Nutrition Surveillance System Research Articles

An evaluation of breastfeeding promotion through peer counseling in Mississippi WIC clinics.

This study evaluates the effectiveness of a peer counseling program at increasing breastfeeding by participants in the Mississippi Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Data from the 1989-1993 Pediatric Nutrition Surveillance System were analyzed to compare breastfeeding rates in clinics with and without peer counseling programs. A questionnaire completed by program staff to describe the program in greater detail helped identify characteristics associated with greater success. The incidence of breastfeeding rose from 12.3% to 19.9% in those clinics with peer counseling programs, but only from 9.2% to 10.7% in clinics without a program. Clinics that started a program earlier showed greater changes in breastfeeding incidence. However, the presence of lactation specialists or consultants in the clinic appeared to be more important than the presence of less-trained peer counselors. Peer counselors who spent more than 45 minutes per participant were more effective than those spending less time. The peer counseling program significantly increased the incidence of breastfeeding, particularly in clinics with lactation specialists and consultants. Success can be enhanced by ensuring that peer counselors spend a great deal of time with the participants.

Promotion of a Healthy Weight Among Navajo Nation Women.infant and Children Families

LEARNING OUTCOME: To identify three activities to use with paraprofessionals in promoting a healthy weight for children enrolled in the Navajo Nation Women, Infant and Children (WIC)programHigh weight-for-height (>95th percentile) has increased over the last twelve years in the Navajo Nation's infants and children. Out of 28,772 records examined by the 1994 CDC Pediatric Nutrition Surveillance System for the Navajo Nation, high weight-for-height is currently 11.7% which is above the national average and below Year 2000 goals. In the Navajo Nation (WIC) program, high weight-for-height is the second highest pediatric risk. Within the Shiprock region, the most recent assessment of high weight-for-height was 17.7% in infants and 22.8% in children. A need to provide appropriate nutrition intervention and counseling within the family to monitor the rate of weight gain while maintaining adequate calories for growth and a healthy weight is critical. The WIC program provides an excellent opportunity to complement and supplement childrens' home-based food experiences. Since a large portion of nutrition education is provided by paraprofessionals within the WIC program, a nutrition education workshop provided current research and methods to be used in the Navajo Nation WIC clinics for promoting a healthy weight within the WIC family. Concepts presented ranged from where food comes from, how foods are prepared and what foods are healthy were presented. Activities included: parent/child responsibilities, case studies/care plans, fat, fiber and weight control activities, grocery shopping tips/tours, food guide py ramid games and kitchen activities for kids were promoted. There is a need for Navajo specific education material for promoting a healthy weight.

Nutrition assessment and dietary guidelines: experience from the Dutch Nutrition Surveillance System.

Nutrition assessment and dietary guidelines: experience from the Dutch Nutrition Surveillance System.

The role of universal distribution of vitamin A capsules in combatting vitamin A deficiency in Bangladesh.

Vitamin A deficiency is a major public health problem among preschool-aged children in many developing countries. In Bangladesh, a national nutritional surveillance system was initiated in 1990 to monitor 1) the occurrence of vitamin A deficiency by history of night blindness and 2) the routine coverage of national twice-yearly prophylactic vitamin A capsule (VAC) distribution. This study comprised data collected from June 1990 to August 1994. The VAC distribution had a mean coverage rate of 48.7% (95% confidence interval (CI) 48.4-49.0) in the rural areas; the coverage rate in the urban slums was 93.7% (95% CI 93.4-94.0). In the rural areas, the mean prevalence of night blindness was 0.86% (95% CI 0.81-0.91) and the bimonthly prevalence of night blindness ranged from 0.50% (95% CI 0.32-0.77) to 1.48% (95% CI 1.19-1.85), while in the urban slums the mean prevalence was 0.22% (95% CI 0.18-0.28) and the bimonthly prevalence ranged from zero to 0.62% (95% CI 0.27-1.37). The efficiency of VAC distribution was 27% (95% CI 17.6-35.3) in the rural areas and 77.8% (95% CI 61.8-87.1) in the urban slums. After adjustment for multiple potentially confounding factors, VAC receipt by individual children reduced the risk of night blindness in both rural and urban areas (rural areas: odds ratio (OR) = 0.74, 95% CI 0.63-0.87; urban slums: OR = 0.39, 95% CI 0.19-0.82). Breastfeeding was a protective factor for night blindness in both rural (OR = 0.53, 95% CI 0.42-0.67) and urban (OR = 0.32, 95% CI 0.15-0.66) areas. Night blindness was inversely related to the level of routinely attained coverage, and the degree of protection was associated with the time interval between the moment of VAC receipt and the moment of data collection. Although the prevalence of vitamin A deficiency in Bangladesh has been considerably lower in the 1990s than it was in the 1980s, it is still prevalent at all socioeconomic levels. Supplementation with high-dose VACs is an effective strategy for reducing night blindness, but the efficiency of the program will improve when coverage in the rural areas increases.

