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[PMID]:29447176
[Au] Autor:Svefors P; Selling KE; Shaheen R; Khan AI; Persson LÅ; Lindholm L
[Ad] Endereço:International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
[Ti] Título:Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh.
[So] Source:PLoS One;13(2):e0191260, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Nutrition interventions may have favourable as well as unfavourable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat), with early prenatal food and micronutrient supplementation, reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) supplement was associated with an increased risk of stunted growth in infancy and early childhood. This unfavourable outcome was not included in the previous cost-effectiveness analysis. The aim of this study is to evaluate whether the MINIMat interventions remain cost-effective in view of both favourable (decreased under-five-years mortality) and unfavourable (increased stunting) outcomes. METHOD: Pregnant women in rural Bangladesh, where food insecurity still is prevalent, were randomized to early (E) or usual (U) invitation to be given food supplementation and daily doses of 30 mg, or 60 mg iron with 400 µg of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 µg of folic acid. E reduced stunting at 4.5 years compared with U, MMS increased stunting at 4.5 years compared with Fe60, while the combination EMMS reduced infant mortality compared with UFe60. The outcome measure used was disability adjusted life years (DALYs), a measure of overall disease burden that combines years of life lost due to premature mortality (under five-year mortality) and years lived with disability (stunting). Incremental cost effectiveness ratios were calculated using cost data from already published studies. RESULTS: By incrementing UFe60 (standard practice) to EMMS, one DALY could be averted at a cost of US$24. CONCLUSION: When both favourable and unfavourable outcomes were included in the analysis, early prenatal food and multiple micronutrient interventions remained highly cost effective and seem to be meaningful from a public health perspective.
[Mh] Termos MeSH primário: Transtornos do Crescimento/etiologia
Fenômenos Fisiológicos da Nutrição do Lactente/economia
Micronutrientes/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Bangladesh/epidemiologia
Pré-Escolar
Análise Custo-Benefício/métodos
Suplementos Nutricionais
Feminino
Ácido Fólico
Abastecimento de Alimentos
Transtornos do Crescimento/tratamento farmacológico
Transtornos do Crescimento/mortalidade
Seres Humanos
Lactente
Mortalidade Infantil
Fenômenos Fisiológicos da Nutrição do Lactente/efeitos dos fármacos
Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia
Recém-Nascido
Ferro
Masculino
Micronutrientes/administração & dosagem
Política Nutricional
Gravidez
Cuidado Pré-Natal
Fenômenos Fisiológicos da Nutrição Pré-Natal
Oligoelementos
Vitaminas
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Micronutrients); 0 (Trace Elements); 0 (Vitamins); 935E97BOY8 (Folic Acid); E1UOL152H7 (Iron)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191260


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[PMID]:28461197
[Au] Autor:Abebe Z; Haki GD; Baye K
[Ad] Endereço:Center for Food Science and Nutrition, College of Natural Sciences, POBOX 1176, Addis Ababa University, Addis Ababa, Ethiopia.
[Ti] Título:Child feeding style is associated with food intake and linear growth in rural Ethiopia.
[So] Source:Appetite;116:132-138, 2017 09 01.
