Nutrition and Health in Developing Countries

Dedication

Series Editor’s Introduction

Foreword

Preface

Table of Contents

Contributors

Chapter 1

Nutrition and Development: A Historical Perspective

1.1 Introduction

1.2 The Idea of Progress in Public Health

1.3 The Rise of Statistics and Probability

1.4 Early Foundations of Preventive Medicine

1.5 The Sanitary Idea

1.6 Contagion Versus Miasma

1.7 Advances in Microbiology

1.8 Nutritional Science in the 19Th Century

1.9 Infant Mortality and Social Reform

1.10 The Emergence of the Vitamins

1.11 Further Research on Nutritional Deficiency Diseases

1.12 Nutritional Immunology

1.13 Vitamin a and Reduction of Child Mortality

1.14 Growth in Food Production

1.15 Long-Term Trends in Diet

1.16 The Decline of Mortality

1.17 Graduate Education in Public Health

1.18 International Organizations

1.18 Conclusions

References

Chapter 2

Maternal Mortality in Developing Countries

2.1 Introduction

2.2 Magnitude and Causes of Maternal Mortality

2.2.1 Measuring Maternal Mortality

2.2.2 Medical Causes of Maternal Mortality

2.3 Strategies to Reduce Maternal Mortality

2.4 Socioeconomic Development, Women’s Education, and Maternal Mortality

2.5 Family Planning and Maternal Mortality

2.6 Nutrition and Maternal Health

2.6.1 Direct Effects of Energy or Micronutrient Defi ciency on Maternal Mortality

2.6.2 Malnutrition and the Risk of Obstructed Labour

2.6.3 Calcium Defi ciency and the Risk of Preeclampsia

2.6.4 Iron Defi ciency and Anemia

2.6.5 Vitamin A Defi ciency and the Risk of Anemia or Infection

2.6.6 Zinc Defi ciency and the Risk of Haemorrhage or Infection

2.6.7 Multiple Micronutrients

2.8 Antenatal Care

2.9 Training of Traditional Birth Attendants

2.10 Access to Professional Delivery Care

2.11 Summary and Conclusions

References

Chapter 3

Low Birth Weight and Neonatal Mortality

3.1 Introduction

3.2 Historical Background

3.3 Definitions

3.3.1 Neonatal Mortality

3.3.2 Perinatal Mortality

3.3.3 Low Birth Weight and Intrauterine Growth Restriction

3.4 Descriptive Epidemiology

3.5 Causes Of Neonatal Death

3.6 Influence Of Maternal Factors

3.6.1 Maternal Factors and Intrauterine Growth Restriction

3.6.2 Maternal Stature and Preterm Birth

3.6.3 Maternal Nutrition and Fetal Death

3.6.4 Maternal Factors and Early Neonatal Death

3.7 Interventions To Improve Neonatal Survival

3.7.1 Folic Acid Supplementation

3.7.2 Tetanus Toxoid Immunization

3.7.3 Syphilis Screening and Treatment

3.7.4 Preeclampsia and Eclampsia Prevention (Calcium Supplementation)

3.7.5 Intermittent Presumptive Treatment for Malaria

3.7.6 Detection and Treatment of Asymptomatic Bacteriuria

3.7.7 Antibiotics for Preterm Premature Rupture of Membranes

3.7.8 Corticosteroids for Preterm Labor

3.7.9 Detection and Management of Breech

3.7.10 Labor Surveillance

3.7.11 Clean Delivery Practice

3.7.12 Resuscitation of Newborn Baby

3.7.13 Breast-feeding

3.7.14 Prevention and Management of Hypothermia

3.7.15 Kangaroo Mother Care

3.7.16 Community-Based Pneumonia Case Management

3.8 Nutritional Interventions

3.8.1 Protein-Energy Supplementation

3.8.2 Maternal Iron Supplementation

3.8.3 Maternal Iodine Supplementation

3.8.4 Antenatal Vitamin A or b-Carotene Supplementation

3.8.5 Antenatal Zinc Supplementation

3.8.6 Multiple Micronutrient Supplementation

3.8.7 Reduction in Childhood Stunting

3.8.8 Prevention of Maternal Obesity

3.9 Implementation of Interventions To Reduce Low Birth Weight and Neonatal Mortality

3.10 Conclusions

3.11 Recommendations

References

Chapter 4

Infant Mortality

4.1 Introduction

4.2 Global Trends

4.2.1 Historical Trends: United States

4.2.2 Decline in Infant Mortality in Developing Countries

4.3 Determinants of Infant Mortality

4.3.1 Macrofactors: Socio-Politico-Economic Dimensions

4.3.2 Gender

4.3.3 Household Socioeconomic Factors

4.3.4 Maternal Age, Parity, and Birth Spacing

4.3.5 Maternal Nutrition and Infant Mortality

4.3.6 Breast-feeding

4.4 Direct and Underlying Causes of Infant Mortality

4.5 Contributions of Neonatal Mortality To Infant Mortality: Causes and Risk Factors

4.6 Interventions For Reducing Infant and Neonatal Mortality

4.7 Future Actions

References

Chapter 5

Child Growth and Development

5.1 Introduction

5.2 Measuring Impaired Growth: Concepts and Indicators

5.2.1 Fetal Growth

