Nutrition and Health in Developing Countries (eBook)

Dedication 6
Series Editor’s Introduction 7
Foreword 11
Preface 13
Table of Contents 17
Contributors 21
Chapter 1 24
Nutrition and Development: A Historical Perspective 24
1.1 Introduction 24
1.2 The Idea of Progress in Public Health 24
1.3 The Rise of Statistics and Probability 27
1.4 Early Foundations of Preventive Medicine 28
1.5 The Sanitary Idea 29
1.6 Contagion Versus Miasma 30
1.7 Advances in Microbiology 31
1.8 Nutritional Science in the 19Th Century 32
1.9 Infant Mortality and Social Reform 33
1.10 The Emergence of the Vitamins 34
1.11 Further Research on Nutritional Deficiency Diseases 37
1.12 Nutritional Immunology 38
1.13 Vitamin a and Reduction of Child Mortality 38
1.14 Growth in Food Production 40
1.15 Long-Term Trends in Diet 41
1.16 The Decline of Mortality 43
1.17 Graduate Education in Public Health 44
1.18 International Organizations 44
1.18 Conclusions 46
References 47
Chapter 2 56
Maternal Mortality in Developing Countries 56
2.1 Introduction 56
2.2 Magnitude and Causes of Maternal Mortality 57
2.2.1 Measuring Maternal Mortality 57
2.2.2 Medical Causes of Maternal Mortality 59
2.3 Strategies to Reduce Maternal Mortality 61
2.4 Socioeconomic Development, Women’s Education, and Maternal Mortality 62
2.5 Family Planning and Maternal Mortality 63
2.6 Nutrition and Maternal Health 64
2.6.1 Direct Effects of Energy or Micronutrient Defi ciency on Maternal Mortality 65
2.6.2 Malnutrition and the Risk of Obstructed Labour 67
2.6.3 Calcium Defi ciency and the Risk of Preeclampsia 68
2.6.4 Iron Defi ciency and Anemia 69
2.6.5 Vitamin A Defi ciency and the Risk of Anemia or Infection 71
2.6.6 Zinc Defi ciency and the Risk of Haemorrhage or Infection 72
2.6.7 Multiple Micronutrients 73
2.8 Antenatal Care 74
2.9 Training of Traditional Birth Attendants 75
2.10 Access to Professional Delivery Care 75
2.11 Summary and Conclusions 77
References 78
Chapter 3 86
Low Birth Weight and Neonatal Mortality 86
3.1 Introduction 86
3.2 Historical Background 86
3.3 Definitions 87
3.3.1 Neonatal Mortality 87
3.3.2 Perinatal Mortality 87
3.3.3 Low Birth Weight and Intrauterine Growth Restriction 88
3.4 Descriptive Epidemiology 89
3.5 Causes Of Neonatal Death 93
3.6 Influence Of Maternal Factors 93
3.6.1 Maternal Factors and Intrauterine Growth Restriction 93
3.6.2 Maternal Stature and Preterm Birth 94
3.6.3 Maternal Nutrition and Fetal Death 94
3.6.4 Maternal Factors and Early Neonatal Death 95
3.7 Interventions To Improve Neonatal Survival 95
3.7.1 Folic Acid Supplementation 95
3.7.2 Tetanus Toxoid Immunization 96
3.7.3 Syphilis Screening and Treatment 96
3.7.4 Preeclampsia and Eclampsia Prevention (Calcium Supplementation) 96
3.7.5 Intermittent Presumptive Treatment for Malaria 96
3.7.6 Detection and Treatment of Asymptomatic Bacteriuria 97
3.7.7 Antibiotics for Preterm Premature Rupture of Membranes 97
3.7.8 Corticosteroids for Preterm Labor 97
3.7.9 Detection and Management of Breech 98
3.7.10 Labor Surveillance 98
3.7.11 Clean Delivery Practice 98
3.7.12 Resuscitation of Newborn Baby 98
3.7.13 Breast-feeding 98
3.7.14 Prevention and Management of Hypothermia 99
3.7.15 Kangaroo Mother Care 99
3.7.16 Community-Based Pneumonia Case Management 99
3.8 Nutritional Interventions 99
3.8.1 Protein-Energy Supplementation 99
3.8.2 Maternal Iron Supplementation 100
3.8.3 Maternal Iodine Supplementation 100
3.8.4 Antenatal Vitamin A or b-Carotene Supplementation 101
3.8.5 Antenatal Zinc Supplementation 101
3.8.6 Multiple Micronutrient Supplementation 101
3.8.7 Reduction in Childhood Stunting 101
3.8.8 Prevention of Maternal Obesity 102
3.9 Implementation of Interventions To Reduce Low Birth Weight and Neonatal Mortality 102
3.10 Conclusions 102
3.11 Recommendations 103
References 103
Chapter 4 110
Infant Mortality 110
4.1 Introduction 110
4.2 Global Trends 111
4.2.1 Historical Trends: United States 111
4.2.2 Decline in Infant Mortality in Developing Countries 111
4.3 Determinants of Infant Mortality 114
4.3.1 Macrofactors: Socio-Politico-Economic Dimensions 114
4.3.2 Gender 115
4.3.3 Household Socioeconomic Factors 116
4.3.4 Maternal Age, Parity, and Birth Spacing 117
4.3.5 Maternal Nutrition and Infant Mortality 117
4.3.6 Breast-feeding 118
4.4 Direct and Underlying Causes of Infant Mortality 120
4.5 Contributions of Neonatal Mortality To Infant Mortality: Causes and Risk Factors 122
4.6 Interventions For Reducing Infant and Neonatal Mortality 124
4.7 Future Actions 126
References 127
Chapter 5 136
Child Growth and Development 136
5.1 Introduction 136
5.2 Measuring Impaired Growth: Concepts and Indicators 138
5.2.1 Fetal Growth 138
5.2.2 Child Growth Indicators and Their Interpretation 140
