scholarly journals Understanding the role of the gut in undernutrition: what can technology tell us?

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323609
Author(s):  
Alex J Thompson ◽  
Claire D Bourke ◽  
Ruairi C Robertson ◽  
Nirupama Shivakumar ◽  
Christine A Edwards ◽  
...  
Keyword(s):  
Low Income ◽  
Severe Acute Malnutrition ◽  
Point Of Care ◽  
Critical Role ◽  
Acute Malnutrition ◽  
Gut Morphology ◽  
Middle Income ◽  
Gut Barrier Function ◽  
Gut Function ◽  
And Function

Gut function remains largely underinvestigated in undernutrition, despite its critical role in essential nutrient digestion, absorption and assimilation. In areas of high enteropathogen burden, alterations in gut barrier function and subsequent inflammatory effects are observable but remain poorly characterised. Environmental enteropathy (EE)—a condition that affects both gut morphology and function and is characterised by blunted villi, inflammation and increased permeability—is thought to play a role in impaired linear growth (stunting) and severe acute malnutrition. However, the lack of tools to quantitatively characterise gut functional capacity has hampered both our understanding of gut pathogenesis in undernutrition and evaluation of gut-targeted therapies to accelerate nutritional recovery. Here we survey the technology landscape for potential solutions to improve assessment of gut function, focussing on devices that could be deployed at point-of-care in low-income and middle-income countries (LMICs). We assess the potential for technological innovation to assess gut morphology, function, barrier integrity and immune response in undernutrition, and highlight the approaches that are currently most suitable for deployment and development. This article focuses on EE and undernutrition in LMICs, but many of these technologies may also become useful in monitoring of other gut pathologies.

scholarly journals Nutritional services for children in Beira, Mozambique: a study reporting on participatory use of data to generate quality improvement recommendations

2019 ◽  
Vol 8 (4) ◽  
pp. e000758 ◽  
Author(s):  
Marzia Lazzerini ◽  
Kajal Chhaganlal ◽  
Augusto Cesar Macome ◽  
Giovanni Putoto
Keyword(s):  
Low Income ◽  
Recovery Rate ◽  
Severe Acute Malnutrition ◽  
Phase 1 ◽  
Participatory Approach ◽  
Health Hazards ◽  
Acute Malnutrition ◽  
Phase 2 ◽  
Middle Income ◽  
Malnourished Children

BackgroundExisting literature suggest frequent gaps in the quality of care (QoC) provided to children with malnutrition in low-income and middle-income countries. Beira is the second largest city in Mozambique. This study included two phases: phase 1 was a systematic assessment of the QoC provided to malnourished children in Beira; phase 2 aimed at using findings of the assessment to develop recommendations, with a participatory approach, to improve QoC.MethodsIn phase 1, all facilities offering nutritional care to children in Beira were included, and exit health outcomes were reviewed against international SPHERE standards. A sample of four (66%) facilities was randomly selected for a comprehensive assessment of all areas contributing to QoC using an adapted WHO tool. In phase 2, key stakeholders were identified, and using a participatory approach, a list of actions for improving the QoC for malnourished children was agreed.ResultsIn phase 1, outcomes of 1428 children with either severe acute malnutrition or moderate acute malnutrition (MAM) were reviewed. In-hospital recovery rate (70.1%) was almost in line with the SPHERE standard (75%), while at outpatient level, it was significantly lower (48.2%, risk ratio (RR) 0.68, p<0.0001). Recovery rate was significantly lower in HIV seropositive compared with seronegative (39.2% vs 52.8%, RR 1.34, p=0.005). High heterogeneity in MAM recovery rate was detected among facilities (range 32.5%–61.0%). Overall, out of all domains contributing to QoC in the sample, 28/46 (60.8%) indicated suboptimal care with significant health hazards and 13/46 (28.2%) indicated totally inadequate care with severe health hazards. In phase 2, a list of 38 actions to improve QoC for malnourished children was agreed among 33 local and national stakeholders.ConclusionsLarge heterogeneity in QoC for malnourished children in Beria was detected. The study documents a concrete example of using data proactively, for agreeing actions to improve QoC.

scholarly journals Management of severe acute malnutrition in low-income and middle-income countries

