clove and Malnutrition

Although the trends of international reports show an increase in overweight and obesity, even in developing countries, there are still areas of the world, such as Sub-Saharan Africa, strongly affected by undernutrition. Specifically, in Madagascar, the percentage of stunted children under 5 is extremely high. Furthermore, the COVID-19 pandemic is expected to increase the risk of all forms of malnutrition, especially in low-income countries, including Madagascar, with serious intergenerational repercussions. This narrative review aims at investigating eating habits and cooking methods of the Malagasy population, addressing sustainable healthy diets through promotion of novel foods. While novel foods are a recent concept, there are data that describe how they may contribute to counteract food insecurity and malnutrition considering context and place. Efforts to promote native, traditional foods as

Topics: Animals; Cooking; Diet; Edible Insects; Feeding Behavior; Humans; Madagascar; Malnutrition; Micronutrients; Moringa

Madagascar is cited as one of the most vulnerable countries to the effects of climate change, with significant impacts to the health of its population. In this study, the vulnerability of Madagascar's health sector to climate change was assessed and appropriate adaptation measures were identified. In order to assess climate risks, vulnerability and identify adaptation options, the Madagascar Ministry of Public Health as well as the National Meteorological and Hydrological Service worked in close collaboration with a team of local experts to conduct a literature review, field surveys, and analyses of current and future climate and health trends. Four climate-sensitive diseases of primary concern are described in the study: acute respiratory infections (ARI), diarrhea, malnutrition, and malaria. Baseline conditions of these four diseases from 2000 to 2014 show acute respiratory infections and diarrheal diseases are increasing in incidence; while incidence of malnutrition and malaria decreased over this period. To assess future impacts in Madagascar, this baseline information was used with climate projections for the two scenarios-RCP 4.5 and RCP 8.5-for the periods 2016⁻2035, 2036⁻2070 and 2071⁻2100. Future climate conditions are shown to exacerbate and increase the incidence of all four climate sensitive diseases. Further analysis of the exposure, sensitivity and adaptive capacity to the climate hazards suggests that the health sector in four regions of Madagascar is particularly vulnerable. The study recommends adaptation measures to improve the monitoring and early warning systems for climate sensitive diseases, as well as to reduce population vulnerability.

Topics: Acclimatization; Adaptation, Physiological; Climate Change; Diarrhea; Environmental Monitoring; Health Status Indicators; Humans; Incidence; Madagascar; Malaria; Malnutrition; Population Surveillance; Public Health Surveillance; Respiratory Tract Infections

Over half of the world's children suffer from poor nutrition, and as a consequence they experience delays in physical and mental health, and cognitive development. There is little data evaluating the effects of delivery of lipid-based, nutrition supplementation on growth and development during pregnancy and early childhood within the context of a scaled-up program. Furthermore, there is limited evidence on effects of scaled-up, home-visiting programs that focus on the promotion of child development within the context of an existing, national nutrition program.. The MAHAY ("smart" in Malagasy) study uses a multi-arm randomized-controlled trial (RCT) to test the effects and cost-effectiveness of combined interventions to address chronic malnutrition and poor child development. The arms of the trial are: (T0) existing program with monthly growth monitoring and nutritional/hygiene education; (T1) is T0 + home visits for intensive nutrition counseling within a behavior change framework; (T2) is T1 + lipid-based supplementation (LNS) for children 6-18 months old; (T3) is T2 + LNS supplementation of pregnant/lactating women; and (T4) is T1 + intensive home visiting program to support child development. There are anticipated to be n = 25 communities in each arm (n = 1250 pregnant women, n = 1250 children 0-6 months old, and n = 1250 children 6-18 months old). Primary outcomes include growth (length/height-for-age z-scores) and child development (mental, motor and social development). Secondary outcomes include care-giver reported child morbidity, household food security and diet diversity, micro-nutrient status, maternal knowledge of child care and feeding practices, and home stimulation practices. We will estimate unadjusted and adjusted intention-to-treat effects. Study protocols have been reviewed and approved by the Malagasy Ethics Committee at the Ministry of Health in Madagascar and by the institutional review board at the University of California, Davis. This study is funded by the Strategic Impact Evaluation Fund (SIEF), the World Bank Innovation Grant, the Early Learning Partnership Grant, the Japan Scaling-up for Nutrition Trustfund, and Grand Challenges Canada. The implementation of the study is financed by Madagascar's National Nutrition Office.. Current Controlled Trials ISRCTN14393738 . Registered June 23, 2015.