5.2.3 The International Reference Population 141
5.2.4 Issues in the Interpretation of Growth Data 142
5.3. Prevalence of Growth Retardation in Developing Countries 144
5.4 Health and Social Consequences of Impaired Growth 151
5.5 Interventions Aimed at Promoting Healthy Growth and Development 154
5.6 Conclusions 157
References 158
Chapter 6 162
Diarrheal Diseases 162
6.1 Introduction 162
6.2 Public Health Importance 162
6.3 Historical Background 163
6.4 Epidemiology 163
6.4.1 Geographical Distribution 163
6.4.2 Risk Factors 163
6.4.3 Incidence 165
6.4.4 Seasonality 166
6.4.5 Duration 166
6.5 Clinical Features/Pathophysiology 167
6.5.1 Major Pathogens Involved in Diarrheal Diseases in Children 167
6.5.2 Pathophysiology 167
6.5.3 Effects of Malnutrition on Mortality 167
6.5.4 Effects of Malnutrition on Morbidity 168
6.5.5 Effects on Growth of Children 169
6.5.6 Effect on Dietary Intake 169
6.5.7 Effects on Nutrient Absorption and Intestinal Function 170
6.5.8 Relationship with Nutrition and Immunity 170
6.5.8.1 Undernutrition 170
6.5.8.2 Vitamin A 170
6.5.8.3 Zinc 171
6.5.8.4 Other Micronutrients 171
6.6 Diagnosis 171
6.7 Treatment 172
6.7.1 Oral Rehydration Therapy 172
6.7.2 Nutritional Management 172
6.7.2.1 Timing of Feeding 172
6.7.2.2 Lactose 173
6.7.2.3 Mixed Diets 173
6.7.2.4 Fiber 174
6.7.2.5 Probiotics 175
6.7.2.6 Prebiotics 176
6.7.2.7 Epidermal Growth Factor 177
6.7.2.8 Short-Chain Fatty Acids 177
6.7.2.9 Glutamine 178
6.7.2.10 Nucleotides 178
6.7.2.11 Lectins 179
6.7.3 Micronutrient Supplementation 179
6.7.3.1 Zinc 179
6.7.3.2 Vitamin A 180
6.7.4 Dietary Management of Persistent Diarrhea 181
6.8 Prevention 181
6.8.1 Breast-Feeding 181
6.8.2 Improved Weaning Practices 182
6.8.3 Use of Safe Water 182
6.8.4 Hand Washing 182
6.8.5 Latrines and Proper Disposal of Human Waste 183
6.8.6 Measles Immunization 183
6.8.7 Nutritional Interventions 183
6.8.7.1 Zinc 183
6.8.7.2 Vitamin A 184
6.8.7.3 Nucleotides 185
6.8.8 Vaccines 185
6.8.9 Other Potential Interventions 186
6.9 Future Directions 186
6.10 Conclusions 187
References 187
Chapter 7 202
Acute Lower Respiratory Infections 202
7.1 Introduction 202
7.2 Public Health Importance 202
7.3 Historical Background 202
7.4 Epidemiology 203
7.4.1 Risk Factors 203
7.4.1.1 Low Birth Weight 203
7.4.1.2 Lack of Breast-Feeding 205
7.4.1.3 Malnutrition 205
7.4.1.4 Micronutrient Status 206
7.4.1.5 Decreased Immunity 207
7.4.1.6 Environmental and Socioeconomic Factors 207
7.4.1.7 Prior Infections 209
7.4.1.8 Other Factors 210
7.4.2 Incidence 210
7.4.3 Seasonality 211
7.4.4 Duration 212
7.4.5 Case Fatality Ratios 212
7.5 Clinical Features/Pathophysiology 213
7.5.1 Clinical Presentation 213
7.5.2 Major Pathogens Involved in Acute Lower Respiratory Diseases in Children 213
7.5.3 Pathophysiology 215
7.5.4 Impact of Acute Respiratory Infections on Nutrition and Growth 217
7.6 Treatment 218
7.6.1 Case Management of Pneumonia 218
7.6.2 Nutritional Interventions for Treatment of Acute Respiratory Infections 218
7.6.2.1 Zinc 218
7.6.2.2 Vitamin A 219
7.6.2.3 Selenium 219
7.7 Prevention 219
7.7.1 Immunization 220
7.7.3 Nutrition 221
7.7.3.1 Breast-Feeding 221
7.7.3.2 Prevention of LBW 221
7.7.3.3 Reduction of Malnutrition 221
7.7.3.4 Zinc Supplementation 221
7.7.3.5 Vitamin A Supplementation 222
7.7.3.6 Selenium Supplementation 222
7.7.4 Other Measures 222
7.8 Future Directions 222
7.8.1 Risk Factors for Pneumonia and Acute Lower-Respiratory Infection 222
7.8.2 Clinical Aspects 223
7.8.3 Prevention 223
7.9 Conclusions 224
References 225
Chapter 8 238
Measles 238
8.1 Introduction 238
8.2 Definition 238
8.3 Public Health Importance 238
8.4 Historical Background 239
8.5 Epidemiology 239
8.6 Pathophysiology 240
8.7 Interaction With Nutrition 241
8.7.1 Effect of Measles on Nutrition 241
8.7.2 Effect of Malnutrition on Measles 241
8.8 Clinical Features 241
8.9 Diagnosis 242
8.10 Treatment 243
8.10.1 Nutritional Support 243
8.10.2 Vitamin A Therapy 244
8.10.3 Vitamin A Dosage 246
8.11 Prevention 246
8.11.1 Measles Vaccine 246
8.11.2 Improving Vitamin A Status of Children 247
8.12 Research Needs 247
8.13 Conclusions 248
References 248
Chapter 9 252
Malaria and Nutrition 252
9.1 Introduction 252
9.2 Historical Background 253
9.2.1 Historical Overview of Malaria 253
9.2.2 Attempts to Eradicate Malaria 253
9.2.3 Modern Approaches to Malaria Control 254
9.2.3.1 Insecticide-Treated Bed Nets 254
9.2.3.2 Vaccine Development 254
9.3 Epidemiology 255
9.3.1 Geographic Distribution and Disease Burden 255
9.3.2 Life Cycle of the Malaria Parasite 256
9.3.3 Classifi cation Schemes of Malaria Endemnicity 258
9.3.4 Clinical Disease 258
9.3.5 Epidemiology of Severe Malaria 259
