Food Nutr Bull
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Management of shock in children with severe malnutrition remains controversial. To date, the evidence supporting either benefit or harm of fluid resuscitation or rehydration is weak. This issue, however, is not unique to children with severe malnutrition; pediatric guidelines worldwide have a weak level of evidence and remain unsupported by appropriate clinical studies. ⋯ However, they cannot be extrapolated to children with gastroenteritis, since this condition was not included in the trial. Current observational studies under way in East Africa may provide insights into myocardial and hemodynamic function in severe malnutrition, including responses to fluid challenge in those complicated by gastroenteritis. Such studies are an essential step for setting the research agenda regarding fluid management of shock in severe malnutrition.
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Review
Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa.
Stunting and overweight are nutritional problems affecting most of sub-Saharan Africa. The region now has the world's highest rate of stunting among children (43%), while overweight and obesity are becoming a global epidemic, and Africa is not spared. The past two decades have seen a dramatic increase in obesity in sub-Saharan Africa. ⋯ Although socioeconomic, demographic, and environmental factors were significant in determining stunting and overweight, other factors, such as nutrition and lifestyle, were important risk factors. Stunting in childhood is a risk factor that may result in overweight and obesity later in adolescence and adulthood, indicating the need to screen children below 1 year of age to identify stunting early in life. Promoting exclusive breastfeeding is reported to be important in preventing both stunting and overweight among children. More research is needed to explore the relationship between stunting and overweight and to explore policy guidelines to address the phenomenon.
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The National Food Security Act (NFSA) 2013, passed recently by the Indian Parliament, aims to ensure food security in India, chiefly by providing cereals at subsidized prices through the Targeted Public Distribution System (TPDS) for about two-thirds of households. The predominant line of criticism of the NFSA has been the costs of such an ambitious rights-based approach in the context of decelerating economic growth and growing fiscal deficits. We argue that the food subsidy has been increasing through the last few decades and is set to climb even higher with this act but that the incremental costs, at about 0.2% of gross domestic product, are not as high as claimed. ⋯ Several concerns remain to be addressed in the design and implementation of the act, including its proposed coverage, a cereal-centric approach, the identification of beneficiaries, and its adaptability at the state level. If these are resolved effectively, the act can prove to be a significant step forward in India's long-drawn-out battle against undernutrition and food insecurity. Finally, the NFSA also provides a fresh opportunity to reform and strengthen the TPDS, which has been an integral component of India's strategy to achieve food security at the national level.
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The financial resource needs for the reduction of undernutrition are significant, while the returns from reducing undernutrition are large. Yet the share of public resources allocated to the reduction of undernutrition remains disproportionately small. ⋯ What is the potential for other categories of public resource investments to reduce undernutrition, and in which sectors are these investments to be found? This paper proposes a framework for addressing this question and ventures some suggestions as to which of the categories of overseas development assistance beyond the well-known "nutrition-specific" and "nutrition-sensitive" categories are most likely to yield improvements in nutrition status if they could be redesigned with this in mind. We conclude that policy makers should look widely within the underlying and basic determinant intervention space for investments that, when changed at the margins, could result in significant improvements in nutrition.