barriers to attendance. Content analysis was used to derive themes.

Results: Awareness of MNCHW was low among the target beneficiaries. Even where programme awareness existed, there was little understanding of the nutrition and health benefits of VAS. Social mobilization focused solely on raising awareness about the dates and location of MNCHW, it did not promote its health benefits. MNCHW has also been overshadowed by the Immunization Plus Days (IPDs) which are conducted monthly. Other barriers to MNCHW attendance included inability to afford transportation costs, and distrust of government programmes.

Conclusions: To increase attendance at MNCHW in northern Nigeria, social mobilization must first address the lack of understanding of the health benefits of the MNCHW programme.

Open Access Conference Proceeding (Abstract)

Evaluation of Salt Iodization at Consumption Level in North-Eastern Thailand

Ina M. Ott, Benja Muktabhant, Katrin Kühn, Nadja Lehmann, Pattara Sanchaisuriya, Florian J. Schweigert

European Journal of Nutrition & Food Safety, Page 873-874
DOI: 10.9734/EJNFS/2015/21139

Objectives: Iodine deficiency disorder (IDD) is an important health problem in Thailand, especially in northern and north-eastern regions. Since the introduction of iodized salt in 1960s many control programs have been implemented judging the effectiveness at community level. Concerns have been expressed regarding public health information and quality control of manufactured iodine-fortified salt (mandatory: 20- 40 ppm). This study assessed the iodine content in Thai table salts.

Methods: Salt samples (n=438) from endemic areas in north-eastern Thailand including eleven districts from three different provinces were collected either by asking school children to bring salt used for home cooking or with the help of local health volunteers during home visits. Salt analysis was conducted by using a portable photometer for quantitative iodine determination (iCheckTM- iExTM IODINE).

Results: Median iodine concentration was 7.0 ppm (IQR 0.0-32.9) being highest in district 2 and district 6 (51.9 ppm, IQR 24.4-82.7 and 36.6 ppm, IQR 32.0-49.1, respectively). Samples from province A (5.4 ppm, IQR 0.0-31.2) contained significantly less iodine than from province B and province C (20.6 ppm, IQR 5.7-34.4 and 26.3 ppm, IQR 5.9-34.7, respectively; p<0.001). 137 salt samples (31.3%) were not fortified, 24.4% were fortified at levels < 20 ppm and 30.1% were sufficiently fortified (20- 40 ppm); 14.2% were fortified above 40 ppm.

Conclusions: Analysis revealed high variability in iodine content between and within different provinces. The results show that IDD programs need to address quality control at factory, retail and household levels.

Open Access Conference Proceeding (Abstract)

Towards an Anemia-Free West Bengal: Convergent Policies and Collective Action

Minakshi Singh, Vani Sethi, Jayati Mitra, Sanjib K. De, Asadur M. Rahman, Victor M. Aguayo

European Journal of Nutrition & Food Safety, Page 738-739
DOI: 10.9734/EJNFS/2015/21065

Objectives: West Bengal - India's most densely populated state - is home to 8.3 million adolescent girls. Surveys indicate that 62 percent of adolescent girls were anemic, despite several sectoral programmes in place. To address this situation, the Government of West Bengal launched in 2012 Anemia Free West Bengal strategy convening all stakeholders, integrating flagship programmes and introducing new schemes as needed.

Methods: Six sectoral Departments that were implementing programmes focusing on adolescent girls were brought together under the leadership of State Chief Minister to convergently deliver interventions that includes: 1) Food supplements fortified with nine essential micronutrients; 2) weekly iron and folic acid supplementation; 3) Biannual deworming; 4) A new conditional cash transfer scheme to promote secondary education and prevent child marriage; 5) A state-wide mass and mid-media communication campaign; and 6) Partnerships for social mobilization at community and household level. Programme convergence included formation of a state planning and monitoring committee, joint training of staff, pooling of resources as feasible, common reporting using standardized tools using dis-aggregation of reporting data by social group.  

Results: By mid-2013, all monthly inter-sectoral progress review meetings had been held as planned, three of the six departments had pooled budgets to support the strategy, and about 2 million adolescent girls were already receiving iron and folic acid supplementation weekly, deworming bi-annually, fortified food supplements, and/or cash transfers.

Conclusions: The better practices from W. Bengal experience are critical know-hows on building political commitment and programme convergence on programming for adolescent girls through a common vision.

Open Access Conference Proceeding (Abstract)

Designing Rigorous Program Evaluations to Assess the Impact on Child Growth of Integrated IYCN Programs in Burkina Faso and Ethiopia

Saskia Osendarp, Abdulaziz Adish, Banda Ndiaye, Aregash Samuel, Inge Brouwer, Dominique Roberfroid, Patrick Kolsteren, Lynnette Neufeld

European Journal of Nutrition & Food Safety, Page 875-876
DOI: 10.9734/EJNFS/2015/21140

Objectives: The Micronutrient Initiative and academic partners have designed two program impact evaluations of Infant and Young Child Nutrition (IYCN) interventions in Ethiopia and Burkina Faso. The programs include enhanced behavioral change interventions on IYCN, improved quality of local complementary feeding, provision of Multiple Micronutrient Powders (MNPs) to children 6 to 23 months, and ensuring an integrated preventive and community-based management of moderate acute malnutrition.

The objective is to critically review key elements for consideration in the design of future IYCN program evaluations.

Methods: Evaluation designs were based on 1) selection of primary and secondary outcome indicators based on the Program Impact Pathways (PIP), 2) Considerations for assignment of intervention and comparison groups; 3) Considerations on designs in the context of integrated programs; 4) Ability to monitor adverse events within a program.

Results: Following PIP, both impact and process indicators were identified. In Ethiopia, a matched-control cluster design and in Burkina Faso a cluster randomized matched-control design was used with repeated cross-sectional surveys. Sample size calculations took into account the selection of age-appropriate cohorts for the different impact indicators, and a population based sampling scheme. Following recent discussions around the safety of iron-containing supplements in young children without iron deficiency, the evaluations also included practical methods to assess potential adverse events in program settings.

Conclusions: The complexity of measuring impact on child nutrition in an integrated programmatic context is often underestimated, leading to evaluations with inconclusive results or impacts that are difficult to attribute to program. Careful design could help avoid such pitfalls.

Open Access Conference Proceeding (Abstract)

Improving the Availability of Adequately Iodized Salt by Mobilizing the Network of Salt Traders in Uttar Pradesh, India

Richa Pandey, Jee Hyun Rah, Amit Kumar Ghosh, Shraddha Dwivedi, Subhash Chandra Gupta, Dhirendra Kumar Srivastava, Sunil Kumar Garg, Victor M. Aguayo

European Journal of Nutrition & Food Safety, Page 740-741
DOI: 10.9734/EJNFS/2015/21066

Objectives: Uttar Pradesh (UP) is a non-salt producing state in India. Most of the salt is imported and traded in 18 of the 75 districts in the state. In 2009, the household coverage of adequately iodized salt in UP was 43%. This presentation features the important initiative taken by the state government with support by UNICEF to increase the availability of adequately iodized salt by mobilizing the network of salt wholesalers and retailers in UP.

Methods: A total of 204 wholesalers and retailers were mapped across the 18 salt unloading districts. Four titration laboratories in the state medical colleges were revitalized. Salt samples were collected from shops and storage points on a monthly basis and sent to the laboratories to test the samples' iodine content. Reports on the iodization adequacy of salt were issued, shared with the wholesalers and retailers and used to monitor the iodization quality of salt. Monthly dialogue with salt wholesalers and retailers was carried out to sensitize and motivate them to procure and sell only adequately iodized salt. The salt testing results were also used by the Salt Department and the Department of Food and Drug Administration to take punitive actions against manufacturers producing inadequately iodized salt.

Results: The availability of non-iodized salt decreased by 2.5% and availability of adequately iodized salt increased by 10% over a one-year period.

Conclusions: Mapping, sensitization and using a combination of punitive and non punitive approach with the wholesalers and retailers proves to be an effective strategy to ensure adequate availability of appropriately iodized salt.

Open Access Conference Proceeding (Abstract)

Is Vitamin A Supplementation Programme Reaching the Most Vulnerable Children in India? New Evidence from Odisha

Sourav Bhattacharjee, J. H. Rah, B. Dashmohapatra, Santanu Bhaumik, Nina Badgaiyan, Victor M. Aguayo

European Journal of Nutrition & Food Safety, Page 742-743
DOI: 10.9734/EJNFS/2015/21067

Objectives: Surveys in 2002-05 indicated that the prevalence of severe forms of vitamin A deficiency in India was three-fold higher among children from schedule tribe (ST) households than among non-tribal children. Scheduled tribes constitute about 24% of the total population of the state of Odisha. This presentation documents the performance of Odisha's vitamin A supplementation (VAS) programme in reaching the districts and blocks with a higher concentration of tribal population.

Methods: A sub-group, disaggregated analysis of VAS coverage was conducted. Districts and blocks were divided into five quintiles with the highest quintile comprising the 20% of districts and blocks with the highest concentration of ST households.

Results: The full VAS coverage in Odisha increased from 61% in 2006 to 97% in 2011. Overall, full VAS coverage figures increased in all quintiles between 2006 and 2011. However, the most significant increases were recorded in the quintiles with the lowest ST concentration, while the increases in the highest quintiles were more modest. Since 2006, the districts and blocks with the highest proportion of ST children consistently had the lowest full VAS coverage. The estimated number of non-fully covered children decreased from 1.2 million in 2006 to 0.1 million in 2011, but ST children still represent about 32.3% of those who are not fully-covered.

Conclusions: Despite significant improvement in full VAS coverage, a large number of the most vulnerable children are not yet benefitting from this life protecting intervention. Priority is to be given to districts, blocks and villages with higher concentrations of tribal population.

Open Access Conference Proceeding (Abstract)

An Integrated Strategy for Attention in Nutrition (EsIAN) Increases Physicians' and Nurses' Nutrition Knowledge and Perceptions in Mexico

Ana Cecilia Fernandez-Gaxiola, Armando Garcia-Guerra, Lynnette M. Neufeld, Amado D. Quezada-Sanchez, Amira Hernandez-Cabrera, Anabelle Bonvecchio, Ana Lilia Lozada, Juan Rivera

European Journal of Nutrition & Food Safety, Page 877-878
DOI: 10.9734/EJNFS/2015/21141

Objectives: To assess changes in physicians' and nurses nutrition knowledge and perceptions from EsIAN. EsIAN was developed to attend to the nutritional needs of Oportunidades beneficiary families. Oportunidades is the Mexican conditional cash transfer program. In Mexico, appropriate attention to undernutrition and anemia is needed simultaneous with attention to overweight and obesity. EsIAN includes nutritional supplements and a behavior change communication strategy with nutrition counseling tools. The strategy was implemented on pilot scale; we report here the effects on health-care providers' nutrition knowledge and perceptions.

Methods: EsIAN was implemented in 2008 in 91 clinics in central Mexico.  Effectiveness was assessed in 2012 using a mixed methods approach. Data from two cross-sectional samples were analyzed adjusting standard errors by health care center clusters.

Results: Physicians' and nurses' (PN) perceived they have more than 90% capacity to implement the EsIAN in their everyday's practice.  Compared to baseline, in 2012 a significantly higher proportion of PN reported recommending exclusive breastfeeding for 6 months (85.7% vs. 23.4%) and breastfeeding techniques (79.8% vs. 12.8%) (p<0.001). More than 88% monitored children growth using weight-for-height and height-for-age indicators as recommended by EsIAN. Nutritional supplements seemed appropriate to 97.8% and 92.3% urban and rural PN, respectively.

Conclusions: EsIAN is a highly accepted strategy that can be nationally implemented and is effective to improve providers knowledge and perceptions of essential nutrition actions.

Open Access Conference Proceeding (Abstract)

Vitamins and Minerals in Guatemala´s New Basic Food Basket

Diana Maldonado Villatoro, Michele Marie Monroy-Valle, Pablo Toledo Chaves

European Journal of Nutrition & Food Safety, Page 744
DOI: 10.9734/EJNFS/2015/21068

Objectives: To quantify the amount of vitamins and minerals contained in Guatemala´s New Basic Food Basket (BFB) to determine adherence to the Recommended nutrient intake (RNI).

Methods: Micronutrients that are deficient in the population were analyze (Vitamin A, Thiamin, Riboflavin, Niacin, Folate, Vitamin B12, Iron, Iodine and Zinc). The RNI, and nutrient excess for each micronutrient were based on the population and their food consumption data from the "National survey on family income and expenditure 2009-2010". The food consumption was analyzed in Households within the urban and rural areas. The Vitamin and Mineral Requirements in Human Nutrition established by FAO/WHO were the gold standard to identify the gap between the RNI and the content of each nutrient in de New BFB.

Results: The National BFB and the Rural BFB achieve the recommendations on Thiamin, Niacin, Folate and Iron, the RNI exceed in Vitamin A and Iodine, and is low in Riboflavin, Zinc and Vitamin B12. The Urban BFB meets the RNI in most of the nutrients, except Vitamin A and Iodine, which is exceeded probably because of the Cane Sugar and Salt fortification country policy.

Conclusions: The three BFB adhere to the energy and macronutrient recommendations, but they present gaps between the RNI and the food content of micronutrients that are deficient in the population. The excess on Vitamin A in baskets is more than a quarter of the RNI, and the principal food source of this micronutrient is the fortified cane sugar.

Open Access Conference Proceeding (Abstract)

Commercial Promotion of Micronutrient Powder for Infants and Young Children in Tanzania

Generose Mulokozi, Godfrey Mbaruku, Leah Quin

European Journal of Nutrition & Food Safety, Page 879-880
DOI: 10.9734/EJNFS/2015/21142

Objectives: Micronutrients deficiencies are serious public health problems in Tanzania. Home fortification with micronutrient powder (MNP) has been introduced in eight food-insecure districts of Tanzania as a complementary intervention by the "Tuboreshe Chakula Project," to improve the nutritional quality of foods consumed by children aged 6 - 59 months.

The objective of the strategy is to promote consumption of MNP in households with eligible children.

Methods: The USAID "Tuboreshe Chakula" project organized a commercial distribution channel involving a main distributor, wholesalers and retailers/village kiosks. MNP sachets are sold at affordable prices, helped by a government tax exemption. Before introduction, the project advocated through sensitization seminars for government and community leaders and trainings for health service providers and community health workers. Social marketing and behavioral change communication (BCC) strategies create community awareness and mobilize mothers and caregivers to purchase MNP for their children. Educational materials developed in collaboration with government stakeholders were provided to health workers, mothers/caregivers and traders.

Results: Six months after introduction of MNP, information on MNP has spread significantly in the target communities: 70% of households recognize the MNP sachet. The number of target households feeding their children MNP has risen to 11%, and 1.6 million sachets have been distributed throughout the target districts.

Conclusions: Through advocacy, trainings and well-designed social marketing to stakeholders, distribution of MNP through a commercial channel has a great potential for reaching infants and young children within a short period of time.

Open Access Conference Proceeding (Abstract)

Understanding Fruit and Vegetable Consumption: A Qualitative Investigation in the Mitchells Plain Sub-district of Cape Town

Catherine Pereira, Milla McLachlan, Jane Battersby

European Journal of Nutrition & Food Safety, Page 745-746
DOI: 10.9734/EJNFS/2015/21069

Objectives: Many South Africans do not consume enough fruit and vegetables. However, people are generally aware of the benefits of adequate consumption. To understand this gap between knowledge and practice, this study investigated underlying factors influencing consumption through a qualitative, cross-sectional, descriptive case study conducted in Mitchell’s Plain, Cape Town.

Methods: Four focus groups to gain broad understanding and 15 interviews with strategically selected individuals influential in food preparation, distribution or consumption, to gain in-depth understanding of specific factors influencing fruit and vegetable consumption were conducted.

Results: The study identified a number of drivers of fruit and vegetable consumption patterns. Barriers to consumption included perishability and affordability; that fruit/vegetables are not considered priority food items (inadequate time and effort is allocated to purchasing and preparation); reported negative side-effects of consumption, and that health benefits are not immediately apparent. Consumption was facilitated by personal preference, traditional dishes that include fruit/vegetables, increased availability of fruit/vegetables and discipline in children. Suggestions to improve consumption included providing practical advice to decrease preparation time and cost, and recipes to increase appeal of fruit/vegetable dishes. However, this needs to be understood in the context of the bigger structural issues that help or hinder fruit and vegetable consumption.

Conclusions: Limited fruit and vegetable consumption is not simply determined by limited nutrition knowledge or poor decision making by households, but rather by a much wider set of social, economic and spatial processes. Innovative behaviour change strategies to increase consumption that take cognisance of wider structural barriers to consumption are required.

Open Access Conference Proceeding (Abstract)

Post-partum High-dose Vitamin A Supplementation to Improve Vitamin A Status of Mother and Infant: The Role of Timing and Inflammation

Nguyen Song Tu, Tran Thuy Nga, Marjoleine Amma Dijkhuizen, Jacques Berger, Henrik Friis, Frank Tammo Wieringa

European Journal of Nutrition & Food Safety, Page 747-748
DOI: 10.9734/EJNFS/2015/21070

Objectives: Vitamin A deficiency (VAD) in infancy remains an important health problem. Post-partum maternal high-dose vitamin A supplementation (MHDVAS) was recommended but recently cancelled by WHO as efficacy was unclear. We investigated effects of inflammation and timing of MHDVAS on VA status in mothers and newborns.

Methods: In a randomized, double-blinded placebo-controlled trial, 400 pregnant women were randomly assigned at 28–32 weeks gestation, to receive MHDVAS within 1 week after delivery (WK1) or 6 weeks post-partum (WK6). Breastmilk, plasma VA and inflammation markers were measured at several time-points during the first 6 months post-partum.

Results: Retinol concentrations during pregnancy and 6 months post-partum were strongly correlated (R=0.53, P<0.001). Prevalence of VAD(<0.70 μmol/L) in mothers 6 months post-partum was low (2.7%), but high in infants (33.6%), regardless of intervention. 77.6% of infants had retinol concentrations <1.05 μmol/L. Breastmilk vitamin A concentrations (<1.05 μmol/L) were deficient in only 5% of the women first week post-partum, but increased to 28% of the women 6 months post-partum and tended to be higher in the WK1 compared to the WK6 (31.4% and 24.5%,P<0.10). Retinol liver stores were significantly higher in children from mothers receiving MHDVAS at WK6 as compared to WK1 (P<0.001), with 27% and 46.9% of the infants having insufficient VA liver stores respectively.

Conclusions: Lactation caused depletion of vitamin A stores in mothers. Delaying the high-dose VAS post-partum from WK1 to WK6 did not affect circulating retinol, but did significantly increased VA liver stores in infants 6 months after birth. Health-benefits should be evaluated in a larger trial.

Open Access Conference Proceeding (Abstract)

Variation of Serum Selenium (Se) in Children from Amhara Region, Ethiopia. Will Low Se Affect the Success of Salt Iodization in Ethiopia?

