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Rawal Medical Journal. 2018 Jul-Sep; 43(3):462-466.Objective: To evaluate the nutritional status of the Pakistani children aged 2-5 years. Methods: A cross-sectional study of 1474 children, aged 2-5 years, was undertaken from Multan, Lahore, Rawalpindi and Islamabad, Pakistan from March-June, 2016. The head circumference (HdC) measurement of each subject was taken. Following the WHO age and sex-specific cut-off points, nutritional status of children was determined. Results: The mean age and HdC of the total subjects was4.15±0.87 years and 48.51 ±1.79 cm, respectively. Mean HdC increased with advancement of age in both boys and girls. Moderate under-nutrition was more prevalent than severe under-nutrition in both genders. Based on the HdC, the overall (age and sex combined) percentage of under-nourishment was 16.2 while these percentages were 16.4 and 15.8 for girls and boys, respectively. Conclusion: The study showed that a considerable number of Pakistani children were undernourished. A high rate of under-nutrition was observed in girls than in boys.
Children. 2018 May 4; 5(5)Pakistan has one of the highest prevalences of child malnutrition as compared to other developing countries. This narrative review was accomplished to examine the published empirical literature on children’s nutritional status in Pakistan. The objectives of this review were to know about the methodological approaches used in previous studies, to assess the overall situation of childhood malnutrition, and to identify the areas that have not yet been studied. This study was carried out to collect and synthesize the relevant data from previously published papers through different scholarly database search engines. The most relevant and current published papers between 2000(-)2016 were included in this study. The research papers that contain the data related to child malnutrition in Pakistan were assessed. A total of 28 articles was reviewed and almost similar methodologies were used in all of them. Most of the researchers conducted the cross sectional quantitative and descriptive studies, through structured interviews for identifying the causes of child malnutrition. Only one study used the mix method technique for acquiring data from the respondents. For the assessment of malnutrition among children, out of 28 papers, 20 used the World Health Organization (WHO) weight for age, age for height, and height for weight Z-score method. Early marriages, large family size, high fertility rates with a lack of birth spacing, low income, the lack of breast feeding, and exclusive breastfeeding were found to be the themes that repeatedly emerged in the reviewed literature. There is a dire need of qualitative and mixed method researches to understand and have an insight into the underlying factors of child malnutrition in Pakistan.
Complementary Feeding Interventions Have a Small but Significant Impact on Linear and Ponderal Growth of Children in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.
Journal of Nutrition. 2017 Nov; 147(11):2169S-2178S.Background: World Health Assembly member states have committed to ambitious global targets for reductions in stunting and wasting by 2025. Improving complementary diets of children aged 6-23 mo is a recommended approach for reducing stunting in children <5 y old. Less is known about the potential of these interventions to prevent wasting.Objective: The aim of this article was to review and synthesize the current literature for the impact of complementary feeding interventions on linear [length-for-age z score (LAZ)] and ponderal [weight-for-length z score (WLZ)] growth of children aged 6-23 mo, with the specific goal of updating intervention-outcome linkages in the Lives Saved Tool (LiST).Methods: We started our review with studies included in the previous LiST review and searched for articles published since January 2012. We identified longitudinal trials that compared children aged 6-23 mo who received 1 of 2 types of complementary feeding interventions (nutrition education or counseling alone or complementary food supplementation with or without nutrition education or counseling) with a no-intervention control. We assessed study quality and generated pooled estimates of LAZ and WLZ change, as well as length and weight gain, for each category of intervention.Results: Interventions that provided nutrition education or counseling had a small but significant impact on linear growth in food-secure populations [LAZ standardized mean difference (SMD): 0.11; 95% CI: 0.01, 0.22] but not on ponderal growth. Complementary food supplementation interventions with or without nutrition education also had a small, significant effect in food-insecure settings on both LAZ (SMD: 0.08; 95% CI: 0.04, 0.13) and WLZ (SMD: 0.05; 95% CI: 0.01, 0.08).Conclusions: Nutrition education and complementary feeding interventions both had a small but significant impact on linear growth, and complementary feeding interventions also had an impact on ponderal growth of children aged 6-23 mo in low- and middle-income countries. The updated LiST model will support nutrition program planning and evaluation efforts by allowing users to model changes in intervention coverage on both stunting and wasting. (c) 2017 American Society for Nutrition.
Levels and trends in child malnutrition. UNICEF/ WHO / World Bank Group joint child malnutrition estimates: key findings of the 2017 edition.
