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Biomedical subjects

Martin W Bloem

Publications and source records attributed to Martin W Bloem.

11 recordsLinked to original sources
PubMed2007

Paternal smoking is associated with increased risk of child malnutrition among poor urban families in Indonesia.

OBJECTIVE: Paternal smoking is highly prevalent in Asia, and tobacco may account for a large proportion of household expenditures among poor families. We sought to characterise the relationship between paternal smoking, child malnutrition and food expenditures. DESIGN: Data on smoking, household expenditures and child malnutrition were examined in a stratified multistage cluster sample of households in the Indonesia nutrition surveillance system. Main outcome measures were child wasting (weight-for-height Z-score < - 2), underweight (weight-for-age Z-score < - 2) and stunting (height-for-age Z-score < - 2), and severe wasting, underweight and stunting (defined by respective Z-scores < - 3). SETTING: In total, 175,583 households from urban slum areas in Indonesia. SUBJECTS: Children 0-59 months of age. RESULTS: The prevalence of paternal smoking was 73.8%. After adjusting for child gender and age, maternal age and education, and weekly per capita household expenditures, paternal smoking was associated with child stunting (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.08-1.14, P < 0.0001), severe wasting (OR = 1.17, 95% CI 1.03-1.33, P = 0.018) and severe stunting (OR = 1.09, 95% CI 1.04-1.15, P < 0.001). In households where the father was a smoker, tobacco accounted for 22% of weekly per capita household expenditures, with less money spent on food compared with households in which the father was a non-smoker. CONCLUSIONS: Among poor families in urban slum areas of Indonesia, paternal smoking diverts household money from food to tobacco and exacerbates child malnutrition.

Adult↗
PubMed2005

Micronutrient deficiencies and gender: social and economic costs.

Vitamin and mineral deficiencies adversely affect a third of the world's people. Consequently, a series of global goals and a serious amount of donor and national resources have been directed at such micronutrient deficiencies. Drawing on the extensive experience of the authors in a variety of institutional settings, the article used a computer search of the published scientific literature of the topic, supplemented by reports and published and unpublished work from the various agencies. In examining the effect of sex on the economic and social costs of micronutrient deficiencies, the paper found that: (1) micronutrient deficiencies affect global health outcomes; (2) micronutrient deficiencies incur substantial economic costs; (3) health and nutrition outcomes are affected by sex; (4) micronutrient deficiencies are affected by sex, but this is often culturally specific; and finally, (5) the social and economic costs of micronutrient deficiencies, with particular reference to women and female adolescents and children, are likely to be considerable but are not well quantified. Given the potential impact on reducing infant and child mortality, reducing maternal mortality, and enhancing neuro-intellectual development and growth, the right of women and children to adequate food and nutrition should more explicitly reflect their special requirements in terms of micronutrients. The positive impact of alleviating micronutrient malnutrition on physical activity, education and productivity, and hence on national economies suggests that there is also an urgent need for increased effort to demonstrate the cost of these deficiencies, as well as the benefits of addressing them, especially compared with other health and nutrition interventions.

Adult↗
PubMed2005

Food-for-work programs in Indonesia had a limited effect on anemia.

Indonesia's economic crisis of late 1990s lowered consumption of micronutrient-rich foods, which increased the prevalence of micronutrient deficiencies, including anemia. As a postcrisis response, 5 nongovernmental organizations (NGOs) implemented Food for Work (FFW) programs to protect food consumption levels and nutritional status by providing rice, sometimes combined with oil and/or pinto beans. An independent evaluation assessed the effect of the FFW programs on nutrition outcomes, particularly anemia. A quasi-experimental design was used in which 1500 beneficiary and 1500 control households were randomly selected and followed in each of 3 urban and 2 rural sites. Baseline data were collected before program implementation and subsequently at approximately 6-mo intervals for 2.5 y. The poor were found to be appropriately targeted, and program participation ranged from 4 to 18 mo. The proportion of households with debts ranged from 32 to 70%; although it was higher among beneficiaries than controls, it increased among controls, but not beneficiaries. However, only among urban poor mothers in Surabaya were the odds of anemia at endline lower when participating in the FFW program (0.60, 95%CI [0.40-0.89]). Other risk factors for anemia in mothers and children included nutritional status (anemia at baseline, low BMI, receipt of vitamin A capsule, child age) and socioeconomic status (maternal education, having official residency in the area, income level). Thus, postcrisis FFW programs had limited effect on anemia, the main identified nutritional problem. Closer attention is required to the potential for affecting nutritional outcomes through FFW, including food aid quality and quantity and complementary nonfood interventions. Micronutrient deficiencies should be addressed directly via supplements and fortified foods.

