Browsing by Subject "Malnutrition"

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Baseline assessment and cost analysis of a supplementary feeding intervention on Adivasi children in West Bengal, India : How to diversify diets with locally available resources cost-effectively to reduce the burden of child and maternal undernutrition and anaemia?
(2022) Golembiewski, Silvia; Sousa-Poza, Alfonso
This dissertation presented and analyzed the living, health and nutrition situation of tribal Adivasi children (aged 6-39 months) as well as of their mothers living in rural Birbhum district, West Bengal, India. It was found that extended families use to have higher incomes (p<0.05) compared to nuclear families and that higher education of mothers (having completed at least class eight) is associated with higher incomes, too (p<0.05). Higher incomes were further found associated with a lesser incidence of moderate and severe anaemia amongst children (p<0.05). Further, active child caring was found to decrease the incidence of stunting (p<0.05, for caring efforts of three hours or more per day) - while mothers tied up in cooking (with cooking efforts of 6 and more hours a day) showed to have bigger likelihood of having a wasted or underweight child (p<0.05). It was suggested that the provision of gas cookers along with cooking gas to Adivasi families may be helpful to free mothers to care more actively for their children and reduce therewith child undernutrition. The dissertation further revealed that either father or mother deciding alone how to expense available income is superior to joint spending decisions - and it was in fact HHs with mothers deciding alone which showed the largest share of children with no or merely mild anaemia (p<0.05). It was suggested, accordingly, that mothers may be entrusted to manage a food budget on their own. Very importantly, the nutritional status of children and their mothers was found to be linked, where mothers with adequate BMI (18.5 and higher) had less often than expected a wasted child (p<0.001) and also less often an underweight child (p=0.001). Severe thin mothers (with a BMI<16.0) showed biggest likelihood of having a child with at least one anthropometric failure. No significant association was found between the anaemia status of the mother and her youngest child (p>0.05). Still, non-anaemic mothers showed bigger likelihood of having non-anaemic children than mothers with poorer Hb statuses, and - the other way around - mothers with severe anaemia showed the biggest likelihood of having children with moderate anaemia. It was argued, accordingly, that not only children but also their mothers should be better nourished in order to break the vicious circle of undernutrition - with a focus on lactating mothers who have highest nutritional intake needs. Overall, 94 percent of tribal Adivasi children were found anaemic (n=307, age range: 6-39 months, Hb<11g/dl) as well as 86 percent of their mothers (n=283, Hb<12g/dl). Anaemia in children was found significantly associated with the age of the child (p<0.001) where Hb was found to rise with increasing age and children above three years reached mild forms of anaemia - while children aged 6-23 months commonly suffered from moderate anaemia. Further, the consumption of fruit was found to decrease the incidence of moderate and severe anaemia (p<0.05). There was also a link between child undernutrition and the occurrence of severe anaemia, where children with no anthropometric failure (CIAF indicator) showed lesser likelihood to develop severe anaemia compared to children with at least one anthropometric failure (p<0.05). Seeing the high incidence of anaemia and interlinking to child undernutrition as well as interlinking of nutritional status of children and their mothers - the question arose how to overcome child as well as maternal undernutrition and anaemia? The present comparative intervention study conducted in 21 tribal villages found that providing diversified meals three times a week to children aged 6-39 months rose their mean Hb by 0.98g/dl (compared to 0.45g/dl in the CG); it was found that after 12 months children receiving the diversified meals showed a bigger share of non-anaemic or only mildly anaemic children compared to the CG (p<0.05). Further, children who had received the diversified meals showed bigger likelihood of achieving Hb increases which belong to the top 30 percent of all reported Hb increases (amounting to 1.40g/dl and more) after 12 months of intervention compared to the CG (p<0.01). It was argued, accordingly, that providing nutritious meals to undernourished tribal Adivasi children increases Hb and reduces anaemia. No significant difference in the distribution of non-anaemic and mildly anaemic children versus moderately and severely anaemic children could be found when comparing a group of children who had received a leaf powder of Moringa and Amaranthus along with diversified meals to the CG (p>0.05) and when comparing a group of children who had received a (low dosed) micronutrient sprinkle along with diversified meals (p>0.05). A cost-effectiveness analysis of 425 locally available foods has been conducted in order to work out those foods delivering highest nutrient density in relation to their retail cost (adjusted for edible portion). Foods from the FGs cereals and millets, vegetables, and roots and tubers belonged more often to the top 30 percent of cost-effective foods as per winter-price analysis (p<0.001) - while also grain legumes became cost-effective as per summer-price analysis (p<0.05). While the overall cost-effectiveness of FGs showed little difference considering winter- and summer price analyses, the cost-effectiveness of specific foods within some of the analyzed FGs did actually change (especially in case of vegetables). It was recommended, accordingly, to use most cost-effective locally available foods to nourish undernourished children and mothers adequately - and to consider also seasonal price changes of foods thereby. The developed aggregate cost-effectiveness indicator covered 38 nutrients. Further, five anti-nutritive elements to be limited in the diet of undernourished individuals had been considered: oxalate, phytate, polyphenols, sodium as well as dietary fibre. The need to process foods rich in anti-nutrients in order to cover the RDAs of undernourished children and mothers was highlighted - working out a categorization of anti-nutritive elements in low (≤ 4th percentile), medium (> 4th until ≤ 8th percentile), high (>8th until ≤ 9.5th percentile) or very high (> 9.5th percentile) contents. On the basis of knowing most cost-effective locally available foods and assessing also their anti-nutritive elements, a weekly meal schedule has been worked out in cooperation with the nutritionist Caroline Stiller (who was the second PhD candidate in this twin PhD project and knows the local setting well). It became clear that the RDAs of moderately malnourished children and their mothers can hardly be fully covered with locally available foods alone - where a deficit of 20 and more percent of the RDA remained with regard to vitamins A, E, B1 and B2, as well as of zinc and linoleic acid (children), with regard to vitamins A, E, B1, B2 and B9, as well as of potassium and linoleic acid (lactating women), with regard to vitamins B1, B2 and B9, as well as of iron, potassium and linolenic acid (pregnant women), and with regard to vitamins B1 and B2, as well as of iron, potassium and linolenic acid (non-pregnant and non-lactating women). It was further found that the costs associated with the suggested cost-effective and nutrient-dense weekly meal schedule exceeded available family budgets (calculated based on n=66 HHs and with respect to consumed portion sizes of children and mothers) by 217 percent in case of children (with a weekly cost of 267 Rs. rather than the available 144 Rs.), and by 200 percent in case of lactating, pregnant as well as non-pregnant non-lactating mothers. The role of government services (AWCs, the PDS, and the MGNREGA), kitchen gardening/wild plant collection, own fishing activities and crop diversification in covering this deficit was enumerated and it was found that AWCs are able to cover the largest part of the weekly financing deficit (amounting to 34 percent in case of children), followed by kitchen gardens/wild plant collection (24 percent). As breastfeeding is deeply rooted in the Santal Adivasi communities (96 percent of mothers, n=275, were found to breastfeed their youngest child - with a mean age of 21.2 months), it is proposed in this dissertation that lactating women should be included as beneficiaries of AWCs in order to cover their nutrient needs and break - finally - the circle of undernutrition where children and mothers need to be seen together, rather than focusing merely on children in the well-known 1000-days window of opportunity.
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.
Entwicklung eines computergestützten Assessment-Tools zur Erfassung des Ernährungszustandes von Senioren
(2011) Ott-Renzer, Cornelia; Biesalski, Hans-Konrad
Introduction: Worldwide a demographic change of population is to be observed, thus also in Germany. Special expertise in geriatric diagnostics and therapy will gain in importance. Thereby, a special relevance comes up to determination of nutritional status by corresponding screening and assessment. Conventional assessment mostly equates to questionnaire methods. Purpose/Question: Focus was on developing a software (geroMAT-Malnutrition Assessment and Therapy for gerontologic patients) for identification Senior´s nutritional state, a kind of "management tool" for diagnostics and intervention. Methods: Investigation was open, cooperative and multi-centric, as well as clinical-experimentally invested. In three partial studies (I: Suitability of the MNA® as a reference method; II: Anthropo-metry, biochemistry, body composition; III: Food patterns and intake, not-nutritive factors) indicators of malnutrition were initially selected. In a final analysis Model I (prognosis of malnutritional risk) and accordingly Model II (prognosis of the MNA®) have been developed for their use in geroMAT. Results: Prevalence of malnutrition was (in this random sample) 5%, 44% were at risk and 51% were well nourished. Due to inhomogeneity in class range by assessment with the MNA®, modelling of a dichotomic risk variable ("RiskMal", homogeneous) occurred. All up 25 features and 12 (optional) additional items from the partial studies I-III could be generated and attached to further analysis. Model I prognosticated "RiskMal" reliably (auROC=.739). Although firstly Model II predicted MNA® well (r=0,5167), model quality could be improved even further by the well-chosen parametres of a feature subset selection for Models I and II (Í: r=0,822;II: r=0,6634). Discussion: The Models I/II reached the requirements made on developing geroMAT. According to the features, geroMAT would be multi-centric usable, simple to learn and operable, documentable and reproduceable, interprofessionally and without high expense, as well as modern. Advantages of geroMAT, compared with the MNA® lay in its detailedness and its choice of further options, its capture of documented information off the normal anamnesis process and the initiation or monitoring of individual interventions. Conclusions: Mean aim of the study, the identification of indicators and model development, was reached. Other model validation studies should follow before the final clinical practice of geroMAT.
