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Novel dietary assessment methods are needed to study chronic disease risk in agrarian cultures where food availability is highly seasonal. In 16,320 rural Nepalese women, we tested a novel food frequency questionnaire, administered once, to assess past 7-day intake and usual frequency of intake throughout the year for year-round foods and when in season for seasonal foods. Spearman rank correlations between usual and past 7-day intakes were 0.12–0.85 and weighted kappa statistics, representing chance-corrected agreement, were 0.10–0.80, with better agreement for frequently consumed foods. The questionnaire performed well, but may require refinement for settings of extremely low dietary diversity.

Context: Maternal vitamin A deficiency is a public health concern in the developing world. Its prevention may improve maternal and infant survival.Objective: To assess efficacy of maternal vitamin A or beta carotene supplementation in reducing pregnancy-related and infant mortality.Design, Setting, and Participants: Cluster randomized, double-masked, placebo-controlled trial among pregnant women 13 to 45 years of age and their live-born infants to 12 weeks (84 days) postpartum in rural northern Bangladesh between 2001 and 2007. Interventions Five hundred ninety-six community clusters (study sectors) were randomized for pregnant women to receive weekly, from the first trimester through 12 weeks postpartum, 7000 μg of retinol equivalents as retinyl palmitate, 42 mg of all-trans beta carotene, or placebo. Married women (n = 125,257) underwent 5-week surveillance for pregnancy, ascertained by a history of amenorrhea and confirmed by urine test. Blood samples were obtained from participants in 32 sectors (5%) for biochemical studies.Main Outcome Measures: All-cause mortality of women related to pregnancy, stillbirth, and infant mortality to 12 weeks (84 days) following pregnancy outcome.Results: Groups were comparable across risk factors. For the mortality outcomes, neither of the supplement group outcomes was significantly different from the placebo group outcomes. The numbers of deaths and all-cause, pregnancy-related mortality rates (per 100,000 pregnancies) were 41 and 206 (95% confidence interval [CI], 140-273) in the placebo group, 47 and 237 (95% CI, 166-309) in the vitamin A group, and 50 and 250 (95% CI, 177-323) in the beta carotene group. Relative risks for mortality in the vitamin A and beta carotene groups were 1.15 (95% CI, 0.75-1.76) and 1.21 (95% CI, 0.81-1.81), respectively. In the placebo, vitamin A, and beta carotene groups the rates of stillbirth and infant mortality were 47.9 (95% CI, 44.3-51.5), 45.6 (95% CI, 42.1-49.2), and 51.8 (95% CI, 48.0-55.6) per 1000 births and 68.1 (95% CI, 63.7-72.5), 65.0 (95% CI, 60.7-69.4), and 69.8 (95% CI, 65.4-72.3) per 1000 live births, respectively. Vitamin A compared with either placebo or beta carotene supplementation increased plasma retinol concentrations by end of study (1.46 [95% CI, 1.42-1.50] μmol/L vs 1.13 [95% CI, 1.09-1.17] μmol/L and 1.18 [95% CI, 1.14-1.22] μmol/L, respectively; P < .001) and reduced, but did not eliminate, gestational night blindness (7.1% for vitamin A vs 9.2% for placebo and 8.9% for beta carotene [P < .001 for both]).Conclusion: Use of weekly vitamin A or beta carotene in pregnant women in Bangladesh, compared with placebo, did not reduce all-cause maternal, fetal, or infant mortality.Trial Registration: clinicaltrials.gov Identifier: NCT00198822. [ABSTRACT FROM AUTHOR]

