scholarly journals In Ethiopia, India, and Peru, Household Expenditures on Fats Are More Strongly Associated with Children's Future Heights Than Expenditures on Other Food Groups (P10-006-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Debbie Humphries ◽  
Sarah Weingarten ◽  
Kirk Dearden ◽  
Benjamin Crookston ◽  
Mary Penny ◽  
...  
Keyword(s):  
Dietary Diversity ◽  
Food Group ◽  
Child Growth ◽  
Food Groups ◽  
Country Level ◽  
Household Food ◽  
Food Expenditures ◽  
Total Food ◽  
Future Child ◽  
Food Expenditure

Abstract Objectives We hypothesized that household food expenditures on 7 key dietary food groups—starches, fruits & vegetables, legumes, eggs, dairy, meat and fat—woul differentially affect future child height-for-age z scores (HAZ), after adjusting for household, parental and community characteristics. We investigated the associations of household food group expenditures at 5 years (y) and 8y with child HAZ at 8y and 12y, respectively. Methods We used data from 6993 children, born around 2001, from Ethiopia, India, Peru and Vietnam, collected at ages 5, 8, and 12y from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in Purchasing Power Parity adjusted dollars (PPP$) to allow meaningful cross-country comparisons) on food groups and child HAZ at subsequent rounds of collection to assess longitudinal relations. Total food expenditures, rural/urban residence, maternal and paternal education, and child sex were controlled for in our models. Results In Ethiopia, results pointed to total food expenditure as one of the critical and significant components associated with subsequent child HAZ; and among the food groups, expenditures on fats had the largest associations with future child HAZ. In India and Peru, expenditure on one specific food group—fats—seemed to be the most important significant predictor of future HAZ in children from among food expenditures. In Vietnam, starches were a significant negative predictor of future HAZ, which may relate to the significance of dietary diversity and prediction of future HAZ for this country's cohort. Conclusions Our results pinpoint specific facets of the diet that may have had the greatest impact on child growth for each country. They also point to the importance of examining country-level context, and caution about generalizing from one context to others. These results, moreover, highlight the usefulness of household food expenditure survey data in analyzing children's nutrition at the country level, and may help to influence child food and nutrition policies in these four unique countries. Funding Sources This study is based on research funded by the Bill & Melinda Gates Foundation, Eunice Shriver Kennedy National Institute of Child Health and Development and Grand Challenges Canada.

scholarly journals Are Household Expenditures on Food Groups Associated with Children’s Future Heights in Ethiopia, India, Peru, and Vietnam?

2020 ◽  
Vol 17 (13) ◽  
pp. 4739
Author(s):  
Sarah E. Weingarten ◽  
Kirk A. Dearden ◽  
Benjamin T. Crookston ◽  
Mary E. Penny ◽  
Jere R. Behrman ◽  
...  
Keyword(s):  
Purchasing Power Parity ◽  
Food Group ◽  
Child Growth ◽  
Food Groups ◽  
Power Parity ◽  
Household Expenditures ◽  
Household Food ◽  
Food Expenditures ◽  
Expenditure Data ◽  
Food Expenditure

Household expenditure surveys, routinely conducted in low—and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures. We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP—Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ. In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02–0.07 higher future HAZ. In Vietnam every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children’s linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.

scholarly journals Diet Diversity to Assess Diet Quality of Pre-Conception Women in Bekasi, West Java

2021 ◽  
Vol 1 (1) ◽  
pp. 46-55
Author(s):  
Arindah Nur Sartika ◽  
Tri Marta Fadhilah
Keyword(s):  
Nutritional Status ◽  
Diet Quality ◽  
Dietary Diversity ◽  
Food Group ◽  
Reproductive Age ◽  
Food Groups ◽  
West Java ◽  
Diet Diversity ◽  
Total Food