9.3.6 Diagnosis and Drug Treatment of Malaria 259
9.3.6.1 Diagnosis 259
9.3.6.2 Drug Treatments 259
9.3.7 Host-Parasite Interactions and Immunity 260
9.3.8 Modulating Factors of Malaria Morbidity and Mortality 262
9.4 Effects of Nutrition on Malaria 262
9.4.1 Early Perceptions of the Impact of Nutrition on Malaria 262
9.4.2 Malnutrition and Malaria: Synergism or Antagonism? 263
9.4.2.1 Malnourished Individuals and Malaria Morbidity and Mortality 263
9.4.2.1.1 Clinic-Based Studies. 263
9.4.2.1.2 Early Hospital-Based Studies of Severe Malaria. 263
9.4.2.1.3 Critical Analysis of the Early Hospital-Based Studies. 272
9.4.2.1.4 Modern Hospital-Based Studies of Severe Malaria. 272
9.4.2.1.5 Cross-Sectional Studies of Malariometric Indicators. 273
9.4.2.1.6 Longitudinal Cohort Studies and Effects of Nutrition on Drug-Resistant Malaria. 273
9.4.2.2 Studies in Famine Relief 274
9.4.2.3 Studies in Animals 275
9.4.2.4 Synthesis of Data Concerning Effects of Protein-Energy Malnutrition on Malaria 275
9.4.3 Impact of Malaria on Growth 276
9.4.4 Infl uence of Specific Nutrients on Malaria Morbidity 277
9.4.4.1 Iron 277
9.4.4.2 Zinc 278
9.4.4.3 Vitamin A 279
9.4.4.4 B Vitamins 280
9.4.4.4.1 Folate. 280
9.4.4.4.2 Riboflavin. 281
9.4.4.4.3 Thiamine. 282
9.4.4.5 Vitamin E and Other Antioxidants 282
9.5 Conclusions and Recommendations 283
References 284
Chapter 10 298
Tuberculosis 298
10.1 Introduction 298
10.1.1 Definitions 298
10.1.2 Public Health Importance 298
10.2 Historical Background 299
10.2.1 Antiquity 299
10.2.2 Early Ideas About Tuberculosis 300
10.2.3 Tuberculosis as an Infectious Disease 301
10.2.4 Cod-Liver Oil Therapy 301
10.2.5 BCG Vaccine and Tuberculosis Chemotherapy 302
10.2.6 The Decline of Tuberculosis in Industrialized Countries 302
10.3 Epidemiology 303
10.3.1 Geographic Distribution 303
10.3.2 High-Risk Groups and Risk Factors 304
10.3.3 Incidence and Prevalence of Tuberculosis in Vulnerable Populations 304
10.3.3.1 HIV Infection 304
10.3.3.2 Children 305
10.3.3.3 Older Adults 305
10.3.3.4 Other Populations at Risk 305
10.3.4 Drug-Resistant Tuberculosis 306
10.4 Clinical Features/Pathophysiology 306
10.4.1 Clinical Features of Tuberculosis 306
10.4.2 Pathophysiology 307
10.4.3 Role of Nutrition 308
10.4.3.1 Protein and Energy Status 308
10.4.3.2 Vitamin A 309
10.4.3.3 Vitamin D 310
10.4.3.4 B Complex Vitamins 310
10.4.3.5 Vitamin C 310
10.4.3.5 Other Nutritional Problems 311
10.4.4 Strength of Evidence Regarding Role of Nutrition 311
10.5 Diagnosis 313
10.5.1 Clinical Diagnosis of Latent Tuberculosis Infection 313
10.5.2 Clinical and Laboratory Diagnosis of Active Tuberculosis 313
10.5.2.1 Staining Techniques 314
10.5.2.2 Mycobacterial Culture 314
10.5.2.3 Molecular Methods 314
10.5.2.4 Histopathology 314
10.5.2.5 Specimen Collection and Laboratory Safety 314
10.5.3 Differential Diagnosis 315
10.6 Treatment and Prevention 315
10.6.1 General Considerations 315
10.6.2 Treatment of Active Tuberculosis 315
10.6.2.1 General Treatment Regimens 315
10.6.2.2 Special Circumstances 317
10.6.3 Treatment of Latent Tuberculosis Infection 318
10.6.4 BCG Vaccination 318
10.6.5 Environmental Measures 319
10.7 Summary and Conclusions 319
10.8 Recommendations 319
References 320
Chapter 11 330
Human Immunodeficiency Virus Infection 330
11.1 Introduction 330
11.2 Historical Background 331
11.3 Epidemiology 332
11.3.1 Highest-Risk Groups 332
11.3.2 Prevalence and Incidence 332
11.3.3 Risk Factors 333
11.3.3.1 Transmission of HIV 333
11.3.3.2 Progression of the Disease 334
11.4 Clinical Features/Pathophysiology 334
11.4.1 Clinical Features 334
11.4.1.1 Primary HIV Infection 336
11.4.1.2 Asymptomatic HIV Infection 336
11.4.1.3 Symptomatic HIV Infection 336
11.4.1.4 Acquired Immune Defi ciency Syndrome 336
11.4.2 Pediatric HIV Infection 337
11.4.2.1 Factors Affecting Disease Progression in Children 337
11.4.2.2 Classifi cation of HIV Infection in Children 338
11.4.3 Pathogenesis 339
11.4.4 Role of Nutrition 340
11.4.4.1 The Role of Nutritional Factors in HIV Progression and Transmission 340
11.4.4.2 The Impact of HIV Infection on Nutritional Status 347
11.5 Diagnosis 349
11.6 Treatment 350
11.7 Prevention 350
11.8 Summary and Conclusions 351
References 352
Chapter 12 364
Malnutrition 364
12.1 Introduction 364
12.1.1 Defi nitions and Historical Overview 364
12.2 Measuring Physical Status and Growth 367
12.2.1 Anthropometric Indices of Nutritional Health 367
12.2.2 Growth References 368
12.2.3 Expression of Anthropometry 369
12.2.4 Severe Malnutrition 369
12.3 Patterns and Timing of Growth Retardation 370
12.3.1 Prevalence and Patterns of Global Anthropometric Status 370
12.3.2 Timing of Growth Faltering and Potential for Catch-Up Growth 370