Dawd Gashu, Gulelate Desse, Karim Bougma, Aregash Samuel, Abdulaziz Adish, Barbara Stoecker, Grace Marquis

European Journal of Nutrition & Food Safety, Page 881-882
DOI: 10.9734/EJNFS/2015/21143

Objectives: To assess Se status of 54-60 month-old children in the Amhara region, Ethiopia

Methods: Serum from 280 children from five zones of the Amhara regional state, Ethiopia, was analyzed by inductively coupled plasma mass spectrometry (ICP-MS).

Results: The mean serum Se concentration was 65.89±38.4 µg/L (median: 54.54 µg/L). Individual values ranged from 10.66-255.45 µg/L. Overall, 77% of the study children were below the recommended cutoff.  The mean serum Se varied by administrative zones (p<0.05). Mean serum Se concentrations from West Gojjam 44.13±11.37 µg/L; East Gojjam 60.03±26.06 µg/L; and South Gonder 61.76±24.34 µg/L were below the cutoff while mean Se concentrations for South Wollo 153.95±50.47 µg/L; Wagehmera 179.95±46.87 µg/L were adequate;. Means for children from East and West Gojjam and South Gonder were not different (p=0.42) from each other but they were different (p < 0.05) from means of children from South Wollo and Wagehmera. In addition, mean Se concentrations for children from South Wollo and Wagehmera were different (P<0.05) from each other.

Conclusions: Our data illustrate the variability of serum Se in children by zones. Although, Ethiopia is making progress with salt iodization, low Se status in some areas may hamper iodine metabolism and success of the salt iodization program.

Open Access Conference Proceeding (Abstract)

Knowledge, Attitudes and Practices of Prenatal Iron-folic Acid Supplementation among Pregnant Women and Health Staff in Rural Niger

Cesaire T. Ouedraogo, Ryan K. Wessells, Nancy Keith, Ibrahim F. Bamba, Maimouna Doudou, Banda Ndiaye, Sonja Y. Hess

European Journal of Nutrition & Food Safety, Page 749-750
DOI: 10.9734/EJNFS/2015/21071

Objectives: We aimed to assess knowledge, attitudes and practices (KAP) of iron and folic acid (IFA) supplementation among pregnant women and health staff in rural Niger.

Methods: KAP were assessed in 4 randomly selected villages in the Zinder region of Niger as part of a formative research study conducted to inform the design of a program to improve antenatal care services. Data collection included home interviews of pregnant women (n=72) and a focus group of 8-10 pregnant women in each village. In 5 randomly selected health centers, we observed 33 antenatal care (ANC) consultations, and interviewed pregnant women and health staff following these observations.

Results: Among 72 pregnant women interviewed in their homes, 96% had knowledge of IFA supplements and 97% of these stated at least one health benefit of IFA.  However, among those who had already attended at least 1 ANC visit (n=52), only 65 % reported having taken IFA supplements on the day prior the interview.  Reported side effects were rare.  Among 5 health centers visited, 3 had IFA supplement in stock. Health staff did not provide IFA supplements to the pregnant women during 18 of 33 observed ANC consultations of which only 7 cases could be explained by the lack of IFA supplements in stock.

Conclusions: IFA supplements are well known by pregnant women. The supply chain of the health centers should be ensured and health staff retrained for an effective IFA supplementation among pregnant women.

Open Access Conference Proceeding (Abstract)

Can Diffuse Mid Infrared Reflectance Provide Information on Soil Micronutrient Status?

Mercy Nyambura, Riikka Keskinen, Erick Towett, Keith Shepherd, Martti Esala

European Journal of Nutrition & Food Safety, Page 751-752
DOI: 10.9734/EJNFS/2015/21072

Objectives: The objective of this study was to evaluate the potential of MIR to predict micronutrient status while reanalyzing archived soil (n=1649) samples after long-term storage (40 years).

Methods: The infrared spectra of the samples collected from 30 countries from across the world were recorded between 4000-600 cm-1 wavelength range. 10 % of the samples were measured for Cu, Mn, Mo, Zn, B, Pb, Co, and Fe using the conventional wet chemistry reference methods. A modified partial least squares method with cross-validation is being used to develop calibration models for prediction of micronutrient properties of the samples from their spectra.

Results: The micronutrients were in a wide range: Cu (0.03 - 100), Mn (0.9 - 378), Mo (0.007 - 3.6), Zn (0.09 - 185), B (0.06 - 10), Pb (0 - 38), Co (0 - 421), and Fe (0 - 445) showing significant differences in the micronutrient contents of the different soils. The spectra of the samples were recorded between 4000-600 cm-1 range. A modified partial least squares method with cross-validation will be used to develop calibration models for prediction of micronutrient properties of the samples from their spectra. Predictive models based on MIR spectra are under development for all properties.

Conclusions: Predictive models based on MIR spectra for all soil micronutrients can be used to predict a number of soil properties and it has potential to bridge the gaps in the data.

Open Access Conference Proceeding (Abstract)

Strengthening District Support to the Micronutrient Program in a Low Income Setting: Rural Mali (West Africa)

Fama Kondo, Traore Doufain, Lazare Coulibaly, Zana Berthe, Fatoumata Diallo, Marie Diakite, M’Bo Awa, Abdramane Maiga, Leigh Jaschke, Houleymata Diarra

European Journal of Nutrition & Food Safety, Page 883-884
DOI: 10.9734/EJNFS/2015/21144

Objectives: Since 2003, the Malian Ministry of Health (MoH) and its partners have adopted and scaled up a national program to deliver Vitamin A Supplementation (VAS) to children 6-59 months and post-partum women. The programme has achieved consistently high coverage of over 90%, however the majority of funding for implementation is provided by partners. The MoH has identified the need to increase country ownership of the VAS programme to increase programme sustainability.

Methods: District level advocacy workshops were held in two regions with district health teams, local administration and civil society participants. The workshops, facilitated by the National Division of Nutrition and HKI Mali, provided information to participants to increase their awareness of VAS and encourage the mobilization of local resources to support VAS programme activities. Seven workshops were held one month before the most recent national Child Health Days (CHDs) with a total of 455 participants.

Results: 178 district stakeholders committed to allocate additional resources to VAS distribution events, including allowances for distributers, fuel for supervision vehicles, transport for social mobilizers, and health supplies for VAS distribution. Decision makers also initiated local solutions for service delivery of VAS distribution, including covering the fuel cost for vaccinators, increasing local social mobilization efforts and adding a budget line for VAS activities in the community development plan.

Conclusions: Advocacy efforts were effective in increasing resources allocated to VAS distribution and demonstrated an increase in local engagement at the district level.

Open Access Conference Proceeding (Abstract)

Tools for Strengthening Implementation of Large-scale Nutrition Programs: An Evaluation of the Program Assessment Guide (PAG)

Geoff Marks, Jo Durham, David Pelletier, Suzanne Gervais, Marion Roche

European Journal of Nutrition & Food Safety, Page 753-754
DOI: 10.9734/EJNFS/2015/21073

Objectives: The Program Assessment Guide (PAG) is a 44 page 9 module workshop facilitation guide developed as "a tool to strengthen the design and implementation of large-scale nutrition programs."  It has been used to guide workshops for this purpose in Kyrgyzstan, Bolivia, Tanzania, Nepal and Haiti, among others.   There is growing interest in the PAG but experience with its use has not been previously evaluated. We report on an external evaluation to learn from these experiences, as a basis for understanding its performance, factors that influence its performance and potential refinements.

Methods: The evaluation was guided by the PAG's underlying theory of change and was based on a review of workshop reports, outputs and evaluations, field visits, assessment of outcomes from selected workshops, programs and locations and an overall synthesis of experience to date.

Results: The PAG has been well-accepted by implementers in the workshops, identified bottlenecks not previously recognized and generated concrete action plans for program strengthening.  A major challenge has been to ensure implementation of the action plans after the workshop.

Conclusions: The PAG shows promise as a tool for strengthening implementation of large-scale nutrition programs but greater efforts and clear expectations of required human and financial resources are needed to secure commitments in order to ensure implementation of the action plan.

Open Access Conference Proceeding (Abstract)

Progress in Elimination of Iodine Deficiency Disorders in Zimbabwe- A Program Coverage

Wisdom Dube, Tasiana Nyadzayo

European Journal of Nutrition & Food Safety, Page 885
DOI: 10.9734/EJNFS/2015/21145

Objectives: To report on a post 21-year program implementation progress towards elimination of iodine deficiency as a public health problem in Zimbabwe.

Methods: A national goiter survey done in Zimbabwe 1988 indicated the existence of iodine deficiency disorders as a severe public health problem. In 1993, a salt iodization strategy was initiated. Levels of salt iodization were set at 25 to 55 ppm as potassium iodate. A monitoring framework was set to monitor Iodine consumption in salt. Evaluation was done after 21 years of implementation following a descriptive cross-sectional study design survey. 1648 urine samples were collected from children 6 -12 years and tested for urinary iodine concentration. Salt samples from the households where the children came from were also tested for the presence of Iodine using rapid salt test kits and titration methods.

Results: Following a 21 year-post salt iodization program, median UI of 185 μg /l; and 3% of urine samples had UI level less than 50 μg/l and 15.5% of urine samples had UI level less than 100 μg/l. 10% of the children had urinary iodine level above 300 μg/l. 94%, of the salt was iodised. However, 32,6% of the salt had excessive iodine content above 55 ppm.

Conclusions: Implementation of salt iodization program resulted in the elimination of iodine deficiencies as a public health problem in Zimbabwe. However the proportion of households who used effectively iodized salt in Zimbabwe was still low. There remains high percentage of salt with excessive levels of iodine, warranting monitoring fortification at production level.

Open Access Conference Proceeding (Abstract)

Increased Availability of Micronutrient Rich Foods and Income among Women Farmers Participating in a Cluster Randomized Control Trial of Homestead Food Production (HFP) in Cambodia

Aminuzzaman Talukder, Hou Kroeun, Jennifer Foley, Judy McLean, Tim Green, Annie Wesley

European Journal of Nutrition & Food Safety, Page 755-756
DOI: 10.9734/EJNFS/2015/21074

Objectives: Household food insecurity and under-nutrition are prevalent in Cambodia where there is a lack of dietary diversity and reliance on rice. To address these issues, HKI has implemented HFP to increase the availability and consumption of micronutrient-rich foods. We are currently integrating household level fishponds to enhance plant-based HFP; small nutrient-rich fish, consumed whole, are raised together with large fish, which can be eaten or sold. We aim to improve household food security, micronutrient intake and status.

To report on the progress of our 24-month cluster RCT after one year intervention in Prey Veng Province.

Methods: 90 clusters were established each consisting of a village model farm and 10 families headed by women farmers (n=990). Each cluster was randomly assigned to either: 1) HFP, 2) HFP plus aquaculture, or 3) control. A baseline survey was completed and process monitoring onging with production, and income data among other variables.

Results: Median vegetable and fruit production increased by 8 kg and 4 kg, respectively in households receiving any HFP. Income generation from the sale of fruit and vegetables in HFP farms increased by 55%. Small and large fish production increased by 1 and 5 kg, respectively.

Conclusions: Early in the intervention we are observing increased fish, fruit and vegetables production as well as income generation. We hope that this will translate into an improvement in nutritional and in in particular micronutrient status.

Open Access Conference Proceeding (Abstract)

Improved Dairy Cows in Uganda: Pathways to Poverty Alleviation and Improved Child Nutrition

Nassul Kabunga

European Journal of Nutrition & Food Safety, Page 886-887
DOI: 10.9734/EJNFS/2015/21146

Objectives: The objective of this study was to rigorously assess the impact of improved dairy cow breeds adoption on the following outcome levels:

(i) Enterprise—milk productivity, own-milk consumption and milk commercialization;

(ii) Household—the number of meals household consumes, food and non-food expenditure, food and non-food poverty incidences, poverty depths and severity;

(iii) Individual child-level nutrition—stunting and wasting of children below 5 years.

Methods: We use a nationally representative primary dataset that was recently collected from Ugandan households of rural and urban settings. We employ modern impact assessment methods that account for selection bias to achieve consistent estimates.

Results: We find that adopting improved dairy cows significantly increases milk productivity, milk commercialization and food expenditure. Consequently, adoption substantially reduces household poverty and stunting for young children below 5 years. These results are consistent with the perceived role of new agro-technologies. Considering heterogeneity in farm size, we further find that households with small farms increase milk yield, food expenditure and reduce poverty substantially due to adoption while large farms increase own-milk consumption and commercialization but also reduce stunting of children below 5 years. This suggests that the nutritional benefits of adoption may not sufficiently help reduce child malnutrition for young children living on small farms.

Conclusions: We argue that for holistic and sustainable improvements in broader welfare and nutrition outcomes, agricultural development programs should be accompanied with related programs on gender empowerment, nutrition education, as well as food safety and hygiene.

Open Access Conference Proceeding (Abstract)

Influence of Micronutrient Status during Infancy and Middle Childhood on Cognition at Middle Childhood

Tippawan Pongcharoen, Chureeporn Chitchumroonchokchai, Uruwan Yamborisut, Atitada Boonpraderm, Emorn Wasanwisut, Pattanee Winichagoon

European Journal of Nutrition & Food Safety, Page 757
DOI: 10.9734/EJNFS/2015/21075

Objectives: To evaluate the relationship between micronutrient status during infancy and middle childhood on cognition at middle childhood.

Methods: A longitudinal study was conducted in apparent healthy children in the northeast of Thailand. Intelligence Quotient (IQ) was measured using the Wechsler Intelligence Scale for Children, III (Thai) at 9 y. Hemoglobin, serum ferritin, and serum zinc (sZn) were assessed at early infancy (4 mo), late infancy (1 y), and middle childhood (9 y). Serum transferrin receptor and urine iodine (UI) were assessed at 9 y. Using multiple regression, the relationship between micronutrient status during infancy and middle childhood and cognition at middle childhood was ascertained.

Results: Full scale IQ and performance IQ at 9 y was influenced by sZn at 1 y (β = 0.4 μmol/L, p = 0.011 and β = 0.6 μmol/L, p = 0.001). The influence of UI at 9 y on Verbal IQ at 9 was small but significant (β = 0.02 μg/L, p = 0.024). None of the iron status at 4 mo, 1 y, and 9 y were associated with IQ.

Conclusions: In apparent healthy children, zinc status at late infancy and iodine status at middle childhood were associated with IQ at middle childhood. Further analyses are needed to understand this relationship.

Open Access Conference Proceeding (Abstract)

Project of National Strategies for Food Fortification in Vietnam

Van Tran, Tuyen Le, Nga Tran, Truong Nguyen, Tu Nguyen, Dzung Nguyen

European Journal of Nutrition & Food Safety, Page 888-889
DOI: 10.9734/EJNFS/2015/21147

Objectives: The overall goal is to reduce the prevalence of vitamin and mineral deficiencies including vitamin A, iron and zinc deficiencies. The project will continue its efforts to prevent the population from falling back into deficiency.

Over the project, 4 type of fortified food are produced: soya sauce, fish sauce, vegetable oil and flavoring powders for >55 million people (50% of the total population) throug >20 manufacturers

Methods: Micronutrient deficiency is public health problem in Vietnam. Iron status has improved but a large part of the population continues to be deficient for zinc and vitamin A or has a marginal status for all the bio-indicators tested.

With the support of the Global Alliance for Improved Nutrition (GAIN), the National Institute of Nutrition (NIN) in Vietnam began to fortify fish sauce in 2005, following studies showed the positive impact of fish sauce fortification.

The second phase of the four year projects subsidizes fortificant for the producers over one year in Vietnam; provides technical support in the area of production and standards to get mandatory fortification in place.

Results: 16 food producers signed a commitment to join in the project. Vitamin A-fortified oil, vitamin A-fortified granules, iron fortified fish sauce, iron-fortified soya sauce are introduced to Vietnam consumers. Fortification legislation is developed and revised by the government. The food law contains an article on fortification which stipulates that micronutrient fortification is mandatory if it can be shown the corresponding deficiency constitute a public health problem.

Conclusions: The project begun in 9/2011 and be concluded in 10/2015.

Open Access Conference Proceeding (Abstract)

Adequacy of Diets for Kenyan Women and Children under Five Years Using 24 hr Recall Data

Jacqueline Kung'u, Lucy Murage, Zipporah Bukania, Gladys Mugambi, Terry Wefwafwa

European Journal of Nutrition & Food Safety, Page 758-759
DOI: 10.9734/EJNFS/2015/21076

Objectives: The Ministry of Health in conjunction with several stakeholders conducted a nationally representative 24-hour dietary recall component of the Kenya National Micronutrient Survey (KNMS) to characterize the average intake and dietary pattern of women of reproductive age and children 7-59 months.

Methods: 296 clusters were randomly selected for the KNMS survey. Within each cluster, we  randomly selected 2 households that met the inclusion criteria of having either a women of reproductive age, a child under five years of age or both, who are usual residents of the household.  An interactive 24-hr recall multiple pass approach was used to collect one day dietary intake data on all households and repeated on a sub-set of 20% households on non-consecutive days.  Using PC-SIDE software (version 1.0, June 2013) for data analysis, we determined the usual intake of each nutrient. We report here the dietary data of 399 women (15-49 years) 55 children (7-12 months) and 214 children (13-59 months). 

Results: Average energy, iron, vitamin A and zinc intakes in women were 1944 kcal, 12.6 mg, 778 μg and 8.1 mg respectively while these nutrient intakes in children 7-12 months and 13-59 months were 473 Kcal, 2.5 mg, 126 μg, 2.1mg and 1036 kcal, 6.3 mg, 366 μg, 4.3 mg respectively. Prevalence of inadequacy among women, children 7-12 months and children 13-59 months using EAR cutoffs and adjusting for intra individual variability was  17%, 94% and 9% for iron; 43%, 99% and 41% for vitamin A; 49%, 62% and 23% for zinc respectively. 

Conclusions: These data point towards a number of programmatic interventions to improve the adequacy of diets for Kenyan women and children.

Open Access Conference Proceeding (Abstract)

What is the Right Indicator to Evaluate Impact of Interventions? Examples from a Rice Fortification Trial in Cambodia

Khov Kuong, Marion Fiorentino, Marlene Perignon, Chhoun Chamnan, Megan Parker, Kurt Burja, Kannitha Kong, Jacques Berger

European Journal of Nutrition & Food Safety, Page 760-761
DOI: 10.9734/EJNFS/2015/21077

Objectives: Large-scale programs often use proxy indicators for evaluation purposes but little is known on whether use of these indicators might lead to erroneous conclusions regarding impact of programs. In the FORISCA-UltraRice+NutriRice trial in Cambodia, fortified rice was introduced through the WFP schoolmeal program (WFP-SMP). A wide range of impact indicators collected during the study was explored to test the usefulness of 2 proxy indicators (anemia and stunting) for program evaluation.

Methods: In a placebo-controlled, double blinded trial, 20 schools (n=9500) were randomly allocated to no SMP (control, 4 schools), normal schoolmeal (placebo, 4 schools) or a schoolmeal with fortified rice (3 different types, 4 schools each). Data on absenteeism and morbidity was available for all schoolchildren, whereas biochemical data (hemoglobin, iron, zinc and vitamin A status), anthropometry, parasite infection and cognitive performance was available for ~25% of children.

