Prepregnancy and Pregnancy Nutrition on Women's Health and Its Impact

The overall nutrition status of females remains deficient. Among female school children 13-18 years of age, calorie consumption ranged from 65–90% of the RDA (Recommended Dietary Allowance), protein consumption from 60–71% of RDA, and vitamin A intake was 50% of RDA. Prevalence of anemia ranged from 72–98% and that of intestinal parasitic infection ranged from 17–62%. Gender bias may adversely affect the nutrition of the female child. An adolescent is likely to begin pregnancy with a negative nutrition balance. In a multicentric study, 93,356 married women, aged 15–45 years, were interviewed at home in a community-based survey from 23 districts in India. Forty to eighty percent were married before 18 years of age, and the incidence of teenage pregnancy was 66%. The magnitude of the problem and the adverse effects malnutrition may have in later life requires well-designed studies in order to find solutions.     

Ecological strategies to promote healthy body image among children

Background: Personal habits of children and adolescents related to healthy body image (BI) are influenced by various determinants in the micro‐ and macroenvironment. These include attitudes and behaviors about eating; exercise and physical appearance modeled by parents, teachers, and peers; as well as opportunities to learn new habits and social praise for healthy choices. The coordinated school health program (CSHP) is compatible with the 5 levels of an ecological approach to developing new health behaviors. Methods: Authors systematically applied the ecological model to all 8 components of coordinated school health. Next, strategies for each of the components were developed using the professional literature as well as author expertise in the areas of health education, exercise science, and dietetics. Results: For each strategy, applicable health and physical education standards, as well as goals for each strategy and additional Web resources, were provided to assist educators and administrators in supporting healthy BI among students. Conclusions: Educators may effectively use a coordinated approach to guide multiple intervention activities aimed at increasing healthy habits among adolescents and their families. The strength of the CSHP is its collaborative nature with active participation by students, faculty members, family caregivers, agency professionals, community residents, and health care providers.     

社区妇幼卫生健康服务调查分析

采用国家统一的项目调查问卷 ,对 0— 2岁儿童的母亲 2 2 7人 ,0— 2岁儿童 2 2 7人进行入户调查 ,对调查数据进行分析。结果 ,74 .89% 0— 2岁儿童母亲早孕接受保健服务 ,92 .51 %孕期进行产前检查≥ 8次 ,96.4 8% 0— 2岁儿童获得身高、体重保健服务 ,89.72 %获得口腔保健服务和 57.94 %眼保健服务 ,婴儿母乳喂养率在产院时达 92 .5%。表明城市社区内的妇幼卫生工作基本做到了网络化、制度化 ,妇女儿童的基本卫生保健能够得到落实 ,但母婴产后保健服务还须进一步加强 ,4— 6个月婴儿的母乳喂养率有待提高 ,儿童保健需拓宽服务项目 ,以满足社区妇女儿童的保健需求     

Health and nutrition in adolescents of the Primorye Territory

The paper presents the results of a study of health status and some factors of nutrition in 1900 adolescents aged 10-17 years from the Primorye Territory. A comprehensive assessment of the height and development established health group 1 only in 4.2%, which is 6.5% less than the initial data of preventive examinations at educational establishments. The implication of the morphofunctional status was underestimated in assessing the health status. The findings of the pattern of nutrition in children adolescents from the Primorye Territory point to its irregularity, unbalanced characteristics in terms of basic ingredients, accompanied by low health indices. Metabolic trophotropicity was revealed in the adolescents of the Primorye Territory at the present stage. These processes were most marked in 13-year-old girls. In the average, in every 7 children protein metabolism tended to decrease with the maximum manifestation of these disorders at the age of 11-12 years.     

儿童青少年肥胖的医学营养治疗与HCH管理模式

肥胖已经成为严峻的全球性公共卫生问题。截至2014年,我国7岁以上学龄儿童青少年的超重率为12.2%,肥胖率为7.3%,共有3 496万人。2030年可达5 000万。儿童青少年肥胖的医学营养治疗,包括积极的高危人群筛查,肥胖儿童青少年的饮食、运动、生活方式综合干预等。上海儿童医学中心-上海潍坊社区服务中心医联体门诊采用“医院-社区-家庭(HCH)管理模式”对上海地区儿童青少年肥胖进行医学营养综合治疗,获得良好效果,值得进一步应用推广。     

Community participation in the field of health and nutrition

This article presents the concept of community participation as a strategy for achieving development. Community assessment, awareness, involvement, participation, and empowerment need to be to ensured before community participation can become a self-dynamic process. From the Integrated Nutrition Health Programme (INHP) in India came the following features that highlighted the community participation process, including: (a) women group formation and/or strengthening, (b) a participatory rural appraisal (PRA) exercise, (c) sub-center level team formation, (d) mother meetings, and (e) service providers with women's groups (WGs). The strategies of the INHP integrate several developmental sectors so as to bring about lasting positive health and nutrition related behavioral changes among the targeted beneficiaries. The Convergent Community Action (CCA) approach, introduced by the Panchayat government, is an updated social action strategy enhancing the capability of the family and the community to meet the needs of children and women.     

