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Patrick Kolsteren

Publications and source records attributed to Patrick Kolsteren.

14 recordsLinked to original sources
PubMed2006

Monitoring food and nutrient availability in a nationally representative sample of Bolivian households.

The study objective was to estimate food and nutrient availability in Bolivian households using data from the nationally representative under the Programme for the household surveys undertaken yearly from 1999 to 2002 Improvement of Surveys and the Measurement of Living Conditions in Latin America and the Caribbean (MECOVI). In the present study, we analysed data from four repeated, cross-sectional surveys and applied European Data Food Networking (DAFNE) methodology for post-harmonising the data. Raw data of 19 483 households in Bolivia (3035 in 1999, 4857 in 2000, 5845 in 2001 and 5746 in 2002) were retrieved from the databases of the national household surveys. Results showed that the Bolivian diet is characterised by higher availability of foods of plant origin (cereals, fruits, potatoes and vegetables). Meat, milk and their products follow in the dietary preferences of Bolivians. Disparities in food availability within the country were also observed. Rural households systematically recorded lower amounts of food available, in comparison with the urban ones. Households of higher social status recorded higher availability values for all food groups, except for potatoes and cereals. Findings suggest that Bolivian households of lower socio-economic status prefer energy-dense and cheaper food sources. We concluded the dietary and socio-demographic data collected in the MECOVI household surveys could serve nutrition surveillance purposes. In addition, the application of DAFNE methodology for post-harmonising the data allows both national and international comparisons.

Animals↗
PubMed2006

Iron solubility compared with in vitro digestion-Caco-2 cell culture method for the assessment of iron bioavailability in a processed and unprocessed complementary food for Tanzanian infants (6-12 months).

The Fe solubility test is a commonly used, easy and relatively cheap in vitro tool for predicting Fe bioavailability in food matrices. However, the outcome of a recent field trial comparing the effect on Fe status of Tanzanian infants of processed v. unprocessed complementary foods (CF), with otherwise the same composition, challenged the validity of this test for predicting Fe bioavailability. In the solubility test, significant more soluble Fe was observed in processed compared with unprocessed foods (mean 18.8 (sem 0.21) v. 4.8 (sem 0.23) %; P<0.001). However, in the field trial, no significant difference in Fe status was seen between processed and unprocessed CF groups after 6 months' follow-up. Therefore, twenty-four samples of these CF (twelve processed and twelve unprocessed batches) were analysed in triplicate for Fe availability using an in vitro digestion-Caco-2 cell culture method and results were compared with solubility results. Significantly more soluble Fe was presented to Caco-2 cells in the processed compared with unprocessed samples (mean 11.5 (sem 1.16) v. 8.5 (sem 2.54) %; P=0.028), but proportionally less Fe was taken up by the cells (mean 3.0 (sem 0.40) v. 11.7 (sem 2.22) %; P=0.007). As a net result, absolute Fe uptake was lower (not significantly) in processed compared with unprocessed CF (mean 1.3 (sem 0.16) v. 3.4 (sem 0.83) nmol/mg cell protein; P=0.052). These data clearly demonstrate that the Fe solubility test was not a good indicator of Fe bioavailability in these particular food matrices. In contrast, the results of an in vitro Caco-2 model supported the effects observed in vivo.

Biological Availability↗
PubMed2006

Is the 2000 CDC growth reference appropriate for developing countries?

In 2000, the Centers for Disease Control and Prevention (CDC) produced a revised growth reference. This has already been used in different settings outside the USA. Using data obtained during a nutritional survey in Madagascar, we compare results produced by using both the 2000 CDC and the 1978 National Center for Health Statistics (NCHS)/World Health Organization (WHO) growth references. We show that changing the reference has an important impact on nutritional diagnosis. In particular, the prevalence of wasting is greatly increased. This could generate substantial operational and clinical difficulties. We recommend continued use of the 1978 NCHS/WHO reference until release of the new WHO multi-country growth charts.

Age Factors↗
PubMed2005

A concise overview of national nutrition action plans in the European Union Member States.

