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Micronutrient supplementation of young stunted Beninese children: effects on appetite and growth performance
Linear growth retardation (stunting) still has a high prevalence rate in developing countries (ACC/SCN, 2000). In the republic of Benin reported prevalence rates range from 25% to 40%. In malnourished children it is quite common to observe a combination of multiple micronutrient deficiency, loss of appetite and growth retardation. However, possible interactions between these parameters are not yet adequately mapped.The research presented in this thesis was performed to examine whether micronutrient supplementation may improve appetite and growth in young stunted children. We have performed three micronutrient supplementation studies on stunted children in southern Benin and we have measured effects on appetite and growth performance. In order to be able to assess appetite, an appropriate measuring procedure for appetite had to be developed.For measuring appetite in humans there is no standard, but the habitual daily energy intake is usually considered to be the most appropriate proxy for appetite. However, the common methods to assess habitual daily energy intake are quite invasive and time consuming, and therefore perhaps not appropriate for a quick assessment of young children's appetite. To develop an appropriate appetite measurement tool which can be applied in young Beninese children, we have carried out four trials on a total of 109 children, 18-30 months of age (Chapter 3). Ad libitum intakes of test foods (a maize porridge or rice) served after an overnight fast according to standardized offering procedures were measured on three days. The reproducibility (as coefficient of variation) of the appetite test as calculated from the triplicate measurements was 40% for the maize porridge ('aklui') and 25% for rice ('riz-au-gras'). Habitual breakfast and daily food intake were measured during three consecutive days. Energy intake from the maize porridge was positively and significantly associated with the daily energy intake (n=38, r=0.41, p < 0.05) and with the energy intake from breakfast (r=0.52, p < 0.01). Correlations for the rice test food were less pronounced and non-significant. We conclude that the ad libitum energy intake from a culturally appropriate and well-accepted food as maize porridge can be considered a valid estimate of appetite, provided a standardized procedure is used. If the appetite test is applied in intervention studies it may be necessary to perform the test in duplicate or triplicate (like we did) to perform statistical tests with sufficient power.The first intervention study was carried out to assess the impact of iron supplementation alone or in combination with a deworming treatment on the growth performance of 3-5 year old children (Chapter 2). A total of 177 children were selected from low-income households in a rural area in southern Benin and were allocated to one of four treatments: iron (60 mg elemental iron/day) + albendazole (200 mg/day for 3 consecutive days, at start of study and after one month), iron + albendazole-placebo, albendazole + iron-placebo or placebos. The group of children can be considered as stunted (58% had height-for-age Z-score < -2) and anemic (76% had Hb < 110 g/L), but not as wasted (2% had weight-for-height Z-score < -2). After three months of intervention the blood hemoglobin level in the iron-treated children was significantly increased by 5 g/L (p=0.032) when compared with the levels of the placebo children. There were no significant effects of iron and deworming treatment on growth performance. As expected, Ascaris lumbricoides and hookworm infections decreased significantly in albendazole-treated subjects (p < 0.05). A food consumption survey, performed after the supplementation period was finished, revealed that the overall diet of the children should be considered as marginal. Therefore, we hypothesised that the absence of positive intervention effects on growth performance might be due to a multiple micronutrient deficiency.Therefore, we have studied the effect of a multivitamin-multimineral supplementation on appetite and growth (Chapter 4). A placebo-controlled study was performed in which 101 stunted children (height-for-age Z-score < -2), aged 17-32 months, received either a multivitamin-multimineral supplement (VITALIA-tablets, containing 11 vitamins and 8 minerals) or a placebo. The tablets were given daily to the children for 6 weeks. Knee-heel length, length, weight, arm circumference and appetite were assessed three times before and three times after supplementation. Growth was also assessed 4 months after the intervention. Appetite was assessed using the appetite test procedure as described in Chapter 3 and knee-heel length was assessed using knemometry. Each test day, morbidity data and the mother's report on the child's appetite throughout the preceding day were recorded. We hypothesised that a 6-week supplementation would improve appetite of the children by 25%. However, no significant effects on appetite and growth could be detected. We hypothesised that this lack of effect in the present study might be associated with the high burden of helminth infections and the high level of iron deficiency. Perhaps, the iron content of the multivitamin-multimineral supplement had not been sufficient to compensate the iron deficiency or