12.4 Epidemiologic Evidence 373
12.4.1 Conceptual Diagram 373
12.4.2 Consequences of Malnutrition 373
12.4.2.1 Mortality 373
12.4.2.2 Infection and Disease 376
12.4.2.3 Functional Outcomes 377
12.4.2.4 Summary 379
12.4.3 Causes of Malnutrition and Poor Growth 379
12.4.3.1 Infection 380
12.4.3.2 Diet 382
12.4.3.3 Relative and Combined Effects of Infection and Poor Diet on Child Growth 385
12.4.4 The Underlying Determinants: Food, Care, and Heath 387
12.4.4.1 Programmatic Implications 387
12.5 Nutrition-Oriented Interventions and Programs: Necessary Elements and Optimal Designs 387
12.5.1 Manuals and Guides to Assist with Designing Programs 389
12.5.2 Treatment of Severe Malnutrition 389
12.6 Research Needs and Priorities 390
12.7 Summary and Conclusions 392
References 392
Chapter 13 400
Vitamin A Deficiency 400
13.1 Introduction 400
13.2 The Nutrient: Vitamin A 400
13.2.1 Structure and Nomenclature 401
13.2.2 Absorption and Transport 402
13.2.3 Metabolism and Functions 402
13.2.3.1 Visual Cycle 402
13.2.3.2 Gene Regulation 404
13.2.4 Dietary Sources and Intake Recommendations 404
13.3 Public Health Significance of Vitamin a Deficiency 408
13.3.1 Prevalence 408
13.3.1.1 Preschool-Aged Children 409
13.3.1.2 Newborns and Neonates 412
13.3.1.3 School-Aged Children 413
13.3.1.4 Women of Reproductive Age 413
13.3.2 Effects on Child Morbidity and Mortality 413
13.3.3 Effects on Infant Morbidity and Mortality 416
13.3.4 Effects on Maternal Morbidity and Mortality 417
13.4 Historical Background 418
13.5 Epidemiology 422
13.5.1 Location 422
13.5.2 Persons at Risk 424
13.5.2.1 Age 424
13.5.2.2 Gender 425
13.5.2.3 Socioeconomic status 425
13.5.3 Periodicity 426
13.5.4 Proximal Causes 427
13.5.4.1 Breast-Feeding 427
13.5.4.2 Complementary Feeding 428
13.5.4.3 Infectious Disease Morbidity 429
13.6 Clinicopathological Features 431
13.6.1 Xerophthalmia 431
13.6.1.1 Night Blindness (XN) 431
13.6.1.2 Conjunctival Xerosis with Bitot’s Spots (X1B) 431
13.6.1.3 Corneal Xerosis (X2), Ulceration, and Necrosis (X3) 432
13.6.2 Infection 433
13.7 Treatment 434
13.8 Prevention 435
13.8.1 Dietary Diversifi cation 436
13.8.2 Fortification 437
13.8.3 Supplementation 438
13.9 Conclusion 440
References 441
Chapter 14 458
Nutritional Rickets and Vitamin DDeficiency 458
14.1 Introduction 458
14.2 Definition 458
14.3 Public Health Importance 459
14.4 Historical Background 460
14.5 Epidemiology 461
14.6 Pathophysiology/Clinical Features 467
14.7 Diagnosis 467
14.8 Treatment 469
14.9 Prevention 470
14.10 Future Directions 472
14.11 Conclusions 472
References 473
Chapter 15 478
Zinc Deficiency 478
15.1 Introduction 478
15.2 Public Health Significance 478
15.3 Historical Background 479
15.4 Epidemiology 479
15.5 Metabolism of Zinc 480
15.5.1 Zinc Absorption 480
15.5.2 Zinc Transport 481
15.5.3 Zinc Storage 481
15.5.4 Zinc Excretion 481
15.6 Biological Functions of Zinc 482
15.6.1 Zinc Metalloenzymes 482
15.6.2 Zinc Fingers 482
15.6.3 Zinc and Biomembranes 482
15.6.4 Zinc and Immune Function 482
15.6.5 Other Functions of Zinc 483
15.7 Pathophysiology of Zinc Deficiency 483
15.7.1 Dietary Sources and Intake of Zinc 483
15.7.2 Absorption and Bioavailability of Zinc 484
15.7.3 Zinc Dietary Requirements 485
15.8 Clinical Manifestations of Zinc Deficiency 486
15.9 Assessment of Zinc Status 487
15.9.1 Plasma or Serum Zinc Concentrations 487
15.9.2 Dietary Assessment 488
15.9.3 Other Methods 488
15.10 Zinc Supplementation as a Public Health Intervention 489
15.10.1 Diarrheal Disease in Children 489
15.10.2 Respiratory Disease in Children 489
15.10.3 Malaria in Children 490
15.10.4 Growth and Development of Children 490
15.10.5 Maternal Health 491
15.10.6 Human Immunodefi ciency Virus Infection 492
15.11 Prevention of Zinc Deficiency 492
15.12 Conclusions 494
15.13 Recommendations 494
References 495
Chapter 16 502
Iron Deficiency and Anemia 502
16.1 Introduction 502
16.2 Defining Anemia and Iron Deficiency 502
16.3 Historical Background 503
16.4 Epidemiology 503
16.4.1 Prevalence of Iron Deficiency and Anemia 503
16.4.2 Risk Factors for Iron Deficiency 504
16.5 Metabolism of Iron 505
16.5.1 Absorption of Iron 505
16.5.2 Transport of Iron 507
16.5.3 Storage of Iron 507
16.5.4 Iron Turnover and Loss 507
16.5.5 Iron-Nutrient Interactions 508
16.6 Role of Iron in Biological Functions 508
16.6.1 Hemoglobin 508
16.6.2 Myoglobin 508
16.6.3 Cytochromes 508
16.6.4 Other Iron-Containing Enzymes 509
16.6.5 Iron and Immune Function 509
16.7 Pathogenesis of Iron Deficiency and Anemia 509
16.7.1 Increased Requirement for Iron 509
16.7.2 Poor Dietary Intake 510
16.7.3 Abnormal Iron Loss 510
16.8 Functional Consequences of Iron Deficiency 510
