Middle Upper Arm Circumference Research Articles

A novel, efficient method for estimating the prevalence of acute malnutrition in resource-constrained and crisis-affected settings: A simulation study.

IntroductionThe assessment of the prevalence of acute malnutrition in children under five is widely used for the detection of emergencies, planning interventions, advocacy, and monitoring and evaluation. This study examined PROBIT Methods which convert parameters (mean and standard deviation (SD)) of a normally distributed variable to a cumulative probability below any cut-off to estimate acute malnutrition in children under five using Middle-Upper Arm Circumference (MUAC).MethodsWe assessed the performance of: PROBIT Method I, with mean MUAC from the survey sample and MUAC SD from a database of previous surveys; and PROBIT Method II, with mean and SD of MUAC observed in the survey sample. Specifically, we generated sub-samples from 852 survey datasets, simulating 100 surveys for eight sample sizes. Overall the methods were tested on 681 600 simulated surveys.ResultsPROBIT methods relying on sample sizes as small as 50 had better performance than the classic method for estimating and classifying the prevalence of acute malnutrition. They had better precision in the estimation of acute malnutrition for all sample sizes and better coverage for smaller sample sizes, while having relatively little bias. They classified situations accurately for a threshold of 5% acute malnutrition. Both PROBIT methods had similar outcomes.ConclusionsPROBIT Methods have a clear advantage in the assessment of acute malnutrition prevalence based on MUAC, compared to the classic method. Their use would require much lower sample sizes, thus enable great time and resource savings and permit timely and/or locally relevant prevalence estimates of acute malnutrition for a swift and well-targeted response.

Annual Crop-Yield Variation, Child Survival, and Nutrition Among Subsistence Farmers in Burkina Faso.

Whether year-to-year variation in crop yields affects the nutrition, health, and survival of subsistence-farming populations is relevant to the understanding of the potential impacts of climate change. However, the empirical evidence is limited. We examined the associations of child survival with interannual variation in food crop yield and middle-upper arm circumference (MUAC) in a subsistence-farming population of rural Burkina Faso. The study was of 44,616 children aged <5 years included in the Nouna Health and Demographic Surveillance System, 1992-2012, whose survival was analyzed in relation to the food crop yield in the year of birth (which ranged from 65% to 120% of the period average) and, for a subset of 16,698 children, to MUAC, using shared-frailty Cox proportional hazards models. Survival was appreciably worse in children born in years with low yield (full-adjustment hazard ratio = 1.11 (95% confidence interval: 1.02, 1.20) for a 90th- to 10th-centile decrease in annual crop yield) and in children with small MUAC (hazard ratio = 2.72 (95% confidence interval: 2.15, 3.44) for a 90th- to 10th-centile decrease in MUAC). These results suggest an adverse impact of variations in crop yields, which could increase under climate change.

Household cereal crop harvest and children\u2019s nutritional status in rural Burkina Faso

BackgroundReduction of child undernutrition is one of the Sustainable Development Goals for 2030. Achievement of this goal may be made more difficult in some settings by climate change through adverse impact on agricultural productivity. However, there is only limited quantitative evidence on the link between household crop harvests and child nutrition. We examined this link in a largely subsistence farming population in rural Burkina Faso.MethodsData on the middle-upper arm circumference (MUAC) of 975 children ≤5 years of age, household crop yields, and other parameters were obtained from the Nouna Health and Demographic Surveillance System. Multilevel modelling was used to assess the relationship between MUAC and the household crop harvest in the year 2009 estimated in terms of kilocalories per adult equivalent per day (kcal/ae/d).ResultsFourteen percent of children had a MUAC <125 mm (a value indicative of acute undernutrition). The relationship between MUAC and annual household food energy production adjusted for age, sex, month of MUAC measurement, household wealth, whether a household member had a non-agricultural occupation, garden produce, village infrastructure and market presence, suggested a decline in MUAC below around 3000 kcal/ae/d. The mean MUAC was 2.49 (95% CI 0.45, 4.52) mm less at 1000 than at 3000 kcal/ae/d.ConclusionsLow per capita household crop production is associated with poorer nutritional status of children in a rural farming population in Burkina Faso. This and similar populations may thus be vulnerable to the adverse effects of weather on agricultural harvest, especially in the context of climate change.

Household food insecurity is associated with both body mass index and middle upper-arm circumference of mothers in northwest Ethiopia: a comparative study.