Topics: Breast Feeding; Child Development; Cluster Analysis; Cost-Benefit Analysis; Dietary Supplements; Female; Health Promotion; House Calls; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Madagascar; Malnutrition; Maternal-Child Health Services; Parenting; Pregnancy; Prenatal Care; Research Design

Madagascar is among the 10 highest burden countries for malnutrition. Protein-energy malnutrition, anemia, and vitamin deficiencies are major public health problems. Hunger is exacerbated by an annual locust invasion. The current policy of large-scale government spraying of pesticides from planes is logistically complex, costly, and damaging to the environment.. Our research aimed to study the feasibility of turning the locust invasion into a protein-rich food supply for families and an economic opportunity for youth.. We conducted 20 focus group discussions (FGDs) with females and males aged 18-24 and 25 years or older and with female artisans in 6 swarm communes in Madagascar's south to understand enablers and barriers to collection, preparation, and consumption of locusts.. Enablers include consumption by all ages in Antandroy culture and perception of locusts as a delicacy, tasty, and free. Family members have different roles in the collection and preparation of locusts. Local technologies for mass collection include digging trenches in fields and entrapment via sisal netting. Common preparations include boiling in salted water, drying, skewering, frying, and grinding locusts into flour. Disablers include pesticide contamination of locusts and the view that locusts are a famine food.. Our research provided a first step in demonstrating the feasibility of transforming locust infestations into economic and nutritional opportunities in a fragile environment with high levels of poverty and malnutrition. It contributes to advocacy in Madagascar to end the use of pesticides. It responds to the government desire to address the protein-energy malnutrition burden and youth poverty in an integrated way.

Topics: Adolescent; Adult; Female; Humans; Madagascar; Male; Malnutrition; Pesticides; Plague; Protein-Energy Malnutrition; Qualitative Research; Sustainable Development; Young Adult

The Vakinankaratra region of Madagascar has a high burden of child undernutrition which, in addition to poor psychosocial stimulation, is a strong risk factor of poor child development. However, there are limited studies evaluating the relations between developmental deficits, child nutrition outcomes, and home stimulation in the region. The purpose of this study was to assess the development of children aged 11-13 months in relation to their nutritional status and to examine parental home stimulation attitudes and practices in the Vakinankaratra region.. Cognitive (n = 36), language (n = 36), motor (n = 36), and socioemotional (n = 76) development were assessed using the Bayley Scales of Infant and Toddler Development III. Household stimulation environment was evaluated using the family care indicators survey. Stunting (length-for-age z-score < - 2) and underweight (weight-for-age z-score < - 2) were determined using the 2006 WHO growth standards. Perceptions of and barriers to greater home stimulation for children were collected using focus group discussions among parents and in-depth interviews with community nutrition agents.. Almost all mothers reported that parent-child interaction with talk and play was very important. Alarmingly high stunting rates (> 69%) were observed in this subsample. Limited time and tiredness were the major barriers to home stimulation mentioned by parents and confirmed by key informants. Children had a very limited variety of play materials, and most of the mothers used household objects (75%) and materials from outside the house (71%) as children's toys. Composite cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]) scores were low. Fine motor, cognitive, and receptive and expressive language scores were correlated [0.4 < r < 0.7, p < 0.05].. The very high stunting rates and very low performance on cognitive, motor, language, and socioemotional development assessments of children in the Vakinankaratra region require urgent attention.