16.8.1 Anemia and Mortality 511
16.8.2 Birth Outcomes 511
16.8.3 Child Behavior and Development 512
16.8.4 Work Performance and Productivity 512
16.8.5 Heavy Metal Absorption 512
16.8.6 Iron and Infection 513
16.9 Assessment of Iron Nutritional Status 516
16.9.1 Tests for Iron Deficiency 516
16.9.2 The Meaning of Anemia 516
16.9.3 Field Testing for Hemoglobin 517
16.9.4 Detection of Anemia by Clinical Examination 517
16.9.5 Use of Frequency Distributions of Hemoglobin in Assessing Iron Status 517
16.9.6 The Diagnosis of Multiple Conditions Contributing to Anemia 518
16.10 Control of Iron Deficiency 518
16.10.1 Primary Health Care-Based Approaches 518
16.10.1.1 Iron Supplementation 518
16.10.1.2 Control of Intestinal Helminth Infection 520
16.10.2 Nutrition Education and Promotion 520
16.10.3 Fortification 520
16.10.4 Iron Overload 521
16.11 Conclusions 522
16.12 Recommendations 522
References 523
Chapter 17 530
Iodine Deficiency Disorders 530
17.1 Introduction 530
17.2 Public Health Significance 530
17.3 Historical Background 530
17.4 Epidemiology 532
17.4.1 Geographical Distribution 532
17.4.2 Prevalence 533
17.4.3 Risk Factors 534
17.5 Metabolism of Iodine 534
17.5.1 Iodine Absorption and Transport 534
17.5.2 Iodine Storage 534
17.5.3 Synthesis of Thyroid Hormones 535
17.5.4 Transport and Turnover of Thyroid Hormones 535
17.5.5 Thyroid Hormones and Gene Expression 535
17.6 Role of Iodine in Biological Functions 536
17.6.1 Metabolism 536
17.6.2 Growth and Development 536
17.6.3 Brain Development 536
17.6.4 Iodine and Immune Function 537
17.7 Pathophysiology of Iodine Deficiency 537
17.7.1 Dietary Sources and Intake of Iodine 537
17.7.2 Goitrogens 537
17.7.3 Iodine Dietary Requirements 538
17.8 Clinical Manifestations of Iodine Deficiency Disorders 538
17.8.1 Goiter 538
17.8.2 Cretinism 539
17.8.3 Growth and Development 539
17.8.4 Reproductive Failure 540
17.8.5 Perinatal, Infant, and Child Mortality 540
17.9 Assessment of Iodine Status 540
17.9.1 Goiter Rate 541
17.9.2 Urinary Iodine Concentrations 543
17.9.3 Blood Thyroid-Stimulating Hormone 543
17.10 Prevention of Iodine Deficiency Disorders 543
17.10.1 Iodized Salt 544
17.10.2 Oral Iodized Oil 544
17.10.3 Iodized Oil Injections 545
17.10.4 Other Strategies 545
17.11 Conclusions 546
References 546
Chapter 18 554
Multiple Micronutrient Malnutrition 554
18.1 Introduction 554
18.2 Prevalence of Multiple-Micronutrient Malnutrition 556
18.2.1 Women of Reproductive Age 556
18.2.2 Children 557
18.3 Consequences of Multiple-Micronutrient Malnutrition During the Life Cycle 558
18.3.1 Pregnancy 558
18.3.1.1 Two-Way Micronutrient Interactions in Pregnancy 559
18.3.1.2 Prenatal Multivitamin-Mineral Supplements 560
18.3.2 Lactation 567
18.3.3 Childhood 568
18.3.3.1 Growth 568
18.3.3.2 Micronutrient Status 569
18.3.3.3 Morbidity 569
18.3.3.4 Motor and Mental Development 576
18.3.4 Adult Morbidity 578
18.4 Programmatic Implications 579
18.4.1 Improving Dietary Intake 579
18.4.1.1 Behavior Change Programs 579
18.4.1.2 Promoting Animal Production and Home Gardening 581
18.4.2 Fortification 581
18.4.3 Multiple-Micronutrient Supplements 585
18.5 Conclusions 587
References 588
Chapter 19 600
Nutrition in the Elderly in Developing Countries 600
19.1 The Biology of Human Aging and Survival: an Evolutionary Perspective 600
19.1.1 Overview 600
19.1.2 Evolutionary Perspective on Aging 601
19.1.3 The Evolutionary Paradoxes 601
19.1.4 The Biology of Aging 602
19.2 Senescence of Tissue and Organ Function with Aging 602
19.2.1 Function of the Alimentary and Digestive Tract in Aging 604
19.3 Successful Aging, Normative Aging, and Frail Aging of Individuals Within a Population 604
19.4 Demography of Aging of Populations in Developing Countries 604
19.5 The Burden of Chronic Diseases in the Aging 605
19.5.1 Nontransmissible Disease Epidemiology in Developing Country Populations 605
19.5.2 Relationship of Chronic Disease to Diet and Nutrition in Developing Countries 606
19.6 Nutritional Requirements, Nutrient Intake Recommendations, and Guidelines for Healthful Eating for the Elderly 606
19.7 Dietary Intake and Eating Behavior by Elderly in Developing Countries 613
19.7.1 Assessing Dietary Intakes in Older Subjects: Caveats for Developing Countries 613
19.7.2 Patterns of Dietary Consumption in Later Life 614
19.8 Nutritional Deficiency and Excess and its Assessment in the Elderly of Developing Countries 615
19.8.1 Deficiency and Undernutrition States in Developing Country Elderly 615
19.8.1.1 Diagnosing Undernutrition 616
19.8.2 Excess and Overnutrition States in Developing Country Elderly 617
19.8.2.1 Diagnosing Overnutrition 618
19.9 Conclusions 618
References 619
Chapter 20 624