BackgroundFood insecurity and associated malnutrition result in serious health problems in developing countries. This study determined levels of maternal undernutrition and its association with food insecurity in northwest Ethiopia.Materials and methodsThis was a community-based comparative cross-sectional study conducted May 24–July 20, 2013. Multistage random sampling was used to select 4,110 samples. Availability of Ethiopia’s Productive Safety Net Programme was used for grouping the study areas. A food-security access scale developed by the Food and Nutrition Technical Assistant project was used to measure food security. Sociodemographic data were collected using a structured questionnaire. A binary logistic regression model was used to assess the association of food insecurity and maternal undernutrition.ResultsFrom the total participants, 12.6% (95% confidence interval [CI] 11.6%–13.6%) had a body mass index (BMI) <18.5 kg/m2. Comparison of maternal undernutrition in the two study areas revealed 8.8% (95% CI 7.6%–10.2%) in the program area and 16.4% (95% CI 14.8%–18.1%) in nonprogram areas were undernourished. Severe food insecurity was significantly associated with BMI of mothers (adjusted odds ratios [AORs] 3.6 and 2.31, 95% CI 2.32–5.57 and 1.52–3.5, respectively) in both program and nonprogram areas. Mild (AOR 1.77, 95% CI 1.21–2.6) and moderate (AOR 1.6, 95% CI 1.18–2.16) food insecurity significantly associated with maternal undernutrition in nonprogram areas. In the same way, all forms of food insecurity significantly associated with maternal middle upper-arm circumference in both program and nonprogram areas. The odds of mothers who did not exercise decision-making practice on the household income was also 4.13 times higher than those who did (AOR 4.13, 95% CI 2.2–7.77) in the program area.ConclusionFood insecurity significantly associated with both maternal BMI and middle upper-arm circumference in both study areas. Female authority also significantly associated with BMI of the mothers in the program area. Maternal nutrition-intervention programs should focus on women-empowerment strategies that enable them to decide on the income for household-nutrition provision.

Identification and Comparative Analysis of Essential Performance Indicators in Two Levels of Soccer Expertise

This study aims to identify the essential performance indicators in two level of soccer expertise. A total of 84 elite’s soccer players and 100 novice players from eight soccer academies in Malaysia were enrolled and subjected to standard anthropometric, fitness, skills related performance testing and responded to the questionnaire in mastery and performance. Principal component analysis (PCA) was employed to determine the most indispensable variables pertinent to the requirement of the game in relation to the level of expertise of the players. The initial PCA shows seven components out of 26 as the most significant for both elite and novice soccer players with a considerable eigenvalue > 1. Moreover, the PCA after varimax rotation highlighted seven principles components (PCs) for elite and novice players respectively. Each of the seven components contained varifactors (VF) selected based on their higher factor loading and that distinguish the players on their expertise. The first PCs for elite’s players revealed strong loading from sit and reach (0.780), vertical jump (0.635), VO 2max (0.637) and age (0.752). The second PCs revealed weight (0.639), biceps (0.859), triceps (0.769), subscapular (0.847), suprailiac (0.886) and middle upper arm circumference (0.776). The third PCs revealed 505 agility (0.618), 5m speed (0.712), 10m speed (0.858) and 20m speed (0.929). The forth PCs revealed task (-0.675) and short pass (0.789) and the last PCs revealed sit up (-0.702). For novice’s players, the first PCs revealed vertical jump (0.624), weight (0.861), height (0.856), sitting height (0.632), middle upper arm circumference (0.673), calf circumference (0.790) and maturity (0.651). The second PCs revealed biceps (0.832), triceps (0.899), subscapular (0.816) and suprailiac (0.869). The third PCs revealed 5m speed (-0.847), 10m speed (-0.877), 20m speed (-0.785) and VO 2max (0.658). The forth PCs revealed task (0.694) and ego (0.747) and the last PCs revealed short pass (0.766).

Adverse Birth Out Comes and Associated Factors among Delivered Mothers in Dessie Referral Hospital, North East Ethiopia

