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A demographic dividend of the FP2020 Initiative and the SDG reproductive health target: Case studies of India and Nigeria.
Gates Open Research. 2018 Feb 22; 2:11.Background: The demographic dividend, defined as the economic growth potential resulting from favorable shifts in population age structure following rapid fertility decline, has been widely employed to advocate improving access to family planning. The current framework focuses on the long-term potential, while the short-term benefits may also help persuade policy makers to invest in family planning. Methods: We estimate the short- and medium-term economic benefits from two major family planning goals: the Family Planning 2020 (FP2020)'s goal of adding 120 million modern contraceptive users by 2020; Sustainable Development Goals (SDG) 3.7 of ensuring universal access to family planning by 2030. We apply the cohort component method to World Population Prospects and National Transfer Accounts data. India and Nigeria, respectively the most populous Asian and African country under the FP2020 initiative, are used as case studies. Results: Meeting the FP2020 target implies that on average, the number of children that need to be supported by every 100 working-age people would decrease by 8 persons in India and 11 persons in Nigeria in 2020; the associated reduction remains at 8 persons in India, but increases to 14 persons in Nigeria by 2030 under the SDG 3.7. In India meeting the FP2020 target would yield a saving of US$18.2 billion (PPP) in consumption expenditures for children and youth in the year 2020 alone, and that increased to US$89.7 billion by 2030. In Nigeria the consumption saved would be US$2.5 billion in 2020 and $12.9 billion by 2030. Conclusions: The tremendous economic benefits from meeting the FP2020 and SDG family planning targets demonstrate the cost-effectiveness of investment in promoting access to contraceptive methods. The gap already apparent between the observed and targeted trajectories indicates tremendous missing opportunities. Accelerated progress is needed to achieve the FP2020 and SDG goals and so reap the demographic dividend.
The inter-relationship among economic activities, environmental degradation, material consumption and population health in low-income countries: a longitudinal ecological study.
BMJ Open. 2015; 5(7):e006183.OBJECTIVES: The theory of ecological unequal exchange explains how trade and various forms of economic activity create the problem of environmental degradation, and lead to the deterioration of population health. Based on this theory, our study examined the inter-relationship among economic characteristics, ecological footprints, CO2 emissions, infant mortality rates and under-5 mortality rates in low-income countries. DESIGN: A longitudinal ecological study design. SETTING: Sixty-six low-income countries from 1980 to 2010 were included in the analyses. Data for each country represented an average of 23 years (N=1497). DATA SOURCES: Data were from the World Development Indicators, UN Commodity Trade Statistics Database, Global Footprint Network and Polity IV Project. ANALYSES: Linear mixed models with a spatial power covariance structure and a correlation that decreased over time were constructed to accommodate the repeated measures. Statistical analyses were conducted separately by sub-Saharan Africa, Latin America and other regions. RESULTS: After controlling for country-level sociodemographic characteristics, debt and manufacturing, economic activities were positively associated with infant mortality rates and under-5 mortality rates in sub-Saharan Africa. By contrast, export intensity and foreign investment were beneficial for reducing infant and under-5 mortality rates in Latin America and other regions. Although the ecological footprints and CO2 emissions did not mediate the relationship between economic characteristics and health outcomes, export intensity increased CO2 emissions, but reduced the ecological footprints in sub-Saharan Africa. By contrast, in Asia, the Middle East and North Africa, although export intensity was positively associated with the ecological footprints and also CO2 emissions, the percentage of exports to high-income countries was negatively associated with the ecological footprints. CONCLUSIONS: This study suggested that environmental protection and economic development are important for reducing infant and under-5 mortality rates in low-income countries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Asia-Pacific Population Journal. 2013 Dec; 28(2):27-49.Life-cycle deficits for women and men in India at different stages of the life cycle are examined in the present paper. Disaggregating lifecycle deficits according to sex, which is termed gender accounting, is important for gender-based budgeting, as it helps Governments allocate funds according to gender needs. A Life-cycle deficit is the difference between income and consumption at different stages of the life cycle. The significance of the paper lies in its contribution to understanding the male-female differential in public and private expenditure on health care, education, and other goods and services in monetary terms and life-cycle deficit. The author finds that, overall, women have a lifecycle deficit, largely due to their lower rates of participation in the paid workforce. However, women perform a large amount of unpaid labour; thus, their life-cycle deficit could turn into a surplus if a monetary value were placed on unpaid labour. However, it is also shown in the present paper that consumption on health-care needs is higher for males in childhood as well as in old age, which can be partly attributed to the discriminatory sociocultural practices that are prevalent in India. As regards education, households tend to spend more on male education than on female education after the age of 15, which is the age at which free-of-charge public education ends. The author concludes that gender accounting needs to be strengthened so as to allow Governments to allocate funds in order to promote gender equality and empower women. The author also recommends that, in order to achieve gender equality, public funding of health care is not enough. More needs to be done to remove the sociocultural barriers to the use of public services, such as health services.