Results: At baseline, anemia prevalence was significantly lower in non-SMP (9.5% vs 16.6%, P<0.05) and iron status significantly higher in non-SMP schools than in intervention schools (P<0.005). Stunting prevalence was high (41.5%) and not different among the schools. After 6 months of consumption, fortified rice had no overall impact on anemia prevalence or hemoglobin concentrations, but improved micronutrient status and cognitive performance in some intervention groups.

Conclusions: Anemia prevalence is a valid indicator to select schools for SMP, but stunting prevalence had little value in this study. Changes in anemia prevalence did not correspond to changes in functional outcomes, showing that program evaluation requires better proxy indicators. Funded by USDA/FAS, WFP-DSM consortium and IRD.

Open Access Conference Proceeding (Abstract)

Better Together: Women-focused Agriculture Plus Nutrition Education Improve Growth in Young Children Compared to Nutrition Education Alone

Sheela Sinharoy, Jillian Waid, S. H. Thilsted

European Journal of Nutrition & Food Safety, Page 890-891
DOI: 10.9734/EJNFS/2015/21149

Objectives: Homestead food production (HFP) programs aim to provide families with access to micronutrient-rich foods and increase dietary diversity for improved functional outcomes, while also empowering women. However, evidence is lacking globally of the impact of HFP on child growth and nutrition. This research examines the relationship between HFP and child growth and nutrition.

Methods: A large-scale program covering 406,866 households was implemented in southern Bangladesh from 2004-2010. Households were purposively assigned to two intervention arms: (a) HFP with maternal and child health and nutrition (HFP+MCHN) or (b) maternal and child health and nutrition only (MCHN-only). MCHN consisted of antenatal care, child growth monitoring and a minimal food ration. HFP included technical advice and inputs for production of micronutrient-rich vegetables and poultry rearing. Baseline and endline data were analysed to examine child stunting and underweight between intervention arms.

Results: Severe stunting (P<0.037) and severe underweight (P<0.014) between intervention arms were significantly different at endline, with no significant difference at baseline. Dietary diversity in children (6-23 months) was significantly higher (P<0.012) at endline in HFP+MCHN compared to MCHN-only areas, with no significant difference at baseline.

Conclusions: An agriculture-nutrition intervention was associated with increased dietary diversity and improved growth and nutritional status in children under 2 years of age. This provides new evidence of the effect of a women-focused HFP program with nutrition education on dietary quality and nutritional status. Promising areas for future research may include the impact of similar programs on additional functional outcomes such as cognition and school performance.

Open Access Conference Proceeding (Abstract)

Changes in Micronutrient Intervention in Nigeria, 2003-2008, and Implications for Intervention Scale-up

Olufolakemi Anjorin, Olutayo Adeyemi, Isaac Akinyele

European Journal of Nutrition & Food Safety, Page 1022-1023
DOI: 10.9734/EJNFS/2015/21219

Objectives: Nigeria is third of 34 countries that contribute 90% of the global burden of stunting, and has the third highest numbers of wasted children. Prevailing evidence emphasizes the need for effective scale-up of interventions like micronutrient supplementation. This study assessed micronutrient interventions in Nigeria and how coverage has changed over time, in order to identify modifications that may be necessary to achieve such scale-up.

Methods: Data from the 2003 and 2008 Nigeria Demographic and Health Surveys (NDHS) were used. Intervention access was estimated using information about skilled health-worker-to-client contact. Descriptive and chi-square statistics were obtained using complex survey design, in Stata 11.2.

Results: From 2003 to 2008, prevalence of households with adequately iodized salt decreased from 97.1% to 52.9% (p<0.0001). Prevalence of children 6-59 months who received vitamin A supplements in the 6 months preceding the NDHS also decreased (34.1% to25.1%, p<0.0001), but women receiving vitamin A postpartum increased from 19.8% to 24.9% (p=0.004). For iron, there were no changes in prevalence of zero-supplementation during pregnancy (40.0% to 43.9%, p=0.13). Similarly, there were no improvements in prevalence of health-worker-to-client contact. Skilled antenatal care prevalence was 58.1% and 58.0% in2003 and 2008 respectively (p=0.96); skilled assistance at delivery was 35.5% and 39.5% (p=0.16); and 23.4% and 33.0% respectively (p<0.0001) of children 12-59 months had received zero vaccinations.

Conclusions: There were lack of improvements in already low micronutrient intervention coverage, and poor services utilization among clients. Promoting health services utilization may help scale-up micronutrient interventions in Nigeria.

Open Access Conference Proceeding (Abstract)

Implementing Large-scale Food Fortification in Tanzania: Lessons Learned

Christina Nyhus Dhillon, Mawuli Sablah, George Kaishozi

European Journal of Nutrition & Food Safety, Page 762
DOI: 10.9734/EJNFS/2015/21078

Objectives: The main objective is to identify achievements, challenges and lessons learned in implementing large scale food fortification in Tanzania for the benefit of other countries attempting to initiate national mandatory fortification of staple foods

Methods: Lessons learned were drawn from fortification program documents and interviews with fortification stakeholders. The lessons learned cover the key components of fortification programs, including production, distribution, quality control and enforcement, standards setting, legislation, social marketing and communication, monitoring and evaluation. A food rapid assessment tool (FRAT) survey was conducted to determine appropriate staple food vehicles for fortification.

Results: The FRAT survey identified wheat flour, maize meal, and vegetable oil as appropriate fortification vehicles. It was estimated that 23 million could be reached with both fortified vegetable oil and wheat flour. Political will and commitment especially at highest level of leadership was critical in engendering support for fortification from both the public and private sector. Furthermore, establishment of a local premix distribution hub in Tanzania has ensured regular availability of premix. Importantly, Tanzania exonerated the purchase of premix from taxes, a model for east Africa.

Conclusions: Through mandatory legislation and enabling political environment Tanzania has successfully launched and scaled up fortification of vegetable oil and wheat flour.

Open Access Conference Proceeding (Abstract)

Dietary Intakes of Fe, Zn and Protein and Anthropometric Measures of Mothers and Children Living in Pulse or Cereal-Growing Rural Communities of Ethiopia

Getahun Ersino Lombamo, Carol Henry, Gordon Zello

European Journal of Nutrition & Food Safety, Page 1024-1025
DOI: 10.9734/EJNFS/2015/21221

Objectives: In pulse and cereal-based agricultural communities, we compared the nutrition of mothers and children (<5y) through anthropometric and dietary assessment.

Methods: A between-group design (Feb-July 2013) was applied in purposively selected pulse (Holagoba Kukie, Halaba-HK, n~200) and cereal-growing (Edo-Qontola, Zeway-EQ, n~200) communities in Ethiopia. Dietary diversity scores (DDS) were assessed using FAO guidelines. Median intakes of Fe, Zn and protein were determined from weighed food records representative of weekly intake. Maternal undernutrition was set at a BMI<18.5 and WHO guidelines were used for stunting, wasting and underweight in children.

Results: DDS for mothers and children (6-60 mth) based on 9 food groups, was 3 for both communities. Consumption from animal sources was minimal. Intakes of protein (61.9 g), Fe (64.1mg) and Zn (13.7 mg) for HK mothers were higher compared to 42.8 g, 44.3 mg and 9.3 mg in EQ mothers. Corresponding protein, Fe and Zn values for children were 17.1 g, 18.1 mg and 3.5 mg in HK and 18.5 g, 17.4 mg and 4.1 mg in EQ, respectively. Prevalence of low BMI was 22.7% HK and 14.1% EQ. Estimates of child stunting, wasting and underweight were 60.6%, 10.3% and 41.1% in HK and 41.8%, 4.1% and 21.6% in EQ, respectively.

Conclusions: Poor DDS and high levels of maternal undernutrition and child stunting were found in both communities. The unexpected finding of greater undernutrition in pulse-growing HK (better nutrient intake) requires investigation and may be due to general health, increased activities or other nutrient deficiencies in mothers. Overall, this community baseline study indicates a need to strengthen nutrition service delivery programs to mothers-children.

Open Access Conference Proceeding (Abstract)

Validation of Vitamin A Supplementation Coverage Using Post-event Coverage Surveys in 11 Sub-Saharan African Countries

Heather Katcher, Leigh Jaschke, Geoffrey Oruru, Jennifer Nielsen, Jessica Blankenship

European Journal of Nutrition & Food Safety, Page 763-764
DOI: 10.9734/EJNFS/2015/21079

Objectives: Twice-yearly child health days (CHDs) have had remarkable success reaching children twice-yearly with life-saving interventions, including vitamin A supplementation (VAS). In 2012, over 80% of targeted children in Sub-Saharan Africa received VAS according to tally-sheet data. All countries implementing CHDs use tally-sheet data to measure coverage; however, coverage measured from tally-sheets is prone to errors due to inaccurate census data, incorrect tallying and mathematical errors totaling coverage across districts and regions.

Methods: To validate coverage reported by tally-sheets, Helen Keller International implemented Post-Event Coverage Surveys (PECS) using a 30x30 cluster design and standard WHO EPI cluster sampling methodology in 11 countries in sub-Saharan Africa. For each survey, 900 caretakers of children 6-59 months were interviewed within six weeks of CHDs to reduce recall bias.

Results: Thirty-five post event coverage surveys were conducted between January 2010 and July 2013. PECS coverage was lower than administrative coverage in 33/35 (94%) of cases. PECS and administrative coverage data were within a 5% margin of difference in 5 cases (14%), and within >5-10% in 8 cases (23%). However, in 11 cases (31%), results differed by >10-20%, and in 11 cases (31%), results differed by 21-82%.

Conclusions: PEC surveys indicate considerable over-reporting of coverage by tally-sheets and provide critical data that is essential to evaluate and improve VAS distribution during CHDs. The continued use of PEC surveys is recommended in areas where tally-sheet data has not been confirmed or has been shown to be unreliable.

Open Access Conference Proceeding (Abstract)

Beyond Fortification of Centrally Processed Maize: Extending Fortification Technology to Small and Medium Scale Maize Millers in Tanzania

David Dodson, Felix Brooks-church, Elliot Anderson

European Journal of Nutrition & Food Safety, Page 1026-1027
DOI: 10.9734/EJNFS/2015/21222

Objectives: The passing of national fortification standards is a critical component to the success of any fortification program. Implementation of fortification within the centralized mill’s operations is relatively straightforward. However, when a majority of consumption of a staple food product is processed in small and medium scale mills, how can the benefits of fortification be realized in these communities? The objective was to design, develop, test, and implement a robust and affordable solution beginning with small maize mills in Tanzania.

Methods: By engaging in a design process at Stanford University in 2009, the sponsoring organization was able to adapt the base technology through a pilot program in 30 small mills in Nepal. Translation of the Nepal milling device to the asset base of the typical small scale maize mills found in East Africa has now resulted in a design that requires no modifications to the millers current operations and can be installed within 10min. The device provides fortification capabilities and ensures quality control through the use of a easy to use control panel that also has data storage capabilities for monitoring.

Results: Currently installing first release of 100 devices in Tanzania. The first release has the potential to fortify maize flour with essential micronutrients for an estimated 1 million annually.

Conclusions: The device provides a simple, affordable, and scalable solution to micronutrient malnutrition. By delivering micronutrients at the milling stage, the intervention reduces user and lowers the barriers to adoption.

Open Access Conference Proceeding (Abstract)

Monitoring and Evaluation of Complex Market-based Approaches to Improve Micronutrient Malnutrition: The Case of Amsterdam Initiative against Malnutrition (AIM)

Inge D. Brouwer, Marlene Roefs, Sjoerd Dijkstra, Charlotte Pedersen

European Journal of Nutrition & Food Safety, Page 892-893
DOI: 10.9734/EJNFS/2015/21150

Objectives: AIM is a partnership of 20 organizations in Europe and Africa. It includes 7 projects that combine assurance of sufficient and affordable quality of food supply (‘push') with stimulation of demand for nutritious foods (‘pull'). AIM provides the opportunity to assess the effectiveness of different market-based solutions and extract lessons for up-scaling and replication. The public-private and multi-strategy character of the AIM programme requires a monitoring and evaluation (M&E) system that addresses the complexity of the AIM partnership and its interventions.

Methods: Through participatory consultation result pathways and M&E plans for each project were developed.  These laid the basis for the AIM overall programme logic and M&E framework.

Results: Building the M&E system involved (re)defining project impact pathways; identifying indicators; further landscape analysis; investment in baseline studies and evaluations; designing monitoring and reflection processes; formulation of project overarching learning questions and specific research questions within the projects.

Conclusions: Building a meaningful M&E system for a complex programme like AIM's requires: bridging a development perspective (government, NGOs) with a production perspective (business); addressing reluctance to cover extra costs for M&E; finding creative solutions for building evidence, including rigorous designs for complex interventions; and reaching agreement on sharing results in the public domain which is not always desirable from a production perspective. Building capacity and trust coupled with good governance forms the basis for this process.x

Open Access Conference Proceeding (Abstract)

National Experience on Wheat Flour Fortification Program of Government of Nepal: A Review

Pramod Koirala

European Journal of Nutrition & Food Safety, Page 1028
DOI: 10.9734/EJNFS/2015/21223

Objectives: Wheat flour fortification is one of the such move towards control of micronutrient deficiency and was begin in 2002 with the tripartite agreement between Department of Food Technology and Quality control (DFTQC), Nepal, Flour Mills Association and Ministry of Health and Population. Wheat flour both whole and refined was taken as the food vehicle for micro-nutrient fortification as the per capita utilization of wheat flour is 78 gram per head per day in Nepal.

Methods: This study is a decade long (2002 to 2013) national experience of national food control agency in Nepal which is involved in monitoring fortified wheat flour in Nepal.

Results: Three nutrients Vit A palmitate 1 mg  per kg, Iron 60 mg per kg in the elemental form and Folic acid 1.5 mg per kg were the fortificants chosen for wheat flour fortification. The expenditure incurred for the these three nutrient pre mix, the logo and technical backstopping was supported by Micro-nutrient Initiatives (MI). In order to regulate the fortification activity in the roller mills, Government of Nepal build up voluntary standard in 2006 with the supposition that flour mills will initiate fortification. Shortly, Government becomes conscious that there is call for mandatory standard for fortified flour. Therefore, in 2011 Government come up with mandatory standard.

Conclusions: At present, each and every roller mills in Nepal manufacture fortified flour and Department of Food Technology and Quality Control is engage in monitoring of it.

Open Access Conference Proceeding (Abstract)

Knowledge and Practices on the Prevention of Anemia in Pregnancy in the Cascades Region (Burkina Faso)

Ilboudo Bernard, Savadogo G. Léon Blaise, Kinda Maurice, Guiguemde T. Robert, Dramaix-Wilmet Michèle, Donnen Philippe

European Journal of Nutrition & Food Safety, Page 765-766
DOI: 10.9734/EJNFS/2015/21080

Objectives: To study the knowledge and practices on anemia prevention during pregnancy among health professionals, community health workers and pregnant women.

Methods: We carried out a cross-sectional study in antenatal clinics in the Cascades region in Burkina Faso during one month, from May to June 2012. We gathered data on knowledge on the prevention of anemia in pregnancy among health professionals, community health workers, and pregnant women through a questionnaire. Practice performance of health professionals working in these antenatal clinics were gathered through direct observation and was judged satisfactory if they realized 80% of expected acts of antenatal care. For community health workers and pregnant women, recognition of nutritional deficiencies as the predominant cause of anemia in pregnancy, was the main way to assess their knowledge on the subject.

Results: A total of 124 health professionals, 77 community health workers and 1763 pregnant women were enrolled. Health professionals knew the definition, the diagnosis and the main causes of anemia in pregnancy respectively in 46.7%, 53.2% and 46.0% of cases. The practice of prenatal consultation was satisfactory in 13.1% of cases. Only 19.5% of community health workers and 19.6% of pregnant women were able to identify nutritional deficiencies as a potential cause of anemia.

Conclusions: Any intervention aimed at improving the prevention of anemia in pregnancy in Burkina Faso should focus on the strengthening of the skill of the actors and the knowledge of pregnant women in the field.

Open Access Conference Proceeding (Abstract)

Consumption of Higher Frequency and Duration of Micronutrient Powders Does not Increase Diarrhea Morbidity among Peruvian Children 6-11 Months of Age

Nelly Zavaleta, David Loza, Patricia Egoavil, Jorge Sachez, Roberto Mosqueira, Kimberly Harding, Lynnette Neufeld, Saskia Osendarp

European Journal of Nutrition & Food Safety, Page 1029-1030
DOI: 10.9734/EJNFS/2015/21224

Objectives: There have been concerns around the safety of daily iron-containing multiple micronutrient powders (MNP) in young children in malaria-endemic and malaria-free environments. We analysed the effects of different MNP delivery regimens on diarrhea-related morbidity in children in a malaria-free area of Peru.

Methods: A total of 400 children 6 to 11 months of age, were randomized to one of four groups: every-other day for 6 months (A), daily for 6 months (B), every-other-day for 12 months (C), and daily for 12 months (D). All children were followed for 12 months. All MNP had the same formulation, including 12.5 mg iron, and zinc, vitamin A, vitamin C and folic acid. MNP were provided to caregivers every month and data on consumption and diarrhea morbidity were assessed twice a month. Point prevalence of diarrhea morbidity was calculated as number of days ill per total days of observation.

Results: Data of 399 (99.8%) children were analyzed by intention-to-treat. Group A was the control with 2.07% diarrhea days. No differences in diarrhea morbidity were observed among groups (group B: 1.85% days with diarrhea (OR:0.89; 95%CI0.79,1.01); group C:2.06% (OR:0.96.95%CI:0.88,1.12); group D:2.14% (OR:1.03;95%CI: 0.92,1.16). There were also no differences among regimens, stratified by age at baseline (6-8 mo vs 9-11 mo) but overall young children were ill more frequently than older children.

Conclusions: Daily consumption of MNPs for longer periods of time, does not lead to increased diarrhea compared to every-other-day supplementation for 6 months. The reasons for the lower OR of daily consumption for 6 months are being explored.

Open Access Conference Proceeding (Abstract)

The Prospects of Dacryodes Edulis and Persea Americana Seeds Intervention against Oxidants

Hanson Iyawe

European Journal of Nutrition & Food Safety, Page 1031
DOI: 10.9734/EJNFS/2015/21225

Objectives: The thrust of this work was the assessment of the mineral contents of two tropical fruit seeds D. edulis and P. americana. The aim was to make available empirical data as to the possible nutritional benefits that may be derived from the consumption of the processed seeds.

Methods: The method employed for mineral contents determination was the Atomic Adsorption Spectrophotometry (AAS), and the mineral content for each sample was paired with the World Health Organization (WHO) Recommended Daily Allowances (RDA), according to age brackets.

Results: Adequate amount of potassium, manganese, magnesium, iron and zinc for children (4-8 years). The seeds of D. edulis and P. americana were observed to have adequate amounts of potassium, calcium, manganese, magnesium, iron, zinc and selenium for adult males (25-50 years), with potassium and calcium limiting for adult females (25-50 years).