Topics: Child Development; Child, Preschool; Growth Disorders; Home Environment; Humans; Infant; Infant Nutrition Disorders; Infant, Newborn; Madagascar; Malnutrition; Mother-Child Relations; Nutritional Status; Parent-Child Relations; Parenting

Although the children malnutrition in Madagascar and the environmental pollution of this country has been widely discussed, there is no research on the differences in toxic elements accumulation in human body in dependence on nutritional status of Malagasy. Nine elements concentration (Al, As, Cd, Cr, Hg, Ni, Pb, Sn and Sb) was determined in scalp hair of 103 schoolgirls (8–15 years old), living in two areas: urban – close to Antananarivo (UR) and rural Berevo region (RU). Samples were analysed by an inductively coupled plasma optical emission spectrometer. The nutritional status was evaluated by Cole’s index. Underweight was related to higher accumulation of Al, Cd and Cr in the hair girls, and more common among girls living in RU than UR region (42 %

Topics: Adolescent; Cadmium; Child; Environmental Monitoring; Female; Hair; Humans; Madagascar; Malnutrition; Nutritional Status; Residence Characteristics; Trace Elements

Topics: Caregivers; Cross-Sectional Studies; Energy Intake; Feeding Behavior; Female; Foods, Specialized; Humans; Infant; Infant Nutritional Physiological Phenomena; Madagascar; Male; Malnutrition; Meals; Mothers; Nutritional Status; Prevalence; Rural Population; Socioeconomic Factors

malnutrition due to inadequate food supply is a major challenge in low- and middle-income countries. The purpose of this study is to identify the sociocultural drivers of malnutrition.. we conducted a qualitative study in the Amoron´I Mania region, Madagascar. The study involved pregnant women, mothers and fathers, grandmothers and health actors such as "matrones", community workers and health workers. A total of 24 semi-structured individual interviews and 6 focus groups were used to collect data. Thematic analysis was used.. malnutrition refers to a lack of food and undernourishment. It revolves around the amount of rice consumption, socio-cultural factors and insufficient financial resources. Vulnerable groups were mainly composed of children and pregnant women. Severe malnutrition including signs was reported, but there was evidence for local adaptation. Thus, families were trying by different means to fight against malnutrition.. the socio-cultural context modulates knowledge and perception of the causes, the manifestations and the vulnerability or non-vulnerability of an individual as well as the severity of malnutrition.

Topics: Adolescent; Adult; Aged; Female; Focus Groups; Food Supply; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Interviews as Topic; Madagascar; Male; Malnutrition; Middle Aged; Perception; Pregnancy; Qualitative Research; Rural Population; Severity of Illness Index; Vulnerable Populations; Young Adult

Malnutrition and accessible high-quality protein food sources are two of the world's alimentary challenges. Edible insects are nowadays recognized as a possible functional food solution with lower environmental impacts and beneficial health effects.. In this context, the aim of the present study is to evaluate Madagascar cockroach (Gromphadorhina portentosa) flour supplementation effects on a malnourished mice model, considering its effects on metabolism, adiposity, and inflammatory liver profiles.. Male Swiss mice are divided into five groups and fed with experimental diets for eight weeks, including a standard diet (ST) ad libitum, AIN93 ad libitum (AIN), insect flour-enriched AIN93 (AIN+IM), AIN-40% feed restriction (AIN-FR), and insect flour-enriched AIN-40% of feed restriction (AIN-FR+IM). The metabolic profiles, adipose tissue, biochemical parameters, and liver IL-6 and IL-10 expression are evaluated.. The main findings show a body weight and metabolism improvement followed by an increased recovery of the adipocyte area in the AIN-FR+IM group when compared to the AIN-FR malnourished group. Reduced hepatic IL-6 and increased IL-10 expression are also detected in the AIN-FR+IM group.. The results show that insect flour supplementation enhances both body weight and adiposity gain/recovery. The results also show hepatic improvement of inflammatory markers.

Topics: Animals; Cockroaches; Diet; Dietary Supplements; Flour; Liver; Madagascar; Male; Malnutrition; Mice; Patents as Topic

Topics: Adolescent; Adult; Agriculture; Child; Child, Preschool; Droughts; Food Insecurity; Humans; Madagascar; Malnutrition

