Feeding Intervention

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Charlotte G Neumann - One of the best experts on this subject based on the ideXlab platform.

  • animal source foods have a positive impact on the primary school test scores of kenyan schoolchildren in a cluster randomised controlled Feeding Intervention trial
    British Journal of Nutrition, 2014
    Co-Authors: Judie Hulett, N O Bwibo, Robert E. Weiss, Osman Galal, Natalie Drorbaugh, Charlotte G Neumann
    Abstract:

    Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school Feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised Feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic Feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no Intervention Feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B 12 , Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

  • school snacks decrease morbidity in kenyan schoolchildren a cluster randomized controlled Feeding Intervention trial
    Public Health Nutrition, 2013
    Co-Authors: Charlotte G Neumann, N O Bwibo, Luohua Jiang, Robert E. Weiss
    Abstract:

    Objective To examine the effects of three different school snacks on morbidity outcomes. Design Twelve schools were randomized to either one of three Feeding groups or a Control group. There were three schools per group in this cluster randomized trial. Children in Feeding group schools received school snacks of a local plant-based dish, githeri, with meat, milk or extra oil added. The oil used was later found to be fortified with retinol. Physical status, food intake and morbidity outcomes were assessed longitudinally over two years. Setting Rural Embu District, Kenya, an area with high prevalence of vitamin A deficiency. Subjects Standard 1 schoolchildren (n 902; analytic sample) enrolled in two cohorts from the same schools one year apart. Results The Meat and Plain Githeri (i.e. githeri+oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time. Conclusions The Intervention study showed beneficial effects of both animal source foods and of vitamin A-fortified oil on morbidity status.

  • Meat supplementation increases arm muscle area in Kenyan schoolchildren.
    The British journal of nutrition, 2012
    Co-Authors: Charlotte G Neumann, Luohua Jiang, Robert E. Weiss, Monika Grillenberger, Constance A Gewa, Jonathan H. Siekmann, Suzanne P. Murphy, Nimrod O. Bwibo
    Abstract:

    The present study examines the effect of animal-source-food (ASF) intake on arm muscle area growth as part of a larger study examining causal links between ASF intake, growth rate, physical activity, cognitive function and micronutrient status in Kenyan schoolchildren. This randomised, controlled Feeding Intervention study was designed with three isoenergetic Feeding Interventions of meat, milk, and plain traditional vegetable stew (githeri), and a control group receiving no snack. A total of twelve elementary schools were randomly assigned to Interventions, with three schools per group, and two cohorts of 518 and 392 schoolchildren were enrolled 1 year apart. Children in each cohort were given Feedings at school and studied for three school terms per year over 2 years, a total of 9 months per year: cohort I from 1998 to 2000 and cohort II from 1999 to 2001. Food intake was assessed by 24 h recall every 1-2 months and biochemical analysis for micronutrient status conducted annually (in cohort I only). Anthropometric measurements included height, weight, triceps skinfold (TSF) and mid-upper-arm circumference (MUAC). Mid-upper-arm muscle area (MAMA) and mid-upper-arm fat area (MAFA) were calculated. The two cohorts were combined for analyses. The meat group showed the steepest rates of gain in MUAC and MAMA over time, and the milk group showed the next largest significant MUAC and MAMA gain compared with the plain githeri and control groups (P< 0.05). The meat group showed the least increase in TSF and MAFA of all groups. These findings have implications for increasing micronutrient intake and lean body mass in primary schoolchildren consuming vegetarian diets.

  • effects of a school Feeding Intervention on school attendance rates among elementary schoolchildren in rural kenya
    Nutrition, 2011
    Co-Authors: Edith Mukudi Omwami, Charlotte G Neumann, N O Bwibo
    Abstract:

    OBJECTIVE: A randomized controlled school Feeding Intervention offered an opportunity to determine whether school Feeding resulted in improved school attendance among elementary schoolchildren in a rural district of Kenya. METHODS: Twelve schools with a total of 554 children in the 1998 first-grade cohort were randomly assigned to four research groups, three of which received a fortified local staple-based snack (Githeri meal) at morning recess. The groups--designated as Meat-Githeri, Milk-Githeri, and Energy-Githeri--received a recess meal that provided 240 kcal in the first school year and 313 kcal for the remainder of study period. The Intervention study covered the second school term of 1998 through the second school term of 2000. Assessment for all indexed children included baseline assessment of anthropometric measures of height-for-weight, weight-for-age, and height-for-age, and socioeconomic status at baseline, as well as daily school attendance for each of the school terms. Analysis included descriptive statistics, partial correlations statistics, regression analysis, χ(2), and General Linear Model (GLM) repeated measures analysis. In all the analyses, P < 0.05 was used as the criterion of statistical significance. RESULTS: Baseline regression analysis for the overall study sample population showed that age-dependent anthropometric measures of nutritional status were statistically significant predictors of school attendance rates. Partial correlation analysis evidenced a statistically significant positive association between baseline attendance rates and the measures of socioeconomic status and the age-dependent anthropometric measures. The Intervention groups performed better than the control group on the repeated measure of school attendance.