The impact of childhood conditions and concurrent morbidities on child health and well-being

Background   Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.
Methods   We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5–18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0–100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).
Results   Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9–23.2%, dental 11.9–22.7%, vision 7.2–14.7%, chronic allergies 8.8–13.9%, attention problems 5.1–13.8% and behaviour problems 5.7–12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (−7.69 to −21.51) for physical health conditions, and 28 points (−5.15 to −33.81) for mental health conditions.
Conclusions   Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.     

Past,present and future of Integrated Child Development Services (I.C.D.S.)

India's Integrated Child Development Services (ICDS) was established in 33 projects in 1975 and is spread over 22 states; 67 additional projects were begun in 1977, and over the next 2 years; 100 additional projects were added. By 1991=92, coverage was almost 50% of the country with 2696 projects; the expectation is for 100% coverage by the year 2000. An infrastructure chart identifies the organization and integration between level and social welfare and health departments. Objectives are clearly identified and the departments functionally linked. Linkages are achieved by shared space and activities at various levels. Over the past 17 years, services have included minimum needs programs, integrated rural development and poverty alleviation, national health policy and education policy, universal immunization, and the development of women and children in rural areas. ICDS is sponsored 100% by the status and uniquely relies on the honorary anganwadi worker (AWW), who is a woman, recruited and chosen by the community, aged 21-45 years and middle-school educated. The AWW was responsibility for 2000 households or 1000 persons in rural areas and 700 persons in tribal areas. The AWW is crucial to the functioning of the program and receives an honorarium of Rs. 225-275/month for implementing the ICDs program; AWWs have helpers who are paid Rs. 110/month. Training over a 3-year period is conducted at the Bal Sevika Training Institute by the Indian Council of Child Welfare. Additional health personnel and their role and the number of persons/per area AWWS are responsible for, equipment, and functions are also described. The AWW is responsible for nonformal preschool education, organization of supplementary nutrition feeding, health and nutrition education of women and families, immunization of women and children, treatment and referral of common illnesses, growing monitoring, and community participation. Presently, there are 2506 central sector projects and 190 state sector projects and 250,000 AWWs. The preschool education, health, and nutrition programs are summarized. Future directions will encompass future child and mother development and expansion to cover all 90 districts having a birth rate higher than 39/1000. Lessons learned from the past will be integrated and may involve cost containment, acceleration of development of services, alternative services, and giving mothers more responsibility for improving health and nutrition.     

Popular education and child nutrition: experience with women in a rural area of Mexico]

OBJECTIVE: Community intervention was undertaken using the health promotion strategy, the objective being to develop a health education program for women. METHODS: The popular education methodology was used with the purpose of generating organizational and social participation processes to improve hates of child nutrition and survival. RESULTS: The main results are linked with the generation of community self-care processes and the creation of a health promoters' group which has been working with women, focusing their work on improving child nutrition and family health. The health promoters have taken charge of the epidemiological surveillance program for child nutrition and, together with the mothers, have undertaken a series of actions which have helped to decrease the rate of malnutrition among the children participating in this programs. CONCLUSIONS: There would be greater possibility of success if the general population were involved in the solution of this problem. This would be possible by the use of an adequate methodology which brought about greater community participation in such a way as to leave room for its own improvement. Popular education provides such a tool. It is necessary to continue to increase experience in health education with this type of methodology.     

Meal skipping children in low-income families and community practice implications

We examined dietary habits, food intakes, health status, and school and community life of meal skipping children, and investigated factors predicting meal skipping of children. A sample was composed of 944 children in low-income families who were provided with public meal service. The sample was obtained from the Survey of Meal Service for Poor Children conducted by the Korea Institute for Health and Social Affairs in 2007. Meal skipping was significantly associated with a lower nutrition and health status, and poor school performance of children, as hypothesized. The school age of child, family structure, region, job of caretaker, concern about diet, and the child''s visit to welfare center significantly predicted frequency of meal skipping. We suggested a few implications for community practice to reduce meal skipping of children.     