50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III) was initiated to help address stunting and developmental delay. We report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of Ifanadiana in southeastern Madagascar in 2016.. The data are from a cross-sectional analysis of the 2016 wave of IHOPE panel data (a population-representative cohort study begun in 2014). We interviewed women ages 15-49 using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. We analyzed ECDI data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if ECDI z scores were > 1 standard deviation below study mean. Covariates included demographics, adult involvement, household environment, and selected child health factors. Variables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level.. Of 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. This was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had > = 4 stimulation activities in past 3 days. Greater paternal engagement (OR 1.5 (1.09, 2.07)) was associated with increased delay vs. international norms. Adolescent motherhood (OR. 4.09 (1.40, 11.87)) decreased children's development vs. peers. Engagement from a non-parental adult reduced odds of delay for both outcomes (OR (95%CI = 0.76 (0.63, 0.91) & 0.27 (0.15, 0 48) respectively). Stunting was not associated with delay risk (1.36 (0.85, 2.15) or low development (0.92 (0.48, 1.78)) when controlling for other factors.. In this setting of high child malnutrition, stunting is not independently associated with developmental risk. A low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. Stimulation from non-parent adults is associated with lower odds of delay.

Topics: Adolescent; Adult; Child; Child, Preschool; Cohort Studies; Cross-Sectional Studies; Developmental Disabilities; Female; Growth Disorders; Humans; Infant; Madagascar; Male; Malnutrition; Middle Aged; Risk Factors; Young Adult

Topics: Child; Child Health; Child Mortality; Child, Preschool; Drinking Water; Health Services Accessibility; Humans; Madagascar; Malnutrition; Poverty; Sanitation; Vaccination Coverage; Vulnerable Populations

Madagascar has adopted strategies to fight against maternal malnutrition, but the evaluation of their implementation is not effective.Purpose of research: The present study aims to describe beneficiary appreciation of interventions to fight maternal malnutrition and to identify their expectations.. A qualitative study was conducted in the Amoron’i Mania region, Madagascar. The study included mothers of children under 5, pregnant women, and other family members and community members (fathers, grandmothers, matrons and community workers). Six focus groups and 16 individual interviews were conducted to collect the data. The thematic analysis was used.. Food supplementation, improved production of agriculture and livestock, and nutrition education, operated by NGOs, are the best-known interventions. The health centers were not mentioned as interveners and their interventions were ignored. The effectiveness of the intervention is generally judged on the benefits perceived by the beneficiaries. Interveners working on a project basis were assessed as unsustainable. Two main problems were mentioned: first, the insufficiency of agricultural production resulting in the inaccessibility of the ingredients required for the nutrition education, and second the low coverage of the interventions. The improvement of agricultural production is the main suggestion mentioned to fight against maternal undernutrition.. Beneficiaries thought that existing interventions in the region are insufficient to address the problem of malnutrition among mothers.

Topics: Agriculture; Female; Focus Groups; Food Supply; Health Education; Humans; Madagascar; Malnutrition; Maternal Nutritional Physiological Phenomena; Mothers; Pregnancy; Qualitative Research

Child undernutrition is a global health issue that is associated with poor sanitation and an altered intestinal microbiota. Immunoglobulin (Ig) A mediates host-microbial homeostasis in the intestine, and acutely undernourished children have been shown to have altered IgA recognition of the fecal microbiota. We sought to determine whether chronic undernutrition (stunting) or intestinal inflammation were associated with antibody recognition of the microbiota using two geographically distinct populations from the Afribiota project. Fecal bacteria from 200 children between 2 and 5 years old in Antananarivo, Madagascar, and Bangui, Central African Republic (CAR), were sorted into IgA-positive (IgA+) and IgA-negative (IgA-) populations by flow cytometry and subsequently characterized by 16S rRNA gene sequencing to determine IgA-bacterial targeting. We additionally measured IgG+ fecal bacteria by flow cytometry in a subset of 75 children.. Stunted children (height-for-age z-score ≤ -2) had a greater proportion of IgA+ bacteria in the fecal microbiota compared to non-stunted controls. This trend was consistent in both countries, despite the higher overall IgA-targeting of the microbiota in Madagascar, but lost significance in each country individually. Two of the most highly IgA-recognized bacteria regardless of nutritional status were Campylobacter (in CAR) and Haemophilus (in both countries), both of which were previously shown to be more abundant in stunted children; however, there was no association between IgA-targeting of these bacteria and either stunting or inflammatory markers. IgG-bound intestinal bacteria were rare in both stunted and non-stunted children, similar to levels observed in healthy populations.. Undernourished children carry a high load of intestinal pathogens and pathobionts. Our data suggest that stunted children have a greater proportion of IgA-recognized fecal bacteria. We moreover identify two putative pathobionts, Haemophilus and Campylobacter, that are broadly targeted by intestinal IgA. This study furthers our understanding of host-microbiota interactions in undernutrition and identifies immune-recognized microbes for future study.