The Nutrition Transition and Its Relationship to Demographic Change 624
20.1 Introduction 624
20.2 Background: Patterns of the Nutrition Transition 625
20.3 Economic Change and the Nutrition Transition 628
20.4 Demographic Change and the Nutrition Transition 630
20.4.1 Key Dimensions of World Urbanization 630
20.4.2 Proportion Living in Cities 631
20.4.3 Concentrated Population Growth 632
20.4.4 Shift in the Proportion of Poor Living in Cities 632
20.5 The Nature and Pace of the Nutrition Transition 633
20.5.1 Japanese and Korean Accelerated Model 633
20.5.2 Low-Income Countries with Rapid Income Increases: The Case of China 634
20.5.3 Degenerative Dietary and Epidemiologic Transition with Limited or No Economic Improvement 634
20.5.4 Other Low-Income Countries 636
20.6 Conclusion 636
References 637
Chapter 21 640
The Rapid Emergence of Obesity in Developing Countries 640
21.1 Introduction 640
21.2 Methods 641
21.2.1 Survey Design and Sample 641
21.2.2 Measures 641
21.3 Results 642
21.3.1 The Prevalence in Lower- and Middle-Income Countries 642
21.3.1.1 Latin America 642
21.3.1.2 Asia 642
21.3.1.3 Western Pacific 649
21.3.1.4 Middle East 649
21.3.1.5 Sub-Saharan Africa 650
21.3.2 Obesity Trends in Lower- and Middle-Income Countries 650
21.3.2.1 Brazil 653
21.3.2.2 China 654
21.3.2.3 Indonesia 654
21.3.2.4 Vietnam 655
21.3.2.5 Kuwait 655
21.3.2.6 Mauritius 655
21.3.2.7 Russia 655
21.3.2.8 Western Pacific 656
21.4 Implications for Public Health 656
21.4.1 Obesity 656
21.4.2 Physical Activity 657
21.4.3 Interactions of Obesity and Activity 657
21.4.4 Genetic Component 657
21.5 Research and Policy Implications 657
References 658
Chapter 22 662
Rapid Urbanization and the Challenges of Obtaining Food and Nutrition Security 662
22.1 Introduction 662
22.2 Increasing Urban Poverty and Undernutrition 663
22.2.1 Poverty Data 664
22.2.2 Nutrition Data 664
22.3 Challenges to Obtaining Food, Nutrition, and Health Security in an Urban Environment 665
22.3.1 The Importance of Cash, Employment, Food Prices, and Agriculture for Urban Livelihood and Food Security 665
22.3.1.1 Dependence on Cash for Food 665
22.3.1.2 Urban Marketing Systems, Supermarkets, and Food Price Policies 665
22.3.1.3 Urban Employment 666
22.3.1.4 Urban Food Production 667
22.3.2 Stronger Formal Safety Nets and Weaker Informal Safety Nets? 667
22.3.3 The Increased Labor Force Participation of Women and Its Consequences for Child Care 668
22.3.3.1 Women’s Work Patterns and Child Care Use in Urban and Rural Areas 668
22.3.3.2 Impact of Maternal Work on Child Care Practices 669
22.3.4 Lifestyle Changes 670
22.3.4.1 Dietary Patterns 670
22.3.4.2 Activity Patterns 671
22.3.4.3 Health Implications 671
22.3.5 Increased Availability of Services, But Questionable Accessby Poor Households 672
22.3.6 Environmental Contamination 672
22.3.6.1 Air Pollution 672
22.3.6.2 Water and Food Contamination 673
22.3.7 Legal Rights 673
22.3.7.1 Urban Agriculture 673
22.3.7.2 Informal Marketing Activities Such as Street Foods 674
22.3.7.3 Insecurity of Tenure and Development Activity 674
22.4 Implications for Policy and Research 674
22.5 Conclusions 676
References 677
Chapter 23 680
Impact of Parental Tobacco Use on Child Malnutrition and Survival 680
23.1 Introduction 680
23.2 Historical Background 681
23.3 Epidemiology of Tobacco Use 681
23.3.1 World Health Organization Conceptual Framework for the Tobacco Epidemic 681
23.3.2 The African Region 683
23.3.3 The Region of the Americas 684
23.3.4 The Eastern Mediterranean Region 685
23.3.5 The European Region 685
23.3.6 The Southeast Asia Region 686
23.3.7 The Western Pacific Region 686
23.4 Tobacco Use and Child Malnutrition 687
23.4.1 Indonesia 688
23.4.2 Bangladesh 689
23.4.3 India 690
23.4.4 “Going Up in Smoke”: Tobacco Versus Food 690
23.5 Other Adverse Effects of Parental Smoking on Child Health 691
23.5.1 Respiratory Health 691
23.5.2 Low Birth Weight 691
23.5.3 Circulating Antioxidants 692
23.5.4 Increased Health Care Utilization 692
23.6 Parental Tobacco Use and Child Mortality 692
23.7 Tobacco Control 693
23.7.1 Indirect Advertising and Trademark Diversification 694
23.7.2 Industry Programs to Counter Antitobacco Science 694
23.7.3 Offshore Strategies 696
23.7.4 Industry-Funded Youth Smoking Prevention Programs 696
23.7.5 Appeals to International Trade Organizations and Representatives 696
23.8 Conclusions 696
23.9 Recommendations 697
References 697
Chapter 24 700
Humanitarian Emergencies 700
24.1 Introduction 700
24.1.1 Defi nitions and History 700
24.1.2 Objective of the Chapter 702
24.2 Epidemiology of Humanitarian Emergencies 702
24.2.1 Global Trends in Number of Conflicts, Refugees, and Internally Displaced Persons 702