New York, New York, UNICEF, 2017. 16 p.The inter-agency team released new joint estimates for child stunting, overweight, underweight, wasting and severe wasting (May 2017 edition) using the same methodology as in previous years. These new estimates supersede former analyses results published by UNICEF, WHO and the World Bank Group. Given that country data are at maximum available from surveys conducted in the year previous to when the modelling exercise takes place, in 2017 the joint estimates were derived up to 2016 with extrapolation for stunting until 2025.
New York, New York, UNICEF, 2017 Jul. 32 p.This report provides compelling new evidence that backs up an unconventional prediction UNICEF made in 2010: The higher cost of reaching the poorest children with life-saving, high-impact health interventions would be outweighed by greater results. This new study combines modelling and data from 51 countries. The results indicate that the number of lives saved by investing in the most deprived is almost twice as high as the number saved by equivalent investment in less deprived groups.
Maternal and Child Nutrition. 2017 Aug 10; 1-3.Written by the WHO/UNICEF NetCode author group, the comment focuses on the need to protect families from promotion of breast-milk substitutes and highlights new WHO Guidance on Ending Inappropriate Promotion of Foods for Infants and Young Children. The World Health Assembly welcomed this Guidance in 2016 and has called on all countries to adopt and implement the Guidance recommendations. NetCode, the Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes and Subsequent Relevant World Health Assembly Resolutions, is led by the World Health Organization and the United Nations Children's Fund. NetCode members include the International Baby Food Action Network, World Alliance for Breastfeeding Action, Helen Keller International, Save the Children, and the WHO Collaborating Center at Metropol University. The comment frames the issue as a human rights issue for women and children, as articulated by a statement from the United Nations Office of the High Commissioner for Human Rights.
New York, New York, UNICEF, 2017 Jun. 84 p.This report details the results achieved by UNICEF for and with children worldwide in 2016. It covers the organization’s programme work, humanitarian action, partnerships and advocacy efforts in all strategic sectors, with an emphasis on reaching every child and accelerating progress for the most vulnerable and disadvantaged girls and boys. The report also highlights UNICEF’s innovations, its efforts to improve efficiency and effectiveness, and the stories of individual children and families directly affected by UNICEF’s work in the course of its 70th anniversary year.
Dietary Inadequacies in HIV-infected and Uninfected School-aged Children in Johannesburg, South Africa.
Journal of Pediatric Gastroenterology and Nutrition. 2017 Mar 22;OBJECTIVES: The World Health Organization (WHO) recommends that HIV-infected children increase energy intake and maintain a balanced macronutrient distribution for optimal growth and nutrition. Few studies have evaluated dietary intake of HIV-infected children in resource-limited settings. METHODS: We conducted a cross-sectional analysis of the dietary intake of 220 perinatally HIV-infected children and 220 HIV-uninfected controls ages 5–9 years in Johannesburg, South Africa. A standardized 24-hour recall questionnaire and software developed specifically for the South African population was used to estimate intake of energy, macronutrients, and micronutrients. Intake was categorized based on recommendations by the WHO and Acceptable Macronutrient Distribution Ranges (AMDRs) established by the Institute of Medicine (IOM). RESULTS: The overall mean age was 6.7 years and 51.8% were boys. Total energy intake was higher in HIV-infected than HIV-uninfected children (1341 vs. 1196 kcal/day, p=0.002), but proportions below the recommended energy requirement were similar in the two groups (82.5 vs. 85.2%, p=0.45). Overall, 51.8% of the macronutrient energy intake was from carbohydrates, 13.2% from protein, and 30.8% from fat. The HIV-infected group had a higher percentage of their energy intake from carbohydrates and lower percentage from protein compared to the HIV-uninfected group. Intakes of folate, vitamin A, vitamin D, calcium, iodine, and selenium were suboptimal for both groups. CONCLUSIONS: Our findings suggest that the typical diet of HIV-infected children as well as uninfected children in Johannesburg, South Africa does not meet energy or micronutrient requirements. There appear to be opportunities for interventions to improve dietary intake for both groups.
WHO guideline: Use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years.
