Browsing by Subject "Anemia"

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Anemia among Syrian refugee children aged 6 to 23 months living in Greater Beirut, Lebanon, including the Voices of Mothers’ and Local Healthcare Staff: A mixed-methods study
(2023) Jeremias, Theresa; Abou-Rizk, Joana; Burgard, Leonie; Entenmann, Isa; Nasreddine, Lara; Jomaa, Lamis; Hwalla, Nahla; Frank, Jan; Scherbaum, Veronika
Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow’s milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.
Anthropometrics, hemoglobin status and dietary micronutrient intake among Tanzanian and Mozambican pigeon pea farmers
(2022) Eleraky, Laila; Issa, Ramula; Maciel, Sónia; Mbwana, Hadijah; Rybak, Constance; Frank, Jan; Stuetz, Wolfgang
Inadequate consumption of micronutrient-dense and protein-rich foods such as vegetables, legumes and meat is an important contributing cause for anemia and deficiencies of vitamin A and iron in rural communities of Tanzania and Mozambique. A cross-sectional study was conducted to assess the nutritional status (anthropometrics and hemoglobin) and diets in particular micronutrient intake of female and male pigeon pea farmers from Lindi, Tanzania, and Gurué, the Zambézia province of Mozambique. A total of 1526 farmers (669 from Tanzania, 857 from Mozambique) were studied, of whom 16% were overweight and 35% were anemic. The highest prevalence of overweight and anemia, at 35% and 48%, was observed in Tanzanian and Mozambican women, respectively. Overall, only a small proportion of women and men reached the recommended daily dietary intake of vitamin A (10%), iron (51%) and zinc (44%). Multiple regression models revealed that dark green leafy vegetables (DGLVs) highly predicted vitamin A intake, whereas legumes in Tanzania and starchy plants in Mozambique were actually the dominant sources of vitamin A. Cereals covered over half of the iron and the zinc intake in both countries. An increased consumption of micronutrient-rich DGLVs and legumes, while reducing the high amounts of refined maize or polished rice, is suggested to counteract the high prevalence of anemia and overweight among smallholder farmers in East and South Eastern Africa.
Baseline assessment and effect of a supplementary community-based nutrition intervention study on the prevention/treatment of anemia among young Adivasi children in West Bengal, India
(2020) Stiller, Caroline K.; Biesalski, Hans-Konrad
Background: India´s Adivasi scheduled tribe population is disproportionately affected by anemia and undernutrition. On the avenue to sustainably promote child health locally available resources have to be maxed out. Subsequently, designed recipes may find entrance and modify dietary routines on household level, through interactive home-based cooking trainings, community awareness and homestead food production. Study design: From February 2015 onwards, the cluster-randomized controlled feeding trial was conducted in 21 tribal villages Birbhum District, West Bengal. The intervention lasted for 18 months and embraced four assessment points (t0, t6, t12, t18) including medical checkup, measurement of Hb concentrations (HemoCue Hb201+) as well as anthropometric indices. A semi-structured household (HH) survey was part of the baseline assessment. The research comprises one control group (CG) and three intervention groups (diversified meals only (IG1), with the addition of locally producible Amaranthus tricolor/Moringa oleifera leaf powders (ALP/MLP) in the ratio 2:1 (IG2), or with an adjusted amount of commercially produced micronutrient powder (MNP) TopNutri (IG3)). Supplementary meals were provided three times a week during an on-the-spot community feeding program. 293 children (6-39 months) were valid for the pre-/post intervention effect analysis. Objectives: To assess the overall burden of anemia and undernutrition and to investigate nutrition-sensitive and nutrition-specific factors determining the maternal and child nutritional status at baseline, moreover to identify independent drivers of anemia in Adivasi children (Article I and II). To design improved recipes and to evaluate their effect in a supplementary feeding intervention on the primary outcome variable hemoglobin (Hb), and the secondary outcome variables stunting (HAZ), underweight (WAZ), and wasting (WHZ) (Article III). The first article (Chapter 4) provides data on the maternal nutritional status and child feeding practices, and describes socio-demographic characteristics, family planning methods, use of antenatal