Pre-conception women have important role to determine children nutritional status. Children with good nutritional status are born from mothers who have good diet. Diversified diet also can prevent woman to suffer from chronic energy malnutrition and anemia during pregnancy. This study aims to assess diet quality of pre-conception women in Kota Bekasi, West Java. The study conducted as observational study design, specifically using cross sectional approach. About 105 “bride to be” from 8 Religious Affairs Office in Kota Bekasi, West Java, Indonesia was joined the study. Respondents were interviewed with structured questionnaire consist of social economic characteristics and dietary intake. Dietary assessment was done using 24-h food recall to fill Minimum Dietary Diversity for Women of reproductive Age (MDD-W) questionnaire. The result showed out of 10 food groups, median consumption of food groups consumed by respondents was 4 food groups, also as the highest proportion of total food group (36.19%), followed by 5 food groups (25.71%), and 3 food groups (21.90%). Maximum score of dietary diversity is 8 (0.95%), and minimun score is 2 (3.81%). Meanwhile, most consumed food group was staple foods (99.05%). Nuts and seeds were the least proportion of food group (3.81%) consumed by respondents. There was around one-third (38.10%) of the respondents consumed total food group below recommended score (<5). Diet diversity of pre-conception women should be improved. To prevent from malnutrition, pre-conception women are suggested to vary their diet. Nutrition education during premarital class/ consultation is recommended.

scholarly journals Nutrition Intervention Using Behavioral Change Communication without Additional Material Inputs Increased Expenditures on Key Food Groups in Bangladesh

2020 ◽  
Vol 150 (5) ◽  
pp. 1284-1290
Author(s):  
Andrea M Warren ◽  
Edward A Frongillo ◽  
Phuong H Nguyen ◽  
Purnima Menon
Keyword(s):  
Behavioral Change ◽  
Dietary Diversity ◽  
Nutrition Intervention ◽  
Food Groups ◽  
Child Feeding ◽  
Additional Material ◽  
Change Communication ◽  
Intensive Intervention ◽  
Percentage Points ◽  
Food Expenditures

ABSTRACT Background Behavioral change communication (BCC) promotes skills and knowledge to improve infant and young child feeding, but without additional material inputs, recipients must develop strategies to translate knowledge into action. Using data from the Alive & Thrive initiative in Bangladesh (2010–2014), we aimed to test whether households receiving the intensive intervention (opposed to the nonintensive intervention) increased expenditures on key foods for mothers and children (e.g., foods that were promoted by the intervention and also changed in maternal and child diets). Methods The intensive intervention provided interpersonal counseling, community mobilization, and mass media campaigns to promote breastfeeding and complementary feeding. A cluster-randomized design compared 20 subdistricts randomly assigned to the intensive (4281 households) or nonintensive (4284 households) intervention. Measures included food and nonfood expenditures, dietary diversity, and women's economic resources. Linear and logistic regression tested difference-in-differences (DD) in expenditures and dietary diversity, accounting for subdistricts as clusters, and the association between maternal and child consumption of specific food groups and corresponding food expenditures. Results Expenditures on eggs and flesh foods increased more in intensive areas than in nonintensive areas by 53 (P &lt; 0.01) and 471 (P &lt; 0.01) taka/mo, respectively. Household food expenditures increased more in intensive areas by 832 taka (P = 0.02), whereas changes in nonfood expenditures did not differ. Women's employment and control of income increased more in intensive areas by 12 (P = 0.03) and 13 (P &lt; 0.01) percentage points, respectively, while jewelry ownership decreased more by 23 percentage points (P &lt; 0.01). Higher expenditures on food groups were reflected in higher consumption by women and children. Conclusions Recipients in the intensive intervention mobilized additional resources to improve diets, reflected in increased expenditures and consumption of promoted foods. BCC interventions should document how recipients produce desired results without additional material inputs, particularly for behaviors that likely require additional resources. This trial was registered at clinicaltrials.gov as NCT01678716.

scholarly journals Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

2006 ◽  
Vol 9 (5) ◽  
pp. 644-650 ◽  
Author(s):  
NP Steyn ◽  
JH Nel ◽  
G Nantel ◽  
G Kennedy ◽  
D Labadarios
Keyword(s):  
Sensitivity And Specificity ◽  
Dietary Diversity ◽  
Pearson Correlation ◽  
Child Growth ◽  
World Health ◽  
Food Groups ◽  
Nutrient Adequacy ◽  
Z Scores ◽  
Food Variety ◽  
The Mean

AbstractObjectiveTo assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children.MethodsSecondary data analyses were undertaken with nationally representative data of 1–8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated.ResultsThe children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7–8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the ‘other group’ (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity.ConclusionEither FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

scholarly journals Agricultural Food Production Diversity and Dietary Diversity among Female Small Holder Farmers in a Region of the Ecuadorian Andes Experiencing Nutrition Transition