Nutrition Surveillance Bangladesh: A Useful Tool for Policy Planning at the Local and National Levels

As a response to the inability of both governmental and non-governmental organizations to provide vital information during the floods of 1987 and 1988 in Bangladesh, a nutrition surveillance system (the NSP) was established in April 7990. This is a collaborative effort that involves international and indigenous non-governmental organizations and the government of Bangladesh, and is coordinated by Helen Keller International and funded by the US Agency for International Development. During the past three years the NSP has demonstrated an ability to provide regular and dependable information on the prevalence of undernutrition and morbidity in children under five years of age, household socioeconomic characteristics, food prices, and the extent of distress at household and community levels from data collected every two months by NGOs and the government in selected rural districts and urban slums in all regions of the country. The system was established as a bottom-up surveillance system based on NGO-specific teams with a continuous central quality control system to ensure the collection of reliable data. The NSP has proved to be an excellent tool for policy makers from several sectors, involving health, agriculture, and food aid The NGOs use it for the continuous monitoring of their development programmes and to identify mechanisms through which services can be delivered most effectively. Regional-level analyses evaluated the impact of the universal vitamin A capsule distribution programme. After the cyclone of 1991, the NSP demonstrated its flexibility by expanding rapidly to cover affected districts and provide pertinent information to those involved in relief efforts. Most recently, the NSP has provided information on the role of food prices on nutrition status and assisted the Ministry of Food in its decision-making. The model is worthy of consideration for replication in other countries in the world.

Anthropometric profile of children aged 0 to 5 years in the city of Niterói, Rio de Janeiro, Brazil

The Niterói-based Nutritional and Food Surveillance System (SISVAN Niteroi, RJ, Brazil) performed an anthropometric survey which included 2,248 children from zero to 60 months of age in September 1992, during a mass vaccination day program. The purpose was to determine the nutritional status of children from that city. The indexes used were Weight for Age (WA), Weight for Height (WH), and Height for Age (HA), and the reference population was that of the NCHS (National Center for Health Statistics, USA), adopted and recommended by the WHO. The indexes were analyzed using the classifications by Gomez and Z-Scores. Prevalence of undernutrition was calculated on the basis of the proportion of children with Z-scores under -2.00, using HAZ to stabilish chronic forms and WHZ for acute ones. A data base was built using Epi Info, version 5.0 1b, and a special program from CDC (Centers for Disease Control) was used to calculate anthropometric indexes. The results showed as much as 20.1 % of undernutrition, including all forms from the Gomez classification. In the city as a whole, 6.8% had HAZ under -2.00. The results indicated a serious situation of chronic undernutrition that demands continuous nutritional surveillance in Niteroi, and especially in the city's Eastern District.

Decentralized data management in nutritional surveillance for timely warning and intervention.

In this paper we describe a theoretical approach for decentralized data management in sentinel community nutritional surveillance systems for timely warning and intervention, by using customized computer programs. By making the data available at lower levels first, the decentralized data management system builds the institutional capacity at regional level and allows rapid and appropriate action by decision-makers. In addition, it facilitates the flow of information and strengthens the involvement of field staff. Reports from field experiences should further demonstrate the feasibility, efficacy, costs and benefits of customized data management computer programs.