Introduction: Though there are studies on the various forms of adverse birth outcomes particularly in developing countries, there is limited information on determinant maternal and fetal factors of adverse birth outcomes at Dessie referral hospital including north east Ethiopia. Objective: To assess adverse birth outcomes and associated factors among delivered mothers in Dessie referral hospital, Dessie, Ethiopia. Methods: Institutional based cross sectional study design was conducted in Dessie referral hospital from February 30-March 30, 2017. Random sampling technique was used and 462 sample size was deployed. The collected data was checked; coded and entered to Epi info 7.3 and exported to SPSS version 20 for further analysis. Bivariate logistic regression model used to determine the independent association of dependent and independent variables on the bases of COR; 95 percent of confidence level and significance level of 0.25 Those variables which had significance level of less than 0.25 transferred to multivariable logistic regression. Multivariable logistic regression also used to control the possible effects of confounder variables on the basis of AOR; 95 percent of confidence level and significance level of 0.05. Result: A total of 462 delivered mothers participated in this study which yields 100% response rate. The study finding showed that the proportion of adverse birth outcome among the study participants was 32.5%. Out of 462 births 8.2% were still birth, 16.7% were low birth weight, 15.2% preterm and 8.4% were with visible birth defects. Mothers who didn’t attend antenatal care were 4 times more likely to have adverse birth outcome when compared to those who attended antenatal care follow up, [AOR=4.01, 95% CI(2.8,8.3 )]. Similarly, mothers with hemoglobin level less than 11 mg/dl were encountered adverse birth outcomes 3 times more when compared to those with hemoglobin level greater or equal to 11 mg/dl [AOR=3.04, 95% CI(1.62, 5.71)]. The presence of any form of pregnancy complication to current pregnancy were 3 times more likely to result in adverse birth outcomes as compared to no complication [AOR=2.9, 95% CI (1.64, 5.15)]. Conclusion and Recommendation: proportion of adverse birth outcome among the study participants was high. Lack of antenatal care, hemoglobin level, and pregnancy complications, middle upper arm circumference, were predictors of adverse birth outcomes. Increasing antenatal care uptake, prevention and treatment of chronic medical illness, and anemia and improvements in quality of maternal health services require strict attention.

Risk Factors of Postpartum Hemorrhage in Bondowoso District, East Java

Background : Postpartum hemorrhage is the leading cause of the maternal death worldwide. Postpartum hemorrhage accounted 20% of all causes of maternal death in Bondowoso, East Java. This study aimed to examine the risk factors of postpartum hemorrhage. Subjects and M et hod: This was an analytic observational study using case control design. The study was carried out at 5 community health centers, Bondowoso District, East Java, from March to May 2017. A sample of 120 study subjects were selected for this study by fixed disease sampling, consisting of 40 postpartum women with hemorrhage and 80 postpartum women without hemorrhage. The dependent variable was postpartum hemorrhage. The independent variables were family income, birth space, type of delivery, mother's middle upper arm circumference (MUAC), antenatal visit, and high-risk score card. The data were collected by a set of pre-tested questionnaire. Path analysis was employed for data analysis. Results : Post partum bleeding was directly affected by birth space 10 years (b=3.03; 95% CI = 1.52 to 4.55; p 10 years (b=0.80; 95% CI= 0.32 to 1.57; p= 0.041), family income < Rp 1,417,000 (b=0.72; 95% CI= -0.57 to 1.49; p= 0.070), and antenatal visit ≥ 4 (b=0.70; 95% CI= -0.07 to 1.48; p= 0.076). MUAC was affected by family income ≥ Rp 1,417,000 (b=0.67; 95% CI= -0.08 to 1.44; p= 0.083). Type of delivery (assisted) was affected by high-risk score card <2 (b=1.00; 95% CI = 0.22 to 1.77; p= 0.011) and mother’s MUAC <23.5 cm (b=1.04; 95% CI= 0.20 to 1.88; p= 0.015). Conclusion : Post partum bleeding was directly affected by birth space, antenatal visit, high risk score, type of delivery. High-risk score card was affected by birth space, family income, and antenatal visit. MUAC was affected by family income. Type of delivery (assisted) was affected by high-risk score card and mother’s MUAC. K eywords : postpartum hemorrhage, risk factor Correspondence: Ratna Puspitasari. Masters Program in Public Helath, Sebelas Maret University, Surakarta. Email: ratnapuspita1987@yahoo.co.id. Mobile: +6285791373311 Journal of Maternal and Child Health (2017), 2(2): 177-187 https://doi.org/10.26911/thejmch.2017.02.02.08

Effects of Maternal Education, Psychosocial Stress, Nutritional Status at Pregnancy, and Family Income, on Birthweight in Nganjuk, East Java

