Browsing by Subject "Anaemia"

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    Baseline assessment and cost analysis of a supplementary feeding intervention on Adivasi children in West Bengal, India : How to diversify diets with locally available resources cost-effectively to reduce the burden of child and maternal undernutrition and anaemia?
    (2022) Golembiewski, Silvia; Sousa-Poza, Alfonso
    This dissertation presented and analyzed the living, health and nutrition situation of tribal Adivasi children (aged 6-39 months) as well as of their mothers living in rural Birbhum district, West Bengal, India. It was found that extended families use to have higher incomes (p<0.05) compared to nuclear families and that higher education of mothers (having completed at least class eight) is associated with higher incomes, too (p<0.05). Higher incomes were further found associated with a lesser incidence of moderate and severe anaemia amongst children (p<0.05). Further, active child caring was found to decrease the incidence of stunting (p<0.05, for caring efforts of three hours or more per day) - while mothers tied up in cooking (with cooking efforts of 6 and more hours a day) showed to have bigger likelihood of having a wasted or underweight child (p<0.05). It was suggested that the provision of gas cookers along with cooking gas to Adivasi families may be helpful to free mothers to care more actively for their children and reduce therewith child undernutrition. The dissertation further revealed that either father or mother deciding alone how to expense available income is superior to joint spending decisions - and it was in fact HHs with mothers deciding alone which showed the largest share of children with no or merely mild anaemia (p<0.05). It was suggested, accordingly, that mothers may be entrusted to manage a food budget on their own. Very importantly, the nutritional status of children and their mothers was found to be linked, where mothers with adequate BMI (18.5 and higher) had less often than expected a wasted child (p<0.001) and also less often an underweight child (p=0.001). Severe thin mothers (with a BMI<16.0) showed biggest likelihood of having a child with at least one anthropometric failure. No significant association was found between the anaemia status of the mother and her youngest child (p>0.05). Still, non-anaemic mothers showed bigger likelihood of having non-anaemic children than mothers with poorer Hb statuses, and - the other way around - mothers with severe anaemia showed the biggest likelihood of having children with moderate anaemia. It was argued, accordingly, that not only children but also their mothers should be better nourished in order to break the vicious circle of undernutrition - with a focus on lactating mothers who have highest nutritional intake needs. Overall, 94 percent of tribal Adivasi children were found anaemic (n=307, age range: 6-39 months, Hb<11g/dl) as well as 86 percent of their mothers (n=283, Hb<12g/dl). Anaemia in children was found significantly associated with the age of the child (p<0.001) where Hb was found to rise with increasing age and children above three years reached mild forms of anaemia - while children aged 6-23 months commonly suffered from moderate anaemia. Further, the consumption of fruit was found to decrease the incidence of moderate and severe anaemia (p<0.05). There was also a link between child undernutrition and the occurrence of severe anaemia, where children with no anthropometric failure (CIAF indicator) showed lesser likelihood to develop severe anaemia compared to children with at least one anthropometric failure (p<0.05). Seeing the high incidence of anaemia and interlinking to child undernutrition as well as interlinking of nutritional status of children and their mothers - the question arose how to overcome child as well as maternal undernutrition and anaemia? The present comparative intervention study conducted in 21 tribal villages found that providing diversified meals three times a week to children aged 6-39 months rose their mean Hb by 0.98g/dl (compared to 0.45g/dl in the CG); it was found that after 12 months children receiving the diversified meals showed a bigger share of non-anaemic or only mildly anaemic children compared to the CG (p<0.05). Further, children who had received the diversified meals showed bigger likelihood of achieving Hb increases which belong to the top 30 percent of all reported Hb increases (amounting to 1.40g/dl and more) after 12 months of intervention compared to the CG (p<0.01). It was argued, accordingly, that providing nutritious meals to undernourished tribal Adivasi children increases Hb and reduces anaemia. No significant difference in the distribution of non-anaemic and mildly anaemic children versus moderately and severely anaemic children could be found when comparing a group of children who had received a leaf powder of Moringa and Amaranthus along with diversified meals to the CG (p>0.05) and when comparing a group of children who had received a (low dosed) micronutrient sprinkle along with diversified meals (p>0.05). A cost-effectiveness analysis of 425 locally available foods has been conducted in order to work out those foods delivering highest nutrient density in relation to their retail cost (adjusted for edible portion). Foods from the FGs cereals and millets, vegetables, and roots and tubers belonged more often to the top 30 percent of cost-effective foods as per winter-price analysis (p<0.001) - while also grain legumes became cost-effective as per summer-price analysis (p<0.05). While the overall cost-effectiveness of FGs showed little difference considering winter- and summer price analyses, the cost-effectiveness of specific foods within some of the analyzed FGs did actually change (especially in case of vegetables). It was recommended, accordingly, to use most cost-effective locally available foods to nourish undernourished children and mothers adequately - and to consider also seasonal price changes of foods thereby. The developed aggregate cost-effectiveness indicator covered 38 nutrients. Further, five anti-nutritive elements to be limited in the diet of undernourished individuals had been considered: oxalate, phytate, polyphenols, sodium as well as dietary fibre. The need to process foods rich in anti-nutrients in order to cover the RDAs of undernourished children and mothers was highlighted - working out a categorization of anti-nutritive elements in low (≤ 4th percentile), medium (> 4th until ≤ 8th percentile), high (>8th until ≤ 9.5th percentile) or very high (> 9.5th percentile) contents. On the basis of knowing most cost-effective locally available foods and assessing also their anti-nutritive elements, a weekly meal schedule has been worked out in cooperation with the nutritionist Caroline Stiller (who was the second PhD candidate in this twin PhD project and knows the local setting well). It became clear that the RDAs of moderately malnourished children and their mothers can hardly be fully covered with locally available foods alone - where a deficit of 20 and more percent of the RDA remained with regard to vitamins A, E, B1 and B2, as well as of zinc and linoleic acid (children), with regard to vitamins A, E, B1, B2 and B9, as well as of potassium and linoleic acid (lactating women), with regard to vitamins B1, B2 and B9, as well as of iron, potassium and linolenic acid (pregnant women), and with regard to vitamins B1 and B2, as well as of iron, potassium and linolenic acid (non-pregnant and non-lactating women). It was further found that the costs associated with the suggested cost-effective and nutrient-dense weekly meal schedule exceeded available family budgets (calculated based on n=66 HHs and with respect to consumed portion sizes of children and mothers) by 217 percent in case of children (with a weekly cost of 267 Rs. rather than the available 144 Rs.), and by 200 percent in case of lactating, pregnant as well as non-pregnant non-lactating mothers. The role of government services (AWCs, the PDS, and the MGNREGA), kitchen gardening/wild plant collection, own fishing activities and crop diversification in covering this deficit was enumerated and it was found that AWCs are able to cover the largest part of the weekly financing deficit (amounting to 34 percent in case of children), followed by kitchen gardens/wild plant collection (24 percent). As breastfeeding is deeply rooted in the Santal Adivasi communities (96 percent of mothers, n=275, were found to breastfeed their youngest child - with a mean age of 21.2 months), it is proposed in this dissertation that lactating women should be included as beneficiaries of AWCs in order to cover their nutrient needs and break - finally - the circle of undernutrition where children and mothers need to be seen together, rather than focusing merely on children in the well-known 1000-days window of opportunity.