The role of material deprivation and consumerism in the decisions to engage in transactional sex among young people in the urban slums of Blantyre, Malawi.
Global Public Health. 2016 Mar; 11(3):295-308.Transactional sex has been associated with a high risk of HIV acquisition and unintended pregnancy among young women in urban slums in sub-Saharan Africa. However, few studies have explored the structural drivers of transactional sex from the perspective of both genders in these settings. This paper explores how young men and women understand the factors that lead to transactional sex among their peers, and how deprivation of material resources (housing, food and health care access) and consumerism (a desire for fashionable goods) may instigate transactional sex in the urban slums of Blantyre, Malawi. Data from 5 focus group discussions and 12 in-depth interviews undertaken with a total of 60 young men and women aged 18-23 years old, conducted between December 2012 and May 2013, were analyzed using anticipated and grounded codes. Housing and food deprivation influenced decisions to engage in transactional sex for both young men and women. Poor health care access and a desire for fashionable goods (such as the latest hair or clothing styles and cellular phones) influenced the decisions of young women that led to transactional sex. Interventions that engage with deprivations and consumerism are essential to reducing sexual and reproductive health risks in urban slums.
[From a method for family planning to a differentiating lifestyle drug: images of the pill and its consumer in gynaecological advertising since the 1960s in West Germany and France] Vom Mittel der Familienplanung zum differenzierenden Lifestyle-Praparat : Bilder der Pille und ihrer Konsumentin in gynakologischen Werbeanzeigen seit den 1960er Jahren in der BRD und Frankreich.
NTM. 2012 Feb; 20(1):1-30.Add to my documents.
PNAS. Proceedings of the National Academy of Sciences of the United States of America. Early Edition.. 2010;  p.Substantial changes in population size, age structure, and urbanization are expected in many parts of the world this century. Although such changes can affect energy use and greenhouse gas emissions, emissions scenario analyses have either left them out or treated them in a fragmentary or overly simplified manner. We carry out a comprehensive assessment of the implications of demographic change for global emissions of carbon dioxide. Using an energy–economic growth model that accounts for a range of demographic dynamics, we show that slowing population growth could provide 16–29% of the emissions reductions suggested to be necessary by 2050 to avoid dangerous climate change. We also find that aging and urbanization can substantially influence emissions in particular world regions.
Tropical Medicine and International Health. 2008 Oct; 13(10):1245-56.OBJECTIVE: To estimate recurrent costs per patient and costs for a national HIV/AIDS treatment programme model in Rwanda. METHODS: A national HIV/AIDS treatment programme model was developed. Unit costs were estimated so as to reflect necessary service consumption of people living with HIV/AIDS (PLWHA). Two scenarios were calculated: (1) for patients/clients in the year 2006 and (2) for potential increases of patients/clients. A sensitivity analysis was conducted to test the robustness of results. RESULTS: Average yearly treatment costs were estimated to amount to 504 US$ per patient on antiretroviral therapy (ART) and to 91 US$ for non-ART patients. Costs for the Rwandan HIV/AIDS treatment programme were estimated to lie between 20.9 and 27.1 million US$ depending on the scenario. ART required 9.6 to 11.1 million US$ or 41-46% of national programme costs. Treatment for opportunistic infections and other pathologies consumed 7.1 to 9.3 million US$ or 34% of total costs. CONCLUSION: Health Care in general and ART more specifically is unaffordable for the vast majority of Rwandan PLWHA. Adequate resources need to be provided not only for ART but also to assure treatment of opportunistic infections and other pathologies. While risk-pooling may play a limited role in the national response to HIV/AIDS, considering the general level of poverty of the Rwandan population, no appreciable alternative to continued donor funding exists for the foreseeable future.