5.2.2 Child Growth Indicators and Their Interpretation

5.2.3 The International Reference Population

5.2.4 Issues in the Interpretation of Growth Data

5.3. Prevalence of Growth Retardation in Developing Countries

5.4 Health and Social Consequences of Impaired Growth

5.5 Interventions Aimed at Promoting Healthy Growth and Development

5.6 Conclusions

References

Chapter 6

Diarrheal Diseases

6.1 Introduction

6.2 Public Health Importance

6.3 Historical Background

6.4 Epidemiology

6.4.1 Geographical Distribution

6.4.2 Risk Factors

6.4.3 Incidence

6.4.4 Seasonality

6.4.5 Duration

6.5 Clinical Features/Pathophysiology

6.5.1 Major Pathogens Involved in Diarrheal Diseases in Children

6.5.2 Pathophysiology

6.5.3 Effects of Malnutrition on Mortality

6.5.4 Effects of Malnutrition on Morbidity

6.5.5 Effects on Growth of Children

6.5.6 Effect on Dietary Intake

6.5.7 Effects on Nutrient Absorption and Intestinal Function

6.5.8 Relationship with Nutrition and Immunity

6.5.8.1 Undernutrition

6.5.8.2 Vitamin A

6.5.8.3 Zinc

6.5.8.4 Other Micronutrients

6.6 Diagnosis

6.7 Treatment

6.7.1 Oral Rehydration Therapy

6.7.2 Nutritional Management

6.7.2.1 Timing of Feeding

6.7.2.2 Lactose

6.7.2.3 Mixed Diets

6.7.2.4 Fiber

6.7.2.5 Probiotics

6.7.2.6 Prebiotics

6.7.2.7 Epidermal Growth Factor

6.7.2.8 Short-Chain Fatty Acids

6.7.2.9 Glutamine

6.7.2.10 Nucleotides

6.7.2.11 Lectins

6.7.3 Micronutrient Supplementation

6.7.3.1 Zinc

6.7.3.2 Vitamin A

6.7.4 Dietary Management of Persistent Diarrhea

6.8 Prevention

6.8.1 Breast-Feeding

6.8.2 Improved Weaning Practices

6.8.3 Use of Safe Water

6.8.4 Hand Washing

6.8.5 Latrines and Proper Disposal of Human Waste

6.8.6 Measles Immunization

6.8.7 Nutritional Interventions

6.8.7.1 Zinc

6.8.7.2 Vitamin A

6.8.7.3 Nucleotides

6.8.8 Vaccines

6.8.9 Other Potential Interventions

6.9 Future Directions

6.10 Conclusions

References

Chapter 7

Acute Lower Respiratory Infections

7.1 Introduction

7.2 Public Health Importance

7.3 Historical Background

7.4 Epidemiology

7.4.1 Risk Factors

7.4.1.1 Low Birth Weight

7.4.1.2 Lack of Breast-Feeding

7.4.1.3 Malnutrition

7.4.1.4 Micronutrient Status

7.4.1.5 Decreased Immunity

7.4.1.6 Environmental and Socioeconomic Factors

7.4.1.7 Prior Infections

7.4.1.8 Other Factors

7.4.2 Incidence

7.4.3 Seasonality

7.4.4 Duration

7.4.5 Case Fatality Ratios

7.5 Clinical Features/Pathophysiology

7.5.1 Clinical Presentation

7.5.2 Major Pathogens Involved in Acute Lower Respiratory Diseases in Children

7.5.3 Pathophysiology

7.5.4 Impact of Acute Respiratory Infections on Nutrition and Growth

7.6 Treatment

7.6.1 Case Management of Pneumonia

7.6.2 Nutritional Interventions for Treatment of Acute Respiratory Infections

7.6.2.1 Zinc

7.6.2.2 Vitamin A

7.6.2.3 Selenium

7.7 Prevention

7.7.1 Immunization

7.7.3 Nutrition

7.7.3.1 Breast-Feeding

7.7.3.2 Prevention of LBW

7.7.3.3 Reduction of Malnutrition

7.7.3.4 Zinc Supplementation

7.7.3.5 Vitamin A Supplementation

7.7.3.6 Selenium Supplementation

7.7.4 Other Measures

7.8 Future Directions

7.8.1 Risk Factors for Pneumonia and Acute Lower-Respiratory Infection

7.8.2 Clinical Aspects

7.8.3 Prevention

7.9 Conclusions

References

Chapter 8

Measles

8.1 Introduction

8.2 Definition

8.3 Public Health Importance

8.4 Historical Background

8.5 Epidemiology

8.6 Pathophysiology

8.7 Interaction With Nutrition

8.7.1 Effect of Measles on Nutrition

8.7.2 Effect of Malnutrition on Measles

8.8 Clinical Features

8.9 Diagnosis

8.10 Treatment

8.10.1 Nutritional Support

8.10.2 Vitamin A Therapy

8.10.3 Vitamin A Dosage

8.11 Prevention

8.11.1 Measles Vaccine

8.11.2 Improving Vitamin A Status of Children

8.12 Research Needs

8.13 Conclusions

References

Chapter 9

Malaria and Nutrition

9.1 Introduction

9.2 Historical Background

9.2.1 Historical Overview of Malaria

9.2.2 Attempts to Eradicate Malaria

9.2.3 Modern Approaches to Malaria Control

9.2.3.1 Insecticide-Treated Bed Nets

9.2.3.2 Vaccine Development

9.3 Epidemiology

9.3.1 Geographic Distribution and Disease Burden

9.3.2 Life Cycle of the Malaria Parasite

9.3.3 Classifi cation Schemes of Malaria Endemnicity

9.3.4 Clinical Disease

9.3.5 Epidemiology of Severe Malaria

9.3.6 Diagnosis and Drug Treatment of Malaria

9.3.6.1 Diagnosis

9.3.6.2 Drug Treatments