[Is] ISSN:1095-8304
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Little is known about mother-child feeding interactions and how this is associated with food intake and linear growth. OBJECTIVE: To characterize mother-child feeding styles and investigate their associations with accepted mouthful and linear growth in west Gojam, rural Ethiopia. SUBJECTS/DESIGN: Two, in-home, meal observations of children aged 12-23 months (n = 100) were video-taped. The number of mouthful accepted was counted and the caregiver/child feeding styles were coded into positive/negative categories of self-feeding, responsive-feeding, active-feeding, social-behavior and distraction. Data on socio-demographic characteristics, child feeding practices, perception about child's overall appetite, and strategies adopted to overcome food refusal were collected through questionnaire-based interviews. Child and mothers' anthropometric measurements were also taken. RESULTS: Stunting was highly prevalent (48%) and the number of mouthful accepted was very low. Offering breastmilk and threatening to harm were the main strategies adopted to overcome food refusal. Although all forms of feeding style were present, active positive feeding style was dominant (90%) and was positively associated with mouthful accepted. Talking with non-feeding partner (64%), and domestic animals (24%) surrounding the feeding place were common distractions of feeding. Feeding was mostly terminated by caregivers (75%), often prematurely. Overall, caregivers of stunted children had poorer complementary- and breast-feeding practices and were less responsive to child's hunger and satiation cues (P < 0.05). Positive responsive feeding behaviors were associated with child's number of mouthful accepted (r = 0.27; P = 0.007) and stunting (r = 0.4; P < 0.001). CONCLUSION: Low complementary food intake in this setting is associated with caregivers' feeding style and stunting. Nutrition interventions that reinforce messages of optimal infant and young child feeding and integrate the promotion of responsive feeding behaviors are needed.
[Mh] Termos MeSH primário: Regulação do Apetite
Comportamento Alimentar
Transtornos de Alimentação na Infância/etiologia
Transtornos do Crescimento/etiologia
Fenômenos Fisiológicos da Nutrição do Lactente
Desnutrição/etiologia
Saúde da População Rural
[Mh] Termos MeSH secundário: Regulação do Apetite/etnologia
Desenvolvimento Infantil
Educação Infantil/etnologia
Estudos Transversais
Países em Desenvolvimento
Ingestão de Energia/etnologia
Etiópia
Comportamento Alimentar/etnologia
Transtornos de Alimentação na Infância/etnologia
Transtornos de Alimentação na Infância/fisiopatologia
Transtornos de Alimentação na Infância/prevenção & controle
Feminino
Transtornos do Crescimento/epidemiologia
Transtornos do Crescimento/etnologia
Transtornos do Crescimento/prevenção & controle
Seres Humanos
Lactente
Almoço/etnologia
Masculino
Desnutrição/etnologia
Desnutrição/fisiopatologia
Desnutrição/prevenção & controle
Mães
Prevalência
Saúde da População Rural/etnologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:27770258
[Au] Autor:Franke D; Steffens R; Thomas L; Pavicic L; Ahlenstiel T; Pape L; Gellermann J; Müller D; Querfeld U; Haffner D; Zivicnjak M
[Ad] Endereço:Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
[Ti] Título:Kidney transplantation fails to provide adequate growth in children with chronic kidney disease born small for gestational age.
[So] Source:Pediatr Nephrol;32(3):511-519, 2017 Mar.
[Is] ISSN:1432-198X
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Children with chronic kidney disease are frequently born small for gestational age (SGA) and prone to disproportionately short stature. It is unclear how SGA affects growth after kidney transplantation (KTx). METHODS: Linear growth (height, sitting height, and leg length) was prospectively investigated in a cohort of 322 pediatric KTx recipients, with a mean follow-up of 4.9 years. Sitting height index (ratio of sitting height to total body height) was used to assess body proportions. Predictors of growth outcome in KTx patients with (n = 94) and without (n = 228) an SGA history were evaluated by the use of linear mixed-effects models. RESULTS: Mean z-scores for all linear body dimensions were lower in SGA compared with non-SGA patients (p < 0.001). SGA patients presented with higher target height deficit and degree of body disproportion (p < 0.001). The latter was mainly due to reduced leg growth during childhood. Pubertal trunk growth was diminished in SGA patients, and the pubertal growth spurt of legs was delayed in both groups, resulting in further impairment of adult height, which was more frequently reduced in SGA than in non-SGA patients (50 % vs 18 %, p < 0.001). Use of growth hormone treatment in the pre-transplant period, preemptive KTx, transplant function, and control of metabolic acidosis were the only potentially modifiable correlates of post-transplant growth in SGA groups. By contrast, living related KTx, steroid exposure, and degree of anemia proved to be correlates in non-SGA only. CONCLUSIONS: In children born SGA, growth outcome after KTx is significantly more impaired and affected by different clinical parameters compared with non-SGA patients.