Topics: Bacteria; Central African Republic; Child, Preschool; Feces; Female; Growth Disorders; Humans; Immunoglobulin A; Immunoglobulin G; Madagascar; Male; Malnutrition; RNA, Ribosomal, 16S

Topics: Child; Child, Preschool; Dietary Supplements; Growth and Development; Humans; Lipids; Madagascar; Malnutrition

The prison population in low-income countries is a group vulnerable to undernutrition, particularly incarcerated women. The aim of the study is to assess the nutritional status of women in prison and to determine the social profile and prison conditions related to undernutrition.. A cross-sectional study was conducted among 125 women prisoners in Antanimora prison located in the city of Antananarivo, Madagascar. All women detained for 3 months or more at the time of the survey were included in the study. Data collection was conducted in May and June 2013. A survey of women and anthropometric measurements were carried out to collect the data.. The proportion of undernourished female prisoners is 38.4%. Five percent of pregnant and lactating women and 44.3% of non-lactating and non-pregnant women are undernourished. The factors related to undernutrition of women prisoners are: taking two meals a day instead of three meals (p = 0.003), insufficient energy intake (p < 0.001), incarceration duration of more than 10 months (p < 0.001), absence of family visits (p = 0.013) and lack of financial assistance from family (p = 0.013).. Improving the prisoners' diets and assistance from family both help to fight against prisoner undernutrition in prisons.

Topics: Adolescent; Adult; Cross-Sectional Studies; Diet; Energy Intake; Female; Humans; Lactation; Madagascar; Malnutrition; Middle Aged; Nutritional Status; Pregnancy; Pregnancy Complications; Prisoners; Young Adult

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Cohort Studies; Diarrhea; Female; Health Surveys; Humans; Hypertension; Infant; Infant, Newborn; Madagascar; Male; Malnutrition; Middle Aged; Rural Population; Sex Distribution; Urban Population; Young Adult

Universal salt iodization (USI) was adopted in Madagascar in 1995 within the framework of a worldwide policy to eliminate iodine deficiency disorders. Despite early USI adoption, there are no representative data on the iodine status of the Malagasy population. The aims of this study were to determine the iodine status of the Malagasy population and to assess the use of adequately iodized salt among households. We randomly sampled women of reproductive age (WRA) using a national, two-stage, stratified cross-sectional survey in 2014. Casual urine from WRA and salt samples from the household containing WRA were collected to measure urinary iodine concentration (UIC) and to assess household salt iodine content. Data from 1,721 WRA in 1,128 households were collected and analysed. The national median UIC was 46 μg L

Topics: Adult; Cluster Analysis; Cross-Sectional Studies; Female; Humans; Iodine; Madagascar; Malnutrition; Nutrition Surveys; Nutritional Status; Young Adult

Topics: Child; Child Mortality; Child, Preschool; Delivery of Health Care; Disease Outbreaks; Female; Growth Disorders; Humans; Hygiene; Madagascar; Malnutrition; Maternal Mortality; Measles; Political Systems; United Nations; Vaccination Coverage