OBJECTIVE: This study presents an overview of national nutrition action plans in the member states of the European Union (EU), before its enlargement in 2004. In addition, their compliance with key recommendations of the World Health Organization, as documented in the First Action Plan for Food and Nutrition Policy and the Global Strategy on Diet, Physical Activity and Health, has tentatively been evaluated on the basis of the policy documents published. DESIGN: Literature review of publicly available policy national plans on nutrition and physical activity. SETTING: Member states of the EU before enlargement in May 2004. RESULTS: The development of national nutrition action plans is gaining momentum. Six of the 15 EU member states - namely, Sweden, Finland, Denmark, France, The Netherlands and the UK - have an operational nutrition policy and four of them have published an elaborated description of their nutrition policy in English. By the end of 2004, another four countries are expected to have their plan finalised. The available nutrition action plans generally seem to comply with international recommendations, although large variations are observed between the member states in terms of terminology, nutritional recommendations, institutional framework, nutritional scope, social groups targeted and monitoring and evaluation structures. CONCLUSIONS: Although the importance of nutritional surveillance, a comprehensive approach to nutritional problems and stakeholder involvement is recognised by the action plans, the justification for it is vaguely described. This paper advocates for proper evaluation and documentation of interventions in public health nutrition and nutrition policies.

European Union↗
PubMed2005

Perceptions of growth monitoring and promotion among an international panel of district medical officers.

The growth chart has been proposed as an educational tool to make the child's growth visible to both health workers and caregivers and to enhance communication between them. In the case of growth faltering, this would trigger timely corrective measures. Although the relevance of growth monitoring and promotion (GMP) has often been questioned in the literature, opinions of District Medical Officers responsible for local implementation of GMP are unknown. The aim of this qualitative research was to explore the perceptions and difficulties of an international panel of District Medical Officers regarding GMP. As an exploratory study, in-depth interviews of an international panel of District Medical Officers (n=19) were conducted. Data were coded using the QSR Nudist 5.0 software. A discrepancy between intended purposes and practice of GMP was detected at two levels. First, lack of participation of care-givers was reported. Second, the District Medical Officers expressed a restrictive interpretation of the concept of growth monitoring. The communication with parents was never reported as a means or a result of GMP, neither as an evaluation criterion of programme efficiency. The growth chart was mainly considered a tool intended to be used by health services for the purpose of diagnosis. This two-fold discrepancy between the intention of international policy-planners and practice of local programme implementers could be a crucial factor affecting the performance of GMP. More emphasis should be put on social communication and involvement of caregivers.

Adult↗
PubMed2005

Feeding practices and factors contributing to wasting, stunting, and iron-deficiency anaemia among 3-23-month old children in Kilosa district, rural Tanzania.

Infants in Tanzania are particularly vulnerable to under-nutrition during transition from breastmilk (as the only source of nourishment) to solid foods. A cross-sectional study was undertaken in Kilosa district in Tanzania to determine the feeding practices and the extent of wasting, stunting, and iron-deficiency anaemia. The study was done in two stages: in the first stage, a 24-hour dietary assessment was conducted to identify the type of complementary foods given and the eating habits according to age for 378 children aged 3-23 months. In the second stage, a progressive recruitment of 309 infants aged six months was made to measure weight, length, haemoglobin (Hb) concentration, zinc protoporphyrin concentration, and malaria parasitaemia. Birth-weight, the potential contributing factor to under-nutrition and iron-deficiency anaemia, was obtained from the children's clinic cards. The 24-hour dietary assessment revealed that children consumed mainly a thin porridge prepared from maize flour as complementary food. Carbohydrates contributed most energy (on average 69%), followed by fats (18.6%) and protein (on average 12.1%). The complementary food co-vered only 15%, 20%, and 27% of the recommended iron intake for children aged 6-8, 9-11 and 12-23 months respectively. The mean Hb concentration was 9.3 +/- 1.9 g/dL, 68% of the infants were moderately anaemic (7 < or =11 g/dL), and about 11% were severely anaemic with Hb below 7 g/dL, while 21% were non-anaemic Hb (> or =11 g/dL). Equally, the mean zinc protoporphyrin concentration was 10.0 +/- 6.2 microg/g Hb, and 76% of the infants were iron-deficient (>5 microg/g Hb). The prevalence of stunting was 35%, while wasting was only 1.3%. Low birth-weight and low body mass index of mothers were the strong predictors of stunting, whereas low birth-weight and iron-deficiency were the strong predictors of anaemia. The prevalence of malaria parasitaemia was high, affecting 50% of the infants. Having malaria was the only independent predictor associated with stunting, anaemia, and iron-deficiency. There is an urgent need to improve tradi-tional complementary foods in the studied community in terms of energy density, amount of fat in the diet, and bioavailability of macro and micronutrients.

Anemia, Iron-Deficiency↗
PubMed2004

Integrating adherence to highly active antiretroviral therapy into children's daily lives: a qualitative study.