[Mh] Termos MeSH primário: Transtornos do Crescimento/etiologia
Transplante de Rim/métodos
Insuficiência Renal Crônica/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Envelhecimento
Criança
Pré-Escolar
Estudos de Coortes
Feminino
Crescimento
Seres Humanos
Lactente
Recém-Nascido
Recém-Nascido Pequeno para a Idade Gestacional
Perna (Membro)/crescimento & desenvolvimento
Modelos Lineares
Masculino
Estudos Prospectivos
Insuficiência Renal Crônica/complicações
Insuficiência Renal Crônica/patologia
Maturidade Sexual
Tórax/crescimento & desenvolvimento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1007/s00467-016-3503-5


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[PMID]:29443755
[Au] Autor:Cai X; Yu D; Xie Y; Zhou H
[Ad] Endereço:Department of Pediatrics, West China Second University Hospital.
[Ti] Título:Argininemia as a cause of severe chronic stunting and partial growth hormone deficiency (PGHD): A case report.
[So] Source:Medicine (Baltimore);97(7):e9880, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Argininemia is an autosomal recessive inherited disorder of the urea cycle. Because of its atypical symptoms in early age, diagnosis can be delayed until the typical chronic manifestations - including spastic diplegia, deterioration in cognitive function, and epilepsy - appear in later childhood. PATIENT CONCERNS: A Chinese boy initially presented with severe stunting and partial growth hormone deficiency (PGHD) at 3 years old and was initially treated with growth hormone replacement therapy. Seven years later (at 10 years old), he presented with spastic diplegia, cognitive function lesions, epilepsy, and peripheral neuropathy. DIAGNOSES: Ultimately, the patient was diagnosed with argininemia with homozygous mutation (c.32T>C) of the ARG1 gene at 10 years old. Blood tests showed mildly elevated blood ammonia and creatine kinase, and persistently elevated bilirubin. INTERVENTIONS: Protein intake was limited to 0.8 g/kg/day, citrulline (150-200 mg [kg d]) was prescribed. OUTCOMES: The patient's mental state and vomiting had improved after 3 months treatment. At 10 years and 9 month old, his height and weight had reached 121cm and 22kg, respectively, but his spastic diplegia symptoms had not improved. LESSONS: This case demonstrates that stunting and PGHD that does not respond to growth hormone replacement therapy might hint at inborn errors of metabolism (IEM). IEM should also be considered in patients with persistently elevated bilirubin with or without abnormal liver transaminase, as well as elevated blood ammonia and creatine kinase, in the absence of hepatic disease.
[Mh] Termos MeSH primário: Transtornos do Crescimento
Hiperargininemia
[Mh] Termos MeSH secundário: Arginase/genética
Bilirrubina/análise
Criança
Pré-Escolar
Diagnóstico Diferencial
Transtornos do Crescimento/diagnóstico
Transtornos do Crescimento/etiologia
Hormônio do Crescimento/análise
Hormônio do Crescimento/deficiência
Hormônio do Crescimento/uso terapêutico
Terapia de Reposição Hormonal/efeitos adversos
Terapia de Reposição Hormonal/métodos
Seres Humanos
Hiperargininemia/diagnóstico
Hiperargininemia/genética
Hiperargininemia/fisiopatologia
Hiperargininemia/terapia
Masculino
Mutação
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
9002-72-6 (Growth Hormone); EC 3.5.3.1 (Arginase); RFM9X3LJ49 (Bilirubin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009880


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[PMID]:29309064
[Au] Autor:Doherty T; Rohde S; Besada D; Kerber K; Manda S; Loveday M; Nsibande D; Daviaud E; Kinney M; Zembe W; Leon N; Rudan I; Degefie T; Sanders D
[Ad] Endereço:Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
[Ti] Título:Reduction in child mortality in Ethiopia: analysis of data from demographic and health surveys.
