Browsing by Subject "Moringa oleifera"

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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.