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Intervention In Child Nutrition by Jan Hoorweg,Rudio Niemeijer Pdf
First published in 1989. The studies that form the basis for this monograph were carried out between 1976 and 1979. The African Studies Centre in Leiden has a standing interest in child nutrition and provided the funds and resources for what was ambitiously termed the 'Nutrition Intervention Research Project'.
Author : World Health Organization Publisher : World Health Organization Page : 442 pages File Size : 52,5 Mb Release : 2013 Category : Medical ISBN : 9789241548373
Pocket Book of Hospital Care for Children by World Health Organization Pdf
The Pocket Book is for use by doctors nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. This second edition is based on evidence from several WHO updated and published clinical guidelines. It is for use in both inpatient and outpatient care in small hospitals with basic laboratory facilities and essential medicines. In some settings these guidelines can be used in any facilities where sick children are admitted for inpatient care. The Pocket Book is one of a series of documents and tools that support the Integrated Managem.
Disease Control Priorities, Third Edition (Volume 2) by Robert Black,Ramanan Laxminarayan,Marleen Temmerman,Neff Walker Pdf
The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.
Donald A. P. Bundy,Nilanthi de Silva,Susan Horton,Dean T. Jamison
Author : Donald A. P. Bundy,Nilanthi de Silva,Susan Horton,Dean T. Jamison Publisher : World Bank Publications Page : 502 pages File Size : 50,7 Mb Release : 2017-11-20 Category : Medical ISBN : 9781464804397
Disease Control Priorities, Third Edition (Volume 8) by Donald A. P. Bundy,Nilanthi de Silva,Susan Horton,Dean T. Jamison Pdf
More children born today will survive to adulthood than at any time in history. It is now time to emphasize health and development in middle childhood and adolescence--developmental phases that are critical to health in adulthood and the next generation. Child and Adolescent Health and Development explores the benefits that accrue from sustained and targeted interventions across the first two decades of life. The volume outlines the investment case for effective, costed, and scalable interventions for low-resource settings, emphasizing the cross-sectoral role of education. This evidence base can guide policy makers in prioritizing actions to promote survival, health, cognition, and physical growth throughout childhood and adolescence.
Maternal and Child Nutrition by Jatinder Bhatia,Zulfiqar Ahmed Bhutta,Satish C. Kalhan Pdf
How to prevent and manage low birth weight Growth and nutrition during the fetal period and the first 24 months after birth are important determinants of development in early childhood. Optimal nutrition and health care of both the mother and infant during these first 1000 days of an infant's life are closely linked to growth, learning potential and neurodevelopment, in turn affecting long-term outcomes. Children with low birth weight do not only include premature babies, but also those with intrauterine growth restrictions who consequently have a very high risk of developing metabolic syndrome in the future. Epidemiology, epigenetic programming, the correct nutrition strategy and monitoring of outcomes are thus looked at carefully in this book. More specifically, two important nutritional issues are dealt with in depth: The first being the prevention of low birth weight, starting with the health of adolescent girls, through the pre-pregnancy and pregnancy stages and ending with lactation. The second point of focus concerns the nutritional follow-up and feeding opportunities in relation to dietary requirements of children with low birth weight.
The Operational Evidence Base for Delivering Direct Nutrition Interventions in India by Rasmi Avula,Suneetha Kadiyala,Kavita Singh,Purnima Menon Pdf
The persistence of undernutrition in the face of Indias impressive economic growth is of enormous concern. Less than 55 percent of mothers and children receive any essential health and nutrition inputs that are critical for improving maternal and child nutrition. We conducted a desk review (1) to document the extent to which national and civil society/NGO programs in India reflect current technical recommendations for nutrition and (2) assess the operational evidence base for implementing essential interventions for nutrition in the Indian context. We reviewed the design of the two major national programs, Integrated Child Development Services (ICDS) and the National Rural Health Mission (NRHM). Subsequently, we used Google Scholar to search the published literature from 2000 to 2012 for evidence of interventions addressing the inputs to improve child nutrition. Finally, we contacted 70 program stakeholders to identify the unpublished evidence on inputs in program models implemented by civil society/nongovernment organizations. We find that, by design, the two national programs (ICDS and NRHM) together appear to incorporate all the essential inputs and use evidence-based interventions. There is an expectation by design that the frontline workers of ICDS and NRHM coordinate and collaborate to deliver the interventions. A review of 22 program models shows that a majority focused on improving breastfeeding and timely initiation of complementary feeding. However, only a few addressed the full spectrum of complementary feeding, vitamin A deficiency, pediatric anemia, and severe acute malnutrition. None addressed how to reduce intestinal parasitic burdens or prevent malaria. There is limited published literature on the effectiveness of the recommended interventions to deliver the essential inputs. There are few efficacy studies and even fewer effectiveness studies or program evaluations on delivering essential nutrition interventions in the Indian context. The most commonly used delivery strategies across multiple essential inputs were home visits that involved individual or group counseling by community health workers or by self-help groups. Mass media and community events such as marriages and fairs were used as avenues to generate support for the interventions. Some programs used community mobilization to promote the interventions. Several of these programs worked to improve coordination and convergence between ICDS and NRHM and to strengthen these existing systems through training, improved monitoring, and supervision. Overall, a large gap persists in both the published and gray literature on how to promote interventions to address the essential inputs. Much more operational evidence is needed to ensure high-quality delivery of the evidence-based interventions that are already being implemented nationwide. Given the potential for the national programs to effectively deliver interventions to achieve maximum coverage and impact, and the government of Indias current interest in ICDS system strengthening, this is an opportune time to test some of the innovations using the ICDS and NRHM platforms.