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2454
Author(s):  
Christopher L Melby ◽  
Fadya Orozco ◽  
Jenni Averett ◽  
Fabián Muñoz ◽  
Maria José Romero ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Rural Areas ◽  
Dietary Diversity ◽  
Household Food Insecurity ◽  
Food Groups ◽  
Household Food ◽  
Small Holder Farmers ◽  
Production Diversity ◽  
Small Holder ◽  
Agricultural Food

Some rural areas of Ecuador, including the Imbabura Province of the Andes Highlands, are experiencing a double burden of malnutrition where micronutrient deficiencies persist at the same time obesity is increasing as many traditional home-grown foods are being replaced with more commercially prepared convenience foods. Thus, the relationships among agricultural food production diversity (FPD), dietary diversity (DD), and household food insecurity (HFI) of the rural small holder farmers need further study. Therefore, we examined these associations in small holder farmers residing in this Province in the Andes Highlands (elevation > 2500 m). Non-pregnant maternal home managers (n = 558, x age = 44.1, SD = 16.5 y) were interviewed regarding the number of different agricultural food crops cultivated and domestic animals raised in their family farm plots. DD was determined using the Minimum Dietary Diversity for Women Score (MDD-W) based on the number of 10 different food groups consumed, and household food insecurity (HFI) was determined using the 8-item Household Food Insecurity Experience Scale. The women reported consuming an average of 53% of their total food from what they cultivated or raised. Women with higher DD [MMD-W score ≥ 5 food groups (79% of total sample)] were on farms that cultivated a greater variety of crops (x = 8.7 vs. 6.7), raised more animals (x = 17.9 vs. 12.7, p < 0.05), and reported lower HFI and significantly higher intakes of energy, protein, iron, zinc, and vitamin A (all p < 0.05). Multiple regression analyses demonstrated that FPD was only modestly related to DD, which together with years of education, per capita family income, and HFI accounted for 26% of DD variance. In rural areas of the Imbabura Province, small holder farmers still rely heavily on consumption of self-cultivated foods, but greater diversity of crops grown in family farm plots is only weakly associated with greater DD and lower HFI among the female caretakers.

scholarly journals Pattern and Extent of Street Food Consumption in Hohoe, Volta Region, Ghana: A Community-Based Cross-Sectional Survey

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Winnifred Ekua Baidoe ◽  
Mark Kwame Ananga ◽  
Elorm Kwame Nyinaku
Keyword(s):  
Food Consumption ◽  
Dietary Diversity ◽  
Sampling Technique ◽  
Food Group ◽  
Daily Basis ◽  
Food Groups ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Street Food

Background. For most people in developing countries, street food is a major source of sustenance, and Ghana is no exception. Street food vending has seen tremendous growth in Ghana as a result of the insurgence of urbanisation. Despite being one of the largest sectors of national economy in terms of employment and sales of food, very little is known about street food consumption patterns in Ghana. The current study explored the patterns and extent of street food consumption in the Hohoe township. Methods. A cross-sectional design which recruited 403 subjects through a multistage sampling technique. A semistructured questionnaire was used to gather information on demographics, types of street foods, extent of street food consumption, safety concerns, and diversity of street foods patronised. Means, standard deviations, and Chi-square tests were used to determine the association between selected variables at <0.05 level of significance. Results. The top 5 foods mostly patronised by respondents are porridge foods-Koko (17.9%), rice and stew (17.4%), banku (12.6%), waakye (11.5%), and kenkey (8.7%) with porridge foods consumed almost on a daily basis. Convenience (37.2%) and affordability (17.1%) greatly influenced the choice of street foods among consumers. Occupation and the level of education are strongly correlated with the concern for safety of street foods {(X2 = 17.3094, P<0.008); (X2 = 17.1731, P<0.002)}. The dietary diversity score of most respondents was in the high tercile (77.7%) (≥6 food groups), whilst the cereals dominate the food group mostly consumed by respondents. Conclusion. The study suggests that patronising street food is very high in Hohoe municipality, irrespective of the gender, occupation, or educational level. As an “informal” sector of food business, street foods often escape formal inspection and control. They can, therefore, both be the source of food safety problems and contribute to the deterioration of environmental hygiene. This is a call on policy makers and regulators to take a critical look at the sector.