Conclusions: These data suggests that the seeds of D. edulis and P. americana contain enough manganese, zinc and selenium to protect against oxidant molecules.

Open Access Conference Proceeding (Abstract)

Complementary Interventions for Preventing and Controlling Iodine Deficiencies in Pregnant Women, Infants, and Young Children

Arnold Timmer, Carmen Ho, Michael Zimmerman, Jonathan Gorstein, Frits Van der Haar

European Journal of Nutrition & Food Safety, Page 894-895
DOI: 10.9734/EJNFS/2015/21151

Objectives: Inadequate dietary iodine is the main cause of preventable brain damage, posing a serious threat to intellectual development and productivity throughout the world. Salt iodization is the primary strategy for preventing and eliminating iodine deficiencies, and 76% of households worldwide have access to adequately iodized salt. In several settings, new interventions provide iodine containing products for vulnerable groups - pregnant and lactating women, infants (0-5 months), and young children (6-23 months). However, the extent to which these ‘complementary interventions' meet the iodine requirements of these groups has not been investigated. We therefore examined these interventions to understand whether they meet vulnerable groups' needs. We also estimated the number of recipients reached.

Methods: We reviewed literature, household surveys, and guidelines to assess whether salt iodization can meet vulnerable groups' iodine requirements. Then, complementary interventions used in public health contexts were mapped, their iodine contribution estimated, and the number of recipients reached calculated.

Results: Our analysis suggests that salt iodization may meet the requirements of pregnant and lactating women, but possibly not all infants and young children. There is great variability in objectives, delivery methods, and iodine contribution of complementary interventions. The coverage of various complementary interventions ranges from 0 to 13% of the vulnerable population groups.

Conclusions: There is a need for careful coordination to ensure appropriate amounts of iodine are delivered to recipients. Failing to do so can result in the delivery of too little or too much iodine, which can have negative health consequences.

Open Access Conference Proceeding (Abstract)

A Health Systems Strengthening Approach to Improve Nutrition of Pregnant Women and Newborns in Ethiopia, Kenya and Senegal

Jacqueline Kung'u, Banda Ndiaye, Crispin Ndedda, Girma Bogale, Emily Gold, Lynnette Neufeld

European Journal of Nutrition & Food Safety, Page 767-768
DOI: 10.9734/EJNFS/2015/21081

Objectives: Coverage of nutrition interventions for pregnant women is poor, but potential for improvement is limited where health systems are weak.  The Community-based Maternal and Newborn Health and Nutrition (CBMNH) program aims to increase utilization and quality of health and nutrition services for pregnant women and newborns by strengthening health systems.  With the program's focus on increasing demand for prenatal and birth services, we implemented Knowledge, Attitudes and Practices (KAP) surveys to identify  key individuals/factors influencing demand and use.

Methods: As part of the baseline surveys, we randomly selected women with children 0-11 months. Using mixed methods, we assessed current KAP surrounding nutrition in antenatal care.

Results: We identified gaps in the provision and utilization of services, particularly antenatal care (ANC), iron-folic acid supplements (IFA), among others.  The proportion of women who had attended 4 ANC visits during pregnancy was 4.8% in Ethiopia, 43% in Kenya, and 50% in Senegal; about a fifth in Ethiopia and Kenya and 60.7% in Senegal attended ANC in the first trimester.  Only 3.4% of women in Ethiopia, 36.7% in Kenya and 93.6% in Senegal had taken ≥90 IFA tablets during pregnancy.  Qualitative data found that knowledge and attitudes of women regarding care seeking for ANC and benefits of IFA during pregnancy period was low.

Conclusions: In all 3 countries, but particularly Ethiopia, health and nutrition services for pregnant women and newborns are under-provided and under-utilized. This evaluation revealed both demand and supply side barriers that are now being addressed as part of the on-going program.

Open Access Conference Proceeding (Abstract)

Cost effectiveness of Zinc Supplementation for the Treatment of Acute Diarrhoea in Children under 5 Years in Colombia

Aurelio Mejia, Sara Atehortua, Ivan D. Florez, Javier M. Sierra, Maria E. Mejia, Carolina Ramirez

European Journal of Nutrition & Food Safety, Page 1032-1033
DOI: 10.9734/EJNFS/2015/21226

Objectives: To determine the relative cost-effectiveness of zinc supplementation for the treatment of acute diarrhoea in children under five years in Colombia.

Methods: Cost-effectiveness analysis from the perspective of the Colombian Health System. We evaluated standard treatment with addition of zinc versus standard treatment without zinc supplement for children from birth to five years. The time horizon was the duration of the diarrhoea. Effectiveness information was extracted from a Cochrane systematic review and Colombian databases and observational studies. Identification and measurement of resource use was based in clinical guidelines, protocols and expert opinion. Unit costs were obtained from Colombian tariff manuals. We performed deterministic sensitivity analysis to assess the impact of changes in the cost and effectiveness of the strategies on the results of the model.

Results: The average treatment cost of one diarrhoea episode in Colombia is USD $40.77 using standard treatment, and USD $32.96 with zinc supplementation, a reduction of $7.81 USD. Additionally, zinc supplementation is more effective than standard treatment without zinc: it reduces diarrhoea-related mortality and incidence of persistent diarrhoea. The results are sensitive to changes in the probability of hospitalization and persistent diarrhoea, but conclusions do not change substantially.

Conclusions: Zinc for the treatment of acute diarrhoea is a highly cost-effective strategy from the perspective of the Colombian Health System. It is more cost-effective in children with higher risk of persistent diarrhoea and hospitalization.

Open Access Conference Proceeding (Abstract)

Strengthening Government Health Management Information System (HMIS) and Innovative Monitoring Approaches in Micronutrient Demonstration Programs: Experience from Three Asian Countries

Deepika Chaudhery, Payal Gupta, S. Kaushik

European Journal of Nutrition & Food Safety, Page 896-897
DOI: 10.9734/EJNFS/2015/21152

Objectives: The Micronutrient Initiative (MI) is supporting host governments to demonstrate effective strategies to strengthen zinc supplementation as adjunct to ORS for the treatment of diarrhea and IFA supplementation to reduce anemia among pregnant women across three Asian countries. The objective of this paper is to describe experiences related to designing and implementing a monitoring framework in these programs in Indonesia, Bangladesh and Afghanistan.

Methods: A monitoring framework was developed with two key components. Key indicators on coverage and stocks were incorporated in the government HMIS. Data on knowledge, and practices were collected through MI district field officers with short and simple checklists. Regular feedback based on this information was provide to the health system managers for program improvements.

Results: In Bangladesh and Afghanistan HMIS was modified to record and report on coverage of zinc supplements in treatment of diarrhea among children <5 years. Stock out indicators for zinc and ORS were also incorporated in the system. An indicator receipt of >180 IFA tablets during pregnancy is being introduced.

Monitoring checklists also provided programmatically useful information. For example, in Indonesia care-givers discontinuation of zinc tablets prior to the mandated 10 days was highlighted as a problem and necessary action was initiated.

Conclusions: Monitoring systems need to be simple so that they can be implemented and sustained by government systems. Adapting the government HMIS and ensuring data flow takes time and requires technical support. Considering the utility of monitoring checklists, the Government of Bangladesh has adapted them for use by their health personnel.

Open Access Conference Proceeding (Abstract)

High Levels of Iron Deficiency Anaemia (IDA) and Stunting by 6-11 Months of Age in Northern Zambia: Evidence of the Need for Early-Life Intervention Scale-Up

Zachary Daly, Mélanie Suter, Agnes Aongola, Dominique Brunet, Tim Green, Judy Mclean

European Journal of Nutrition & Food Safety, Page 1034-1035
DOI: 10.9734/EJNFS/2015/21227

Objectives: Anaemia and stunting are widespread in Zambia with developmental implications from the individual to the national level. To address these conditions, an integrated Home Fortification with Micronutrient Powders (MNP) and Infant and Young Child Feeding (IYCF) programme has been introduced in Mbala district, Northern Province, Zambia. Here we present key findings from a baseline survey conducted to inform the project and investigate relationships among morbidity, biochemical and anthropometrics in children 6-11 months.

Methods: A convenience sample of 631 child-caregiver pairs was recruited from health centres and outposts in Mbala District. We collected demographic, health, biochemical and anthropometric data. Children with severe anaemia or severe acute malnutrition were excluded and referred for treatment.

Results: Stunting was 30% and 57% of the children were anaemic (haemoglobin <110 g/L), 42% were iron deficient (serum ferritin <30 µg/L) and 22% had IDA. Children with fever in the previous two weeks had higher rates of anaemia (65% versus 49%, p <0.001) and lower mean haemoglobin (104 g/L versus 107 g/L; p =0.005). 5% were Vitamin A deficient based on retinol binding protein <0.7 µmol/L. Furthermore, 74% of children had signs of inflammation (C-reactive protein >5mg/L and/or alpha-1-glycoprotein >1 g/L).

Conclusions: The high rates of anaemia, stunting, and inflammation all indicate a high burden of disease and/or malnutrition among these young children. Children with recent fever were more likely to be anaemic which might have implications for physical and cognitive development. Interventions must target early life to prevent irreversible consequences.

Open Access Conference Proceeding (Abstract)

Rice Fortified with Iron in School Meals Improves Cognitive Performance in Cambodian School Children

Marion Fiorentino, Marlene Perignon, Khov Kuong, Kurt Burja, Kannitha Kong, Megan Parker, Jacques Berger, Frank Tammo Wieringa

European Journal of Nutrition & Food Safety, Page 769-770
DOI: 10.9734/EJNFS/2015/21082

Objectives: Nutritional status can have a large impact on schoolperformance in children, with micronutrient deficiencies affecting cognitive performance and school attendance through increased morbidity. The FORISCA-UltraRice+NutriRice Trial in Cambodia tested impact of multi-micronutrient fortified rice (MMFR) through the WFP school meal program (SMP) on micronutrient status, health and cognitive performance.

Methods: The FORISCA-UltraRice+NutriRice study was a cluster-randomized, double-blinded, placebo-controlled trial in 9500 schoolchildren. Sixteen schools participating in WFP-SMP were randomly assigned to receive either MMFR including vitamin A (MMFR+VA), MMFR without VA (MMFR-VA) or unfortified rice (placebo) as breakfast distributed 6 days/week for 6 months. Four additional schools not participating in SMP were randomly selected as control group. Cognitive performance (Raven's Colored Matrices, Block Design and Picture completion), and vitamin A and iron status were determined in 25% of the schoolchildren.

Results: Cognitive performance was significantly correlated to stunting (P<0.05) and total body iron (TBI) at baseline and endline (P<0.05), but not to vitamin A status. Cognitive performance improved in all children (P<0.001). Children receiving MMFR-VA (iron without vitamin A) had significant higher improvements in Block Design scores as compared to children receiving MMFR+VA (iron plus vitamin A, P<0.001) or control (P=0.022), and tended to be higher than placebo (P=0.09).

Conclusions: Iron status, as well as chronic nutritional deprivation (stunting) are both important determinants of cognitive performance in schoolchildren. Improving iron status through fortified SMP can enhance schoolperformance, but interactions with other micronutrients may modify this effect. The optimal dose of micronutrients needs to be established. Funded by USDA/FAS, WFP-DSM consortium and IRD.

Open Access Conference Proceeding (Abstract)

Designing a SBCC Strategy for Rural Malawi Demonstrates Potential of SUN Movement

Mutinta Hambayi, Stephen Kodish, James Mtonga, Trust Mlambo, Nancy Arbuto

European Journal of Nutrition & Food Safety, Page 1036-1037
DOI: 10.9734/EJNFS/2015/21228

Objectives: Nutrition programs addressing chronic malnutrition require social and behavior change communication (SBCC) that resonates with communities and addresses specific cultural and contextual challenges. The objective was to develop a culturally relevant SBCC strategy for Ntchisi district, Malawi as part of a WFP-supported government stunting prevention program.

Methods: We conducted interviews with national and district-level stakeholders and reviewed materials on local nutrition-related SBCC activities. We conducted formative research using participatory community workshops, in-depth interviews, and ethnographic methods to understand infant and young child feeding (IYCF) practices and perceptions of a lipid-based nutrition supplement (LNS). We applied these findings along with knowledge from the peer-reviewed scientific literature around effective SBCC to develop an Ntchisi district-specific SBCC strategy

Results: National and district-level stakeholders are united through the SUN movement to reduce stunting. The government of Malawi has a National Education and Communication Strategy (NECS) based on SUN tenants; however, most stakeholders could not articulate how to operationalize NECS. Nonetheless, by aligning with the NECs strategy, stakeholders welcomed the development of a Ntchisi-specific SBCC strategy. Results from the formative research guided the tailoring of NECs messages to generate salient communication targeting unique challenges and facilitating factors of the lean, harvest, and post-harvest seasons around IYCF

Conclusions:  This work demonstrated how a national-level commitment to the SUN movement can facilitate community-level operations.  Supplementing SUN materials with results from formative research is necessary for context-specific and culturally-appropriate approaches to behavior change.

Open Access Conference Proceeding (Abstract)

Iodised Salt Consumption in Medical Colleges of India

Rahul Srivastava, O. P. Aslesh, Kapil Yadav, Vivek Gupta, Chandrakant Pandav

European Journal of Nutrition & Food Safety, Page 771-772
DOI: 10.9734/EJNFS/2015/21083

Objectives: To assess the knowledge regarding Iodine deficiency disorders and iodized salt among selected persons involved in providing cooked food to the doctors and students of the Medical colleges of India and to study the procurement and storage practices and iodine content of salt in kitchens of Hostels and Canteens of the Medical colleges of India

Methods: Cross sectional study was conducted involving 24 medical colleges in 11 states. Knowledge assessment of 96 person responsible for purchase of salt in hostel/canteen kitchen and 97 supervisors were conducted. Salt samples from 135 hostel/canteen kitchen were tested for iodine content using titration.

Results: Among the participants responsible for purchase of salt in the canteen, 80.2% have heard about iodine and 82.3% think that iodine is necessary for better health. Eighty five percent of the purchasing personnel think that it was necessary to take iodized salt. Out of the total, 85% of purchase in charge and 93% of supervisors said that they purchase only iodized salt for the hostel/canteen kitchen. Only 31.9% of the salt samples were stored in air tight containers. Eighty one percent of salt samples received were adequately iodized.

Conclusions: The knowledge regarding the Iodine Deficiency Disorder and iodized salt was found to be adequate in the study and has resulted in emphasis on purchase of Iodized salt. But the existence of inadequately iodized salt in the samples collected shows the need for strict monitoring and enforcement of Prevention of Food Adulteration act.

Open Access Conference Proceeding (Abstract)

Household Utilization of Iodized Bouillon Cubes Affects Iodine Intake in Senegal

Banda Ndiaye, Kendra Siekmans, Ismael Ngnie Teta, Abdulaziz Adish, Roland Kupka, Mouhamadou Guelaye Sall

European Journal of Nutrition & Food Safety, Page 898-899
DOI: 10.9734/EJNFS/2015/21153

Objectives: To prevent iodine deficiency, Senegal mandated the iodization of all salt produced, imported or distributed.  There has been a dramatic increase in use of bouillon, which is claimed to contain iodine in Senegal. We undertook this survey to better understand the extend of bouillon cube use in the context of salt iodization.

Methods: A nationwide cross-sectional stratified cluster sample household-level survey was conducted to measure urinary iodine concentration in women 15-45 years and children 6-12 years, iodized salt and bouillon consumption, and iodine concentration in salt available in households. In all, 3,768 households were surveyed including 7,980 women and 6,309 children. 

Results: Only 56% of households surveyed had iodized salt. Average iodine concentration in salt was 22ppm. Average per capita daily household consumption was 4.79 g salt (5.01g urban, 4.60g rural; P<0.001) and 3.98 g bouillon cube (4.29g urban, 3.74g rural; P< 0.05). Median urinary iodine concentration in children was 104.42µg/l (141.25µg/l urban, 82.63µg/l rural) and 92.20µg/l for women (114.73µg/l urban, 72.95µg/l rural).

Conclusions:  This study shows that household consumption of bouillon cubes is high in Senegal; mean UI seems to be adequate in urban setting but insufficient in rural areas, suggesting a lower intake of iodine from iodized salt/bouillon cube.  Adequate iodine concentration in bouillon cube could be an avenue to tackle IDD in Senegal; however, further research is warranted on current content and bioavailability of iodine in bouillon cube as well as feasibility of iodization of bouillon cube as complement to iodized salt in Senegal to guide decisions.

Open Access Conference Proceeding (Abstract)

Prevalence of Vitamin a Deficiency among Infants Participating in the Mama SASHA Proof of Concept Project in Western Kenya

Frederick Grant, Donald Cole, Kirimi Sindi, Carol Levin, Dean Garett, Simon Kariuki, Hermann Ouedarogo, Cornelia Loechl, Rhona Baingana, Mary Oyunga, Jan Low

European Journal of Nutrition & Food Safety, Page 1038-1039
DOI: 10.9734/EJNFS/2015/21229

Objectives: Vitamin A (VA) deficiency (VAD) is a significant burden among children under-5-years-old and pregnant and lactating women in sub-Saharan Africa. We assessed the levels of VA and prevalence of VAD among children age 6-23 mo in 2 counties in western Kenya.

Methods: Dry-Blood-Spot (DBS) samples were obtained from 1838 infants in a community-based cross-sectional survey. Laboratory analysis of retinol-binding protein (RBP) and C-reactive protein (CRP) was carried out using a rapid EIA to estimate VA and subclinical inflammation statuses, respectively. A validation of DBS as a matrix using 60 matching serum-DBS samples was carried out. Values were adjusted for influence of inflammation using CRP (CRP, >5 mg/L) and population prevalence of VAD (RBP<0.825 µmol/L, biologically equivalent to 0.70 µmol/L retinol) estimated.

Results: Mean (geometric±SD) concentration of RBP was adequate (1.56±0.79 µmol/L) with inflammation-adjusted mean (±SE) prevalence of VAD being high (18.3±1.1%). The level of CRP was within normal range (1.06±4.95 mg/L) whilst 18.4±0.9% had subclinical inflammation (CRP>5 mg/L). VAD was not associated with child sex (Chi-squared, Χ2=0.42, P=0.51), child nutritional status (wasting (P=0.68) and stunting (P=0.91), reported child intake of VA capsule within the past 1 year (P=0.84), maternal VA nutritional knowledge (Χ2=0.10, P=0.80), or reported maternal intake of VA capsule within 2 months of delivery (P=0.27). Older children had a 10% increased risk of VAD.

Conclusions: Prevalence of VAD in this sample of infants was high irrespective of intake of VA capsule or maternal VA nutrition knowledge. A sustainable food-based intervention in this area of western Kenya to combat VAD especially in pregnant women and infants is warranted.