Inflammation and nutrition: friend or foe?
(2023) Stumpf, Franziska; Keller, Bettina; Gressies, Carla; Schuetz, Philipp
The importance of the interplay between inflammation and nutrition has generated much interest in recent times. Inflammation has been identified as a key driver for disease-related malnutrition, leading to anorexia, reduced food intake, muscle catabolism, and insulin resistance, which are stimulating a catabolic state. Interesting recent data suggest that inflammation also modulates the response to nutritional treatment. Studies have demonstrated that patients with high inflammation show no response to nutritional interventions, while patients with lower levels of inflammation do. This may explain the contradictory results of nutritional trials to date. Several studies of heterogeneous patient populations, or in the critically ill or advanced cancer patients, have not found significant benefits on clinical outcome. Vice versa, several dietary patterns and nutrients with pro- or anti-inflammatory properties have been identified, demonstrating that nutrition influences inflammation. Within this review, we summarize and discuss recent advances in both the role of inflammation in malnutrition and the effect of nutrition on inflammation.
Mangelernährung bei Tumorpatienten unter Chemotherapie : Anwendung und Weiterentwicklung eines computergestützten Programmes zur Erfassung und Vorhersage des Ernährungsstatus onkologischer Patienten
(2012) Renger, Sebastian; Biesalski, Hans-Konrad
Malnutrition is a serious problem in the health care of cancer in- and outpatients. Especially for outpatients there is little information on their nutritional status available, because nutritional screenings are not often used, although there is plenty of them accessible. The workgroup of Professor Biesalski developed a software, called oncoMAT, to calculate the current and the prospective nutritional status of tumour patients. Patient data of cancer patients from Tübingen and Freiburg were collected and analysed to test the program. For comparison the gold standard SGA (Suvjective Global Assessment) was used. Anthropometry, BIA, blood analysis and patient questioning about adverse events were used to evaluate the nutritional status as well. Results were checked for specificity and sensitivity. The Risk-Score statements were evaluated considering different model-conditions. To calculate the prognostic score, patient- and illnessrelated parameters were proved by a variance analysis and a multiple linear regression.
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.