scholarly journals Household Food Insecurity, Dietary Diversity, Stunting, and Anaemia among Left-Behind Children in Poor Rural Areas of China

2019 ◽  
Vol 16 (23) ◽  
pp. 4778 ◽  
Author(s):  
Yang ◽  
Yuan ◽  
Yang ◽  
Zou ◽  
Ji ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Rural Areas ◽  
Dietary Diversity ◽  
Rural China ◽  
Nutritional Intervention ◽  
Food Group ◽  
Hunan Province ◽  
Household Food Insecurity ◽  
Left Behind ◽  
Household Food

Left-behind children (LBC) are a newly emerged social group in China. Poor nutritional status is particularly prominent in this population. However, their food insecurity tends to attract very little attention. This study aims to investigate the relationship between food insecurity and undernutrition (stunting and anaemia) in 3 to 5-year-old LBC in rural China. Face-to-face interviews were administered to 553 LBC caregivers in 40 rural villages of Hunan Province, China. The Household Food Insecurity Access Scale (HFIAS) was used to assess household food insecurity (HFI). Dietary diversity score (DDS) and food group consumption frequency were measured by 24 h-recall and food frequency questionnaires (FFQ). Hemoglobin tests and anthropometric measurements including height and weight were measured by trained health professionals. Logistic regression was constructed to assess the association between household food insecurity and dietary diversity, stunting, and anaemia. A high prevalence of household food insecurity was determined (67.6%). The weighted prevalence of stunting and anaemia were 16.6% and 26.5%, respectively. Food insecurity was positively associate with LBC stunting (severe HFI: OR = 6.50, 95% CI: 2.81, 15.00; moderate HFI: OR = 3.47, 95% CI: 1.60, 7.54), and anaemia (severe HFI: OR = 1.91, 95% CI: 1.02, 3.57). LBC with food insecurity had significantly lower dietary diversity than those who were food-secure (p < 0.001). The prevalence of household food insecurity among LBC in poor rural China is high and is associated with low DDS, stunting, and anaemia. Nutritional intervention programs and policies are urgently needed to reduce household food insecurity and undernutrition for this vulnerable population.

scholarly journals Using National Survey Data From Nigeria to Assess Maternal-Child Dietary Concordance and Inform Nutrition Program Strategy

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 389-389
Author(s):  
Nadia Akseer ◽  
Rebecca A Heidkamp ◽  
Andrew Thorne-Lyman
Keyword(s):  
Maternal Education ◽  
Fruits And Vegetables ◽  
Dietary Diversity ◽  
Maternal Diet ◽  
Food Group ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Food Groups ◽  
Diet Diversity ◽  
Maternal Child

Abstract Objectives Improving child diet diversity is a policy priority in many settings. Multiple factors influence complementary feeding practices in low-income countries including household food access, caregiver-level factors and cultural practices. Child's dietary data is often available in national surveys (i.e., Demographic and Health Surveys, DHS), but they typically lack diet data from adults. The 2018 Nigeria DHS was among the first to measure food group intake in both young children and women. We describe the relationship between child and maternal diet diversity in Nigeria and highlight implications for design of infant and young child feeding (IYCF) programs. Methods Using the Nigeria DHS 2018 dataset, we estimated consumption of individual food groups in the previous 24 hours as well as minimum dietary diversity for children 6–23 months (MDD-C) and their mothers, women 15–49 years (MDD-W) using WHO-UNICEF definitions. We compare rates of concordance and discordance between n = 8975 mother-child pairs for individual food groups and MDD using McNemar's tests. Probit regression was used to identify drivers of MDD-C. Results Nationally, 22% of children achieve MDD-C; 51% of mothers achieve MDD-W. For both populations, the most commonly consumed group is grains, roots and tubers (&gt;80%) Dairy and eggs are the least consumed. Maternal-child (age 12–23 months) discordance is highest for consumption of legumes and nuts (36%), vitamin A rich fruits and vegetables (39%) and other fruits and vegetables (57%); mothers consume these more frequently. Children are more likely than mothers to consume dairy (19% vs 8%) and eggs (8% vs 4%). Maternal-child food group discordance is consistently higher for children 6–11months than children 12–23 months. Results vary at state level and by maternal age group. Children's MDD probability is increased by MDD-W (27%, P &lt; 0.001), higher maternal education (8%, P &lt; 0.01) and household wealth (7%, P &lt; 0.01). Conclusions Maternal and child diet diversity is suboptimal in Nigeria. Maternal diet is a primary driver of child diet in Nigeria. Legumes and nuts and fruits and vegetables are available but not consistently fed to children; an important finding for IYCF program design. The forthcoming DHS-8 core questionnaire will provide child and maternal diet data for more than 90 countries. Funding Sources Bill & Melinda Gates Foundation.