Nutritional risk factors among low-income pregnant US women: The centers for disease control and prevention (CDC) pregnancy nutrition surveillance system, 1979 through 1993

B irth outcome has been shown to be affected by many sociodemographic and physiological factors, including race or ethnicity, 1-:~ socioeconomic status, 4 maternal age, 5'6 pre-pregnancy weight, 71~ total gestational weight gain, 7-9 smoking, 6 alcohol consumption, 1~-1:~ and anemia) 4-~7 Low birthweight increases the risk of infant mortality and is associated with increased risk of developmental disabilities, congenital anomalies, and chronic medical condi t ions) s Although much is known about the relationship between birthweight and the a forement ioned risk factors, nationally there are few ongoing data available on the distribution of these risk factors among pregnant women in the general population. Since 1979, the Centers for Disease Control and Prevention (CDC) has been moni tor ing certain nutri t ion-related pregnancy risk factors and characteristics of low-income women participating in various public health programs. The CDC Pregnancy Nutri t ion Surveillance System (PNSS) is a collaborative p rogram with participating state and territorial health depar tments and Indian health agencies. Individual prenatal and postpa r tum clinical records are continuously collected and compiled at the local or state level. The collected data are forwarded to CDC periodically for processing and tabulation. The resulting informat ion is furnished back to states to assist them in identifying and moni tor ing the prevalence of prenatal nutr i t ion problems and behavioral risk factors that are related to adverse pregnancy outcomes. This surveillance system is intended to provide information for health care providers in the states for p rogram planning and interventions that will lead to improved birth ou tcomes . The system is also in tended to assist the states to build their own capacity to m o n i t o r p regnancyre la ted risk factors and b i r th ou tcome. History of the Pregnancy Nutrition Surveillance System

The Validity of Clinic-Based Nutrition Surveillance Data: A Study from Selected Sites in Northern Malawi

Many developing countries collect on the weight for age of children attending health facilities as one element of a nutrition surveillance system. This study compares the estimates of malnutrition from seven health clinics in northern Malawi with estimates derived from nearby community-level surveys. The results show that prevalence of underweight in clinics does not accurately reflect community prevalence. Clinic estimates often differ by two- to threefold from community estimates, and the direction of the bias is not constant across clinics, making these data an invalid basis for targeting programmes according to nutritional need. Similar results were reported in five other studies in the literature, indicating that the Malawi results are not unusual. It is suggested that, contrary to current practice, cross-sectional clinic-based data should be assumed invalid for targeting purposes unless proved otherwise in a given country. Trend data at regional and country levels require further validation.

The height census of first grade schoolchildren: anthropometric data analysis

The present study aims at identifying prior areas for nutritional programs considering growth scores of children entering the first grade of school. Data were obtained through the nutritional surveillance system in a Brazilian city called Osasco, São Paulo. The analysis was meant to determine the magnitude and distribution of growth retardation. In order to establish the nutritional status of children the indicator height/age expressed by standard deviation scores (z-score) was used. Values below -2 s.d. of the reference population median (NCHS) were considered height retarded. Children's growth was geographically distributed into groups of schools according to height deficit prevalence. Results showed marked differences among the schools with deficit prevalence varying between 0 and 16.1%. This led to the identification of communities with good health and nutrition levels, and communities exposed to different levels of malnutrition. The level of dissociation was such that it was possible to pinpoint areas and micro-areas where social programs and investments are most needed.

The height census of first grade schoolchildren: data quality and cost analysis in two Brazilian municipalities

The present study describes a first attempt in Brazil to establish a nutrition surveillance system based on the systematic collection of the height of children entering the first grade of primary school. The strategy used recognized the School District as the nuclear institution to operate the system. A quality control system showed that trained people were able to collect anthropometric data with margin of error compatible with the purposes of the system. Costs were low, around 30 cents US per child examined, and they can be further reduced since the system is operated in large scale.