care services and birth, childcare, mother-child dyad analysis. Moderate/severe forms of anemia and underweight were prevalent in every second mother. Child feeding practices and child caring were found to be suboptimal. Infants (6 to 11 months) were particularly vulnerable with merely every fourth child fulfilling the minimum acceptable diet (2 to 3 meals per day and  4 food groups (FG) per day). On HH level the serving of animal-sourced foods, legumes, vegetables and fruits has to be scaled up. The second article (Chapter 5) assessed the prevalence of anemia and undernutrition among Santal Adivasi children, determined independent predictors of moderate/severe anemia, and depicted agricultural assets, livelihood, aspects of food security and hygiene, morbidity rates, health seeking behavior. Binary Logistic regression assessed five independent predictors of moderate/severe anemia in children (Hb<10g/dl): child´s age<24 months, low WAZ scores, any morbidity (fever, diarrhea, or respiratory infection), low maternal Hb concentrations, lack of dietary diversification (low count of FG consumed during the previous 24 hours). The third arcticle (Chapter 6) assessed the intervention effects of the three study meals on the prevention/treatment of anemia (and undernutrition) in Adivasi children. IG1 (diversified meals only) showed significant higher Hb concentrations as compared to CG during the intervention (adjusted for age and Hb concentrations at baseline, time between assessment points, and gender). The mean Hb of IG2 or IG3, remained comparable to CG. Concluding remarks: Distressing rates of anemia and undernutrition were found among Adivasi mothers and children. To address identified drivers of anemia in Adivasi children and lower the burden of undernutrition multi-sectoral programmatic actions comprising the key pillars nutrition, agriculture and health care are recommended for timely intervention before the child reaches two years of age; accompanied by hygienic and sanitary activities, with interactive awareness trainings being in the center of actions. Lack of dietary diversification was not only found as predictor for anemia at baseline, moreover the low-dose intervention trial confirmed diversified meals only (IG1) being a successful food-based approach in significantly increasing the Hb concentration as opposed to the CG, thus is suggested as useful preventive strategy to overcome nutrition-related anemia amongst Santal Adivasi children (aside iron therapy). Study findings indicate the adding of MNP (IG3) as being beneficial for decreasing the burden of undernutrition and infectious diseases.
Food and nutrition security and associated health aspects of Syrian refugee mothers and their offspring : a mixed-method study in Greater Beirut, Lebanon
(2023) Abou-Rizk, Joana; Scherbaum, Veronika
Nutrition during the first 1000 days of life – from conception to two years of age – lays the foundation for optimal health, cognitive and social development, and well-being of children and mothers. Malnutrition and hidden hunger in mothers and their offspring during the perinatal period can have long-lasting and irreversible consequences on human capital and increase the risk to non-communicable diseases among adulthood through intergenerational effects. Since the Arab Spring in 2011, the Syrian humanitarian crisis has escalated to become the world’s largest by the end of 2018, forcing 6.7 million to flee, mainly to neighboring countries. In 2015, Lebanon was the host of more than 1.5 million refugees and displaced persons from Syria, reaching the highest per capita concentration of refugees worldwide. The protracted crisis has increasingly weakened Lebanon, in turn exposing vulnerable groups, especially women of reproductive age and children below five years, to increased risks of inadequate nutrition and health status. To date, there has been a lack of studies among refugees that examine the nutritional and health situation and investigate the underlying and immediate determinants of malnutrition among women of reproductive age and children below five years. Therefore, knowledge gaps regarding the prevalence of anemia and nutritional status of Syrian refugee mothers and children were identified as important research areas in this dissertation. Assessing the food security and mental health of Syrian refugee mothers, examining the dietary intake and infant feeding practices, and investigating their respective determinants and associated risk factors were also important areas of focus. This research