Background : Low birthweight (LBW) is one of the primary causes of infant mortality. It shares 27% of infant mortality rate (IMR). The Indonesian Demographic and Health Survey in 2007 reported that the IMR was 34 deaths per 1,000 live births. As much as 30.3% of this rate was accounted by LBW. As such LBW is an important global public health issue. Countries arround the world have committed to overcome this problem. This study aimed to investigate the effects of maternal education, psychosocial stress, nutritional status at pregnancy, and family income, on birthweight. Subjects and Method : This was an observational analytic study with case control design. The study was conducted in Ngetos community health center, Nganjuk, East Java, from May to June, 2017. A total sample of 120 were selected for this study by fixed disease sampling, compresing 40 infants with low birthweight and 80 infants with normal birthweight. The dependent variable was birthweight. The independent variables were maternal education, psychosocial stress, nutritional status at pregnancy (middle-upper arm circumference, MUAC), maternal anemia, and family income. MUAC was measured by MUAC measuring tape. Hemoglobin concetration was measured by Sahli meter. Psychosocial stress was measured by Holmes and Rahe stress scale. The other variables were measured by a set of questionnaire. Path analysis was used for data analysis. Results : MUAC ≥23.5 cm (b= -0.80, SE= 0.57; p=0.064), hemoglobin concetration ≥11 g/dL (b= -120.16, SE= 45.14, p=0.008), and low psychosocial stress (b= -0.80, SE= 0.57, p=0.164) directly and negatively affected low birthweight. Maternal education ≥Senior High School (b= 1.28, SE = 0.056, p= 0.022), psychosocial stress (b= -0.001, SE<0.001, p=0.097), and family income (b= 0.97, SE= 0.46, p=0.036) positively affected MUAC. MUAC ≥23.5 cm positively affected hemoglobin concentration ≥11 g/dL (b= 0.19, SE = 20.84, p<0.001). Conclusion: MUAC, hemoglobin concetration, and low psychosocial stress directly and negatively affect low birthweight. Keywords : low birthweight, MUAC, maternal anemia, psychosocial stress, family income Correspondence: Dhewi Nurahmawati. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: dhenoura@gmail.com. Mobile: +62813330787826. Journal of Maternal and Child Health (2017), 2(4): 324-334 https://doi.org/10.26911/thejmch.2017.02.04.04

Anthropometric indices and measures to assess change in the nutritional status of a population: a systematic literature review

Undernutrition is a major public health issue highlighted by the 2015 Sustainable Development Goals, with target 2.2 aiming to ‘end hunger’ by 2030. On-going surveillance is essential detecting nutritional stress in a population and is key to planning consequent interventions. Whilst methodologies of nutritional surveillance systems vary across different settings, organisations and even within the same country, the direct evidence-base underpinning these practices is limited. This paper aims therefore to: 1) compare the performance of different anthropometric indices/measurements for detecting change in the nutritional situation at population level; 2) discuss their properties and appropriateness for use in a surveillance system. This systematic literature review considered peer-reviewed and grey literature. Evidence was compiled from standard electronic databases, websites and snowballing. The search was performed in November 2015 by a single reviewer using the following terms to capture two concepts: 1) Undernutrition and 2) Nutrition surveillance. The search was limited to children under five and the period considered started in 1980. Languages included English and French. Articles had to assess whether the changes or trend observed at population level were statistically significant. All study designs were included. A total of 4563 articles were retrieved from the electronic database search. Most articles (3137, 89%) were not directly relevant based on title and abstract; 39 articles were reviewed in full. A total of 17 articles met the inclusion criteria and an additional 4 papers were added after snowballing. A number of measures and indices such as weight, weight-for-height/length, triceps skinfold and middle-upper arm circumference performed well in the detection of short term changes in the nutritional situation of a population. Height/Length-for-age responded the most to long term change. Applying a standard set of criteria (simplicity, acceptability, cost, independence of age, reliability and accuracy) to determine which is the most appropriate measure or index identified middle-upper arm circumference as the one with the greatest net benefits. Limited available evidence suggests that mid-upper arm circumference is the best measure to detect short term changes in the nutritional state of a population: this should receive higher priority in surveillance systems.

Food banking for improved nutrition of HIV infected orphans and vulnerable children; emerging evidence from quality improvement teams in high food insecure regions of Kiambu, Kenya.

IntroductionEstimated 236,548 People Living with HIV (PLHIV) were in Central-Eastern Kenya in 2013. Kiambu County had 46,656 PLHIV with 42,400 (91%) adults and 4,200(9%) children (1-14yrs). Amref Health Africa in Kenya, supported through USAID-APHIAplus KAMILI project, initiated two food banks to respond to poor nutritional status of the HIV infected children. Quality Improvement Teams were used to facilitate food-banking initiatives. The study aimed at assessing and demonstrating roles of community food-banking in improving nutrition status of HIV-infected children in food insecure regions.MethodsA pre and post-test study lasting 12 months (Oct 2013 to September 2014) conducted in Kiambu County, Kenya covering 103 HIV infected children. Two assessments were conducted before and after the food banking initiative and results compared. Child Status Index (CSI) and the Middle Upper Arm Circumference (MUAC) tools were used in data collection at households. Paired T-test and Wilcoxon test were applied for analysing MUAC and CSI scores respectively using the SPSS.ResultsThere was a significant improvement in the children’s nutrition status from a rating of ‘bad’ in CSI Median (IQR) score 2(2-1) before food banking to a rating of ‘fair’ in CSI Median (IQR) score 3(4-3) after food banking intervention (p=<0.001) while MUAC increased from Mean (SD) of 5.6(2.6) before intervention to 7.2(2.8) after food banking (p=<0.001).ConclusionFood banking is a community-based nutritional intervention that can address factors of food access, affordability and availability. Food banking is a sustainable way to contribute to quality nutrition and reduced related deaths among HIV infected children.