上海市瑞金二路街道社区妇幼保健工作10年总结

10年来 ,上海市卢湾区瑞金二路街道在街道、区卫生局、区妇幼保健院 (所 )、社区卫生服务中心的共同探索中建立了高效的社区妇幼卫生管理及服务体系 ,开展社区妇幼保健工作 ,建立及健全保健网络 ,开展健康教育 ,10年内无孕产妇死亡 ,母乳喂养率、孕产妇及儿童系统管理率均明显提高 ,5岁以下儿童死亡率、常见儿童疾病发生率均明显降低 ,有力地保障了该社区妇女儿童的健康     

Mental health impact for adolescents living with prolonged drought

Background:  A 2004 study showed adolescents living in rural Australia were aware of the impact of drought on self, family and community, but did not report levels of emotional distress higher than adolescents of similar age and gender in the Australian community. It was proposed that the rural lifestyle had helped adolescents build resilience for managing this environmental adversity.
Objective:  To re sample adolescents from the same rural area and determine if this resilience remained after ongoing drought three years later.
Design:  A mixed methods approach using focus groups and a self-report questionnaire.
Setting:  Government Central Schools within the Riverina region of New South Wales.
Participants:  Male and female adolescents ( n =  111) aged 11–17 years completed the self-report questionnaires, while some adolescents ( n =  61) within this group also participated in focus groups.
Main outcome measure:  The Strengths and Difficulties Questionnaire and a Drought and Community Survey for Children comprised the self-report survey.
Results:  Adolescents reported significantly higher levels of emotional distress than those in the previous study ( t (191)  =  2.80, P <  0.01) and 12% of adolescents scored in the clinical caseness range. Thematic analysis showed consistency with the previous study as well as new themes of grief, loss and the impacts of global climate change.
Conclusions:  Results indicate a reporting of lesser well-being than was reported by a comparable group of young people four years earlier. A preventative intervention with a focus on family and community is recommended to address the mental health of adolescents enduring a chronic environmental adversity such as drought.     

Study of impact of nutrition & health day strategy on the coverage rates of supplementary nutrition and health interventions among the ICDS beneficiaries in a rural block of Madhya Pradesh

To study the trends of beneficiary coverage (pregnant and lactating women and children less than two years of age) for utilization of supplementary nutrition and health services in a rural block before and after the launch of a strategy to converge Health & Integrated Child Development Services (ICDS) on a single day christened "Nutrition and Health Day" (NHD). It is a before and after intervention design in rural ICDS block Amarwada in district Chhindwada. As a part of intervention, NHD were organised on which convergent services of Health & ICDS were made available to the beneficiaries. On the weekly NHDs, uncooked supplementary nutrition for the week was distributed to pregnant and lactating mothers and children under two. The Health worker visited the Anganwadi Centre (AWC) and immunized children and pregnant women, distributed IFA, Vitamin A and provided health and nutrition education. The study assessed the impact of these interventions on the coverage rates of the services. Study was conducted between May 97 and March 98. The routine monitoring reports of the ICDS and Health System of the state government were used as study tools. The study sample comprised of AWC beneficiaries in the project area. The total population of the block was 89,476. Participation in the supplementary nutrition program (SNP) increased two to three folds in all categories of the target population. Immunization and Vitamin A coverage levels for children also showed an increase of about 3 and 5-8 times from baseline status respectively in a year's time. Among pregnant women, Tetanus Toxoid (TT) and Iron and Folic Acid (IFA) utilization rates have also shown two and five fold increase respectively.     

The Effect of a Multidisciplinary Lifestyle Intervention on Health Parameters in Children versus Adolescents with Severe Obesity

Lifestyle interventions are the common treatment for children and adolescents with severe obesity. The efficacy of these interventions across age groups remain unknown. Therefore, this study aimed to compare the effectiveness of a lifestyle intervention on health parameters between children and adolescents with severe obesity. A longitudinal design was carried out at the Centre for Overweight Adolescent and Children’s Healthcare (COACH) between December 2010 and June 2020. Children (2–11 years old, n = 83) and adolescents (12–18 years old, n = 77) with severe obesity received a long-term, tailored, multidisciplinary lifestyle intervention. After 1 year, 24 children (28.9%) and 33 adolescents (42.9%) dropped out of the intervention. The primary outcome was the change in body mass index (BMI) z-score after one and two years of intervention. The decrease in BMI z-score over time was significantly higher in children compared to adolescents, the mean decrease was 0.15 (0.08–0.23) versus 0.03 (−0.05–0.11) after one year and 0.25 (0.15–0.35) versus 0.06 (−0.06–0.17) after two years of intervention; p values for the difference between children and adolescents were 0.035 and 0.012. After two years, multiple improvements in cardio metabolic health parameters were observed, especially in children. In conclusion, during our tailored lifestyle intervention, a positive and maintained effect on health parameters was observed in children with severe obesity. Compared to children, the effect on health parameters was less pronounced in adolescents.     