project was conducted between July and October 2018 in collaboration with the American University of Beirut in primary healthcare centers in the Greater Beirut area in Lebanon using quantitative and qualitative surveys (mixed-methods survey) among Syrian refugee mothers and their child aged below five years of age. This work comprises a total of three research articles that have been published in peer-reviewed international journals. The first article (Chapter 3) describes the prevalence of anemia and the nutritional status of mothers and children below five years of age and indicates a moderate public heath significance among Syrian refugees in the Greater Beirut area, Lebanon. The existence of the so-called double burden of malnutrition and hidden hunger (micronutrient deficiencies) has been documented, as mothers and children from the same household were affected by undernutrition, overnutrition, and / or anemia. A strong association between maternal and child anemia in the same household and an association between anemia and overweight / obesity among mothers has also been demonstrated. Analysis of the 24-hr dietary recalls of pregnant, lactating, non-pregnant non-lactating mothers revealed inadequate dietary intake and nutrient deficiencies during pregnancy and lactation. The second article (Chapter 4) presents data on the prevalence of food insecurity, low dietary diversity, and poor mental health among Syrian refugee mothers in Greater Beirut, Lebanon. A significant association between food insecurity and low dietary diversity as well as poor mental health status was found. Low household monthly income and a high household crowding index were significantly associated with low dietary diversity and food insecurity. In addition, the results showed that low-income households consumed monotonous diets, characterized by a high consumption of refined starchy staples and grains. The third paper (Chapter 5) focused on the nutritional and health status of infants under six months. Overall, the public heath significance for anemia and wasting was moderate. Inadequate infant feeding practices, such as the intake of pre-lacteal feeding and liquids, were demonstrated in newborns, which in turn contributed to delayed initiation of breastfeeding and low rates of exclusive breastfeeding. Factors supporting infant feeding practices included proper knowledge on maternal nutrition and exclusive breastfeeding and support from healthcare professionals or family during breastfeeding. Identified barriers included cultural practices such as the early introduction of foods, breastmilk substitutes, and giving water or herbal tea to infants under six months of age. Maternal health issues and social factors such as misinformation from family members and violations of the Code of Marketing of Breastmilk Substitutes also affected breastfeeding. A conceptual framework was also developed in this dissertation to provide a comprehensive understanding of the linkages and pathways between the enabling, underlying, and immediate determinants and the nutritional and health outcomes in the context of humanitarian crises. Based on this conceptual framework, three principal pathways were identified to explain the following associations: (1) from the enabling determinants to anemia and nutritional status, (2) from socio-economic status and host country resources to food consumption and diets, and (3) from pre-resettlement experiences and dietary acculturation to food consumption and diets. In addition, the concluding discussion (Chapter 6) presented the role of maternal mental health status and health services and their impact on maternal nutrition and anemia status as well as infant feeding. In summary, this dissertation contributes to the knowledge about the anemia and nutritional status of Syrian refugee women and children as well as on the food security and mental health status of mothers living in an urban setting of a protracted humanitarian crisis in Lebanon. It also provides insights into the emergence of malnutrition among women and children in the context of refugees and shows the pathways between different levels of determinants of nutrition and health. Implications for practice can be drawn from this dissertation, such as the development or strengthening of evidence-based culture-specific nutritional interventions that are targeted to the refugee context. Priorities for future research were also identified, including the need to improve the effectiveness of nutritional interventions in conflict settings.