Intervention In Child Nutrition by Jan Hoorweg,Rudio Niemeijer Pdf
First published in 1989. The studies that form the basis for this monograph were carried out between 1976 and 1979. The African Studies Centre in Leiden has a standing interest in child nutrition and provided the funds and resources for what was ambitiously termed the 'Nutrition Intervention Research Project'.
Author : The World Bank Publisher : World Bank Publications Page : 168 pages File Size : 55,8 Mb Release : 2010-08-27 Category : Medical ISBN : 0821384074
What Can We Learn from Nutrition Impact Evaluations? by The World Bank Pdf
Evaluation Summary What Can We Learn from Nutrition Impact Evaluations? High levels of child malnutrition in developing countries contribute to mortality and have long-term consequences for children s cognitive development and earnings as adults. Recent impact evaluations show that many different interventions have had an impact on children s anthropometric outcomes (height, weight, and birth weight), but there is no simple answer to the question What works? to address the problem. Similar interventions have widely different results in different settings, owing to differences in local context, the causes and severity of malnutrition, and the capacity for program implementation. Impact evaluations of programs supported by the Bank, which are generally large-scale, complex inter-ventions in low-capacity settings, show equally variable results. The findings confirm that it should not be assumed that an intervention found effective in a randomized medical setting will have the same effects when implemented under field conditions. There are many robust experimental and quasi-experimental methods for assessing impact under difficult circumstances often found in field settings. The relevance and impact of nutrition impact evaluations could be enhanced by collecting data on service delivery, demand-side behavioral outcomes, and implementation processes to better understand the causal chain and what part of the chain is weak, in parallel with impact evaluations. It is also important to understand better the distribution of impacts, particularly among the poor, and to document better the costs and effectiveness of interventions. High levels of child malnutrition in developing countries are contributing to mortality and present long-term consequences for the survivors. An estimated 178 million children under age 5 in developing countries are stunted (low height for age) and 55 million are wasted (low weight for height). Malnutrition makes children more susceptible to illness and strongly affects child mortality. Beyond the mortality risk in the short run, the developmental delays caused by undernutrition affect children s cognitive outcomes and productive potential as adults. Micronutrient deficiencies vitamin A, iron, zinc, iodine, for example are also common and have significant consequences. Progress in reducing malnutrition has been slow: More than half of countries are not on track to achieve the Millennium Development Goal of halving the share of children who are malnou-rished (low weight for age) by 2015. The food price and financial crises are making achievement of this goal even more elusive. The World Bank has recently taken steps to ex-pand its support for nutrition in response to the underlying need and the increased urgency due to the crises. WHAT DO WE KNOW ABOUT REDUCING MALNUTRITION? The increased interest and resources focused on the problem of high and potentially increasing rates of undernutrition raises the question, what do we know about the causes of malnutrition and the in-terventions most likely to reduce it? The medical literature points to the need to inter-vene during gestation and the first two years of life to prevent child malnutrition and its consequences. It suggests that investments in interventions during this window of opportunity among children under 2 are likely to have the greatest benefits. Recently published meta-analyses of the impact evaluation literature point to several interventions found effective for reducing undernutrition in spe-cific settings. However, there are limitations to the generalizability of those reviews findings, particularly in the context of large-scale government programs most likely to be supported by the World Bank. The reviews tend to disproportionately draw on the findings of smaller, controlled experiments; there are few examples of evaluations of large-scale programs, over which there is less control in implementation. In reviewing a large number of studies, interventions, and outcomes, they tend to focus on average impacts. They generally do not explain the magnitude or variability of impacts across or within studies. Very few address the programmatic reasons why some interventions work or don t work, nor do they assess the cost-effectiveness of interventions. Objectives of the Review This paper reviews recent impact evaluations of interventions and programs to improve child anth-ropometric outcomes height, weight, and birth weight with an emphasis on both the findings and limitations of the literature and on understanding what might happen in a non-research setting. It further reviews in greater detail the experience and lessons from evaluations of the impact of World Bank-supported programs on nutrition outcomes. Specifically, the review addresses four questions. First, what can be said about the impact of different interventions on children s anthropometric outcomes? Second, how do these findings vary across settings and within target groups, and what accounts for this variability? Third, what is the evidence of the cost-effectiveness of these interventions? Finally, what