Geneva, Switzerland, WHO, 2016. 60 p.The use of multiple micronutrient powders for point-of-use fortification of foods has been suggested as an alternative to mitigate or overcome the constraints associated with supplementation and mass fortification. They are intended to increase the vitamin and mineral intake of infants and young children aged 6 to 23 months as well as preschool and school-age children aged 2-12 years. This guideline is intended to help Member States and their partners in their efforts to make evidence-informed decisions on the appropriate nutrition actions to improve the nutritional status of infants and children aged 6 months to 12 years. It will also support their efforts to achieve the Sustainable Development Goals, the global targets set by the Comprehensive implementation plan on maternal, infant and young child nutrition, and the Global strategy for women’s, children’s and adolescents’ health 2016-2030. It is intended for a wide audience, including governments, nongovernmental organizations, health-care workers, scientists and donors involved in the design and implementation of micronutrient programmes and antenatal care services, and their integration into national and subnational public health strategies and programmes. This guideline provides global, evidence-informed recommendations on the use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6-23 months and children aged 2-12 years.
What can we learn from nutrition impact evaluations? Lessons from a review of interventions to reduce child malnutrition in developing countries.
Washington, D.C., World Bank, 2010 Aug.  p.This paper reviews recent impact evaluations of interventions and programs to improve child anthropometric outcomes- height, weight, and birth weight-with an emphasis on both the findings and the limitations of the literature and on understanding what might happen in a non-research setting. It further reviews the experience and lessons from evaluations of the impact of the World Bank-supported programs on nutrition outcomes. Specifically, the review addresses the following four questions: 1) what can be said about the impact of different interventions on children's anthropometric outcomes? 2) How do these findings vary across settings and within target groups, and what accounts for this variability? 3) What is the evidence of the cost-effectiveness of these interventions? 4) What have been the lessons from implementing impact evaluations of Bank-supported programs with anthropometric impacts? Although many different dimensions of child nutrition could be explored, this report focuses on child anthropometric outcomes-weight, height, and birth weight. These are the most common nutrition outcome indicators in the literature and the ones most frequently monitored by national nutrition programs supported by the World Bank. Low weight for age (underweight) is also the indicator for one of the Millennium Development Goals.
Washington, D.C., World Bank, 2004 May.  p. (Health, Nutrition and Population (HNP) Discussion Paper; World Bank Report No. 69106)This paper argues for more nuance in the interpretation of progress towards the Nutrition Millennium Development Goal indicator (halving the prevalence of underweight children, under 5 years old, by 2015). Interpretation of a country's performance based on trends alone is ambiguous, and can lead to erroneous prioritization of countries in need of donor assistance. For instance, a country may halve the prevalence by 2015, but will still have unacceptable high malnutrition rates. This paper analyses which countries are showing satisfactory and unsatisfactory progress using the Annual Rate of Change (ARC), and then introduces the World Health Organization-classification of severity of malnutrition in the analysis to provide more nuance. It highlights that a little less than half of the Bank's client population is likely to halve underweight by 2015. Although the paper uses national data only, it flags the risks and recommends that countries take regional disparities into their needs-analysis. The paper also argues for more attention to the other important nutrition indicators, stunting and micronutrient deficiencies, which remain enormous problems, and briefly discusses solutions to reducing underweight malnutrition.
[Washington, D.C.], World Bank, 2010 Jun. 4 p. (en breve No. 157)Children in Haiti are born into some of the harshest conditions on the planet, and are left at a disadvantage in terms of growth, development, and potential to thrive. Malnutrition rates in Haiti are among the worst in the LAC region. Nearly one-third of all children under-five suffer from stunted growth and three-quarters of children 6-24 months are anemic. Malnutrition takes a serious and irreversible toll, making children more susceptible to disease and death and compromising their cognitive and physical development, which results in low human capital and diminished lifetime earnings. Yet, scaling up ten key nutrition interventions in Haiti is estimated to cost only $46.5 million per year, which is less than 1% of Haiti’s total GDP. (excerpt)
Washington, D.C., World Bank, 2006.  p. (Health, Nutrition, and Population Series)The prevalence of child undernutrition in India is among the highest in the world, nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity, and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this book explores the dimensions of child undernutrition in India and examines the effectiveness of the Integrated Child Development Services (ICDS) program, India’s main early child development intervention, in addressing it. Although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged behind those achieved by other countries with similar economic growth. Nutritional inequalities across different states and socioeconomic and demographic groups remain large. Although the ICDS program appears to be well designed and well placed to address the multidimensional causes of undernutrition in India, several problems exist that prevent it from reaching its potential. The book concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation.