Seasonal variation affects nutrition particularly in contexts where people's food consumption depends on their production of food. Assessing the effect of the season on nutrition status can help us to identify strategies to address undernutrition. This study aims to measure the variations in food consumption and the incidence of undernutrition according to season, and to identify the factors associated with the incidence of undernutrition.. A cohort study was conducted among 608 mothers aged between 18 and 45 years living in the Amoron'i Mania Region of Madagascar. Inclusion in the study occurred during the post-harvest season, and mothers were followed until the end of the next lean period (7 months). A dichotomous variable of the frequency of consumption of various foods was used to establish variation in food consumption. Body Mass Index < 18.5 kg/m. During the lean season, the frequency of consumption of leafy green vegetables, peanuts, fish, and eggs decreased significantly. In contrast, the frequency of fruit, legumes, and non-leafy green vegetables consumption increased significantly. The prevalence of undernutrition (based on the BMI and/or MUAC) among mothers increased from 19.6% in the post-harvest period to 27.1% in the lean period (p < 0.001). The incidence of undernutrition (based on the BMI and/or MUAC) during the follow-up was 12.2%. The factors related to undernutrition were low and medium score of movable property possession (Adjusted RR = 3.26 [1.33-7.94] and Adjusted RR = 2.48 [1.01-6.10]), no toilet (Adjusted RR = 1.76 [1.07-2.91]), and pregnancy (Adjusted RR = 2.92 [1.42-6.04]) (based on the MUAC only for pregnancy).. This study highlights the variation in the frequency and type of food consumption and subsequent deterioration in mothers' nutritional status during the lean season. Economic, hygiene, and reproductive factors were associated with undernutrition. Analyzing the existing interventions to fight maternal undernutrition is necessary to determine whether or not seasonality is considered and addressed.

Topics: Adolescent; Adult; Cohort Studies; Diet; Female; Humans; Madagascar; Malnutrition; Middle Aged; Mothers; Pregnancy; Prevalence; Seasons; Young Adult

Global recognition that the complex and multicausal problems of malnutrition require all players to collaborate and to invest towards the same objective has led to increased private sector engagement as exemplified through the Scaling Up Nutrition Business Network and mechanisms for blended financing and matched funding, such as the Global Nutrition for Growth Compact. The careful steps made over the past 5 to 10 years have however not taken away or reduced the hesitation and scepticism of the public sector actors towards commercial or even social businesses. Evidence of impact or even a positive contribution of a private sector approach to intermediate nutrition outcomes is still lacking. This commentary aims to discuss the multiple ways in which private sector can leverage its expertise to improve nutrition in general, and complementary feeding in particular. It draws on specific lessons learned in Bangladesh, Côte d'Ivoire, India, Indonesia, and Madagascar on how private sector expertise has contributed, within the boundaries of a regulatory framework, to improve availability, accessibility, affordability, and adequate use of nutritious foods. It concludes that a solid evidence base regarding the contribution of private sector to complementary feeding is still lacking and that the development of a systematic learning agenda is essential to make progress in the area of private sector engagement in nutrition.

Topics: Bangladesh; Consumer Product Safety; Cote d'Ivoire; Developing Countries; Diet; Food; Food Labeling; Humans; India; Indonesia; Infant; Infant Nutritional Physiological Phenomena; Madagascar; Malnutrition; Nutrition Policy; Nutritive Value; Private Sector; Public Sector; World Health Organization

The benefits of including nutritional education in programmes that tackle moderate and severe acute malnutrition remain poorly documented. This study in Madagascar evaluated the nutritional status of children who took part in an innovative programme that included maternal education, on completion and after a year.. Each year, this outpatient programme admits 2400 malnourished children from six months to 59 months in the lower districts of Antananarivo, Madagascar. Children were drawn by lots, and their anthropometric data were measured. A descriptive retrospective longitudinal study was conducted on 573 children who took part between 2010 and 2013.. The programme lasted an average of 38 days and, on completion, 82.2% had reached the recovery threshold, and 16.2% had moved up to mild malnutrition. This was achieved with food supplements of 720 kcal per day, despite the Malagasy Public Health recommendation of 1000-1500 kcal per day. After one year, 79.1% were still above the recovery threshold, and 15% had mild malnutrition. The recovery rate was higher for children under 24 months of age (odds ratio 2.9, 95% confidence interval 1.93-4.59).. Most children who attended this malnutrition programme with maternal education in Madagascar reached the recovery threshold on completion and had maintained it after one year.