  • comparison of blood smear microscopy to a rapid diagnostic test for in vitro testing for p falciparum malaria in kenyan school children
    East African Medical Journal, 2009
    Co-Authors: Charlotte G Neumann, N O Bwibo, Jonathan H. Siekmann, Erin Mclean, B Browdy, N Drorbaugh
    Abstract:

    Objective: To compare the diagnostic performance of microscopy using Giemsastained thick and thin blood smears to a rapid malaria dipstick test (RDT) in detecting P. falciparum malaria in Kenyan school children. Design: Randomised, controlled Feeding Intervention trial from 1998-2001. Setting: Rural Embu district, Kenya. The area is considered endemic for malaria, with four rainy seasons per year. Chloroquine resistance was estimated in 80% of patients. Children had a spleen rate of 45%. Subjects: A sample of 515 rural Kenyan primary school children, aged 7-11 years, who were enrolled in a Feeding Intervention trial from 1998-2001. Main outcome measures: Percent positive and negative P. falciparum malaria status, sensitivity, specificity and positive and negative predictive values of RDT. Results: For both years, the RDT yielded positive results of 30% in children compared to microscopy (17%). With microscopy as the “gold standard,” RDT yielded a sensitivity of 81.3% in 1998 and 79.3% in 2000. Specificity was 81.6% in 1998 and 78.3% in 2000. Positive predictive value was 47.3% in 1998 and 42.6% in 2000, and negative predictive value was 95.6% in 1998 and 94.9% in 2000. Conclusion: Rapid diagnostic testing is a valuable tool for diagnosis and can shorten the interval for starting treatment, particularly where microscopy may not be feasible due to resource and distance limitations. East African Medical Journal Vol. 85 (11) 2008: pp. 544-549

Lynne Daniels - One of the best experts on this subject based on the ideXlab platform.

  • comparison of early Feeding practices in mother father dyads and possible generalization of an efficacious maternal Intervention to fathers Feeding practices a secondary analysis
    International Journal of Environmental Research and Public Health, 2020
    Co-Authors: Lynne Daniels, Anthea Magarey, Kimberley M Mallan, Jan M Nicholson, Elena Jansen, Karen Thorpe
    Abstract:

    To compare Feeding practices within mother-father dyads and explore whether outcomes of an efficacious Intervention for mothers generalised to fathers' Feeding practices. The NOURISH RCT evaluated an early Feeding Intervention that promoted positive Feeding practices to support development of healthy eating habits and growth. The Intervention was delivered to first-time mothers via 2 × 12 week modules commencing when children were 4 and 14 months. Mothers self-reported Feeding practice outcomes at child age 2 years using validated scales (1 = low to 5 = high) from the Child Feeding Questionnaire (CFQ). Nine months later, an independent cross-sectional descriptive study to investigate fathers' Feeding practices was initiated. Fathers were recruited by contacting (via letter) mothers participating in two pre-existing studies, including the NOURISH trial. Fathers completed a Feeding practices questionnaire, similar to that used for NOURISH outcome assessments. Seventy-five fathers recruited via the NOURISH cohort (21% response) returned questionnaires. Response data from this subset of fathers were then linked to the corresponding NOURISH maternal data. Complete data were available from 70 dyads. Compared with mothers, fathers self-reported higher concern about child overweight (2.2 vs. 1.3), restriction (3.6 vs. 2.9) and pressure (2.6 vs. 2.1), all p < 0.001. Fathers whose partners were allocated to the Intervention group used less pressure (mean difference 0.46, p = 0.045) and were more willing to let the child decide how much to eat (-0.51, p = 0.032). Fathers' higher concern about child weight and more frequent use of non-responsive Feeding practices, when compared with mothers, identify them as potentially potent contributors to child Feeding. This preliminary evidence for modest generalisation of an efficacious maternal Intervention to apparent effects on some paternal Feeding practices speaks to the importance and promise of including fathers in early Feeding Interventions.

  • child dietary and eating behavior outcomes up to 3 5 years after an early Feeding Intervention the nourish rct
    Obesity, 2016
    Co-Authors: Anthea Magarey, Chelsea E Mauch, Kimberley M Mallan, Rebecca Perry, Rachel Elovaris, Jo Meedeniya, Rebecca Byrne, Lynne Daniels
    Abstract:

    Objective To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early Feeding Intervention (concealed allocation, assessor masked randomized controlled trial). Methods In this study, 698 first-time mothers with healthy term infants were allocated to receive anticipatory guidance on protective Feeding practices or usual care. Outcomes were assessed at 2, 3.7, and 5 years (3.5 years post-Intervention). Dietary intake was assessed by 24-h recall and Child Dietary Questionnaire. Mothers completed a food preference questionnaire and Children's Eating Behavior Questionnaire. Linear mixed models assessed group, time, and time × group effects. Results There were no group or time × group effects for fruit, vegetable, discretionary food, and nonmilk sweetened beverage intake. Intervention children showed a higher preference for fruit (74.6% vs. 69.0% liked, P < 0.001), higher Child Dietary Questionnaire score for fruit and vegetables (15.3 vs. 14.5, target ≥18, P = 0.03), lower food responsiveness (2.3 vs. 2.4, of maximum 5, P = 0.04), and higher satiety responsiveness (3.1 vs. 3.0, of maximum 5, P = 0.04). Conclusions Compared with usual care, an early Feeding Intervention providing anticipatory guidance regarding positive Feeding practices led to small improvements in child dietary score, food preferences, and eating behaviors up to 5 years of age, but not in dietary intake measured by 24-h recall.

