Kathryn G. Dewey

Introduction: The WHO cut-offs to define anaemia among children (haemoglobin, Hb 2 for the pooled AUC analysis indicated generally low to moderate heterogeneity across studies. Conclusions: The current WHO cut-offs to define anaemia among children are in the middle to upper range of Hb values that best discriminate concurrent physical activity and development, and are in the lower range of values that best discriminate subsequent child development. Along with other types of evidence, this study provides additional evidence to inform Hb cut-offs to define anaemia among young children.

Background: Multiple micronutrient deficiencies, including zinc deficiency, remain highly prevalent among pregnant women in many low- and middle-income countries and are associated with a multitude of adverse outcomes. Objective: The objectives of this analysis were to assess the impacts of prenatal multiple micronutrient supplements (MMS) compared to iron and folic acid (IFA) supplements on maternal zinc status among pregnant women at 36 weeks gestation and assess associations with birth outcomes. Methods: We analyzed plasma zinc concentrations at baseline (< 20 weeks gestation) and late pregnancy (36 weeks gestation) from a sub-set of pregnant women randomly assigned to receive either daily MMS (containing 30 mg/d zinc) or IFA supplements (n = 125/group) in the iLiNS DYAD trial in Ghana. Gestational and infant anthropometric outcomes were measured at birth. Results: At baseline, mean + SD plasma zinc concentrations were 61.9 + 13.6 µg/dL and 16.5% of women were zinc deficient (plasma zinc concentration < 50 µg/dL). At 36 weeks gestation, mean + SD plasma zinc concentrations were lower as compared to baseline, but did not differ significantly between groups (IFA: 52.2 + 8.1 µg/dL vs. MMS: 52.9 + 9.5 µg/dL; p = 0.25). Similarly, there was no difference in the estimated prevalence of zinc deficiency between groups at 36 weeks (IFA: 43.0% vs. MMS: 38.4%, p = 0.24). There were few significant associations between maternal plasma zinc concentrations or zinc deficiency and birth outcomes. Conclusions: Daily MMS supplementation for > 16 weeks during pregnancy did not significantly increase plasma zinc concentrations, and the prevalence of zinc deficiency increased over the course of pregnancy. Other complementary interventions to address both nutritional and underlying non-nutritional causes of zinc deficiency may be necessary to improve zinc status during pregnancy in this, and other vulnerable, populations. Registry: The trial was registered as a clinical trial on ClinicalTrials.gov ( NCT00970866 ) on September 2, 2009. https://clinicaltrials.gov/study/NCT00970866 .

Introduction: Undernutrition is a cause of nearly half of all deaths among children under 5 years old. Small-quantity lipid-based nutrient supplements (SQ-LNS) have been shown to prevent child wasting, stunting, anaemia and mortality among children 6–23 months of age in low- and middle-income countries (LMICs). Scaling up effective preventive interventions is urgent given the current global food insecurity and nutrition crisis. Method: To prioritise SQ-LNS scale-up activities, we identified countries with the highest burdens of wasting, stunting and all-cause mortality among children 6–23 months of age at the national level using the most recent national survey data including the Demographic and Health Survey and Multiple Indicator Cluster Surveys, as well as the Lives Saved Tool in LMICs. National-level estimates informed a care cascade model to assess the potential impact of SQ-LNS on all-cause mortality, stunting and wasting. We also conducted a subnational level analysis among the 20 highest burden countries with the most recent available survey data to identify the highest burden regions. Results: Our analysis identified the top 20 countries with the highest burden of the three outcomes as: Niger, South Sudan, Yemen, Sudan, Somalia, Democratic Republic of Congo, Eritrea, Nigeria, Central African Republic, Guinea, Equatorial Guinea, Chad, Papua New Guinea, Benin, Mali, Angola, Pakistan, Timor-Leste, Sierra Leone and Côte d'Ivoire, although for some countries the survey data were collected >10 years ago. Some of these countries also ranked high in population estimates of acute food insecurity. The care cascade model demonstrates that a large number of cases of stunting and wasting and deaths could be potentially averted if SQ-LNS is provided. Conclusion: Most of the top 20 countries are in Sub-Saharan Africa, with a few in South and Southeast Asia. This geographical concentration underscores the urgent need for targeted interventions in these regions to prevent child malnutrition.