beneficial effects can only be obtained when the worm load is under control.Therefore, the aim of the third intervention study was to assess whether a combination of a multivitamin-multimineral supplement and an iron supplement would improve appetite and growth of 18-30 months old stunted and anemic Beninese children, provided that their wormload would be under control (Chapter 5). Hundred and fifty stunted (height-for-age Z-score < -2) and anemic children (Hb < 110 g/L) were selected and randomly assigned to one of four treatments: multivitamin-multimineral + iron, multivitamin-multimineral + placebo, placebo + placebo, and placebo + iron. Supplements were provided daily for 6 weeks and intake of tablets was supervised. The multivitamin-multimineral supplements were VITALIA-tablets (11 vitamins + 10 minerals) and iron was given as ferrous fumarate tablets (66 mg iron/tablet). A week before supplementation and during the last week of supplementation, all children received a deworming treatment. Each child was treated with 600 mg of mebendazole (200 mg per day during 3 consecutive days). Appetite, knee-heel length, dietary intake and morbidity status were assessed before and after supplementation. Length, weight, arm circumference and hemoglobin were assessed before, just after supplementation and 4 months after the intervention. Appetite was assessed by the validated appetite test using 'riz-au-gras' as test food. Dietary intakes were assessed during 3 consecutive days by means of the observed weighed record method. As expected, the iron-supplemented groups did show a significant improvement of blood hemoglobin level, but supplementation with iron or the multivitamin-multimineral supplement did not improve appetite or growth performance, despite the deworming treatment. The lack of improvement is difficult to explain. One of the explanations might be that micronutrients are only effective if the diet contains enough protein and energy. The dietary data indeed suggest that the overall quality of the children's diet was not appropriate and that most of the children suffer from a chronic protein-energy malnutrition. An other explanation might be that the duration of supplementation (6 weeks) had been too short to observe a meaningful improvement of appetite and growth. We suggest that future studies on appetite and growth performance should use a combined energy-protein-micronutrient supplement and that the supplementation duration should be sufficiently long for correcting the energy-protein-micronutrient deficiency.</p
Micronutrient supplementation of young stunted Beninese children: effects on appetite and growth performance
Linear growth retardation (stunting) still has a high prevalence rate in developing countries (ACC/SCN, 2000). In the republic of Benin reported prevalence rates range from 25% to 40%. In malnourished children it is quite common to observe a combination of multiple micronutrient deficiency, loss of appetite and growth retardation. However, possible interactions between these parameters are not yet adequately mapped.The research presented in this thesis was performed to examine whether micronutrient supplementation may improve appetite and growth in young stunted children. We have performed three micronutrient supplementation studies on stunted children in southern Benin and we have measured effects on appetite and growth performance. In order to be able to assess appetite, an appropriate measuring procedure for appetite had to be developed.For measuring appetite in humans there is no standard, but the habitual daily energy intake is usually considered to be the most appropriate proxy for appetite. However, the common methods to assess habitual daily energy intake are quite invasive and time consuming, and therefore perhaps not appropriate for a quick assessment of young children's appetite. To develop an appropriate appetite measurement tool which can be applied in young Beninese children, we have carried out four trials on a total of 109 children, 18-30 months of age (Chapter 3). Ad libitum intakes of test foods (a maize porridge or rice) served after an overnight fast according to standardized offering procedures were measured on three days. The reproducibility (as coefficient of variation) of the appetite test as calculated from the triplicate measurements was 40% for the maize porridge ('aklui') and 25% for rice ('riz-au-gras'). Habitual breakfast and daily food intake were measured during three consecutive days. Energy intake from the maize porridge was positively and significantly associated with the daily energy intake (n=38, r=0.41, p < 0.05) and with the energy intake from breakfast (r=0.52, p < 0.01). Correlations for the rice test food were less pronounced and non-significant. We conclude that the ad libitum energy intake from a culturally appropriate and well-accepted food as maize porridge can be considered a valid estimate of appetite, provided a standardized procedure is used. If the appetite test is applied in intervention studies it may be necessary to perform the test in duplicate or triplicate (like we did) to perform statistical tests with sufficient power.The first intervention study was carried out to assess the impact of iron supplementation alone or in combination with a deworming treatment on the growth performance of 3-5 year old children (Chapter 2). A total of 177 children were selected from low-income households in a rural area