9.3.7 Host-Parasite Interactions and Immunity

9.3.8 Modulating Factors of Malaria Morbidity and Mortality

9.4 Effects of Nutrition on Malaria

9.4.1 Early Perceptions of the Impact of Nutrition on Malaria

9.4.2 Malnutrition and Malaria: Synergism or Antagonism?

9.4.2.1 Malnourished Individuals and Malaria Morbidity and Mortality

9.4.2.1.1 Clinic-Based Studies.

9.4.2.1.2 Early Hospital-Based Studies of Severe Malaria.

9.4.2.1.3 Critical Analysis of the Early Hospital-Based Studies.

9.4.2.1.4 Modern Hospital-Based Studies of Severe Malaria.

9.4.2.1.5 Cross-Sectional Studies of Malariometric Indicators.

9.4.2.1.6 Longitudinal Cohort Studies and Effects of Nutrition on Drug-Resistant Malaria.

9.4.2.2 Studies in Famine Relief

9.4.2.3 Studies in Animals

9.4.2.4 Synthesis of Data Concerning Effects of Protein-Energy Malnutrition on Malaria

9.4.3 Impact of Malaria on Growth

9.4.4 Infl uence of Specific Nutrients on Malaria Morbidity

9.4.4.1 Iron

9.4.4.2 Zinc

9.4.4.3 Vitamin A

9.4.4.4 B Vitamins

9.4.4.4.1 Folate.

9.4.4.4.2 Riboflavin.

9.4.4.4.3 Thiamine.

9.4.4.5 Vitamin E and Other Antioxidants

9.5 Conclusions and Recommendations

References

Chapter 10

Tuberculosis

10.1 Introduction

10.1.1 Definitions

10.1.2 Public Health Importance

10.2 Historical Background

10.2.1 Antiquity

10.2.2 Early Ideas About Tuberculosis

10.2.3 Tuberculosis as an Infectious Disease

10.2.4 Cod-Liver Oil Therapy

10.2.5 BCG Vaccine and Tuberculosis Chemotherapy

10.2.6 The Decline of Tuberculosis in Industrialized Countries

10.3 Epidemiology

10.3.1 Geographic Distribution

10.3.2 High-Risk Groups and Risk Factors

10.3.3 Incidence and Prevalence of Tuberculosis in Vulnerable Populations

10.3.3.1 HIV Infection

10.3.3.2 Children

10.3.3.3 Older Adults

10.3.3.4 Other Populations at Risk

10.3.4 Drug-Resistant Tuberculosis

10.4 Clinical Features/Pathophysiology

10.4.1 Clinical Features of Tuberculosis

10.4.2 Pathophysiology

10.4.3 Role of Nutrition

10.4.3.1 Protein and Energy Status

10.4.3.2 Vitamin A

10.4.3.3 Vitamin D

10.4.3.4 B Complex Vitamins

10.4.3.5 Vitamin C

10.4.3.5 Other Nutritional Problems

10.4.4 Strength of Evidence Regarding Role of Nutrition

10.5 Diagnosis

10.5.1 Clinical Diagnosis of Latent Tuberculosis Infection

10.5.2 Clinical and Laboratory Diagnosis of Active Tuberculosis

10.5.2.1 Staining Techniques

10.5.2.2 Mycobacterial Culture

10.5.2.3 Molecular Methods

10.5.2.4 Histopathology

10.5.2.5 Specimen Collection and Laboratory Safety

10.5.3 Differential Diagnosis

10.6 Treatment and Prevention

10.6.1 General Considerations

10.6.2 Treatment of Active Tuberculosis

10.6.2.1 General Treatment Regimens

10.6.2.2 Special Circumstances

10.6.3 Treatment of Latent Tuberculosis Infection

10.6.4 BCG Vaccination

10.6.5 Environmental Measures

10.7 Summary and Conclusions

10.8 Recommendations

References

Chapter 11

Human Immunodeficiency Virus Infection

11.1 Introduction

11.2 Historical Background

11.3 Epidemiology

11.3.1 Highest-Risk Groups

11.3.2 Prevalence and Incidence

11.3.3 Risk Factors

11.3.3.1 Transmission of HIV

11.3.3.2 Progression of the Disease

11.4 Clinical Features/Pathophysiology

11.4.1 Clinical Features

11.4.1.1 Primary HIV Infection

11.4.1.2 Asymptomatic HIV Infection

11.4.1.3 Symptomatic HIV Infection

11.4.1.4 Acquired Immune Defi ciency Syndrome

11.4.2 Pediatric HIV Infection

11.4.2.1 Factors Affecting Disease Progression in Children

11.4.2.2 Classifi cation of HIV Infection in Children

11.4.3 Pathogenesis

11.4.4 Role of Nutrition

11.4.4.1 The Role of Nutritional Factors in HIV Progression and Transmission

11.4.4.2 The Impact of HIV Infection on Nutritional Status

11.5 Diagnosis

11.6 Treatment

11.7 Prevention

11.8 Summary and Conclusions

References

Chapter 12

Malnutrition

12.1 Introduction

12.1.1 Defi nitions and Historical Overview

12.2 Measuring Physical Status and Growth

12.2.1 Anthropometric Indices of Nutritional Health

12.2.2 Growth References

12.2.3 Expression of Anthropometry

12.2.4 Severe Malnutrition

12.3 Patterns and Timing of Growth Retardation

12.3.1 Prevalence and Patterns of Global Anthropometric Status

12.3.2 Timing of Growth Faltering and Potential for Catch-Up Growth

12.4 Epidemiologic Evidence

12.4.1 Conceptual Diagram

12.4.2 Consequences of Malnutrition

12.4.2.1 Mortality

12.4.2.2 Infection and Disease