BACKGROUND: We developed a systematic method of cleaning and calibration-checking for the pneumotachometer tube of the SpiroPro portable spirometer; this method maximized spirometry accuracy in a population-based study in a remote area of Nepal. METHODS: We tested 10 factory-calibrated pneumotachometer tubes. Each use consisted of a full set of spirometry maneuvers, per the American Thoracic Society (ATS) spirometry criteria. RESULTS: The pneumotachometers remained accurate, per the ATS criteria, for 5-9 disinfections, but began to drift toward inaccuracy after the first disinfection. All the pneumotachometers had become inaccurate, per the ATS criteria, after 10 disinfections. CONCLUSIONS: In a remote field setting the SpiroPro pneumotachometer tube can be cleaned and reused 5-9 times before it becomes inaccurate per the ATS criteria. Rigorous rinsing in distilled water and repeated calibration checks, at various flows up to 12 L/s, are essential for precise and accurate spirometry with the SpiroPro. Reusing the SpiroPro pneumotachometer in a remote setting may impose measurement bias. Single use of SpiroPro pneumotachometers, albeit more costly, will provide better data. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Micronutrient deficiencies during pregnancy may be linked to poor newborn health and poor host defences against infection. We assessed newborn morbidity to determine the effect of four combinations of antenatal micronutrient supplements. DESIGN: Cluster-randomised, double-masked, controlled trial. SETTING: Rural community in Nepal. INTERVENTIONS: Women received daily supplements from early pregnancy through to 3 months postpartum of vitamin A alone (control) or vitamin A with folic acid, folic acid plus iron, folic acid plus iron plus zinc or a multiple micronutrient supplement containing these and 11 other nutrients. MAIN OUTCOME MEASURES: Infants were visited in their home at birth (n = 3927) and for each of 9 days thereafter to elicit a 24-h history of nine infant morbidity symptoms, measure infant respiratory rate and axial temperature, and assess the infant for chest indrawing. At 6 weeks of age, infants were visited again in their homes to elicit a 30-day and 7-day history of 10 morbidity symptoms using parental recall. RESULTS: Maternal micronutrient supplementation had no effect on 10-day morbidity or morbidity 30-day and 7-day morbidity assessed at 6 weeks of age all relative risks were close to 1. Symptoms of birth asphyxia increased by about 60% (p<0.05) in infants of women who received the multiple micronutrient supplement compared with the control. Symptoms of combinations of sepsis, preterm and birth asphyxia were associated with 8- to 14-fold increased odds of 6-month infant mortality. CONCLUSIONS: None of the combinations of antenatal micronutrient supplements tested improved symptoms of neonatal morbidity in the first 10 days of life or at 6 weeks of age. Further research is needed to elucidate the association and mechanism of increased risk of birth asphyxia following maternal multiple micronutrient supplementation. Trial registration numbers: NCT00115271. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the length of time following pregnancy during which the risk of mortality was elevated among women in rural Nepal. METHODS: An analysis was performed of prospective data on women participating in the control group of a large, population-based trial. Weekly visits were made for three years to 14805 women aged 14-45 years. Pregnancy and vital status were assessed. A total of 7325 pregnancies were followed. Mortality during and following pregnancy, expressed on a person-time basis, was compared to referent mortality unrelated to pregnancy (52 weeks after pregnancy) in the same cohort. FINDINGS: The relative risk (RR) of death during pregnancy but before the onset of labour was 0.93 (95% confidence interval (CI): 0.38-2.32). During the perinatal period, defined as lasting from the onset of labour until seven days after outcome, the RR of death was 37.02 (95% CI: 15.03-90.92). The RR for 2 to 6 weeks, 7 to 12 weeks, and 13 to 52 weeks after pregnancy were 4.82, 2.59 and 1.01 with 95% CI of 1.77-13.07, 0.81-8.26 and 0.40-2.53, respectively. The RR of death was 2.21 (95% CI. 1.03-4.71) during the conventional maternal mortality period (pregnancy until 6 weeks after outcome). It was 2.26 (95% CI: 1.05-4.90) when the period was extended to 12 weeks after pregnancy outcome. CONCLUSION: The risk of mortality associated with pregnancy should be assessed over the first 12 weeks following outcome instead of over the first 6 weeks. Copyright © 2002 World Health Organization [ABSTRACT FROM AUTHOR]

