scholarly journals PROTOCOL: Efficacy and effectiveness of micronutrient supplementation and fortification interventions on the health and nutritional status of children under‐five in low and middle‐income countries: a systematic review

2018 ◽  
Vol 14 (1) ◽  
pp. 1-36 ◽  
Author(s):  
Emily C Keats ◽  
Aamer Imdad ◽  
Jai K Das ◽  
Zulfiqar A Bhutta
Keyword(s):  
Systematic Review ◽  
Nutritional Status ◽  
Micronutrient Supplementation ◽  
Middle Income ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Nutritional Status Of Children ◽  
Low And Middle Income

PP124 Health Technology Assessment And Feedback For Healthy Workplace Culture In Malaria Care In Low And Middle Income Countries

2018 ◽  
Vol 34 (S1) ◽  
pp. 114-114
Author(s):  
Patrick Okwen ◽  
Raphael Cheabum ◽  
Etienne Che ◽  
Joy Ngwemsi Mbunu ◽  
Miriam Nkangu
Keyword(s):  
Workplace Culture ◽  
Evidence Based ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Percent Improvement ◽  
Evidence Based Care ◽  
Low And Middle Income

Introduction:Malaria is a leading cause of mortality and morbidity in children under five in low and middle income countries (LMICs). Management of malaria in children under five years of age is challenging. One challenge faced by clinical practice in LMICs is lack of evidence to guide practice. This challenge is further compounded by different training backgrounds of team members. In the management of malaria in Cameroon, conflicts usually arise between clinicians, lab technicians and pharmacists resulting in over diagnosis and treatment of malaria. The patient's view is usually not considered. This leads to over diagnosis and over prescriptions for malaria in children under five years of age.Methods:We used the Joanna Briggs Institute (JBI) approach of getting research into practice to organize stakeholder meetings, assess existing evidence in malaria care, develop evidence criteria for management based on levels of evidence, assess the gamut of care for malaria, provide feedback to clinicians and re-assess practice. We used the JBI practical application of clinical evidence system (PACES) and getting research into practice (GRiP) evidence implementation tools in the process to facilitate teamwork, collaboration on evidence and provide feedback.Results:A collaborative approach to assessments and feedback including all healthcare stakeholders significantly improved workplace culture of evidence-based care and staff-to-staff relationships as well as staff-to-patient relationships. Over a period of twelve months, we reported eighty-four percent fewer conflicts between staff and ninety-eight percent fewer conflicts between staff and patients. For malaria management, overall criteria showed a thirty-one percent improvement in compliance with best practice recommendations with evidence levels of Grade 1.Conclusions:The project demonstrated that local leadership and evidence-based care can significantly improve practice in resource limited settings.

scholarly journals Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 491 ◽  
Author(s):  
Christina Oh ◽  
Emily C. Keats ◽  
Zulfiqar A. Bhutta
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Child Health ◽  
Low Birthweight ◽  
Grey Literature ◽  
Micronutrient Supplementation ◽  
Maternal Anemia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.

scholarly journals Incidence and etiology of clinically-attended, antibiotic-treated diarrhea among children under five years of age in low- and middle-income countries: evidence from the Global Enteric Multicenter Study

2020 ◽  
Author(s):  
Joseph A Lewnard ◽  
Elizabeth T Rogawski McQuade ◽  
James A Platts-Mills ◽  
Karen L Kotloff ◽  
Ramanan Laxminarayan
Keyword(s):  
Multicenter Study ◽  
Incidence Rates ◽  
Sub Saharan Africa ◽  
Molecular Diagnostic ◽  
Middle Income ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Stool Specimens ◽  
Low And Middle Income