24.2.2 Main Causes of Morbidity and Mortality 704
24.2.3 Communicable Diseases, with Specific Focus on HIV/AIDS/STI 705
24.2.4 Malnutrition and Food Security 706
24.2.5 Reproductive Health 707
24.2.6 Mental Health 708
24.3 Programming 709
24.4 New Developments and Challenges 711
24.4.1 New Humanitarianism and Humanitarian Reform 711
24.4.2 Other Initiatives for Improvement of Accountability and Quality 713
24.4.3 Health, Nutrition, and Conflicts in a Changing Global Environment 713
24.5 Summary Recommendations for The Way Forward 714
24.5.1 Policy Recommendations 715
24.5.2 Technical Recommendations 715
24.5.3 Training Recommendations 716
References 716
Chapter 25 722
Tackling Nutrient Deficiencies and Life-Threatening Disease 722
25.1 Introduction 722
25.2 Food and Disease, Cause and Effect 723
25.3 Nutrient-Disease Synergies and Nutrient Deficiencies 724
25.4 Responding to Malnutrition and Disease Through Food 726
25.4.1 General Food Distribution 729
25.4.2 Supplementary Feeding 734
25.4.3 Therapeutic Feeding 736
25.4.4 Addressing Micronutrient Deficiencies 737
25.5 Conclusions and Future Directions 738
References 739
Chapter 26 744
The Indian Ocean Tsunami of December 26, 2004 744
26.1 Introduction 744
26.2 Loss and Damage Caused by the Tsunami 745
26.3 Response to the Tsunami 746
26.3.1 Relief and Recovery Phase 746
26.3.2 Coordination of Response 747
26.3.3 Financial Support 748
26.3.4 Lessons Learned for Next Disaster Response 748
26.4 Impact of Tsunami on Health and Nutrition: Focus on Indonesia 749
26.4.1 Preexisting Health and Nutrition Situation 749
26.4.2 Impact on Health and Nutrition 750
26.4.2.1 Communicable Diseases 750
26.4.2.2 Handling Dead Bodies 751
26.4.2.3 Injuries 751
26.4.2.4 Mental Health Problems 752
26.4.3 Interventions for Health and Nutrition 753
26.4.3.1 Disease and Health and Nutrition Surveillance Systems 753
26.4.3.2 Improving Health and Nutritional Status of the Affected Population 754
26.4.3.3 The Need for Micronutrients in Emergencies 754
26.4.3.4 Example of Distributing Vitamin and Mineral Preparations: Tsunami Relief in Indonesia 756
26.5 Conclusions and Recommendations 757
References 758
Chapter 27 762
The Impact of Supermarkets on Farmers, Consumers, and Food Security in Developing Countries 762
27.1 Introduction 762
27.2 The Supermarket Revolution: What’s Happening? 763
27.3 An Analytical Perspective on the Impact of Supermarkets 766
27.3.1 Consumers and Public Health 768
27.3.2 Small Farmers 768
27.3.3 Food Security 769
27.4 The Development Dimensions of the Supermarket Revolution 769
27.4.1 Supermarkets: Complements or Substitutes for a Public Role in Marketing? 770
27.4.2 Macroeconomic and Growth Issues 770
27.5 Putting Supermarkets in a Food Policy Framework 771
27.6 Conclusions 772
References 773
Chapter 28 776
Homestead Food Production for Improving Nutritional Status and Health 776
28.1 Introduction 776
28.2 The Contribution of Homestead Food Production to Increasing Food Security. 779
28.3 Is Homestead Food Production Economically Viable for Households and Communities? 781
28.4 Assessing the Impact of Homestead Food Production on Nutrition and Health: the Case of Vitamin a Deficiency 782
28.4.1 Conceptual Framework for Impact of Food-Based Programs on Nutritional Status and Health 782
28.4.2 How Food Consumption Can Increase Vitamin A Status 783
28.4.2.1 Studies of Plant Foods for Combating Vitamin A Deficiency 785
28.4.2.2 Factors Determining Bioavailability and Bioconversion of Carotenoids Studies 786
28.4.2.2.1 Host-Related Factors. 786
28.4.2.2.2 Food-Related Factors. 787
28.4.2.2.3 Meal-Related Factors. 788
28.4.2.3 Guidelines for Maximizing Vitamin A Intake from Plant Foods 788
28.4.3 Health Effects of Increased Consumption of Vitamin A-Rich Foods 790
28.4.3.1 How the Consumption of Vitamin A-Rich Foods Can Affect Health 790
28.4.3.2 Evidence of Impact of Vitamin A-Rich Foods on Health in Developing Countries Beyond a Vitamin A Effect 790
28.4.3.3 Summary of Role of Foods for Health 791
28.4.4 Impact of Homestead Food Production on Nutritional Status and Health 791
28.4.4.1. Example of Impact of Homestead Food Production on Nutritional Status or Health 793
28.4.4.2 Approaches for Assessing Impact of HFP on Nutritional Status or Health 794
28.5 Homestead Food Production Contributes to Development Through Empowerment of Women 796
28.6 A Programmatic Approach to Increase and Improve Homestead Food Production Practices 796
28.7 Conclusions and Recommendations 798
References 799
Chapter 29 804
Food Policy 804
29.1 Introduction 804
29.2 Definitions 804
29.3 Food Policy: What’s Different? 806
29.3.1 The Food and Health Dimension 806
29.3.2 The Poverty and Development Dimension 807