Topics: Child Nutrition Disorders; Child, Preschool; Female; Health Education; Humans; Infant; Longitudinal Studies; Madagascar; Male; Malnutrition; Maternal Behavior; Nutritional Status; Retrospective Studies

Malnutrition among children population of less developed countries is a major health problem. Inadequate food intake and infectious diseases are combined to increase further the prevalence. Malnourishment brings to muscle cells loss with development of cardiac complications, like arrhythmias, cardiomyopathy and sudden death. In developed countries, malnutrition has generally a different etiology, like chronic diseases. The aim of our study was to investigate the correlation between malnutrition and left ventricular mass in an African children population.. 313 children were studied, in the region of Antsiranana, Madagascar, with age ranging from 4 to 16 years old (mean 7,8 ± 3 years). A clinical and echocardiographic evaluation was performed with annotation of anthropometric and left ventricle parameters. Malnutrition was defined as a body mass index (BMI) value age- and sex-specific of 16, 17 and 18,5 at the age of 18, or under the 15th percentile. Left ventricle mass was indexed by height2.7 (LVMI).. We identified a very high prevalence of children malnutrition: 124 children, according to BMI values, and 100 children under the 15th percentile. LVMI values have shown to be increased in proportion to BMI percentiles ranging from 29,8 ± 10,8 g/m2.7 in the malnutrition group to 45 ± 15,1 g/m2.7 in >95th percentile group. LVMI values in children < 15th BMI percentile were significantly lower compared to normal nutritional status (29,8 ± 10,8 g/m2,7 vs. 32,9 ± 12,1 g/m2,7, p = 0.02). Also with BMI values evaluation, malnourished children showed statistically lower values of LVMI (29,3 ± 10,1 g/m2,7 vs. 33,6 ± 12,5 g/m2,7, p = 0.001).. In African children population, the malnourishment status is correlated with cardiac muscle mass decrease, which appears to be reduced in proportion to the decrease in body size.

Topics: Adolescent; Child; Child, Preschool; Female; Heart Ventricles; Humans; Madagascar; Male; Malnutrition; Organ Size

This study aimed to understand consumers' habits and belief structures concerning local food products and to develop a new snack as a way to fight against children malnutrition in Madagascar. A large variety of natural food resources grow in Madagascar, like Moringa oleifera (MO) which leaves are rich in nutrients but not consumed. First, a survey conducted in four areas of Madagascar revealed that MO leaves are known for their health benefits but infrequently consumed, probably because of their low satiating power and strong odor. In the studied areas, different levels of consumption were observed, which may be linked to varying levels of familiarity with MO by the local populations, this in turn resulting from different situations regarding geographical and historical availability. In contrary, resources such as cassava are perceived as having negative effects on health but are widely consumed because they are cheap, liked by children and satiating. The second step in the study aimed to propose products that could increase MO consumption without completely changing food practices. The acceptability of snacks associating cassava roots and MO was evaluated by means of hedonic tests performed by children. Between the snacks tested, the preferred snack contained the highest quantity of MO and was sweetened. There was no effect of area on the acceptance of the formulated snacks. This work is an evaluation of the potential of MO in the diet of malnourished population.

Topics: Adult; Child; Consumer Behavior; Diet; Feeding Behavior; Female; Food Preferences; Humans; Madagascar; Male; Malnutrition; Manihot; Moringa oleifera; Nutritive Value; Satiation; Snacks; Surveys and Questionnaires; Sweetening Agents; Taste; Vegetables

Madagascar is severely affected by the problem of children malnutrition. The present study aimed at exploring school children Malagasy parents' food practices and beliefs structures about the nutritional value of foods, to better understand the causes of this malnutrition. A combination of Focus Groups (72 participants), and questionnaires (1000 interviewees) was used to evaluate the food beliefs and the nutritional habits of low income parents of school age children in urban and rural areas of Antananarivo and Antsiranana. The respondents' beliefs were shown to focus not only on the nutrient and energetic composition of food, but also to involve more general relations between food and health and particularly the sanitary properties of food. Compared with such sanitary properties, nutrient content was not considered to be the priority in food choice and food preparation. The food category considered to be the most nutritive was cereals, ahead of protein foods, or vegetables and fruit. Nutritional beliefs were not the same in the Antananarivo and Antsiranana areas, nor between urban and rural areas of Antsiranana. Different socio-economic contexts, food availability and information may explain these differences. This study could guide actors involved in nutrition promotion to adapt to specific areas their nutrition programmes in the fight against malnutrition.