12.4.2.3 Functional Outcomes

12.4.2.4 Summary

12.4.3 Causes of Malnutrition and Poor Growth

12.4.3.1 Infection

12.4.3.2 Diet

12.4.3.3 Relative and Combined Effects of Infection and Poor Diet on Child Growth

12.4.4 The Underlying Determinants: Food, Care, and Heath

12.4.4.1 Programmatic Implications

12.5 Nutrition-Oriented Interventions and Programs: Necessary Elements and Optimal Designs

12.5.1 Manuals and Guides to Assist with Designing Programs

12.5.2 Treatment of Severe Malnutrition

12.6 Research Needs and Priorities

12.7 Summary and Conclusions

References

Chapter 13

Vitamin A Deficiency

13.1 Introduction

13.2 The Nutrient: Vitamin A

13.2.1 Structure and Nomenclature

13.2.2 Absorption and Transport

13.2.3 Metabolism and Functions

13.2.3.1 Visual Cycle

13.2.3.2 Gene Regulation

13.2.4 Dietary Sources and Intake Recommendations

13.3 Public Health Significance of Vitamin a Deficiency

13.3.1 Prevalence

13.3.1.1 Preschool-Aged Children

13.3.1.2 Newborns and Neonates

13.3.1.3 School-Aged Children

13.3.1.4 Women of Reproductive Age

13.3.2 Effects on Child Morbidity and Mortality

13.3.3 Effects on Infant Morbidity and Mortality

13.3.4 Effects on Maternal Morbidity and Mortality

13.4 Historical Background

13.5 Epidemiology

13.5.1 Location

13.5.2 Persons at Risk

13.5.2.1 Age

13.5.2.2 Gender

13.5.2.3 Socioeconomic status

13.5.3 Periodicity

13.5.4 Proximal Causes

13.5.4.1 Breast-Feeding

13.5.4.2 Complementary Feeding

13.5.4.3 Infectious Disease Morbidity

13.6 Clinicopathological Features

13.6.1 Xerophthalmia

13.6.1.1 Night Blindness (XN)

13.6.1.2 Conjunctival Xerosis with Bitot’s Spots (X1B)

13.6.1.3 Corneal Xerosis (X2), Ulceration, and Necrosis (X3)

13.6.2 Infection

13.7 Treatment

13.8 Prevention

13.8.1 Dietary Diversifi cation

13.8.2 Fortification

13.8.3 Supplementation

13.9 Conclusion

References

Chapter 14

Nutritional Rickets and Vitamin DDeficiency

14.1 Introduction

14.2 Definition

14.3 Public Health Importance

14.4 Historical Background

14.5 Epidemiology

14.6 Pathophysiology/Clinical Features

14.7 Diagnosis

14.8 Treatment

14.9 Prevention

14.10 Future Directions

14.11 Conclusions

References

Chapter 15

Zinc Deficiency

15.1 Introduction

15.2 Public Health Significance

15.3 Historical Background

15.4 Epidemiology

15.5 Metabolism of Zinc

15.5.1 Zinc Absorption

15.5.2 Zinc Transport

15.5.3 Zinc Storage

15.5.4 Zinc Excretion

15.6 Biological Functions of Zinc

15.6.1 Zinc Metalloenzymes

15.6.2 Zinc Fingers

15.6.3 Zinc and Biomembranes

15.6.4 Zinc and Immune Function

15.6.5 Other Functions of Zinc

15.7 Pathophysiology of Zinc Deficiency

15.7.1 Dietary Sources and Intake of Zinc

15.7.2 Absorption and Bioavailability of Zinc

15.7.3 Zinc Dietary Requirements

15.8 Clinical Manifestations of Zinc Deficiency

15.9 Assessment of Zinc Status

15.9.1 Plasma or Serum Zinc Concentrations

15.9.2 Dietary Assessment

15.9.3 Other Methods

15.10 Zinc Supplementation as a Public Health Intervention

15.10.1 Diarrheal Disease in Children

15.10.2 Respiratory Disease in Children

15.10.3 Malaria in Children

15.10.4 Growth and Development of Children

15.10.5 Maternal Health

15.10.6 Human Immunodefi ciency Virus Infection

15.11 Prevention of Zinc Deficiency

15.12 Conclusions

15.13 Recommendations

References

Chapter 16

Iron Deficiency and Anemia

16.1 Introduction

16.2 Defining Anemia and Iron Deficiency

16.3 Historical Background

16.4 Epidemiology

16.4.1 Prevalence of Iron Deficiency and Anemia

16.4.2 Risk Factors for Iron Deficiency

16.5 Metabolism of Iron

16.5.1 Absorption of Iron

16.5.2 Transport of Iron

16.5.3 Storage of Iron

16.5.4 Iron Turnover and Loss

16.5.5 Iron-Nutrient Interactions

16.6 Role of Iron in Biological Functions

16.6.1 Hemoglobin

16.6.2 Myoglobin

16.6.3 Cytochromes

16.6.4 Other Iron-Containing Enzymes

16.6.5 Iron and Immune Function

16.7 Pathogenesis of Iron Deficiency and Anemia

16.7.1 Increased Requirement for Iron

16.7.2 Poor Dietary Intake

16.7.3 Abnormal Iron Loss

16.8 Functional Consequences of Iron Deficiency

16.8.1 Anemia and Mortality

16.8.2 Birth Outcomes

16.8.3 Child Behavior and Development

16.8.4 Work Performance and Productivity

16.8.5 Heavy Metal Absorption

16.8.6 Iron and Infection

16.9 Assessment of Iron Nutritional Status

16.9.1 Tests for Iron Deficiency

16.9.2 The Meaning of Anemia