2014 ◽  
Vol 100 (3) ◽  
pp. 283-287 ◽  
Author(s):  
Indi Trehan ◽  
Mark J Manary
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Environmental Enteropathy ◽  
Fortified Milk

Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods.

scholarly journals Incidence Correction Factors for Moderate and Severe Acute Child Malnutrition From 2 Longitudinal Cohorts in Mali and Burkina Faso

2020 ◽  
Vol 189 (12) ◽  
pp. 1623-1627
Author(s):  
Francisco M Barba ◽  
Lieven Huybregts ◽  
Jef L Leroy
Keyword(s):  
Burkina Faso ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Incidence Data ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized ◽  
Definition Of ◽  
Mid Upper Arm Circumference

Abstract Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies, which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor $K$, obtained from the few available cohorts that measured AM. We estimated $K$ factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from 2 cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition—PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using complete (weight-for-length z score, mid-upper arm circumference (MUAC), and edema) and partial (MUAC, edema) definitions of SAM and MAM. $K$ estimates for SAM were 9.4 and 5.7 in Burkina Faso and in Mali, respectively; K estimates for MAM were 4.7 in Burkina Faso and 5.1 in Mali. The MUAC and edema–based definition of AM did not lead to different $K$ estimates. Our results suggest that $K$ can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.

scholarly journals Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 681
Author(s):  
Ritu Rana ◽  
Marie McGrath ◽  
Ekta Sharma ◽  
Paridhi Gupta ◽  
Marko Kerac
Keyword(s):  
At Risk ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Cochrane Library ◽  
Breastfeeding Support ◽  
Middle Income ◽  
Middle Income Countries ◽  
Breastfeeding Practices ◽  
Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

scholarly journals Foreign aid on economic growth in Africa: A comparison of low and middle-income countries

2015 ◽  
Vol 18 (4) ◽  
pp. 449-462 ◽  
Author(s):  
Aye Mengistu Alemu ◽  
Jin-Sang Lee
Keyword(s):  
Economic Growth ◽  
Foreign Aid ◽  
Low Income ◽  
Empirical Studies ◽  
Critical Role ◽  
Generalized Method Of Moments ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Theoretical Hypothesis

Previous empirical studies on the effects of foreign aid on economic growth have generated mixed results that make it difficult to draw policy recommendations. The main reason for such mixed results is the choice of a single aggregate list of countries, regardless of the disparities in levels of development. This study therefore fills the development gap by disaggregating the African data into a panel of 20 middle- income and 19 low- income African countries over a period of 15 years between 1995 and 2010, and employing a dynamic generalized method of moments (GMM) model to address the dynamic nature of economic growth as well as the problems of endogeneity. The results of this study support the theoretical hypothesis that a positive relationship between aid and GDP growth exists, but only for low-income African countries, not middle-income ones. On the other hand, the study reveals that middle- income African countries tend to experience a greater impact on their economic growth from foreign direct investment (FDI) and natural resources revenues, mainly oil exports. This implies that the frequent criticism that foreign aid has not contributed to economic growth is flawed, at least in the case of low-income African countries. In fact, foreign aid has played a critical role in stimulating economic growth in such countries through supplementing domestic sources of finance such as savings, thus increasing the amount of investment and capital stock in them.

scholarly journals Multimorbidity Patterns and Function Among Adults in Low- and Middle-income Countries: a Scoping Review Protocol

2021 ◽  
Author(s):  
Karina Berner ◽  
Nassib Tawa ◽  
Quinette Louw
Keyword(s):  
Scoping Review ◽  
Low Income ◽  
Data Extraction ◽  
Rehabilitation Services ◽  
Health Coverage ◽  
Policy Planning ◽  
Functional Impairments ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Function

