Background Food fortification can be an effective intervention to improve maternal and child health. Folic acid fortification can reduce neural tube defects due to folate deficiency. Iron fortification is effective to reduce maternal anemia due to iron deficiency. The paper describes the methods for estimating current coverage levels for iron fortification and folic acid fortification and estimates current impact of fortification in low- and middle-income countries (LMICs) using the Lives Saved Tool (LiST). Methods The database was obtained from Global Fortification Data Exchange. We used the following indicators from the database: food intake, fortification standard, percent of food produced in industrial mills, and percent of industrially milled food that is fortified. Together with the recommended dietary allowances for women of reproductive age (WRA), we calculated percentage of WRA getting recommended intake through fortification and used the percentage as an estimate for fortification coverage. We then used LiST to estimate the health impact of fortification on maternal and child health. Results Folic acid was fortified in 72 countries, with a median coverage of 43%. Iron was fortified in 87 countries, with a median coverage of 23%. Forty-six LMICs fortified either folic acid, iron, or both. And the weighted coverage of folic acid fortification and iron fortification were 34% and 19%, respectively. A greater percentage of WRA got appropriate levels of folic acid and iron via fortification in higher income countries. Based on LiST projection, it is estimated that in 2021, over 4 million anemia cases among WRA will be averted due to consumption of iron fortified food. About 1900 stillbirths and 3000 neonatal deaths due to neural tube defects will be averted due to consumption of folic acid fortified food. Conclusions We estimated the coverage of folic acid fortification and iron fortification in LMICs and included them in the most recent version of LiST. Trends in coverage will be included in LiST as data become available. Our analysis shows that while most LMICs have fortification programs, currently the effects of these programs are limited either through low levels of fortification in industrialized food, low consumption of fortified food or both.
Objectives Our objective was to assess changes in prelacteal feeding practices in rural Bangladesh over a 15-year period, from ∼2004 to ∼2019, and to identify household, maternal, and infant characteristics associated with that trend. Methods The analysis used data from 21,804 infants enrolled in a cluster-randomized controlled trial of newborn vitamin A supplementation from 2004–2006, and from 4631 infants enrolled in a cluster-randomized controlled trial of a digital health intervention from 2018–2019. In both studies, trained field workers collected data on household socioeconomic status and maternal demographic characteristics at the time of enrollment. Upon receiving notification of an infant's birth, field workers visited the home as soon as possible, collecting detailed data on breastfeeding initiation and any foods or liquids other than breast milk provided to the infant. Prelacteal feeding was defined as giving infants any food or liquid other than breast milk within first 3 days of life. We used bivariate and multivariate logistic regression analyses to examine the association between different household, maternal, and infant characteristics and prelacteal feeding. We then applied a regression decomposition method to understand the factors associated with the changing prevalence of prelacteal feeding over time. Results The prevalence of prelacteal feeding was 88.0% during the period of 2004–2006. Among women practicing prelacteal feeding, sugar/sugar candy water was the most commonly fed prelacteal (41.2%), followed by animal milk (40.0%), honey (35.4%), and drops (11.8%). By 2018–2019, the prevalence of prelacteal feeding had declined to 24.7%. Most frequently consumed prelacteals were most commonly sugar/sugar candy water (20.0%), honey (20.0%), animal milk (19.7%), and drops (14.3%). Final analysis will include examination of the changing factors associated with this decline including rising maternal education, improvements in socioeconomic status, and exposure to media. Conclusions The prevalence of prelacteal feeding has dropped considerably in rural Bangladesh since 2004. Funding Sources The Bill and Melinda Gates Foundation; United States Agency for International Development; Sight and Life.
Objectives To assess the association between exposure to prelacteal feeding and infant growth from birth to 3 months of age. Methods We analyzed data from a cohort of mothers and infants (n = 2569) identified as part of ongoing pregnancy and birth surveillance in rural Gaibandha, Bangladesh. Trained interviewers visited women in their households during pregnancy to collect sociodemographic data. Project staff were notified of a birth by telephone and interviewers visited the home within three days post-partum, at one-week, and at three months. At each visit, interviewers collected detailed data on breastfeeding, any foods provided to the infant other than breast milk, and morbidity. Infant weight, length, and mid-upper arm circumference were measured according to standardized protocols at birth and three months of age. For analysis, we defined exposure to prelacteal feeding (PLF) as giving infants any food or liquid other than breastmilk within first 3 days of life. Infant length and weight measurements were used to produce length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores. Stunting, wasting, and underweight were defined as a LAZ, WLZ, or WAZ < −2, respectively. We used multiple linear regression and multiple logistic regression to assess the association between anthropometric indices and PLF practices, controlling for low birthweight, infant sex, infant age, maternal education, maternal age, and wealth. Results The prevalence of PLF was 25.2%. The prevalence of stunting, wasting and underweight was 29.0%, 3.8% and 22.3%, respectively. For stunting (adjusted risk ratio (ARR) = 1.02 [95% CI: 0.89–1.16]) and wasting (ARR = 0.97 [95% CI: 0.63–1.50]), there were no differences between infants who received PLF and infants who did not receive any PLF. Infants who received PLF tended to have higher risk of underweight (ARR = 1.10 [95% CI: 0.95–1.28]). For LAZ, WAZ, and WLZ score, no differences were observed in the adjusted analysis between infants who received PLF and those who did not receive any PLF. Conclusions There was no association between exposure to PLF and infant growth from birth to 3 months of age. More research is needed to explore the potential effect of PLF on other outcomes. Funding Sources Bill & Melinda Gates Foundation; Johnson & Johnson; UBS Optimus Foundation.
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