Yves Martin-Prével

Simple Food Group Diversity Indicators Predict Micronutrient Adequacy of Women’s Diets in 5 Diverse, Resource-Poor Settings

Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.

Economic crisis and malnutrition: socioeconomic determinants of anthropometric status of preschool children and their mothers in an African urban area

OBJECTIVE To assess the relative importance of socioeconomic and maternal/prenatal determinants of the nutritional situation of children < 6 years old in an urban African area after several years of economic crisis. DESIGN Cross-sectional cluster sample survey. SETTING Brazzaville, capital city of the Congo. SUBJECTS Information on socioeconomic characteristics was gathered from a random sample of 1368 households by house visits and anthropometric measurements were performed using standardized procedures on preschool children (n = 2373) and their mothers (n = 1512). RESULTS The influence of socioeconomic factors on the nutritional status of children, taking into account adjustment variables such as mothers age and childs age and sex was assessed. For stunting, as well as for the mean height-for-age index among children, the main determinants were economic level of the household (P = 0.048 and P = 0.004, respectively), schooling of the mother (P = 0.004 and P < 10(-3)) and living in the peripheral district (P = 0.005 and P < 10(-3)). The influence of socioeconomic determinants on weight-for-age and wasting was less straightforward. When adjusting, in addition, for maternal and prenatal factors (mothers height and body mass index (BMI) and birth weight), most of the effects of the socioeconomic determinants on the nutritional status of children persisted somewhat, but the effect of the economic level on the stunting became not significant (P = 0.11). The mean BMI of mothers appeared to be related to the economic level of the household (P < 10(-4)), to the marital status (P = 0.01) and to the occupation of the mother (P < 10(-4)). CONCLUSIONS Among the socioeconomic determinants of malnutrition in children, some, such as economic level of the household or schooling of the mother, seem to act mainly through prenatal factors, whereas others, mainly dwelling district characteristics, seem to influence more directly the childrens nutritional status.

Deterioration in the nutritional status of young children and their mothers in Brazzaville, Congo, following the 1994 devaluation of the CFA franc

The effects of the January 1994 devaluation of the African Financial Community (CFA) franc on the nutritional situation of the populations concerned has been little documented. We report in this article on two nutritional cross-sectional surveys that were conducted before and after this devaluation (1993 and 1996) in two districts of Brazzaville, Congo. The surveys involved a representative sample of 4206 households with a child aged 4-23 months. Complementary feeding practices and the anthropometric indices of the children and their mothers were compared, adjusting for changes in household socioeconomic characteristics. The results show a decline in the quality of the first complementary foods offered to the infants, i.e. less frequent use of special transitional foods and imported complementary flours (of higher nutritional quality), and preparation of less nutritious local gruels. Overall, the nutritional situation had deteriorated, with greater levels of stunting and wasting among children, mothers with lower body mass index, and infants with reduced birth weights. Increased food prices would appear to be the direct cause of the decreased quality in complementary feeding, but factors other than the devaluation have also had an impact on household welfare. The influence of these factors on nutritional-status is discussed.

Infections in Infants during the First 12 Months of Life: Role of Placental Malaria and Environmental Factors

Background The association between placental malaria (PM) and first peripheral parasitaemias in early infancy was assessed in Tori Bossito, a rural area of Benin with a careful attention on transmission factors at an individual level. Methodology Statistical analysis was performed on 550 infants followed weekly from birth to 12 months. Malaria transmission was assessed by anopheles human landing catches every 6 weeks in 36 sampling houses and season defined by rainfall. Each child was located by GPS and assigned to the closest anopheles sampling house. Data were analysed by survival Cox models, stratified on the possession of insecticide-treated mosquito nets (ITNs) at enrolment. Principal Findings Among infants sleeping in a house with an ITN, PM was found to be highly associated to first malaria infections, after adjusting on season, number of anopheles, antenatal care (ANC) visits and maternal severe anaemia. Infants born from a malaria infected placenta had a 2.13 fold increased risk to present a first malaria infection than those born from a non infected placenta ([1.24–3.67], p<0.01) when sleeping in a house with an ITN. The risk to present a first malaria infection was increased by 3.2 to 6.5, according to the level of anopheles exposure (moderate or high levels, compared to the absence of anopheles). Conclusions First malaria infections in early childhood can be attributed simultaneously to both PM and high levels of exposure to infected anopheles. Protective measures as Intermittent Preventive Treatment during pregnancy (IPTp) and ITNs, targeted on both mothers and infants should be reinforced, as well as the research on new drugs and insecticides. In parallel, investigations on placental malaria have to be strengthened to better understand the mechanisms involved, and thus to protect adequately the infants high risk group.