Adult↗
PubMed2004

Risk factors for xerophthalmia among mothers and their children and for mother-child pairs with xerophthalmia in Cambodia.

OBJECTIVE: To characterize the risk of xerophthalmia among nonpregnant women and their children and the risk factors for households in which both mother and child have xerophthalmia. METHODS: In case-control analyses of more than 15 000 households in the National Micronutrient Survey of Cambodia, univariate and multivariate logistic regression were used to estimate odds ratios (ORs) for nonpregnant mothers, children, and mother-child pairs with xerophthalmia. MAIN OUTCOME MEASURES: Risk factors for xerophthalmia. RESULTS: Of 10 942 children aged 18 to 60 months and 9587 nonpregnant women, the adjusted prevalence of xerophthalmia was 0.7% and 1.9%, respectively. In multivariate analyses, a child was at higher risk of xerophthalmia when the mother had xerophthalmia (OR = 4.36; 95% confidence interval [CI], 2.25-8.46), and a mother was at higher risk of xerophthalmia when a child had the disease (OR = 9.21; 95% CI, 3.56-23.82). Households were at higher risk for having both mother and child with xerophthalmia if there was a history of diarrhea in the mother (OR = 6.48; 95% CI, 1.49-28.23) or in a child younger than 60 months (OR = 10.16; 95% CI, 1.55-66.62) in the last 2 weeks. CONCLUSIONS: Xerophthalmia clusters among mothers and children in Cambodia and is associated with diarrheal disease. Interventions are needed to address vitamin A deficiency and diarrheal disease at the household level.

Adult↗
PubMed2004

Macro shocks and micro outcomes: child nutrition during Indonesia's crisis.

A survey of households in rural Java is used to assess the nutritional impact of Indonesia's drought and financial crisis of 1997/1998. A time-age-cohort decomposition reveals significant nutritional impacts. However, child weight-for-age (WAZ) remained constant throughout the crisis, despite rapid increases in food prices and the consequent household consumption shock. The evidence is consistent with the hypothesis that within households, mothers buffered children's caloric intake, resulting in increased maternal wasting. However, reductions in the consumption of high-quality foods further resulted in increased prevalence of anemia for both mothers and children. The combined effects were particularly severe for cohorts conceived and weaned during the crisis.

Child↗
PubMed2003

Association of household rice expenditure with child nutritional status indicates a role for macroeconomic food policy in combating malnutrition.

Macroeconomic food policies have the potential to reduce malnutrition by improving access to food, a determinant of nutritional status. However, very little is understood about the mechanisms and the magnitude of the effects of macroeconomic food policies such as food price policies on nutritional status. Data collected by the Nutritional Surveillance Project on a total of 81,337 children aged 6-59 mo in rural Bangladesh between 1992 and 2000 were used to examine how changes in rice price affect child underweight. Rice consumption per capita declined only slightly during the period but rice expenditure per capita varied widely due to fluctuations in rice price. Rice expenditure was positively correlated with the percentage of underweight children (r = 0.91, P = 0.001). Households were found to spend more on nonrice foods as their rice expenditure declined, and nonrice expenditure per capita was negatively correlated with the percentage of underweight children (r = -0.91, P = 0.001). Expenditure on nonrice foods per capita increased with the frequency with which nonrice foods were consumed (P < 0.05) and with the diversity of the diet (P < 0.001). The findings suggest that the percentage of underweight children declined when rice expenditure fell because households were able to spend more on nonrice foods and thereby increase the quantity and quality of their diet. We hypothesize that macroeconomic food policies that keep the price of food staples low can contribute toward reducing child underweight.

Bangladesh↗
PubMed2003

Integrating strategies for combating vitamin A deficiency: successes in Asia.