29.4 Food Policy in Historical Perspective 808
29.5 The Sectoral Perspective 810
29.6 Lessons for Food Policy 813
29.6.1 Three Things Not to Do 813
29.6.2 Three Things to Do 813
References 814
Chapter 30 816
Need, Efficacy, and Effectiveness of Multiple Vitamin/Mineral Supplements for Young Children and Considerations for Programs 816
30.1 Introduction 816
30.2 Existence and Consequences of Multiple Vitamin and Mineral Deficiencies 818
30.2.1 Vitamin and Mineral Deficiencies in Infants and Young Children 818
30.2.2 Why Supply a Combination of Vitamins and Minerals? 819
30.2.3 Need for Vitamins and Minerals is Particularly High in Emergencies 819
30.3 Methods Used for Reviewing Impact of Increased Intake of Vitamins and Minerals by Children 820
30.4 Vitamin and Mineral Supplements, Recommended Intake, and Composition of Supplements Used 820
30.5 Efficacy of Multimicronutrient Supplements for Children 828
30.5.1 Micronutrient Status 828
30.5.1.1 Hemoglobin and Anemia 828
30.5.1.2 Ferritin and Iron Deficiency 832
30.5.1.3 Serum Retinol, Vitamin a Deficiency 832
30.5.1.4 Serum Zinc and Zinc Deficiency 832
30.5.1.5 Iron and Zinc Interaction 836
30.5.1.6 Other Micronutrients 836
30.5.2 Growth 837
30.5.3 Morbidity and Mortality 840
30.5.3.1 Evidence from Reviewed Studies 840
30.5.3.2 Could Vitamin and Mineral Supplementation Increase Morbidity? 841
30.5.3.3 Other Ways to Reduce Morbidity 842
30.5.4 Development (Cognitive, Learning Ability) 843
30.6 Effectiveness of Multivitamin and Mineral Supplements for Children 843
30.7 Issues to be Considered for Programs That Provide Vitamins and Minerals 844
30.7.1 Dosage and Kind of Preparation 844
30.7.2 Duration and Frequency of Distribution 845
30.7.3 Supplementation in the Case of Infectious Diseases, Including Malaria 845
30.7.4 Concurrent Supplementation with Other Vitamin and Mineral Supplements or Fortified Foods 846
30.8 Conclusions and Recommendations 846
References 848
Chapter 31 854
How Much Do Data Influence Programs for Health and Nutrition? 854
31.1 Introduction 854
31.1.1 Paradigm Shifts in the Field of Public Health/Nutrition 855
31.1.2 Data to Inform Public Health/Nutrition Programming 857
31.2 Design and Implementation of a Surveillance System 858
31.2.1 Conceptual Model, Indicators, and Questionnaire 860
31.2.2 Sampling 862
31.2.3 Quality Control 863
31.2.4 Data Entry, Data Cleaning, and Data Analysis 864
31.3 Communicating the Results 865
31.4 Identifying Priorities for and Monitoring of Programs: Use of Surveillance Data 866
31.4.1 Vitamin A Capsule Distribution 866
31.4.2 Vaccination Programs 867
31.4.3 Food Fortification 868
31.4.4 Assessing a Program’s Impact Under Real-Life Circumstances 869
31.5 Understanding Causes of Malnutrition: Surveillance Findings 870
31.5.1 Factors Related to Child Malnutrition in Bangladesh 870
31.5.2 Effectiveness of Homestead Food Production 871
31.5.3 Macroeconomic Policies and Malnutrition 872
31.5.4 Indicators for Impact of Crises on Health and Nutrition 872
31.5.5 Dual Burden of Overweight and Obesity 874
31.5.6 Effects of Parental Smoking on Malnutrition and Childhood Mortality 875
31.5.7 Parental Education: Every Year Counts 876
31.6 Conclusions and Recommendations 876
References 877
Chapter 32 882
The Economics of Nutritional Interventions 882
32.1 Introduction 882
32.2 The Costs of Undernutrition 883
32.3 The Costs of Nutrition Interventions 888
32.4 Cost-Effectiveness and Benefit: Cost of Nutrition Interventions 890
32.5 Conclusions 891
References 893
Chapter 33 896
Ethics in Public Health Research 896
33.1 Introduction 896
33.2 Basic Ethical Principles 897
33.2.1 Respect for Persons 897
33.2.2 Beneficence 898
33.2.3 Justice 898
33.3 Application of Ethical Principles 899
33.3.1 Informed Consent 899
Case Study 33.1 900
33.3.2 Confidentiality 902
Case Study 33.2 902
33.3.3 Standards of Care 903
Case Study 33.3 904
33.3.4 Responsibility to the Study Community After Completion of Research 905
Case Study 33.4 906
33.4 Ethical Review Processes 908
33.5 Conclusions 909
References 909
Chapter 34 910
Beyond Partial Analysis 910
34.1 Introduction 910
34.2 Public Policy Analysis 912
34.2.1 The Technical Frame 913
34.2.1.1 Causal Analysis 913
34.2.1.2 Analysis of Interventions 915
34.2.2 The Economic Frame 916
34.2.3 The Social/Normative Frame 919
34.2.4 The Political Frame 922
34.2.5 The Administrative/Organizational Frame 924
34.2.6 The Legal Frame 927
34.2.7 Multiple/Integrative Frames 928
34.3 Implications for Truly "Public" Health and Nutrition 929
34.3.1 Implications for Practice 930
34.3.2 Implications for Research 931
34.3.3 Implications for Training 933
34.4 Conclusions 934
References 935
Index 938