Amélioration de la gestion d’un programme de suivi de la croissance à base communautaire des enfants en milieu rural au Rwanda

BackgroundIn order to improve the management of a community based nutrition program in the catchment area of Ruli District Hospital in Rwanda, we carried out a nutrition survey to determine the risk factors for childhood malnutrition in the area. Identifying the groups of children at risk of malnutrition and their risk factors allows the community nutrition workers to target the children who require close monitoring, and assists in the development of key messages for educational nutrition training.MethodsThe prevalence of the three forms of malnutrition was estimated by using the Z-scores height for age, weight for age and weight for height with NCHS/OMS/2000 reference. Logistic regression was performed to identify the risk factors for malnutrition.ResultsOur findings show that children from 12–35 months of age are at greatest risk of malnutrition. Risk factors for wasting include: low monthly income of the household, concurrent illness of the child and a household that does not practice breeding. Risk factors for underweight include: child being greater than 12 months of age, mother of the child being pregnant and history of malnutrition in the household. Finally, risk factors for stunting include the absence of a mosquito net in the household, an insufficient number of working adults in the household, the child being greater than 12 months of age and a household managed by a man alone or by an orphan.ConclusionCommunity based growth monitoring must focus its attention on the children from nine to 35 months of age. Children less than nine months of age are generally followed by the health centers through the immunization program, and the older children are generally followed in the child minder schools that need to be promoted in all the cells. Community messages must focus on the identified risk factors of malnutrition, and a positive deviance approach must be introduced in the entire zone.     

Integrated training of health functionaries in ICDS scheme

India's Integrated Child Development Services (ICDS) was first implemented in October 1975, in 33 experimental blocks and expanded to include 2499 projects by March 1991. ICDS is multisectoral and coordinated at the village, block, district, state, and central government levels. Program responsibility is vested in the women and child development department at the center level and at a variety of different departments at the state level (social welfare, rural development, tribal welfare, or health and family welfare departments). The target population is children under 6 years of age and lactating women aged 15-44 years. Program objectives include improving the nutritional and health status of children aged 0-6 years; providing a foundation for proper psychological, physical, and social development of children; reducing the incidence of mortality, morbidity, malnutrition and school dropouts; effectively coordinating policy and implementation among relevant departments; and enhancing mothers' capabilities to provide for the normal health and nutritional needs of their children. "Anganwadi" workers at the local level and supportive personnel from health departments administer services, which include the following: supplementary nutrition, immunization, health checkups, referral services, treatment of minor illnesses, nutrition and health education for women, preschool education for children aged 3-6 years, and cooperation with improvement in supportive service such as water supply and sanitation.     

Position of the American Dietetic Association: child and adolescent food and nutrition programs

It is the position of the American Dietetic Association that all children and adolescents, regardless of age, sex, socioeconomic status, racial diversity, ethnic diversity, linguistic diversity, or health status, should have access to food and nutrition programs that ensure the availability of a safe and adequate food supply that promotes optimal physical, cognitive, social, and emotional growth and development. Appropriate food and nutrition programs include food assistance and meal programs, nutrition education initiatives, and nutrition screening and assessment followed by appropriate nutrition intervention and anticipatory guidance to promote optimal nutrition status. Food and nutrition programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply and nutrition screening, assessment, and intervention. It is important that continued funding be provided for these programs, which consistently have been shown to have a positive impact on child and adolescent health and well-being. Food and nutrition programs serve as a means to prevent or reduce hunger and food insecurity, but also as a vehicle for nutrition education and promotion of physical activity designed to prevent or reduce overweight and prevent chronic disease. It is the role of the registered dietitian to support adequate and sustained funding for food and nutrition programs, universal health care reimbursement for nutrition services, and the use of research and surveillance programs to evaluate and improve these programs. In addition, the registered dietitian and dietetic technician, registered, are responsible for serving as a nutrition resource to all groups and individuals providing services to children and adolescents, acting as an advocate for the establishment of child-care, school, and community settings conducive to the development of good nutrition habits.     