Abdominal vs. overall obesity among women in a nutrition transition context: geographic and socio-economic patterns of abdominal-only obesity in Tunisia

BackgroundMost assessments of the burden of obesity in nutrition transition contexts rely on body mass index (BMI) only, even though abdominal adiposity might be specifically predictive of adverse health outcomes. In Tunisia, a typical country of the Middle East and North Africa (MENA) region, where the burden of obesity is especially high among women, we compared female abdominal vs. overall obesity and its geographic and socio-economic cofactors, both at population and within-subject levels.MethodsThe cross-sectional study used a stratified, three-level, clustered sample of 35- to 70-year-old women (n = 2,964). Overall obesity was BMI = weight/height2 ≥ 30 kg/m2 and abdominal obesity waist circumference ≥ 88 cm. We quantified the burden of obesity for overall and abdominal obesity separately and their association with place of residence (urban/rural, the seven regions that compose Tunisia), plus physiological and socio-economic cofactors by logistic regression. We studied the within-subject concordance of the two obesities and estimated the prevalence of subject-level “abdominal-only” obesity (AO) and “overall-only” obesity (OO) and assessed relationships with the cofactors by multinomial logistic regression.ResultsAbdominal obesity was much more prevalent (60.4% [57.7-63.0]) than overall obesity (37.0% [34.5-39.6]), due to a high proportion of AO status (25.0% [22.8-27.1]), while the proportion of OO was small (1.6% [1.1-2.2]). We found mostly similar associations between abdominal and overall obesity and all the cofactors except that the regional variability of abdominal obesity was much larger than that of overall obesity. There were no adjusted associations of AO status with urban/rural area of residence (P = 0.21), education (P = 0.97) or household welfare level (P = 0.94) and only non-menopausal women (P = 0.093), lower parity women (P = 0.061) or worker/employees (P = 0.038) were somewhat less likely to be AO. However, there was a large residual adjusted regional variability of AO status (from 16.6% to 34.1%, adjusted P < 0.0001), possibly of genetic, epigenetic, or developmental origins.ConclusionMeasures of abdominal adiposity need to be included in population-level appraisals of the burden of obesity, especially among women in the MENA region. The causes of the highly prevalent abdominal-only obesity status among women require further investigation.

Measuring dietary diversity in rural Burkina Faso: comparison of a 1-day and a 3-day dietary recall

OBJECTIVES To compare dietary diversity scores measured over a 1-day and a 3-day period, and to assess their relationships with socio-economic characteristics and the nutritional status of rural African women. DESIGN A qualitative dietary recall allowed calculation of a dietary diversity score (DDS; number of food groups consumed out of a total of nine). Body mass index (BMI) and body fat percentage (BFP) were used to assess the nutritional status of women. SETTING AND SUBJECTS A representative sample of 550 mothers in north-east Burkina Faso. RESULTS The DDS increased from 3.5 to 4.4 when calculated from a 1-day or a 3-day recall (P < 0.0001), although for the latter the DDS was affected by memory bias. The DDS calculated from a 1-day recall was higher when a market day occurred during the recall period. Both scores were linked to the sociodemographic and economic characteristics of the women. Women in the lowest DDS tertile calculated from the 1-day recall had a mean BMI of 20.5 kg m-(2) and 17.7% of them were underweight, versus 21.6 kg m (-2) and 3.5% for those in the highest tertile (P = 0.0003 and 0.0007, respectively). The DDS calculated from the 1-day recall was also linked to mean BFP; all these links remained significant after adjustment for confounders. For the 3-day period, no such relationships were found to be significant after adjustment. CONCLUSION The DDS calculated from a 1-day dietary recall was sufficient to predict the womens nutritional status. In such a context attention should be paid to market days.

