Browsing by Author "Iversen, Per O."

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    Child development, growth and microbiota : follow-up of a randomized education trial in Uganda
    (International Society of Global Health, 2019) Atukunda, Prudence; Muhoozi, Grace K. M.; Van Den Broek, Tim J.; Kort, Remco; Diep, Lien M.; Kaaya, Archileo N.; Iversen, Per O.; Westerberg, Ane C.
    Background: Undernutrition impairs child development outcomes and growth. In this follow-up study of an open cluster-randomized intervention trial we examined the effects of an education package delivered to mothers in rural Uganda on their children’s development, growth and gut microbiota at 36 months of age. Methods: The parental trial included 511 mother-child pairs recruited when the children were 6-8 months. In that trial, a nutrition, stimulation and hygiene education was delivered to mothers in the intervention group while the control group received routine health care. A follow-up sample of 155 pairs (intervention n = 77, control n = 78) were re-enrolled when the children were 24 months. Developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development (BSID-III) composite scores for cognitive (primary endpoint), language and motor development. Development outcomes were also evaluated using the Ages and Stages Questionnaire (ASQ) and the Mullen Scales of Early Learning (MSEL). Other outcomes included growth and gut microbiota composition. Results: The demographic characteristics were not different (P > 0.05) between the intervention and control groups and similar to those of the parental study. The intervention group had higher BSID-III scores than controls, with mean difference 10.13 (95% confidence interval (CI): 3.31-17.05, P = 0.002); 7.59 (1.62-13.66, P = 0.01); 9.00 (2.92-15.40, P = 0.005), for cognitive, language and motor composite scores, respectively. An improvement in the intervention compared to the control group was obtained for both the ASQ and the MSEL scores. The mean difference in height-for-age z-score was higher in the intervention compared to the control group: 0.50 (0.25-0.75, P = 0.0001). Gut microbiota composition did not differ significantly between the two study groups. Conclusions: The maternal education intervention had positive effects on child development and growth at three years, but did not alter gut microbiota composition. This intervention may be applicable in other low-resource settings.
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    Evaluation of selected aspects of the Nutrition Therapeutic Programme offered to HIV-positive women of child-bearing age in Western Cape Province, South Africa
    (AOSIS Publishing, 2015-04-28) Hansen, Tine T.; Herselman, Marietjie; Du Plessis, Lisanne; Daniels, Luzette; Bezuidenhout, Tirsa; Van Niekerk, Cora; Truter, Laura; Iversen, Per O.
    Background: The Nutrition Therapeutic Programme (NTP) involves the provision of food supplements at primary health clinics (PHCs) to correct nutritional deficiencies in vulnerable groups. Although previous studies have identified problems with implementing the programme at PHCs, assessments of its efficiency have been scarce. Objective: To evaluate implementation of the NTP at PHCs that provide antiretroviral therapy. Methods: A cross-sectional, descriptive study was conducted at 17 PHCs located within 3 districts of Western Cape Province. Two target groups were chosen: 32 staff members working at the sites and 21 women of child-bearing age enrolled in the NTP. Questionnaires were used to obtain data. Results: Only 2 women (10%) lived in food-secure households; the rest were either at risk of hunger (29%) or classified as hungry (61%). Most of the women knew they had to take the supplements to improve their nutritional status, but the majority only recalled receiving basic nutritional advice, and the information was mainly given verbally. Ten of the women had shared their supplements with others, mostly with their children. The study identified lack of clearly defined NTP responsibilities at the PHCs, causing confusion amongst the staff. Although many staff members expressed problems with the NTP, only 38% of them reported having routine evaluations regarding the programme. Conclusion: Several aspects compromised the effectiveness of the NTP, including socioeconomic factors leading to clients’ non-compliance. The strategic organisation and implementation of the NTP varied between different PHCs offering antiretroviral therapy, and staff experienced difficulties with the logistics of the programme.
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    Nutrition, hygiene and stimulation education for impoverished mothers in rural Uganda : effect on maternal depression symptoms and their associations to child development outcomes
    (MDPI, 2019-07-11) Atukunda, Prudence; Muhoozi, Grace K. M.; Westerberg, Ane C.; Iversen, Per O.
    Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and the association of these symptoms to child development. The education comprised complementary feeding, stimulation, and hygiene. We assessed 77 intervention mothers and 78 controls using Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Child development was assessed with Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores for cognitive, language and motor development. Compared to controls, the intervention reduced depression symptoms’ scores with mean (95% CI) differences: −8.26 (−11.49 to −1.13, p = 0.0001) and −6.54; (−8.69 to −2.99, p = 0.004) for BDI II at 20–24 and 36 months, respectively. Similar results were obtained with CES-D. There was a negative association of BDI-II scores and BSID-III cognitive and language scores at 20–24 (p = 0.01 and 0.008, respectively) and 36 months (p = 0.017 and 0.001, respectively). CES-D associations with BSID-III cognitive and language scores showed similar trends. BSID-III motor scores were associated with depression scores at 36 months for both BDI-II and CES-D (p = 0.043 and 0.028, respectively). In conclusion, the group education was associated with reduced maternal depression scores. Moreover, the depression scores were inversely associated with child cognitive and language development outcomes.
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    Seasonality in associations between dietary diversity scores and nutrient adequacy ratios among pregnant women in rural Malawi – a cross-sectional study
    (Swedish Nutrition Foundation, 2019) Hjertholm, Katrine G.; Holmboe-Ottesen, Gerd; Iversen, Per O.; Mdala, Ibrahimu; Munthali, Alister; Maleta, Kenneth; Shi, Zumin; Ferguson, Elaine; Kamudoni, Penjani
    Background: Dietary diversity scores (DDS) are simple indicators often used as proxies for nutrient adequacy. A 10-food group indicator is proposed by the Food and Agriculture Organization of the United Nations as a global standard for measuring dietary diversity among women in low-resource settings. However, its validity as a proxy for nutrient adequacy across different agricultural seasons for pregnant women has not been determined. Objective: We studied associations between DDS and nutrient adequacy ratios (NAR) across two different agricultural seasons (pre- and post-harvest seasons) for pregnant women in rural Malawi and assessed whether a 1-day DDS or a 3-day DDS would be the best indicator of nutrient adequacy. Design: Dietary intakes of 330 pregnant women were assessed between gestational weeks 28 and 35. Intakes of energy, macronutrients, and 11 micronutrients were estimated using three repeated interactive 24-h diet recalls, and DDS were also calculated from these days. Correlation coefficients (r) between DDS, NAR, and mean adequacy ratio (MAR) of the 11 micronutrients were determined. Results: After energy adjustments, we found significant correlations between DDS and MAR with both DDS indicators in the preharvest season (r = 0.22–0.23; p < 0.001) but not in the post-harvest season (p > 0.05). For individual energy-adjusted NARs, correlations were not consistently significant across the two seasons and the two DDS indicators. Conclusions: Our results suggest that DDS could be used to predict overall nutrient adequacy during the preharvest season. As similar correlations were found using both the 1- and 3-day indicators, we recommend using a 1-day DDS, for simplicity. However, as the indicators are sensitive to seasonality they should be used with care in this study setting.