Background: Diarrhea is a leading cause of antibiotic consumption among children in low- and middle-income countries. While vaccines may prevent diarrhea infections for which children often receive antibiotics, the contribution of individual enteropathogens to antibiotic use is minimally understood. We used data from the Global Enteric Multicenter Study (GEMS) to estimate pathogen-specific incidence of antibiotic-treated diarrhea among children under five years old residing in six countries of sub-Saharan Africa and South Asia before rotavirus vaccine implementation. Methods and findings: GEMS was an age-stratified, individually-matched case-control study. Stool specimens were obtained from children presenting to sentinel health clinics with newly-onset, acute diarrhea (including moderate-to-severe and less-severe diarrhea) as well as matched community controls without diarrhea. We used data from conventional and quantitative molecular diagnostic assays applied to stool specimens to estimate the proportion of antibiotic-treated diarrhea cases attributable to each pathogen. Antibiotics were administered or prescribed to 9,606 of 12,109 moderate-to-severe cases and 1,844 of 3,174 less-severe cases. Across all sites, incidence rates of clinically-attended, antibiotic-treated diarrhea were 12.2 (95% confidence interval: 9.0-17.8), 10.2 (7.4-13.9) and 1.9 (1.3-3.0) episodes per 100 child-years at risk at ages 6 weeks to 11 months, 12-23 months, and 24-59 months, respectively. Based on the recommendation for antibiotic treatment to be reserved for cases with dysentery, we estimated a ratio of 12.6 (8.6-20.8) inappropriately-treated diarrhea cases for each appropriately-treated case. Rotavirus, adenovirus serotypes 40/41, Shigella, sapovirus, Shiga toxin-producing Escherichia coli, and Cryptosporidium were the leading antibiotic-treated diarrhea etiologies. Rotavirus caused 29.2% (24.5-35.2%) of antibiotic-treated cases, including the largest share in both the first and second years of life. Shigella caused 14.9% (11.4-18.9%) of antibiotic-treated cases, and was the leading etiology at ages 24-59 months. Conclusions: Our findings should inform the prioritization of vaccines with the greatest potential to reduce antibiotic exposure among children.

scholarly journals Mapping child growth failure across low- and middle-income countries

Nature ◽  
2020 ◽  
Vol 577 (7789) ◽  
pp. 231-234 ◽  
Author(s):  
Keyword(s):  
Growth Failure ◽  
Child Growth ◽  
Reference Standards ◽  
World Health ◽  
Middle Income ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Growth Reference ◽  
Low And Middle Income

AbstractChildhood malnutrition is associated with high morbidity and mortality globally1. Undernourished children are more likely to experience cognitive, physical, and metabolic developmental impairments that can lead to later cardiovascular disease, reduced intellectual ability and school attainment, and reduced economic productivity in adulthood2. Child growth failure (CGF), expressed as stunting, wasting, and underweight in children under five years of age (0–59 months), is a specific subset of undernutrition characterized by insufficient height or weight against age-specific growth reference standards3–5. The prevalence of stunting, wasting, or underweight in children under five is the proportion of children with a height-for-age, weight-for-height, or weight-for-age z-score, respectively, that is more than two standard deviations below the World Health Organization’s median growth reference standards for a healthy population6. Subnational estimates of CGF report substantial heterogeneity within countries, but are available primarily at the first administrative level (for example, states or provinces)7; the uneven geographical distribution of CGF has motivated further calls for assessments that can match the local scale of many public health programmes8. Building from our previous work mapping CGF in Africa9, here we provide the first, to our knowledge, mapped high-spatial-resolution estimates of CGF indicators from 2000 to 2017 across 105 low- and middle-income countries (LMICs), where 99% of affected children live1, aggregated to policy-relevant first and second (for example, districts or counties) administrative-level units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the ambitious World Health Organization Global Nutrition Targets to reduce stunting by 40% and wasting to less than 5% by 2025. Large disparities in prevalence and progress exist across and within countries; our maps identify high-prevalence areas even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where the highest-need populations reside, these geospatial estimates can support policy-makers in planning interventions that are adapted locally and in efficiently directing resources towards reducing CGF and its health implications.

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