Infant feeding practices, nutrition, and associated health factors during the first six months of life among Syrian refugees in Greater Beirut, Lebanon: A mixed methods study
(2022) Abou-Rizk, Joana; Jeremias, Theresa; Nasreddine, Lara; Jomaa, Lamis; Hwalla, Nahla; Frank, Jan; Scherbaum, Veronika
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July–October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes’ distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
Microbiological and proteome analysis to gain insights into the pathogenesis of the highly adapted not-cultivated hemotrophic Mycoplasma suis
(2016) Dietz, Stefanie; Hölzle, Ludwig
The aims of this work were to establish a chronic pig infection model and to clarify unrecognized transmission pathways of M. suis. In addition, proteomics-based investigations of M. suis should be performed to improve the knowledge on the host pathogen interactions and host adaptation in IAP. Based on the succeeded and frequently applied splenectomized M. suis pig model (acute infection model) it was possible to establish a novel non-splenectomized M. suis pig model. This infection model enables the experimental investigation of the chronic M. suis infection. To this end, the piglets were infected intramuscularly with a highly virulent M. suis strain. Infected animals exhibited clinical signs (e.g. Morbus maculosus) including the typical cyclic course of chronic IAP. In the next step, potential transmission pathways of M. suis were analyzed during acute and chronic M. suis infection based on these two pig infection models. Feces, urine, air and dust as well as nasal, vaginal and saliva excretions were collected during the course of infection and examined for M. suis DNA by Rt-PCR. For the first time it was possible to detect M. suis in urine with and without erythrocytes as well as in nasal, vaginal and saliva excretions during acute and chronic infections. These results indicate blood-independent M. suis transmission via vaginal discharge, nasal excretions, saliva, and urine. The non-culturability limited the improvement of proteomic-based investigations of M. suis-related host-pathogen interactions. Therefore, we used modern and sophisticated proteome analysis to solve this problem. Blood samples from experimentally infected pigs at different time points of infection were investigated. For this, novel enrichment methods for M. suis proteins (especially membrane proteins) were established. These methods enabled an improved resolution of the protein expression profile of M. suis and thereby deeper insights into the pathogenesis of this microorganism. Despite of the missing cultivation system it was possible to identify more than 50% of the predicted M. suis proteins during acute infection. This identification ratio is similar to the one found in cultivable bacteria. Furthermore, the results of the proteome analysis indicate that nutrients such as glucose, hexose-6-phosphate, spermidine, putrescine, phosphate, amino acids, magnesium, potassium, sodium and iron are taken up by M. suis from the host leading to the high degree of host adaptation. Therefore, gained information on expressed M. suis proteins involved in transport are helpful in the establishment of an in vitro cultivation system in future. Particularly the supplementation of individual nutrients can play key functions in the media to support growth. Besides the M. suis proteome the acquired dataset firstly enables also the quantitative identification of Sus scrofa proteins differentially expressed during M. suis infection. This information can be used to unravel infection-relevant processes in the host in further studies.
Nutrition-related knowledge, attitudes, practices, and anemia status of lactating mothers in Bukavu, Democratic Republic of the Congo - A cross-sectional analysis
(2024) Beitze, Damaris Elisabeth; Kavira Malengera, Céline; Barhwamire Kabesha, Theophile; Scherbaum, Veronika
Maternal nutrition is impacted by personal and environmental factors including dietary intake, knowledge, food availability, and affordability. This cross-sectional analysis aimed to evaluate nutrition-related knowledge, attitudes, practices, and associations with hemoglobin concentration among lactating mothers in the Bukavu region, Democratic Republic of the Congo. In 444 lactating mothers, nutrition-related knowledge and practice were assessed by questionnaires and translated into knowledge and practice scores ranging from 0 to 1, attitudes and drivers of food choice were assessed, the Dietary Diversity Score (DDS) was assessed with 24 h dietary recalls in a potential range from 0 to 10, and hemoglobin (Hb) was measured in mothers and their infants. Anemia prevalence was 28.2% among mothers and 74.3% among infants aged 3–8 months. Nutritional knowledge and practice were limited (the median total knowledge score was 0.39, median DDS was 3.0). While there were slight positive correlations between knowledge and maternal Hb, DDS did not significantly correlate with either knowledge or Hb. Although half of the mothers stated a perception about their own susceptibility to anemia or vitamin A deficiency (56.4%, 47.4%), less than half of those could justify their estimation (40.9%, 44.2%). Taste (68.1%), appearance (42.5%), availability (29.0%), and health effects (25.6%) were important drivers of food choice. In conclusion, interventions on the different influencing factors including nutrition education strategies are needed.