Assessment of Body Composition in a Group of Pediatric Patients With Cancer: A Single Romanian Center Experience

Cancer patients are particularly susceptible to nutritional depletion. From March 2014 to December 2015, we assessed 146 patients consecutively hospitalized in a tertiary emergency pediatric hospital. The patients were divided into 2 groups: group I, patients with cancer (43 patients), and group II, the control group consisting of 103 age-matched and sex-matched healthy patients. The anthropometric parameters (weight-W, height-H, body mass index [BMI], middle upper arm circumference [MUAC], tricipital skinfold thickness [TST]) and biochemical parameters (proteins, albumin) were comparatively evaluated. Fat mass (FM, kg and %), fat-free mass (FFM, kg), muscle mass (MM, kg), and total body water (TBW, %) were measured in both groups using Tanita BC 420 S MA Analyzer. Anthropometric and biochemical parameters in group I were significantly different from those in group II for weight, height, BMI, MUAC, TST, protein, and albumin (P<0.05). In the study group, FM was much lower compared with controls 16.9% (3.4% to 33.3%) versus 20.3% (6.6% to 38.4%); (P=0.001), and TBW was much higher 60.8% (48.8% to 70.6%) versus 58.5% (45.2% to 68.6%) (P=0.004). FFM and MM were not statistically different in the 2 groups. The results highlight the complex changes of nutritional status in pediatric patients with cancer.

Is Middle-Upper Arm Circumference "normally" distributed? Secondary data analysis of 852 nutrition surveys.

BackgroundWasting is a major public health issue throughout the developing world. Out of the 6.9 million estimated deaths among children under five annually, over 800,000 deaths (11.6 %) are attributed to wasting. Wasting is quantified as low Weight-For-Height (WFH) and/or low Mid-Upper Arm Circumference (MUAC) (since 2005). Many statistical procedures are based on the assumption that the data used are normally distributed. Analyses have been conducted on the distribution of WFH but there are no equivalent studies on the distribution of MUAC.MethodsThis secondary data analysis assesses the normality of the MUAC distributions of 852 nutrition cross-sectional survey datasets of children from 6 to 59 months old and examines different approaches to normalise “non-normal” distributions.ResultsThe distribution of MUAC showed no departure from a normal distribution in 319 (37.7 %) distributions using the Shapiro–Wilk test. Out of the 533 surveys showing departure from a normal distribution, 183 (34.3 %) were skewed (D’Agostino test) and 196 (36.8 %) had a kurtosis different to the one observed in the normal distribution (Anscombe–Glynn test). Testing for normality can be sensitive to data quality, design effect and sample size. Out of the 533 surveys showing departure from a normal distribution, 294 (55.2 %) showed high digit preference, 164 (30.8 %) had a large design effect, and 204 (38.3 %) a large sample size. Spline and LOESS smoothing techniques were explored and both techniques work well. After Spline smoothing, 56.7 % of the MUAC distributions showing departure from normality were “normalised” and 59.7 % after LOESS. Box-Cox power transformation had similar results on distributions showing departure from normality with 57 % of distributions approximating “normal” after transformation. Applying Box-Cox transformation after Spline or Loess smoothing techniques increased that proportion to 82.4 and 82.7 % respectively.ConclusionThis suggests that statistical approaches relying on the normal distribution assumption can be successfully applied to MUAC. In light of this promising finding, further research is ongoing to evaluate the performance of a normal distribution based approach to estimating the prevalence of wasting using MUAC.

Path Analysis on the Effect of Biopsychosocial and Economic Factors during Gestational Period on the Risk of Stunting and Development in Children under Five, in Nganjuk, East Java