Tropical Medicine and International Health. 2008 Mar; 13(3):354-364.The objectives were to present and compare socioeconomic status (SES) rankings of households using consumption and an asset-based index as two alternative measures of SES; and to compare and evaluate the performance of these two measures in multivariate analyses of the socioeconomic gradient in malaria prevalence. Data for the study come from a survey of 557 households in 25 study villages in Tanzania in 2004. Household SES was determined using consumption and an asset-based index calculated using Principal Components Analysis on a set of household variables. In multivariate analyses of malaria prevalence, we also used two other measures of disease prevalence: parasitaemia and self-report of malaria or fever in the 2 weeks before interview. Household rankings based on the two measures of SES differ substantially. In multivariate analyses, there was a statistically significant negative association between both measures of SES and parasitaemia but not between either measure of SES and self-reported malaria. Age of individual, use of a mosquito net, and wall construction were negatively and significantly associated with parasitaemia, whilst roof construction was positively associated with parasitaemia. Only age remained significant when malaria self-report was used as the measure of disease prevalence. An asset index is an effective alternative to consumption in measuring the socioeconomic gradient in malaria parasitaemia, but self-report may be an unreliable measure of malaria prevalence for this purpose. (author's)
Liquid assets: How demographic changes and water management policies affect freshwater resources. Summary.
In: Liquid assets: How demographic changes and water management policies affect freshwater resources, [by] Jill Boberg. Santa Monica, California, RAND, 2005. xiii-xxiii.Demographic factors play an important role in environmental change, along with biophysical, economic, sociopolitical, technological, and cultural factors, all of which are interrelated. Recent demographic trends have sparked concern about the impact of the human population on a critical element of the natural environment - fresh water. In the last 70 years, the world's population has tripled in size while going from overwhelmingly rural to a near balance of urban and rural - a change that affects both how humans use water and the amount they consume. In the late 1980s, concern over a potential water crisis began to grow. Much of the resulting literature has taken an alarmist view. Numerous reports sensationalized the so-called water crisis without talking into account the local or regional nature of water resources and the relationship between supply and demand. A number of factors are cited to support the position that the earth is headed toward a water crisis. They include the following: the human population continues to grow; water withdrawals are outpacing population growth; per-capita water availability is declining; clean, potable water is less available worldwide. (excerpt)
Santa Monica, California, RAND, 2005.  p.Demographic factors play an important role in environmental change, along with biophysical, economic, sociopolitical, technological, and cultural factors, all of which are interrelated. Recent demographic trends have sparked concern about the impact of the human population on a critical element of the natural environment - fresh water. In the last 70 years, the world's population has tripled in size while going from overwhelmingly rural to a near balance of urban and rural - a change that affects both how humans use water and the amount they consume. In the late 1980s, concern over a potential water crisis began to grow. Much of the resulting literature has taken an alarmist view. Numerous reports sensationalized the so-called water crisis without talking into account the local or regional nature of water resources and the relationship between supply and demand. A number of factors are cited to support the position that the earth is headed toward a water crisis. They include the following: the human population continues to grow; water withdrawals are outpacing population growth; per-capita water availability is declining; clean, potable water is less available worldwide. (excerpt)
Studies of Tribes and Tribals. 2007 Dec; 5(2):85-95.The term "environmental refugees" describes a new kind of mass human casualty caused by negative ecological impacts during the last decades. It has been estimated that 25 million environmental refugees are on the move worldwide due to environmental problems, 50 million are left homeless by cyclones, floods and earthquakes, 90 millions are displaced by infrastructural projects. These figures are expected to increase sharply in the next few decades due to the impacts of global warming and the consequence of sea level rise by 2050. Yet, the unfortunate environmental victims are refused refugee status and are not granted assistance and protection by the international community. Why is the number of environmental victims on the increase? Why are they left unassisted? Who should be responsible for what they have been suffered from? What should be done to limit the hardship being suffered by environmentally displaced people? This paper will attempt to answer these questions. (author's)
Mercury levels in cord blood and meconium of healthy newborns and venous blood of their mothers: Clinical, prospective cohort study.