Indonesia and Bangladesh were among the first countries to distribute vitamin A capsules (VAC) to underfives in the early 1970s. Since then, VAC coverage has increased very much. In Indonesia, VAC are now distributed to underfives in two special months. In Cambodia, VAC distribution started less than a decade ago and coverage is yet <50%. After being linked to National Immunization Days, it is now linked to Immunization Outreach, which seems a good strategy. Because VAC are only distributed to underfives and postpartum women, and because coverage is usually around 50-80%, other strategies are implemented simultaneously. Recent HKI-evaluations found that promotion of dark-green leafy vegetables and eggs in Indonesia increased their consumption and improved vitamin A status. In Bangladesh, underfives and women of households with a homestead garden and/or poultry had a lower risk of vitamin A deficiency. The HKI Homestead Food Production Program aims at improving homestead food production activities in order to increase production and consumption of vitamin A-rich foods. Food fortification in Indonesia reaches large parts of the population, while coverage is related to socio-economic status and urban/rural location. The successes in Asia emphasize the need for multiple strategies and integration with other health and agricultural programs.

Adult↗
PubMed2002

The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia.

Iron deficiency anemia among young children is a large health problem. However, there is little information about the prevalence of anemia among young infants because it has been assumed that normal, breast-fed infants have adequate iron stores until 4-6 mo of age. We analyzed cross-sectional data from the HKI/GOI Nutrition and Health Surveillance System in rural Java, Indonesia from Sept. 1999 to Feb. 2001 for hemoglobin (Hb) of 3- to 5-mo-old breast-fed infants (n = 990) and related factors. The prevalence of Hb < 90 g/L was 13.4%, < 100 g/L, 37%, and < 110 g/L, 71%. Multiple logistic regression analysis revealed that normal birth weight infants (>2500 g) of anemic mothers (Hb < 120 g/L) had an odds ratio (OR) [95% confidence interval (CI)] of 1.81 [1.34-2.43] to have a low Hb (< 100 g/L) compared with infants of nonanemic mothers with a normal birth weight. Infants of nonanemic mothers but with low birth weight had an OR of 1.15 [0.61-2.16], and those with low birth weight and anemic mothers of 3.68 [1.69-8.02]. Other risk factors included stunting (OR 1.70 [0.97-2.95]), a young mother (<20 y, OR 1.54 [0.95-2.49]), lower maternal education and living in West Java or East Java. Considering that maternal postpartum Hb reflects Hb during pregnancy, that anemia among mothers in this population is due mainly to iron deficiency, and that children born to anemic mothers are at higher risk of a low Hb, we hypothesize that low infant Hb in this population is due to iron deficiency. Intervention studies in iron deficient populations should test this hypothesis.

Birth Weight↗
PubMed2002

Process indicators for monitoring and evaluating vitamin A programs.

Vitamin A deficiency disorders (VADD) are a major public health problem in many parts of the world and one of the leading underlying causes of childhood mortality. Therefore, VADD control programs can contribute to reaching the international development goal of reducing childhood mortality by two thirds by the year 2015. Although economic development leads to greater food consumption of animal products (the most bioavailable source of vitamin A), other strategies, such as high dose vitamin A capsule supplementation, fortification and food production programs have been developed to tackle the VADD problem independent of economic development efforts. In this article, we discuss the essential role of process indicators in monitoring and fine-tuning VADD control and prevention programs toward ensuring that such programs will be more effective and cost-effective.

Diet↗
PubMedDate not supplied

Measles blindness.

Measles remains a major problem in developing countries, where it affects an estimated 30 million children a year and causes up to one million deaths annually. Measles blindness is the single leading cause of blindness among children in low income countries, accounting for an estimated 15,000 to 60,000 cases of blindness per year. There is a close synergism between measles and vitamin A deficiency that can result in xerophthalmia, with corneal ulceration, keratomalacia, and subsequent corneal scarring or phthisis bulbi. High-dose oral vitamin A supplementation is recommended for all children with measles in developing countries. Higher measles immunization coverage to interrupt measles transmission and interventions aimed at improving vitamin A nutriture of children are the main strategies to prevent measles blindness.

Blindness↗