  • child dietary and eating behavior outcomes up to 3 5 years after an early Feeding Intervention the nourish rct
    Faculty of Health; Institute of Health and Biomedical Innovation, 2016
    Co-Authors: Anthea Magarey, Chelsea E Mauch, Kimberley M Mallan, Rebecca Perry, Rachel Elovaris, Jo Meedeniya, Rebecca Byrne, Lynne Daniels
    Abstract:

    Objective - To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early Feeding Intervention (concealed allocation, assessor masked RCT). Methods - 698 first-time mothers with healthy term infants were allocated to receive anticipatory guidance on protective Feeding practices or usual care. Outcomes were assessed at 2, 3.7 and 5 years (3.5 years post-Intervention). Dietary intake was assessed by 24-hour recall and Child Dietary Questionnaire. Mothers completed a food preference questionnaire and Children’s Eating Behaviour Questionnaire. Linear mixed models assessed group, time and time x group effects. Results - There were no group or time x group effects for fruit, vegetables, discretionary food and non-milk sweetened beverages intake. Intervention children showed a higher preference for fruits (74.6% vs 69.0% liked, P 18, P=0.03), lower food responsiveness (2.3 vs 2.4, of maximum 5, P=.04) and higher satiety responsiveness (3.1 vs 3.0, of maximum 5, P=.04). Conclusions - Compared to usual care, an early Feeding Intervention providing anticipatory guidance regarding positive Feeding practices led to small improvements in child dietary score, food preferences and eating behaviours up to 5 years of age, but not in dietary intake measured by 24-hour recall.

  • child eating behavior outcomes of an early Feeding Intervention to reduce risk indicators for child obesity the nourish rct
    Obesity, 2014
    Co-Authors: Anthea Magarey, Kimberley M Mallan, Jo Meedeniya, Lynne Daniels, Diana Battistutta, Jan M Nicholson, Jordana K Bayer
    Abstract:

    Objective Describe parent-reported child eating behaviour and maternal parenting impact outcomes of an infant Feeding Intervention to reduce child obesity risk. Design and Methods An assessor masked Randomised Controlled Trial (RCT) with concealed allocation of individual mother-infant dyads. The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 months (SD=1.0) at baseline. Outcomes were assessed six months post-Intervention when the children were 2-years old. Mothers reported on child eating behaviours using the Child Eating Behaviour Questionnaire (CEBQ), food preferences and dietary intake using a 24-hour telephone recall. Parenting was assessed using five scales validated for use in Australia. Results Intervention effects were evident on the CEBQ overall (MANOVA P=.002) and 4/8 subscales: child satiety responsiveness (P=.03), fussiness (P=.01), emotional overeating (P<.01), and food responsiveness (P=.06). Intervention children ‘liked’ more fruits (P<.01) and fewer non-core foods and beverages (Ps=.06, .03). The Intervention mothers reported greater ‘autonomy encouragement’ (P=.002) Conclusions Anticipatory guidance on protective Feeding practices appears to have modest positive impacts on child eating behaviours that are postulated to reduce future obesity risk.

  • evaluation of an Intervention to promote protective infant Feeding practices to prevent childhood obesity outcomes of the nourish rct at 14 months of age and 6 months post the first of two Intervention modules
    International Journal of Obesity, 2012
    Co-Authors: Anthea Magarey, Kimberley M Mallan, Rebecca Perry, Lynne Daniels, Diana Battistutta, Jan M Nicholson
    Abstract:

    OBJECTIVE: To evaluate a universal obesity prevention Intervention, which commenced at infant age 4-6 months, using outcome data assessed 6-months after completion of the first of two Intervention modules and 9 months from baseline. DESIGN: Randomised controlled trial of a community-based early Feeding Intervention. SUBJECTS AND METHODS: 698 first-time mothers (mean age 30±5 years) with healthy term infants (51% male) aged 4.3±1.0 months at baseline. Mothers and infants were randomly allocated to self-directed access to usual care or to attend two group education modules, each delivered over three months, that provided anticipatory guidance on early Feeding practices. Outcome data reported here were assessed at infant age 13.7±1.3 months. Anthropometrics were expressed as z-scores (WHO reference). Rapid weight gain was defined as change in weight-for-age z-score (WAZ) > +0.67. Maternal Feeding practices were assessed via self-administered questionnaire. RESULTS: There were no differences according to group allocation on key maternal and infant characteristics. At follow up (n=598 [86%]) the Intervention group infants had lower BMIZ (0.42±0.85 vs 0.23±0.93, p=0.009) and infants in the control group were more likely to show rapid weight gain from baseline to follow up (OR=1.5 CI95%1.1-2.1, p=0.014). Mothers in the control group were more likely to report using non- responsive Feeding practices that fail to respond to infant satiety cues such as encouraging eating by using food as a reward (15% vs 4%, p=0.001) or using games ( 67% vs 29%, p<0.001). CONCLUSIONS: These results provide early evidence that anticipatory guidance targeting the ‘when, what and how’ of solid Feeding can be effective in changing maternal Feeding practices and, at least in the short term, reducing anthropometric indicators of childhood obesity risk. Analyses of outcomes at later ages are required to determine if these promising effects can be sustained.

N O Bwibo - One of the best experts on this subject based on the ideXlab platform.

  • animal source foods have a positive impact on the primary school test scores of kenyan schoolchildren in a cluster randomised controlled Feeding Intervention trial
    British Journal of Nutrition, 2014
    Co-Authors: Judie Hulett, N O Bwibo, Robert E. Weiss, Osman Galal, Natalie Drorbaugh, Charlotte G Neumann
    Abstract:

    Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school Feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised Feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic Feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no Intervention Feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B 12 , Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

  • school snacks decrease morbidity in kenyan schoolchildren a cluster randomized controlled Feeding Intervention trial
    Public Health Nutrition, 2013
    Co-Authors: Charlotte G Neumann, N O Bwibo, Luohua Jiang, Robert E. Weiss
    Abstract:

    Objective To examine the effects of three different school snacks on morbidity outcomes. Design Twelve schools were randomized to either one of three Feeding groups or a Control group. There were three schools per group in this cluster randomized trial. Children in Feeding group schools received school snacks of a local plant-based dish, githeri, with meat, milk or extra oil added. The oil used was later found to be fortified with retinol. Physical status, food intake and morbidity outcomes were assessed longitudinally over two years. Setting Rural Embu District, Kenya, an area with high prevalence of vitamin A deficiency. Subjects Standard 1 schoolchildren (n 902; analytic sample) enrolled in two cohorts from the same schools one year apart. Results The Meat and Plain Githeri (i.e. githeri+oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time. Conclusions The Intervention study showed beneficial effects of both animal source foods and of vitamin A-fortified oil on morbidity status.

  • meat and milk intakes and toddler growth a comparison Feeding Intervention of animal source foods in rural kenya
    Public Health Nutrition, 2012
    Co-Authors: Jennifer L Long, N O Bwibo, Robert E. Weiss, Suzanne P. Murphy, Susan Nyerere, C G Neumann
    Abstract:

    Objective: To examine the effects of animal-source foods on toddler growth. Design: A 5-month comparison Feeding Intervention study with one of three millet-based porridges randomized to eighteen Feeding stations serving 303 children aged 11–40 months. Feeding stations served plain millet porridge (Plain group), porridge with milk (Milk group) or porridge with beef (Meat group). Anthropometry, morbidity and food intake were measured at baseline and regular intervals. Longitudinal mixed models were used to analyse growth. Setting: Embu, Kenya. Subjects: Two hundred and seventy-four children were included in final analyses. Results: Linear growth was significantly greater for the Milk group than the Meat group (P 5 0?0025). Slope of growth of mid-arm muscle area of the Plain group was significantly greater than in the Meat group (P 5 0?0046), while the Milk group’s mid-upper arm circumference growth rate was significantly greater than the Meat group’s (P 5 0?0418). The Milk and Plain groups’ measures did not differ. Conclusions: Milk and meat porridges did not have a significantly greater effect on growth than plain porridge in this undernourished population. Linear growth was influenced by more than energy intakes, as the Plain group’s total body weight-adjusted energy intakes were significantly greater than the Meat group’s, although linear growth did not differ. Energy intakes may be more important for growth in arm muscle. The diverse age distribution in the study makes interpretation difficult. A longer study period, larger sample size and more focused age group would improve clarity of the results.