Open Access Conference Proceeding (Abstract)

The Efficacy of Malunggay Leaves Sprinkle in Improving the Height and Weight, Iron and Vitamin A Status of 8-10 Years Old Schoolchildren

Leah A. Perlas, Clarita R. Magsadia, Josefina A. Desnacido, Michael E. Serafico, Rowena V. Viajar, Emily O. Rongavilla, Glenda P. Azana, Trinidad P. Trinidad

European Journal of Nutrition & Food Safety, Page 773
DOI: 10.9734/EJNFS/2015/21084

Objectives: The Efficacy of Malunggay Leaves Sprinkle in Improving the Height and Weight, Iron and Vitamin A Status of 8-10 Years Old Schoolchildren

Methods: Participants were underweight children aged 8 – 10 years, grouped into: 60 control and 61 experimental. The experimental group was fed snack foods with 3 g of MLP. The control group was given the same snack foods without MLP. Feeding was supervised. Height and weight, food intake, and biochemical parameters (hemoglobin, ferritin, and retinol) were measured before and after 120 feeding days.

Results: Consumption of snack foods for 120 days significantly increased nutrient intakes of the children. Greatest increase was recorded for vitamin A intake of children given 3 g MLP. The endline vitamin A intake was more than the requirement for Vitamin A. Increase in height and weight was recorded for both groups. Proportion of severely thin children decreased from 11.7% to 5.0% among children with MLP. Increase in hemoglobin levels was greater in children with MLP. Retinol levels increased in both groups.

Conclusions: Regular consumption of malunggay leaves may help alleviate VAD and IDA.

Open Access Conference Proceeding (Abstract)

Testing Feasibility of Delivering Vitamin A to Newborns in Bangladesh’s Health Care System

S. Kaushik, Rolf Klemm, Lesley Oot, Zeba Mahmud

European Journal of Nutrition & Food Safety, Page 900-901
DOI: 10.9734/EJNFS/2015/21154

Objectives: Supplementing newborns with vitamin A within 48 hours of birth has been shown to reduce infant mortality in Bangladesh, India and Indonesia. This study evaluated the feasibility of delivering vitamin A to newborns through existing maternal and child health services in Bangladesh.

Methods: Two sub-districts in each of 3 districts were randomized to one of two newborn vitamin A supplement (NVAS)distribution strategies: (1) providing theNVASandadministration instructions to pregnant women during clinic-based ANC visits (ANC model), and (2) having a health worker directly dose newborns during a post-natal visit (PNC model).All intervention components (i.e. health worker training, vitamin A capsule supplies, delivery of education messages and birth notification) were implemented through the existing health infrastructure.  Primary outcomes, assessed by a pre-post survey, included coverage (% of newborns dosed) and timing of dose (% dosed within 48 hrs of birth) in December 2010 and June 2011.

Results: 54% and 40% of newborns were supplemented in ANC and PNC models, respectively. 75%of dosed infants were reached within 48 hours of birth. Integrating NVAS into the health program did not increase ANC coverage, but significantly increased post-natal visits in both models(from 38% to 67%  and 30% to 62% in the ANC and PNC models, respectively).  Newborn VAS dosing was positively perceived by health workers and mothers.  There were no serious side-effects.

Conclusions: Introducing newborn VAS through existing public maternal and child health services is feasible in Bangladesh.

Open Access Conference Proceeding (Abstract)

Food Fortification Monitoring and Evaluation Framework: Operationalizing the Uganda National Fortification Guidelines

Abel Muzoora, Elizabeth Madraa, Margaret Kyenkya, Nancy Adero, Sarah Ngalombi

European Journal of Nutrition & Food Safety, Page 774-775
DOI: 10.9734/EJNFS/2015/21085

Objectives: The Government of Uganda has stepped up efforts in recent years to address malnutrition. As part of these efforts, in July 2013, Uganda shifted from a voluntary project-based model for food fortification to a public-private partnership mandatory program. This was mandated by 2011 Food and Drugs amendment Regulations. To support the implementation of this program, the government recognized the need for a centralized system that tracks this information and provides regular feedback to the various stakeholders.

SPRING, in partnership with the Ministry of Health, facilitated the development a monitoring and evaluation framework that will be the basis of this feedback system.

Methods: A meeting was convened in October 2013 with stakeholders from key government groups as well as representatives from industries, donors and implementing partners, together comprising the M&E technical working group on food fortification. Participants were asked to agree on a standard list of fortification indicators relevant at sector, national and international/regional level and to identify how food fortification indicators can be streamlined into existing health management information systems, censuses and surveys.

Results: The final draft framework incorporated elements from the World Health Organization flow chart for fortification M&E but incorporated some innovative elements to respond to Uganda’s context. For instance, the framework made an effort to incorporate existing data flow from Uganda Bureau of Statistics into the reporting structures.

Conclusions: The final draft framework is going through approval by the National Technical Working group on Food Fortification. If approved, this framework should strengthen the national food fortification systems.

Open Access Conference Proceeding (Abstract)

Micronutrient Deficiencies in Pre-school Age Children and Women of Reproductive Age in Jordan

James P. Wirth, Nichols Erin, Ibrahim Khatib, Hanan Masa'd, Rawhieh Barham, Nancy Aburto, Svenja Jungjohann, Kevin Sullivan, Mary Serdula

European Journal of Nutrition & Food Safety, Page 902-903
DOI: 10.9734/EJNFS/2015/21155

Objectives: Jordan's 2010 National Micronutrient Survey assessed the prevalence and severity of anemia and micronutrient deficiencies in Jordanian women and children.

Methods: A stratified multistage cluster sampling was used to establish a nationally representative household-based sample of Jordanian children (12 - 59 months) and non-pregnant women of reproductive age (15-49 years). Weighted descriptive statistics were used to calculate national prevalence and multivariate analyses were undertaken for the determination of risk factors of vitamin D deficiency

Results: Anemia in children (hemoglobin < 110g/L) and women (hemoglobin < 120g/L) was a mild (17.0%) and moderate (30.6%) public health problem, respectively. Vitamin A deficiency (serum retinol < 0.70 umol/L) was prevalent in 18.3% of children and 4.8% of women. Vitamin D deficiency (25(OH)D3 < 11.0 ng/mL and < 12.0 ng/mL in children and women, respectively) was prevalent in 19.8% of children and 60.3% of women. Vitamin D deficiency was significantly more likely in women who routinely cover themselves with a scarf compared to those women who do not cover. In urban areas, children whose mothers were vitamin D deficient were more likely to be vitamin D deficient than children whose mothers were not deficient.

Conclusions: With the exception of vitamin A, a higher burden of micronutrient deficiencies is seen in Jordanian women than children. Vitamin D deficiency in women is the most prevalent micronutrient deficiency in Jordan with approximately 3 out of 5 women being deficient.

Open Access Conference Proceeding (Abstract)

Linearity, Reproducibility and Comparison of iCheckTM CAROTENE with Spectrophotometer and HPLC for Evaluation of Total Carotenoids in Cassava Roots

Peter A. Kulakow, Elizabeth Y. Parkes, Simone K. Friedrich, Florian Schweigert, Oladeji Alamu, Norbert Maroya, Busie Maziya-Dixon

European Journal of Nutrition & Food Safety, Page 1040-1041
DOI: 10.9734/EJNFS/2015/21230

Objectives: Breeding cassava roots with enhanced levels of proVitamin A carotenoids (biofortification) is a cost effective approach to overcome vitamin A deficiency, especially for women and children in rural areas who are vulnerable with livelihoods dependent on cassava. Biofortification breeding needs rapid, economical screening tools for beta carotene for 100s to 1000s of genotypes. The screening process needs to be completed in weeks so stem cuttings of selected genotypes can be established in the next breeding stages. This is particularly important as biofortification becomes mainstreamed in many cassava breeding programs in Africa. Here we report a rapid portable screening device developed by BioAnalyt (iCheckTM CAROTENE ) to quantify total carotenoids. This approach can be used at both on-station and off-station field trials often in rural areas without access to laboratories or electricity. Up to 60 samples per day can be completed with a small group of trained technicians. The iCheckTM CAROTENE results obtained were compared with laboratory TCC values using HPLC and spectrophotometer to validate the method.

Methods: Twelve cassava genotypes obtained from IITA as fresh storage roots were compared by three different analytical methods: iCheckTM CAROTENE, laboratory photometer and HPLC to assess reproducibility, correlation and linearity, for quantifying beta carotene.

Results: Results showed the two photometric methods resulted in nearly identical measurements (r2 = 0.99). The comparison of two different methods (iCheckTM CAROTENE and HPLC showed high correlation of r2 = 0.94.

Conclusions: iCheckTM CAROTENE holds promise to facilitate screening of large populations of cassava genotypes at early cassava breeding stages.

Open Access Conference Proceeding (Abstract)

Assessment of Jordan's Wheat Flour Fortification External Monitoring System

James P. Wirth, Erin Nichols, Hanan Masa'd, Rawhieh Barham, Quentin W. Johnson, Mary Serdula

European Journal of Nutrition & Food Safety, Page 776-777
DOI: 10.9734/EJNFS/2015/21086

Objectives: To assess the performance of the external monitoring system utilized in Jordan according to the CDC criteria for surveillance systems.

Methods: The performance of the external monitoring system was assessed qualitatively following the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems. Specifically, seven attributes of the system (simplicity, flexibility, data quality, acceptability, representativeness, timeliness, and stability) were assessed.

Results: The monitoring system uses five key indicators that are representative, simple to collect, and collected in a flexible manner. Indicators include 1) monthly production of wheat flour, 2) monthly number of 25 kg premix boxes used, 3) average addition rate (calculated), 4) addition rate as a % of 250 g/MT target (calculated), and 5) iron concentration in flour sample. While data on production of fortified flour and premix utilization can be provided in a timely manner, on-site mill monitoring and flour sample collection are more challenging due to resource constraints.

Conclusions: The frequent collection of a small number of indicators can provide program managers with timely information with which to base decisions, and successfully documents the performance of each mill and the whole fortification program. Moreover, the system is acceptable to participating agencies and millers and is stable due to mandatory fortification legislation which provides the legal framework for external monitoring. This system can serve as a model for other national fortification programs considering external monitoring approaches.

Citation: Wirth JP et al. Nutrients, 11:4741-4759,2013.

Open Access Conference Proceeding (Abstract)

Adherence to Intake Recommendations of Lipid-based Nutrient Supplements (LNS) and Iron/Folic Acid (IFA) among Pregnant and Lactating Women (PLW) in a Community Health Program Setting

Kassandra Harding, Christine Stewart, Susana Matias, Malay Mridha, Stephen Vosti, Kathryn Dewey

European Journal of Nutrition & Food Safety, Page 1042-1043
DOI: 10.9734/EJNFS/2015/21231

Objectives: Limited knowledge exists on sustained adherence to small quantity LNS for PLW and how this compares to other prenatal supplements, particularly in programmatic settings. We aimed to address these gaps.

Methods: A random subsample of women (n=360) from an ongoing LNS effectiveness trial were selected for home interviews about use and preferences of LNS or IFA.  Purposively selected women (n=16) and key informants (n=18) participated in in-depth interviews about perceptions and acceptability of LNS.

Results: Prevalence of high-adherers (≥70%) based on self-reported supplement consumption was 67%, 68%, 81%, 87% and 71% among LNS recipients during pregnancy, early and late lactation and IFA recipients during pregnancy and early lactation, respectively (P=0.044). Programmatic factors (e.g. distribution and visits by program staff) were significantly associated with reported high adherence in all groups. Among LNS recipients, overall supplement acceptability score was positively associated (odds ratio (OR): 2.94; P<0.0010) and reports of previous stillbirths were negatively associated (OR: 0.12; P=0.0054) with reported high-adherence. In in-depth interviews, women reported benefits of taking LNS to both themselves and their infants, but some faced barriers to consumption such as aversion to LNS odor and taste during pregnancy, forgetfulness, and disruptions in supply.

Conclusions: Adherence to LNS was sustained throughout the physiological periods at levels comparable to other supplementation programs. To achieve high adherence, these results suggest that maternal supplementation programs should focus on programmatic barriers and consider counseling on reminder techniques. Odor and taste acceptability of LNS, particularly during pregnancy, may also need to be addressed.

Open Access Conference Proceeding (Abstract)

Comparison of Methods to Assess Adherence to Small-quantity Lipid Based Nutrient Supplements (SQ-LNS) and Dispersible Tablets among Young Burkinabe Children Participating in a Community-based Intervention Trial

Souheila Abbeddou, Sonja Y. Hess, Elizabeth Yakes Jimenez, Jérôme W. Somé, Rosemonde M. Guissou, Zinewende P. Ouedraogo, Stephen A. Vosti, Jean Bosco Ouedraogo, Kenneth H. Brown

European Journal of Nutrition & Food Safety, Page 1003-1004
DOI: 10.9734/EJNFS/2015/21209

Objectives: Adherence to supplementation provided during an intervention trial can affect study outcomes. We compared different approaches for estimating adherence to SQ-LNS and dispersible tablets in a randomized clinical trial in Burkina Faso to evaluate concordance among results and factors associated with reported non-adherence.

Methods: 2453 children (9-18 mo) were randomly assigned to receive daily 20 g SQ-LNS with varying contents of zinc and a dispersible tablet (0 or 5mg zinc). During weekly home visits, reported adherence to SQ-LNS and tablets was collected through caregiver interview and disappearance rate was calculated based on unused packages. In a randomly selected subgroup (n=192), 12-h home observations were completed when children were 11 and 16 mo of age, to assess supplement consumption.

Results: Average daily reported SQ-LNS and tablet adherence was 97%±6%. SQ-LNS and tablet disappearance rate also showed high weekly adherence (98%±5%). By contrast, home observation found that only 68% and 58% of children at 11 and 16-mo, respectively, received SQ-LNS during the observation periods (Rho=0.06, P=0.294 reported vs. observed), and fewer (36 and 28%) received a tablet at 11 and 16-mo (Rho=0.11, P=0.05).  Fever, diarrhea, malaria, vomiting and loss of appetite reduced significantly reported consumption of SQ-LNS and, to a lesser extent, tablet (P<0.0001). 

Conclusions: Discrepancies among observed and reported results suggest possible over-reporting of adherence to products and/or that consumption occurs outside the 12h home observation period. Child morbidity may change child acceptance or caregiver perceptions regarding the suitability of supplementation. Better methods are needed to assess adherence in community supplementation trials.

Open Access Conference Proceeding (Abstract)

Effective Modalities to Improve Pregnant Women’s Compliance to Daily Prenatal Iron Supplementation

Aregash Samuel, Girma Mamo, Samson Gebremedhin, Tibebu Moges, Tsehai Assefa, Amha Kebede

European Journal of Nutrition & Food Safety, Page 778-779
DOI: 10.9734/EJNFS/2015/21087

Objectives: Prenatal Iron Supplementation (PIS) has a paramount contribution for reducing maternal mortality. The coverage and compliance in Ethiopia is 17.3% and 0.4% respectively. The aim of this study was to determine the coverage of and adherence to prenatal PIS and to identify factors affecting utilization of the service.

Methods: The formative research was conducted in eight selected woredas, namely Alamata, Enderta, Menze Mama, Menze Gera, Ada Berga, Meta Robi, Sankura and Meskan. The study applied descriptive cross-sectional design with quantitative and qualitative elements targeted at determining the coverage and adherence of PIS and identifying factors affecting utilization of PIS.

Results: Among women who gave birth in the preceding year, 40.1% took iron tablets during the pregnancy. The coverage exceeded 50% in Sankura, Enderta and Alamata Woredas; whereas, only one-in-three and one-in-ten women were supplemented in Menze Gera and Menze Mama woredas respectively. However, only 3.6% of them took the supplement for the recommended 90 or more days.

Conclusions: The coverage among women who gave birth in the preceding year and among women who were pregnant at the time of the survey was 40.1% and 38.5%, respectively. Lack of adequate stock and poor logistic system, lack of training for front line health workers on ANC, lack of BCC and job aid materials, fear of side effect, fear of taking medication during pregnancy, lack of awareness on the benefits of the supplement have contributed for the low coverage and adherence to PIS.

Open Access Conference Proceeding (Abstract)

Combining Nutritional Communication and Supplementation of Multi-Micronutrient to Improve Nutritional Status of Vietnamese Children Aged 6-23 Months

Huong Cao, Hop Le

European Journal of Nutrition & Food Safety, Page 1044-1045
DOI: 10.9734/EJNFS/2015/21232

Objectives: To determine effect of weekly dose of MNP combining with nutritional communication on hemoglobin concentration and anthropomectric index of children aged 6-23 months.

Methods: A randomized controlled trial was done:  Control group (n=100) and intervention group (n=99): the mothers were guided to use combination of 7 food groups recommended by WHO to prepare complementary food with adding MNP for children. The dose of MNP was 3 sachets per week during 20 weeks. Component of sachet: iron (12.5 mg); zinc (5 mg); vitamin A (300 mcg), vitamin D (10 mg), vitamin c (30 mg)  vitamin B1, B2, B6 each (0.5 mg), vitamin B12 (0,9 µg); vitamin E (5 mg); Niacin 6 mg);  Copper (0,56), iodince (90 µg of); selemium (17 µg).

Results: Before intervention, there is not significant difference between two group on hemoglobin concentration, anthropomectric index, prevalence of malnutrition and anemia: 55,1% (intervention group) and 51,1%  (control group).  After intervention, improvement of   hemoglobin concentration in the intervention group (7.2±6.6 g/L) was significant higher than that in control group (1,9±4.8 g). Prevalence of anemia was significant decreased in both group, however, it was lower (13,5%)  as compared to control group (33%). Height for Age Z-score in the intervention group was lightly increased  while it t was decreased in control group, that made significant difference  on Height  for Age -score between two groups

Conclusions: Combination of nutritional communication and MNP supplementation had positive effect in reduction of anemia and improving hemoglobin concentration and Height for Age Z-score.

Open Access Conference Proceeding (Abstract)

Impact of Small-quantity Lipid-based Nutrient Supplements on Infant and Young Child Feeding Practices

Mary Arimond, Souheila Abbeddou, Seth Adu-Afarwuah, Ulla Ashorn, Kenneth Brown, Jaimie Hemsworth, Sonja Hess, Elizabeth Jimenez, Chiza Kumwenda, Anna Lartey, Harriet Okronipa, Jean-Bosco Ouedraogo, Stephen Vosti, Kathryn Dewey

European Journal of Nutrition & Food Safety, Page 904-905
DOI: 10.9734/EJNFS/2015/21156

Objectives: Lipid-based nutrient supplements (LNS) are energy-dense and could change infant and young child feeding (IYCF) practices by changing caregiver perceptions of needs and/or child appetite and demand for breast milk and local complementary foods. We hypothesized that LNS (10-40g/day) would not have significant impacts on IYCF practices.

Methods: Infants in three randomized controlled trials were assigned to receive either LNS from 9-18 mo (Burkina Faso) or 6-18 mo (Ghana and Malawi) or a delayed intervention (DI). All caregivers were given brief didactic messages promoting continued breastfeeding and diverse diets at first distribution of LNS; messages were repeated periodically in Ghana and Malawi (all groups) and not repeated systematically in Burkina Faso. IYCF practices were assessed at 18 mo by caregiver recall of the preceding day and week.