Topics: Adult; Child; Edible Grain; Feeding Behavior; Female; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Madagascar; Male; Malnutrition; Middle Aged; Nutritional Status; Nutritive Value; Oryza; Parents; Residence Characteristics; Schools; Socioeconomic Factors; Surveys and Questionnaires; Vegetables; Young Adult

Topics: Case-Control Studies; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Madagascar; Male; Malnutrition; Poverty; Retrospective Studies; Risk Factors; Tuberculosis

Nutritional and hygienic practices contribute to high morbidity and mortality rates related to malnutrition in Madagascar. This study, a research effort that brought together charitable organisations, non-governmental organisations (NGOs) and university collaborators, investigates women's health knowledge in the Anosy region of Madagascar. The needs assessment sought to characterise women's knowledge and understanding of nutrition and hygiene. Eight focus groups of 13-60 women each were conducted in the seven most impoverished communes of the Anosy region (n=373). Participants were recruited with the aid of a UK-Malagasy partnered NGO, Azafady. Study findings show that women fully understand the interplay between poor nutrition, hygiene and malnutrition but are unable to change everyday practices because the barriers to better nutrition and hygiene seem beyond their control. These findings may be used to prioritise projects and research seeking to improve nutrition and hygiene, thus reducing malnutrition in the Anosy region.

Topics: Female; Focus Groups; Food Supply; Health Knowledge, Attitudes, Practice; Humans; Hygiene; Madagascar; Malnutrition; Needs Assessment; Nutrition Assessment; Poverty Areas; Water Supply; Women

The parents 'educational conditions are one of the factors of health inequalities among children. During May 2009, the parents' instruction level of children admitted at the triage unit of a Pediatric Service in Antananarivo, Madagascar was evaluated and related to the severity of their children' health status and to the mode of reference. All the surviving children (from 2 months to 15 years old) were included in this study. Patients were classified by the IMCI guideline and we analyzed the educational level of their mothers. Each patient was classified as severe illness or without severe illness, according to IMCI algorithm. The quality of referring physician was recorded: public physicians, liberal physicians, nurses, or without referral. Among 296 children, 9 (3%) died before admission, 217 (75.6%) were included. Among them, 123 (56.7%) had a severe illness and 38,2% general signs of danger. The severity (92.3 versus 54.4%; P = 0.003), the number of severe dehydration (15.4 versus 3.9%; P = 0,027) and malnutrition (15.4 versus 4.4%; P = 0.039) were related with a poor parents educational level. The referral agents were mostly liberal physicians (56.7%), public physicians (26.7%) or nurses (1.8%). Mothers with higher educational level preferred to attend liberal physicians (58 versus 41.9%; P = 0.1). The reference delay was shorter if there was a severe illness (6.41 versus 19.6 days; P < 0.000) or no medical referral (51.1 versus 24.4%; P > 0.000). Despite the fact that access to hospital care was respectful of a two-step process (85.3%), the number of patients with severe illness was high among families with low educational level. Theses results suggest to educate in priority the mother with low education, in order to recognize the general signs of danger and facilitate early first health care.

Topics: Adolescent; Algorithms; Anemia; Child; Child, Preschool; Dehydration; Diagnosis-Related Groups; Diarrhea; Educational Status; Emergencies; Emergency Service, Hospital; Female; Fever; Hospitals, Urban; Humans; Infant; Madagascar; Male; Malnutrition; Mothers; Pneumonia; Prospective Studies; Referral and Consultation; Severity of Illness Index; Socioeconomic Factors

The main public health issue in Madagascar at the beginning of the 21st century still involves transmissible infectious diseases including re-emerging diseases such as bubonic plague and emerging diseases such as HIV/AIDS, dengue fever and Chikungunya virus infection. Health and hygiene especially access to clean water is still poor especially in rural areas. No improvement in the public health situation with regard to malaria, schistomosomiais or cysticercosis as well as non-infectious diseases such as protein-energy malnutrition is expected within the next decade.

Topics: Anemia, Sickle Cell; Animals; Bites and Stings; Communicable Diseases; Delivery of Health Care; Demography; Diabetes Mellitus; Geography; Humans; Madagascar; Malnutrition; Neoplasms; Public Health; Sanitation