Background: There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Basic Health Research (Riset Kesehatan Dasar, Riskesdas) conducted by The Minister of Health in 2010, showed that prevalence of stunting in Indonesia was 35.6% of children aged under five years old. This study aimed to examine path analysis on the effect of biopsychosocial and economic factors during gestational period on the risk of stunting and development in children under five, in Nganjuk, East Java. Subjects and Method: This was an analytic observational study with case control design. This study was conducted at Bagor Community Health Center, Nganjuk, East Java. A total sample of 150 children under five, consisting of 50 stunted children and 100 normal children, was selected for this study by fixed exposure sampling . The dependent variables were stunting and development. The independent variables were middle upper arm circumference (MUAC) and family support at pregnancy, low birthweight, maternal height, maternal schooling, and family income. The stunting was measured by anthropometry (weight for height). The child development was measured by Kuesioner Pra-Skrining Perkembangan (KPSP). Other variables were measured by a set of questionnaire. The data were analyzed by path analysis. Results: Low birth weight had direct negative effect on stunting (b=0.99; p=0.897). Maternal height (b=-2.58; p= 0.029), maternal education (b=-1.55; p=0.002), and family income (b=-1.30; p=0.002) had direct negative effects on stunting. Low birth weight (b=-0.27; p=0.253) and family income (b=-0.007; p=0.976) have negative but statistically non-significant effect on development. Maternal education had positive but statistically non-significant effect on development (b=2.16; p=0.883). MUAC (b=-4.60; p<0.001) had negative and statically significant effect on low birth weight. Family support had positive but statistically non-significant on low birth weight (b=0.52; p=0.492). Maternal height had positive and statistically significant effect on MUAC (b=3.16; p<0.001). Family income had positive but statistically non-significant effect on MUAC (b=0.83; p=0.253). Conclusion: MUAC and maternal education have indirect, negative and statistically significant effect on stunting Maternal height, maternal education, and family income, have direct, negative, and statistically significant effect on stunting. Keywords: stunting, biopsychosocial, economic, gestational period Correspondence : Erike Yunicha Viridula. Masters Program in Public Health, Sebelas Maret University. Email: yunichasabdana@gmail.com. Journal of Health Promotion and Behavior (2016), 1(3): 180-189 https://doi.org/10.26911/thejhpb.2016.01.03.05

Path Analysis:Effects of Psychological and Socio-Economic Exposures During Gestational Period on the Risk of Under Nutrition in Children Under Five

Background : In Indonesia the prevalence of under nutrition in children under five in 2013 was estimated to be 12.2%. It is estimated that there are still 4.5 million children underfive with under or poor nutrition have not been detected. Poor nutrition in children under five may have serious impact on their health outcome and cognitive ability in later life. This study aimed to investigate the effects of psychological and socio-economic exposure during gestational period and geographical area on the risk of under nutrition in children under five. Subjects and method : This was an analytical observational using case-control design. This study was conducted in Klaten, Central Java, from 8 September to 2 December 2016. A total of 150 subjects consisting of 57 children under five with birth weight <2.500 gram and 93 children under five with birth weight ≥ 2.500 gram, were selected by fixed exposure sampling. The dependent variable was weight for age. The independent variable includedmaternal education, family income, number of children, middle upper arm circumference (MUAC), maternal gestational stress, slow fetal growth for gestasional age, low birth weight, nutritional intake, geographic area. The data were collected by a set of questionnaire, 24 hours food recall, and medical record. The data were analyzed using path analysis. Results : Nutritional intake that is lower than recommended allowance (b=3.14; 95%CI=1.09 to 5.20; p=0.003) and history of birth weight <2.500 gram (b=1.70; 95%CI=0.71 to 2.70; p=0.001) increased the risk of under nutrition in children under five. Slow fetal growth for gestational age, maternal gestational stress, family income < Rp 2,000,000, and middle upper arm circumference (MUAC), had indirect significant effect on the risk of under nutrition in children under five. Conclusion : Nutritional intake lower than recommended allowance and birth weight <2.500 gram increased the risk of under nutrition in children under five. Keywords : gestational period, psychological and socio-economic exposure, under nutrition, children under five. Correspondence: Yespy Anna Wahyu Nurindahsari. School of Health Sciences Guna Bangsa, Yogyakarta. Journal of Maternal and Child Health (2016), 1(2): 83-92 https://doi.org/10.26911/thejmch.2016.01.02.03

A5187 - Medium term effect of the seven-minute high intensity workout on body weight, lean body mass, grip strength and heart rate