Results: The reported prevalence of continued breastfeeding did not vary by intervention group in any site, and was 97%, 74%, and 89% in Burkina Faso, Ghana, and Malawi. Reported frequency of breastfeeding yesterday also did not vary. The proportion of infants meeting the WHO recommendation for minimum dietary diversity (4+ food groups) did not differ by intervention group and was 37%, 75%, and 68% in Burkina Faso, Ghana and Malawi. In Burkina Faso, infants in the LNS group were more likely to meet the WHO recommendation for number of meals/snacks yesterday (79%, vs. 66% in DI group).

Conclusions: Provision of LNS did not change most IYCF practices but increased frequency of feeding in one site.

Open Access Conference Proceeding (Abstract)

Review on the Impact of Orange Fleshed Sweet Potato on the Reduction of Vitamin A Deficiency under Five Years Old Children and Lactating Women in Ethiopia

Henok Kurabachew

European Journal of Nutrition & Food Safety, Page 1005-1006
DOI: 10.9734/EJNFS/2015/21210

Objectives: To combat vitamin A deficiency problem under five years old children and lactating women through food-based intervention which is sustainable approach under Ethiopian circumstance where supplementation of capsule and food fortification is inaccessible.

Methods: For this approach orange-fleshed sweet potato which is rich in β-carotene is used as a potential crop to mitigate vitamin A deficiency.  Given its high provitamin A content, low input requirements and adaptation to African farming systems, orange-fleshed sweetpotatoes can make a sustainable contribution to human vitamin A nutrition. In this regard different food products such as: flat bread, complementary porridge, bread are being developed in Tigray and Southern Nation Nationality Peoples Regional States, Ethiopia from flours of OFSP blended with flours of other crops such as maize and wheat using different combination and the proximate analysis of the products were done accordingly.

Results: The new products were found to be richer in vitamin A content compared to the local staple food of the community and the products were accepted by the community.

Conclusions: Therefore, orange-fleshed sweet potato can be used for the long-term and sustainable intervention to prevent vitamin A deficiency in Ethiopia where it causes the death of children and lactating woman. So, much should be done on recipe development, nutritional education and popularization of orange-fleshed sweet potato to the rural community where supplementation capsule and food fortification is not consistently available to solve the deep-rotted vitamin A deficiency the country is facing.

Open Access Conference Proceeding (Abstract)

Urinary Excretion of 8-isoprostane-F2α, a Biomarker of In vivo Lipid Peroxidation and Oxidative Stress, is Increased in Pregnant Ghanaian Women Taking 60 mg Iron Compared to 20 mg Iron and Multiple Micronutrients

Lacey Baldiviez, Seth Adu-Afarwuah, Per Ashorn, Theresa Pedersen, John Newman, Kathryn Dewey

European Journal of Nutrition & Food Safety, Page 1046-1047
DOI: 10.9734/EJNFS/2015/21233

Objectives: To compare the effects of 3 different iron-containing supplements on 8-isoprostane-F2α, a subclinical indicator of oxidative stress, in pregnant women in Ghana.

Methods: Pregnant women were randomly assigned to receive one of the following 3 interventions: Fe/FA: 60 mg iron and 400 μg folic acid capsule, MMN: 20 mg iron and 18 micronutrients capsule, or LNS: 20 mg iron and multiple micronutrients in a lipid-based nutrient supplement as part of the International Lipid-based Nutrient Supplement trial. We measured urinary 8-isoprostane-F2α and creatinine, to calculate 8-isoprostane-F2α: creatinine ratio in a sub-sample of 217 women at <20 wk and 36 wk gestation.

Results: The overall effect of intervention group on mean (± SE) 8-isoprostane-F2α: creatinine at 36 wk was significant (p=0.04). The significant pairwise comparison was between the Fe/FA group (1.87±0.12 ng/mg creatinine) and the MMN group (1.48±0.09, p=0.02). The LNS group (1.64±0.10) was not significantly different from either of the other two groups.

Conclusions: Our findings suggest that an increase in oxidative stress may occur with daily 60 mg iron compared to 20 mg iron with multiple micronutrients among pregnant women in Ghana.

Open Access Conference Proceeding (Abstract)

Iron Status is Associated with Body Composition in Cambodian Infants and Young Children

Frank Tammo Wieringa, Jutta Skau, Chhoun Chamnan, Henrik Friis, Marjoleine Amma Dijkhuizen, Jacques Berger, Kim Michaelsen, Nanna Roos

European Journal of Nutrition & Food Safety, Page 780-781
DOI: 10.9734/EJNFS/2015/21088

Objectives: Malnutrition in early childhood predisposes to a higher risk for non-communicable diseases such as obesity and cardio-vascular diseases later in life through not fully understood metabolic alterations. Little is known about body composition in early childhood in relation to micronutrient status.

Methods: Infants were recruited through the WinFood project which studied the effectiveness of fortified complementary foods (FCF) in improving health and growth. Anthropometry (weight, height, MUAC, skinfolds), body composition (deuterium dilution) and micronutrient status (iron, zinc, vitamin A) were measured at 6 mo and 15 mo of age.

Results: From 269 Cambodian infants data on body composition and micronutrient status were available for both time-points. Lean body mass increased with 1.96 ±0.59 kg, whereas percentage body fat decreased from 21.7% to 14.9% over the study period (P<0.001). At 6 and 15 mo of age, body fat was strongly correlated to ponderal growth (WHZ, P<0.01) but not to length growth (HAZ) or gender. Vitamin A and zinc status were not related to fat mass. Iron status at 6 and 15 months of age significantly correlated with body composition, with infants with no iron stores at endpoint having a higher fat mass (14.0% vs 15.5%, P=0.02). Infants without iron deficiency during the study had significant lower fat mass (13.3%) than infants who were iron deficient at both time-points (16.4%, P<0.01)

Conclusions: Iron status, but not vitamin A or zinc status, was related to body composition in Cambodian infants. FCF aimed at improving iron status in early childhood may have long-term health benefits.

Open Access Conference Proceeding (Abstract)

Fish Consumption and Iodine and Vitamin D Status

Izzeldin Hussein, Samia Al Ghanamia, Kebreab Ghebremeskel, yoeju Min

European Journal of Nutrition & Food Safety, Page 1048
DOI: 10.9734/EJNFS/2015/21234

Objectives: To investigate the effect of fish consumption on iodine and vitamin of Omani School Children.

Methods: Omani school children aged 9 and 10 years were recruited from two schools in Muscat Governorate in Oman.  The children were randomly divided in to fish and control groups. The fish group received fish menu lunch 4 times a week. The control group did not receive fish or any other dietary supplement. Ethical approval from the Ministry of Health of Oman and parental consent were obtained.

The intervention period was sixteen weeks (four months).

Results: The children who received fish meal for sixteen weeks had higher levels of urinary iodine and plasma vitamin D compared with the control group (p<0.0001).

Conclusions: Regular consumption fish is effective in enhancing iodine and vitamin D status of children.

Open Access Conference Proceeding (Abstract)

Consumption of Red Palm Oil and Relationships with Vitamin A Status, Region, and Household Characteristics in a National Survey of Women and Young Children in Cameroon

Martin Nankap, Reina Engle-Stone, Alex Ndjebayi, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 782-783
DOI: 10.9734/EJNFS/2015/21089

Objectives: Red palm oil (RPO) is an important plant source of vitamin A (VA) in Cameroon, where ~210,000 tons were produced in 2011. We conducted a national survey of children and women to assess the prevalence of VA deficiency, frequency and amount of RPO consumption and factors associated with RPO consumption.

Methods: 1002 households, each with a child 12-59 mo and a woman 15-49 y, were enrolled in a nationally-representative cluster survey with 3 strata (North, South, Cities). VA status was assessed by inflammation-adjusted plasma retinol-binding protein (RBP). RPO consumption was measured by FFQ and 24 h recall.

Results: 35% of children had low adjusted RBP. 54.9% of children and 57.8% of women consumed RPO the previous week, with a mean frequency of 12.2 times/week and 8.7 times /week among consumers, respectively. Median RPO consumption (among consumers) on the previous day was 10.7 g/d for children and 21.4 g/d for women, contributing ~1/3 of total VA intake nationally. RPO consumption was greater among women and children in the South compared with the North and Cities, but did not vary by socio-economic group. Weekly frequency of RPO intake was positively correlated with adjusted RBP among women and children nationally; however, at the regional level, the relationship was significant only among women in the South.

Conclusions: Promoting RPO consumption is a potential strategy to increase VA intakes in Cameroon without increasing the risk of excessive intake. Formative research is needed to understand barriers to RPO consumption.

Open Access Conference Proceeding (Abstract)

Effect of Deworming on Hemoglobin Concentration in Children from 2 to 15 Years from the Bengo Province, Angola

Miguel Brito, Manuel Lemos, Clara Mirante, Sofia Moura, Carlos Mayer

European Journal of Nutrition & Food Safety, Page 1007-1008
DOI: 10.9734/EJNFS/2015/21211

Objectives: The most common causes of anemia are micronutrient deficiencies, but other factors may influence namely inflammation, parasitic infections and inherited disorders. One strategy to combat micronutrient deficiencies is supplementation, yet, in zones with high prevalence of Schistosomiasis or Soil Transmitted Helminthes (STH), supplementation could be not sufficient.

The aim of this study was to evaluate the effects of deworming, on hemoglobin concentration, in children from 2 to 15 years, from Bengo.

Methods: A total of 429 children between 2 to 15 years were involved. Nutritional status and anemia were evaluated. Urine and feces samples were collected for diagnosis of Schistosoma haematobium and STH. Praziquantel (40 mg/Kg) and Albendazol (400 mg) were administrated. All parameters were determined at baseline and after 6 months.

Results: The prevalence at baseline of S. hematobium was 61,9%, Trichuris trichuria 15,3%, Ascaris lumbricoides 11,8 %, Hymenolepis nana 7,8%, and hookworm 3,8%. Anemia was detected in 71,2% of the children (mild 11,7%, moderate 57,1% and severe 2,3%). Average hemoglobin concentration was 106,8 g/L. 6 months after treatment the prevalence of S. hematobium decreased to 44,5%, Trichuris trichuria to 10,9%, Ascaris lumbricoides to 5,0 %, Hymenolepis nana to 6,7%, and hookworm to 0,8%.The average hemoglobin concentration increased by 7,9 g/L and the prevalence of anemia declined to 49,5% (mild 17,1%, moderate 32,2% and severe 0,2%).

Conclusions: These results confirm the benefit of deworming on hemoglobin concentration, even with a single intervention. However it should be clear that integrated intervention aiming nutritional education water treatment, hygiene and sanitation are needed to reduce micronutrient deficiency.

Open Access Conference Proceeding (Abstract)

Household Food Processing Strategies to Improve Bioavailability of Iron and Zinc in Chickpea and Bean Based Ethiopian Dishes

Hiwot Haileslassie, Carol Henry, Robert Tyler

European Journal of Nutrition & Food Safety, Page 906-907
DOI: 10.9734/EJNFS/2015/21157

Objectives: To determine and improve bioavailability of iron and zinc in chickpea and bean varieties released from research center using food processing strategies applicable at household scale

Methods: Two varieties of chickpea (Cicer arietinum L.) namely Habru and Mastewal and two varieties of bean (Phaseolus vulgaris L.) namely Hawassa Dume and Nasir were obtained from Debreziet and Hawassa research center, respectively. Subsample of seeds were subjected to food processing treatments including soaking for 12, 24 and 48 hours, and germination for 24, 48 and 72 hours. Local recipe was used to prepare dishes with and without treatments (control). Mineral and moisture contents were determined by FAAS and AACC methods, respectively. All experiments were carried out in duplicate.

Results: Mineral analysis of raw chickpea varieties indicated that Mastewal had higher zinc (4.5±0.01 mg/g) and calcium (154.3±5.1 mg/g) while Habru had higher iron (4.6±0.1 mg/g). Iron content of all bean based dishes was in a range of 5.8±0.2 and 6.3±0.2 mg/100 g. Iron varied from 2.8±0.2 to 4.6±0.1 mg/100g in chickpea based dishes with significance difference in seeds germinated for 48 and 72 hour. Zinc ranged from 1.9±0.1 to 3.4±0.1 mg/100g and from 2.9±0.1 to 3.8±0.3 mg/100g in chickpea and bean dishes respectively. Calcium was found between 79.1±2.1 and 173±14.6 mg/100 g in all dishes.

Conclusions: Mineral content of chickpea and bean based dishes were well retained in most of the dishes except in 72 hour germination treatment groups. This information is useful in development of food based strategies to tackle micronutrient deficiency. Anti-nutrients in the dishes are being evaluated.

Open Access Conference Proceeding (Abstract)

Multi-micronutrient Fortified Beverage Delivered through the School-based System Improved Iron Status and Test Scores of Children

Imelda Angeles-Agdeppa, Clarita Magsadia, Mario Capanzana

European Journal of Nutrition & Food Safety, Page 1049
DOI: 10.9734/EJNFS/2015/21235

Objectives: This study aimed to evaluate the effectiveness of fortified beverage on the nutritional status and school performance of school children.

Methods: There were 5000 schoolchildren aged 6 to 12 years old participated in the study. Weight and height were measured among the 5000 children while only 1500 were sub-sampled for the evaluation of hemoglobin level and only 3600 children took the tests. Test questions were developed and administered by school supervisors. Children were fed 200 ml ready-to-drink juice fortified with iron, zinc, lysine, vitamin A and C for 120 days. The beverage was delivered through the school system by a feeding coordinator. Data on hemoglobin level, weight, height and test results were collected at base and end of the study.

Results: At end of the study, prevalence of anemia was reduced from 100% to 60%. The rate of underweight decreased significantly from 16.5% at baseline to 13.5% at end of the study. Percentage mean test scores increased significantly between base and end of the study: English (40% to 60%), Math (35% to 58%), Science (32% to 58%).

Conclusions: Consumption of 200 ml fortified juice drink has contributed to the reduction of anemia and increased tests scores of children.

Open Access Conference Proceeding (Abstract)

Distribution of Iron, Vitamin A and Zinc Deficiencies in Children and Women in Senegal

Banda Ndiaye, Kendra Siekmans, Jacqueline Kung'u, Salimata Wade

European Journal of Nutrition & Food Safety, Page 908-909
DOI: 10.9734/EJNFS/2015/21158

Objectives: Reliable data on the micronutrient status of women and children was needed in Senegal to guide evidence-based decision making on interventions to reduce micronutrient deficiencies (MND). This study presents the findings of the first ever national MND survey carried out in Senegal in 2010.

Methods:  A cross sectional household survey sampled 1,810 households stratified by two urban and two rural zones.  Data were collected on biochemical indicators of iron, vitamin A and zinc deficiency from 1,316 women 15-49 y and 1,887 children 12-59 mo.  The analysis adjusted for sub-clinical inflammation.

Results: Subclinical inflammation affected 27.7% of women and 49.5% of children.  44.7% women and 61.5% children had serum ferritin below 15 or 12 µg/l, respectively. 2.1% women and 18.2% children had serum retinol <0.70 µmol/l; 66.7% women and 39.6% children had serum zinc below cutoff. Only 12.8% of women and 11.6% of children had no MND; 18.4% of women and 15.4% of children had at least 3 coexisting MND. The risk of a child having iron (OR 2.70; [1.49, 4.88]) or vitamin A (OR 13.66; [4.07, 45.84]) deficiency was higher in households where a woman had iron or vitamin A deficiency.  Child anemia (66%) and zinc deficiency were not related to the status of women in the household. Women and children in rural areas were more affected by iron and vitamin A deficiencies compared to urban areas.

Conclusions: MND affect a large proportion of women and children in Senegal. Further study of factors contributing to Intra-household clustering and rural/urban differences of MND is warranted.

Open Access Conference Proceeding (Abstract)

Prevention of Spina Bifida and Folic Acid Intake by Women in Northern Uganda

Femke Bannink, Lieven Bauwens, Rita Larok Otim, Geert van Hove

European Journal of Nutrition & Food Safety, Page 784-785
DOI: 10.9734/EJNFS/2015/21090

Objectives: The intake of folic acid (FA) before conception and during the first trimester of pregnancy can prevent spina bifida (SB).  This paper describes FA intake in women in northern Uganda.

Methods: 15 mothers of children with SB, 394 women attending antenatal clinics, and 35 health workers, working at antenatal clinics at government health facilities were interviewed. SPSS16 was used for data analysis.

Results: A fourth of the mothers of children with SB took FA during late pregnancy, none took FA pre conception or in the first trimester. None had knowledge about FA and SB prevention. Of the women attending ANC 33.5% (132/394) had ever heard about SB, none knew FA could prevent SB. 51% took FA in late pregnancy, none preconception, 17.4% during first trimester. 3.0% said FA was not available. Women staying further from health facilities had a significant lower intake of FA compared to those staying nearby. All said to have eaten food rich in FA. None were aware about fortified foods, nor the importance of early FA intake. Only 6% of health workers understood the importance of early FA intake. All health workers recommended FA intake to women attending ANC. 20% of the health workers said FA supplements are not always available.

Conclusions: FA intake is limited in northern Uganda. This is attributed to late presentation of women at ANC, poor supply chain, and limited understanding about the importance of early FA intake. A combined effort, including food fortification, sensitization of health workers, women, and improving FA supply is recommended.

Open Access Conference Proceeding (Abstract)

Role of Nutrition Education to Overcome Food Taboos and Improve Demand for Iron Tablet Intak during Pregnancy in Rural Communities in Ethiopia

Tigist Mamo Cherkose, Sisay Sinamo, Tilaye Hailemichael

European Journal of Nutrition & Food Safety, Page 1009-1010
DOI: 10.9734/EJNFS/2015/21212

Objectives:  The impact of community based nutrition education in nutrient rich foods intake and iron tablets demand among pregnant women in rural communities in Ethiopia.

Methods: A pre and post intervention cross sectional study was conducted using Lot Quality Assurance Sampling (LQAS) method. Ninety sampled pregnant mothers were taken and all of them participated in the survey. A total of 122 and 110 children were assessed for anthropometry and 12 FGDs were conducted. To ensure high quality data on anthropometry, standard techniques were followed. Selected indicators were compared for changes before and after intervention

Results: The proportion of mothers that avoid nutrient rich food stuffs such as milk, meat and eggs have reduced from 90% to 40%. Making fetus large and the consequent deliveries difficult was the main reason for not eating nutrint rich foods during pregnancy. Other foods such as sugarcane and banana were also prohibited during pregnancy. Moreover, the proportion of mothers who received iron tablets has increased from 5% to 32.6%. The prevalence of underweight (weight-for-age Z score <-2SD) has reduced from 27.1% to 22%. Focus group discussions revealed that nutrient rich food intake as well as mothers' demanding for iron tablets   and taking it has improved in the community.

Conclusions: The behavior of the pregnant mother towards food diversification and intake of nutrient dense food during pregnancy improved. The lessons learned from this study  was that nutrition education focused on food taboos during pregnancy will produce significant results in improving maternal nutrition ,iron intake and  pregnancy outcome.

