Sandra L. Huffman

Interventions to Improve Intake of Complementary Foods by Infants 6 to 12 Months of Age in Developing Countries: Impact on Growth and on the Prevalence of Malnutrition and Potential Contribution to Child Survival

To evaluate programmatic efforts to improve dietary intake and growth in 6- to 12-month-old infants in developing countries, we reviewed the results of 5 efficacy trials and 16 programmes conducted in 14 countries. Efficacy trials were able to improve infant dietary intakes by 65 to 302 kcal/day and infant growth by 0.04 to 0.46 SD. Programmes reported large improvements in maternal knowledge and practices concerning infant feeding. Four programmes that provided information reported improvements in dietary intakes of 71 to 164 kcal/day and changes in growth of −0.08 to 0.87 SD. Despite variability in the results, the majority of research and programmatic efforts improved growth rates by 0.10 to 0.50 SD. in absolute terms, this range of improvement in growth would reduce prevalences of malnutrition (< −2 SD) at 12 months of age by 1% to 19% and could reduce deaths due to malnutrition by 2% to 13%, depending on the underlying prevalence of malnutrition in the community.

Breast-feeding patterns in rural Bangladesh.

Nearly 1500 women with live births from February through September 1974 were included in this multiple phase study of breast-feeding patterns in a rural area of Banglandesh. The median duration of breast feeding was observed to be 30 months. Over 75% of the women whose most recently born children were living were breast feeding at 2 1/2 years postpartum. The major reason for discontinuing breast feeding in the 1st year was infant death, and in the 2nd year, pregnancy. Insufficient milk was given as a reason for discontinuing breast feeding by 18% of the women who stopped breast feeding for reasons other than child death; among these women almost 60% were pregnant at the time they stopped. Of the breast-feeding women who became pregnant, over 50% continued to breast feed through the 6th month of pregnancy. A sample of 200 breast-feeding women with children ages 17 to 25 months were followed longitudinally for 1 1/2 years or until the mothers conceived. A seasonal trend in suckling time was observed with women reducing suckling during the harvest season. Total suckling time was inversely associated with socioeconomic factors and with infant nutritional status. No association was found between mean suckling time and maternal nutritional status, maternal morbidity, infant morbidity, or childs sex.

Rapid ethnographic assessment: Applications in a diarrhea management program

This paper reports on a rapid ethnographic assessment methodology (REA) that was developed as an essential component of the dietary management of diarrhea (DMD) program. The DMD program is an interdisciplinary research project that has been developed to design intervention programs to reduce or eliminate the nutritional complications of diarrhea in Peru and Nigeria. Anthropological data gathering was an important component of the intervention design, but time and budgetary constraints required a rapid methodological approach. This paper outlines the REA methodology, describes the advantages and disadvantages of the approach, and discusses future applications for international primary health care interventions.

Nutrition and Fertility in Bangladesh: Breastfeeding and Post Partum Amenorrhoea

From 1975 to 1980 a prospective study a nearly 2,500 married, fertile women was conducted in Matlab, Bangladesh at the International Centre for Diarrhoeal Disease Research. Women were interviewed at monthly intervals to collect information on nutritional and reproductive status, in order to study the factors associated with natural fertility. The median duration of amenorrhoea for women with no child deaths was 15.5 months, with older women and those of higher parities recording longer durations than younger women or those of lower parities. Median duration of amenorrhoea for women with six or more years of education was 8.4 months compared to 16.4 months among women with no education. When classified by weight at pregnancy termination, average duration of amenorrhoea of women weighing less than 38 kg was 17.6 months compared to 13.6 months among women weighing more than 44 kg. Proportional hazards analyses show that mothers education, parity, month of birth, supplementation practices and nutritional sta...

The Case for Promoting Multiple Vitamin and Mineral Supplements for Women of Reproductive Age in Developing Countries

Women in developing countries often consume inadequate amounts of micronutrients because of their limited intake of animal products, fruits, vegetables, and fortified foods. Intakes of micronutrients less than the recommended values increase a womans risk of having micronutrient deficiencies. the adverse effects of deficiencies in vitamin A, iron, and folic acid, including night-blindness in pregnant and lactating women and iron-deficiency anaemia, are well known. Low intakes of these and other nutrients, including zinc, calcium, riboflavin, vitamin B6, and vitamin B12, also have consequences for womens health, pregnancy outcome, and the health and nutritional status of breastfed children. Multiple deficiencies coexist, so the benefit of multiple micronutrient supplements is becoming increasingly apparent. Supplementation of women with multiple vitamins and minerals should be one component of a strategy to improve micronutrient status among women in developing countries. However, there are several issues for programme managers to consider before implementing programmes. Which reference standards will be used to determine nutrient levels to include in the supplements? Which nutrients will be included and in what quantities? Which factors need to be considered in purchasing supplements? These issues are discussed, and guidance is provided on the selection of appropriate supplements for pregnant women and women of reproductive age in developing countries.