Growth patterns of infants exposed to cocaine and other drugs in utero

Objective Exposure to cocaine in utero is known to cause intrauterine growth retardation. This study describes the postnatal growth patterns of infants exposed to cocaine and other drugs in utero.Design A convenience sample of 31 Northern California infants was monitored for 1 year. Infants in foster care were selected to eliminate the environmental effects of a parent's drug-seeking lifestyle. Entrance criteria consisted of age less than 6 months old, in utero drug exposure, and foster-care placement shortly after birth. The infants were predominantly black.Analysis The infants' growth indexes were compared with the expected growth of infants in three reference populations: the National Center for Health Statistics (NCHS) reference population, all infants in the 1991 Pediatric Nutrition Surveillance System (PNSS-all), and black infants in the 1991 PNSS (PNSS-black) using the one-sample exact binomial test. Infants took in more energy and protein per kilogram than 100% of the Recommended Dietary Allowances at every age interval.Results At birth, mean weight of the study infants was significantly lower than that of NCHS, PNSS-all, and PNSS-black infants (P<.01); mean length was significantly lower than that of NCHS and PNSS-all infants (P<.01), but not significantly different from PNSS-black infants. By 6 months, there were no significant differences in weight compared with any group. At all age intervals after birth, mean length for the study infants was significantly less than that of NCHS and PNSS-all infants (P<.01), and significantly less than that of PNSS-black infants (P<.05). Our findings indicate that despite adequate nourishment, stunting in length continued through the first year, resulting in infants who were overweight for length.

Combinations of low thiamin, riboflavin, vitamin B6 and vitamin C intake among Dutch adults. (Dutch Nutrition Surveillance System).

Clustering of low vitamin intake may entail a greater functional and/or health risk than the summation of separate low intakes may suggest. Therefore, the prevalence of combined low thiamin, riboflavin, vitamin B6 and vitamin C intake in various adult sex-age groups in The Netherlands was estimated. Nutritional risks were evaluated by comparing the calculated intakes with the recommendations for each vitamin. For this purpose the data of a subsample of 3353 adults of a nationwide food consumption survey were used, which had been collected in 1987-88 within the framework of the Dutch Nutrition Surveillance System. Food consumption data were obtained through 2-day dietary records. Respondents were segmented into tertiles based on their vitamin intake per 1000 kcal (4.2 MJ) to adjust for energy intake. As compared with the RDAs, mean overall intake was lowest for vitamin B6. Based on tertile analyses, the risk for inadequate intake was relatively high for vitamin C, small for riboflavin and intermediate for thiamin and vitamin B6. Low vitamin densities clustered somewhat since the prevalence of combined low intakes for all four vitamins was higher than expected from probability calculations. This interdependence was mainly the result of a higher consumption of alcoholic beverages and of other food products with a low vitamin density. In affluent societies nutritional risk assessment should not be based solely on single vitamins but should also be oriented at combined low intake levels.

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Vitamin C status in elderly women: A comparison between women living in a nursing home and women living independently

The vitamin C status in blood fractions in 135 elderly women aged 65 years and older was studied within the framework of the Dutch Nutrition Surveillance System. Mean (± standard deviation) vitamin C intake (mg/day) was lower among women living in a nursing home (54±27 mg/ day) than among women living in service flats (97±55 mg/ day) and women living independently (132 ± 44 mg/day). (Service flats are apartments in which the rent includes housekeeping and, when ordered, meal service.) Marginal vitamin C values (<23 μmol/L) in blood fractions and even levels as low as those found in clinical scurvy (<11 μmol/L) were frequently observed. In the nursing home, 35% of the women had plasma vitamin C values below 11 μmol/L, and 23% had values between 11 and 23 μmol/L. Blood levels were not significantly affected by age, smoking status, or use of particular drugs but were strongly ( r = .47 or, after logarithmic transformation, r = .64) associated with daily intake of vitamin C. Low intake of vitamin C resulted from an overall low food consumption and selective restriction of food products rich in vitamin C. Vitamin C losses caused by food preparation practices and distribution in the nursing home's catering system reduced actual vitamin C intake levels but these losses were not substantially greater than those that are assumed to occur as a result of preparation practices by women living independently.

Trends and patterns in height and weight status of low‐income U.S. children

To better define the trends and patterns of growth for low-income children, we studied the anthropometry data collected by the second National Health and Nutrition Examination Survey (NHANES II) and the CDC Pediatric Nutrition Surveillance System (PNSS). Based on NHANES II, we found that low-income children appear to have a greater prevalence of shortness (low height-for-age), but do not have a greater prevalence of overweight (high weight-for-height) when compared with children from higher income families. Based on 12 states that were monitored continuously by the PNSS from 1980 to 1989, low-income children under 5 years of age appear to have a stable trend of height and weight status, with the exception of Asian children, most of whom were from Southeast Asian refugee background, showed a dramatic improvement in height status. However, based on PNSS data for the years 1977 to 1990 from Louisiana and Michigan, school-aged children and adolescents appear to have become slightly taller as well as having significant increases in body weight in relation to height. An additional investigation is needed to verify this trend of increasing excess weight among older, low-income children.

