Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd World Congress on Public Health, Nutrition & Epidemiology Osaka, Japan.

Day 1 :

  • Adolescent & Environmental health
Location: 1
Speaker
Biography:

Frances O’Callaghan is a health psychologist in the School of Applied Psychology, Griffith University. Her research focuses on psychosocial influences on health and illness, sleep disorders, and fetal alcohol spectrum disorders.

Abstract:

Poor sleep quality and excessive daytime sleepiness are positively associated with common mental disorders such as depression, anxiety and somatoform disorders, as well as lapses in concentration and daytime tiredness. These relationships are complicated among university students who have high caffeine consumption, and high stress, both of which affect sleep quality. Methodology and Theoretical Orientation: This was a quantitative study involving 175 full-time university students from 17 to 25 years (mean = 19.43, SD = 2.06). Students completed an online questionnaire about their sleep quality, daytime functioning, caffeine consumption and recent level of stress symptomatology. Findings: Poor quality sleep was associated with diminished daytime functioning. Increased caffeine consumption influenced daytime functioning by lowering the quality of an individual’s sleep. However, the relationship between quantity of caffeine consumption and sleep was dependent on the time of day the caffeinated beverages were consumed. Increased stress was related to both reduced sleep quality and reduced daytime functioning. Conclusions: The findings highlight the implications for daytime functioning of university students not getting sufficient quality sleep, and the role of lifestyle factors pertaining to caffeine use and stress

Speaker
Biography:

Dr Cheah Whye Lian is an associate professor in the Department of Community Medicine and Public Health.  Her research focused on the issues on overweight and obesity from children to adulthood.  She has knowledge in conducting quantitative, qualitative and mixed-methods research.  Her work also involves studies among the indigenous groups of Sarawak, looking at the interaction between cultural and health behaviors, particularly among the Iban and Bidayuh communities.    She is the principal investigator of a project focusing on non-communicable disease among adolescents in Sarawak funded by Ministry of Higher Education Malaysia.  She also had completed projects on physical activity, body image, disordered eating among school children.  

Abstract:

The association between obesity and hypertension has been largely reported in adult population, but limited for adolescents, particularly in Sarawak.  The objective of this study was to determine the prevalence of hypertension and its association with obesity among indigenous adolescents aged 12-17 years in Sarawak. It was a cross-sectional using questionnaire, anthropometric and blood pressure measurement. Using a systematic sampling procedure, a total of 18 secondary schools representing urban and rural from 11 divisions of Sarawak were selected. Data was analyzed using Statistical Package for Social Sciences Program (SPSS) version 22.0. A total of 1780 secondary school children participated in the study with 58.9% females and 20.1% reported at least one of the parents with history of hypertension.   The prevalence of pre-hypertension was 13.4%, stage 1 hypertension was 13.5% and stage 2 hypertension was 4.7%.  The prevalence of overweight and obesity was 24.4%, elevated waist circumference was 13.4, and overfat and obese was 6.2%.  The prevalence of hypertension among male respondents was 23.9%, female respondents was 14.1%. In multiple logistic regression, adjusting for age and family history, hypertension was associated with sex (males) (OR=3.20, p<0.000), ethnic group (ref=Iban, Malay, OR=0.72, p=0.015; Bidayuh, OR=0.65, p=0.019), overweight and obese (OR=3.311, p<0.000), elevated waist circumference (OR=2.15, p<0.000),   overfat and obese (OR=2.08, p=0.004).  Hypertension and obesity in this population is highly prevalent. Screening blood pressure and assessment of nutritional status can be recommended as the routine health assessment in school health programme to detect and provide early intervention to those at risk of hypertension.    

Speaker
Biography:

My name is Byanicha Aurora. I am 27 years old from Indonesia. I has completed my medical in 2012 and graduated from Sriwijaya University, South Sumatera, Indonesia. I had worked as an Intership doctor in 2013-2014 at one of regional hospitals and community health centres in Jambi City. After finishing my intership program, I have worked as a general practioner in rural area of Indonesia that called PTT doctor for almost 3 years, and now I have been a government employee working in the same area when i was still being a PTT doctor. I am going to publish my first paper by title of Determinants of Stunting among 0-23 month-old in rural area of Indonesia  in the 5th Asia Pacific Conference on Public Health held at Sarawak, Malaysia.