Science of the Total Environment. 2007 Mar; 374(1):60-70.The purpose of this study is to investigate the chronic mercury intoxication in pregnant women and newborns living in Istanbul, Turkey. The research was carried out as a prospective with 143 pregnant women and their newborns. Venous blood from the mother, cord blood from the neonate, and meconium were collected for mercury analysis. Frequency of fish and vegetable-eating and the number of teeth filled were investigated. Analyses were made in cold vapor Atomic Absorption Spectrophotometer (AAS, µg/L). Mercury levels were 0.38±0.5 µg/L (0-2.34) in venous blood of pregnant women, 0.50±0.64 µg/L (0-2.36) in umbilical cord blood and 9.45±13.8 µg/g (0-66.5) in meconium. Maternal blood mercury level was lower than the known toxic limit for humans (EPA, 5 µg/L). Mercury levels of the maternal venous blood were significantly correlated with umbilical cord blood. The primary risk factors affecting mercury levels were eating fishmeals more than twice a week and having filled teeth more than five. The fact that the mother had a regular vegetable diet everyday reduced the mercury levels. Increased levels of mercury in the mother and umbilical cord blood could lead to retarded newborns' weight and height. Pregnant women living in Istanbul may be not under the risk of chronic mercury intoxication. Fish consumption more than twice per week and tooth-filling of mother more than five may increase mercury level. On the contrary, regular diet rich in vegetable decreases the mercury level. (author's)
[Unpublished] 2007. Presented at the Population Association of America 2007 Annual Meeting, New York, New York, March 29-31, 2007. 30 p.The present paper examined the relationship of population to the environment and with growing population, poverty and urbanization the environment is degrading. Conducted an analysis of changes and trends over last fifty years. The study reveals that the country's population growth is imposing an increasing burden on the country's limited and continually degrading natural resource base. The natural resources are under increasing strain, even though the majority of people survive at subsistence level. Population pressure on arable land contributes to the land degradation. The increasing population numbers and growing affluence have already resulted in rapid growth of energy production and consumption in India. The environmental effects like ground water and surface water contamination; air pollution and global warming are of growing concern owing to increasing consumption levels. The paper concludes with some policy reflections, the policy aimed at overall development should certainly include efforts to control population and environmental pollution. (author's)
Asia-Pacific Population Journal. 2006 Dec; 21(3):7-16.Every country in the Asian and Pacific region is in the midst of a demographic transition that is producing large changes in age structure with important implications for economic growth and standards of living. In the early stages of the transition, high fertility and declining infant and child mortality produce a bulge in the population at young ages. The middle of the transition is marked by an increase in the share of the population concentrated at the working ages as large cohorts of children reach adulthood and as the relative number of children are depressed by fertility decline. At the end of the transition, the share of the older population increases. In part, this is a consequence of continued reductions in mortality rates, but of greater consequence are the low fertility rates that characterize the final stages of the demographic transition. (excerpt)
Food and Nutrition Bulletin. 2004 Sep; 25(3):239-247.An agricultural project in Highland Ecuador provided a model context to better understand the nutrition of rural women. The adequacy of women's nutrition and the strength of associations with age and socioeconomic status were studied in 104 rural households over four rounds (two seasons) during the 1995-1996 agricultural year using a cross-sectional with repeated-measures design. Women were at high risk for micronutrient deficiencies (calcium, iron, riboflavin, and vitamin B12) due to low intakes of animal products. Two distinct constructs representing socioeconomic status were identified: modern lifestyle and farming wealth. In multivariate models, farming wealth was associated with quality of women's diet (animal protein adjusted for energy, p = 0.01). Diet quality, in turn, was positively associated with anthropometric status (p = 0.02). Women over the age of 50 weighed approximately 3.7 kg less than younger women and consumed less energy (300 kcal) and micronutrients (p < 0.05). Age was positively associated with respiratory morbidity (p = 0.01). These findings, while directly relevant to a specific context, suggest the need for cross-cultural studies to identify the extent of, and factors contributing to, the risk of nutritional inadequacy in postreproductive women in developing countries. (author's)
Behavior-change trials to assess the feasibility of improving complementary feeding practices and micronutrient intake of infants in rural Bangladesh.