16.9.3 Field Testing for Hemoglobin

16.9.4 Detection of Anemia by Clinical Examination

16.9.5 Use of Frequency Distributions of Hemoglobin in Assessing Iron Status

16.9.6 The Diagnosis of Multiple Conditions Contributing to Anemia

16.10 Control of Iron Deficiency

16.10.1 Primary Health Care-Based Approaches

16.10.1.1 Iron Supplementation

16.10.1.2 Control of Intestinal Helminth Infection

16.10.2 Nutrition Education and Promotion

16.10.3 Fortification

16.10.4 Iron Overload

16.11 Conclusions

16.12 Recommendations

References

Chapter 17

Iodine Deficiency Disorders

17.1 Introduction

17.2 Public Health Significance

17.3 Historical Background

17.4 Epidemiology

17.4.1 Geographical Distribution

17.4.2 Prevalence

17.4.3 Risk Factors

17.5 Metabolism of Iodine

17.5.1 Iodine Absorption and Transport

17.5.2 Iodine Storage

17.5.3 Synthesis of Thyroid Hormones

17.5.4 Transport and Turnover of Thyroid Hormones

17.5.5 Thyroid Hormones and Gene Expression

17.6 Role of Iodine in Biological Functions

17.6.1 Metabolism

17.6.2 Growth and Development

17.6.3 Brain Development

17.6.4 Iodine and Immune Function

17.7 Pathophysiology of Iodine Deficiency

17.7.1 Dietary Sources and Intake of Iodine

17.7.2 Goitrogens

17.7.3 Iodine Dietary Requirements

17.8 Clinical Manifestations of Iodine Deficiency Disorders

17.8.1 Goiter

17.8.2 Cretinism

17.8.3 Growth and Development

17.8.4 Reproductive Failure

17.8.5 Perinatal, Infant, and Child Mortality

17.9 Assessment of Iodine Status

17.9.1 Goiter Rate

17.9.2 Urinary Iodine Concentrations

17.9.3 Blood Thyroid-Stimulating Hormone

17.10 Prevention of Iodine Deficiency Disorders

17.10.1 Iodized Salt

17.10.2 Oral Iodized Oil

17.10.3 Iodized Oil Injections

17.10.4 Other Strategies

17.11 Conclusions

References

Chapter 18

Multiple Micronutrient Malnutrition

18.1 Introduction

18.2 Prevalence of Multiple-Micronutrient Malnutrition

18.2.1 Women of Reproductive Age

18.2.2 Children

18.3 Consequences of Multiple-Micronutrient Malnutrition During the Life Cycle

18.3.1 Pregnancy

18.3.1.1 Two-Way Micronutrient Interactions in Pregnancy

18.3.1.2 Prenatal Multivitamin-Mineral Supplements

18.3.2 Lactation

18.3.3 Childhood

18.3.3.1 Growth

18.3.3.2 Micronutrient Status

18.3.3.3 Morbidity

18.3.3.4 Motor and Mental Development

18.3.4 Adult Morbidity

18.4 Programmatic Implications

18.4.1 Improving Dietary Intake

18.4.1.1 Behavior Change Programs

18.4.1.2 Promoting Animal Production and Home Gardening

18.4.2 Fortification

18.4.3 Multiple-Micronutrient Supplements

18.5 Conclusions

References

Chapter 19

Nutrition in the Elderly in Developing Countries

19.1 The Biology of Human Aging and Survival: an Evolutionary Perspective

19.1.1 Overview

19.1.2 Evolutionary Perspective on Aging

19.1.3 The Evolutionary Paradoxes

19.1.4 The Biology of Aging

19.2 Senescence of Tissue and Organ Function with Aging

19.2.1 Function of the Alimentary and Digestive Tract in Aging

19.3 Successful Aging, Normative Aging, and Frail Aging of Individuals Within a Population

19.4 Demography of Aging of Populations in Developing Countries

19.5 The Burden of Chronic Diseases in the Aging

19.5.1 Nontransmissible Disease Epidemiology in Developing Country Populations

19.5.2 Relationship of Chronic Disease to Diet and Nutrition in Developing Countries

19.6 Nutritional Requirements, Nutrient Intake Recommendations, and Guidelines for Healthful Eating for the Elderly

19.7 Dietary Intake and Eating Behavior by Elderly in Developing Countries

19.7.1 Assessing Dietary Intakes in Older Subjects: Caveats for Developing Countries

19.7.2 Patterns of Dietary Consumption in Later Life

19.8 Nutritional Deficiency and Excess and its Assessment in the Elderly of Developing Countries

19.8.1 Deficiency and Undernutrition States in Developing Country Elderly

19.8.1.1 Diagnosing Undernutrition

19.8.2 Excess and Overnutrition States in Developing Country Elderly

19.8.2.1 Diagnosing Overnutrition

19.9 Conclusions

References

Chapter 20

The Nutrition Transition and Its Relationship to Demographic Change

20.1 Introduction

20.2 Background: Patterns of the Nutrition Transition

20.3 Economic Change and the Nutrition Transition

20.4 Demographic Change and the Nutrition Transition

20.4.1 Key Dimensions of World Urbanization

20.4.2 Proportion Living in Cities