Seasonal dimensions of energy protein malnutrition in rural bangladesh: The role of agriculture, dietary practices, and infection

The influence of seasonal variations in agriculutral practices, dietary intakes and illness on the nutritional status of preschool children was examined in this longitudinal study of approximately 200 woman‐child pairs in rural Bangladesh. The seasonal nature of cropping patterns was associated with varying levels of rice prices, agriculture wage rates, and household food stocks. Rice prices were highest, household food stocks lowest and agricultural demand weakest in August‐October, the months preceding the major rice harvest. Maternal work patterns also varied by season with the peak demand on womens time coincident with postharvest rice processing activities. Breastfeeding frequency declined during the months when maternal activities increased, suggesting that time available for childrearing activities varied seasonally. Seasonal patterns in diarrheal disease and other illnesses were also observed. Maternal and child nutritional status exhibited seasonal variations which were associated with low level...

Malnutrition, menarche, and marriage in rural Bangladesh.

In order to assess the impact of nutritional status on the onset of menarche and the association between age at menarche and age at marriage, a survey of 1155 girls, ages 10 through 20, was conducted in a rural area of Bangladesh in March 1976. In order to obtain an estimated mean of age of menarche, probit analysis was used. The mean age of menarche using this technique is estimated at 15.65 for Muslims and 15.91 for Hindus. It was learned that in recent years the age of menarche has increased in a rural area. This increase seems to be associated with malnutrition caused by the war, postwar inflation, floods and famines during the 1971-75 period. When age is controlled for, the prominent effect of weight on menstrual status is evident. 98% of the girls whose weights were 88 pounds or greater had reached menarche compared to only 1% of those weighing less than 66 pounds. Body weight appears to be 1 of the most important factors for the determination of onset of menarche. There exists a seasonality of onset of menarche with a peak in winter. Age of marriage among this rural population has increased and may be associated with the increasing age of menarche. Since both age of menarche and age of marriage have increased, fertility among females age 15-19 may be expected to decrease in the future if this pattern continues.

Multiple micronutrient supplementation during pregnancy in developing-country settings: Policy and program implications of the results of a meta-analysis

Background An independent Systematic Review Team performed a meta-analysis of 12 randomized, controlled trials comparing multiple micronutrients with daily iron–folic acid supplementation during pregnancy. Objective To provide an independent interpretation of the policy and program implications of the results of the meta-analysis. Methods A group of policy and program experts performed an independent review of the meta-analysis results, analyzing internal and external validity and drawing conclusions on the program implications. Results Although iron content was often lower in the multiple micronutrient supplement than in the iron–folic acid supplement, both supplements were equally effective in tackling anemia. Community-based supplementation ensured high adherence, but some mothers still remained anemic, indicating the need to concomitantly treat infections. The small, significant increase in mean birthweight among infants of mothers receiving multiple micronutrients compared with infants of mothers receiving iron-folic acid is of similar magnitude to that produced by food supplementation during pregnancy. Larger micronutrient doses seem to produce greater impact. Meaningful improvements have also been observed in height and cognitive development of the children by 2 years of age. There were no significant differences in the rates of stillbirth, early neonatal death, or neonatal death between the supplemented groups. The nonsignificant trend toward increased early neonatal mortality observed in the groups receiving multiple micronutrients may be related to differences across trials in the rate of adolescent pregnancies, continuing iron deficiency, and/or adequacy of postpartum health care and merits further investigation. Conclusions Replacing iron–folic acid supplements with multiple micronutrient supplements in the package of health and nutrition interventions delivered to mothers during pregnancy will improve the impact of supplementation on birthweight and on child growth and development.

Nutrition and post-partum amenorrhoea in rural Bangladesh.

Summary A cross-sectional survey of 2048 breastfeeding women in rural Bangladesh was conducted in 1975 to explore factors affecting the duration of post-partum amenorrhoea. Information on menstrual status, infant supplementation, socio-economic status and anthropometric measurements was collected for lactating women with infants 13–21 months of age. The median length of amenorrhoea was observed to be over 18 months. There was a higher probability of being amenorrhoeic for older women and those of lower socio-economic status. Maternal malnutrition extended the duration of amenorrhoea slightly. Women feeding their infants higher-quality supplements were less likely to be amenorrhoeic than those supplying their infants with less adequate supplements. The figures suggest that the pattern of breastfeeding plays the primary role in determining lengths of lactational amenorrhoea for this rural population.

Promotion and advocacy for improved complementary feeding: can we apply the lessons learned from breastfeeding?

Although many successes have been achieved in promoting breastfeeding, this has not been the case for complementary feeding. Some successes in promoting complementary feeding at the community level have been documented, but few of these efforts have expanded to a larger scale and become sustained. To discover the reasons for this difference, the key factors for the successful promotion of breastfeeding on a large scale were examined and compared with the efforts made in complementary feeding. These factors include definition and rationale, policy support, funding, advocacy, private-sector involvement, availability and use of monitoring data, integration of research into action, and the existence of a well-articulated series of steps for successful implementation. The lessons learned from the promotion of breastfeeding should be applied to complementary feeding, and the new Global Strategy for Infant and Young Child Feeding provides an excellent first step in this process.