Food and Nutrition Bulletin. 2004 Sep; 25(3):228-238.This study used simple rapid-assessment techniques to test the feasibility of increasing the consumption of complementary foods by infants by asking mothers to increase meal quantity or frequency or by altering the viscosity/energy density of the food. The feasibility of using micronutrient supplements either added directly to food or administered as liquid drops was also examined. The study was conducted in rural Bangladesh and involved four separate short-term behavioral change trials. Depending on the trial, fieldworkers recruited 30 to 45 infants 6 to 12 months of age. Following recommendations to increase the amount of food provided to infants, the mean intakes from single meals increased from 40 ± 23 g on day 1 to 64 ± 30 g on day 7 (p < 0.05). In a second trial, the mean meal frequency increased from 2.2 ± 1.3 on day 1 to 4.1 ± 1.3 on day 7 (p < 0.05). Provision of high-energy-density diets, prepared by decreasing viscosity with a-amylase or by hand-mashing rice and dhal into a paste before feeding, increased single-meal energy consumption from 54 ± 35 kcal to 79 ± 52 kcal or 75 ± 37 kcal (p < 0.05), respectively. Both types of micronutrient supplements were well accepted and used according to recommendations. In conclusion, it was possible to change short-term child-feeding behaviors to promote increased food intake, meal frequency, energy density, and micronutrient consumption. Because each of these interventions lasted for only about 1 week, however, the long-term sustainability of these changes is not known. Moreover, the effect of increased feeding of complementary foods on intakes of breastmilk and total daily consumption of energy and nutrients requires further study. (author's)
Response to "Malnutrition and dietary protein: Evidence from China and from international comparisons".
Food and Nutrition Bulletin. 2003; 24(3):291-295.The opportunity to comment on the paper by Jamison and his colleagues  is most welcome. My perspective, and biases, on the issues they discuss are based largely on work in pediatrics and community health in Turkey, Colombia, and Thailand during a period of 17 years. In addition, I was privileged to visit China in 1973 as a member of the Early Childhood Development Delegation, one of the earliest US delegations to visit China, when I was able to pay particular attention to growth in children under five years of age [2-4]. Nutrition, growth, and mortality in young children have been major concerns throughout my career. Dr. Jamison has studied health issues having to do with China for many years, and this is an interesting contribution. There is no need here to repeat the study design, but the three populations from which data were used for the study, must be mentioned. They include: Data from a sample of urban adults, aged 18 to 25 years, from 13 provinces of China, in 1979: information on average heights and weights for men and women and on average income and availability of energy and protein; Data from a sample of adult men and women from 64 rural counties: information on heights and weights plus data on income, energy availability, and protein share from 26 provinces, around 1983; Data from 41 populations of men and 33 populations of women in 40 and 32 countries, respectively: information on average heights, as well as income, energy, protein share, and ethnic group, around 1960. (excerpt)
Food-consumption patterns in Central West Africa, 1961 to 2000, and challenges to combating malnutrition.
Food and Nutrition Bulletin. 2003; 24(2):167-182.We discuss food-consumption patterns in Central West Africa from 1961 to 2000 and some implications for combating malnutrition. The availability of food in the region improved in the 1960s, declined sharply in the 1970s and the early 1980s, and has shown a modest positive trend since the mid-1980s. Notwithstanding obvious progress over the past decades and in the region as a whole, food availability today remains below the required levels for large parts of the population and appears unstable over time, particularly in the Sahelian zone. On average, diets in this zone contain fewer than 2,200 kcal, compared with almost 2,500 kcal in the coastal zone. Conversely, protein deficiency is more common in the coastal zone, where a typical diet contains only 45 g of protein, compared with 60 g in the Sahelian zone. Furthermore, consumption is showing a dietary shift toward cereals, while yield growth lags far behind population growth. The associated import dependency and pressure on land seem to gain significance regardless of the region's agro-ecological capacity to increase and to substitute cereal imports for locally produced food. Moreover, food consumption appears responsive to income changes (calorie-income elasticity ranges from 0.25 to 0.62), while, in turn, it has a significant impact on nutritional outcomes (stuntingcalorie elasticity of -1.42). We conclude that combating malnutrition requires first broad-spectrum income growth, and next specific policies that promote the yield and the contribution to diets of nutritious food produced within the region. (author's)
Planning a national food-based strategy for sustainable control of vitamin A deficiency in Ghana: Steps toward transition from supplementation.
