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To assess the impact of the 1996–2005 integrated community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) in Malawian preschool children living in rural areas.
Prospective study of three large-scale cross-sectional surveys conducted in 1996, 2000 and 2004 in MICAH and Comparison populations.
Rural areas in Malawi.
Preschool children (6·0–59·9 months) from randomly selected households (474 from the 1996 baseline survey; 1264 from 2000 MICAH areas; 1500 from 2000 Comparison areas; 1959 from 2004 MICAH areas; and 1008 from 2004 Comparison areas), who responded to a household questionnaire, were weighed and measured using standard protocols.
At the baseline in 1996, the prevalence of stunting (60·2 %) was very high. By 2000, the prevalence of stunting had declined to 50·6 % and 56·0 % (χ2 = 7·8, P = 0·005) in MICAH and Comparison areas, respectively. In 2004, the prevalence of stunting did not differ significantly between MICAH and Comparison areas (43·0 % v. 45·1 %; χ2 = 1·11, P = 0·3). Severe stunting affected 34·7 % of children at baseline, which declined to 15·8 % and 17·1 % (χ2 = 0·86, P = 0·4) in MICAH and Comparison areas, respectively, by 2004. Regional variations existed, with proportionately fewer children from the Northern region being stunted compared to their Central and Southern region counterparts.
Given the length of implementation, wide-scale coverage and positive impact on child growth in Phase I (1996–2000), the MICAH programme is a potential model for combating linear growth retardation in rural areas in Malawi, although the catch-up improvement in Comparison areas during Phase II (2000–2004) cannot be adequately explained.
To assess the impact of an integrated community-based micronutrient and health (MICAH) programme on anaemia (Hb < 120 g/l) among non-pregnant rural Malawian women aged 15–49 years from communities that participated in the 1996–2005 MICAH programme.
Prospective study of two large-scale cross-sectional surveys conducted in 2000 and 2004 as part of programme evaluation in MICAH and Comparison areas.
Rural areas across Malawi. The MICAH programme implemented a comprehensive package of interventions to reduce anaemia, based on a broad range on direct and indirect causes in Malawi. The project approaches included: Fe supplementation; dietary diversification and modification; food fortification; and strengthening primary health care.
Non-pregnant women of childbearing age (15–49 years old, n 5422), from randomly selected households that responded to a household questionnaire, had their Hb measured from finger-prick blood samples using the HemoCue®.
In 2000, there was no significant difference in Hb concentration between MICAH and Comparison areas (mean (se): 117·4 (0·4) v. 116·8 (0·5) g/l, P > 0·05) and the corresponding prevalence of anaemia (53·5 % v. 52·9 %, P > 0·05). By 2004, Hb concentration had increased significantly in MICAH but not in Comparison areas (mean (se): 121·0 (0·4) v. 115·7 (0·6) g/l, P < 0·001), and the prevalence of anaemia had declined significantly in MICAH areas (53·5 % to 44·1 %, χ2 = 28·2, P < 0·0001) but not in Comparison areas (52·8 % to 54·0 %, χ2 = 0·3, P = 0·6).
The MICAH programme was an effective public health nutrition programme that was associated with significant reductions in the prevalence of anaemia among non-pregnant rural Malawian women.
Folic acid food fortification has successfully reduced neural tube defect-affected pregnancies across Canada. The effect of this uncontrolled public health intervention on folate intake among Canadian children is, however, unknown. Our objectives were to determine folic acid intake from food fortification and whether fortification promoted adequate folate intakes, and to describe folic acid-fortified food usage among Ontario preschoolers.
Cross-sectional data were used from the NutriSTEP™ validation project with preschoolers recruited using convenience sampling. Mean daily total folate and folic acid intakes were estimated from 3 d food records, which included multivitamin supplement use. Comparisons were made to Dietary Reference Intakes, accounting for and excluding fortificant folic acid, to determine the prevalence of inadequate and excessive intakes.
Two hundred and fifty-four preschoolers (aged 3–5 years).
All participants (130 girls, 124 boys) ate folic acid-fortified foods and 30 % (n 76) used folic acid-containing supplements. Mean (se) fortificant folic acid intake was 83 (2) μg/d, which contributed 30 % and 50 % to total folate intake for supplement users and non-users, respectively. The prevalence of total folate intakes below the Estimated Average Requirement was <1 %; however, excluding fortificant folic acid, the prevalence was 32 %, 54 % and 47 % for 3-, 4- and 5-year-olds, respectively. The overall prevalence of folic acid (fortificant and supplemental) intakes above the Tolerable Upper Intake Level was 2 % (7 % among supplement users).
Folic acid food fortification promotes dietary folate adequacy and did not appear to result in excessive folic acid intake unless folic acid-containing supplements were consumed.
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