20.4.3 Concentrated Population Growth

20.4.4 Shift in the Proportion of Poor Living in Cities

20.5 The Nature and Pace of the Nutrition Transition

20.5.1 Japanese and Korean Accelerated Model

20.5.2 Low-Income Countries with Rapid Income Increases: The Case of China

20.5.3 Degenerative Dietary and Epidemiologic Transition with Limited or No Economic Improvement

20.5.4 Other Low-Income Countries

20.6 Conclusion

References

Chapter 21

The Rapid Emergence of Obesity in Developing Countries

21.1 Introduction

21.2 Methods

21.2.1 Survey Design and Sample

21.2.2 Measures

21.3 Results

21.3.1 The Prevalence in Lower- and Middle-Income Countries

21.3.1.1 Latin America

21.3.1.2 Asia

21.3.1.3 Western Pacific

21.3.1.4 Middle East

21.3.1.5 Sub-Saharan Africa

21.3.2 Obesity Trends in Lower- and Middle-Income Countries

21.3.2.1 Brazil

21.3.2.2 China

21.3.2.3 Indonesia

21.3.2.4 Vietnam

21.3.2.5 Kuwait

21.3.2.6 Mauritius

21.3.2.7 Russia

21.3.2.8 Western Pacific

21.4 Implications for Public Health

21.4.1 Obesity

21.4.2 Physical Activity

21.4.3 Interactions of Obesity and Activity

21.4.4 Genetic Component

21.5 Research and Policy Implications

References

Chapter 22

Rapid Urbanization and the Challenges of Obtaining Food and Nutrition Security

22.1 Introduction

22.2 Increasing Urban Poverty and Undernutrition

22.2.1 Poverty Data

22.2.2 Nutrition Data

22.3 Challenges to Obtaining Food, Nutrition, and Health Security in an Urban Environment

22.3.1 The Importance of Cash, Employment, Food Prices, and Agriculture for Urban Livelihood and Food Security

22.3.1.1 Dependence on Cash for Food

22.3.1.2 Urban Marketing Systems, Supermarkets, and Food Price Policies

22.3.1.3 Urban Employment

22.3.1.4 Urban Food Production

22.3.2 Stronger Formal Safety Nets and Weaker Informal Safety Nets?

22.3.3 The Increased Labor Force Participation of Women and Its Consequences for Child Care

22.3.3.1 Women’s Work Patterns and Child Care Use in Urban and Rural Areas

22.3.3.2 Impact of Maternal Work on Child Care Practices

22.3.4 Lifestyle Changes

22.3.4.1 Dietary Patterns

22.3.4.2 Activity Patterns

22.3.4.3 Health Implications

22.3.5 Increased Availability of Services, But Questionable Accessby Poor Households

22.3.6 Environmental Contamination

22.3.6.1 Air Pollution

22.3.6.2 Water and Food Contamination

22.3.7 Legal Rights

22.3.7.1 Urban Agriculture

22.3.7.2 Informal Marketing Activities Such as Street Foods

22.3.7.3 Insecurity of Tenure and Development Activity

22.4 Implications for Policy and Research

22.5 Conclusions

References

Chapter 23

Impact of Parental Tobacco Use on Child Malnutrition and Survival

23.1 Introduction

23.2 Historical Background

23.3 Epidemiology of Tobacco Use

23.3.1 World Health Organization Conceptual Framework for the Tobacco Epidemic

23.3.2 The African Region

23.3.3 The Region of the Americas

23.3.4 The Eastern Mediterranean Region

23.3.5 The European Region

23.3.6 The Southeast Asia Region

23.3.7 The Western Pacific Region

23.4 Tobacco Use and Child Malnutrition

23.4.1 Indonesia

23.4.2 Bangladesh

23.4.3 India

23.4.4 “Going Up in Smoke”: Tobacco Versus Food

23.5 Other Adverse Effects of Parental Smoking on Child Health

23.5.1 Respiratory Health

23.5.2 Low Birth Weight

23.5.3 Circulating Antioxidants

23.5.4 Increased Health Care Utilization

23.6 Parental Tobacco Use and Child Mortality

23.7 Tobacco Control

23.7.1 Indirect Advertising and Trademark Diversification

23.7.2 Industry Programs to Counter Antitobacco Science

23.7.3 Offshore Strategies

23.7.4 Industry-Funded Youth Smoking Prevention Programs

23.7.5 Appeals to International Trade Organizations and Representatives

23.8 Conclusions

23.9 Recommendations

References

Chapter 24

Humanitarian Emergencies

24.1 Introduction

24.1.1 Defi nitions and History

24.1.2 Objective of the Chapter

24.2 Epidemiology of Humanitarian Emergencies

24.2.1 Global Trends in Number of Conflicts, Refugees, and Internally Displaced Persons

24.2.2 Main Causes of Morbidity and Mortality

24.2.3 Communicable Diseases, with Specific Focus on HIV/AIDS/STI

24.2.4 Malnutrition and Food Security

24.2.5 Reproductive Health

24.2.6 Mental Health

24.3 Programming

24.4 New Developments and Challenges

24.4.1 New Humanitarianism and Humanitarian Reform

24.4.2 Other Initiatives for Improvement of Accountability and Quality