OBJECTIVE: To acquire a deeper understanding of factors that influence adherence to highly active antiretroviral therapy (HAART) in a pediatric population. METHODS: We performed a qualitative study of adherence in children who receive HAART in a Belgian pediatric acquired immune deficiency syndrome referral center. Eleven primary caregivers were interviewed to assess their child's adherence and influencing factors. The interview guidelines were developed on the basis of an extensive literature review. Adherence to treatment was assessed using caregivers' self-report and laboratory results. Content analysis for common items was performed, and statements of adherent and less-adherent patients were compared. RESULTS: Three main factors influenced adherence. Adherent patients were found to internalize the medical information to a stronger extent than less-adherent patients. Adherent patients showed stronger motivation to stick to the medical regimen on the basis of personal cost-benefit analyses, ie, perceived benefits outweighed the costs or difficulties experienced. Adherent patients developed greater problem-solving capacities, ie, ways to deal with practical complications of medication intake. The interviews revealed a fourth, more dynamic component: knowledge, motivation, and capacities evolved in a progressive way, related to individual stages of coping with human immunodeficiency virus (HIV). CONCLUSIONS: The data suggest that coping with HIV and the process of establishing good adherence may be interrelated. Caregivers who accept the disease may be more likely to internalize the received information and thus develop a stronger motivation to fight for the child's life. Problem-solving skills sustain this adherence, and medication becomes a priority in the adherent caregivers' daily lives. On the contrary, less-adherent caregivers may be situated at less advanced stages of the coping process. Thus, tailor-made approaches adapted to the individual HIV-related coping strategies need to be developed to improve adherence in children and caregivers.

Adolescent↗
PubMed2004

Bringing together viewpoints of mothers and health workers to enhance monitoring and promotion of growth and development of children: a case study from the Republic of Congo.

In 1996, the Government of the Republic of Congo launched a pilot project to improve the child growth and development component of primary healthcare. The present study was carried out (i) to explore perceptions and practices of mothers and health workers regarding child growth, health, and development, and (ii) to design culturally-appropriate tools to enhance their monitoring and promotion. The study was carried out in two randomly-selected health centres in Brazzaville. Qualitative data collected included 16 focus-group discussions with 174 mothers, two focus-group discussions with 18 health workers, and 20 individual interviews with paediatricians or psychologists. The health workers reported that the main indicator of child growth was weight, while the mothers used broader concepts for evaluating growth and development of their toddlers. A strategy encompassing anthropometrics, developmental milestones, and acquisition of social skills was elaborated to enhance communication between health workers and mothers. A new growth chart was designed, and a new calendar of systematic visits, including key tasks and messages, was established. However, these new tools derived from the formative research still need to be carefully tested.

Body Height↗
PubMed2003

The 1998 flood in Bangladesh: is different targeting needed during emergencies and recovery to tackle malnutrition?

Bangladesh suffered the century's worst flood during July-October 1998 and appealed for assistance. To provide information for appropriate interventions to tackle nutritional problems, a rapid assessment survey was conducted to look at the nutritional situation, problems encountered by the community, their coping mechanisms and rehabilitation priorities in six rural areas. The survey was repeated after four months to measure the outcome of activities during the flood and the necessity for future assistance. There were 3,048 children measured in both surveys (1,597 and 1,451). The sample of most interest was a sub-group of 180 children present in two previous independent surveys. The analysis found that while moving from the crisis period to post-flood phase there was evidence of a 'crossover phenomenon' in the recovery pattern of nutritional status. Sixty-eight per cent of the children who were malnourished (WHZ < -2SD) during the crisis period (18 per cent) recovered enough to cross the cut-off point and became normal after four months. Another 8 per cent of children (9 per cent of all normal) who were normal during the crisis period, after four months had deteriorated to be malnourished. Thus, despite there being a shift in the overall distribution of nutritional status, there has been another shift that reduced the net effect. Subsequent episodes of diarrhoea, access to food and loan burden had also influenced the recovery pattern of the children's nutritional status as evident from the statistically significant associations. These findings raise questions about targeting acute malnutrition during emergencies, and using the same criteria during both the crisis and rehabilitation phases.

Acute Disease↗
PubMed2002

Evaluation of the nutritional characteristics of a finger millet based complementary food.

Finger millet (Eleusine coracana), kidney beans (Phaseolus vulgaris), peanuts (Arachis hypogoea), and mango (Mangifera indica) were processed separately and then combined, on the basis of their amino acid scores and energy content, into a complementary food for children of weaning age. The finger millet and kidney beans were processed by germination, autoclaving, and lactic acid fermentation. A mixture containing, on a dry matter basis, 65.2, 19.1, 8.0, and 7.7% of the processed finger millet, kidney beans, peanuts, and mango, respectively, gave a composite protein with an in vitro protein digestibility of 90.2% and an amino acid chemical score of 0.84. This mixture had an energy density of 16.3 kJ.g(-1) of dry matter and a decreased antinutrient content and showed a measurable improvement in the in vitro extractability for calcium, iron, and zinc. A 33% (w/v) pap made from a mix of the processed ingredients had an energy density of 5.4 kJ.g(-1) of pap, which is sufficient to meet the energy requirements of well-nourished children of 6-24 months of age at three servings a day and at the FAO average breast-feeding frequency.