Abstract:

Incidence of cardiovascular disease in adulthood could not be separated from the continuous interaction from infancy through adolescence. Some risk factors for cardiovascular disease occurred since his teens. High level of low-density lipoprotein and cholesterol is often indicative of increased risk for cardiovascular disease. The ratio of LDL to HDL and total cholesterol to HDL can be used to reveal the risk of it. This research is to estimate the influence of 12 potential factors and to find association of BMI and waist to hip ratio with the level of LDL to HDL and total cholesterol to HDL ratio. A correlation ratio (ETA) design study using primary data which are gathered prospectively among random adolescents in Jambi whose BMI is underweight,normal,overweight,and obese that could participate on the day of the survey. Data on 12 potential factors including daily intake, physical ativity, and family history were collected three days.We administered a questionnaire and measured BMI and waist to hip ratio to assess statistical relation with the level of LDL to HDL and total cholesterol to HDL ratio. Category of LDL to HDL and total cholesterol to HDL ratio was stratified from high risk and low risk.  Examination of lipid profiles were done at the clinical laboratory of Abdul Manap Regional Public Hospital in Jambi. Duration of research was about 3 months. The study included 50 people with age span of 16 to 20 years old with all of them had low level of LDL to HDL and total cholesterol to HDL ratio. Most of samples were underweight (42%) resulting low risk for cardiovascular disease as well as normal (24%), overweight (26%),and obese (8%) people. BMI was likely to influence the low level of  LDL to HDL (ƞ2=0,705) and total cholesterol to HDL ratio (ƞ2=0,765),confirmed statistically significant. 94% samples with low risk category of waist to hip ratio were likely to have low risk for cardiovascular disease. Waist to hip ratio influenced the low level of  LDL to HDL (ƞ2 =0,003)  and total cholesterol to HDL ratio (ƞ2 =0,021). Other factors that associated with  the level of LDL to HDL and total cholesterol to HDL ratio were frequence of daily intake including fruit, vegetables, and snacking consumption, physical activity, and family history of uncommunicable disease. The strongest association was a relation of the level of LDL to HDL and total cholesterol to HDL ratio with Body Mass Index. By knowing the risk factors, cardiovascular disease can be prevented at earlier age.

 

η 2 {displaystyle eta ^{2}}Key words : Cardiovascular disease, lipid profile, risk factor

Speaker
Biography:

Dr Jerome McIntosh is a newly qualified doctor with a passion for innovation and enterprise in healthcare. His continual conquest for healthcare improvement has driven him to complete a BSc alongside his medical degree in Innovation and Enterprise in Clinical Medicine. He has used his time here to be involved in various healthcare improvement and evaluation projects, with a special interest in sport and its application in healthcare improvement. His commitment has been rewarded early in his professional journey having been awarded Early Career Innovator Prize at the International Festival of Public Health 2016.  Alongside his academic proficiencies he is a national level athlete competing in the 100m and 200m disciplines and has won various honors, the most notable; a Bronze medal at the British Universities and College Sports National Championships and the Gold medal at the North of England Senior Indoor Championships 2016. 

Abstract:

Objectives: This study aims to review current literature to assess the effectiveness of E-Health interventions in increasing physical activity in young people.

Study Design: This study is a systematic review of the literature.

Methods: A search of the literature databases Embase, Medline and the Cochrane Library, using key words ‘Adolescents’; ‘Young people’; ‘Students’; ‘Young Adults’; ‘Teenagers’; ‘E-health’; ‘Internet-based’; ‘Web-based’; ‘Exercise’; ‘Activity’; ‘Sport’; and ‘Intervention’ yielded 10 articles which fit the criteria for inclusion. PRISMA protocol was used and papers were excluded if they were disease focused, not specific to young people (those attending school, college or university), or did not measure physical activity as an outcome.