[So] Source:J Glob Health;6(2):020401, 2016 Dec.
[Is] ISSN:2047-2986
[Cp] País de publicação:Scotland
[La] Idioma:eng
[Ab] Resumo:Background: To examine changes in under-5 mortality, coverage of child survival interventions and nutritional status of children in Ethiopia between 2000 and 2011. Using the Lives Saved Tool, the impact of changes in coverage of child survival interventions on under-5 lives saved was estimated. Methods: Estimates of child mortality were generated using three Ethiopia Demographic and Health Surveys undertaken between 2000 and 2011. Coverage indicators for high impact child health interventions were calculated and the Lives Saved Tool (LiST) was used to estimate child lives saved in 2011. Results: The mortality rate in children younger than 5 years decreased rapidly from 218 child deaths per 1000 live births (95% confidence interval 183 to 252) in the period 1987-1991 to 88 child deaths per 1000 live births in the period 2007-2011 (78 to 98). The prevalence of moderate or severe stunting in children aged 6-35 months also declined significantly. Improvements in the coverage of interventions relevant to child survival in rural areas of Ethiopia between 2000 and 2011 were found for tetanus toxoid, DPT3 and measles vaccination, oral rehydration solution (ORS) and care-seeking for suspected pneumonia. The LiST analysis estimates that there were 60 700 child deaths averted in 2011, primarily attributable to decreases in wasting rates (18%), stunting rates (13%) and water, sanitation and hygiene (WASH) interventions (13%). Conclusions: Improvements in the nutritional status of children and increases in coverage of high impact interventions most notably WASH and ORS have contributed to the decline in under-5 mortality in Ethiopia. These proximal determinants however do not fully explain the mortality reduction which is plausibly also due to the synergistic effect of major child health and nutrition policies and delivery strategies.
[Mh] Termos MeSH primário: Saúde da Criança
Mortalidade da Criança
Mortalidade Infantil
[Mh] Termos MeSH secundário: Criança
Etiópia/epidemiologia
Transtornos do Crescimento
Inquéritos Epidemiológicos
Seres Humanos
Lactente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.7189/jogh.06.020401


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[PMID]:29324840
[Au] Autor:Gari T; Loha E; Deressa W; Solomon T; Lindtjørn B
[Ad] Endereço:School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
[Ti] Título:Malaria increased the risk of stunting and wasting among young children in Ethiopia: Results of a cohort study.
[So] Source:PLoS One;13(1):e0190983, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Given the high prevalence of malnutrition in a malaria-endemic setting, improving nutritional status could serve as a tool to prevent malaria. However, the relationship between the two conditions remains unclear. Therefore, this study assessed the association between under-nutrition and malaria among a cohort of children aged 6 to 59 months old. METHODS: Two cohorts of children were followed for 89 weeks in a rural Rift Valley area of Ethiopia. In the first approach (malaria-malnutrition), a cohort of 2,330 non-stunted and 4,204 non-wasted children were included to assess under-nutrition (outcome) based on their previous malaria status (exposure). In the second approach (malnutrition-malaria), a cohort of 4,468 children were followed-up to measure malaria (outcome), taking under-nutrition as an exposure. A weekly home visit was carried out to identify malaria cases. Four anthropometry surveys were conducted, and generalized estimating equation (GEE) method was used to measure the association between undernutrition and malaria. RESULTS: The prevalence of stunting was 44.9% in December 2014, 51.5% in August 2015, 50.7% in December 2015 and 48.1% in August 2016. We observed 103 cases with 118 episodes of malaria, 684 new stunting and 239 new wasting cases. The incidence rate per 10,000 weeks of observation was 3.8 for malaria, 50.4 for stunting and 8.2 for wasting. Children with malaria infection, [Adjusted Odds Ratio (AOR) = 1.9; 95% Confidence Interval (CI), 1.2-2.9)] and younger age (AOR = 1.3; 95% CI, 1.1-1.5) were more likely to be stunted. Furthermore, children with malaria infection (AOR = 8.5; 95% CI, 5.0-14.5) and young age group (AOR = 1.6; 95% CI, 1.2-2.1) were more likely to be wasted. However, stunting and wasting were not risk factors of subsequent malaria illness. CONCLUSIONS: Malaria infection was a risk factor for stunting and wasting, but stunting or wasting was not associated with subsequent malaria illness. As our study shows that malaria is a risk factor for stunting and wasting, a close follow-up of the nutritional status of such children may be needed. TRIAL REGISTRATION: PACT R2014 11000 882128 (8 September 2014).