Amino Acids↗
PubMedDate not supplied

[Management of malnutrition in preschool children: the role of primary health care services].

Although the prevalence of malnutrition in developing countries is decreasing, it is still a major problem for many children under five. As socio-economic conditions are the main determinants, a final solution for this problem can only be envisaged in the long run. Still, short-term strategies need to be defined in order to relieve the sufferings of individual children and their families. Understanding the problem and consequently formulating intervention programs at the local level remains a complex and difficult issue. The first reason being that the process of malnutrition expresses itself in different forms and with variable consequences. A second reason making malnutrition a complex problem is that the primary causes -- the interaction between insufficient food supply and the frequent recurrence of infectious diseases -- are determined by a multitude of factors of different natures. This complexity -- of its expressions, effects, and causality -- makes it difficult to get a global vision and understanding of the problem, which clearly impedes the definition of rational and integrated intervention strategies. Nevertheless, a better understanding of the pathophysiology of malnutrition and of the factors that influence the growth process in preschool age, will help to better direct actions. To this effect, a conceptual model will be built, based on recent insight in the process of malnutrition within this age group. From this model, two lines of action for increasing the chances of preschool children to express their initial growth potential, become apparent. A first series of activities could tackle the process that, via wasting and recurrence of infections, leads to an increased mortality risk. As timely intervention reduces the risk of depletion of energy reserves, these activities would also have an indirect impact on physical development. Elaborating strategies for secondary prevention and for treating severe cases belongs to the specific competence of the health sector. In the second line of action, the aim is to intervene before reserves are depleted. Here, primary prevention and health promotion are choice activities. This frame of reference will be used for analysing existing health programs for preschool children and how they propose to improve the management of malnutrition. This analysis will show that primary health care services can play a much more important role than usually attributed to them. Identifying these gaps and elaborating alternatives is the purpose of this article.

Child Development↗
PubMedDate not supplied

[Nutrition surveillance: 25 years later].

Nutrition surveillance is a rather recent application of epidemiological surveillance to nutrition. It covers not only the morbidity and mortality of nutritional disorders, but is at least as much interested in their major determinants. After some fifteen years of trial and error, nutrition surveillance has today found its way: its concepts, methods and uses are well established by now. After retrieving experiences conducted since the seventies and the eighties, and on the basis of their own experience, the authors have come to identify a few major features of nutrition surveillance: predominance of the supply of information over the collection of data; the early identification of users; the importance of causal analysis as a departure point for conceiving a surveillance activity; the highly selective choice of data to be collected; a permanent concern for sustainability; the participation of all actors (or "stakeholders") and, from a technical viewpoint, the place of qualitative data collection techniques (borrowed from social anthropology) to complement quantitative data. The authors summarize the major steps followed in the design and implementation of a nutrition surveillance activity, emphasizing the benefits of a careful and in-depth preparation during the so-called "pre-surveillance" phase.

Data Collection↗
PubMedDate not supplied

[Street food among children: a study in north Tunisia].

As urbanization increases in Tunisia, eating meals outside the home is becoming more frequent. Children are prime consumers for the fast food sold in the streets. Neither their nor their parents' attitude towards street food is well documented as yet. This study was conducted in the city of Bizerte in February 1998. Its aim was to gather information about street food and parents' and children's attitudes towards it to help organize educational sessions with the children, parents, teachers, and vendors. The study interviewed 421 primary school children, ranging in age from 6 to 15 years (mean age: 10 years), from 24 schools. Half received pocket money, a percentage that did not differ by sex. Three quarters of the children used more than 75% of their pocket money to buy street food. The items bought most frequently were candy (27.2%), sandwiches (23.9%), pastries (23.9%), sunflower seeds and peanuts (21%), and either pizza, chocolate, or cheese (20.3%); the largest proportion of money was spent on sandwiches. In more than half the cases (55.7% of the children), the main motivation for buying street food was either to replace or fill out a meal at home, with sandwiches or pastries. The parents' monthly income did not influence the children's purchasing behavior, but the rhythm of receiving pocket money did. Most children were satisfied with the nutritional and hygienic quality of the food available, but their opinion of this quality as well as the reasons for buying the food and the prices spent on it differed considerably from that of their parents. This study highlights the important role of street foods in the daily diet of schoolchildren and the need for appropriate nutrition education in primary schools.

Adolescent↗