BACKGROUND: Impaired dark adaptation occurs commonly in vitamin A deficiency. OBJECTIVE: We sought to examine the responsiveness of dark-adaptation threshold to vitamin A and beta-carotene supplementation in Nepali women. DESIGN: The dark-adapted pupillary response was tested in 298 pregnant women aged 15-45 y in a placebo-controlled trial of vitamin A and beta-carotene; 131 of these women were also tested at 3 mo postpartum. Results were compared with those for 100 nonpregnant US women of similar age. The amount of light required for pupillary constriction was recorded after bleaching and dark adaptation. RESULTS: Pregnant women receiving vitamin A had better dark-adaptation thresholds (-1.24 log cd/m(2)) than did those receiving placebo (-1.11 log cd/m(2); P: = 0. 03) or beta-carotene (-1.13 log cd/m(2); P: = 0.05) (t tests with Bonferroni correction). Dark-adaptation threshold was associated with serum retinol concentration in pregnant women receiving placebo (P: = 0.001) and in those receiving beta-carotene (P: = 0.003) but not in those receiving vitamin A. Among women receiving placebo, mean dark-adaptation thresholds were better during the first trimester (-1.23 log cd/m(2)) than during the second and third trimesters (-1.03 log cd/m(2); P: = 0.02, t test). The mean threshold of nonpregnant US women (-1.35 log cd/m(2)) was better than that of all 3 Nepali groups (P: < 0.001, t test, for all 3 groups). CONCLUSIONS: During pregnancy, pupillary dark adaptation was strongly associated with serum retinol concentration and improved significantly in response to vitamin A supplementation. This noninvasive testing technique is a valid indicator of population vitamin A status in women of reproductive age. Copyright © 2000 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

BACKGROUND: Wheat flour is a possible food vehicle for vitamin A fortification. OBJECTIVE: This study assessed the efficacy of consumption of a vitamin A-fortified wheat-flour bun (pandesal) on the vitamin A status of school-age children. DESIGN: This was a double-masked clinical trial conducted in 396 and 439 children aged 6-13 y attending 4 rural schools in the Philippines. The children were randomly assigned to a vitamin A-fortified (experimental) or nonfortified (control) group. A 60-g vitamin A-fortified pandesal (containing approximately 133 microg retinol equivalents) or a nonfortified pandesal was consumed by the children 5 d/wk for 30 wk. Vitamin A status, hemoglobin concentration, anthropometric status, morbidity, and dietary intake were assessed at baseline and 30 wk later. A modified relative dose response (MRDR) was assessed in a subsample of 20% of the children ( approximately 75/group) with the lowest initial serum retinol concentration at the 30-wk follow-up. RESULTS: Baseline serum retinol significantly modified the effect of the intervention. The fortified group, whose initial serum retinol concentrations were below the median, had a 0.07 +/- 0.03-micromol/L greater improvement in serum retinol at the 30-wk follow-up than did the control group (P: = 0.02). Improved vitamin A status was also evident in the MRDR subsample. End-of-study differences in the MRDR showed that vitamin A- fortified pandesal intake decreased the percentage of children with inadequate liver vitamin A stores by 50% (15.3% compared with 28.6%; P: = 0.05). CONCLUSIONS: Daily consumption of vitamin A-fortified pandesal significantly improved the vitamin A status of Filipino school-age children with marginal-to-low initial serum retinol concentrations. Copyright © 2000 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

BACKGROUND: The effect of vitamin A supplementation on the survival of infants aged <6 mo is unclear. Because most infant deaths occur in the first few month of life, maternal supplementation may improve infant survival. OBJECTIVES: The objective was to assess the effect of maternal vitamin A or beta-carotene supplementation on fetal loss and survival of infants <6 mo of age. DESIGN: Married women of reproductive age in 270 wards of Sarlahi district, Nepal, were eligible to participate. Wards were randomly assigned to have women receive weekly doses of 7000 microg retinol equivalents as retinyl palmitate (vitamin A), 42 mg all-trans-beta-carotene, or placebo. Pregnancies were followed until miscarriage, stillbirth, maternal death, or live birth of one or more infants, who were followed through 24 wk of age. RESULTS: A total of 43559 women were enrolled; 15832 contributed 17373 pregnancies and 15987 live born infants to the trial. The rate of fetal loss was 92.0/1000 pregnancies in the placebo group, comparable with rates in the vitamin A and beta-carotene groups, which had relative risks of 1.06 (95% CI: 0.91, 1.25) and 1.03 (95% CI: 0.87, 1.19), respectively. The 24-wk mortality rate was 70.8/1000 live births in the placebo group, comparable with rates in the vitamin A and beta-carotene groups, which had relative risks of 1.05 (95% CI: 0.87, 1.25) and 1.03 (95% CI: 0.86, 1.22), respectively. CONCLUSIONS: Small weekly doses of vitamin A or beta-carotene given to women before conception, during pregnancy, and through 24 wk postpartum did not improve fetal or early infant survival in Nepal. Copyright © 2000 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