Open Access Conference Proceeding (Abstract)

The Effects of Fortified Milk on Height and Biomarkers of Zinc and Vitamin C Levels of Schoolchildren

Imelda Angeles-Agdeppa, Clarita Magsadia, Trinidad Trinidad, Mario Capanzana

European Journal of Nutrition & Food Safety, Page 1050
DOI: 10.9734/EJNFS/2015/21236

Objectives: This study aimed to determine the effects of consumption fortified milk on the nutritional status and biomarkers of zinc and vitamin C of schoolchildren.

Methods: About 141 anemic 6 year old schoolchildren participated in the study. These were randomly allocated into three groups: Group 1: 1 glass of milk; Group 2: 2 glasses of milk; and Group 3 had water only. The milk was fortified with iron, zinc, vitamins A & C. Feeding was done for 120 days under supervised regimen. Anthropometric indices were measured at base and end of the study. Similarly, blood samples were collected for the evaluation of zinc and vitamin C levels. Milk consumption was monitored and documented.

Results: There was a significant increase in height in all groups but higher increment was observed in the 2 glasses group. All groups have increased weight from baseline to endline with the 2 glasses group having the highest increment, but were not statistically significant between groups. A significant increasing trend was observed with serum zinc in children fed with milk and more pronounced in children consuming 2 glasses of milk.

Conclusions: Consumption of fortified milk have resulted to increased height, zinc and vitamin C levels of schoolchildren and effects are more pronounced when 2 glasses were taken daily.

Open Access Conference Proceeding (Abstract)

Community Level Fortification: Lessons from Projects in Malawi, Senegal and Tanzania

Alison Mildon, Melani O'Leary, Miriam Yiannakis, Naomi Klaas

European Journal of Nutrition & Food Safety, Page 786-787
DOI: 10.9734/EJNFS/2015/21091

Objectives: Rural smallholder farming communities are inadequately reached by national food fortification initiatives. World Vision projects in Malawi, Senegal and Tanzania explored the implementation and sustainability potential for community level fortification to increase households' access to micronutrients.

Methods: Fortification projects were initiated within an integrated nutrition and health program. Micronutrient premix was added to staple grains during milling at medium scale mills (Malawi), village hammermills (Malawi, Tanzania) or at home after milling (Senegal, Tanzania). In Senegal two community bakeries for fortified bread were established. Partial cost-recovery systems were implemented in all projects but sustainability plans in Malawi and Senegal relied on a transition to independent business models to fund ongoing premix and quality control costs, with community oversight.

Results: The projects introduced a novel method of increasing micronutrient intake which was widely accepted by local communities. More than 20,000 households accessed fortified grains. Common challenges included accessibility of premix supply and quality control services, and cost-recovery. Operating in rural areas increased premix supply costs and limited quality control monitoring by national standards agencies. Sustainability of activities without external funding was limited. Transition to cost-recovery was overcome in Malawi through extensive community sensitization but resulted in a shift to food-to-food fortification in Tanzania. In Senegal, community committees sustained premix procurement through fortified bread sales.

Conclusions: Community level fortification was well accepted and has potential to improve micronutrient intake of rural households unreached by commercially fortified products. Further formative work is needed to identify contextually feasible systems for premix supply, quality control and cost recovery.

Open Access Conference Proceeding (Abstract)

Socially Marketing Micronutrients: The Development of a Multi-channel Communications Campaign in Bolivia

Kimberly Harding, Marion Roche, Ali MacLean, Daniel López de Romaña, Marcelo Loayza, Lizeth Tapia

European Journal of Nutrition & Food Safety, Page 1051-1052
DOI: 10.9734/EJNFS/2015/21237

Objectives: To describe the process for developing a national multi-channel communications campaign, emphasizing mass media, to increase demand and utilization of micronutrient supplements for women and children in Bolivia as part of the national Programa Multisectorial Desnutrición Cero.

Methods: The design of campaign materials and messages was informed by a baseline knowledge, attitude, and practice (KAP) assessment (n=452), conducted in four departments. Findings were used, along with channel analysis, to develop a dissemination plan. Draft materials were field-tested using focus groups (n=12) with target audiences (n=120) and modified based on feedback. All activities were carried-out in collaboration with the Ministry of Health and Sports.

Results: The baseline KAP survey showed variation across different micronutrient supplements and departments, for example any knowledge of vitamin A ranged from 55-100% and any knowledge of therapeutic zinc for diarrhoea or stunting ranged from 10-30%. Television and radio were the preferred channels for receiving health and nutrition information, including on services available. Field-testing of draft materials found generally high acceptance and valuing of the materials; feedback led to modifications which increased emphasis on enablers for how to conduct the recommended practices. Final materials included television and radio advertisements, road-side billboards, health center banners, and calendars for caregivers.

Conclusions: A national multi-channel communications campaign to promote micronutrient supplementation was developed.  After seven months of implementation, an endline survey will be conducted to assess the association between campaign exposure and KAP, which will allow us to understand the potential influence of each communication channel on coverage and utilization of micronutrient supplements.

Open Access Conference Proceeding (Abstract)

The Cost of Home Delivery Schemes for Lipid-based Nutrient Supplement Products: A Policy Experiment from Rural Malawi

Stephen Vosti, Jacob Humber, Thokozani Phiri, Per Ashorn, Ken Maleta, Kathryn Dewey

European Journal of Nutrition & Food Safety, Page 1053-1054
DOI: 10.9734/EJNFS/2015/21238

Objectives: Public policy makers may play a role in promoting products demonstrated to be efficacious.  Home delivery reduces households’ out-of-pocket costs of accessing these products; however, home delivery may be expensive, especially in rural areas.  This paper provides evidence based on a home-delivery scheme undertaken by the International Lipid-Based Nutrient Supplements (iLiNS-DOSE) Project in rural Malawi.

Methods: Estimates of home delivery costs for lipid-based nutrient supplements (LNS), including product procurement, transportation, staffing and storage costs, are based on those faced by the iLiNS-DOSE Project.  A cost model was developed and used to run a hypothetical five-year policy experiment to provide LNS to 60% of the approximately 12,000 young children aged 6-24 months.  LNS is delivered bi-weekly to all children in the targeted age bracket; older early-enrollees and young late-enrollees would not receive the full 18-month intervention.

Results: Total cost of the hypothetical five-year intervention would be approximately US$3.3m.  Cost per treated-child is US$69; cost per fully-treated-child is US$89.  63% and 21% of the total cost is attributable to product purchases and personnel costs, respectively.

Conclusions: Home delivery of LNS products brings the private costs of procuring them to zero.  However, the cost of procurement, storage and weekly home delivery of these products, shouldered by the public sector in our example, can be large relative to other product delivery mechanisms. Changes to intervention protocol (target population, frequency of delivery, etc.) will affect costs.  The expected health and other benefits associated with each proposed intervention strategy should be compared to these costs to set priorities.

Open Access Conference Proceeding (Abstract)

Review of the National Wheat Flour Fortification Program in Egypt - Assessing Compliance of Mills Fortifying Flour/Baladi Bread with Folate and Iron and Estimating Consumption of Fortified Flour in Women of Reproductive Age with HIECS Data

Svenja Jungjohann, Alia Hafiz, Magdy Shehata

European Journal of Nutrition & Food Safety, Page 788-789
DOI: 10.9734/EJNFS/2015/21092

Objectives: To evaluate outcomes of the Government of Egypt national wheat flour fortification program, including fortification level of flour at mills and the estimation of fortified flour/baladi bread intake using Egypt Household Income, Expenditure, and Consumption Survey (HIECS) data to determine the contribution of fortification to dietary intake of iron and folic acid (FA) among women of reproductive age (WRA).

Methods: Flour samples were collected from 53 mills and analyzed for iron content using atomic absorption spectrometry. HIECS 2010/2011 data was used to estimate average consumption of fortified flour and iron and folic acid intake of WRA using the FAO adjustment factors for calculating adult equivalent consumption units.

Results: 95% of the flour samples collected at the mills during the audit were fortified at optimal levels or above. In the region with highest prevalence of deficiency, Lower Egypt, women's estimated daily intake of fortified flour was lower as compared with other regions, but still provided over 24% and 48% of RDA of iron and FA, respectively. In Upper Egypt, consumption of fortified flour and intake of iron and FA was highest providing over 33% and 60% of RDA, respectively.

Conclusions: The fortified flour is reaching those in need and is significantly increasing dietary intake of iron and FA among WRA. Together with the monitoring of the fortification levels at the mills this data allows tracking of the coverage and consumption of fortified foods in Egypt. An adaptation of the HIECS data collection tool could further improve the estimate of fortified food intake.

Open Access Conference Proceeding (Abstract)

Role of National Legislation in the Interpretation and Practice of Salt Iodization Standards

Lucie Bohac, Kimberly Harding, Arnold Timmer, ICCIDD-GLobal Network Iodine Task Force

European Journal of Nutrition & Food Safety, Page 1055-1056
DOI: 10.9734/EJNFS/2015/21239

Objectives: The ICCIDD/GN Iodine Task Force was established in response to changing environment and program maturity of salt iodization programs worldwide. It aims to improve the evidence and thus the quality and effectiveness of iodine nutrition programs to help update program guidelines. To assess the role of national legislation in the interpretation and practice of salt iodization standards to achieve optimal iodine intake.

Methods: A review of scientific literature, reports and data, including the development of a database to review current legislation and policies regarding universal salt iodization (USI) in national programs for eliminating iodine deficiency disorders, was conducted and analyzed to provide information on the interpretation of iodization standards.

Results: Review of legislation governing iodization indicates variation in the interpretation of normative guidance (20-40 ppm) on standards. True USI (iodize all salt for human and animal consumption) is not always mandated or implemented. There are examples of changes in legislation in response to dynamic national contexts such as consumption of processed foods. Varied standards and legislation between countries complicate regional approaches to standards setting and can create trade barriers. When iodization is voluntary, information gaps often exist regarding application of the standard and the extent to which iodized salt is used in processed foods.

Conclusions: Adherence to normative guidance for iodization standards is not a prerequisite for achieving optimal iodine intake. Legislation governing iodization should preferably be mandatory and support the use of iodized salt for ALL human consumption, to facilitate an evidence based approach to setting standard in a dynamic context.

Open Access Conference Proceeding (Abstract)

Common Asian Wheat Flour-based Foods: Impact of Flour Fortification on Processing Factors and Organoleptic Properties

Annoek Van den Wijngaart, Karen Codling

European Journal of Nutrition & Food Safety, Page 790-791
DOI: 10.9734/EJNFS/2015/21093

Objectives: While Western foods have been made with fortified wheat flour for decades, foods commonly consumed in Asia are infrequently made with fortified flour. Hence, we coordinated a multi-country study on the processing factors and organoleptic impact of flour fortification on Asian foods.

Methods: Researchers in China, India, Indonesia, Malaysia, the Philippines, and Sri Lanka produced fortified flour as per the 2009 World Health Organization Recommendations on Wheat and Maize Flour Fortification, and used this flour to make commonly eaten Asian wheat flour foods, including 15 kinds of noodles and breads. Each fortification premix included iron, folic acid, and vitamin B12; some also included vitamins A, B1, B2, and zinc, depending on country fortification standards. Researchers assessed processing factors, sensory and physical attributes through a panel of consumers and, where feasible, nutrient retention in the different foods.

Results: Processing and organoleptic differences between fortified and non-fortified products were minimal. They were considered acceptable in all cases. Also no significant differences in processing and sensory characteristics were reported between the fortified products based on the different iron compounds, i.e. electrolytic iron, NaFeEDTA, ferrous sulphate, or ferrous fumarate.

Studies on retention of nutrients showed that micronutrients appeared to be retained throughout the food preparation process.

Conclusions: It is possible to fortify flour with enough vitamins and minerals to expect a health impact without changing consumer acceptance of Asian foods.

Open Access Conference Proceeding (Abstract)

Willingness-to-Pay for LNS Products: Evidence from the iLiNS Studies

Stephen Vosti, Katherine Adams, Emmanuel Ayifah, Rosemonde Guissou, Thokozani Phiri, Per Ashorn, Anna Lartey, Ken Maleta, Jean Bosco Ouedraogo, Kathryn Dewey, Travis Lybbert

European Journal of Nutrition & Food Safety, Page 1057-1058
DOI: 10.9734/EJNFS/2015/21240

Objectives: Households’ stated willingness-to-pay (WTP) for small-quantity lipid-based nutrient supplements (LNS) influence the economic viability of retail outlets for these products, and will guide public policy action when WTP falls short of LNS production/distribution costs.  This presentation provides evidence on WTP for LNS products tested in the context of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Malawi, Ghana and Burkina Faso.

Methods: Field-based contingent valuation methods provide estimates of WTP for LNS for pregnant/lactating women (LNS-P&L) and for children 6-24 mo of age (LNS-child), and for their traditional alternatives.  Experimental auctions provide incentive-compatible estimates of WTP for LNS-P&L (Ghana) and for LNS-child (Burkina Faso).

Results: Average hypothetical WTP at baseline for LNS-child (one 20g sachet) was approximately US$0.39 (Ghana), US$0.23 (Burkina Faso) and US$0.20 (Malawi-DOSE).  Average hypothetical WTP at baseline for LNS-P&L (one 20g sachet) was approximately US$0.61 (Ghana) and US$0.17 (Malawi-DYAD).  Average experimental WTP for LNS-P&L (20g sachet) was, respectively, approximately US$0.25 (Ghana) and US$0.12 (Burkina Faso).  Several household characteristics that could be used for programmatic targeting, e.g., number of children under five years of age, were associated with WTP.

Conclusions: Hypothetical WTP is positive for the vast majority of respondents in all study areas and average WTP is above estimated average national production costs for all LNS products; hence, LNS products may be commercially viable.  However, large proportions of respondents reported WTP below average production costs (e.g., approximately 6% of respondents reported zero WTP in the Ghana baseline) signalling the need to consider publically assisted mechanisms for reaching resource-poor households.

Open Access Conference Proceeding (Abstract)

Determinants of Vitamin A Status among Pregnant Women Participating in the Mama SASHA Cohort Study of Vitamin A in Western Kenya: Preliminary Findings

Victor Akelo, Fredrick Grant, Haile Selassie Okuku, Rose Wanjala, Jan Low, Donald Cole, Carol Levin, Amy Webb Girard

European Journal of Nutrition & Food Safety, Page 1059-1060
DOI: 10.9734/EJNFS/2015/21241

Objectives: Mothers' vitamin A (VA) status during pregnancy and lactation determine infants' VA levels. We estimated VA status during pregnancy and assessed its determinants using data on 505 pregnant women attending first antenatal care visit in Western Kenya.

Methods: VA and iron status were assessed using plasma retinol binding protein (RBP), and ferritin and transferrin receptor, respectively, corrected for inflammation as measured by C-reactive protein (CRP>5 mg/L) and alpha-1-acid glycoprotein (>1 g/L)]. Anemia was assessed with Hemocue hemoglobinometer.

Results: Only 34% of women had heard of VA, and 26% of them could not specify its importance. School was the most common source of VA information (68%), followed by health facility (19%). Mean (±SD) RBP was 1.44 (±0.35) µmol/l and the prevalence of VA deficiency (VAD) was 21.8%. Prevalence of inflammation (by CRP) was 24%. Anemia, but not iron deficiency, was the only factor associated with VAD (OR (CI): 1.68 (1.05, 2.71). Other potentially modifiable factors, including food insecurity, dietary diversity, awareness of VA, household or maternal consumption of VA rich foods, maternal MUAC and gestational age were not associated with VAD.

Conclusions: The prevalence of VAD is high among pregnant women in Western Kenya and associated with anemia but not iron deficiency. Additional research is needed to understand the etiology of VAD in this population.

Open Access Conference Proceeding (Abstract)

Formative Research to Guide Successful Scale-up of Micronutrient Powder Programmes: Lessons Learned from a 4 Country Comparison

Melanie Sutér, Abuid Omwega, Dominique Brunet, Jeanne Ejigui, Viorica Berdaga, Fidele Ngabo, Jennifer Foley, Judy McLean

European Journal of Nutrition & Food Safety, Page 792-793
DOI: 10.9734/EJNFS/2015/21094

Objectives: Micronutrient Powders (MNP) have been shown to reduce anaemia among young children and are reportedly easy-to-use for home fortification of complementary foods. Many countries are considering implementing MNP. However, to facilitate optimal implementation, formative research must be conducted to address country-specific household barriers such as cultural practices, knowledge and beliefs.

1. Compare findings from 4 countries where formative research was conducted to inform MNP protocols and communication materials.

2. Evaluate tools and share lessons learned to inform country-specific MNP programmes.

Methods: In Rwanda, Zambia, Cameroon and Lao PDR, focus groups were conducted with caregivers; and individual caregivers, health workers and community leaders were interviewed on IYCF knowledge, attitudes and practices, anaemia and beliefs. Home-based MNP trials then followed children 6-23 months over 14-30 days with caregivers interviewed to evaluate acceptability and adherence at baseline, midpoint and endline. Formative research tools, MNP and IYCF communication and training materials were tested.

Results: Practices varied considerably by country and important barriers identified, particularly regarding complementary feeding. Age at introduction, suitable food vehicle availability and consistency were frequently not concordant with recommendations. For example, in Rwanda porridge was too liquid and in Laos sticky rice too dense for delivering MNP. Whereas, home fortification was universally accepted and tools developed were highly usable.

Conclusions: Formative research was indispensible as knowledge, attitudes and practices varied widely between countries with implications for usage, training and communication materials. Tailoring global guidelines using our research tools will help ensure optimal development of country-specific protocols and ultimate effectiveness of MNP home fortification scale-up.

Open Access Conference Proceeding (Abstract)

Effects of Alternative Spatial Distribution Schemes on Household Access Costs of Lipid-based Nutrient Supplements: Case Study in Rural Burkina Faso

Stephen Vosti, Matthew Hamilton, Rosemonde Guissou, Sonja Hess, Kathryn Dewey, Jean Bosco Ouedraogo

European Journal of Nutrition & Food Safety, Page 1061-1062
DOI: 10.9734/EJNFS/2015/21242

Objectives: Identifying cost-effective strategies for delivering efficacious nutrient supplements is a policy challenge, especially in rural areas.  This paper examines the effects of alternative distribution outlet schemes on transportation costs of 3,146 households in the Dandé health clinic catchment area (1,600 sq. km), Burkina Faso, site of the International Lipid-Based Nutrient Supplements Zinc research project.

Methods: Spatially referenced data on households, hospitals, clinics and markets, and on the road networks that link them, are combined with the motorized transportation fare structure to construct a distance-based transportation cost overlay.  This overlay is then used to estimate the household-specific, one-way transportation costs under alternative lipid-based nutrient supplement (LNS) distribution outlet schemes.

Results: If the full-service Bobo Dioulasso Hospital is the only outlet, average transportation cost is US$ 1.96 and varies widely across households.  Including the local Dandé Hospital in the distribution network reduces the average transportation cost to US$ 1.16; the spatial distribution of household access costs changes.  Extending the network to include all health centers reduces average transportation cost to US$ 0.60.  Adding markets as distribution outlets does not further reduce average transportation costs.

