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To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context.
A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women.
Setting and subjects
Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso.
The mean DDS-9 and DDS-22 were 4.9 ± 1.0 and 6.5 ± 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the women’s socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 ± 4.9 kg m–2 and 37% of them were overweight or obese (BMI ≥ 25 kg m–2). Neither the DDS-9 nor the DDS-22 was associated with the women’s anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22.
In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.
To compare dietary diversity scores measured over a 1-day and a 3-day period, and to assess their relationships with socio-economic characteristics and the nutritional status of rural African women.
A qualitative dietary recall allowed calculation of a dietary diversity score (DDS; number of food groups consumed out of a total of nine). Body mass index (BMI) and body fat percentage (BFP) were used to assess the nutritional status of women.
Setting and subjects
A representative sample of 550 mothers in north-east Burkina Faso.
The DDS increased from 3.5 to 4.4 when calculated from a 1-day or a 3-day recall (P < 0.0001), although for the latter the DDS was affected by memory bias. The DDS calculated from a 1-day recall was higher when a market day occurred during the recall period. Both scores were linked to the sociodemographic and economic characteristics of the women. Women in the lowest DDS tertile calculated from the 1-day recall had a mean BMI of 20.5 kg m− 2 and 17.7% of them were underweight, versus 21.6 kg m− 2 and 3.5% for those in the highest tertile (P = 0.0003 and 0.0007, respectively). The DDS calculated from the 1-day recall was also linked to mean BFP; all these links remained significant after adjustment for confounders. For the 3-day period, no such relationships were found to be significant after adjustment.
The DDS calculated from a 1-day dietary recall was sufficient to predict the women's nutritional status. In such a context attention should be paid to market days.
To study individual determinants of differential benefit from the Senegal Community Nutrition Project (CNP) by monitoring improvement in children's weight-for-age index (WA) or underweight status (WA < –2 Z-scores) during participation.
A follow-up study using the CNP child monitoring data. Linear general models compared variations in WA according to 14 factors describing the beneficiaries and CNP services.
Poor neighbourhoods of Diourbel, a large city in Senegal, West Africa. Over a 6-month period, the CNP provided underweight or nutritionally at-risk 6–35-month-old children with monthly growth monitoring and promotion and weekly food supplementation, provided that mothers attended weekly nutrition education sessions.
All the children who participated in the first two years of the project (n = 4084).
Mean WA varied from − 2.13 (standard deviation (SD) 0.82) to − 1.58 (SD 0.81) Z-scores between recruitment and the end of the follow-up. The lower the child's initial WA, the greater was their increase in WA but the lower was the probability of recovery from underweight. Only 61% of underweight children recovered. Six months of CNP services may not be sufficient for catch-up growth of severely underweight children. The number of food supplement rations received was not a direct indicator of the probability of recovery. After adjustment for services received and initial WA, probability of recovery was lower in girls, in younger children, in twins and when mothers belonged to a specific ethnic group.
Determinants of benefit from CNP differed from the risk factors for underweight. Identification of participants with a lower probability of recovery can help improve outcome. Moreover, an explanation for the lack of recovery could be that many underweight children are stunted but not necessarily wasted.
To demonstrate the effectiveness of the commercial introduction of red palm oil (RPO) as a source of vitamin A (VA) for mothers and children in a non-consuming area, as a dietary diversification strategy.
A pre–post intervention design (no control area) was used to assess changes in VA intake and status over a 24-month pilot project.
Setting and subjects:
The pilot project involved RPO promotion in 10 villages and an urban area in east-central Burkina Faso, targeting approximately 10?000 women and children aged < 5 years. A random sample of 210 mother–child (12–36-months-old) pairs was selected in seven out of the 11 pilot sites for the evaluation.
After 24 months, RPO was reportedly consumed by nearly 45% of mothers and children in the previous week. VA intake increased from 235 ± 23 μg retinol activity equivalents (RAE) to 655 ± 144 μg RAE in mothers (41 to 120% of safe intake level), and from 164 ± 14 μg RAE to 514 ± 77 μg RAE in children (36 to 97%). Rates of serum retinol < 0.70 μmoll−1 decreased from 61.8 ± 8.0% to 28.2 ± 11.0% in mothers, and from 84.5 ± 6.4% to 66.9 ± 11.2% in children. Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake.
Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites. While it is promising as part of a national strategy, additional public health and food-based measures are needed to control VA malnutrition, which remained high in the RPO project area
To assess the relative importance of socioeconomic and maternal/prenatal determinants of the nutritional situation of children < 6 years old in an urban African area after several years of economic crisis.
Cross-sectional cluster sample survey.
Brazzaville, capital city of the Congo.
Information on socioeconomic characteristics was gathered from a random sample of 1368 households by house visits and anthropometric measurements were performed using standardized procedures on preschool children (n=2373) and their mothers (n=1512).
The influence of socioeconomic factors on the nutritional status of children, taking into account adjustment variables such as mother's age and child's age and sex was assessed. For stunting, as well as for the mean height-for-age index among children, the main determinants were economic level of the household (P=0.048 and P=0.004, respectively), schooling of the mother (P=0.004 and P < 10−3) and living in the peripheral district (P=0.005 and P < 10−3). The influence of socioeconomic determinants on weight-for-age and wasting was less straightforward. When adjusting, in addition, for maternal and prenatal factors (mother's height and body mass index (BMI) and birth weight), most of the effects of the socioeconomic determinants on the nutritional status of children persisted somewhat, but the effect of the economic level on the stunting became not significant (P=0.11). The mean BMI of mothers appeared to be related to the economic level of the household (P < 10−4), to the marital status (P=0.01) and to the occupation of the mother (P < 10−4).
Among the socioeconomic determinants of malnutrition in children, some, such as economic level of the household or schooling of the mother, seem to act mainly through prenatal factors, whereas others, mainly dwelling district characteristics, seem to influence more directly the children's nutritional status.
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