Background: The Seven minute training program composed from aerobic and resistance exercises, is becoming a very popular workout. This is due to the fact that it targets individuals who would like to exercise but who have time constrains due to their busy lifestyles. The objective of the study is to investigate if this type of exercise, characterized by high intensity and very short duration would have a positive effect on body weight and composition, grip strength, heart rate and blood pressure. Methods: Only healthy participants between the ages of 18 to 30 are included in this study. The workout investigated here was developed by the American College of Sports Medicine. The duration of this study is 6 weeks where 42 participants in total will do the 7 minute workout 5 days a week. Measurements such as height, weight, body mass index, waist circumference, hip circumference, middle upper arm circumference, blood pressure, heart rate, hand grip, and bioelectrical impedance are being collected and recorded during the beginning, middle, and the end of the full training program. Weight is recorded weekly. Participants will also fill a questionnaire related to their eating and physical activity habits. This will allow us to categorize them later based on their initial physical fitness and body weight. Measurements and the workout are conducted at the Lebanese American University in Beirut, Lebanon under supervision (data collection will end approximately on the 1 of June 2015). The study has been granted the Institutional Review Board approval. Preliminary Results: We have recruited 30 participants so far (19 women and 11 men) of which 17 have already finished the 6 week period. Preliminary analysis showed significant increase in hand grip strength (right and left) (p1⁄40.04) and an increase in the Mid-upper arm circumference (p1⁄40.032). A trend of decreasing waist to hip ratio is observed (p1⁄40.057). No changes in weight and BMI have been noted between the 1 and the 6 week yet. Body composition analysis is in process. Participants will be divided into categories depending on their baseline physical fitness level and their diet type. Conclusion: This novel intervention study will show the effect of very short duration high intensity exercise on anthropometric measures and heart rate. We expect an increase in muscle strength and mass. Body weight changes might not be perceived at this level as this activity does not involve remarkable fat loss, or heavy muscle building. This type of workout should be coupled with a complete exercise program, and should only be part of a healthy lifestyle and full workout program. Nevertheless individuals with time constraints can do the 7 minute workout on days when they cannot exercise for longer periods.

Tuberculosis incidence rate and risk factors among HIV-infected adults with access to antiretroviral therapy

The objective of this study is to determine the incidence rate and risk factors of tuberculosis (TB) among HIV-infected adults accessing antiretroviral therapy (ART) in Tanzania. A prospective observational study among HIV-infected adults attending HIV clinics in Dar es Salaam. We estimated TB incidence rates among HIV-infected patients prior to and after ART initiation. We used Cox proportional hazard regressions to determine the predictors of incident TB among HIV-infected adults enrolled in the HIV care and treatment programme. We assessed 67 686 patients for a median follow-up period of 24 (interquartile range: 8-49) months; 7602 patients were diagnosed with active TB. The TB incidence rate was 7.9 [95% confidence interval (95% CI), 7.6-8.2] per 100 person-years prior to ART initiation, and 4.4 (95% CI, 4.2-4.4) per 100 person-years for patients receiving ART. In multivariate analyses, patients on ART in the first 3 months had a 57% higher risk of TB (hazard ratio: 1.57, 95% CI, 1.47-1.68) than those not on ART, but the risk significantly decreased with increasing duration of ART. Risk factors for incident TB included being male, having low BMI or middle upper arm circumference, lower CD4 cell count and advanced WHO disease stage. There was seasonal variation for incident TB, with higher risk observed following the rainy seasons (May, June and November). In TB endemic regions, HIV-infected patients initiating ART, particularly men and those with poor nutritional status, should be closely monitored for active TB at ART initiation. In addition to increasing the access to ART, interventions should be considered to improve nutritional status among HIV-infected patients.

Iron Folate Consumption, Energy dan Iron Adequacy Level Associated With Prevalence of Anemia Among Pregnant Women in Jember

Background and purpose: Anemia among pregnant women is still being a public health problem in Indonesia.This study aimed to determine association between iron folate consumption, energy and iron adequacy level withprevalence of anemia among pregnant women. Methods: This was a cross-sectional study conducted in eight community health centers in Jember, East Java with128 pregnant women as subjects selected by stratified random sampling method from pregnant women’s cohort ineach of the primary health centers. Data were collected from interviews using semiquantitative food frequencyquestionnaire, chronic energy deficiency status by measuring the middle upper arm circumference (MUAC), and data ofhemoglobin levels with Easy Touch GCHb (Bioptik Technology Inc., China). Data were analyzed bivariate by chi-squareand multivariate by logistic regression. Results: This study found that the prevalence of anemia among pregnant women in Jember was 60.16% (95%CI:51.76-68.56). Multivariate analysis resulted that variables which were significantly reduce risk of anemia amongpregnant women were: household income (adjusted OR=0,09; 95%CI: 0.03-0.51), iron folate consumption (adjustedOR=0.16; 95%CI: 0.04-0.69), adequacy of energy (adjusted OR=0.06; 95%CI: 0.01-0.33), and iron adequacy level(adjusted OR=0.11; 95%CI: 0.01-0.90). Conclusion: Household income, intake food with high energy and iron, and also iron folate consumption weresignificantly reduced the risk of anemia among pregnant women.

Angiotensin-converting enzyme gene insertion/deletion polymorphism in nutritional disorders in children.