Results: Eight of the 10 studies had significant increases in physical activity as a result of an E-health intervention. Studies that did not use a theoretical principle to underpin their intervention did not achieve successful results. Interventions based on social cognitive theory were very successful in achieving an increase in physical activity. The theory of planned behaviour had mixed results, with studies having contrasting results. SMART goal principle was not effective in increasing physical activity, but had positive findings in supplementary outcomes such as goal setting.

Conclusions: E-health interventions are a very successful way to increase physical activity. More research is required to look at what theoretical principles are best to underpin interventions, and also to assess the length of intervention required for optimal results post intervention. Ideas surrounding implementation and the mediums used requires more study to evidence base these interventions for schools, colleges and university via intra or extra curriculum. 

Yu-sheng Shen

National Chengchi University, Taiwan

Title: The relationship and effect of green space and health
Speaker
Biography:

Yu-sheng Shen received his Master of Urban and Regional Planning degree at National Taipei University in 2004. In 2016, he received his Ph.D. degree at the Department of Land Economics in National Chengchi University. Yu-sheng Shen has his expertise in environmental health and urban planning.

Abstract:

Previous studies have shown that green spaces are beneficial to health; however, few studies have analyzed the relationship among green space, atmospheric environment, and health. This work applies collaborative conceptual modelling (CCM) approach to analyze the relationship and effect  of green space, atmospheric environment, and health. Moreover, to enhance the benefits of green space on health, this paper also proposes several strategies for managing green spaces. The proposed strategies may serve as a reference for other metropolitan areas with features similar to those of the study area.

  • Epidemiology, Infections and Public Health
Location: 2
Speaker
Biography:

Mark Owusu is a Research Fellow at the University of Canterbury with a passion in health policy and non-communicable disease epidemiology. His research interest lies in the control of non-communicable diseases in Africa with a focus on hypertension and diabetes. He is currently researching on the current epidemiological trends in hypertension and diabetes occurrence in Ghana and the policy response to these conditions at the School of Health Sciences, University of Canterbury, New Zealand.

Abstract:

Introduction: Although interest in non-communicable disease research in Africa in general and Ghana, in particular, is increasing, the real burden of hypertension and diabetes and the policy response to these conditions have not yet received the necessary attention.

Statement of the problem: Overemphasis of research on infectious disease (especially malaria and HIV/AIDs) control in Ghana means that few studies have addressed the increasing incidence of diabetes and hypertension. With evidence on policy interventions for controlling hypertension and diabetes generally emanating from High-Income Countries, more studies are needed from Low-and-Middle-Income Country settings to inform policy and practice. 

Study purpose: This study focuses on establishing the burden of hypertension and diabetes mellitus in Ghana and explores the perspectives of relevant stakeholders on how they understand and are responding to the challenge of hypertension and diabetes mellitus in Ghana.

Methods: Using a pragmatic policy approach, this paper presents a progress report on the analysis of data from the Global Burden of Disease database and routine hospital data from the Ghana Health Service using Joinpoint tools; as well as key informant interview and focus group data from relevant stakeholders in the Ghanaian health system.

Expected outcome: Considering the fact that countries in sub-Saharan Africa share many social, economic and political characteristics, it is expected that this study will have useful lessons for hypertension and diabetes policy and practice beyond Ghana.

Speaker
Biography:

Dr. Kim has enthusiasm and expertise in public health. He is actively participating in community health promotion activities and has atopy and asthma education information center. He is evaluating the quality of life of children with allergies and is trying to provide a basis for health promotion school for allergic diseases

Abstract:

The EuroQol Group developed the EQ-5D-Y, a child-friendly version of the EQ-5D to be used with children and adolescents. This study aimed to comparison of health-related quality of life of elementary school students according to allergy symptoms using of the EQ-5D-Y.  The subjects of the study were recruited by convenience sampling from 10 primary schools in Gyungbuk, South Korea. We sent informing newsletter to the students' families. The EQ-5D-Y was self-administered in the sample population and demographic and health information were collected from the subjects’ parents or guardians. In order to explore the construct validity of the EQ-5D-Y, the difference in the percentage of respondents reporting problems by prevalence of allergic symptoms (wheezing, runny or blocked nose, and itchy rash) in the past 12 months. In addition, the difference in the percentage of respondents reporting problems and EQ-VAS score depending on the number of allergic symptoms were examined. Total 2,494 questionnaire were collected. Missing response was 24 (0.96%) on the EQ-5D-Y and 187 (7.5%) on the VAS. Proportion of reported problem ranged from 2.3% on the mobility to 9.8% on the having pain or discomfort dimension. Group with wheezing, rhinorrhea or nasal stiffness, and itching rash were showed significantly higher problem reporting proportion in most EQ-5D-Y dimensions than healthy group without each symptom. As the number of symptoms increase, Percentage of respondent reporting problems were increased and the VAS score decreased.   

Speaker
Biography:

Pamela N. Magande is a medical doctor with a postgraduate degree in Public health. Her main interest is developing practical, cheap ways of improving community health. She is currently working in HIV care and treatment in Zimbabwe.

Abstract:

Statement of the Problem: Clients on anti-retroviral therapy (ART) are living longer and have risk of hypertension. Side effects of medicines and aging increase this risk. Hypertension prevalence among clients on ART in Kadoma City was estimated to be 30% in 2015. Of these, 61% had uncontrolled hypertension. This was high compared to 46% of hypertensives in the general population who had uncontrolled hypertension. We determined factors associated with uncontrolled hypertension among clients on ART.

Methodology: A 1.1 unmatched case control study was conducted. Interviews, anthropometric measurements and record reviews were to collect data on demography and medical history. Epi Info 7 was used for univariate, bivariate analysis and logistic regression.

Findings: One hundred and fifty-two cases and 152 controls were recruited into the study. Adding salt to dishes regularly aOR=5.69(3.19-10.16), body mass index (BMI) above 25kg/m2 aOR= 2.81(1.60- 4.91) and history of elevated blood pressure in previous year aOR=2.34(1.33-4.13) were independent risk factors. Independent protective factors were duration more than two years since HIV diagnosis aOR=0.58(0.35-0.95), duration less than five years since hypertension diagnosis aOR=0.50(0.30-0.83) and walking or cycling as a means of transport aOR=0.27(0.16-0.48).

Conclusion: Adding salt to dishes regularly, BMI above 25 kg/m2, history of elevated blood pressure in the previous year, duration more than two years since HIV diagnosis, duration less than five years since hypertension diagnosis and walking or cycling as a means of transport were independently associated with uncontrolled hypertension. Health education on lifestyle changes like walking and cycling as transport and dietary modification such as salt intake reduction were recommended.

Key words: Uncontrolled hypertension, ART, Kadoma

Speaker
Biography:

Hui Wang has her expertise in nutritional epidemiology and molecular epidemiology. Her passion was dedicated on the mechanism of environmental and genetic impact on the diseases pathogenesis .Previously, she focused on the genetic deficiency of innate immunity would trigger the process of cancer, research has published on Hepatology.  Recently, the dietary pattern of China is undergoing the transition period; meanwhile, the overweight situation gets more and more serious. Thus, she moved her research on the nutritional epidemiology. Papers have published in European Journal of Clinical Nutrition and Nutrition research.  

Abstract:

Purpose: To investigate the gender difference of getting metabolic syndrome (MetS) and its various associations with dietary diversity at different ages. Methods: Data of adults(n=4308) aged 18+ y with three consecutive 24-h recalls and complete co-variates information were extracted from Chinese Nutrition and Health Survey in 2009. Modified Dietary Diversity Score (DDS) was adopted to capture the diversity of diet. MetS was defined by the harmonized criteria. Multivariable adjusted logistic regression was carried out to detect the association between DDS and MetS and its components for young, middle aged and elderly adults by a cross-sectional study. Results: Female were more likely to get MetS than male counterparts, especially after 50 years old, and the risk follows an inverse-U shape for both genders. Moveover, DDS played a significant protective role in MetS for young female (<45), similar trends were detected in serum TGs, abdominal adiposity, blood pressure, and fasting blood glucose (all P trends < 0.05). However, this association reversed in old female (>60) [OR (95%CI): 1.69(1.05, 2.72)] and male adults [OR (95%CI): 1.59(1.04, 2.44); 2.18(1.30, 3.65)]. Greater DDS was associated with higher serum TGs, and lower HDL-C level for male adults (45≤ & <60) [OR (95%CI): 1.56(1.17,2.08); 2.00(1.24,3.24)], higher blood pressure for old men (>60) [OR (95%CI): 2.49(1.76,3.53); 1.54(1.00,2.35)], but lower blood pressure and fasting blood glucose in young man(<45) (all P <0.05). Conclusion: The association between DDS and MetS varies at different ages and differs for male and female. Targeted strategy of health education in balanced diet should be designed for different population, especially, the old women and middle aged men to reduce the burden of chronic diseases. 

Speaker
Biography:

Anne Jamaludin research is mainly focused on injury prevention (accidental and non-accidental injuries) in children. Her passion is on advocating for child’s rights and health within the healthcare delivery settings to ensure that all children have access to health and living in a safe environment.

Abstract:

It is well established that accidental and non-accidental injuries are a major public health problem globally. Not only do they affect individuals, injuries affect families, the community, government and internationally as well. Injuries span throughout childhood and into adulthood. Purpose of this study is to identify what are the difficulties and challenges in identifying and reporting NAI at the emergency (ETD) and trauma department in Malaysian hospitals.

Thirty in-depth interviews were conducted at the ETD in three major hospitals in the Klang Valley, Malaysia which consists of specialists, medical officers, nurses and medical assistants.

Low rate of NAI cases (2.7%) identified proved that there is significant gap identified in medical professionals’ knowledge and skills related to understanding, identifying and detecting NAI, particularly among medical officers who are in charge of diagnosis and reports in the hospital. Those who had previous experience or encounters in dealing with NAI cases would have higher suspicion index compared to those who haven’t. Other medical professionals such as nurses and medical assistants although do not have the mandate to diagnose or report of NAI cases, needed to have the basic knowledge and awareness and play more active role in their respective settings. 

Speaker
Biography:

Her distinction in Forensic Medicine has pursued Dr Thilaka Chinnayah to further her interest in public health. After obtaining Masters in Occupational Health, she specializes in field epidemiology and was the first graduate of Epidemic Intelligence Program to be sent to WHO, Manila to sub-specialize in Health Security and Emergencies.  Attachment as a senior epidemiologist has given her vast exposure to international work in West Africa, Federated States of Micronesia, Mongolia and Lao PDR. She shared her experience and knowledge in disaster management during the flooding and cyclones in Thailand, Indonesia and Vanuatu. She was involved in many outbreak investigations and was at ground zero when Malaysia detected its first case of Mers-CoV and the unusual outbreak of Sarcocystitis. In recognition of her excellence contribution to public health, she received several national awards from the Government and NGOs and nominated for the Great Women of Our Times 2016 by the Women’s Weekly Magazine.  

Abstract:

Measles Elimination Programme (MEP) in Malaysia was started in 2004 and targeted elimination by 2010. However, this target has not achieved and revised target was set as 2018. Study was carried out to determine the progress made towards the elimination of measles and factors affecting it.

By multistage stratification, we identified four to eight facilities from two districts (urban and rural) respectively, from each of seven states in all regions of country. Secondary data from 2006-2016 measles surveillance system were analyzed from web based reporting system (e-notification and e-measles). Outbreak reports, vaccine coverage at States, Districts and Health Centers were reviewed and personnel involved in measles surveillance and vaccination programme were interviewed. MEP Surveillance indicators for year 2016 were assessed.

Incidence of measles in 2016 was 3 per million populations (target 1/1million) with cyclical peak reported every 3–4 years. No gender differences among the cases. Measles were high in ≤15 years (76%) and among them 29% were children below one year. Fifty percent of the measles cases were not vaccinated. Main reason for non-vaccination being vaccine refusal and on alternative medicine (47%). MCV1 coverage for state and district level was above 95% but some health centers revealed lower coverage (75%-90%). Most of MEP surveillance targets were achieved except for only 72% (target >80%)laboratory results were available within four days of specimen received.