24.4.3 Health, Nutrition, and Conflicts in a Changing Global Environment

24.5 Summary Recommendations for The Way Forward

24.5.1 Policy Recommendations

24.5.2 Technical Recommendations

24.5.3 Training Recommendations

References

Chapter 25

Tackling Nutrient Deficiencies and Life-Threatening Disease

25.1 Introduction

25.2 Food and Disease, Cause and Effect

25.3 Nutrient-Disease Synergies and Nutrient Deficiencies

25.4 Responding to Malnutrition and Disease Through Food

25.4.1 General Food Distribution

25.4.2 Supplementary Feeding

25.4.3 Therapeutic Feeding

25.4.4 Addressing Micronutrient Deficiencies

25.5 Conclusions and Future Directions

References

Chapter 26

The Indian Ocean Tsunami of December 26, 2004

26.1 Introduction

26.2 Loss and Damage Caused by the Tsunami

26.3 Response to the Tsunami

26.3.1 Relief and Recovery Phase

26.3.2 Coordination of Response

26.3.3 Financial Support

26.3.4 Lessons Learned for Next Disaster Response

26.4 Impact of Tsunami on Health and Nutrition: Focus on Indonesia

26.4.1 Preexisting Health and Nutrition Situation

26.4.2 Impact on Health and Nutrition

26.4.2.1 Communicable Diseases

26.4.2.2 Handling Dead Bodies

26.4.2.3 Injuries

26.4.2.4 Mental Health Problems

26.4.3 Interventions for Health and Nutrition

26.4.3.1 Disease and Health and Nutrition Surveillance Systems

26.4.3.2 Improving Health and Nutritional Status of the Affected Population

26.4.3.3 The Need for Micronutrients in Emergencies

26.4.3.4 Example of Distributing Vitamin and Mineral Preparations: Tsunami Relief in Indonesia

26.5 Conclusions and Recommendations

References

Chapter 27

The Impact of Supermarkets on Farmers, Consumers, and Food Security in Developing Countries

27.1 Introduction

27.2 The Supermarket Revolution: What’s Happening?

27.3 An Analytical Perspective on the Impact of Supermarkets

27.3.1 Consumers and Public Health

27.3.2 Small Farmers

27.3.3 Food Security

27.4 The Development Dimensions of the Supermarket Revolution

27.4.1 Supermarkets: Complements or Substitutes for a Public Role in Marketing?

27.4.2 Macroeconomic and Growth Issues

27.5 Putting Supermarkets in a Food Policy Framework

27.6 Conclusions

References

Chapter 28

Homestead Food Production for Improving Nutritional Status and Health

28.1 Introduction

28.2 The Contribution of Homestead Food Production to Increasing Food Security.

28.3 Is Homestead Food Production Economically Viable for Households and Communities?

28.4 Assessing the Impact of Homestead Food Production on Nutrition and Health: the Case of Vitamin a Deficiency

28.4.1 Conceptual Framework for Impact of Food-Based Programs on Nutritional Status and Health

28.4.2 How Food Consumption Can Increase Vitamin A Status

28.4.2.1 Studies of Plant Foods for Combating Vitamin A Deficiency

28.4.2.2 Factors Determining Bioavailability and Bioconversion of Carotenoids Studies

28.4.2.2.1 Host-Related Factors.

28.4.2.2.2 Food-Related Factors.

28.4.2.2.3 Meal-Related Factors.

28.4.2.3 Guidelines for Maximizing Vitamin A Intake from Plant Foods

28.4.3 Health Effects of Increased Consumption of Vitamin A-Rich Foods

28.4.3.1 How the Consumption of Vitamin A-Rich Foods Can Affect Health

28.4.3.2 Evidence of Impact of Vitamin A-Rich Foods on Health in Developing Countries Beyond a Vitamin A Effect

28.4.3.3 Summary of Role of Foods for Health

28.4.4 Impact of Homestead Food Production on Nutritional Status and Health

28.4.4.1. Example of Impact of Homestead Food Production on Nutritional Status or Health

28.4.4.2 Approaches for Assessing Impact of HFP on Nutritional Status or Health

28.5 Homestead Food Production Contributes to Development Through Empowerment of Women

28.6 A Programmatic Approach to Increase and Improve Homestead Food Production Practices

28.7 Conclusions and Recommendations

References

Chapter 29

Food Policy

29.1 Introduction

29.2 Definitions

29.3 Food Policy: What’s Different?

29.3.1 The Food and Health Dimension

29.3.2 The Poverty and Development Dimension

29.4 Food Policy in Historical Perspective

29.5 The Sectoral Perspective

29.6 Lessons for Food Policy

29.6.1 Three Things Not to Do

29.6.2 Three Things to Do

References

Chapter 30

Need, Efficacy, and Effectiveness of Multiple Vitamin/Mineral Supplements for Young Children and Considerations for Programs

