Results for Development Institute

Large-scale food fortification (LSFF) can improve micronutrient intake, but low-income and middle-income countries often lack resources to collect data for LSFF decision making. We designed a methodology using existing data and methods to inform LSFF programming. This study aimed to pilot a methodology using existing diet, market, and diet cost data and assess its implementation feasibility and usefulness for LSFF decision making. We used household food consumption/availability data from Nigeria and Zambia to assess dietary micronutrient inadequacy and model contributions of LSFF. Market survey (Nigeria) and agrifood information system (Zambia) data were used to estimate availability of fortifiable foods. We used Cost of the Diet software to estimate affordability of an adequate diet in Zambia. We engaged country stakeholders to determine modeling parameters and assess methodology implementation. The analyses took ∼6 mo and cost ∼150,000 USD (Nigeria) and ∼250,000 USD (Zambia). Results showed diets were inadequate to meet vitamin A, folate, and zinc requirements of 32%-67% of households in Nigeria and 51%-83% of households in Zambia. Modeling existing LSFF in Nigeria demonstrated improved micronutrient adequacy of diets, with further improvements possible with rice fortification. In Zambia, existing vitamin A-fortified sugar marginally reduced inadequacy. Introducing mandatory wheat flour and/or maize flour fortification could reduce folate and zinc inadequacies. The market assessment demonstrated widespread availability of fortifiable edible oil, sugar, and wheat flour, but not fortifiable maize flour. The cost of the diet in Zambia with LSFF was similar to the cost without LSFF. Stakeholders found the methodology's components together generated useful, timely evidence for LSFF programming. Our methodology showed opportunities for improving the micronutrient adequacy of diets in Nigeria and Zambia through LSFF. The methodology generated evidence that stakeholders agreed can support LSFF planning. Investments and strategies are needed to strengthen capacity to conduct the assessments, reduce costs, and streamline methods.

BackgroundIndonesia has the world’s second-highest tuberculosis (TB) burden, with 969,000 annual TB infections. In 2017, Indonesia faced significant challenges in TB care, with 18% of cases missed, 29% of diagnosed cases unreported, and 55.4% of positive results not notified. The government is exploring a new approach called “strategic purchasing” to improve TB detection and treatment rates and offer cost-effective service delivery.ObjectivesWe aimed to analyze the financial impact of implementing a TB purchasing pilot in the city of Medan and assess the project’s affordability and value for money.MethodsWe developed a budget impact model to estimate the cost-effectiveness of using strategic purchasing to improve TB reporting and treatment success rates. We used using data from Medan’s budget impact model and the Ministry of Health’s guidelines to predict the total cost and the cost per patient.ResultsThe model showed that strategic purchasing would improve TB reporting by 63% and successful treatments by 64%. While this would lead to a rise in total spending on TB care by 60%, the cost per patient would decrease by 3%. This is because more care would be provided in primary healthcare settings, which are more cost-effective than hospitals.ConclusionsWhile strategic purchasing may increase overall spending, it could improve TB care in Indonesia by identifying more cases, treating them more effectively, and reducing the cost per patient. This could potentially lead to long-term cost savings and improved health outcomes.

Objetivo: realizar uma análise comparativa entre as características clínicas e epidemiológicas da febre maculosa em populações pediátricas e adultas, relacionando com as variáveis utilizadas no estudo, para entender as diferenças entre as faixas etárias. Métodos: Estudo epidemiológico, observacional, de delineamento transversal com dados do Sistema de Informação de Agravos de Notificação (SINAN-DATASUS) referentes a casos confirmados de febre maculosa no Brasil entre janeiro de 2007 e dezembro de 2022, incluindo indivíduos de todas as faixas etárias. AS variáveis incluídas no estudo foram idade, sexo do paciente, sinais e sintomas clínicos, reservatórios, local de provável infecção, dados clínicos e de diagnóstico. Os microdados foram extraídos diretamente do servidor do DATASUS por meio de script em linguagem R. Para as análises de associação entre as variáveis explicativas e o desfecho, foi utilizado o teste qui-quadrado de Pearson, considerando nível de significância de 0,05. Como medida de associação foi utilizada a odds ratio (OR) ajustada pelo modelo de regressão logística e respectivo intervalo de confiança a 95% (IC95%). Todas as análises foram realizadas no software R versão 4.3.2 (R Core Team, Vienna, Austria). Resultados: Foram analisados 2709 perfis de febre maculosa, em ambos os grupos, o sexo masculino foi o majoritário, 71,65% em adultos e 62,40% no grupo pediátrico. Febre foi o sintoma mais recorrente, respectivamente, 91% em adultos e 95% na população pediátrica; a hospitalização nas crianças ocorreu com maior frequência: 72,40%, enquanto nos adultos 58,51%, o contato com carrapato foi similar: 85,96 % em adulto e 79,10% no pediátrico, os adultos frequentaram com maior frequência floresta, rio ou cachoeira 80,16 % em comparação 65,11% no grupo pediátrico. Conclusão: O sexo masculino foi mais suscetível, com o ambiente doméstico sendo o local de maior contágio. Na maioria das vezes, crianças são assintomáticas, enquanto na população adulta os sintomas mais comuns incluem dor de cabeça e mialgia. O diagnóstico laboratorial geralmente é limitado, e as taxas de mortalidade são altas.

