Joseph Birundu Mogendi

Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation

BACKGROUND/OBJECTIVES Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. SUBJECTS/METHODS The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. RESULTS Mid-upper arm circumference single cut-off (< 12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively. CONCLUSIONS Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries.

Consumer evaluation of food with nutritional benefits: a systematic review and narrative synthesis.

Abstract As a consequence of the growing interest in, and development of, various types of food with nutritional benefits, the modern consumer views their kitchen cabinet more and more as a medicine cabinet. Given that consumer evaluation of food is considered key to the successful production, marketing and finally consumption of food, a procedure commonly used in medical fields was employed to systematically review and summarize evidence of consumer evaluation studies on nutritious foods. The focus is primarily on consumer understanding of nutritious food and the underlying determinants of consumer evaluation. Our results highlight four groups of key determinants: (1) nutrition knowledge and information; (2) attitudes, beliefs, perceptions and behavioural determinants; (3) price, process and product characteristics; and (4) socio-demographics. The findings also point to the importance of understanding consumer acceptance as one many concepts in the consumer evaluation process, and provide support for developing appropriate strategies for improving health and well-being of consumers.

Genetically Modified Rice with Health Benefits as a Means to Reduce Micronutrient Malnutrition: Global Status, Consumer Preferences, and Potential Health Impacts of Rice Biofortification

Micronutrient malnutrition, characterized by insufficient intake levels of vitamins and minerals, is a major public health problem that affects about 2 billion people worldwide. In order to reduce the burden of this “hidden hunger”, biofortification is more and more being advocated as an alternative to current micronutrient interventions. Through enhancement of the micronutrient level of staple crops, it could address micronutrient malnutrition where the need is highest. Because staple crops are characterized by low micronutrient concentrations, genetic breeding techniques are often applied to increase levels of specific vitamins, such as folate and provitamin A. This study sheds light on the global status of micronutrient malnutrition, biofortification, and GM biofortified rice as both a GM food product with health benefits and a micronutrient intervention. Thereby, key consumer preference studies and cost-effectiveness analyses on Folate Biofortified Rice and Golden Rice are presented. Support is found for GM biofortified rice as a well-accepted GM food crop and a highly cost-effective health intervention.

A novel framework for analysing stakeholder interest in healthy foods: A case study on iodine biofortification

ABSTRACT Despite the availability of novel strategies to prevent micronutrient malnutrition, such as biofortification, limited understanding of stakeholders often hampers their success. We build upon the existing literature on protection motivations (PMT) and technology acceptance (TAM) to develop an integrated PMTAM model for analyzing stakeholders’ reactions, on both the supply and demand sides. Regarding the latter, the case of the iodine biofortified food chain is used to evaluate African households’ interest. All model constructs, and threat appraisal in particular, are decisive in determining the uptake of biofortification, while also social demographics and own nutrition status play an important role.

Integration and validation of an SMS-based bidding procedure of eliciting consumers’ willingness-to-pay for food

Purpose Despite the large body of research on consumers’ willingness-to-pay for new food, few studies have tried to integrate new technology-based systems and improve their validity. The purpose of this paper is to analyse the integration of short messaging service (SMS) in experimental auctions. Design/methodology/approach Based on a case study on iodine biofortified food with 180 household decision makers in Africa, a standard Becker-Degroot-Marschak procedure was compared with the novel SMS-based procedure through five information/auction rounds. Thereby, a standard protocol commonly employed in validation of medical diagnostic tests was adopted, assessing the sensitivity, specificity, precision, negative predictive values, likelihood ratios and post-test probability. Findings The SMS-based elicitation exhibited high levels of sensitivity (89-95 per cent), specificity (63-73 per cent), precision (40-60 per cent), NPV (92-98 per cent), LR+(2.6-3.3) and LR−(0.08-0.2) for all the auction rounds. The post-test plot indicates that the novel procedure is particularly consistent in ascertaining positive and negative valuations for a new food product. Originality/value Even though SMS-based bidding is shown to be an accurate, but also convenient and attractive bidding procedure, which is in line with novel ways of purchasing food, further validation is inevitable to determine its reliability in different contexts and its most effective use.

Reliability of Mid-Upper Arm Circumference Measurements Taken by Community Health Nurses

Mid upper arm circumference-based diagnosis of severe acute malnutrition is seen as very attractive because it is assumed to be simple to use in measuring the arm and also requires a single cut-off without having to compute an index or compare to a reference population. The circumference of the left upper arm measured at the mid-point between the tip of the shoulder and the tip of the elbow is referred to as mid upper arm circumference (MUAC). MUAC was originally used in emergency settings where huge populations had to be screened within a short time. However, in the past few years the development of community therapeutic care of acute malnutrition implied a need for a diagnostic tool. The general objective of the study was to assess the inter- and intra-observer variability in MUAC measurements of under-five children by community health nurses in selected communities of the Northern Region in Ghana. A community-based cohort study was conducted on a convenience sample of 120 community health nurses and nursing students from selected communities in the Northern region of Ghana. Each CHN measured MUAC for four unique children on three consecutive days to assess intra-observer variability. To assess inter-observer variability, 50 independent nursing students took MUAC measures of four children on the same day. Bland Altman plots showed a high degree of agreement of MUAC measures taken repeatedly for three days by the same observers and ICC= 0.993. MUAC measures among observers (inter-observer) and ICC =0.042 showed a considerable level of variability among different observers. This study showed that MUAC is reliable when repeated measures are taken on children by the same observers, but using different observers for the same children showed a high level of variability.