RESUMO

OBJECTIVE: To conduct the first national dietary survey and examine inter-island differences in and relationships between iron consumption and reports of anemia. DESIGN AND METHODS: A total of 144 households, randomly selected from electoral lists for Grand Turk (n=48), Providenciales (n=46), and Middle Caicos (n=50), participated in the survey. Food consumption (via food frequency questionnaire), self-reported health history, and sociodemographic data were collected from female household-heads during home interviews. Data on frequency of consumption and tabulated iron score for each "normal" food portion size were used to calculate each household's iron-intake-score. Chi-squared analyses were used to compare inter-island intake score categories. RESULTS: Households were assigned to low (<100), medium (100-160), or high (>160) iron-intake-score categories. The proportion of households with low scores was lower on Grand Turk (<5%) and Providenciales (0%) compared to Middle Caicos (20%), the least developed island. CONCLUSION: Suboptimal iron intakes, especially on Middle Caicos, support the prevailing view that anemia in vulnerable groups could be of dietary origin. Findings highlight the need for additional research to determine how various factors (eg, diet, supplement use, physiology, and environment) impact iron status. In the short term, we must identify and treat cases and provide culturally appropriate nutrition education to increase dietary iron intake and promote safe use of multivitamin/mineral supplements. National dependence on imported foods makes this the most viable public health intervention option until the etiology of anemia is fully determined.

Assuntos

Assuntos

Assuntos

RESUMO

In a prospective study, 163 moderately malnourished children, living in the slums of Kingston, were followed up for one year. The anthropometric measurements in weight and length in those children receiving a High Energy Supplement (HES), and in wasting in those receiving, additionally, a course of metronidazole (MET) have been previously reported. The point prevalence as assessed by positive stool tests for helminths and parasites of the children treated with metronidazole, and if deemed necessary with mebendazole, increased significantly over the period of one year concurrent with improvement of their nutritional status (chi-2 = 13.57; p < .001). A significant increase was observed in both the supplemented and unsupplemented group (chi-2 = 3.98; p < .05 and chi-2 = 5.31; p < .05 respectively). Children receiving health care (HC) only, or health care and a high energy supplement (HC/HES) failed more than twice (17 per cent) as often the community-based management as those receiving additional metronidazole (HC/MET and HC/HES/MET) (8 per cent). Admissions to hospital for full nutritional and clinical recovery in the HC/HES group were mostly for enteric infections and septicaemia, while children in the MET groups were admitted for respiratory tract infections leading to anorexia. Malnourished children, managed in the community, are less likely to be admitted for failure if a course of metronidazole and mebendazole is given combined with their rehabilitation, using HES. This treatment reduces social and nutritional costs to the child, as well as costs to the public health service (AU)

Assuntos

RESUMO

Fifty-one moderately and severely malnourished children were studied in the community. They were randomly allocated to receive either medical care and an energy dense dietary supplement for three mons and then medical care alone for a further three months (supplemented) or to receive medical care alone for the six months (unsupplemented). All children were seen at two-weekly intervals, alternately in their homes by community Health Aides and in the clinic by a paediatrician. At each visit, a morvidity questionnaire was administered to obtain the mother's history of the child's illness during the previous two weeks. Weight was measured every two weeks and height monthly. Clinical assessment was done montly. During the first 3 months, growth velocity was higher in the supplemented than the unsupplemented children (2.4 and 1.2 times normal growth rate). During the second 3 months, growth rate was equal in the two groups (1.1 times normal growth rate). The mean ñ SD number of days of respiratory illness and diarrhoea (3 or more loose stools daily) were as follows: FOLLOW-UP PERIOD: Respiratory infection: (1-3 MONTHS - Unsuppl. 22ñ17, Suppl. 23ñ12), (4-6 MONTHS - Unsuppl. 15ñ13, Suppl. 20ñ15); Diarrhoea: (1-3 MONTHS - Unsuppl. 6ñ9), (4-6 MONTHS: Unsuppl. 2ñ3, Suppl. 8ñ12): No. Of Children With > 7 Days: (1-3 MONTHS: Unsuppl. 8/25, Suppl. 18/26), (4-6 MONTHS: Unsuppl. 1/24, Suppl. 7/25). In the first three months, the supplement was not associated with any significant decrease or increase in morbidity from respiratory illness or diarrhoea. Although more of the children had diarrhoea lasting for over seven days, these latter children did not show a diminution in rate of weight gain. In the second three-month period, there were fewer days of both respiratory illness and of diarrhoea in the unsupplemented children than in the children who had been supplemented during the previous three months. There were fewer children who had diarrhoea for more than seven days in the three-month period amongst the unsupplemented than the previously supplemented. Their preliminary analysis shows that dietary supplementation with an energy dense formula does not lead to a reduction in morbidity in malnourished children. It is possible that the supplement is associated with an increased in incidence of diarrhoea following its cessation (AU)