BACKGROUND: Vitamin A deficiency is associated with stunting and wasting in preschool children, but vitamin A supplementation trials have not shown a consistent effect on growth. OBJECTIVE: We examined the effect of vitamin A supplementation on height and weight increments among Indonesian preschool children. DESIGN: Data were obtained from a randomized, double-masked, placebo-controlled trial of rural Javanese children aged 6-48 mo. Children received 206000 IU vitamin A (103000 IU if aged <12 mo) or placebo every 4 mo. RESULTS: High-dose vitamin A supplementation modestly improved the linear growth of the children by 0.16 cm/4 mo. The effect was modified by age, initial vitamin A status, and breast-feeding status. Vitamin A supplementation improved height by 0.10 cm/4 mo in children aged <24 mo and by 0.22 cm/4 mo in children aged >/=24 mo. The vitamin A-supplemented children with an initial serum retinol concentration <0.35 micromol/L gained 0.39 cm/4 mo more in height and 152 g/4 mo more in weight than did the placebo group. No growth response to vitamin A was found among children with an initial serum retinol concentration >/=0.35 micromol/L. In non-breast-fed children, vitamin A supplementation improved height by 0.21 cm/4 mo regardless of age. In breast-fed children, vitamin A supplementation improved linear growth by approximately 0.21 cm/4 mo among children aged >/=24 mo, but had no significant effect on the growth of children aged <24 mo. CONCLUSION: High-dose vitamin A supplementation improves the linear growth of children with very low serum retinol and the effect is modified by age and breast-feeding. Copyright © 2000 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

Background: Studies on the effect of vitamin A supplementation on growth have yielded various results. It is possible that such growth is dependent on the burden of infectious diseases in the population.Methods: We analysed data from a randomized, double-masked, placebo-controled trial to examine the role of respiratory infections and diarrhoea in modifying the growth response to vitamin A supplementation. A single high dose of vitamin A or placebo was given every 4 months to 1405 children aged 6-48 months, and 4430 child treatment cycles were used in this analysis.Results: Vitamin A supplementation modestly improved linear but not ponderal growth of children who experienced little respiratory infection and especially of those who had vitamin A intake below the normative requirement (<400 RE/day). Children who received vitamin A and were free of respiratory infection grew 0.22 cm/4 months (95% CI: 0.08, 0.37) more in height than the placebo group, but those with > or =21.5% of days of respiratory infection did not show a significant growth response to vitamin A supplementation. Children who experienced no respiratory infection and had vitamin A intake <400 RE/day benefited most, gaining 0.31 cm/4 months (95% CI: 0.10, 0.52) more in height compared to the placebo group. Diarrhoea was associated with poorer growth, but did not significantly modify the effect of vitamin A supplementation on growth.Conclusions: Vitamin A supplementation improves the linear growth of children who have a low intake of vitamin A but this impact is muted with increasing levels of respiratory infections. [ABSTRACT FROM AUTHOR]