Measles is still endemic in Malaysia and the incidence showed 3-4 years of cyclical peak. Low vaccine coverage at the level of health center and delayed lab result hinder measles elimination. National measles supplementary immunization activity targeting children 1-15 years is recommended focusing on low coverage areas. In addition, a follow-up campaign every three years, strengthening health education on acceptance of vaccination and improving turn over time of laboratory will ensure measles elimination in Malaysia achieved by 2022.

Speaker
Biography:

Angga Hendro Priyono is one of student in Faculty of Medicine, Lampung University, He is a Secretary of Student Representative Council in his University. He has published more than five papers journal and serving as an editorial board member. He has done more than three community services on public health scope in three different villages. Because of the devotion, the village can explore the existing resources in the village and can be utilized optimally by the local community.

Abstract:

Malaria is one of the most contagious diseases which is still a public health problem in the world including Indonesia. The prevalence of malaria in Indonesia is 6.0 percent, with malaria endemic areas spread from east to west. Statistical data describes Lampung as an endemic area with the highest point in Sukajaya Lempasing village, Pesawaran. The high incidence of malaria in the village is caused by the lack of community’s role to eradicate malaria. Therefore, it is necessary to create an appropriate solution to optimize the role of community in malaria eradication. In order to optimize the role of Sukajaya Lempasing village community, we formed  a group of agent named BOM PASSION. BOM PASSION agents serve as promoter of malaria prevention as well as implementing BOM PASSION program to suppress malaria incidence rate.  The program will be consist of junk bank, Nila fish farming, and the making of peripheral blood smear preparations. Selected agents are agents that suitable with the criteria: 25-45 years old and want to attend counseling and training on malaria. Counseling and training are given in 5 stages (malaria, junk bank and  mosquito nets counseling also training of how to make peripheral blood smear preparations and  nila fish farming). In every stage of counseling and training, agents are required to do pretest and post test to assess the changes of their knowledge. After counseling and training have been completed, evaluation and  agents confirmation is carried out. The result of this program is in the form of agents consist of 25 people that divided into five divisions such as core comitte, junk bank, Nila fish farming, blood smear preparations, and field coordination. The agents are able to promote malaria prevention and carry out the whole program of BOM PASSION systematically resulting in a decrease of malaria incidance rate.

Speaker
Biography:

Deanna Mulvihill has her expertise in evaluation and passion in improving the health and wellbeing. Her open and contextual evaluation model based on responsive constructivists creates new pathways for improving healthcare

Abstract:

Introduction: The prevalence of gastric cancer in Korea is increasing, and anemia is one of the most common complications of a gastrectomy. The purpose of this study was to estimate the incidence of

anemia and assess its associated factors in long-term gastric cancer survivors.

Methods: This study was a retrospective cohort study of gastric cancer patients who visited a single

medical center from January 2009 to December 2014 in Korea. We included 385 patients who survived

for at least five years after gastrectomy with no recurrence or metastasis. Anemia was defined by World

Health Organization criteria (Hb < 12 g/dL in women and <13 g/dL in men).

Results: Hemoglobin levels decreased from 14.24 ± 1.23 mg/dL before surgery to 13.60 ± 1.57 mg/dL one year after surgery (P < 0.001). The cumulative incidence rate of anemia after surgery increased linearly from 18.7% in the first year to 39.5% in the fifth year. The risk of anemia was higher in females (RR, 2.00; 95% CI, 1.26e3.18), patients that received total gastrectomy (RR, 3.00; 95% CI, 2.09e4.30) and patient with diabetes (RR, 1.87; 95% CI, 1.05e3.22). A higher postoperative BMI decreased the risk of anemia (RR, 0.38; 95% CI, 0.22e0.67).