Food and Nutrition Bulletin. 2001; 22(4):361-365.In an effort to control the high prevalence of vitamin A deficiency in Ghana, which studies have shown to be of public health significance, a number of interventions are being pursued. Periodic, massive-dose supplementation strategy, developed as a short-term life-saving intervention, is currently under way, either as part of the polio eradication program or combined with the existing health delivery system, schools, or community-based infrastructures. This has been successfully accomplished, and therefore the stage is set for the design and implementation of a long-term, sustainable solution. This is important in order to make the transition from a subsidized periodic capsule-distribution effort to a more sustainable food-based intervention, which could supply other vital nutrients as well as vitamin A in the diet. This report describes a proposal for a food-based strategy against a backdrop of low consumption in spite of the relatively high availability of some vitamin A-rich foods in most parts of Ghana. The aim is to improve vitamin A status of vulnerable groups through increased production, availability, and consumption of vitamin A-rich foods. The proposal is therefore to undertake a range of food-based interventions that will include horticultural interventions that aim to increase production and availability of vitamin A-rich foods, such as dark-green leafy vegetables and orange-colored fruits and vegetables and tubers in the diet of Ghanaian households. There will also be a comprehensive behavior change and communication strategy, to raise awareness of the causes and consequences of vitamin A deficiency and the need for consumption of adequate vitamin A-rich foods at the household level. Further emphasis will be placed on efforts to promote consumption of red palm oil, since this oil is generally available and not subjected to acute seasonal shortages. A phased community-based program will be implemented in four districts during the next three years, with the aim of applying lessons learned to the rest of the country. The monitoring framework will cover the planning process, provision of services, utilization of services, and coverage of target groups. These dietary approaches offer long-term sustainable options for improving the quality of family diets and overcoming vitamin A deficiency. (author's)
Enhancing vitamin A intake in young children in western Kenya: Orange-fleshed sweet potatoes and women farmers can serve as key entry points.
Food and Nutrition Bulletin. 2001; 22(4):376-387.In western Kenya, where vitamin A deficiency is common and the white sweet potato is an important secondary staple, orange-fleshed sweet potatoes were introduced and their consumption was promoted, along with other vitamin A-rich foods. Ten women's groups grew a number of varieties of sweet potato on group plots in on-farm trials. Five of the groups also received an intervention consisting of nutritional education, individual counseling, and participatory rapid appraisal techniques to promote vitamin A consumption, while the other five formed the control group that received no additional promotion. Changes in consumption of children under five years of age were assessed before and after a one-year intervention period using the Helen Keller International food-frequency method. Varieties were tested for yield, agronomic performance, taste and appearance, and dry matter content. They were also assessed for ß-carotene content in the forms of boiled and mashed puree, sweet potato flour, and processed products. Children in the intervention group consumed vitamin A-rich foods almost twice as frequently as control children (93% more), especially orange-fleshed sweet potatoes, mangoes, dark-green leafy vegetables, butter, and eggs. The yields of orange-fleshed sweet potatoes were at least twice those of white sweet potatoes, as were the taste and appearance ratings. The dry matter content of the varieties exceeded 25%, except for one that was preferred as a weaning food. ß-Carotene values were high enough that one cup of boiled and mashed sweet potato fed daily to children of weaning age would alone meet their requirement of vitamin A, even using the higher 12:1 ß-carotene:retinol conversion. Orange-fleshed sweet potatoes produced and prepared by women farmers can serve as a key food-based entry point for reducing vitamin A deficiency. (author's)
An integrated primary health-care and provitamin A household food-production program: Impact on food-consumption patterns.
Food and Nutrition Bulletin. 2001; 22(4):370-375.Food diversification is a long-term food-based strategy to address vitamin A deficiency. In order to improve the vitamin A status of preschool children in a rural South African community, a home-based food-production program targeting provitamin A-rich foods was integrated with a community-based growth-monitoring system. This integrated system provided the infrastructure needed for nutritional education and promotion of the food-production program. Dietary intake was collected by 24-hour recall at baseline and 12 and 20 months after implementation of the food-production program. At baseline, the median intake of vitamin A was 150 µg RE. One year after implementation, the vitamin A intake increased to 1,133 µg RE in children from households with a project garden and to 640 µg RE in control children. Eight months later, vitamin A intake was 493 µg RE in children from households with a project garden and 129 µg RE in control children. We concluded that a home-based food-production program resulted in a significant increase in vitamin A intake. Home gardens should therefore be promoted, but they should focus on foods needed to address specific nutrient deficiencies. (author's)
Marketing of red palm oil as a food source of vitamin A in Burkina Faso: A pilot project involving women's groups.