[Mh] Termos MeSH primário: Transtornos do Crescimento/etiologia
Malária/complicações
Síndrome de Emaciação/etiologia
[Mh] Termos MeSH secundário: Antropometria
Pré-Escolar
Estudos de Coortes
Etiópia/epidemiologia
Transtornos do Crescimento/epidemiologia
Seres Humanos
Incidência
Lactente
Malária/epidemiologia
Prevalência
Fatores de Risco
Síndrome de Emaciação/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190983


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[PMID]:29178640
[Au] Autor:Sukalo M; Schäflein E; Schanze I; Everman DB; Rezaei N; Argente J; Lorda-Sanchez I; Deshpande C; Takahashi T; Kleger A; Zenker M
[Ad] Endereço:Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany.
[Ti] Título:Expanding the mutational spectrum in Johanson-Blizzard syndrome: identification of whole exon deletions and duplications in the UBR1 gene by multiplex ligation-dependent probe amplification analysis.
[So] Source:Mol Genet Genomic Med;5(6):774-780, 2017 11.
[Is] ISSN:2324-9269
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Johanson-Blizzard syndrome (JBS, MIM #243800) is a very rare autosomal recessive disorder characterized by exocrine pancreatic insufficiency, nasal wing hypoplasia, hypodontia, and other abnormalities. JBS is caused by mutations of the UBR1 gene (MIM *605981), encoding a ubiquitin ligase of the N-end rule pathway. METHODS: Molecular findings in a total of 65 unrelated patients with a clinical diagnosis of JBS who were previously screened for UBR1 mutations by Sanger sequencing were reviewed and cases lacking a disease-causing UBR1 mutation on either one or both alleles were included in this study. In order to discover mutations that are not detectable by Sanger sequencing, we designed a probe set for multiplex ligation-dependent probe amplification (MLPA) analysis of the UBR1 gene and analyzed the copy number status of all 47 UBR1 exons. RESULTS: Our previous studies using Sanger sequencing could detect mutations in 93.1% of 130 disease-associated UBR1 alleles. Six patients with a highly suggestive clinical diagnosis of JBS and unsolved genotype were included in this study. MLPA analysis detected six alleles harboring exon deletions/duplications, thereby raising the mutation detection rate in the entire cohort to 97.7% (127/130 alleles). CONCLUSION: We conclude that single or multi-exon deletions or duplications account for a substantial proportion of JBS-associated UBR1 mutations.