The effectiveness of the WHO training course on complementary feeding counseling in a primary care setting, Ismailia, Egypt.
Journal of the Egyptian Public Health Association. 2014 Apr; 89(1):1-8.BACKGROUND: The adequacy and timing of complementary feeding of the breastfed child are critical for optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2 years of life. One of them was the WHO complementary feeding counseling course (CFC). OBJECTIVES: To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilities of primary healthcare physicians; on caretaker's knowledge and adherence to physicians' recommendations and their feeding practices; and on children's growth. PARTICIPANTS AND INTERVENTIONS: A single-blinded randomized-controlled study was carried out in 40 primary healthcare centers divided into matched pairs according to their location, either in rural or urban areas, and training of the selected physicians on integrated management of childhood illness. One center from each pair was selected randomly for its physician to receive CFC training in nutrition counseling and the matched center was selected as a control. Forty primary healthcare center physicians and 480 mother-child (6-18 months) pairs were included in the study. The mother-child pairs recruited were visited at home within 2 weeks, 90, and 180 days after the initial consultation with trained health workers. Special questionnaires were used to collect information on healthcare providers' knowledge of nutrition counseling and practice (counseling skills); maternal knowledge of basic nutrition-counseling recommendations, maternal compliance with the recommended feeding practice; child dietary intake; and gains in weight and length. RESULTS: CFC-trained physicians were more likely to engage in nutrition counseling and to deliver more appropriate advice. This was reflected in improvements in maternal recall of complementary feeding messages, which were higher in the intervention group compared with the control group. Six months after the consultation, children in the intervention group had significantly greater weight gains compared with the control group (0.96 vs. 0.78 kg; P=0.038). Children in the intervention group, who were 12-18 months of age at the time of recruitment, had significantly less faltering in length gain compared with the control group (height/age Z-score; 0.23 vs. 0.04; P=0.004). CONCLUSION AND RECOMMENDATIONS: Nutrition counseling training improved counseling abilities of primary healthcare physicians and led to improvements in mothers' knowledge and practices of complementary feeding. In turn, this led to improved growth of children. We recommend wide and regular utilization of the CFC course to improve the knowledge and skills of health workers who provide counseling to mothers for complementary feeding.
BMJ. 2016; 352:i8.Add to my documents.
How well do WHO complementary feeding indicators relate to nutritional status of children aged 6-23 months in rural northern Ghana?
BMC Public Health. 2015 Nov 23; 15(1157):1-12.Background Though the World Health Organization (WHO) recommended Infant and Young Child Feeding (IYCF) indicators have been in use, little is known about their association with child nutritional status. The objective of this study was to explore the relationship between IYCF indicators (timing of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet) and child growth indicators. Methods A community-based cross-sectional survey was carried out in November 2013. The study population comprised mothers/primary caregivers and their children selected using a two-stage cluster sampling procedure. Results Of the 1984 children aged 6-23 months; 58.2 % met the minimum meal frequency, 34.8 % received minimum dietary diversity (=4 food groups), 27.8 % had received minimum acceptable diet and only 15.7 % received appropriate complementary feeding. With respect to nutritional status, 20.5 %, 11.5 % and 21.1 % of the study population were stunted, wasted and underweight respectively. Multiple logistic regression analysis revealed that compared to children who were introduced to complementary feeding either late or early, children who started complementary feeding at six months of age were 25 % protected from chronic malnutrition (AOR=0.75, CI=0.50 - 0.95, P=0.02). It was found that children whose mothers attended antenatal care (ANC) at least 4 times were 34 % protected [AOR 0.66; 95 % CI (0.50 - 0.88)] against stunted growth compared to children born to mothers who attended ANC less than 4 times. Children from households with high household wealth index were 51 % protected [AOR 0.49; 95 % CI (0.26 - 0.94)] against chronic malnutrition compared to children from households with low household wealth index. After adjusting for potential confounders, there was a significant positive association between appropriate complementary feeding index and mean WLZ (ß=0.10, p=0.005) but was not associated with mean LAZ. Conclusions The WHO IYCF indicators better explain weight-for-length Z-scores than length-for-age Z-scores of young children in rural Northern Ghana. Furthermore, a composite indicator comprising timely introduction of solid, semi-solid or soft foods at 6 months, minimum meal frequency, and minimum dietary diversity better explains weight-for-length Z-scores than each of the single indicators.
UNICEF Training Package for Scaling Up Skilled Community Infant and Young Child Feeding Counselors: Zimbabwe Experience.
