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Background/Objectives:Iron deficiency anemia is a major public health problem in developing countries and may affect school performance and physical work capacity in nonpregnant adolescents, and may increase the risk of anemia during subsequent teenage pregnancies. We assessed the effect of weekly iron (120 mg elemental iron) and vitamin A (25 000 IU) supplementation on hemoglobin, iron status and malaria and nonmalaria morbidity in adolescent schoolgirls.Subjects/Methods:A total of 279 schoolgirls aged 12–18 years from public primary schools in Kisumu, western Kenya. Double-blind randomized placebo-controlled trial using a factorial design.Results:Five months of iron supplementation was associated with a 0.52 g dl−1 (0.21, 0.82) greater increase in hemoglobin relative to iron placebo. The effect was only observed in girls with iron deficiency on enrollment (1.34 g dl−1 (0.79, 1.88)), but not in iron-replete girls (−0.20 g dl−1 (−0.59, 0.18)). Similar differences in treatment effect were seen between menstruating and nonmenstruating girls. The effect of iron was independent of vitamin A. The baseline prevalence of vitamin A deficiency was low (6.7%) and no sustained increase in hemoglobin was seen with weekly vitamin A (−0.07 g dl−1 (−0.38, 0.25)). Incidence of malaria parasitemia was higher in the iron than iron-placebo groups (Rate ratio 1.33 (0.94, 1.88)).Conclusions:Weekly iron supplementation results in substantial increases in hemoglobin concentration in adolescent schoolgirls in western Kenya, which may outweigh possible risks caused by malaria, but only in iron-deficient or menstruating girls and not in iron-replete and nonmenstruating girls.European Journal of Clinical Nutrition (2009) 63, 173–182; doi:10.1038/sj.ejcn.1602919; published online 10 October 2007 [ABSTRACT FROM AUTHOR]

Objective:The objectives of this study were (1) to assess whether a cohort of school-aged children experiences progression of stunting over a 2-y-period of observation and (2) to identify baseline nutritional and body composition risk factors for the progression of stunting.Methods:As part of a large-scale, randomized controlled trial assessing the impact of insecticide-treated bednets (ITNs) on nutritional status, we longitudinally followed a cohort of school-aged children over a 2-y-period in western Kenya. Anthropometric measurements were made at four time points from which Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and body mass index (BMIZ) were calculated. Two measures of body composition, upper arm fat area and upper arm muscle area, were derived from mid-upper arm circumference (MUAC) and triceps skinfold thickness.Results:Subjects experienced a mean change in HAZ from baseline to 9 months of −0.16 [−0.19, −0.13], from baseline to 16 months of −0.18 [−0.22, −0.15], and from baseline to 24 months of −0.36 [−0.41, −0.31]. Thus, the average individual's change in HAZ at the three follow-up time points is significantly less than zero, meaning that, on average, the cohort is deviating further from NCHS reference medians over time. The baseline nutritional measure that explained the greatest amount of variance in the progression of stunting was the upper arm muscle area Z-score (F=8.1; P=0.005).Conclusions:This longitudinal study provides further evidence from a distinct ecological setting regarding the progression of undernutrition during middle childhood in the developing world. It suggests that school-aged children in the developing world do not experience catch-up growth or remain stable. Rather, they continue to deviate from NCHS standards, accruing greater height deficits with age. In addition, absolute lean body mass explained the most variability in the progression of stunting, which supports cross-sectional findings from other studies.European Journal of Clinical Nutrition (2005) 59, 914–922. doi:10.1038/sj.ejcn.1602161; published online 1 June 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: Nutritional status is an important marker of overall health and linear growth retardation has serious long-term physiological and economic consequences. Approximately 35 and 29%of preschool children in sub-Saharan Africa are stunted and underweight, respectively. There is relatively little information available about the nutritional status in adolescents, the age group with the highest growth velocity after infancy. We conducted a series of cross-sectional surveys to determine the prevalence and main risk groups for malnutrition and to describe the associations between age, sexual maturation and nutritional status in adolescent schoolgirls in western Kenya. DESIGN:: Three cross-sectional surveys; one in Mumias, using random sampling in all schools, and two surveys in Asembo, using a multi-stage random sample design. SETTING:: Public primary schools in two different rural malaria endemic areas in western Kenya with high levels of malnutrition in preschool children. SUBJECTS:: In all, 928 randomly selected adolescent schoolgirls aged 12-18?y. RESULTS:: Overall prevalence of stunting and thinness was 12.1 and 15.6%, respectively. Of the total, 2%were severely stunted. Menarche and start of puberty were delayed by approximately 1.5-2?y compared to a US reference population. The prevalence of stunting and thinness decreased with age and mean height for age z-scores converged towards the median of the US reference curve. Girls who had not yet started menstruating were more likely to be stunted than the girls of the same age who were post-menarche. CONCLUSIONS:: Stunting and thinness are common in young adolescent schoolgirls in these poor rural settings in western Kenya, but the prevalence decreases with age, providing observational support that children catch up on incomplete growth attained earlier in life due to a maturational delay of 1.5-2?y allowing prolonged growth. SPONSORSHIP:: This study was supported by a grant from The Netherlands Foundation for the Advancement of Tropical Research (WOTRO), the Netherlands.European Journal of Clinical Nutrition (2005) 59, 41-48. doi:10.1038/sj.ejcn.1602031 Published online 11 August 2003 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: Anemia is a major public health concern in preschool children and pregnant women in the developing world. While many studies have examined these two at-risk groups, there is a paucity of data on anemia in adolescents living in developing countries in the complex ecologic context of poverty, parasitism, and malnutrition. We evaluated the prevalence, severity, and risk factors of anemia in adolescent schoolgirls in an area with intense malaria transmission in western Kenya. DESIGN:: Two cross-sectional surveys were conducted, using a multistage random sample design. SETTING:: Public primary schools in an area with intense malaria transmission in western Kenya. SUBJECTS:: A total of 648 randomly selected adolescent schoolgirls aged 12-18?y. RESULTS:: The prevalence of anemia (Hb <120?g/l) was 21.1%; only one girl had an Hb less than 70?g/l. Ferritin levels were available from a subsample of 206 girls. The prevalence of iron deficiency (ferritin <12?µg/l) was 19.8, and 30.4% of anemic girls were iron deficient. Malaria and schistosomiasis were the main risk factors for anemia in younger girls (12-13?y), while menstruation was the principal risk factor in older girls (14-18?y). CONCLUSIONS:: Iron deficiency and anemia in school-attending girls in western Kenya were more prevalent than in developed countries, but considerably less prevalent than in preschool children and pregnant women from the same study area. Our findings are consistent with other recent school-based surveys from western Kenya, but not with recent community- and school-based cross-sectional surveys from other parts of sub-Saharan Africa. It deserves further study to determine if adolescent girls not attending school are at higher risk of anemia. SPONSORSHIP:: This study was supported by a grant from The Netherlands Foundation for the Advancement of Tropical Research (WOTRO), the Netherlands.European Journal of Clinical Nutrition (2004) 58, 681-691. doi:10.1038/sj.ejcn.1601865 [ABSTRACT FROM AUTHOR]