Antecedentes: La desnutrición es más común en pacientes diabéticos y esto puede influir en la severidad del pie diabético debido a la alteración en la cicatrización Objetivo: Describir las características de los pacientes hospitalizados por pie diabético, su estado nutricional, su estadio y buscar correlaciones entre ellas. Método: Estudio retrospectivo y analítico del Hospital General Regional Dr. Carlos Macgregor Sánchez Navarro de abril a julio de 2023. Muestra de 23 pacientes con pie diabético con registros médicos y de los procedimientos completos. Se recopilaron datos demográficos, clínicos y laboratoriales, se evaluaron con las escalas CONUT y WIFI. Resultados: Promedio de 61.5 años y una duración promedio de diabetes de 9.1 años, lesiones avanzadas en el pie, con pulsos ausentes, deformidades y claudicación. Todos con anemia y control glucémico subóptimo. La relación proteica sugiere inflamación, estrés metabólico y desnutrición. Escalas WIFI y CONUT: lesiones avanzadas y desnutrición. No se encontró asociación estadísticamente significativa entre el estado nutricional y la gravedad de las lesiones. Conclusiones: En pacientes mayores con diabetes de larga duración, el pie diabético es complejo. Es esencial un buen control de glucosa y atención multidisciplinaria. Se debe evaluar y mejorar el estado nutricional para mejores resultados clínicos y calidad de vida.

A Pandemia da Covid-19 causou uma série de transformações que afetaram a vida das pessoas e as organizações de maneira significativa. Durante este período o setor supermercadista assumiu um certo protagonismo ao ser qualificado como atividade essencial, o que acarretou adaptações forçadas para adequar suas operações aos critérios estabelecidos pelas autoridades competentes. Tais adaptações refletiram na forma de se relacionar com clientes, colaboradores e fornecedores, bem como em aspectos operacionais e higiênico-sanitários que precisaram ser revistos e/ou implementados. Este artigo teve como objetivo analisar o resultado operacional financeiro dos grandes supermercados presentes nas três maiores cidades do Sul de Minas Gerais do ponto de vista populacional durante o período da pandemia tendo como base para a análise os indicadores de performance por eles publicizados em periódico relevante para o setor. O resultado da análise demonstrou que, mesmo em um cenário adverso, os supermercados alcançaram desempenho regular, mantendo crescimento do faturamento e pequenas oscilações quanto aos demais indicadores durante o período compreendido pela pesquisa.

This study examined drivers and barriers to iron and folic acid (IFA) supplementation and consumption of iron- and vitamin A-rich foods among women of reproductive age (WRA) and adolescent girls in Niger. This was an exploratory qualitative study using focus group discussions and semi-structured interviews. This study was conducted in the rural areas of three districts in Maradi and Zinder regions of southern Niger. The study included a purposive sample of 56 WRA (15-49 years), 34 non-pregnant adolescent girls (10-14 years), 105 family members and community leaders, 32 health workers, and 12 national and regional level stakeholders. Respondents demonstrated widespread knowledge of recommendations for IFA during pregnancy and had positive attitudes toward supplements. However, supply barriers were significant, and adherence was limited by side effects, among other constraints. Despite knowledge about and positive attitudes towards micronutrient source foods, respondents reported that limited food access was an overriding constraint to increasing consumption. WRA were seen as nutritionally vulnerable, however husbands were often not able to provide sufficient nutritious food and there was a cultural expectation that wives serve themselves food last. Adolescent girls were not seen as nutritionally vulnerable and there was little family support for their consumption of nutritious foods. Projects should work with local actors to develop multi-pronged solutions that address supply and access barriers for IFA and micronutrient-rich foods and to improve social support for nutrition.