Nutritional and hemoglobin status in relation to dietary micronutrient intake: studies in female and male small-scale farmers from Lindi region, Tanzania, and Gurué district, Mozambique
(2024) Eleraky, Laila; Frank, Jan
Inadequate consumption of micronutrient-dense and protein-rich foods, such as vegetables, legumes and meat, are important contributing causes for malnutrition, anemia and micronutrient deficiencies in rural communities of Tanzania and Mozambique. The increasing public health concern of the malnutrition form of overweight has repeatedly been reported in urban as well as rural areas of Sub-Sahara Africa and may have already reached farmers in Tanzania and Mozambique. Nutritional status is assessed by anthropometry, dietary intake and hemoglobin. Compared to the often-used body mass index (BMI) and traditional 24-hour recall, the mid-upper-arm-circumference (MUAC), as well as a food group-based algorithm (CIMI) can be suitable additional assessment tools, especially in resource poor environments. Cross-sectional studies within the framework of the Vegi-Leg project were conducted to assess the nutritional status (anthropometrics and hemoglobin measurements), and the dietary behaviours (Household Dietary Diversity Scores (HDDS), Food Frequency Questionnaires (FFQ) and 24-hour recalls) of female and male farmers from rural areas of Tanzania and Mozambique. Data were analysed by region, sex, age, partly season (Tanzania)and correlates. Additional data from similar projects, namely Scale-N and Trans-SEC in rural villages of Tanzania were included in MUAC and CIMI analysis. MUAC as an additional and easy-to-handle anthropometric marker for underweight, as well as overweight was evaluated using data from Vegi-Leg and Scale-N surveys. MUAC cut-offs, calculated via BMI cut-offs and multiple linear regression (MLR), compared to those selected by highest Youden’s index (YI) value, were assessed. The CIMI algorithm included 23 food groups and was tested in comparison to NutriSurvey (detailed quantitative 24 hour recalls) with data from Scale-N and Trans-SEC.A total of 1526 farmers from the Vegi-Leg project (669 from Tanzania, 857 from Mozambique) were studied, of whom 19% were overweight and 35% were anemic. The study showed an overall higher prevalence of overweight (19%) than underweight (10%), mainly due to the high prevalence of overweight female farmers (up to 35%) in southern Tanzania. The highest prevalence of overweight and anemia, at 35% and 48%, was observed in Tanzanian and Mozambican women, respectively. Regarding HDDS and FFQ data, pigeon pea farmers in Lindi and Gurué reported high consumption frequencies of cereals, legumes, vegetables and oil, while meat, fish and eggs were only consumed rarely. Overall, only a small proportion of enrolled women and men reached the recommended daily dietary intake of vitamin A (10%), iron (51%) and zinc (44%) according to the 24-hour recalls. Multiple regression models revealed that dark green leafy vegetables (DGLVs) highly predicted vitamin A intake, whereas legumes in Tanzania and starchy plants in Mozambique were the dominant sources of vitamin A. Cereals contributed to over half of the iron and the zinc intake in both countries. Seasonal analysis revealed high fluctuations for the consumption frequency of food items from the food groups ‘legumes and pulses’, ‘green leafy vegetables’, ‘other vegetables’ and ‘fruits’, including tomatoes, pigeon peas, mangoes and oranges. The results from Lindi Tanzania revealed, that in seasons, when the availability of food groups like fruits, legumes or vegetables was low, the consumption frequency decreased significantly. BMI, which correlated positively and strongly with MUAC, was higher in Tanzania than in Mozambique and higher among female than male farmers, and decreased significantly from the age of 65 years. MUAC cut-offs of <24 cm and ≥30.5 cm, calculated by multiple linear regression, detected 55% of farmers being underweight and 74% being overweight, with a specificity of 96%; the higher cut-off <25 cm and lower cut-off ≥29 cm, each selected according to Youden’s Index, consequently detected more underweight (80%) and overweight farmers (91%), but on the basis of a lower specificity (87–88%). The results of the algorithm CIMI and NutriSurvey were similar with regard to the average intake and range of data distribution. The correlation coefficients of NutriSurvey and CIMI with regards to energy (0.931), protein (0.898), iron (0.775) and zinc (0.838) intake, supported the matching of both calculations. An increased consumption of micronutrient rich DGLVs and legumes, while reducing the high amounts of refined sugar, maize and polished rice, is suggested to counteract the high prevalence of anemia and overweight among smallholder farmers in rural Tanzania and Mozambique. MUAC cut-offs to detect malnutrition whether defined via linear regression or Youden’s Index, proved to be easy-to-use tools for large-scale rural screenings of both underweight and overweight. The food group based CIMI algorithm is a valid instrument that calculates energy and nutrient intake in agreement with the preferred nutrition software NutriSurvey.