The Utility of Clinic-Based Anthropometric Data for Early/Timely Warning Systems: A Case Study from Niger

The purpose of this study was to investigate the utility of clinic-based anthropometric data for early/timely warning purposes as a part of nutritional surveillance systems. The study combines the unique circumstances of the 1984–1985 Sahelian famine with retrospective time series of cereal prices, morbidity, and anthropometric data. Thus, the behaviour of clinicbased anthropometric data is compared to that of the other series and to the known evolution of the Sahelian famine. A conceptual framework for the use of clinicbased anthropometric data is developed, and time-series and regression techniques are used to explore the hypothesis that routinely collected anthropometric data can provide early indications of impending food emergencies. The clinic-based data performed well in identifying the famine several months in advance of official recognition of a problem and donor mobilization of resources. This suggests that properly analysed clinic data can be useful for the early detection of impending food crises, though further research will be needed to determine the general applicability of this finding. Several methodological issues related to the use of this type of data are explored.

Marginal nutritional status among institutionalized elderly women as compared to those living more independently (Dutch Nutrition Surveillance System).

The nutritional status (assessed by anthropometric indices, and biochemical and hematological variables in blood) of three groups of elderly women (aged > or = 65 years) was evaluated within the framework of the Dutch Nutrition Surveillance System. The groups were composed of women living in a nursing home (n = 51), women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and women living independently (n = 52). Mean blood levels of folate, pyridoxal 5'-phosphate, 25-hydroxyvitamin D, alpha-tocopherol, vitamin C, albumin, selenium and total cholesterol were significantly (p < 0.05) lower among nursing home women. Among these women a biochemical deficiency was frequently found for 25-hydroxyvitamin D (73%), pyridoxal 5'-phosphate (57%), vitamin C (38%), selenium (30%) and folate (28%). These nutritional risks were largely independent of each other. Since folate and pyridoxal 5'-phosphate were associated with several clinicochemical indicators, health status may be an important determining factor for this unfavorable situation. Low 25-hydroxyvitamin D concentrations were associated with limited exposure to ultraviolet radiation and nonusage of vitamin D supplements. We conclude that dietary intake variables are not the only determinants of a marginal nutritional status among nursing home women. Use of foods with a high nutrient density should be encouraged, whereas other preventive measures are needed to improve vitamin D status.

Clustering of dietary variables and other lifestyle factors (Dutch Nutritional Surveillance System).

The aim was to investigate whether dietary factors cluster in a favourable or unfavourable way and to characterise the groups identified by lifestyle and sociodemographic variables. This cross sectional study was based on data of the 1987-1988 Dutch national food consumption survey (DNFCS), obtained from a panel by a stratified probability sample of the non-institutionalised Dutch population. 3781 adults (1802 males and 1979 females) of the DNFCS, aged 19 to 85 years, were studied. To estimate dietary intake two day food records were used. Lifestyle factors were collected by structured questionnaire and sociodemographic variables were available from panel information. Cluster analysis was used to classify subjects into groups based on similarities in dietary variables. Subsequently, these groups were characterised by sociodemographic and lifestyle factors as well as by the consumption of food groups. Eight clusters were found. In comparison with the guidelines, the dietary quality in four clusters was poor. The cluster with the poorest dietary intake (high intake of fat, cholesterol, and alcohol; low intake of dietary fibre) showed on average a high consumption of animal products (except milk), fats and oils, snacks, and alcoholic beverages, and a low consumption of fruit, potatoes, vegetables, and sugar rich products. Smoking, body mass index, dietary regimen on own initiative, hours of sleep, gender, age, socioeconomic status, and day of the week were found to discriminate among the clusters. Cluster analysis resulted in substantial differences in mean nutrient intake and seems useful for dietary risk group identification. Undesirable lifestyle habits were interrelated in some clusters, but an exclusive lifestyle for health risk has not been found.