Journal of Nutrition Education and Behavior. 2015 May-Jun; 47(3):286-9.Add to my documents.
Systematic review of integration between maternal, neonatal, and child health and nutrition and family planning. Final report.
Washington, D.C., Global Health Technical Assistance Project, 2011 May. 284 p. (Report No. 11-01-303-03; USAID Contract No. GHS-I-00-05-00005-00)This reveiw seeks to focus on the MNCHN and FP components of SRH to examine the evidence for MNCHN-FP integration, review the most up-to-date factors that promote or inhibit program effectiveness, discuss best practices and lessons learned, and identify recommendations for program planners, policymakers, and researchers. The objective was to address these key questions: 1) What are the key integration models that are available in the literature and have been evaluated?; 2) What are the key outcomes of these integration approaches?; 3) Do integrated services increase or improve service coverage, cost, quality, use, effectiveness, and health?; 4) What is the quality of the evaluation study designs and the quality of the data from these evaluations?; 5) What types of integration are effective in what context?; 6) What are the best practices, processes, and tools that lead to effective, integrated services? What are the barriers to effective integration?; 7) What are the evidence/research and program gaps? What more do we need to know?; and 8) How can future policies and programs be strengthened?
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.2)Recognizing that accelerated global action is needed to address the pervasive and corrosive problem of the double burden of malnutrition, in 2012 the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified a set of six global nutrition targets that by 2025 aim to: achieve a 40% reduction in the number of children under-5 who are stunted; achieve a 50% reduction of anaemia in women of reproductive age; achieve a 30% reduction in low birth weight; ensure that there is no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%; reduce and maintain childhood wasting to less than 5%. As part of its efforts, the World Health Organization (WHO) has developed a series of six policy briefs, linked to each of the global targets, to guide national and local policy-makers on what actions should be taken at scale, in order to achieve the targets. Recognizing that the six targets are interlinked, many evidence-based, effective interventions can help make progress toward multiple targets. The purpose of these briefs is to consolidate the evidence around which interventions and areas of investment need to be scaled up, and to guide decision-makers on what actions need to be taken in order to achieve real progress toward improving maternal, infant and young child nutrition. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.3)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the first target: a 40% reduction in the number of children under-5 who are stunted. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing stunting rates among children aged under 5 years. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.7)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the fifth target: Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in improving exclusive breastfeeding rates among infants less than six months. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.6)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan for maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the fourth target: No increase in childhood overweight. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners prevent continued increases in overweight in children and ensure that the target is met. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.4)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025 . This policy brief covers the second target: a 50% reduction of anaemia in women of reproductive age. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners in reducing the rates of anaemia among women of reproductive age. (Excerpts)
Geneva, Switzerland, WHO, 2014.  p. (WHO/NMH/NHD/14.8)In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. This policy brief covers the sixth target: reduce and maintain childhood wasting to less than 5%. The purpose of this policy brief is to increase attention to, investment in, and action for a set of cost-effective interventions and policies that can help Member States and their partners to reduce and maintain the rate of childhood wasting. (Excerpts)
The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions.
Maternal and Child Nutrition. 2013; 9 Suppl 2:6-26.In 2012, the World Health Organization adopted a resolution on maternal, infant and young child nutrition that included a global target to reduce by 40% the number of stunted under-five children by 2025. The target was based on analyses of time series data from 148 countries and national success stories in tackling undernutrition. The global target translates to a 3.9% reduction per year and implies decreasing the number of stunted children from 171 million in 2010 to about 100 million in 2025. However, at current rates of progress, there will be 127 million stunted children by 2025, that is, 27 million more than the target or a reduction of only 26%. The translation of the global target into national targets needs to consider nutrition profiles, risk factor trends, demographic changes, experience with developing and implementing nutrition policies, and health system development.This paper presents a methodology to set individual country targets, without precluding the use of others. Any method applied will be influenced by country-specific population growth rates. A key question is what countries should do to meet the target. Nutrition interventions alone are almost certainly insufficient, hence the importance of ongoing efforts to foster nutrition-sensitive development and encourage development of evidence-based, multisectoral plans to address stunting at national scale, combining direct nutrition interventions with strategies concerning health, family planning, water and sanitation, and other factors that affect the risk of stunting. In addition, an accountability framework needs to be developed and surveillance systems strengthened to monitor the achievement of commitments and targets.