Assuntos

RESUMO

The feasibility of rehabilitating malnourished children in the community, using the health service framework, was examined over a 6-month period. Eighty moderately and severely malnourished children, aged 3-36 months, were recruited from the Casualty Department, U.H.W.I., and Clinics in Kingston. The results of the first fifty to complete are reported. The children were randomly assigned to two treatment groups which provided medical care with and without a dietary supplement. The supplement, as prescribed, provided 750 Kcal/day for 3 months (55 percent of their energy requirements). At enrollment, both group had similar weight-for-age (WFA), height-for-age (HFA) and weight-for-height (WFH). At this point, mean WFA were 67 percent and 66 percent for supplemented and control groups respectively. By the end of the second month, the supplemented group was better nourished than their controls (p<0.05). The mean WFA were 73 percent and 69 percent respectively. By the end of the third month, the advantage of the supplemented group was more pronounced (p<0.01) with mean WFA of 74 percent and 69 percent respectively. This represented 8 percent WFA improvements in the supplemented as opposed to a 2 percent improvement in their controls. Mean weight gains of 1.22 and 0.84 Kg in supplemented and control groups were 2.0 and 1.3 times respectively, the normal rate for children of the same age. After three months, the supplemented group which had had three severely malnourished children at enrollment had none, while the control group which had had four still had two. Twice as many supplemented as opposed to control children had advanced to the mildly malnourished category. However, three months after the supplementation ceased (6 months), both groups were distributed similarly between the Gomez categories. Both interventions resulted in some catch-up growth. The regime of medical care plus supplementation proved more effective during the supplementation period. However, this advantage was not maintained when both groups received medical care only. Continous medical care and a onger supplementation period are needed for community rehabilitation of Jamaican malnourished children (AU)

Assuntos

RESUMO

Cohen et al (1974) found a high prevalence of anaemia amongst 0-13 year-old children in the Turks and Caicos Islands. There was a marked inter-island variation with 69 percent of 5-year-old children on Middle Caicos and 28 percent on Grand Turk being anaemic. They ascribed this anaemia as probably being due to iron deficiency. A food frequency questionnaire was designed and weighted so that household iron consumption could be computed as a score. The method was pretested and the score calibrated against 24-hr recalls for three days in 10 individuals: a correlation coefficient of r=0.93 was obtained between the two methods. The questionnaire was administered to the female household head of 144 households on Grand Turk (48), Provodentiales (46) and Middle Caicos (50), selected at random from the register of voters. The foods consumed formed a series of Guttman scales for each of the eight food groups. Chicken, fish, rice, bread and evaporated milk were most frequently consumed. The dietaries were very restricted on each island, with Middle Caicos only having eight major items consumed more than three times per week, by more than 25 percent of households. The households were divided into low, medium and high iron intake categories based on iron scores which correspond to ó7.5, 7.6 to 12.9 and o13mg Fe/d. Grand Turk and Provodentiales were similar with 1 percent of families in the low iron group and 76 percent in the high group. In contrast, 20 percent of families in Middle Caicos were in the low, and only 44 percent in the high iron intake group. The iron equivalent of the overall scores for the three islands were 15.2ñ2.1, 14.6ñ1.7 and 11.8ñ2.7mg/d respectively. The mean RDA for iron for this population's age/sex structure is 10.1 mg/d. When the contributions to the total iron intake from each food group were calculated, Middle Caicos households had significantly lower intakes in each category. These data add support to the hypothesis that dietary iron deficiency is responsible for the high prevalence of anaemia in the Turks & Caicos Islands. Bread and rice were consumed more than 3 times weekly by 98 and 93 percent of households on each island: these were the only items which would be suitable for iron fortification. As the flour and rice are entirely imported from the U.S.A., in relatively small quantities (total population 7,700), it is probably more cost-effective to distribute prophylactic iron supplements than to fortify a dietary constituent (AU)

Assuntos

RESUMO

Cohen et al (1974) found a high prevalence of anaemia amongst 0-13 year old children in the Turks and Caicos Islands. There was marked interisland variation with 69 percent of 5 year old children on Middle Caicos and 28 percent on Grand Turk being anaemic. They speculate that this anaemia is due to dietary iron deficiency. A food frequency questionnaire was designed and weighted so that household iron could be computed as a score. The method was pretested and the score calibrated against triplicate 24 hour recalls on 10 individuals. A correlation coefficient of r = 0.93 was obtained between the two methods. The questionnaire was then administered to the female household head of 144 households on Grand Turk (48), Providenciales (46) and Middle Caicos (50), selected at random from the register of voters. The food consumed formed a series of Guttman Scales for each of the seven food groups. Chicken, fish, rice, bread and evaporated milk were most frequently consumed. The dietaries were restricted on each island with Middle Caicos having only eight major items consumed more than three times per week by more than 23 percent of households. The households were divided into low, medium and high iron intake categories based on iron scores which correspond to ó 7.7,7.8 - 12.8, o 12.9 mg Fe/d. Grand Turk and Providenciales were similar with 1 percent of the families in the low iron group and 76 percent in the high group. In contrast, Middle Caicos had 20 percent of families in the low iron group and only 44 percent in the high iron intake group. The iron equivalent of the total scores for the three islands were 15.2 ñ 2.1, 14.6 ñ 1.7, 11.8 ñ 2.7 mg/d respectively. The mean Recommended Dietary Allowance for iron for these populations' age/sex structure is 10.1 mg/d. When the contributions to the total iron intake from each group was calculated, Middle Caicos households had significantly lower intakes in each category. These data add strong support to the hypothesis that dietary iron deficiency is responsible for the high prevalence of anaemia in the Turks and Caicos. (AU)

Assuntos