Die erste KiGGS-Folgebefragung (KiGGS Welle 1)

The “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) is part of the health monitoring system of the Robert Koch Institute (RKI). Following the KiGGS baseline study (2003???06), which comprised interviews and physical examinations of 0- to 17-year-old participants, KiGGS Wave 1 (2009???2012) was carried out as a telephone-based survey. In addition to providing longitudinal data, a second essential aim of KiGGS is to regularly provide population-based cross-sectional data on the health situation of children and adolescents aged 0–17 years living in Germany. Therefore, the study population of KiGGS Wave 1 consists of re-invited participants from the baseline study (KiGGS cohort), supplemented by newly invited children aged 0–6 years. The newly invited participants were randomly chosen from local population registries in the 167 baseline sample points. This method was chosen to supplement the sample with younger age groups. This article focuses on the age groups from 0 to 17 years, which are relevant for prevalence estimations among children and adolescents. In total 12,368 children and adolescents took part; among them 4,455 newly invited and 7,913 re-invited participants (response 38.8 and 72.9?%, respectively). A comparison of the net sample with the resident German population (0–17 years) regarding particular population characteristics and an analysis of the relationship between the re-participation rate and certain characteristics collected in the baseline study (7–17 years) suggest a mostly unbiased sample. To account for certain aspects of the population and nonresponse, cross-sectional and trend analyses were partially corrected by weighting factors.     

Die Gesundheit von Kindern und Jugendlichen in Deutschland

The deficits in our knowledge of the health status of infants, children, and adolescents in Germany are large and significant. To close the gaps, the concept for a national, representative health interview and examination survey of the young generation has been developed by the Robert Koch Institute supported by the expertise of German and international specialists. The development of the concept, study design and methodology took several years. After a pilot study, which took place over a period of 12 months and involved 1,630 young people aged between 0 and 17 years, the concept, design and materials were thoroughly revised. The survey will start in 2003, and include about 20,000 individuals in this age range. It will be the most comprehensive health study of young people ever undertaken in Germany. The funding comes from the German Federal Ministries of Health and of Research and Education, as well as from the Robert Koch Institute. Over a period of 3 years, participants, randomly selected from the registries of inhabitants, will be medically examined and their parents interviewed. From the age of 11, the youngsters themselves will also fill in a questionnaire serving as an additional source of information. The data obtained will form the basis for a National Health Report on children and adolescents, open new fields of prevention and intervention, and support the research of the scientific community as a Public Use File which will be available 1 year after the end of data collection.     

Measles outbreak in Burkina Faso, 2009: a case-control study to determine risk factors and estimate vaccine effectiveness

Objective

We investigated a large measles outbreak that occurred in 2009 in Burkina Faso in order to describe the epidemic, assess risk factors associated with measles, and estimate measles vaccine effectiveness.

Methods

We reviewed national surveillance and measles vaccine coverage data, and conducted a case–control study in three geographic areas. Case-patients were randomly selected from the national case-based measles surveillance database or, when a case-patient could not be traced, were persons in the same community who experienced an illness meeting the WHO measles clinical case definition. Controls were matched to the same age stratum (age 1–14 years or age 15–30 years) and community as case-patients. Risk factors were assessed using conditional logistic regression.

Results

Lack of measles vaccination was the main risk factor for measles in all three geographic areas for children aged 1–14 years (adjusted matched odds ratio [aMOR] [95% confidence interval (CI)], 19.4 [2.4–155.9], 5.9 [1.6–21.5], and 6.4 [1.8–23.0] in Bogodogo, Zorgho, and Sahel, respectively) and persons aged 15–30 years (aMOR [95% CI], 3.2 [1.1–9.7], 19.7 [3.3–infinity], 8.0 [1.8–34.8] in Bogodogo, Zorgho, and Sahel, respectively). Among children aged 1–14 years, VE of any measles vaccination prior to 2009 was 94% (95% CI, 45–99%) in Bogodogo, 87% (95% CI, 37–97%) in Zorgho, and 84% (95% CI, 41–96%) in Sahel. Main reasons for not receiving measles vaccination were lack of knowledge about vaccination campaigns or need for measles vaccination and absence during vaccination outreach or campaign activities.

Conclusion

These results emphasize the need for improved strategies to reduce missed opportunities for vaccination and achieve high vaccination coverage nationwide in order to prevent large measles outbreaks and to continue progress toward measles mortality reduction.