Off-farm income diversification among rural households in Nigeria : impact on income, food security and nutrition
(2009) Babatunde, Raphael O.; Qaim, Martin
The promotion of off-farm activities and income diversification in order to provide alternative income earning opportunities for rural households in developing countries has received increased policy attention recently. The growing importance of off-farm activities has also led to rising interest in analyzing the wider implications for household livelihoods and rural development, especially in Africa. In this dissertation, the impact of off-farm income diversification on income, food security and nutrition is analyzed in rural Nigeria. This is done within the scope of three research articles. The analyses build on a survey of 220 farm households, which was carried out in Kwara State, north-central Nigeria, in 2006. The first article is entitled ?The role of off-farm income in rural Nigeria: Driving forces and household access?. Off-farm employment is disaggregated into different segments to take account of heterogeneity in the rural labor market. Various econometric techniques are used to model the determinants of household participation in and income from different economic activities. Furthermore, the contribution of the individual income sources to overall income inequality is examined using the Gini decomposition method. Results indicate that almost 90% of the households sampled have at least some off-farm income; on average, off-farm income accounts for 50% of total household income. Sixty-five percent of the households are involved in some type of off-farm employment ? 44% in agricultural wage employment, 40% in non-agricultural wage employment, and 50% in self-employed non-farm activities. In fact, self-employed activities are the dominant source of off-farm income, accounting for almost one-fourth of overall household income. The share of off-farm income is positively correlated with overall income, indicating that the relatively richer households benefit much more from the off-farm sector. Strikingly, the share of off-farm income also increases with farm size, suggesting that there are important complementarities between farm and off-farm income. The econometric analysis shows that households with little productive assets and those who are disadvantaged in terms of education and infrastructure are constrained in their ability to participate in more lucrative off-farm activities. Accordingly, off-farm income tends to increases income inequality. The analysis counters the widespread notion that shrinking per capita land availability is always the main driving force for the growing importance of off-farm activities. It shows that financial capital rather than land is the scarcest factor for farm households in the study region, so that cash income from off-farm activities can also help to expand farm production. Entry barriers to off-farm activities for poor households need to be overcome to promote equitable rural development. In the second article, entitled ?Impact of off-farm income on food security and nutrition in Nigeria?, 7-day food expenditure and anthropometric data are used to analyze the effects of off-farm income on household calorie consumption, dietary quality, micronutrient supply and child nutritional status. Descriptive analysis indicates that engagement in off-farm activities is associated with higher calorie consumption and a reduced prevalence of undernourishment. Dietary quality, measured by the calorie supply that comes from fruits, vegetables and animal products, is also higher among households with off-farm income. Similarly, households with off-farm income enjoy a higher supply of micronutrients, particularly iron and vitamin A. Child nutritional status, indicated by the average Z-scores for height-for-age, weight-for-age, and weight-for-height of children aged 0 to 5 years, is also better in households with off-farm income. Employing instrumental variable approaches, econometric analyses confirms that the net effect of off-farm income on household food security and nutrition is positive and in the same magnitude as the effect of farm income. This is an interesting result, because it is often believed that farm income is more important than off-farm income for food security and dietary quality in rural areas. Accordingly, improving poor households? access to the off-farm sector can contribute to reducing problems of rural malnutrition. In the third article, entitled ?Patterns of income diversification in rural Nigeria: Determinants and impacts?, descriptive analysis is used to examine income diversification patterns among households, disaggregated by income classes and livelihood strategies. Econometric models, focusing on three measures of income diversification ? the number of income sources, the share of off-farm income in total income and the Herfindahl diversification index ? are also estimated. The impact of diversification on total household income is analyzed using an instrumental variable approach. The results indicate that rural households in Nigeria have indeed a diversified income base, with 93% having at least two sources of income. Interestingly, richer households tend to be more diversified than poorer ones, and income diversification leads to net increases in total household income. Yet, the regression models also show that households have unequal abilities to diversify their income sources. Education, asset endowment, access to credit and good infrastructure conditions increase the levels of household diversification. These factors improve the opportunities to start own businesses and find employment in the higher-paying non-farm sector. In other words, resource-poor households in remoter areas are more constrained in diversifying their income sources. What are the broader policy implications? Enhancing poor households? access to off-farm activities is important to support equitable rural development, since farming alone often cannot sustain a sufficient livelihood. In the Nigerian context ? as in many other parts of SSA ? this requires improvements in the physical infrastructure, including roads, electricity, water, and telecommunication, but also improvements in rural education and financial markets. But up to what level is income diversification desirable? According to economic theory, specialization allows exploitation of comparative advantages and economies of scale, resulting in higher profits and household incomes. Hence, when markets function properly, diversification is associated with foregone benefits. When there is risk involved and formal insurance markets fail, these foregone benefits can be considered as an informal insurance fee that poor households in particular are willing to pay. But the fact that richer households are more diversified in rural Nigeria suggests that there are other mechanisms at work, too. An important motive for richer households to have highly diversified income sources instead of specializing more is that there are limited opportunities to expand single economic activities. This is mainly due to markets that are small and poorly integrated in rural Nigeria, which again is largely a function of infrastructure weaknesses. Better roads, for instance, would enable villagers to commute to the next bigger town, where they might find more stable employment. Better roads and information networks would also improve marketing opportunities for food and non-food products originating from household self-employed activities. Therefore, income diversification should not be considered as a policy objective per se. Rather, it has to be understood as a household response to various market imperfections. Hence, the policy objective should be to reduce these imperfections and make markets work better. While this would facilitate income diversification among the poorest, it would probably promote a higher degree of specialization among relatively richer households.