scholarly journals Stunting and Household Food Expenditures between Junior High School Students from Smoker And Non-Smoker Families

2020 ◽  
Vol 2 (1) ◽  
pp. 308-313
Author(s):  
Risky Malinda ◽  
Etti Sudaryati ◽  
Evawany Aritonang
Keyword(s):  
High School Students ◽  
Junior High School ◽  
Growth Failure ◽  
Household Expenditure ◽  
Total Income ◽  
School Students ◽  
Cross Sectional ◽  
Household Food ◽  
Food Expenditures ◽  
Food Expenditure

Stunting is a linear growth failure due to insufficient long-term nutritional intake. The higher the proportion of household expenditure from total income, the lower the economic level of the family so it is at risk of food insecurity. This study aims to determine the differences in the proportion of stunting and household food expenditure between students from smokers and non-smokers families. This study was an observational study with a cross sectional design with a sample of 98 students from smokers 'families and 98 students from nonsmokers' families. Stunting data is obtained by measuring student height. Household food expenditure is obtained by comparing the total household expenditure spent on food with the total income earned during income. This study uses statistical analysis using the chi-square test. There was a difference in the proportion of stunting (p = <0.001) and the proportion of household food expenditure (p = <0.001) between smokers and non-smokers 'families where the proportion of stunting and household improvement was higher among smokers' families. The conclusion is there’re differences in the proportion of stunting and household food expenditure in students from smoker families and non-smoker families. Families should limit cigarette consumption and allocate appropriately in household food expenditures.

scholarly journals The Influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania

2019 ◽  
Author(s):  
Ahmed Gharib Khamis ◽  
Akwilina Wendelin Mwanri ◽  
Julius Edward Ntwenya ◽  
Katharina Kreppel
Keyword(s):  
Fruits And Vegetables ◽  
Dietary Diversity ◽  
Secondary Data ◽  
Food Group ◽  
Limited Information ◽  
Food Groups ◽  
Child Feeding ◽  
Young Child Feeding ◽  
Nutritional Status Of Children ◽  
Minimum Dietary Diversity

Abstract Background Undernutrition poses a serious health challenge in developing countries. Tanzania has the highest undernutrition burdens in East and Southern Africa. Poor infant and young child feeding practices including consumption of undiversified diet are the main cause for undernutrition. There is limited information regarding the association between dietary diversity and undernutrition in Tanzania. The objective of this paper was to examine to what extent the dietary diversity is associated with undernutrition of children of 6 to 23 months in Tanzania.Methods This is a secondary data analysis from data collected by the Tanzania Demographic and Health Survey of 2015-2016. Stunting, wasting and underweight were calculated from Z-scores based on 2006 WHO standards. A dietary diversity score was created by summing the number of food groups reported for each child by the mother ranging from 0 to 7. Then, a Minimum Dietary Diversity (MDD) indicator was used to assess the diversity of the diet given to children. Bivariate and multivariate logistic regression techniques were used to assess the odds ratios of becoming undernourished.Results A total of 2,960 children were enrolled in this study. The majority (73.9%) of children did not reach the recommended Minimum Dietary Diversity (MDD). The most commonly consumed types of foods were grains, roots and tubers (91%), and Vitamin A containing fruits and vegetables (65%). Consumption of a diverse diet was significantly associated with a reduction of stunting, wasting and being underweight in children. The likelihood of being stunted, wasted and underweight was found to decrease as the number of food group consumed increased. Children who did not received an MDD diet had a significantly higher likelihood of being stunted (AOR=1.37, 95% CI; 1.13-1.65) and underweight (AOR=1.49, 95% CI; 1.15-1.92), but this was not the case for wasting. Consumption of animal source foods has been found to be associated with reduced stunting among children.Conclusion Consumption of a diverse diet was associated with a reduction in undernutrition among children of 6 to 23 months in Tanzania. Measures to improve the type of complementary foods in order to meet the energy and nutritional demands of children should be considered in Tanzania.

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