The aim of this study was to establish the role of angiotensin-converting enzyme gene insertion/deletion (ACE I/D) polymorphism in determining obesity or undernutrition in a child population in Romania. We assessed 293 consecutively hospitalized patients in a tertiary emergency pediatric hospital. The patients were divided, according to body mass index (BMI), into three groups: group I, the control group consisting of 126 children, group II patients with undernutrition (85 patients) and group III patients with obesity (82 patients). ACE I/D polymorphisms were performed in all three patient groups, as well as the measuring of anthropometric parameters [middle upper arm circumference (MUAC), tricipital skinfold thickness (TST)]. All patients also underwent paraclinical evaluations (protein and albumin). The cutoffs criteria for moderate undernutrition were: BMI between -2.0 SD and -3.0 SD, severe undernutrition: BMI <-3.0 SD, moderate obesity: BMI between +2.0 SD and +3.0 SD and severe obesity: BMI >+3.0 SD. We observed that DD genotype (64.7%) was prevalent in the moderate undernutrition group, while ID (35.3%) and II genotypes were higher in the subgroup of severe undernutrition, with significant correlations in DD and ID genotype groups between BMI and MUAC, protein and albumin (p < 0.0001). In the obese group, we observed significant correlations in DD genotype, between BMI and MUAC (p = 0.0014) and TST, and for II genotype, between BMI and TST (p = 0.0071). II genotype was associated with severe obesity, while D allele carriers were associated with moderate undernutrition and moderate obesity. BMI, MUAC, TST and serum protein levels are correlated with D allele carriers of ACE genes in children with moderate undernutrition and moderate obesity, whereas II genotype is an unfavorable prognostic factor corresponding to severe obesity and severe undernutrition.

IL-6 572 C/G, 190 C/T, and 174 G/C gene polymorphisms in children's malnutrition.

The aim of the present study was to establish the correlations between the polymorphisms of the genes interleukin-6 (IL-6) 572, 190, and 174 in children's malnutrition. We assessed 283 hospitalized children and divided them into 2 groups: group I (control) included 110 patients with normal nutritional status, median (range) age 10.90 (1-18) years; and group II consisted of 173 malnourished patients, median (range) age 10.70 (1-18) years. The 2 groups underwent IL-6 572 cytosine allele (C)/guanine allele (G), 190 C/thymine allele (T), and 174 G/C polymorphism testing, measurement of anthropometric indicators (mid-upper arm circumference and tricipital skinfold thickness [TST]), and paraclinical evaluation (protein, albumin). We observed that the GG and CG genotypes were more frequent in malnourished children for the IL-6 174 gene (P = 0.0001), whereas the CT heterozygous genotype was more frequent in the malnourished group for the IL-6 190 gene (P = 0.003). Body mass index (BMI), middle upper arm circumference (MUAC), TST, and low serum albumin levels correlated with the GG and CG genotypes of the IL-6 572 and IL-6 174 genes, and with the CT genotype of the IL-6 190 gene, in children with malnutrition, whereas the IL-6 190 TT genotype was a protective factor for malnutrition (P = 0.0001). Malnutrition is more frequently associated in children with IL-6 174 G allele carriers (GG and CG genotypes), whereas IL-6 190 TT genotype has a protective function. In malnourished children, the IL-6 572/190/174 GG/CT/CG, GG/CT/GG, GG/CC/GG, and GG/CC/CG combined genotypes are more frequent.

O-050 The Role Of Fto Rs17817449 And Rs 9939609 Snp (single Nucleotide Polymorphism) In Children’ Obesity

Obesity is a problem with great importance and certain actuality in the field of paediatric pathology because of its increased incidence in children and its complications. Fat mass and obesity associated (FTO) genes are related with weight gain and obesity during childhood, being correlated with body mass index (BMI) and leptin levels. The aim of our study was to establish the role of the polymorphisms of rs9939609 and rs17817449 FTO genes in determining obesity in a child population from Romania. Methods We assessed 225 hospitalised children in a tertiary emergency paediatric hospital divided into: control group - 110 patients with normal nutritional status and obese group -105 patients. The two groups underwent the evaluation of FTO rs17817449 and rs 9939609 SNP , and the measurement of anthropometric parameters [body mass index (BMI), middle upper arm circumference (MUAC), tricipital skinfold thickness (TST)]. Results We observed that the AA genotype of Rs9939609 SNP gene, is more frequent in obese group [p = 0.01, OR 2.778 95% CI (1.245–6.201)] and the A alleles is heigher in obese group [p = 0, 0148, OR 1,692 95%]. According to the RS17817449 gene mutation no association was found. We observed correlations in AA genotype, between BMI and MUAC (p = 0.0011) and TST, while A allele carriers was associated only with MUAC. Conclusion Rs9939609 SNP AA genotype and A allele carriers are associated with obesity in children, and are both correlated with BMI and MUAC, while AA genotype is also correlated with TST.