Food and Nutrition Bulletin. 2001; 22(4):388-394.Consumption of red palm oil for its provitamin A activity could extend to nonproducing areas of Africa. To assess the impact of red palm oil introduction, vitamin A status was measured in a random sample of mother-child pairs in the pilot areas. This paper describes the marketing approach, the evaluation design, and results after one year. Red palm oil purchased in southern Burkina Faso is retailed in the north-central pilot area by women's groups. At onset, serum retinol was low in 66% of children and 43% of mothers. After one year, 94% of mothers reported liking red palm oil, 71% had purchased it, and 32% had consumed some in the last week. The rates of risk of inadequate vitamin A intake declined by one-third. Prior to scaling-up, the main challenges ahead are positioning red palm oil as a food supplement rather than a cooking oil, and determining whether the increased demand can be met by local production without undue pressure on prices. (author's)
Food Additives and Contaminants. 2006 Jul; 23(7):700-708.In Egypt, there is a paucity of biomarker data on aflatoxin (AF) exposure. The study assessed the level and frequency of breast milk, AFM/1 as a biomarker of maternal exposure. Breast milk samples were collected from a selected groups of 388 Egyptian lactating mothers of children attending the New El-Qalyub Hospital, Qalyubiyah governorate, Egypt, during May-September 2003. Following aflatoxin extraction, AFM/1 levels were assessed by high-performance liquid chromatography (HPLC) with fluorescence detection. Approximately 36% of mothers tested positive for AFM/1 ( median 13.5 pg ml, interquartile range (IQR) 10.27-21.43) Non-working status (p=0.018, odds ration (OR) =2.87), obesity (p=0.004, OR=3.0), high corn oil consumption (p = 0.028 OR =3.57), contributed to the occurrence of AF in breast milk. AFM/1 contamination of breast milk was frequent, albeit at moderate levels. Growth and development of the infant is rapid and thus it is possible that AF exposure through breast milk has a significant health effect. (author's)
Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2006 Mar.  p. (USAID Development Experience Clearinghouse DocID / Order No: PN-ADF-999; USAID Contract No. HRN-C-00-00-00019-00)The pharmaceutical and medical supply system for Ministry of Health hospitals in Jordan is bureaucratic and centralized. Routine paperwork consumes staff time that ideally would go to patient care, procurement does not necessarily match medical needs, pharmacists have little access to the latest information, and resources are limited. This assessment looks at the pharmaceutical system in terms of structure, process, and outcomes to identify its strengths and weaknesses. Drug utilization is measured against internationally established indicators. Based on its findings, the assessment makes recommendations that are intended to lead to improvements in patient care, administrative procedures, use of staff, and financial resources. (author's)
Recommendations for an educational programme to improve consumer knowledge of and attitudes towards nutritional information on food labels.
SAJCN. South African Journal of Clinical Nutrition. 2001 Feb; 14(1):28-35.The needs and objectives of the various groups affected by nutritional labelling illustrate the complex and controversial nature of nutritional labelling and the problems in formulating a simple and easily understood system. Twenty homogeneous white middle-income suburbs were chosen at random from a total of 39 strata. The multistage cluster method of sampling was used to divide each suburb into smaller clusters. One area was chosen at random from each suburb. Twenty homes were then systematically selected to bring the total sample number of respondents to 400. White middle-income women completed a questionnaire analysing consumer attitudes towards and knowledge of nutritional labelling in order to identify the objectives needed for the formulation of an educational programme concerning the nutritional labelling of food containers. The results of the survey suggest that although white middle-income women (N = 388) lacked nutritional labelling knowledge (pass rate < 20%), they had a positive attitude towards nutritional labelling (mean 18.29 ± 4.8). As knowledge scores increased, the following factors became more positive: attitudes towards nutritional labelling (R = 0.2905, P = 0.0000), nutritional education (c2 = 40.9273, P = 0.01), and the use of nutritional labelling in the purchase of food (r = 0.2230, P = 0.0258). The results of this survey suggest a definite need for a nutritional labelling education programme in South Africa. Although the subject group could be considered representative of the top end of the South African market, a comprehensive needs assessment of the relevant target markets that make up South Africa's diverse population should be undertaken for the formulation of a national nutritional education programme. (author's)