Promoting dietary diversification in the ASEAN region : exposing food taboos, and exploring the nutrient profiles of underutilized, indigenous food resources
(2020) Köhler, Realm; Biesalski, Hans-Konrad
The Association of Southeast Asian Nations (ASEAN) is composed of Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam. The ASEAN region is ailing from moderate to serious incidence of malnutrition. Among the member countries, Brunei Darussalam has the highest prevalence of child obesity (17.8%), while Malaysia has the highest prevalence of adult obesity (15.6%). Indonesia has the highest percentage of young children suffering from wasting at 13.5%. Lao PDR has the highest percentage of the undernourished in the population (16.5%), at the same time, having the highest percentage of stunted children under five years of age (43.85%). It also has the highest HHI score with 38.7, which corresponds to having a severe case of micronutrient deficiencies, and the highest death rates for both children under five years of age (63 deaths per 1,000 live births) and mothers (197 deaths per 100,000 live births). To fight malnutrition, nutrition-specific interventions address the immediate determinants of nutrition of specific vulnerable groups – young children, pregnant and lactating women, and others. Dietary diversification is an example of a nutrition-specific intervention. This dissertation was conducted to turn the spotlight towards the ASEAN region, its triple burden of malnutrition, and to dietary diversification as a sustainable way to lighten the load. It tackled one of the stumbling blocks to the acceptance of dietary diversification – food taboos, and one of the stepping stones towards its successful implementation – nutrient profiling of underutilized, indigenous resources in the region. This dissertation postulated that plant- and animal-based food taboos adhered to by pregnant, post-partum, and lactating Southeast Asian women can hinder dietary diversification in the most vulnerable and crucial moment of the first 1,000 days of life. The two review papers generated were the first to consolidate and showcase researches on food taboos covering the region. They highlighted the need for culture-sensitive health interventions to address maternal and child health problems that could lead to the attainment of the sustainable development goals of reducing the maternal and under-five mortality ratios and empowering women in Southeast Asia, as well as the priority health goals of the ASEAN. The underutilized, indigenous resources in the ASEAN region have the potential to be valuable components of a diversified diet. To prove this statement and to further promote dietary diversification, the dissertation tackled the nutrient profiling of the edible insects – Bombay locust (Patanga succincta), scarab beetle (Holotrichia sp.), house cricket (Acheta domesticus), and mulberry silkworm (Bombyx mori) from Thailand, and the sago grub (Rhynchophorus bilineatus) from Indonesia. For the pigmented rice varieties, the Camoros (red), Tinta (purple) and Malinao black rice from the Philippines were analyzed, while a review of pigmented rice varieties from Thailand was also conducted. The results of the analysis showed, and based on the Codex Alimentarius on food labelling, that the edible insects are “high in” protein and can be “sources of” or “high in” minerals. Also, data showed that the pigmented rice varieties from the Philippines and the pigmented Thai rice varieties have higher mineral and vitamin contents in comparison with white Jasmine rice. The findings in this dissertation have shown that edible insects and pigmented rice varieties can be added to diversify and improve the nutritional quality of people’s diets and to fight malnutrition from the household level. The novel research into indigenous food resources contributes to the advancement of knowledge in the field of entomology and biodiversity conservation, and of course, in food science and nutrition. Most importantly, the dissertation’s contribution to the promotion of dietary diversification in the hope of attaining improved human health and nutrition will benefit the whole ASEAN region.