in southern Benin and were allocated to one of four treatments: iron (60 mg elemental iron/day) + albendazole (200 mg/day for 3 consecutive days, at start of study and after one month), iron + albendazole-placebo, albendazole + iron-placebo or placebos. The group of children can be considered as stunted (58% had height-for-age Z-score < -2) and anemic (76% had Hb < 110 g/L), but not as wasted (2% had weight-for-height Z-score < -2). After three months of intervention the blood hemoglobin level in the iron-treated children was significantly increased by 5 g/L (p=0.032) when compared with the levels of the placebo children. There were no significant effects of iron and deworming treatment on growth performance. As expected, Ascaris lumbricoides and hookworm infections decreased significantly in albendazole-treated subjects (p < 0.05). A food consumption survey, performed after the supplementation period was finished, revealed that the overall diet of the children should be considered as marginal. Therefore, we hypothesised that the absence of positive intervention effects on growth performance might be due to a multiple micronutrient deficiency.Therefore, we have studied the effect of a multivitamin-multimineral supplementation on appetite and growth (Chapter 4). A placebo-controlled study was performed in which 101 stunted children (height-for-age Z-score < -2), aged 17-32 months, received either a multivitamin-multimineral supplement (VITALIA-tablets, containing 11 vitamins and 8 minerals) or a placebo. The tablets were given daily to the children for 6 weeks. Knee-heel length, length, weight, arm circumference and appetite were assessed three times before and three times after supplementation. Growth was also assessed 4 months after the intervention. Appetite was assessed using the appetite test procedure as described in Chapter 3 and knee-heel length was assessed using knemometry. Each test day, morbidity data and the mother's report on the child's appetite throughout the preceding day were recorded. We hypothesised that a 6-week supplementation would improve appetite of the children by 25%. However, no significant effects on appetite and growth could be detected. We hypothesised that this lack of effect in the present study might be associated with the high burden of helminth infections and the high level of iron deficiency. Perhaps, the iron content of the multivitamin-multimineral supplement had not been sufficient to compensate the iron deficiency or beneficial effects can only be obtained when the worm load is under control.Therefore, the aim of the third intervention study was to assess whether a combination of a multivitamin-multimineral supplement and an iron supplement would improve appetite and growth of 18-30 months old stunted and anemic Beninese children, provided that their wormload would be under control (Chapter 5). Hundred and fifty stunted (height-for-age Z-score < -2) and anemic children (Hb < 110 g/L) were selected and randomly assigned to one of four treatments: multivitamin-multimineral + iron, multivitamin-multimineral + placebo, placebo + placebo, and placebo + iron. Supplements were provided daily for 6 weeks and intake of tablets was supervised. The multivitamin-multimineral supplements were VITALIA-tablets (11 vitamins + 10 minerals) and iron was given as ferrous fumarate tablets (66 mg iron/tablet). A week before supplementation and during the last week of supplementation, all children received a deworming treatment. Each child was treated with 600 mg of mebendazole (200 mg per day during 3 consecutive days). Appetite, knee-heel length, dietary intake and morbidity status were assessed before and after supplementation. Length, weight, arm circumference and hemoglobin were assessed before, just after supplementation and 4 months after the intervention. Appetite was assessed by the validated appetite test using 'riz-au-gras' as test food. Dietary intakes were assessed during 3 consecutive days by means of the observed weighed record method. As expected, the iron-supplemented groups did show a significant improvement of blood hemoglobin level, but supplementation with iron or the multivitamin-multimineral supplement did not improve appetite or growth performance, despite the deworming treatment. The lack of improvement is difficult to explain. One of the explanations might be that micronutrients are only effective if the diet contains enough protein and energy. The dietary data indeed suggest that the overall quality of the children's diet was not appropriate and that most of the children suffer from a chronic protein-energy malnutrition. An other explanation might be that the duration of supplementation (6 weeks) had been too short to observe a meaningful improvement of appetite and growth. We suggest that future studies on appetite and growth performance should use a combined energy-protein-micronutrient supplement and that the supplementation duration should be sufficiently long for correcting the energy-protein-micronutrient deficiency
Going Beyond Counting First Authors in Author Co-citation Analysis
The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
We provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
We conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
We have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
Author-wise bibliometric analysis based on entropy.</p
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