Conclusions: During five years of follow-up after gastrectomy, the incidence of anemia steadily increased, and the risk of anemia was higher in females, total gastrectomy patients, patients with diabetes, low BMI patients.

 

 

Speaker
Biography:

Muhammad Sarwat Mirza possesses wide experience in the field of program/ project designing and development, program management, Monitoring, Evaluation & Research especially related to Reproductive Health, Nutrition and Family Planning, working with HANDS for last 22 years. He had experience of developing Behavior Change Communication material for promotion of breast feeding, dietary habits of pregnant and lactating women, nutrition for children and adolescents. among the rural communities. Recently he has concluded two operation research projects with multiple partners and donors on “Nutrition and Reproductive health issues of Pregnant women to improve the birth outcome and reduce the low birth weight incidence”, and Rapid assessment of drought stricken area in Pakistan. He played a major role in organizing the Pakistan SUN movement (Scale Up Nutrition) CSO Alliance.

 

Mr. Mirza did MBBS and master in Public health and had served at Dept. of Pediatrics, The Aga Khan University Hospital Pakistan. He worked on several clinical research projects such as Dietary management of diarrhea, control trial of local food, zinc supplementation in malnourished children.  He is serving as Research advisor for Community Health Initiatives related to Food, Nutrition and Research to Allama Iqbal Open University Pakistan for post graduate medical students.  He is a citizen of Pakistan and fluent in English and Urdu.

Abstract:

Keywords: Anemia in Pregnant women, low birth weight. Multiple Micro-nutrient, communit based intervention

 

In Pakistan, 32% of all babies born have low birth weight which is a major contributor to new born and infant mortality and stunting of 44% of children <5 years of age.  

 

We conducted first prospective community based study in Pakistan that has researched the effect of Multiple Micro-nutrient (MMN) along with a set of composite community based interventions on prevalence of anemia among pregnant women and incidence of low weight births in the remotest and highly food insecure regions. The hypothesis postulated that the proper counseling and guidance at community level about nutrition, dietary intake of proper local foods and micro-nutrient supplements (including the iron-folate) may improve the nutrition status of pregnant women and hemoglobin level through improved dietary practices and ensures the regular intake of micro-nutrients. All these impact the improve birth weight of the newborn child.

 

Study participants were 1,204 pregnant women (600 in intervention and 604 in control group). The interventions were nutrition counselling, provision of multiple micro-nutrient and de-worming tablets, regular follow up, measurement of weight, hemoglobin in each trimester of each enrolled pregnant women

 

  • In the intervention group (69.1%) women modified their diet. Significantly higher proportion of women increased the number of meals and content

-          (98.7%) pregnant women reported regular intake of mulitple micronutrient.  

  • The change in mean haemoglobin levels in the intervention area was 2 gm/dl, which is significantly higher
  • The low birth weight among the intervention group women was 3.8%, significantly lower than the national figure of 32%. Analysis showed that per unit (kilogram) increase in weight since the enrollement higher Hb in last trimester, a higher gain in Hemoglobin and BMI levels reduced the risk of low weight birth by 0.90 times.

Conclusion:

Our study successfully demonstrated that in rural remote areas where the food insecurity already prevailed, community based provision and improving intake of Multiple Micro-Nutrient to pregnant women, deworming, dietary counselling, significantly reduce the prevalence of anemia and resultantly reduce the incidence of low birth weight.

Speaker
Biography:

Ni Ketut Aryastami a researcher at the Center for Humanity and Health Management, National Institute of Health Research and Development , Ministry of Health Rep. of  Indonesia. Her background is nutritionist with expertise in public health management and Community nutrition. She got her PhD from the University of Indonesia with the disertation titled: ‘Early growth appointed growth towards pre-pubertal”.  Stuntedness in children is her main interest. The ongoing project she working is ‘Study on policy implementation of the first thousand days of life in Indonesia”. 