[Mh] Termos MeSH primário: Anus Imperfurado/genética
Displasia Ectodérmica/genética
Transtornos do Crescimento/genética
Perda Auditiva Neurossensorial/genética
Hipotireoidismo/genética
Deficiência Intelectual/genética
Nariz/anormalidades
Pancreatopatias/genética
Ubiquitina-Proteína Ligases/genética
[Mh] Termos MeSH secundário: Adulto
Alelos
Anus Imperfurado/diagnóstico
Sequência de Bases
Criança
Pré-Escolar
DNA/química
DNA/isolamento & purificação
DNA/metabolismo
Análise Mutacional de DNA
Displasia Ectodérmica/diagnóstico
Éxons
Feminino
Deleção de Genes
Duplicação Gênica
Genótipo
Transtornos do Crescimento/diagnóstico
Perda Auditiva Neurossensorial/diagnóstico
Seres Humanos
Hipotireoidismo/diagnóstico
Deficiência Intelectual/diagnóstico
Masculino
Reação em Cadeia da Polimerase Multiplex
Pancreatopatias/diagnóstico
Fenótipo
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
9007-49-2 (DNA); EC 2.3.2.27 (UBR1 protein, human); EC 2.3.2.27 (Ubiquitin-Protein Ligases)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1002/mgg3.319


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[PMID]:28468870
[Au] Autor:Hossain M; Choudhury N; Adib Binte Abdullah K; Mondal P; Jackson AA; Walson J; Ahmed T
[Ad] Endereço:Stunting Research Platform, Nutrition and Clinical Services Division, ICDDR, Dhaka, Bangladesh.
[Ti] Título:Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review.
[So] Source:Arch Dis Child;102(10):903-909, 2017 10.
[Is] ISSN:1468-2044
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: We systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs). METHODS: Electronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings. FINDINGS: Fourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed. INTERPRETATION: For all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance. PROSPERO REGISTRATION NUMBER: CRD42016043772.
[Mh] Termos MeSH primário: Transtornos do Crescimento/prevenção & controle
Promoção da Saúde/métodos
Avaliação de Programas e Projetos de Saúde/métodos
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Países em Desenvolvimento
Medicina Baseada em Evidências/métodos
Seres Humanos
Pobreza
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180124
[Lr] Data última revisão:
180124
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1136/archdischild-2016-311050


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[PMID]:28464867
[Au] Autor:Billah SM; Ferdous TE; Karim MA; Dibley MJ; Raihana S; Moinuddin M; Choudhury N; Ahmed T; Hoque DME; Menon P; Arifeen SE
[Ad] Endereço:Maternal and Child Health Division, icddr,b, 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. billah@icddrb.org.
[Ti] Título:A community-based cluster randomised controlled trial to evaluate the effectiveness of different bundles of nutrition-specific interventions in improving mean length-for-age z score among children at 24 months of age in rural Bangladesh: study protocol.
[So] Source:BMC Public Health;17(1):375, 2017 05 02.
[Is] ISSN:1471-2458
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Prevalence of stunting among under-five children in Bangladesh is 36%, varying with geographic and socio-economic characteristics. Previously, research groups statistically modelled the effect of 10 individual nutrition-specific interventions targeting the critical first 1000 days of life from conception, on lives saved and costs incurred in countries with the highest burden of stunted children. However, primary research on the combined effects of these interventions is limited. Our study directly addresses this gap by examining the effect of combinations of 5 preventive interventions on length-for-age z-scores (LAZ) among 2-years old children. METHODS: This community-based cluster randomised trial (c-RCT) compares 4 intervention combinations against one comparison arm. Intervention combinations are: 1) Behaviour change communication (BCC) on maternal nutrition during pregnancy, exclusive breastfeeding, and complementary feeding, along with prenatal nutritional supplement (PNS) and complementary food supplement (CFS); 2) BCC with PNS; 3) BCC with CFS; and 4) BCC alone. The comparison arm receives only routine health and nutrition services. From a rural district, 125 clusters were selected and randomly assigned to any one of the five study arms by block randomisation. A bespoke automated tab-based system was developed linking data collection, intervention delivery and project supervision. Total sample size is 1500 pregnant women, with minimum 1050 resultant children expected to be retained, powered to detect a difference of at least 0.4 in the mean LAZ score of children at 24 months, the main outcome variable, between the comparison arm and each intervention arm. Length and other anthropometric measurements, nutritional intake and other relevant data on mother and children are being collected during enrolment, twice during pregnancy, postpartum monthly till 6 months, and every third month thereafter till 24 months. DISCUSSION: This c-RCT explores the effectiveness of bundles of preventive nutrition intervention approaches addressing the critical window of opportunity to mitigate childhood stunting. The results will provide robust evidence as to which bundle(s) can have significant effect on linear growth of children. Our study also will have policy-level implications for prioritising intervention(s) tackling stunting. TRIAL REGISTRATION: The study was retrospectively registered on May 2, 2016 and is available online at ClinicalTrials.gov (ID: NCT02768181 ).