Micronutrient Adequacy of Women’s Diet in Urban Burkina Faso Is Low

In developing countries, urban populations are deemed to have better access to a wider variety of foods than their rural counterparts. Yet, data on micronutrient status are scarce and the impact of urban food consumption behaviors on micronutrient adequacy is not well known. The objective of this study was to assess individual micronutrient adequacy of the diet along with food consumption behaviors of women of reproductive age in Ouagadougou, Burkina Faso. A cross-sectional survey of 182 women was conducted in 2 districts of the city. Nutrient intakes were derived from 3 nonconsecutive quantitative 24-h recalls for each woman. Balance in macronutrients was in the range of recommendations except that mean sugar intake was somewhat high. Mean probability of adequacy across 11 micronutrients was low (0.38). The most problematic micronutrients were vitamin B-12 (only 4% of our sample had sufficient intake), folate (12%), riboflavin (13%), and niacin (20%). Higher intakes of organ meat, flesh foods, vitamin A- and vitamin C-rich fruits and vegetables, and legumes and nuts were significantly associated with lower risk of micronutrient inadequacy. Ready-to-eat foods bought outside the home provided 46% of overall energy intake, 52% of fat intake, and 72% of sugar intake but were not associated with micronutrient inadequacy (P > 0.05). These results highlight the low micronutrient intakes among women of reproductive age in Burkina Faso, even in an urban area.

The 2008 Food Price Crisis Negatively Affected Household Food Security and Dietary Diversity in Urban Burkina Faso

Although the 2008 food price crisis presumably plunged millions of households into poverty and food insecurity, the real impact of the crisis has rarely been documented using field data. Our objective was to assess the consequences of this crisis for household food insecurity and dietary diversity in urban Burkina Faso. Two cross-sectional surveys were conducted among randomly selected households in Ouagadougou in July 2007 (n = 3017) and July 2008 (n = 3002). At each round, food insecurity assessed by the Household Food Insecurity Access Scale (HFIAS), the Dietary Diversity Score of an index-member of the household (IDDS = number of food groups consumed in the last 24 h), and food expenditure were collected. Food prices of the 17 most frequently consumed food items were recorded throughout the study area. Food prices at local markets increased considerably between 2007 and 2008, especially those of fish (113%), cereals (53%), and vegetable oil (44%), increasing the household monthly food expenditure by 18%. Thirty-three percent of households were food secure in 2007 and 22% in 2008 (P = 0.02). Individuals consumed fewer fruits and vegetables, dairy products, and meat/poultry in 2008 than in 2007 (mean IDDS = 5.7 ± 1.7 food groups in 2007 vs. 5.2 ± 1.5 in 2008; P < 0.0001). Differences in IDDS and HFIAS between the 2 y were even more marked after adjustment for confounding factors and food expenditure. Food security and dietary diversity significantly decreased between 2007 and 2008, whereas food prices increased. Households increased their food expenditure, but this was not sufficient to compensate the effects of the crisis.

Are dietary diversity scores related to the socio-economic and anthropometric status of women living in an urban area in Burkina Faso?

OBJECTIVES To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context. DESIGN A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women. SETTING AND SUBJECTS Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso. RESULTS The mean DDS-9 and DDS-22 were 4.9 +/- 1.0 and 6.5 +/- 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the womens socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 +/- 4.9 kg m-2 and 37% of them were overweight or obese (BMI > or = 25 kg m-2). Neither the DDS-9 nor the DDS-22 was associated with the womens anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22. CONCLUSION In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.

Dietary changes in African urban households in response to currency devaluation: foreseeable risks for health and nutrition

OBJECTIVE To investigate the effects of currency devaluation on dietary change and nutritional vulnerability of poor households in two African capital cities. DESIGN A qualitative study based on 120 semistructured individual interviews and four focus group discussions in each city. SETTING Dakar, Senegal (western Africa) and Brazzaville, Congo (central Africa). SUBJECTS All of the subjects were randomly selected women from modest or poor households, who spoke the local common language and were responsible for household meal preparation. Only those likely to restrict the dynamic of focus group discussions (because of language, age or education) were excluded. RESULTS Changes were found in meal preparation characteristics (frequency, sharing pattern) and meal composition. There was frequent depletion of fat and vegetable contents in meals, frequent elimination of desserts and even the elimination of one daily meal. These changes specifically affected economically disadvantaged and socially isolated households, and those headed by women. Other changes were the reduction in the size of consumption units and the development of neighbourhood-specific street food - which has been a growing trend in Brazzaville since the outset of the economic crisis but is more recent in Dakar. CONCLUSIONS If lasting, these changes pose a dual health risk, i.e. reducing dietary diversity and altering the bacteriological quality of prepared meals. In addition, attempts to reduce the consumption units were found to upset community ties that bind these societies.