  • effects of a school Feeding Intervention on school attendance rates among elementary schoolchildren in rural kenya
    Nutrition, 2011
    Co-Authors: Edith Mukudi Omwami, Charlotte G Neumann, N O Bwibo
    Abstract:

    OBJECTIVE: A randomized controlled school Feeding Intervention offered an opportunity to determine whether school Feeding resulted in improved school attendance among elementary schoolchildren in a rural district of Kenya. METHODS: Twelve schools with a total of 554 children in the 1998 first-grade cohort were randomly assigned to four research groups, three of which received a fortified local staple-based snack (Githeri meal) at morning recess. The groups--designated as Meat-Githeri, Milk-Githeri, and Energy-Githeri--received a recess meal that provided 240 kcal in the first school year and 313 kcal for the remainder of study period. The Intervention study covered the second school term of 1998 through the second school term of 2000. Assessment for all indexed children included baseline assessment of anthropometric measures of height-for-weight, weight-for-age, and height-for-age, and socioeconomic status at baseline, as well as daily school attendance for each of the school terms. Analysis included descriptive statistics, partial correlations statistics, regression analysis, χ(2), and General Linear Model (GLM) repeated measures analysis. In all the analyses, P < 0.05 was used as the criterion of statistical significance. RESULTS: Baseline regression analysis for the overall study sample population showed that age-dependent anthropometric measures of nutritional status were statistically significant predictors of school attendance rates. Partial correlation analysis evidenced a statistically significant positive association between baseline attendance rates and the measures of socioeconomic status and the age-dependent anthropometric measures. The Intervention groups performed better than the control group on the repeated measure of school attendance.

  • comparison of blood smear microscopy to a rapid diagnostic test for in vitro testing for p falciparum malaria in kenyan school children
    East African Medical Journal, 2009
    Co-Authors: Charlotte G Neumann, N O Bwibo, Jonathan H. Siekmann, Erin Mclean, B Browdy, N Drorbaugh
    Abstract:

    Objective: To compare the diagnostic performance of microscopy using Giemsastained thick and thin blood smears to a rapid malaria dipstick test (RDT) in detecting P. falciparum malaria in Kenyan school children. Design: Randomised, controlled Feeding Intervention trial from 1998-2001. Setting: Rural Embu district, Kenya. The area is considered endemic for malaria, with four rainy seasons per year. Chloroquine resistance was estimated in 80% of patients. Children had a spleen rate of 45%. Subjects: A sample of 515 rural Kenyan primary school children, aged 7-11 years, who were enrolled in a Feeding Intervention trial from 1998-2001. Main outcome measures: Percent positive and negative P. falciparum malaria status, sensitivity, specificity and positive and negative predictive values of RDT. Results: For both years, the RDT yielded positive results of 30% in children compared to microscopy (17%). With microscopy as the “gold standard,” RDT yielded a sensitivity of 81.3% in 1998 and 79.3% in 2000. Specificity was 81.6% in 1998 and 78.3% in 2000. Positive predictive value was 47.3% in 1998 and 42.6% in 2000, and negative predictive value was 95.6% in 1998 and 94.9% in 2000. Conclusion: Rapid diagnostic testing is a valuable tool for diagnosis and can shorten the interval for starting treatment, particularly where microscopy may not be feasible due to resource and distance limitations. East African Medical Journal Vol. 85 (11) 2008: pp. 544-549

Robert E. Weiss - One of the best experts on this subject based on the ideXlab platform.

  • animal source foods have a positive impact on the primary school test scores of kenyan schoolchildren in a cluster randomised controlled Feeding Intervention trial
    British Journal of Nutrition, 2014
    Co-Authors: Judie Hulett, N O Bwibo, Robert E. Weiss, Osman Galal, Natalie Drorbaugh, Charlotte G Neumann
    Abstract:

    Micronutrient deficiencies and suboptimal energy intake are widespread in rural Kenya, with detrimental effects on child growth and development. Sporadic school Feeding programmes rarely include animal source foods (ASF). In the present study, a cluster-randomised Feeding trial was undertaken to determine the impact of snacks containing ASF on district-wide, end-term standardised school test scores and nutrient intake. A total of twelve primary schools were randomly assigned to one of three isoenergetic Feeding groups (a local plant-based stew (githeri) with meat, githeri plus whole milk or githeri with added oil) or a control group receiving no Intervention Feeding. After the initial term that served as baseline, children were fed at school for five consecutive terms over two school years from 1999 to 2001. Longitudinal analysis was used controlling for average energy intake, school attendance, and baseline socio-economic status, age, sex and maternal literacy. Children in the Meat group showed significantly greater improvements in test scores than those in all the other groups, and the Milk group showed significantly greater improvements in test scores than the Plain Githeri (githeri+oil) and Control groups. Compared with the Control group, the Meat group showed significant improvements in test scores in Arithmetic, English, Kiembu, Kiswahili and Geography. The Milk group showed significant improvements compared with the Control group in test scores in English, Kiswahili, Geography and Science. Folate, Fe, available Fe, energy per body weight, vitamin B 12 , Zn and riboflavin intake were significant contributors to the change in test scores. The greater improvements in test scores of children receiving ASF indicate improved academic performance, which can result in greater academic achievement.