Abstract BackgroundA fifth of adults in low-income and middle-income countries (LMICs) have multimorbid conditions, which are linked to socio-economic deprivation and aging. Multimorbidity is associated with high rates of functional problems and disability, increased healthcare utilization and lower quality of life. Literature on multimorbidity and associations with function is mostly from high-income countries (HICs) and focused among adults. Data regarding patterns and their impact on person-centered outcomes are limited. There is need for research into understanding common patterns of multimorbidity, and their association with functional impairment, particularly in LMICs. Therefore, the need for evidence-based, and context-relevant strategic policy, planning and delivery models for health and rehabilitation services is imperative in attaining Universal Health Coverage (UHC). The planned scoping review aims to provide an overview of the scope and nature of existing literature on multimorbidity patterns and function among adults in LMICs. MethodsA scoping review will be conducted according to a five-step framework guidance. The PRISMA-ScR guidelines will be followed in reporting. A comprehensive electronic search of PubMed, Scopus, EBSCOhost (including MEDLINE and the Cumulative Index to Nursing and Allied Health Literature [CINAHL]), Scielo, Cochrane and Google Scholar will be conducted from January 1976 onwards. Studies will be included if they are primary or secondary, qualitative or quantitative research reported in English, published (between January 1976 and the search date) in a peer-reviewed journal, and describe multimorbidity patterns and associations with physical functional impairments, activity limitations or participation restrictions among adults in LMICs. Search results will be independently screened by two reviewers and data extraction will cover; study characteristics, participants’ characteristics, multimorbidity measures, patterns analysis and functional measures. Descriptive statistics and narrative synthesis will be used to synthesize and summarize the findings.DiscussionPatients with multimorbidity have unique and cross-cutting needs, hence the need for an integrated and person-centered approaches to policy, planning and delivery of medical and rehabilitation services. Considering the shift towards primary healthcare-led management of chronic diseases and UHC, the proposed scoping review is timely and the findings will provide insights into the current extent and scope of multimorbidity research, and guide future inquiry in the field. Protocol registrationOpen Science Framework (OSF), osf.io/gcy7z

scholarly journals Tracking total spending on tuberculosis by source and function in 135 low-income and middle-income countries, 2000–17: a financial modelling study

2020 ◽  
Vol 20 (8) ◽  
pp. 929-942 ◽  
Author(s):  
Yanfang Su ◽  
Ines Garcia Baena ◽  
Anton C Harle ◽  
Sawyer W Crosby ◽  
Angela E Micah ◽  
...  
Keyword(s):  
Low Income ◽  
Middle Income ◽  
Total Spending ◽  
Financial Modelling ◽  
Middle Income Countries ◽  
And Function ◽  
Modelling Study

scholarly journals Factors Influencing Recovery among Children with Moderate Acute Malnutrition Treated at Kirehe District Health Centers

2020 ◽  
Vol 3 (1) ◽  
pp. 20-27
Author(s):  
Vianney Bihibindi Kabundi ◽  
Camille Kayihura ◽  
Onesmus Marete ◽  
Nicodeme Habarurema ◽  
Erigene Rutayisire
Keyword(s):  
Low Income ◽  
Family Income ◽  
Health Facilities ◽  
Health Centers ◽  
Acute Malnutrition ◽  
District Health ◽  
Middle Income ◽  
Factors Associated ◽  
Income Status ◽  
Moderate Acute Malnutrition

Acute malnutrition affects nearly 52 million of under five years children globally, 75% of them live in low to middle income countries. The treatment of acute malnutrition using supplement foods could help children recovering and could reduce the risk of sickness. The present study investigated the factors associated with recovery among children with moderate acute malnutrition (MAM) under a follow-up program at health facilities. A prospective study was conducted in 16 health centers of Kirehe District of Rwanda and included 200 children from 6 to 59 months. A semi-structured questionnaire was used for data collection. All children enrolled in the study spent three months in nutrition program at health centers. The results show that after 3 months in the program 77.5% recovered from MAM. Children aged above 36 to 59 months were recovered at 90% whereas children aged from 24-35 months were recovered at 73.5%. Micronutrients and deworming provided at health facility were contributed to the recovery as children who received them were recovered at 89.1% and for those who didn’t were recovery at 72.1%. The findings demonstrated that boys were 16 times more likely to recover from MAM in three months of intervention than girls (AOR=16.19, p<0.001, 95% CI: 5.39- 48.63). Children from moderate income families were 3 more likely to recover than those from very low income families (AOR=2.8, p=0.029, 95% CI: 1.11-7.51). Male gender, receiving micronutrients and deworming from health facilities and family income status were factors associated with MAM recovery status

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