Ready-to-Use Food (RUF) from composite flour of local commodities in Banten Province, Indonesia for prevention and rehabilitation of malnutrition in children under five
(2021) Fetriyuna, Fetriyuna; Biesalski, Hans-Konrad
Indonesia faces a serious problem of malnutrition especially stunting and underweight caused by micronutrient deficiencies. The high prevalence of undernutrition was also found in Banten Province, Java Island, the most populated island in Indonesia. The Indonesian Demographic and Health Survey (DHS) in 2012 reported that of about 24.5 million children under five years of old, approximately 37% and 12% of them were stunted and wasted. Furthermore, based on the Basic Health Survey (Riskesdas) in 2013 and 2018, the prevalence of stunting in children under five years old was 37.2 % and 30.8%, while the proportion of underweight children was 19.6% and 17.7%. The undernourished children have an increased mortality rate, risk of illness and infections, cognitive shortages, delayed development, and poor school performance. Ready-to-use food (RUF) is a kind of food easily consumed without much preparation and can be made using various techniques for targeted consumers. RUF can be produced using locally available food resources, which may be affordable for most people suffering from undernutrition. To improve and accomplish the nutrient content of RUF to meet the standard for rehabilitation food for malnutrition, the combination of various food resources might enhance the nutritional composition. This nutritious formulation must have the following attributes: good nutritional quality in macro and micronutrient content, highly palatable taste, consistency, and texture suitable for feeding to children, no additional processing required prior to feeding, product stability, long shelf life, and readily available ingredients. This research was divided into three main objectives. The first objective was a baseline assessment of the nutritional condition of the target group of children below five years old. The second section was RUF biscuit product development. The third objective was to investigate the nutritional outcomes of the field study in Banten Indonesia, particularly in WHZ and weight after the RUF provision and weight gain of the children and acceptability. The RUF biscuit was made from the composite flour of local food resources available in Banten province Indonesia which are still underutilized. The result of nutrition content analysis in local food resources showed that the foods have a high nutritional composition as a source of macronutrients and micronutrients (vitamins and minerals). Due to poor handling of post-harvest and processing into the intermediate product (flour), some vitamins were lost during the process. Based on the baseline assessment in 2017, of the 105 children, 4.8% and 11.4% of them were wasted and overweight-obese, while 40% and 23.8% of the children were stunted and underweight. Based on the mid-upper-arm circumference, 16.1% of children were categorized as the risk of chronic energy deficiency (CED). In addition, it was found that most of the children have insufficient intake of protein, Vitamin A, Iron, and Zinc. Twelve recipes developed using the combination of local food resources showed the macronutrient composition that met the requirement for the treatment of Moderate Acute Malnutrition (MAM) children, but not for micronutrient (vitamin and minerals). Five recipes (recipes 3, 4, 7, 11, and 12) were selected based on nutritional composition and sensory evaluation. The selected recipes were continued to further research of acceptability study in Banten, Indonesia. Before the acceptability study in the field, the micronutrient composition of the recipes chosen was improved according to the MAM treatment recommendation. It fortified the RUF with micronutrient premix. The micronutrient stability test was performed to analyze the loss due to baking. Around 15-28% of the vitamins (A, B1, B2, and E) were lost after baking, which was slightly lower than the other published articles, perhaps due to the short process of baking (15 minutes). Furthermore, the micronutrient sources were from the vitamin-mineral premix with higher stability than that from foods. Minerals content was stable during the baking process. Before the acceptability study started, five fortified cookie recipes were tested to select two for the acceptance and intervention pilot study. Most of the children in the acceptance study reported that they accepted and liked the RUF cookies. The consumption of RUF biscuits for two weeks led to an improvement in the nutritional status: Reduction of severe wasting (WHZ) from 5.7% to 4.3% and of severe underweight (WAZ) from 8.6% to 4.3%. There was no difference in terms of stunting (HAZ). Thus, it has been shown that the developed RUF biscuits have the potential to reduce malnutrition in the under 5-year-olds in the target area.
Spatial differences in stunting and household agricultural production in South Africa : (re-)examining the links using national panel survey data
(2017) Otterbach, Steffen; Rogan, Michael
One explanation for the increasing prevalence of stunting in South Africa over the past 15 years while other development indicators have improved is that Big Food retail chains have been contributing to a low quality diet across the country, particularly in poor urban households. We thus use nationally representative longitudinal data (2008–2014) to trace 6 years of stunting’s evolution among South African children, adolescents, and young adults aged 0–19, with particular attention to how the prevalence of under-nutrition differs between urban and rural areas and how the drivers of poor nutrition vary spatially. The results of our random-effects logistic regressions on the nutritional impact of household agricultural production suggest that, conditional on household income, subsistence farming is associated with a lower probability of stunting. Even more important, although under-nutrition retains a strong spatial component, once observable differences in living standards are controlled for, the higher tendency for children in deep rural households to suffer from (severe) stunting reverses.