  • school snacks decrease morbidity in kenyan schoolchildren a cluster randomized controlled Feeding Intervention trial
    Public Health Nutrition, 2013
    Co-Authors: Charlotte G Neumann, N O Bwibo, Luohua Jiang, Robert E. Weiss
    Abstract:

    Objective To examine the effects of three different school snacks on morbidity outcomes. Design Twelve schools were randomized to either one of three Feeding groups or a Control group. There were three schools per group in this cluster randomized trial. Children in Feeding group schools received school snacks of a local plant-based dish, githeri, with meat, milk or extra oil added. The oil used was later found to be fortified with retinol. Physical status, food intake and morbidity outcomes were assessed longitudinally over two years. Setting Rural Embu District, Kenya, an area with high prevalence of vitamin A deficiency. Subjects Standard 1 schoolchildren (n 902; analytic sample) enrolled in two cohorts from the same schools one year apart. Results The Meat and Plain Githeri (i.e. githeri+oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time. Conclusions The Intervention study showed beneficial effects of both animal source foods and of vitamin A-fortified oil on morbidity status.

  • Meat supplementation increases arm muscle area in Kenyan schoolchildren.
    The British journal of nutrition, 2012
    Co-Authors: Charlotte G Neumann, Luohua Jiang, Robert E. Weiss, Monika Grillenberger, Constance A Gewa, Jonathan H. Siekmann, Suzanne P. Murphy, Nimrod O. Bwibo
    Abstract:

    The present study examines the effect of animal-source-food (ASF) intake on arm muscle area growth as part of a larger study examining causal links between ASF intake, growth rate, physical activity, cognitive function and micronutrient status in Kenyan schoolchildren. This randomised, controlled Feeding Intervention study was designed with three isoenergetic Feeding Interventions of meat, milk, and plain traditional vegetable stew (githeri), and a control group receiving no snack. A total of twelve elementary schools were randomly assigned to Interventions, with three schools per group, and two cohorts of 518 and 392 schoolchildren were enrolled 1 year apart. Children in each cohort were given Feedings at school and studied for three school terms per year over 2 years, a total of 9 months per year: cohort I from 1998 to 2000 and cohort II from 1999 to 2001. Food intake was assessed by 24 h recall every 1-2 months and biochemical analysis for micronutrient status conducted annually (in cohort I only). Anthropometric measurements included height, weight, triceps skinfold (TSF) and mid-upper-arm circumference (MUAC). Mid-upper-arm muscle area (MAMA) and mid-upper-arm fat area (MAFA) were calculated. The two cohorts were combined for analyses. The meat group showed the steepest rates of gain in MUAC and MAMA over time, and the milk group showed the next largest significant MUAC and MAMA gain compared with the plain githeri and control groups (P< 0.05). The meat group showed the least increase in TSF and MAFA of all groups. These findings have implications for increasing micronutrient intake and lean body mass in primary schoolchildren consuming vegetarian diets.

  • meat and milk intakes and toddler growth a comparison Feeding Intervention of animal source foods in rural kenya
    Public Health Nutrition, 2012
    Co-Authors: Jennifer L Long, N O Bwibo, Robert E. Weiss, Suzanne P. Murphy, Susan Nyerere, C G Neumann
    Abstract:

    Objective: To examine the effects of animal-source foods on toddler growth. Design: A 5-month comparison Feeding Intervention study with one of three millet-based porridges randomized to eighteen Feeding stations serving 303 children aged 11–40 months. Feeding stations served plain millet porridge (Plain group), porridge with milk (Milk group) or porridge with beef (Meat group). Anthropometry, morbidity and food intake were measured at baseline and regular intervals. Longitudinal mixed models were used to analyse growth. Setting: Embu, Kenya. Subjects: Two hundred and seventy-four children were included in final analyses. Results: Linear growth was significantly greater for the Milk group than the Meat group (P 5 0?0025). Slope of growth of mid-arm muscle area of the Plain group was significantly greater than in the Meat group (P 5 0?0046), while the Milk group’s mid-upper arm circumference growth rate was significantly greater than the Meat group’s (P 5 0?0418). The Milk and Plain groups’ measures did not differ. Conclusions: Milk and meat porridges did not have a significantly greater effect on growth than plain porridge in this undernourished population. Linear growth was influenced by more than energy intakes, as the Plain group’s total body weight-adjusted energy intakes were significantly greater than the Meat group’s, although linear growth did not differ. Energy intakes may be more important for growth in arm muscle. The diverse age distribution in the study makes interpretation difficult. A longer study period, larger sample size and more focused age group would improve clarity of the results.

  • animal source foods improve dietary quality micronutrient status growth and cognitive function in kenyan school children background study design and baseline findings
    Journal of Nutrition, 2003
    Co-Authors: Charlotte G Neumann, N O Bwibo, Robert E. Weiss, Suzanne P. Murphy, Marian Sigman, Shannon E Whaley, Lindsay H Allen, Donald Guthrie, Montague W Demment
    Abstract:

    A previous longitudinal three-country study in Egypt, Kenya and Mexico found significant positive associations between intake of animal source foods (ASF) and growth, cognitive development and physical activity. To test for a causal relationship, a controlled school Feeding Intervention study was designed to test the hypotheses that ASF would improve micronutrient status, growth and cognitive function in Kenyan primary school children. Twelve rural Kenyan schools with 554 children were randomized to four Feeding Interventions using a local vegetable stew as the vehicle. The groups were designated as Meat, Milk, Energy and Control, who received no Feedings. Feeding was carried out on school days for seven terms during 21 mo. PreIntervention baseline measures included nutritional status, home food intake, anthropometry, biochemical measures of micronutrient status, malaria, intestinal parasites, health status and cognitive and behavioral measures. The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in ∼30% of children and widespread inadequate intakes and/or biochemical evidence of micronutrient deficiencies, particularly of iron, zinc, vitamins A and B-12, riboflavin and calcium. Little or no ASF were eaten and fat intake was low. Malaria was present in 31% of children, and hookworm, amebiasis and giardia were widely prevalent. The outcomes measured were rates of change or increase during the Intervention in cognitive function, growth, physical activity and behavior and micronutrient status. Hierarchical linear random effects modeling was used for analysis of outcomes.

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  • comparison of early Feeding practices in mother father dyads and possible generalization of an efficacious maternal Intervention to fathers Feeding practices a secondary analysis
    International Journal of Environmental Research and Public Health, 2020
    Co-Authors: Lynne Daniels, Anthea Magarey, Kimberley M Mallan, Jan M Nicholson, Elena Jansen, Karen Thorpe
    Abstract:

    To compare Feeding practices within mother-father dyads and explore whether outcomes of an efficacious Intervention for mothers generalised to fathers' Feeding practices. The NOURISH RCT evaluated an early Feeding Intervention that promoted positive Feeding practices to support development of healthy eating habits and growth. The Intervention was delivered to first-time mothers via 2 × 12 week modules commencing when children were 4 and 14 months. Mothers self-reported Feeding practice outcomes at child age 2 years using validated scales (1 = low to 5 = high) from the Child Feeding Questionnaire (CFQ). Nine months later, an independent cross-sectional descriptive study to investigate fathers' Feeding practices was initiated. Fathers were recruited by contacting (via letter) mothers participating in two pre-existing studies, including the NOURISH trial. Fathers completed a Feeding practices questionnaire, similar to that used for NOURISH outcome assessments. Seventy-five fathers recruited via the NOURISH cohort (21% response) returned questionnaires. Response data from this subset of fathers were then linked to the corresponding NOURISH maternal data. Complete data were available from 70 dyads. Compared with mothers, fathers self-reported higher concern about child overweight (2.2 vs. 1.3), restriction (3.6 vs. 2.9) and pressure (2.6 vs. 2.1), all p < 0.001. Fathers whose partners were allocated to the Intervention group used less pressure (mean difference 0.46, p = 0.045) and were more willing to let the child decide how much to eat (-0.51, p = 0.032). Fathers' higher concern about child weight and more frequent use of non-responsive Feeding practices, when compared with mothers, identify them as potentially potent contributors to child Feeding. This preliminary evidence for modest generalisation of an efficacious maternal Intervention to apparent effects on some paternal Feeding practices speaks to the importance and promise of including fathers in early Feeding Interventions.

  • child dietary and eating behavior outcomes up to 3 5 years after an early Feeding Intervention the nourish rct
    Obesity, 2016
    Co-Authors: Anthea Magarey, Chelsea E Mauch, Kimberley M Mallan, Rebecca Perry, Rachel Elovaris, Jo Meedeniya, Rebecca Byrne, Lynne Daniels
    Abstract:

    Objective To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early Feeding Intervention (concealed allocation, assessor masked randomized controlled trial). Methods In this study, 698 first-time mothers with healthy term infants were allocated to receive anticipatory guidance on protective Feeding practices or usual care. Outcomes were assessed at 2, 3.7, and 5 years (3.5 years post-Intervention). Dietary intake was assessed by 24-h recall and Child Dietary Questionnaire. Mothers completed a food preference questionnaire and Children's Eating Behavior Questionnaire. Linear mixed models assessed group, time, and time × group effects. Results There were no group or time × group effects for fruit, vegetable, discretionary food, and nonmilk sweetened beverage intake. Intervention children showed a higher preference for fruit (74.6% vs. 69.0% liked, P < 0.001), higher Child Dietary Questionnaire score for fruit and vegetables (15.3 vs. 14.5, target ≥18, P = 0.03), lower food responsiveness (2.3 vs. 2.4, of maximum 5, P = 0.04), and higher satiety responsiveness (3.1 vs. 3.0, of maximum 5, P = 0.04). Conclusions Compared with usual care, an early Feeding Intervention providing anticipatory guidance regarding positive Feeding practices led to small improvements in child dietary score, food preferences, and eating behaviors up to 5 years of age, but not in dietary intake measured by 24-h recall.