have been the lessons from implementing impact evaluations of Bank-supported programs with anthropometric impacts? While there are different dimensions of child nutri-tion that could be explored, the report focuses on child anthropometric outcomes -- weight, height, and birth weight. These are the most common nutrition outcome indicators in the literature and the most frequently monitored by national nutrition programs supported by the World Bank. Low weight for age (underweight) is also the indicator for one of the MDGs. Methodology and Scope Forty-six nutrition impact evaluations published since 2000 were systematically reviewed. These evaluations assessed the impact of diverse interven-tions community nutrition programs, conditional and unconditional cash transfers, early child devel-opment programs, food aid, integrated health and nutrition services, and de-worming. All of the evaluations used research designs that compared the outcomes among those affected by the project to the counterfactual that is, what would have happened to a similar group of people in the absence of the intervention. About half used randomized assignment to create treatment and control groups, while the remainder used matching and various econometric techniques to construct a counterfactual. Among the 46 evaluations, twelve assessed the im-pact of World Bank-supported programs on nutri-tion outcomes in eight countries. While the broader review relies on the analysis of the published impact evaluations as the main source of data, for these twelve evaluations project documents and research outputs were reviewed and World Bank staff, country officials and the evaluators and re-searchers who conducted the studies were interviewed. Findings A wide range of interventions had a positive impact on indicators related to height, weight, wasting, and low birth weight. There were a total of 10 different outcome indica-tors for the four main anthropometric outcomes. A little more than half of the evaluations addressing a height-related indicator found program impacts on at least one group of children, and this was true for about the same share of interventions aimed at improving weight-related and wasting (low weight for height)-related indicators. About three-quarters of the 11 evaluations of interventions that aimed at improving birth weight indicators registered an impact in at least one specification, including five out of seven micronutrient interven-tions. There was no clear pattern of impacts across interventions in every intervention group there were examples of programs that did and did not have an impact on a given indicator, and with varying magnitude. Evaluations of the nutritional impact of programs supported by the World Bank, which are generally large-scale, complex, and implemented in low-capacity settings, show equally variable results. Even controlling for the specific outcome indicator, studies often targeted children of different age groups that might be more or less susceptible to the interventions. It is thus difficult to point to inter-ventions that are systematically more effective than others in reducing malnutrition across diverse set-tings and age groups. Differences in local context, variation in the age of the children studied, the length of exposure to the intervention, and differing methodologies of the studies account for much of the variability in results. Context includes factors like the level and local determinants of malnutrition, differences in the characteristics of beneficiaries (including their age), the availability of service infrastructure, and the implementation capacity of government. Outside of a research setting in the context of a large government program there are many things that can go wrong in either service delivery or the demand response that can compromise impact. Beyond this, there are social factors like the status of women or the presence of civil unrest that can affect outcomes. These findings underscore the conclusion that it should not be assumed that an intervention found effective in a randomized controlled trial in a re-search setting will have the same effects when im-plemented under field conditions in a different set-ting. They also point to the need to understand the prevailing underlying causes of malnutrition in a given setting and the age groups most likely to benefit in selecting an intervention. Further, impact evaluations need to supplement data measuring impact with data on service delivery and demand-side behavioral outcomes to demonstrate the plausibility of the findings, to understand what part of a program works, and to address weak links in the results chain to improve performance. There is scant evidence on the distribution of nutrition impacts who is benefiting and who is not or on the cost-effectiveness of interventions Just because malnutrition is more common among the poor does not mean that they will disproportio-nately benefit from an intervention, particularly if acting on new knowledge or different incentives relies on access to education or quality services. Only a third of the 46 evaluations looked at the distribution of impacts by gender, mother s education, poverty status, or availability of complementary health services. Only nine assessed the impacts on nutritional outcomes of the poor compared with the non-poor. Among the evaluations that did examine variation in results, several found that the children of more educated mothers or in better-off communities are be-nefitting the most. Bank-supported cash transfers, community nutrition, and early child development programs in six of eight countries had some impact on child anthropometric outcomes. Of