Background: Night blindness (XN) is the most common clinical symptom of vitamin A deficiency among children in developing countries. Yet little is known about the aetiology or associated risks of maternal XN. Emerging evidence from South East Asia suggests that it may be more frequent than previously thought in women of reproductive age, especially during pregnancy.Methods: A population-based, case-control study was conducted to reveal the epidemiology of XN among pregnant Nepali women. Night blind cases were identified by history through a weekly community surveillance system. Controls were randomly selected from a pool of pregnant women without XN and pair-matched for gestational age of the cases. A home-based assessment was done within a week of selection, at which 7-day food frequency and morbidity histories were collected, anthropometry measured, and capillary blood drawn for serum retinol, beta-carotene and haemoglobin (Hb) estimation.Results: Cases and controls did not differ by age or number of previous pregnancies. However, cases were more likely to be from the lower castes, be illiterate, live in poorer quality homes, and own no land. The mean serum retinol level of cases was approximately 0.30 mumol/l lower than controls (P < 0.001), indicating a low vitamin A status of night blind pregnant women. Mean Hb level was significantly lower (by 0.7 g/dl, P < 0.004), and the risk of severe anaemia (Hb < 7.0 g/dl) higher among cases than controls (odds ratio = 3.0, 95% CI: 1.25-7.23). Cases were more under-nourished than controls reflected by lower mean weight (-2.6 kg), body mass index (-0.8), arm circumference (-0.9 cm) and triceps skinfold (-0.8 mm). Night blindness was associated with less frequent consumption of preformed vitamin A (milk products, fish and meat) and provitamin A (dark green leafy vegetables and mangoes) foods, especially in summer. Night blind women were 2-3 times more likely to report symptoms of urinary/reproductive tract infections such as lower abdominal pain, painful and burning urination, or vaginal discharge, symptoms of diarrhoea/dysentery, of pre-eclampsia or eclampsia, and of nausea, vomiting or poor appetite throughout pregnancy than controls.Conclusion: Women who experience XN during pregnancy have a low vitamin A status, although several other risk factors appear to cluster among these women as well. Night blind women are also more likely to be anaemic, ill, and acutely under-nourished, and to be consuming a nutritionally poorer diet in pregnancy than non-night blind pregnant women. A simple history of XN can identify women at high risk during pregnancy who may require special nutritional support, antenatal care and counselling. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to estimate the bias and design effects associated with the Expanded Program on Immunization's (EPI) sampling design when estimating xerophthalmia prevalence, and to estimate the savings associated with EPI in terms of distance travelled within selected clusters.Methods: Computer simulation of the EPI sampling strategy was done using maps from a xerophthalmia survey of 40 wards in Sarlahi district, Nepal. Samples of fixed cluster sizes of 7, 10, 15, 20 and 25 were compared. The estimated prevalence using the EPI design was compared with the true prevalence in the 40 wards to estimate the bias. The design effect was estimated by taking the ratio of the variance under EPI sampling to that of stratified random sampling (SRS) with fixed cluster sizes. The EPI was also modified by increasing the distance between selected houses from nearest neighbour to skipping 1-4 houses between selected ones. The difference between the distance travelled within clusters using SRS compared with EPI was weighed against the bias and increased variance.Results: The prevalence of xerophthalmia was 2.8%. The EPI design overestimated xerophthalmia prevalence by between 0.27% and 1.16%. The design effects of EPI cluster sampling within wards varied between 0.73 and 1.35. Neither the bias nor the design effect was related to distance between households or cluster size. Distance travelled within wards was always less for EPI designs with cluster sizes of 7 or 10. There was no saving in terms of distance travelled for designs with cluster sizes from 15 to 25 if there were two or more houses between selected ones. For fixed cluster sizes of 15 or fewer, the EPI sampling design using nearest or next nearest neighbours is a better choice than SRS in terms of minimizing the distance travelled and the mean square error.Conclusions: The choice of an optimum method would need to account for the density of clusters and difficulty of travel between clusters, as well as the costs of travel within clusters. Based on certain assumptions, EPI with 15 children per cluster would be favoured over examining all children in selected wards unless the travel time between wards was more than 2 days. [ABSTRACT FROM AUTHOR]

Background: Vitamin A deficiency is a major public health nutrition problem, affecting an estimated 190 million preschool-aged children and 19 million pregnant and lactating women globally, and 83 million adolescents in Southeast Asia alone. Its consequences (disorders) include xerophthalmia (the leading cause of early childhood blindness), increased severity of infection, anemia, and death. Because vitamin A deficiency is largely due to chronic dietary insufficiency of preformed vitamin A and proactive carotenoids, food fortification can offer an effective approach to prevention.Objective: To provide guidance on fortifying wheat and maize flour milled in industrial rollers for national fortification programs in countries where vitamin A deficiency is considered a public health problem.Methods: Critical review of the literature on the dietary gap in vitamin A intake and levels of wheat flour intake among risk groups as a basis for determining vitamin A fortificant levels. Additional review of efficacy evidence, safety and cost considerations, and country experiences related to wheat-flour fortification with vitamin A.Results: Mill-rolled wheat flour is a technically fortifiable, centrally processed food vehicle that, where routinely and adequately consumed by target groups, should be considered a candidate for fortification. Vitamin A can be stable in flour under typical, ambient conditions, with processing losses estimated at approximately 30%, depending on source and premix conditions.Conclusions: Factors to guide a decision to fortify flour with vitamin A include the extent of deficiency, availability of other food vehicle options, the centrality of milling, market reach and population intake distributions of the flour products, the dietary vitamin A intake required, and associated costs. Large gaps persist in knowledge of these factors, which are needed to enable evidence-based fortification in most countries, leaving most decisions to fortify guided by assumptions. Where flour can and should be fortified, guidelines are given for providing nearly 25% of the Recommended Dietary Allowance for vitamin A to vulnerable groups consuming varying ranges of flour products. The costs will vary according to the level of fortification. [ABSTRACT FROM AUTHOR]