Conclusions: Full-service hospital-based (only) distribution is the most costly LNS distribution scheme to households.  Extending the network of outlets to include all hospitals, health centers and clinics reduces average households access costs by nearly 70%; doing so shifts the cost burden from households to other entities charged with managing this larger outlet network.  At this site, involving retail outlets offers no household transportation costs savings.

Open Access Conference Proceeding (Abstract)

The Integrated Strategy for Attention in Nutrition (EsIAN) Reduces the Prevalence of Anemia in Children 6 to 59 Months in the Context of a Conditional Cash-transfer Program in Mexico

Armando Garcia-Guerra, Lynnette M. Neufeld, Amado Davida Quezada, Ana Cecilia Fernandez-Gaiola, Amira Hernandez-Cabrera

European Journal of Nutrition & Food Safety, Page 1063-1064
DOI: 10.9734/EJNFS/2015/21243

Objectives: EsIAN is designed to improve nutritional outcomes through a strong behavior change campaign and free distribution of nutritional products (micronutrient powders, MNP and/or a fortified complementary food, FCF) for children 6 m to 5 y of age living in poverty.  Both products were distributed in rural areas and MNP only in urban. We assessed changes in the prevalence of anemia in children, in a pre-post effectiveness trial.

Methods: EsIAN was implemented in 2008 in 91 health care centers in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two cross-sectional samples of children aged 6 to 59 months (Rural:  2008 n=802, 2012 n=356; 2008 n=569, Urban:  2012 n=546) were analyzed adjusting standard errors by health care center clusters.

Results: In rural areas, the concentration of hemoglobin increased from 12.0±0.1 (mean±SE) in 2008 to 12.7±0.1 g/dL in 2012 (P˂0.001). The prevalence of anemia dropped significantly both in urban (23.1±2.5% in 2008; 16.1±2.0% in 2012; P<0.05) and rural areas (23.5±2.0% in 2008; 7.0±1.3% in 2012; P˂0.001). The drop was largest among children aged 6 to 23 months in rural areas (28.3±4.5% percentage points reduction).

Conclusions: We document here a dramatic reduction in the prevalence of anemia in communities where EsIAN was implemented.  Although this pre-post design does not allow for direct causal attribution, impact pathway review suggests that these changes are likely to be due to the EsIAN.

Open Access Conference Proceeding (Abstract)

Potential of MIR, TXRF and XRD as Complementary Techniques for Assessment of Soil Properties

Mercy Nyambura, Erick Towett, Andrew Sila, Keith Shepherd, Riikka Keskinen, Martti Esala

European Journal of Nutrition & Food Safety, Page 794-795
DOI: 10.9734/EJNFS/2015/21095

Objectives: To evaluated the potential of combinations of MIR, TXRF and XRD techniques for prediction of soil properties.

Methods: Using Random Forests (RF) algorithm, MIR prediction of soil properties for a set of geo-referenced soil samples associated with the Africa Soil Information Service (AfSIS) project, from 44 sentinel sites, randomized across sub-Sahara Africa, were done . RF regression models were used to model the residuals of the predictions against TXRF spectra combined with MIR first derivative spectra and also against dominant mineralogy groupings measured using XRD.

Results:  MIR resulted in good prediction models (R2>0.80) using RF out-of-bag validation for organic and total C and N, extractable Ca and Al, and pH. Acceptable models (R2>0.60) were obtained for exchangeable bases, but models were poor (R2<0.60) for exchangeable Na, and Mehlich-3 extractable P, K, S, Na, Cu, and Zn. The prediction performance of combined MIR and TXRF spectra was better than MIR alone for several soil properties. Relative improvements in prediction accuracy over MIR alone were: exchangeable Na (828%), Mehlich-3 S 350%; Mehlich-3 Zn; 150%; and Mehlich-3 Cu, 10%. However, TXRF data was generally limited in explaining the residuals of the MIR predictions for extractable P and K.

Conclusions: Element concentrations measured using TXRF could be predicted relatively well from XRD-measured mineralogy composition with prediction r-square of 0.71 for raw mineralogy traces and 0.81 for dominant mineralogy grouping. The results indicate that TXRF and/or XRD fingerprinting reflects mineralogical composition and could supplement MIR prediction of soil properties and help stabilize calibration models across soil types with widely different mineralogy.

Open Access Conference Proceeding (Abstract)

An Economic Model for Optimizing Effective Coverage of MN interventions: A Case Study of Cameroon

Stephen Vosti, Reina Engle-Stone, Justin Kagin, Joanne Arsenault, Robert Hijmans, Ryan Murphy, Erica Rettig, Ann Tarini, Kenneth H. Brown

European Journal of Nutrition & Food Safety, Page 1065-1066
DOI: 10.9734/EJNFS/2015/21244

Objectives: Micronutrient (MN) interventions are generally undertaken at national scale.  New spatially disaggregated data on MN deficiencies in Cameroon suggest that subnational strategies may be more efficient, but methods to choose among alternative interventions are needed.  We developed a tool to plan and manage sub-national MN interventions for Cameroon.

Methods: Data from a nationally representative multi-stage cluster survey were used to determine the spatial distribution of MN deficiencies among population sub-groups at greatest risk. Macroregion-specific data (North, South, Douala/Yaoundé) on food intake were used to predict the effects of alternative MN intervention strategies on the prevalence of inadequate MN intake and absorption.  MN supplements, fortified and biofortified foods, deworming and behavioral change communication to promote breastfeeding are among the interventions examined.  Costs of alternative interventions were prepared.  The costs and nutritional benefits of alternative interventions are included in an economic optimization model that chooses the best combination of MN interventions to ensure adequate MN intake, at regional level, over a ten-year planning horizon, given funding and other constraints.

Results: Preliminary results indicate large spatial differences in MN deficiencies, e.g., estimated prevalence of vitamin A deficiency varied from ~62% (North region) to ~22% (Northwest region).  Consumption of VA-rich foods and fortifiable foods also varies spatially.  Hence, program efficiency may be enhanced by adopting targeted sub-national MN intervention strategies.

Conclusions: Given spatial patterns in MN deficiencies, diet-driven effectiveness of alternative MN interventions, and costs of these interventions, sub-national MN interventions may offer efficiency gains that exceed the costs of planning and implementing them.

Open Access Conference Proceeding (Abstract)

The Effects of Selling Micronutrient Powders on Morbidity Incidence among Preschool Children in Western Kenya

Parmi Suchdev, O. Yaw Addo, Frederick Grant, Reynaldo Martorell, Laird Ruth, Minal Patel, Patricia Juliao, Rob Quick, Rafael Flores-Ayala

European Journal of Nutrition & Food Safety, Page 1011-1012
DOI: 10.9734/EJNFS/2015/21213

Objectives: Although micronutrient powders (MNPs) are considered the preferred approach for childhood anemia control, concerns about iron-related morbidity from clinical trials challenge programmatic scale-up. We aimed to measure the association of community-based sales of MNPs with incidence of diarrhea, fever, and cough in children 6-35 months.

Methods: The study was a community-based, cluster-randomized trial in 60 villages in western Kenya. MNPs and other health products (e.g., insecticide-treated bednets, soap, water disinfectant) were marketed in 30 intervention villages from July 2007-March 2008, followed by expansion of the intervention to both arms. Biweekly household visits monitored self-reported MNP use and morbidity. Using morbidity as the outcomes and MNP as the exposure variable, relative risks were estimated via generalized mixed models with random intercepts for repeated measures within a child and for multiple children from a household, while accommodating potential confounders as fixed effects.

Results: Of the 1079 children enrolled, 881 (81.6%) had data on MNP use; average intake in intervention villages was 0.9 sachets/week. MNP intake was captured as continuous mean sachets and categories of use, but no significant effects were observed on incidence of diarrhea, fever or cough.

Conclusions: Increased MNP use in western Kenya through community-based marketing did not result in increased incidence of infectious morbidity among young children. Integrated distribution of MNPs with other health interventions should be explored further in settings with high child malnutrition and infection burden.

Open Access Conference Proceeding (Abstract)

Intakes from Complementary Foods Consumed by Young Children (Aged 12-23 Months) from North Wollo, Northern Ethiopia, are Inadequate in Calcium, Zinc, Vitamin A and C but not in Iron

Kaleab Baye, Jean-Pierre Guyot, Christèle Icard-Vernière, Claire Mouquet-Rivier

European Journal of Nutrition & Food Safety, Page 796-797
DOI: 10.9734/EJNFS/2015/21096

Objectives: To characterize current feeding practices and to evaluate the adequacy of selected micronutrient intakes of young children in subsistence farming rural households in North Wollo, Ethiopia.

Methods: Using a cross-sectional survey on 76 breastfed young children (aged 12-23 months) in two rural villages in Gobalafto district, data on the socio-demographic status, anthropometry and complementary feeding practices were collected. Two, in-home, non-consecutive 24h recalls were conducted to estimate intakes in iron, zinc, calcium, vitamin A, and vitamin C. Intakes were compared with estimated needs based on WHO/FAO recommended intakes,  assuming average breast milk intake and composition.

Results: About 33% (25 / 76) of the children were stunted. Complementary foods were predominantly cereal and legume based with little consumption of animal products, fruits and vegetables.  The children's diet was entirely that of the family with little or no special attention. The contribution of animal source foods (ASF) to intakes of Ca, Fe and Zn was less than <5 %. Intakes of Ca, Zn, vitamin A and vitamin C from complementary foods were below WHO recommendations. However, iron intakes (mg) and densities (mg/ 100 kcal) met WHO recommendations even when assuming low bioavailability.

Conclusions: Multiple micronutrient deficiencies and inadequate complementary feeding practices are likely in these communities. Food fortification or efforts to enhance dietary diversity by including ASF, dairy, and fruits and vegetables rich in vitamin A and vitamin C are needed. Further investigations are needed on the source (intrinsic/extrinsic) and bioavailability of the iron in these cereal-based complementary foods.

Open Access Conference Proceeding (Abstract)

Sensory Peripheral Nerve Function in Chilean Elderly Consuming Folic Acid Fortified Flour: Relationship to Plasma Folate and a Novel Combined Biomarker of B12 Status

Alex Brito, Joshua W. Miller, Sergey N. Fedosov, Setareh Shahab-Ferdows, Hugo Sanchez, Cecilia Albala, Renato Verdugo, Ricardo Uauy, Lindsay H. Allen

European Journal of Nutrition & Food Safety, Page 1067-1068
DOI: 10.9734/EJNFS/2015/21245

Objectives: It has been reported that low vitamin B12 status and high serum folate is associated with anemia and cognitive impairment. However, few data are available on neurophysiological outcomes, such as peripheral neurophysiology. The objective was to assess associations between folate, B12 and sensory peripheral nerve conduction in Chilean elderly exposed to folic acid fortification.

Methods: The average of the left and right distal sensory conduction latency of the sural nerve, and conduction velocity of the right peroneus nerve were measured in 159 community-dwelling older Chilean. Serum folate, B12, Hcy, MMA, and holoTC were determined. B12 status was defined based on: w=log_10 (holoTC*B12)/(MMA*Hcy)-(age factor) (Fedosov SN, Clin. Chim. Acta. 2013). Nerve conduction, folate and B12 status were divided into tertiles.

Results: Age was 70-78y (57% women). 62.9%, 10.7% and 26.4% were classified as having B12 adequacy (w>-0.5), transitional status (-1.5< w<-0.5) and deficiency (w<-1.5) respectively, while 15.1% presented high folate (>45.3 nmol/L). Nerve conduction velocity of the right peroneus nerve positively correlated with B12 status (r=0.21, p<0.05). In the highest tertile of both B12 (w) and folate only 6% were in lowest tertile of sural nerve conduction vs. 31.5% (p<0.001) with low B12 and high folate. In the highest tertile of both B12 (w) and folate 25% were in lowest tertile of peroneal nerve conduction velocity as compared with 63.2% with low B12 and high folate (p<0.001).

Conclusions: Elderly with both high B12 and folate status were less likely to have poor sensory peripheral nerve conduction than those with low B12 and high folate.

Open Access Conference Proceeding (Abstract)

The Association between Women's Knowledge about Vitamin A and Who they Contact for Advice about Nutrition and Health in Bangladesh

Jillian L. Waid, Zeina Sifri, Nancy Haselow

European Journal of Nutrition & Food Safety, Page 1069-1070
DOI: 10.9734/EJNFS/2015/21246

Objectives: This paper measures the level of basic vitamin A knowledge nationally in Bangladesh and relates this knowledge to the sources of information on which a woman relies. It also reviews the relationship between knowledge of vitamin A and vitamin A intake in children and women.

Methods: Questions about women's knowledge of vitamin A and the people upon whom they rely for nutrition and health information was added to the standard questionnaire of the Food Security and Nutrition Surveillance project (JPGSPH/HKI). This section was administered to 4,512 child caregivers and/or the person responsible for managing the household kitchen.

Results: Overall Bangladeshi women had an adequate knowledge of vitamin A, both the importance of the nutrient and its sources in the diet. There was no significant difference between the knowledge held by child caregivers and other index women in the household, but women who listed no resource people for nutrition and health information outside their household were significantly less aware of the benefits and sources of vitamin A than women who were able to seek advice from other sources.

Conclusions: As almost half of women relied on only family members to learn about nutrition and health, program implementation requires multiple strategies to include husbands and older family members in order to reach these women. In addition, more research into communication networks in rural areas is important in order to design effective project implementation strategies.

Funding: Bill and Melinda Gates Foundation.

Open Access Conference Proceeding (Abstract)

Vitamin A and Iron Status of Women and Young Children in Major Cities of Cameroon before and after Vitamin A Fortification of Vegetable Oil and Iron Fortification of Wheat Flour

Reina Engle-Stone, Alex Ndjebayi, Martin Nankap, Marie-Madeleine Gimou, Avital Friedman, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 798-799
DOI: 10.9734/EJNFS/2015/21097

Objectives: Few data are available on the effectiveness of large-scale food fortification programs. We conducted representative surveys 2 y before and 1 y after introduction of vitamin A (VA)-fortified cooking oil and iron-fortified wheat flour to assess program impact on VA and iron status in urban Cameroon.

Methods: In each survey, 10 different households were selected within each of the same 30 clusters in Douala and Yaoundé (n=~300/survey). Indicators of VA (retinol-binding protein, pRBP) and iron (ferritin; soluble transferrin receptor, sTfR) status, adjusted for presence of inflammation (CRP, AGP) and malaria, were assessed among women 15-49 y and children 12-59 mo. Staple food intake was measured by 1-week FFQ, and post-fortification oil and flour samples were collected.

Results: Oil and flour were each consumed by >80% of participants. Post-fortification, 44% of oil (85% of "branded" oil) and 76% of flour samples were fortified. Controlling for inflammation and malaria, there was no change in pRBP between pre- and post-fortification values among women (1.41 to 1.40 µmol/L) and children (0.87 to 0.88 µmol/L), but ferritin increased (women: 37 to 47 µg/L; children: 39 to 51 µg/L, both P < 0.05) and sTfR decreased (7.7 to 6.2 and 10.6 to 8.2 mg/L, P < 0.01). Prevalence of anemia decreased among women (46 to 38%, P < 0.05) but not children.

Conclusions: After 1 year of a national program, adequately-fortified products are available. Iron status indicators have increased since the initial survey; plausibility analyses will determine whether these changes are attributable to the fortification program.

Open Access Conference Proceeding (Abstract)

Estimating the Micronutrient Adequacy of the Food Supply Using Food Balance Sheets for Targeted Nutrition-sensitive Agricultural Approaches: Example of Bangladesh

Joanne Arsenault, Robert Hijmans, Kenneth Brown

European Journal of Nutrition & Food Safety, Page 1071-1072
DOI: 10.9734/EJNFS/2015/21247

Objectives: To estimate the micronutrient availability and adequacy of the food supply of Bangladesh and estimate the additional agricultural output needed to achieve nutrient adequacy.

Methods: We estimated micronutrient availability of the food supply using an average of 5 years of Food and Agricultural Organization (FAO) food balance sheet data.  We estimated nutrients for non-specific food commodities (e.g., other vegetables) using FAO production data supplemented with known consumption information from a dietary survey.  We estimated the probability of adequacy of the food supply using a method similar to the cut-point method of estimating nutrient intake adequacy.  Then, we estimated the target level of nutrient needed in the food supply to achieve 80% adequacy and amounts of micronutrient-rich foods and land needed to meet the nutrient shortfall.

Results: The current food supply in Bangladesh provides very low amounts (0-1% adequacy) of calcium and vitamins A, C, and folate; and low-moderate amounts of several other micronutrients. Using vitamin A as an example, the food supply would need to provide an additional 570 mcg RAE/capita/d to achieve 80% adequacy.  This could be accomplished by adding ~67g/capita/d of carrots or ~73g/capita/d of orange-flesh sweet potatoes, requiring ~4 and 6% of the country's total agricultural land, respectively.

Conclusions: National food balance sheets can be used to guide agricultural policies to ensure nutrient adequacy of the food supply, recognizing the need to consider other factors like climate, season, economics, and behavior change to drive food production decisions.

Open Access Conference Proceeding (Abstract)

Determination of Zinc in Some Infants and Young Children Foods Available in Supermarkets and Pharmacies Using Atomic Absorption Spectroscopy

Girma Kibatu

European Journal of Nutrition & Food Safety, Page 1073
DOI: 10.9734/EJNFS/2015/21248

Objectives: The aim of this study was to determine the zinc content of some infants and young children foods and supplementations available in supermarkets and pharmacies.

Methods: 1.0 g of food samples were digested by wet ashing method and the content of zinc in the infant foods were determined using flame atomic absorption spectroscopy (FAAS).

Results: The content of Zn in the infant formulas ranged from 0.77 mg/kg to 42.2 mg/kg and follows the order: Cerifam > S-26 > Cerelac-2 > Cerelac-1 > SUN > Mother's Choice > Promil > Baby King > Couscous > Safa.

Conclusions:  The results indicated that the infant formulas, except in Couscous and Safa, have appeared to contain adequate amount of zinc for infants and young children dietary zinc requirements and can be used as Zinc supplements to mothers' milk.

Open Access Conference Proceeding (Abstract)

Creating an Enabling Environment for Scaling-up MNP in Lao PDR: A Private-public Partnership

Judy McLean, Melanie Sutér, Shane Powell, Latsamy Siengsounthone, Sheyla Medina, Bounthom Phengdy, Aine Lynch, Viorica Berdaga

European Journal of Nutrition & Food Safety, Page 800-801
DOI: 10.9734/EJNFS/2015/21098

Objectives: The Scaling-Up-Nutrition movement recognizes the importance of multi-stakeholder partnerships to deliver high-impact nutrition interventions. A private-public partnership in Lao PDR - supported by MMG Limited and involving the Ministry of Health (MoH), UNICEF, Population Services International (PSI) and University of British Columbia (UBC) - offers an opportunity to evaluate such a partnership and to develop an operational delivery model for Micronutrient Powders (MNP).

Develop an effective, scalable and sustainable operational delivery model for MNP through a multi-stakeholder approach involving public and private sector partners.