Abstract:

Statement of the Problem: Growing short has been started in the womb of malnourished mothers, indicated by  having low birth weight and grew in deviation curve. Critical window of growth   taken  place at first 1000 days of  life. This study was conducted to investigate the influence of early growth, towards the growth of pre-puberty’s period. Methodology & Theoretical Orientation: The study design was retrospective, utilizing Indonesian Family Life Survey panel data of 1993, 1997, and 2000.  Study population was Indonesian households covering 13 out of 27 provinces in 1993 for the representativeness of urban-rural and  national. Sampel was children, age 0-2 years old at the baseline, followed up at age of  4-6  and 7-9 years (pre-puberty). The data analysis was done for Multivariate Logistic Regression. Findings: Early child growth was appointed growth of pre-puberty.  Factors related to stunted at early life was poverty (OR=1,78; 95%CI=1,06-2,99), urban settlement (OR=2,92; 95%CI=1,74-4,90), as well as  poor hygiene and sanitation  (OR=1,84; 95%CI=1,10-3,09).  Short at age of 4-6 years is related to short at early age (OR=3,73; 95%CI= 2,160-6,343). Early growth and growth pattern of stunted (S) and normal (N) at early age of 0-2 years  (02) and age of 4-6 years (46) showed, 77,1%  of 02S_46S stayed stunted  (OR=27,43; 95%CI=11,68-64,43). As much as 59,5% of 02N_46S experienced growth faltering becoming  stunted (OR=14,00; 95%CI=5,95-32,95). Children who were 02S_46N account for 84,3%  grew  normally  (OR=1,48; 95%CI=0,55-4,00; p=0,441) at pre-puberty. Growth improvememnt of these subjects were generally  supported by the economic improvements.  Conclusion: Stunting can be corrected during childhood. Efforts on stunting intervention should be focused at the first 1000 days of life, and if necessary be followed up until age of five years. Cohort and Multi-center studies are needed to better understand the problems and factors related to stunting specifically at the pocket areas in Indonesian situation.  

Speaker
Biography:

Rejane Figueiredo is a statistician, with master degree in Statistical and Phd in Epidemiology. Her interest areas are obesity in childhood and adolescence, metabolism and cancer. She is working at The Finnish Health in Teens study (Fin-HIT). Fin-HIT is a cohort study including more than 10 000 Finnish preadolescents in the age 9-12 years. Fin-HIT enables to study a series of etiological hypotheses regarding the role of exposures and mediating factors, including genetic susceptibility, epigenetics, and microbiota on the development of body size. 

Abstract:

Aims: Little is known about impact of maternal alcohol and tobacco consumption on adolescents’ body size. The purpose of this study was to evaluate whether maternal alcohol or tobacco consumption is associated with their children’s body size in adolescence, assessed by Body Mass Index (BMI).

Methods: This study was conduct in subjects recruited into the Finnish Health in Teens cohort (Fin-HIT) between 2011 and 2014. A total of 4,525 subjects aged between 9 and 14 years and their mothers or female adults responsible for the children were analysed. Relative risks (RR) and 95% confidence intervals (CI) were estimated using Multinomial Logistic Regression.

Results: Most children were normal weight (74.5%), 10.6% were underweight and 14.9% were overweight or obese. Among mothers, 50.6% were never smokers, 35.7% were former smokers, and 13.7% were current smokers. Alcohol consumption was classified by Alcohol Use Disorders Identification Test (AUDIT), 12.7% were abstainers (score=0), 65.0% were low-moderate drinkers (scores 1- 4) and 22.3% were harmful drinkers (scores ≥ 5). There were statistically significant associations between currently smoking mothers and children’s overweight (RR=1.36; 95% CI: 1.05-1.75). There was an inverse association between maternal former smoking and children’s underweight (RR = 0.70; CI: 0.56–0.87) compared to never smoker mothers. Among children in puberty, abstainer mothers were more likely to have underweight children compared to low-moderate mothers (RR=1.57; 95% CI: 1.03-2.41).

Conclusion:

Current smoker mothers were associated with children’s overweight and former-smoker mothers were inversely associated with the children’s underweight. Being an abstainer mother was associated with the children’s underweight in puberty stage. If other studies confirm these results, public health interventions aiming at healthy weight of adolescents should target the whole family, not only the adolescents themselves.