[Mh] Termos MeSH primário: Suplementos Nutricionais
Transtornos do Crescimento/prevenção & controle
Comportamentos Relacionados com a Saúde
Mães
Pacotes de Assistência ao Paciente
[Mh] Termos MeSH secundário: Antropometria
Bangladesh
Aleitamento Materno
Desenvolvimento Infantil
Pré-Escolar
Feminino
Seres Humanos
Lactente
Fenômenos Fisiológicos da Nutrição do Lactente
Fenômenos Fisiológicos da Nutrição Materna
Estado Nutricional
Gravidez
Projetos de Pesquisa
População Rural
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1186/s12889-017-4281-0


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[PMID]:29261680
[Au] Autor:Batiro B; Demissie T; Halala Y; Anjulo AA
[Ad] Endereço:Kindo Didaye Woreda Health Office, Halale, Ethiopia.
[Ti] Título:Determinants of stunting among children aged 6-59 months at Kindo Didaye woreda, Wolaita Zone, Southern Ethiopia: Unmatched case control study.
[So] Source:PLoS One;12(12):e0189106, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Stunting is a well-established risk marker of poor child development. Globally in 2017, 155 million children under 5 were estimated to be stunted. While different activities are being done to reduce the burden of stunted growth, the problem is overwhelming in Africa; it was increased by 24%. Therefore, identifying determinants of stunting among children aged 6-59 would help to set priorities for action and to the design of stunting reduction plan at a grassroots level. METHODS: The unmatched case-control study was conducted in randomly selected 8 rural kebeles of Kindo Didaye woreda, Ethiopia from February to April, 2016 to identify the determinants of stunting among children aged 6-59 months. The sampling frame was identified by enumeration of 6-59 months of age children in the entire households of the study area. From which 155 as cases and 310 as controls were chosen using anthropometric measurement based on the median of WHO 2006 reference population. The anthropometric data were analyzed by WHO Anthro 2010 software to generate Z-score values. Odds Ratio along with 95% confidence interval was estimated to identify determinants of stunting using the multivariable logistic regression. RESULTS: Drinking water from unsafe source (AOR = 7.06, 95% CI; 4.40-20.42),occasionally eating animal source food (AOR = 0.51, 95% CI; 0.02-0.68), ARI in the past two weeks (AOR = 3.04, (95% CI; 1.04-13.35), late initiation of breastfeeding after one hours after birth (AOR = 5.16, 95% CI; 2.24-15.90) and lack of vaccination (AOR = 6.38, 95% CI; 2.54-17.10)were significantly associated with stunting. CONCLUSIONS: Factors like exposure to diarrhea disease, exposure to acute respiratory infection, late initiation of breast milk after child breath, squeeze out of 1st breast milk, lack of vaccination, animal source of food, and unsafe source of water for drinking could be used to set priorities for action and to the design of Kindo Didaye woreda plan for stunting reduction down to grassroots level. Therefore, zonal health department and Kindo Didaye woreda health office should promote the importance of colostrums feeding. Drinking water should be decontaminated. Expansion of vaccination program to enhance herd immunity at the community level is important.
[Mh] Termos MeSH primário: Transtornos do Crescimento/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Estudos de Casos e Controles
Pré-Escolar
Diarreia/complicações
Água Potável
Etiópia/epidemiologia
Feminino
Transtornos do Crescimento/etiologia
Seres Humanos
Lactente
Masculino
Mães
Poder Familiar
Infecções Respiratórias/complicações
Classe Social
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Drinking Water)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189106



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