the 12 impact evaluations of Bank support, all but one were of large-scale government programs with multiple interventions and a long results chain. Three-quarters found a positive impact on anthro-pometric outcomes of children in at least one age group, although the magnitude was in some cases not large or applied to a narrow age group. Most of the impact evaluations involved assessment of completely new programs and involved World Bank researchers. Most used quasi-experimental evaluation designs and two-thirds assessed impact after at most 3 years of program implementation. Only half of the evaluations documented the distribution of impacts and only a third presented information on the costs of the intervention (falling short of cost-effectiveness analysis). In two of the countries (Colombia and the Philippines) the evaluations likely had an impact on government policy or programs. Lessons A number of lessons for development practi-tioners and evaluators arose from the review of impact evaluations of World Bank nutrition support. For task managers: Impact evaluations of interventions that are clearly beyond the means of the government to sustain are of limited relevance. The complexity, costs, and fiscal sustainability of the intervention should figure into the decision as to whether an impact evaluation is warranted. Impact evaluations are often launched for the purpose of evaluating completely new pro-grams, but they may be equally or even more useful in improving the effectiveness of ongo-ing programs. There are methods for obtaining reliable impact evaluation results when randomized assignment of interventions is not possible for political, ethical, or practical reasons. For evaluators: In light of the challenges of evaluating large-scale programs with a long results chain, it is well worth the effort to assess the risks to disruption of the impact evaluation ahead of time and identify mitigation measures. The design and analysis of nutrition impact evaluations need to take into account the likely sensitivity of children of different ages to the intervention. For the purposes of correctly gauging im-pact, it is important to know exactly when delivery of an intervention took place in the field (as opposed to the official start of the program). Evaluations need to be designed to provide evidence for timely decision-making, but with sufficient elapsed time for a plausible impact to have occurred. The relevance of impact evaluations for po-licymakers would be greatly enhanced if im-pact evaluations were to document both the
Author : Christopher P. Wild,J. D. Miller,J. D. Groopman Publisher : IARC Working Group Report Page : 0 pages File Size : 40,8 Mb Release : 2016-02-15 Category : Medical ISBN : 9283225090
Mycotoxin Control in Low- and Middle-Income Countries by Christopher P. Wild,J. D. Miller,J. D. Groopman Pdf
This book provides an evaluation of measures to reduce exposure to highly toxic and carcinogenic contaminants in staple diets in Africa as well as parts of Asia and Latin America. Many of the poorest people in these regions are exposed to the pervasive natural toxins, aflatoxins and fumonisins, on a daily basis by eating their staple diet of groundnuts, maize, and other cereals. Exposure to mycotoxins at these high levels substantially increases mortality and morbidity. Aflatoxins are a cause of human liver cancer, and fatalities from acute aflatoxin poisoning outbreaks occur in Africa and Asia. The International Agency for Research on Cancer convened a Working Group of world-leading experts to review the health effects of aflatoxins and fumonisins and to evaluate intervention measures. The panel concluded that these mycotoxins not only are a cause of acute poisoning and cancer but also are a likely contributor to the high levels of stunting in children in affected populations. The Working Group also identified effective measures to reduce exposure in developing countries. The panel evaluated 15 interventions, considering the strength of the evidence as well as its completeness and its transferability at an individual, community, or national level. Four of the interventions were judged to be ready for implementation: improvement of dietary diversity; crop sorting; post-harvest measures, including improved storage; and, in Latin America for maize, optimized nixtamalization. These recommendations would be relevant for investment of public, nongovernmental organization, and private funds at the scale of the subsistence farmer, the smallholder, and through to a more advanced value chain.
Reducing Child Malnutrition in Tanzania by Harold Alderman,Johannes Hoogeveen,Mariacristina Rossi Pdf
Malnutrition is associated with an inadequate diet, poor health and sanitation services, and insufficient care for young children. A combination of income growth and nutrition interventions are therefore suggested to adequately tackle this issue, yet evidence to support this claim is often not available, especially for African settings. The authors evaluate the joint contribution of income growth and nutrition interventions toward the reduction of malnutrition. Using a four-round panel data set from northwestern Tanzania they estimate the determinants of a child's nutritional status, including household income and the presence of nutrition interventions in the community. The results show that better nutrition is associated with higher income, and that nutrition interventions have a substantial beneficial effect. Policy simulations make clear that if one intends to halve malnutrition rates by 2015 (the Millennium Development Goals objective), income growth will have to be complemented by large-scale program interventions.