30.1 Introduction

30.2 Existence and Consequences of Multiple Vitamin and Mineral Deficiencies

30.2.1 Vitamin and Mineral Deficiencies in Infants and Young Children

30.2.2 Why Supply a Combination of Vitamins and Minerals?

30.2.3 Need for Vitamins and Minerals is Particularly High in Emergencies

30.3 Methods Used for Reviewing Impact of Increased Intake of Vitamins and Minerals by Children

30.4 Vitamin and Mineral Supplements, Recommended Intake, and Composition of Supplements Used

30.5 Efficacy of Multimicronutrient Supplements for Children

30.5.1 Micronutrient Status

30.5.1.1 Hemoglobin and Anemia

30.5.1.2 Ferritin and Iron Deficiency

30.5.1.3 Serum Retinol, Vitamin a Deficiency

30.5.1.4 Serum Zinc and Zinc Deficiency

30.5.1.5 Iron and Zinc Interaction

30.5.1.6 Other Micronutrients

30.5.2 Growth

30.5.3 Morbidity and Mortality

30.5.3.1 Evidence from Reviewed Studies

30.5.3.2 Could Vitamin and Mineral Supplementation Increase Morbidity?

30.5.3.3 Other Ways to Reduce Morbidity

30.5.4 Development (Cognitive, Learning Ability)

30.6 Effectiveness of Multivitamin and Mineral Supplements for Children

30.7 Issues to be Considered for Programs That Provide Vitamins and Minerals

30.7.1 Dosage and Kind of Preparation

30.7.2 Duration and Frequency of Distribution

30.7.3 Supplementation in the Case of Infectious Diseases, Including Malaria

30.7.4 Concurrent Supplementation with Other Vitamin and Mineral Supplements or Fortified Foods

30.8 Conclusions and Recommendations

References

Chapter 31

How Much Do Data Influence Programs for Health and Nutrition?

31.1 Introduction

31.1.1 Paradigm Shifts in the Field of Public Health/Nutrition

31.1.2 Data to Inform Public Health/Nutrition Programming

31.2 Design and Implementation of a Surveillance System

31.2.1 Conceptual Model, Indicators, and Questionnaire

31.2.2 Sampling

31.2.3 Quality Control

31.2.4 Data Entry, Data Cleaning, and Data Analysis

31.3 Communicating the Results

31.4 Identifying Priorities for and Monitoring of Programs: Use of Surveillance Data

31.4.1 Vitamin A Capsule Distribution

31.4.2 Vaccination Programs

31.4.3 Food Fortification

31.4.4 Assessing a Program’s Impact Under Real-Life Circumstances

31.5 Understanding Causes of Malnutrition: Surveillance Findings

31.5.1 Factors Related to Child Malnutrition in Bangladesh

31.5.2 Effectiveness of Homestead Food Production

31.5.3 Macroeconomic Policies and Malnutrition

31.5.4 Indicators for Impact of Crises on Health and Nutrition

31.5.5 Dual Burden of Overweight and Obesity

31.5.6 Effects of Parental Smoking on Malnutrition and Childhood Mortality

31.5.7 Parental Education: Every Year Counts

31.6 Conclusions and Recommendations

References

Chapter 32

The Economics of Nutritional Interventions

32.1 Introduction

32.2 The Costs of Undernutrition

32.3 The Costs of Nutrition Interventions

32.4 Cost-Effectiveness and Benefit: Cost of Nutrition Interventions

32.5 Conclusions

References

Chapter 33

Ethics in Public Health Research

33.1 Introduction

33.2 Basic Ethical Principles

33.2.1 Respect for Persons

33.2.2 Beneficence

33.2.3 Justice

33.3 Application of Ethical Principles

33.3.1 Informed Consent

Case Study 33.1

33.3.2 Confidentiality

Case Study 33.2

33.3.3 Standards of Care

Case Study 33.3

33.3.4 Responsibility to the Study Community After Completion of Research

Case Study 33.4

33.4 Ethical Review Processes

33.5 Conclusions

References

Chapter 34

Beyond Partial Analysis

34.1 Introduction

34.2 Public Policy Analysis

34.2.1 The Technical Frame

34.2.1.1 Causal Analysis

34.2.1.2 Analysis of Interventions

34.2.2 The Economic Frame

34.2.3 The Social/Normative Frame

34.2.4 The Political Frame

34.2.5 The Administrative/Organizational Frame

34.2.6 The Legal Frame

34.2.7 Multiple/Integrative Frames

34.3 Implications for Truly "Public" Health and Nutrition

34.3.1 Implications for Practice

34.3.2 Implications for Research

34.3.3 Implications for Training

34.4 Conclusions

References

Index