Zinc status influences several aspects of vitamin A metabolism, including its absorption, transport, and utilization. Two common mechanisms postulated to explain this dependence relate to 1) the regulatory role of zinc in vitamin A transport mediated through protein synthesis, and 2) the oxidative conversion of retinol to retinal that requires the action of a zinc-dependent retinol dehydrogenase enzyme. However, evidence of an effect of zinc intake on vitamin A status from animal experiments is inconclusive, mainly because of the use of inadequate control groups. The higher weight gain of control animals as compared with the zinc-deficient ones in these experiments, even though pair fed, makes it difficult to isolate effects of zinc deficiency per se from those of generalized protein-energy malnutrition. A curvilinear relation has been suggested to describe an effect of plasma zinc on vitamin A transport. In humans, cross-sectional studies have more often than not shown a weak linkage between vitamin A and zinc status. Randomized trials have failed to show a consistent effect of zinc supplementation on vitamin A status. In disease states in which liver function is severely compromised and both zinc and vitamin A metabolism and transport are impaired, serum zinc and vitamin A concentrations tend to be positively correlated. In conclusion, clear evidence of synergy between these 2 micronutrients and its public health significance in humans is lacking. Research should focus on understanding this interaction in the context of coexisting moderate-to-severe zinc and vitamin A deficiencies in the population. Copyright (c) 1998 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

This study aimed to construct indices of living standards in rural Bangladesh that could be useful to study health outcomes or identify target populations for poverty-alleviation programmes. The indices were constructed using principal component analysis of data on household assets and house construction materials. Their robustness and use was tested and found to be internally consistent and correlated with maternal and infant health, nutritional and demographic indicators, and infant mortality. Indices derived from 9 or 10 household asset variables performed well; little was gained by adding more variables but problems emerged if fewer variables were used. A ranking of the most informative assets from this rural, South Asian context is provided. Living standards consistently and significantly improved over the six-year study period. It is concluded that simple household socioeconomic data, collected under field conditions, can be used for constructing reliable and useful indices of living standards in rural South Asian communities that can assist in the assessment of health, quality of life, and capabilities of households and their members. [ABSTRACT FROM AUTHOR]

Properties of bioelectrical impedance analysis (BIA) reflect body-composition and may serve as stand-alone indicators of maternal health. Despite these potential roles, BIA properties during pregnancy and lactation in rural South Asian women have not been described previously, although pregnancy and infant health outcomes are often compromised. This paper reports the BIA properties among a large sample of pregnant and postpartum women of rural Bangladesh, aged 12-46 years, participating in a substudy of a community-based, placebo-controlled trial of vitamin A or beta-carotene supplementation. Anthropometry and single frequency (50 kHz) BIA were assessed in 1,435 women during the first trimester (< or =12 weeks gestation), in 1237 women during the third trimester (32-36 weeks gestation), and in 1,141 women at 12-18 weeks postpartum. Resistance and reactance were recorded, and impedance and phase angle were calculated. Data were examined cross-sectionally to maximize sample-size at each timepoint, and the factors relating to BIA properties were explored. Women were typically young, primiparous and lacking formal education (22.2 +/- 6.3 years old, 42.2% primiparous, and 39.7% unschooled among the first trimester participants). Weight (kg), resistance (omega), and reactance (omega) were 42.1 +/- 5.7, 688 +/- 77, and 73 +/- 12 in the first trimester; 47.7 +/- 5.9, 646 +/- 77, and 64 +/- 12 in the third trimester; and 42.7 +/- 5.6, 699 +/- 79, and 72 +/- 12 postpartum respectively. Resistance declined with age and increased with body mass index. Resistance was higher than that observed in other, non-Asian pregnant populations, likely reflecting considerably smaller body-volume among Bangladeshi women. Resistance and reactance decreased in advanced stage of pregnancy as the rate of gain in weight increased, returning to the first trimester values by the three months postpartum. Normative distributions of BIA properties are presented for rural Bangladeshi women across a reproductive cycle that may be related to pregnancy outcomes and ultimately be used for assessing body-composition in this population. [ABSTRACT FROM AUTHOR]