  • child dietary and eating behavior outcomes up to 3 5 years after an early Feeding Intervention the nourish rct
    Faculty of Health; Institute of Health and Biomedical Innovation, 2016
    Co-Authors: Anthea Magarey, Chelsea E Mauch, Kimberley M Mallan, Rebecca Perry, Rachel Elovaris, Jo Meedeniya, Rebecca Byrne, Lynne Daniels
    Abstract:

    Objective - To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early Feeding Intervention (concealed allocation, assessor masked RCT). Methods - 698 first-time mothers with healthy term infants were allocated to receive anticipatory guidance on protective Feeding practices or usual care. Outcomes were assessed at 2, 3.7 and 5 years (3.5 years post-Intervention). Dietary intake was assessed by 24-hour recall and Child Dietary Questionnaire. Mothers completed a food preference questionnaire and Children’s Eating Behaviour Questionnaire. Linear mixed models assessed group, time and time x group effects. Results - There were no group or time x group effects for fruit, vegetables, discretionary food and non-milk sweetened beverages intake. Intervention children showed a higher preference for fruits (74.6% vs 69.0% liked, P 18, P=0.03), lower food responsiveness (2.3 vs 2.4, of maximum 5, P=.04) and higher satiety responsiveness (3.1 vs 3.0, of maximum 5, P=.04). Conclusions - Compared to usual care, an early Feeding Intervention providing anticipatory guidance regarding positive Feeding practices led to small improvements in child dietary score, food preferences and eating behaviours up to 5 years of age, but not in dietary intake measured by 24-hour recall.

  • child eating behavior outcomes of an early Feeding Intervention to reduce risk indicators for child obesity the nourish rct
    Obesity, 2014
    Co-Authors: Anthea Magarey, Kimberley M Mallan, Jo Meedeniya, Lynne Daniels, Diana Battistutta, Jan M Nicholson, Jordana K Bayer
    Abstract:

    Objective Describe parent-reported child eating behaviour and maternal parenting impact outcomes of an infant Feeding Intervention to reduce child obesity risk. Design and Methods An assessor masked Randomised Controlled Trial (RCT) with concealed allocation of individual mother-infant dyads. The NOURISH RCT enrolled 698 first-time mothers (mean age 30.1 years, SD=5.3) with healthy term infants (51% female) aged 4.3 months (SD=1.0) at baseline. Outcomes were assessed six months post-Intervention when the children were 2-years old. Mothers reported on child eating behaviours using the Child Eating Behaviour Questionnaire (CEBQ), food preferences and dietary intake using a 24-hour telephone recall. Parenting was assessed using five scales validated for use in Australia. Results Intervention effects were evident on the CEBQ overall (MANOVA P=.002) and 4/8 subscales: child satiety responsiveness (P=.03), fussiness (P=.01), emotional overeating (P<.01), and food responsiveness (P=.06). Intervention children ‘liked’ more fruits (P<.01) and fewer non-core foods and beverages (Ps=.06, .03). The Intervention mothers reported greater ‘autonomy encouragement’ (P=.002) Conclusions Anticipatory guidance on protective Feeding practices appears to have modest positive impacts on child eating behaviours that are postulated to reduce future obesity risk.

  • evaluation of an Intervention to promote protective infant Feeding practices to prevent childhood obesity outcomes of the nourish rct at 14 months of age and 6 months post the first of two Intervention modules
    International Journal of Obesity, 2012
    Co-Authors: Anthea Magarey, Kimberley M Mallan, Rebecca Perry, Lynne Daniels, Diana Battistutta, Jan M Nicholson
    Abstract:

    OBJECTIVE: To evaluate a universal obesity prevention Intervention, which commenced at infant age 4-6 months, using outcome data assessed 6-months after completion of the first of two Intervention modules and 9 months from baseline. DESIGN: Randomised controlled trial of a community-based early Feeding Intervention. SUBJECTS AND METHODS: 698 first-time mothers (mean age 30±5 years) with healthy term infants (51% male) aged 4.3±1.0 months at baseline. Mothers and infants were randomly allocated to self-directed access to usual care or to attend two group education modules, each delivered over three months, that provided anticipatory guidance on early Feeding practices. Outcome data reported here were assessed at infant age 13.7±1.3 months. Anthropometrics were expressed as z-scores (WHO reference). Rapid weight gain was defined as change in weight-for-age z-score (WAZ) > +0.67. Maternal Feeding practices were assessed via self-administered questionnaire. RESULTS: There were no differences according to group allocation on key maternal and infant characteristics. At follow up (n=598 [86%]) the Intervention group infants had lower BMIZ (0.42±0.85 vs 0.23±0.93, p=0.009) and infants in the control group were more likely to show rapid weight gain from baseline to follow up (OR=1.5 CI95%1.1-2.1, p=0.014). Mothers in the control group were more likely to report using non- responsive Feeding practices that fail to respond to infant satiety cues such as encouraging eating by using food as a reward (15% vs 4%, p=0.001) or using games ( 67% vs 29%, p<0.001). CONCLUSIONS: These results provide early evidence that anticipatory guidance targeting the ‘when, what and how’ of solid Feeding can be effective in changing maternal Feeding practices and, at least in the short term, reducing anthropometric indicators of childhood obesity risk. Analyses of outcomes at later ages are required to determine if these promising effects can be sustained.

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